Diarrhoea and Constipation

Question 1

What is diarrhoea?

Answer 1

Increased stool frequency and volume and decreased consistency

Question 2

What are the signs of diarrhoea?

Answer 2

Dehydration
Reduced skin turgor
Greater capillary refill time
Shock
fever
Weight loss
Clubbing
Anaemia
Oral ulcers
Rashes
Abdominal masses

Question 3

What is gastroenteritis?

Answer 3

Inflammation of stomach/intestines causing vomiting, diarrhoea and pain

Question 4

What is food poisoning?

Answer 4

Gastroenteritis caused by contaminated food stuff

Question 5

What is dysentery?

Answer 5

Infection of intestines resulting in pain and often bloody/mucoid diarrhoea

Question 6

What is acute diarrhoea indicative of?

Answer 6

Gastroenteritis

Question 7

What are the common causes of diarrhoea?

Answer 7

Gastroenteritis
Traveller’s diarrhoea
C. difficile
IBS
Colorectal cancer
IBD
Coealic

Question 8

What is the cause of E. coli O157 infection?

Answer 8

Agriculture/ animal faeces exposure

Question 9

What is the cause of E. coli infection?

Answer 9

Travel

Question 10

What is the cause of salmonella infection?

Answer 10

Contaminated animal products

Question 11

What is the cause of campylobacter spp. infection?

Answer 11

Contaminated chicken

Question 12

What is the cause of C. difficile infection?

Answer 12

Broad spectrum antibiotic usage

Question 13

What is the cause of vibrio cholerae infection?

Answer 13

Contaminated water

Question 14

Which antibiotics have a high risk of causing C. difficile infection?

Answer 14

Clarithromycin
Co-amoxiclav
Ceftriaxone
Ciprofloxacin

Question 15

What are the viral and parasitic causes of diarrhoea?

Answer 15

Rotavirus
Giarda lamblia
Norovirus
Entamoeba histolytica

Question 16

What is the cause of rota virus infection?

Answer 16

Children under 5

Question 17

What is the cause of giarda lamblia infection?

Answer 17

Contaminated water supplies

Question 18

What is the cause of norovirus infection?

Answer 18

Hospitals/care homes

Question 19

What is the cause of entamoeba histolytica infection?

Answer 19

Foreign travel to areas with poor hygiene

Question 20

What are the causes of bloody diarrhoea?

Answer 20

Campylobacter
Salmonella
E.coli
Amoebiasis
IBD
Colorectal cancer
Colonic polyps

Question 21

What are the causes of mucus in diarrhoea?

Answer 21

IBS
Colorectal cancer
Polpys

Question 22

What are the causes of frank pus in diarrhoea?

Answer 22

IBD
Diverticulitis
Fistula/abscess

Question 23

What are the causes of explosive diarrhoea?

Answer 23

Cholera
Giardia Lamblia
Rotavirus

Question 24

What are the characteristics of steatorrhea?

Answer 24

Gas
Offensive smell
Floating, hard to flush stools

Question 25

What are the causes of steatorrhea?

Answer 25

Pancreatic insufficiency Biliary obstruction

Question 26

What investigations are carried out for diarrhoea?

Answer 26

Bloods: FBC, Fe deficiency, B12, ESR, CRP, U&E Stool culture Stool microscopy Viral PCR Lower GI endoscopy

Question 27

How do you assess the fluid status of a patient?

Answer 27

Fluid balance BP and HR Mucous membranes Weight Leg raising challenge

Question 28

What are the management principles for diarrhoea?

Answer 28

Oral rehydration IV fluids if sustained diarrhoea/vomiting Avoid antibiotics

Question 29

What is constipation?

Answer 29

Pelvic dysfunction or increased transit time. Passage of less than 2 bowel movements/week often passed with difficulty, straining or pain and a sense of incomplete evacuation

Question 30

Constipation + Rectal bleeding =

Answer 30

Cancer

Question 31

Constipation + Distention + Active bowel sounds =

Answer 31

Stricture/ GI obstruction

Question 32

What is important to ask a patient with constipation?

Answer 32

Frequency Nature Consistency Blood/mucus Diarrhoea Recent change in bowel habit

Question 33

What investigations are done for patients with constipation?

Answer 33

Rectal examination Bloods: FBC, ESR, U&E, Ca2+, TFT Colonoscopy

Question 34

What is the management of constipation?

Answer 34

Hydration Diet Exercise Bulking agents Stimulant laxatives Stool softeners Osmotic laxatives

Question 35

What are the general causes of constipation?

Answer 35

Poor diet Lack of exercise IBS Old age Post op pain Hospital environment

Question 36

What are the anorectal causes of constipation?

Answer 36

Anal cancer Colorectal cancer Fissures Strictures Rectal prolapse Mucosal ulceration/neoplasia Pelvic muscle dysfunction

Question 37

What are the intestinal causes of constipation?

Answer 37

Colorectal carcinoma Strictures Pelvic mass Diverticulosis

Question 38

What are the metabolic/endocrine causes of constipation?

Answer 38

Hypercalcaemia Hypothyroidism Hypokalaemia Lead posoning

Question 39

What drugs cause of constipation?

Answer 39

Opiates Anticholinergics Iron Diuretics CCBs

Question 40

What are the neuromuscular causes of constipation?

Answer 40

Spinal or pelvic nerve injury Systemic sclerosis Diabetic neuropathy