Diarrhoea and Constipation Flashcards
What is diarrhoea?
Increased stool frequency and volume and decreased consistency
What are the signs of diarrhoea?
Dehydration
Reduced skin turgor
Greater capillary refill time
Shock
fever
Weight loss
Clubbing
Anaemia
Oral ulcers
Rashes
Abdominal masses
What is gastroenteritis?
Inflammation of stomach/intestines causing vomiting, diarrhoea and pain
What is food poisoning?
Gastroenteritis caused by contaminated food stuff
What is dysentery?
Infection of intestines resulting in pain and often bloody/mucoid diarrhoea
What is acute diarrhoea indicative of?
Gastroenteritis
What are the common causes of diarrhoea?
Gastroenteritis
Traveller’s diarrhoea
C. difficile
IBS
Colorectal cancer
IBD
Coealic
What is the cause of E. coli O157 infection?
Agriculture/ animal faeces exposure
What is the cause of E. coli infection?
Travel
What is the cause of salmonella infection?
Contaminated animal products
What is the cause of campylobacter spp. infection?
Contaminated chicken
What is the cause of C. difficile infection?
Broad spectrum antibiotic usage
What is the cause of vibrio cholerae infection?
Contaminated water
Which antibiotics have a high risk of causing C. difficile infection?
Clarithromycin
Co-amoxiclav
Ceftriaxone
Ciprofloxacin
What are the viral and parasitic causes of diarrhoea?
Rotavirus
Giarda lamblia
Norovirus
Entamoeba histolytica
What is the cause of rota virus infection?
Children under 5
What is the cause of giarda lamblia infection?
Contaminated water supplies
What is the cause of norovirus infection?
Hospitals/care homes
What is the cause of entamoeba histolytica infection?
Foreign travel to areas with poor hygiene
What are the causes of bloody diarrhoea?
Campylobacter
Salmonella
E.coli
Amoebiasis
IBD
Colorectal cancer
Colonic polyps
What are the causes of mucus in diarrhoea?
IBS
Colorectal cancer
Polpys
What are the causes of frank pus in diarrhoea?
IBD
Diverticulitis
Fistula/abscess
What are the causes of explosive diarrhoea?
Cholera
Giardia Lamblia
Rotavirus
What are the characteristics of steatorrhea?
Gas
Offensive smell
Floating, hard to flush stools
What are the causes of steatorrhea?
Pancreatic insufficiency
Biliary obstruction
What investigations are carried out for diarrhoea?
Bloods: FBC, Fe deficiency, B12, ESR, CRP, U&E
Stool culture
Stool microscopy
Viral PCR
Lower GI endoscopy
How do you assess the fluid status of a patient?
Fluid balance
BP and HR
Mucous membranes
Weight
Leg raising challenge
What are the management principles for diarrhoea?
Oral rehydration
IV fluids if sustained diarrhoea/vomiting
Avoid antibiotics
What is constipation?
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
Constipation + Rectal bleeding =
Cancer
Constipation + Distention + Active bowel sounds =
Stricture/ GI obstruction
What is important to ask a patient with constipation?
Frequency
Nature
Consistency
Blood/mucus
Diarrhoea
Recent change in bowel habit
What investigations are done for patients with constipation?
Rectal examination
Bloods: FBC, ESR, U&E, Ca2+, TFT
Colonoscopy
What is the management of constipation?
Hydration
Diet
Exercise
Bulking agents
Stimulant laxatives
Stool softeners
Osmotic laxatives
What are the general causes of constipation?
Poor diet
Lack of exercise
IBS
Old age
Post op pain
Hospital environment
What are the anorectal causes of constipation?
Anal cancer
Colorectal cancer
Fissures
Strictures
Rectal prolapse
Mucosal ulceration/neoplasia
Pelvic muscle dysfunction
What are the intestinal causes of constipation?
Colorectal carcinoma
Strictures
Pelvic mass
Diverticulosis
What are the metabolic/endocrine causes of constipation?
Hypercalcaemia
Hypothyroidism
Hypokalaemia
Lead posoning
What drugs cause of constipation?
Opiates
Anticholinergics
Iron
Diuretics
CCBs
What are the neuromuscular causes of constipation?
Spinal or pelvic nerve injury
Systemic sclerosis
Diabetic neuropathy
