Diarrhoea and Obesity

Question 1

Diarrhoea

Answer 1

Abnormal passing of loose/liquid stools with increase freq, volume or both.

Acute <14 days (symptom improve in 2-4 days)
Chronic >14 days.

Causes:
- Infections (C.diff, salmonella, E.coli), - Gastroenteritis (stomach flu/food poison - inflammation of stomach and intestines)
- AEs of drugs (ie magnesium)
- GI Disorder symptoms.

DRUGS that cause diarrhoea (EXAM Q):
Mnemonic - CALM Diarrhoea
- Colchicine,
- Antibiotics
- Laxatives
- Magnesium (antacids)
- Digoxin

Question 2

Diarrhoea Treatment

Answer 2

Medicine not really needed. Watching out for dehydration is key.
- Diarrhoea is self limiting

Signs of dehydration:
- Less urine/ Dark yellow urine or strong smell.
- Headache, fatigue, thirst, confusion, dry mouth, tiredness
- Sunken eyes, pallor (pale skin)

REFER/RED FLAGS of diarrhoea (EXAM Q):
- Unexplained weight loss
- Rectal bleeding
- Persistent diarrhoea
- Systemic illness
- Recent hospital or antibiotic (clindamycin stop asap) treatment
- Recent foreign travel

Question 3

Treatment of Diarrhoea

Answer 3

Drink loads to prevent dehydration and eat normally
MOST diarrhoea is self limiting

• ORS (oral rehydration sachets) - main treatment for acute diarrhoea. IV for more severe diarrhoea & dehydration
• LOPERAMIDE - for rapid control and mild/mod travellers diarrhoea.
• KAOLIN with morphine (abuse risk)
• CIPROFLOXACIN - occasional prophylaxis for travellers diarrhoea. Routine use not recommended.

Question 4

Obesity`

Answer 4

BMI >30kg/m2 is obesity.
- Ranges on phone pic.

Treatment
Monitor patient weight change, BP, lipids etc

Asses other underlying conditions which can cause weight gain (Hypothyroidism, 2nd gen antipsychotic, B-blocker, Insulin, lithium, sodium valproate, sulphonylureas, TCAs)

ENCOURAGE LIFESTYLE CHANGES!!
- Increase physical activity

DRUGS
- ALWAYS WITH WEIGHT PLAN.
Consider Vits and mineral supplements.
T2DM pts lose weight slower so less strict targets.

ORLISTAT
Only drug Specifically licenced for obesity ONLY (120mg up TDS)
- A lipase inhibitor so reduces absorption of dietary fat.
Orlistat is used to maintain weight loss rather than continue.
- Treatment can only continue >3 months if weight loss since start of treatment has been >5%

MISSED MEAL OR NO FAT = MISS ORLISTAT dose.
Also + VIT D supplements.

LIRAGLUTIDE/SEMAGLUTIDE (GLP 1 agonist) Saxenda and wegovy only brands allowed out of these drugs.
Saxenda - MAX 3mg daily.
Wegovy - MAX 2.4mg weekly
- Saxenda AVOID if CrCl <30ml/min
- Wegovy use is MAX 2 years
More weight loss with semaglutide vs liraglutide and it reduces risk of CVD.

Surgery
Bariatric surgery only if BMI>40 (obesity 3) OR 35-39.9 BMI (obesity 2) with sig. disease like T2DM.
- Ethnic minorities use lower BMI threshold.

Question 5

Weight loss drug requirements NICE

Answer 5

Orlistat
BMI 30 or+ OR
28 or + WITH risk factors (ie T2DM, CVD etc)

Liraglutide
BMI at least 35 OR
BMI at least 32.5 for ethnic minorities with more health risks with obesity AND non diabetic hyperglycaemia (HbA1c 42-47 or FPG 5.5-6.9) AND high risk of CVD.

Semaglutide
BMI at least 35 OR
BMI 30-34.9 and meet criteria for referral for weight loss.
- USE LOWER BMI threshold for ethnic minorities and at least 1 weight related comorbidity.
- Discontinue if at least 5% of initial weight not lost within 6 months.