diarrhoea and treatment Flashcards
what is diarrhoea
a change in normal bowel habits resulting in an increased frequency of movements - soft/watery
epidemiology of diarrhoea
more common in under 5s, 1-3 a year less common in adults, 1 a year and 22% food related highest cause of childhood morbidity
aetiology in infants
Infectious gastroenteritis, toddlers diarrhoea, food intolerance, coeliac disease
aetiology in school age children
Infectious gastroenteritis, antibiotics, rotavirus
aetiology in adults
Infectious gastroenteritis, IBS, IBD, drugs, excess alcohol and spicy food, coeliac disease Campylobacter, rotavirus
aetiology in older people
○ Infectious gastroenteritis, large bowel cancer, faecal impaction, drugs, ischaemic colitis
drugs causing diarrhoea
- abx - metformin - iron - NSAIDs - antacids - beta blockers - digoxin
pathophysiology of diarrhoea
change in balance between absorption and secretion of water
pathophysiology of bacterial diarrhoea
invasive - directly attack mucosal cells - e.coli non-invasive - do not directly damage gut, but produce enterotoxins that disrupt secretion (s.aureaus)
pharmacology of c.diff
- Broad spectrum antibiotics upset microbiome-allowing C.Diff to flourish - Toxins damage lining of colon causing contagious diarrhoea
c.diff risk factors
broad spectrum Abx use >65 years oldprolonged stay in hospital care home immunocompromised etc
c.diff treatment
Vancomycin 125-500mg every 6 hours for 10 day
how to treat acute diarrhoea
- Oral rehydration - rice starch to bulk and prevent or correct dehydration 2. Loperamide - IF rapid control is required - 4mg, then 2mg after every stool (48hrs otc, 5 days rx)
how to treat chronic diarrhoea
- determine and treat underlying cause 2. loperamide while investigating
how to treat diarrhoea in pregnancy and breastfeeding
- rehydrate and refer (loperamide no data but does appear in breastmilk)
how to treat diarrhoea in children
rehydration loperamide is 12+ hygiene
lifestyle factors to ease diarrhoea
- bland foods - clear liquid - avoid caffeine, milk, alcohol, fizzy - hygiene
red flag symptoms in diarrhoea
recent travel abroad blood fever/vomiting severe/persistent abdominal pain pregnancy/breastfeeding dehydration >1 day in infants, 2 in 3+ and 3 everyone else
how to treat travellers diarrhoea
if >3 stools in 24hrs with/out cramps/fever/vomiting - hydration, loperamide and refer
sick day rule drugs
ACEi/ARBSmetformin NSAIDs diuretics
pharmacology of loperamide
Binds to mu-opioid receptors in gut wall and inhibits Acetylcholine (ACh) and Prostaglandin release decreasing parasympathetic activity
how does inhibiting ACh help with diarrhoea
- decreased peristalsis - increased sphincter tone
how does inhibiting prostaglandin help with diarrhoea
- reduced gut secretions and motility - PGE2 - increases intestinal transit time
what other medicines can be used for diarrhoea
co-phenotrope, kaolin and morphine, bismuth, probiotics
what is in co phenotrope
diphenoxylate and atropine
how does diphenoxylate work in diarrhoea
○ Synthetic opioid – pethidine congener; does not readily pass BBB
how does atropine work in diarrhoea
○ Muscarinic ACh receptor antagonist Reduction in ACh reduces parasympathetic drive
how to treat diarrhoea in a stoma
diet and meds review ORS and loperamide - capsules may pass to quickly to be absorbed check output
