diarrhoea and treatment

Question 1

what is diarrhoea

Answer 1

a change in normal bowel habits resulting in an increased frequency of movements - soft/watery

Question 2

epidemiology of diarrhoea

Answer 2

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

Question 3

aetiology in infants

Answer 3

Infectious gastroenteritis, toddlers diarrhoea, food intolerance, coeliac disease

Question 4

aetiology in school age children

Answer 4

Infectious gastroenteritis, antibiotics, rotavirus

Question 5

aetiology in adults

Answer 5

Infectious gastroenteritis, IBS, IBD, drugs, excess alcohol and spicy food, coeliac disease Campylobacter, rotavirus

Question 6

aetiology in older people

Answer 6

○ Infectious gastroenteritis, large bowel cancer, faecal impaction, drugs, ischaemic colitis

Question 7

drugs causing diarrhoea

Answer 7

• abx - metformin - iron - NSAIDs - antacids - beta blockers - digoxin

Question 8

pathophysiology of diarrhoea

Answer 8

change in balance between absorption and secretion of water

Question 9

pathophysiology of bacterial diarrhoea

Answer 9

invasive - directly attack mucosal cells - e.coli non-invasive - do not directly damage gut, but produce enterotoxins that disrupt secretion (s.aureaus)

Question 10

pharmacology of c.diff

Answer 10

• Broad spectrum antibiotics upset microbiome-allowing C.Diff to flourish - Toxins damage lining of colon causing contagious diarrhoea

Question 11

c.diff risk factors

Answer 11

broad spectrum Abx use >65 years oldprolonged stay in hospital care home immunocompromised etc

Question 12

c.diff treatment

Answer 12

Vancomycin 125-500mg every 6 hours for 10 day

Question 13

how to treat acute diarrhoea

Answer 13

1. 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)

Question 14

how to treat chronic diarrhoea

Answer 14

1. determine and treat underlying cause 2. loperamide while investigating

Question 15

how to treat diarrhoea in pregnancy and breastfeeding

Answer 15

• rehydrate and refer (loperamide no data but does appear in breastmilk)

Question 16

how to treat diarrhoea in children

Answer 16

rehydration loperamide is 12+ hygiene

Question 17

lifestyle factors to ease diarrhoea

Answer 17

• bland foods - clear liquid - avoid caffeine, milk, alcohol, fizzy - hygiene

Question 18

red flag symptoms in diarrhoea

Answer 18

recent travel abroad blood fever/vomiting severe/persistent abdominal pain pregnancy/breastfeeding dehydration >1 day in infants, 2 in 3+ and 3 everyone else

Question 19

how to treat travellers diarrhoea

Answer 19

if >3 stools in 24hrs with/out cramps/fever/vomiting - hydration, loperamide and refer

Question 20

sick day rule drugs

Answer 20

ACEi/ARBSmetformin NSAIDs diuretics

Question 21

pharmacology of loperamide

Answer 21

Binds to mu-opioid receptors in gut wall and inhibits Acetylcholine (ACh) and Prostaglandin release decreasing parasympathetic activity

Question 22

how does inhibiting ACh help with diarrhoea

Answer 22

• decreased peristalsis - increased sphincter tone

Question 23

how does inhibiting prostaglandin help with diarrhoea

Answer 23

• reduced gut secretions and motility - PGE2 - increases intestinal transit time

Question 24

what other medicines can be used for diarrhoea

Answer 24

co-phenotrope, kaolin and morphine, bismuth, probiotics

Question 25

what is in co phenotrope

Answer 25

diphenoxylate and atropine

Question 26

how does diphenoxylate work in diarrhoea

Answer 26

○ Synthetic opioid – pethidine congener; does not readily pass BBB

Question 27

how does atropine work in diarrhoea

Answer 27

○ Muscarinic ACh receptor antagonist Reduction in ACh reduces parasympathetic drive

Question 28

how to treat diarrhoea in a stoma

Answer 28

diet and meds review ORS and loperamide - capsules may pass to quickly to be absorbed check output