Diarrhoea, Constipation and C.Diff Flashcards
What are the characteristics of steatorrhoea?
Steatorrhoea is characterised by increased gas, offensive smell and floating, hard-to-flush stools.
What are the 2 typical conditions that can lead to steatorrhoea?
Giardiasis and Coeliac disease
What are present in the stools of inflammatory diarrhoea?
Inflammatory diarrhoea has blood and pus in the stools
What are the common causes of diarrhoea?
Gastroenteritis, Parasites/Protozoa (Campylobacter, Shigella/Salmonella, amoebiasis, E. Coli), IBS, Colorectal cancer, Crohn’s, UC, coeliac
Which conditions will present with mucus in the stools?
IBS, Colorectal cancer and Polyps
Which conditions will present with explosive diarrhoea?
Giardiasis, Cholera, Yersinia, Rotavirus
Detection of eosinophilia in blood cultures suggest?
Eosinophilia in blood cultures suggest parasites
Under what conditions are IV fluids necessary?
If patient is dehydrated and had bloody diarrhoea for more than 2 weeks.
What are the 2 medications that can be given to decrease the frequency of loose stools? Provide dosage and frequency, and route.
Codeine phosphate 30MG TDS PO
Loperamide 2MG PRN PO, max 16MG/day
What is Dysentery?
Dysentery is an infection of the intestines that causes diarrhoea containing blood or mucus.
What are the 2 types of dysentery and which is more common in the UK?
- Bacillary dysentery/Shigellosis: caused by Shigella bacteria. Most common in the UK
- Amoebic dysentery/Amoebiasis: caused by an amoeba, Entamoeba Histolytica, mainly found in tropical areas.
What are the treatment for Clostridium difficile?
Stop the causative antibiotic if possible. Treatment is usually not needed if asymptomatic, but if symptomatic, give Metronidazole 400MG TDS PO for 10-14/7.
Vancomycin 125MG QDS PO for 10-14/7 is better for severe conditions. (or Fidaxomicin 200MG BD for 10-14/7 if patient has multiple co-morbidities and are receiving concomitant antibiotics.)
When is urgent colectomy indicated for Clostridium Difficile patients?
If there is toxic megacolon, LDH increased or if deteriorating.
White cells are microscopically absent in?
Amoebiasis, Cholera, E. Coli and viruses.
What is the presumptive treatment given to patients who present with fever >38 degree celsius and diarrhoea with visible blood?
Ciprofloxacin 500MG BD PO for 6/7
What is the Rome Criteria?
The Rome criteria is a measure which determines if one has constipation.
Constipation is defined as the presence of >2 symptoms during bowel movements (BMs) :
- Straining for >25% of BMs
- Lumpy or hard stools in 25% of BMs
- Sensation of incomplete evacuations for>25% of BMs
- Sensation of anorectal obstruction or blockage for >25% of BMs
- Manual manoeuvers (eg digital evacuation, support of the pelvic floor) to facilitate at least 25% of BMs
- fewer than 3 BMs per week
What term is used to describe “feeling of incomplete evacuation”?
Tenesmus
What are the indications for investigation for patients presenting with constipation?
> 40 yo
change in bowel habit
associated symptoms such as weight loss, PR mucus or blood, tenesmus)
What is the mechanism of action of Senna?
Senna acts directly as an irritant on the colonic wall to induce fluid secretion and colonic motility.
What is a common side effect of Senna?
Abdominal cramps
What are the 4 types of drugs used to treat constipation?
- Bulking agents
- Stimulant laxatives
- Stool softeners
- Osmotic laxatives
What is the mechanism of action of bulking agents? State some examples of bulking agents
Bulking agents increase the volume of the stool and makes it easier to pass. Examples include Bran and Ispaghula husk
What is the mechanism of action of stimulant laxatives? Give examples of stimulant laxatives.
Stimulant laxatives are substances that act on the intestinal mucosa or nerve plexus, altering water and electrolyte secretion.
Examples are Bisacodyl and Senna
What is the mechanism of action of osmotic laxatives?
Give examples of osmotic laxatives.
Osmotic laxatives cause the intestines to hold more water within and create an osmotic effect that stimulates a bowel movement.
Examples are Lactulose and Macrogol (Movicol)
What is the mechanism of action of stool softeners?
Stool softeners are anionic surfactants that allows additional water and fats to be accumulated in the stools, making them easier to move through the GI tract
In which conditions will there be “frank pus”?
IBD, diverticulitis, fistula/abscess
What are the signs and symptoms of severe C. Diff infection?
WCC >15x10^9
Acute rising serum creatinine
And/or colitis
Until how many days of treatment will it be deemed a failure if patients with C. Diff are not improving or worsening?
7 days
Which medication should not be prescribed to patients with acute C. Difficile infection?
Anti-motility agents such as Loperamide
What is suspected if there is microcytic anaemia (decreased MCV) and iron deficiency?
How about macrocytic anaemia?
Decreased MCV and iron deficiency, suspect coeliac disease and colorectal cancer.
If there is increased MCV, think of alcohol abuse or vitamin B12 deficiency due to coeliac or Crohn’s.
What is the sign of severe dehydration in U&E testing?
Decreased potassium
What is looked for in Coeliac serology?
Anti-endomysial antibodies (an IgA antibody)
Anti-transglutaminase antibody
Which laxative is commonly used for patients before procedures? What type of laxative is it?
Sodium Picosulfate. It is a stimulant laxative.
Which types of laxatives should be avoided if there is GI obstruction?
Bulking agents and stimulant laxatives
What is Hirschsprung’s disease?
Hirschsprung’s disease is a condition that prevents movement of the distal colon due to missing nerves cells caused by a birth defect. It is presented as constipation in newborns and toddlers.
What are the common causes of diarrhoea?
- Gastroenteritis
- Parasites/Protozoa
- IBS
- Colorectal cancer
- Crohn’s, Ulcerative Colitis, Coeliac
When are bulk-forming agents useful?
Bulk-forming agents are useful for diarrhoea in diverticular disease, and for reducing the fluidity of faeces in patients with ileostomy and colostomy.
In infectious diarrhoea, which form of anti-diarrhoeal medications are KI? Why?
Anti-motility drugs such as codeine, Loperamide and diphenoxylate. These drugs reduce pathogen clearance and can precipitate toxic megacolon.
