Diarrhoea In SA Flashcards
What it the normal approach to a clinical problem?
Define the problem
Define the system
Define the location
Define the lesion
What is the approach to clinical problem solving in patients with diarrhoea?
Define the problem
Define the location
Define the system
Define the lesion
Why is the problem based approach to diarrhoea different?
With diarrhoea, we here the problem is coming from (small, large bowel or mixed) can indicate what system is involved
What is the problem associated with diarrhoea?
Alteration in normal pattern of defaecation - soft, unformed stools, - increased faecal water content And/or - increased frequency of defaecation
What can reports of diarrhoea be confused with?
Vaginal discharge
Anal sac discharge
CONSTIPATION
How can constipation be confused with diarrhoea?
Straining and not passing a lot is associated with large bowel diarrhoea
Which is the most important tool in classifying the type of diarrhoea present?
HISTORY
How would you approach acute diarrhoea?
Treat symptomatically
Most acute diarrhoea is self resolving
(Parvo and HGE require investigation)
How do you approach chronic diarrhoea?
Requires investigation
Only a small proportion of cases in general practice
What possible locations are associated with diarrhoea
Small bowel
Large bowel
Mixed
Why is it important to differentiate between small and large bowel diarrhoea?
Can help determine if primary or secondary GI disease
Different causes
Different diagnostic approach
Different treatment
How could you test for exocrine pancreatic insufficiency?
Trypsin like immunoreactivity that tests for exocrine pancreatic insufficiency
Describe the appearance of small bowel diarrhoea.
Variable consistency Large quantity Blood - digested (melina) or half digested Weight loss (chronic) Vomiting Borborygmi and flatulence Variable appetite Can easily dehydrate
Describe the appearance of large bowel diarrhoea
Small amounts and frequently Mucous Fresh blood Tenesmus Occasional vomiting Decreased appetite Can lose weight if the pathology uses up calories (e.g. neoplasia or inflammation)
Why might blood be seen in large bowel diarrhoea?
Blood not severe but sign that large bowel is irritated
What type of GI disease can cause small bowel diarrhoea?
Primary most common
Secondary - forms part of clinical signs but not usually primary complaint - exception EPI
What system is associated with small bowel diarrhoea?
Primary GIT Secondary GIT: hepatic disease Pancreatic insufficiency Pancreatitis Hyperthyroidism Addisons (hypoadrenocorticism) Renal disease
In which secondary GI disorder would diarrhoea present as the main clinical sign?
Exocrine pancreatic insufficiency
Small bowel diarrhoea with secondary large due to fats irritating colon
If overt large bowel diarrhoea is the major presenting sign, what is the likely location of the lesion?
Primary GI disease
What is the likely location of the lesion if mixed bowel diarrhoea is seen?
Primary GI
How might blood work be useful when investigating diarrhoea?
To eliminate secondary causes
Can do TLIR for EPI
What typical investigations are required for dealing with diarrhoea?
Faecal exam
Therapeutic trial
More invasive tests (potentially)
