Diarrhoea (oxford clin cases) Flashcards
Define diarrhoea
Increase in the amount of stool passed daily
What are some causes of diarrhoea
Bowel infection Bowel inflammation Increased gut motility Malabsorption Obstructive overflow Medications
What differentials are more likely when a young patient presents with diarrhoea (late teen early adult)?
Infectious diarrhoea
IBS
IBD
Coeliac’s disease
What differentials are more likely when an old patient presents with diarrhoea?
Cancer/polyps causing obstruction/ overflow obstruction
Diverticular disease
Ischaemic colitis
Bacterial overgrowth
At what age is IBD most commonly diagnosed?
Teen- early adulthood (15-25) Older ages (50-80)
What should you be concerned about when a patient presents with diarrhoea? How will you check for this?
Dehydration- assess volume status by checking BP (it might be low, narrow mean arterial pressure), check to see if tongue is coated in mucus/ lips are dry, ask the patient if they are thirsty, heart rate may be tachycardic
Electrolyte or pH disturbance- if the patient is acutely unwell and respiration looks impaired an arterial blood gas may be the best way to quickly assess them. If oxygen sats are normal and respiration is not impaired then do a venous blood gas to avoid discomfort
How do anxiety vs shock affect blood pressure and heart rate
They would both cause tachycardia
Anxiety would increase blood pressure
Shock would cause blood pressure to fall
What elecrolyte status likely to be in someone with diarrhoea?
They are likely to have low K+, HCO3-, Cl-, Na+ as they loose electrolytes in their faeces
What is the treatment for someone who is acutely dehydrated due to diarrhoea?
Put a cannula in so they can be given fluids
Take a set of bloods so you dont need to bleed them later
What do mucoid or jelly like stools suggest?
Infection
What do foul smelling or floating stools suggest?
Pancreatic obstruction or insufficiency
Malabsoprtion (eg coeliacs)
Biliary insufficiency
What do pale stools suggest?
Biliary insufficiency or obstruction
What do stools with blood on wiping suggest?
Anal fissure or haemorrhoids
What do stools with blood mixed in suggest?
Colonic pathology
What does nocturnal diarrhoea suggest?
An organic problem not a motility problem
What dies urgency with diarrhoea suggest?
Infection or IBD
What is tenesmus?
When someone defecates and feels they haven’t emptied their bowels properly
What does tenesmus suggest?
Space occupying lesion eg tumor