diarrhoea - symposium Flashcards
what is diarrhoea?
abnormal passage of loose or liquid stools more than 3 times daily and/or volume of stool greater than 200g/day
what is the difference between chronic and acute diarrhoea?
- acute = less than 4 weeks mainly due to infection and it is self limiting
- chronic = more than 4 weeks, has chronic pathology and always need to investigate
what are some of the acute causes of cause diarrhoea?
Viral:
- Rotavirus
- Norovirus
- Enteric adenovirus
Bacterial:
- Salmonella
- Shigella
- Campylobacter
- Staph.aureus
Parasitic: - Cryptosporidium parvum Can be chronic - - Giardia lamblia - Entamoeba histolytica
what are some the chronic causes of diarrhoea?
Colonic:
- Ulcerative & Crohn’s colitis
- Microscopic colitis
- Colorectal cancer
Small bowel:
- Coeliac disease
- Crohn’s disease
- Bile salt malabsorption
- Lactose intolerance
- Small bowel bacterial overgrowth
Pancreatic:
- Chronic pancreatitis
- Pancreatic cancer
- Cystic fibrosis
Endocrine:
- Hyperthyroidism
- Diabetes
- Addison’s disease
- Hormone secreting tumours (e.g. Carcinoid, VIPoma)
Other:
- Drugs
- Alcohol
- Factitious
what are the mechanics of diarrhoea?
- osmotic
- steatorrhoea
- secretory
- inflammatory
- neoplastic
- ischaemic
- post irradiation
what investigations do you do when someone is suffering with diarrhoea?
- stool tests: microscopy and culture, faecal elastase, faecal calprotectin
- blood tests
- imaging: colonoscopy, CT, video capsule, MRI small bowel
what is ulcerative colitis (UC)?
continuous mucosal inflammation of the colon without granulomas on biopsy, affecting the rectum and variable extent of the colon in continuity and characterised by a relapsing and remitting course
what is Crohn’s disease?
discontinuous and often granulomatous transmural inflammation affecting any area of the gastrointestinal tract
what are the common symptoms of UC?
- bloody diarrhoea
- rectal bleeding
- mucus
- faecal urgency
- abdo pain
- nocturnal defecation
what tests do you do to look for UC?
- stool cultures and CDT
- faecal calprotectin
- CRP
- FBC
- albumin
- flexible sigmoidoscopy/colonoscopy
what are the risk factors associated with UC?
- any age
- M:F = 1:1
- relapsing/remitting course
- positive effect of smoking
- appendectomy protective
- 10-15 fold risk in 1st degree relatives
what is the treatment for severe UC?
- admit
- hydrocortisone 100mg iv
- heparin
- stool chart
- AXR
- daily CRP
what should you avoid in patients with severe UC?
- NSAID’s
- opiates
- anti motility agents
how do you treat severe UC when steroids don’t work?
- infliximab
- cyclosporin
- colectomy
how do you treat mild-moderate UC?
- mesalazine
- prednisolone
- azathioprine
- anti-TNF agents (infliximab, adalimumab)
- tyrosine kinase inhibitor (tofacitinib)
- surgery
