Diarrorhoea Flashcards
What does diarrorhoea strictly mean
Increase in the amount of stools passed daily which normally coincides with increase in frequency and softening
What is name for bright red stools
Haematochezia
What can cause diarrorhoea categories
Infection of bowel Inflammation of bowel Increased motility Malabsorption of nutrients Obstruction overflow Medications
What happens in obstruction overflow diarrorhoea
Mass prevents only liquid stool to pass- constipation can counter-intuitively lead to overflow diarrorhoea
Common cause of overflow diarrorhoea in elderly people
Hard faeces
What can lead to hypermobility diarrorhoea
Hyperthyroid
Anxiety
IBS
What can lead to malabsorption diarrorhoea
Coeliac
Pancreatic insufficiency
What causes inflammation of the bowel diarrorhoea
IBD
Diverticular
What drugs cause diarrorhoea
Colchicine Laxatives Digoxin Thiazide diuretics Metformin Some abx
Differentials for diarrorhoea in young person
IBS Gastroenteritis Coeliac IBD Medication Hyperthyroidism
Differentials for diarrorhoea in older person
Cancer Diverticular disease Overflow diarrorhoea secondary to constipation Ischaemic colitis Infective colitis Bacterial overgrowth
What is bacterial overgrowth syndrome
Slowing down of bowel movements leads to bacterial overgorwth and diarrorhoea
Which patients is bacterial overgrowth syndrome very common
Elderly
Diabetics
What in diarrorhoea patient are you concerned about clinically
Shock- tachycardia and hypotension
Dehydration from loss fluid
Electrolyte imbalances
What could you check for on examination for hypovolaemia
Tahycardia Narrow MAP Low BP Postural drop Mucous membranes If feel thirsty
How do diarrohoea patients present with electrolyte imbalances
Loss of electrolytes in faeces
Secondary to hypovolaemia or ischaemia
How does ischaemia affect ABG
Metabolic acidosis
What is electrolyte response to metabolic acidosis
Hyperkalaemia
How would you exclude anxiety from diarrohoea
BP would also be high as well as HR
Which group of people has naturally low BP
Young females
Questions for characterising diarrorhoea
Mucoid Smell Float Colour Blood
What does mucoid diarrorhoea suggest
Salmonella infection
Polyps
Or any disease causing inflammation of bowel generally
What does foul smelling and floating diarrorhoea suggest
Malabsorption
From coeliac, pancreatic insufficiency, recent cholecystectomy
What does pale diarrorhoea suggest
Blockage of biliary ducts preventing bile salts reaching duodenum- gallstones, chronic pancreatitis
What must clarify about blood in faeces
If when wiping or is just streaked with blood- anal pathology such as haemorrhoids
If blood mixed with blood- IBD, cancer, dysentry
What questions to ask about habit of diarrorhoea
Does have to rush to toilet Is it consistent habit Does feel that clear bowels properly Nocturnal? How often does suffer from diarrorhoea
What does rushing to toilet suggest about diarrorhoea
IBD or infective
What does nocturnal diarrorhoea suggest
Of organic cause such as IBD not functional like hyperthyroidism
What does altered bowel pattern suggest
Young people IBS
Older cancer
What does nausea with diarrorhoea suggest
Infective cause
What does RIF pain with diarrorhoea suggest
Damage to terminal ileum- Crohns, yersinia enterocolitica infection
What does LIF pain with diarrorhoea suggest
Diverticular disease
What does pain relieved by passing bowels suggest
IBS
What does weight loss suggest with diarrorhoea
Chronic pathology- IBD, cancer, chronic pancreatits
What does eye problems with diarrorhoea suggest
IBD
What does skin and joint problems suggest with diarrorhoea
IBD
Eye problems assocaited with IBD
Uveitis
Episcleritis
Scleritis
What is uveitis
Painful red eye with vision loss
What is scleritis
Painful red eye with no vision loss
What is episcleritis
Uncomfortable red eye with no vision loss
What joint problem comes with IBD
Enteric arthritis
Sacroilitis
Skin assocaitions of IBD
Erythema nodosum
Pyoderma gangrenosum
Risk factors to ask about with diarrorhoea
Travel Funny foods Family history of polyps, IBD Medications Stress and diet?
What are assocaited with IBS
Stress and low fibre diet
Why is regularity of diarrohoea important in the history young person
Intermittent rules out hyperthyroidism, ceoeliac and IBD, recurrent suggest IBS
diarrorhoea causes of clubbing
IBD
Coeliac
Hyperthyroidism
What does mass in RIF indicate with diarrorhoea
Crohns
What condition do you get dermatits herpetiformis
Coeliac
What is dermatitis herpetiformis and where is it found
Extensor surface of the limbs and scalp- itchy rash that often hard due to scratching
In diarrorhoea DRE what are you looking
Anal ulcers and fistulae from crohns
Malignancy cause of overflow diarrohoea
What condition frequently has anal fistulas and ulcers
Crohns
What diarrohoea conditions can cause anemia
Could be from
Malabsorption- coeliac, cancer, IBD
Blood loss- cancer, UC, ischaemic colitis, infective colitis
Inflammatory markers that can be raised
ESR
CRP
Platelets
Tests for coeliac
TTG IgA
Anti endomysial
Anti gliadin
Anaemia in coeliac
Microcytic
What will albumin be in IBD
Low from chronic diarrorhoea
What dos pus cells in faeces suggest
IBD
What is risk factor for C diff
Abx
PPIs
Immunocompromised
When cant you do FOBT
On aspirin or any AC- will give false positives
Believed pathophysiology of crohns
Mutation in genes responsible for clearing up phagocytosed bacteria leading. Inability to clear leads to cytokine release and walling off by other immune cells- granuloma
What is pathophysiology of crohns similar to
TB
Differences between UC and crohn presentation
UC more likely to be bloody
Crohns causes weight loss
Crohns pain RIF, UC LIF and diffuse
Crohns patients fail to thrive between attacks and UC are well
What must be done with UC flare investigation
AXR to check for toxic megacolon
Investigations and findings for crohns
AXR showing signs of bowel inflammation
Colonoscopy with biopsy showing non caseating granuloma
Tx crohns
Steroid sparing medication such as methotrexate, azathioprine and infliximab
Surgery if necessary
Why arent steroids used in crohns
To avoid side effects
Also they dont induce mucosal healing or modify disease state
What is difference between food poisoning and infective diarrorhoea
Food poisoning due to presence of toxins whereas infective diarrorhoea due to ingestion of pathogens
What does onset of sx soon after eating in infectious diarrorhoea suggest
Bacteria had pre formed toxins- staph aureus and bacillus cereus implied
Management of infectious diarrorhoea
Lots of hydration with rehydration salts too
IV fluids only considered if severely dehydrated or cant tolerate oral fluids
Diagnosis of IBS
ROME III criteria
At least 3 months of recurrent abdo pain or discomfort with 2 of following
- improvement on defaecation
- onset noticed change in stool frequency
- onset noticed change in form of stool
Managment of IBS
Reassure isnt serious
Anti-spasmodics (Loperamide)
Anti-depressants (Amitriptyline) at lower does than depression intention
Patient with explosive diarrorhoea whos been in hospital for ages on ABx
C diff
Management of C diff
Fluid resus
Stool sample
Isolation of ward with glove and gowning of all staff seeing the patient
ABx
Addresss precipitants such as ABx and PPIs to see if can be removed temporarily
ABx for C. Diff
Metronidazole for 2 weeks
Vancomycin reserved for those with severe disease
What is pathophysiology of UC
Actually a systemic inflammatory condition that mainly affects the bowel. Pathophysiology unknown but affects bowel in distal to proximal fashion from the rectum upwards with clear boundary between abnormal and normal
Presentation of UC
Painless bloody diarrorhoea
Red eye
Back and joint pain
Associated conditions of UC
PSC
Adenocarcinoma- unlike crohns
Cholangiocarcinoma
Management of UC
Drugs such as sulfasazine, methotrexate, azathioprine and corticosteroids
Check regularly for adenocarcinoma
During acute exacerbations do AXR to check for toxic megacolon
Potential surgery see other card
Surgery for UC
Potentially curative as removes the symptomatic effects and risk of cancer however results in lifelong ileostomy
New ileal-pouch-anal-anastamosis development
Presents with constipation and ocasional uncontrolled motions of just liquid
Overflow diarrorhoea
Features of overflow diarrorhoea defaecaction
Liquid and gas can pass
Very hard to control
What to ask about for query hyperthyroid diarrorhoea
Tremor
Palpitations
Anxious
Renal complication of IBD
Kidney stones from reduced Ca
Bone complication of IBD
Osteoporosis and osteomalacia from reduced Ca
How does hyperthyroidism lead to diarrorhoea
Sensitisation of catecholamine receptors, over activation leads to diarrorhoea
Biliary complication of crohns
Gallstones due to reduced reabsorption of bile salts
Most likely cause of infectious diarrorhoea in institutions
Norovirus
Most likely cause of infectious bloody diarrorhoea outbreak
Shigella or E coli
Most likely cause of post BBQ diarrorhoea
Campylobacter
Most likely cause of rapid onset infectious diarrorhoea
Staph aureus or bacillus cereus which have pre made toxins
Systemic complication of IBD
Amyloid
