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Year 3 Conditions > Diarrorhoea > Flashcards

Diarrorhoea Flashcards

1
Q

What does diarrorhoea strictly mean

A

Increase in the amount of stools passed daily which normally coincides with increase in frequency and softening

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2
Q

What is name for bright red stools

A

Haematochezia

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3
Q

What can cause diarrorhoea categories

A 
Infection of bowel
Inflammation of bowel
Increased motility
Malabsorption of nutrients
Obstruction overflow
Medications
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4
Q

What happens in obstruction overflow diarrorhoea

A

Mass prevents only liquid stool to pass- constipation can counter-intuitively lead to overflow diarrorhoea

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5
Q

Common cause of overflow diarrorhoea in elderly people

A

Hard faeces

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6
Q

What can lead to hypermobility diarrorhoea

A

Hyperthyroid
Anxiety
IBS

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7
Q

What can lead to malabsorption diarrorhoea

A

Coeliac

Pancreatic insufficiency

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8
Q

What causes inflammation of the bowel diarrorhoea

A

IBD

Diverticular

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9
Q

What drugs cause diarrorhoea

A 
Colchicine
Laxatives
Digoxin
Thiazide diuretics
Metformin
Some abx
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10
Q

Differentials for diarrorhoea in young person

A 
IBS
Gastroenteritis
Coeliac
IBD
Medication
Hyperthyroidism
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11
Q

Differentials for diarrorhoea in older person

A 
Cancer
Diverticular disease
Overflow diarrorhoea secondary to constipation
Ischaemic colitis
Infective colitis
Bacterial overgrowth
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12
Q

What is bacterial overgrowth syndrome

A

Slowing down of bowel movements leads to bacterial overgorwth and diarrorhoea

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13
Q

Which patients is bacterial overgrowth syndrome very common

A

Elderly

Diabetics

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14
Q

What in diarrorhoea patient are you concerned about clinically

A

Shock- tachycardia and hypotension
Dehydration from loss fluid
Electrolyte imbalances

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15
Q

What could you check for on examination for hypovolaemia

A 
Tahycardia
Narrow MAP
Low BP
Postural drop
Mucous membranes
If feel thirsty
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16
Q

How do diarrohoea patients present with electrolyte imbalances

A

Loss of electrolytes in faeces

Secondary to hypovolaemia or ischaemia

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17
Q

How does ischaemia affect ABG

A

Metabolic acidosis

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18
Q

What is electrolyte response to metabolic acidosis

A

Hyperkalaemia

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19
Q

How would you exclude anxiety from diarrohoea

A

BP would also be high as well as HR

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20
Q

Which group of people has naturally low BP

A

Young females

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21
Q

Questions for characterising diarrorhoea

A 
Mucoid
Smell
Float
Colour
Blood
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22
Q

What does mucoid diarrorhoea suggest

A

Salmonella infection
Polyps
Or any disease causing inflammation of bowel generally

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23
Q

What does foul smelling and floating diarrorhoea suggest

A

Malabsorption

From coeliac, pancreatic insufficiency, recent cholecystectomy

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24
Q

What does pale diarrorhoea suggest

A

Blockage of biliary ducts preventing bile salts reaching duodenum- gallstones, chronic pancreatitis

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25
Q

What must clarify about blood in faeces

A

If when wiping or is just streaked with blood- anal pathology such as haemorrhoids
If blood mixed with blood- IBD, cancer, dysentry

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26
Q

What questions to ask about habit of diarrorhoea

A 
Does have to rush to toilet
Is it consistent habit
Does feel that clear bowels properly
Nocturnal?
How often does suffer from diarrorhoea
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27
Q

What does rushing to toilet suggest about diarrorhoea

A

IBD or infective

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28
Q

What does nocturnal diarrorhoea suggest

A

Of organic cause such as IBD not functional like hyperthyroidism

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29
Q

What does altered bowel pattern suggest

A

Young people IBS

Older cancer

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30
Q

What does nausea with diarrorhoea suggest

A

Infective cause

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31
Q

What does RIF pain with diarrorhoea suggest

A

Damage to terminal ileum- Crohns, yersinia enterocolitica infection

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32
Q

What does LIF pain with diarrorhoea suggest

A

Diverticular disease

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33
Q

What does pain relieved by passing bowels suggest

A

IBS

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34
Q

What does weight loss suggest with diarrorhoea

A

Chronic pathology- IBD, cancer, chronic pancreatits

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35
Q

What does eye problems with diarrorhoea suggest

A

IBD

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36
Q

What does skin and joint problems suggest with diarrorhoea

A

IBD

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37
Q

Eye problems assocaited with IBD

A

Uveitis
Episcleritis
Scleritis

38
Q

What is uveitis

A

Painful red eye with vision loss

39
Q

What is scleritis

A

Painful red eye with no vision loss

40
Q

What is episcleritis

A

Uncomfortable red eye with no vision loss

41
Q

What joint problem comes with IBD

A

Enteric arthritis

Sacroilitis

42
Q

Skin assocaitions of IBD

A

Erythema nodosum

Pyoderma gangrenosum

43
Q

Risk factors to ask about with diarrorhoea

A 
Travel
Funny foods
Family history of polyps, IBD
Medications
Stress and diet?
44
Q

What are assocaited with IBS

A

Stress and low fibre diet

45
Q

Why is regularity of diarrohoea important in the history young person

A

Intermittent rules out hyperthyroidism, ceoeliac and IBD, recurrent suggest IBS

46
Q

diarrorhoea causes of clubbing

A

IBD
Coeliac
Hyperthyroidism

47
Q

What does mass in RIF indicate with diarrorhoea

A

Crohns

48
Q

What condition do you get dermatits herpetiformis

A

Coeliac

49
Q

What is dermatitis herpetiformis and where is it found

A

Extensor surface of the limbs and scalp- itchy rash that often hard due to scratching

50
Q

In diarrorhoea DRE what are you looking

A

Anal ulcers and fistulae from crohns

Malignancy cause of overflow diarrohoea

51
Q

What condition frequently has anal fistulas and ulcers

A

Crohns

52
Q

What diarrohoea conditions can cause anemia

A

Could be from
Malabsorption- coeliac, cancer, IBD
Blood loss- cancer, UC, ischaemic colitis, infective colitis

53
Q

Inflammatory markers that can be raised

A

ESR
CRP
Platelets

54
Q

Tests for coeliac

A

TTG IgA
Anti endomysial
Anti gliadin

55
Q

Anaemia in coeliac

A

Microcytic

56
Q

What will albumin be in IBD

A

Low from chronic diarrorhoea

57
Q

What dos pus cells in faeces suggest

A

IBD

58
Q

What is risk factor for C diff

A

Abx
PPIs
Immunocompromised

59
Q

When cant you do FOBT

A

On aspirin or any AC- will give false positives

60
Q

Believed pathophysiology of crohns

A

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

61
Q

What is pathophysiology of crohns similar to

A

TB

62
Q

Differences between UC and crohn presentation

A

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

63
Q

What must be done with UC flare investigation

A

AXR to check for toxic megacolon

64
Q

Investigations and findings for crohns

A

AXR showing signs of bowel inflammation

Colonoscopy with biopsy showing non caseating granuloma

65
Q

Tx crohns

A

Steroid sparing medication such as methotrexate, azathioprine and infliximab
Surgery if necessary

66
Q

Why arent steroids used in crohns

A

To avoid side effects

Also they dont induce mucosal healing or modify disease state

67
Q

What is difference between food poisoning and infective diarrorhoea

A

Food poisoning due to presence of toxins whereas infective diarrorhoea due to ingestion of pathogens

68
Q

What does onset of sx soon after eating in infectious diarrorhoea suggest

A

Bacteria had pre formed toxins- staph aureus and bacillus cereus implied

69
Q

Management of infectious diarrorhoea

A

Lots of hydration with rehydration salts too

IV fluids only considered if severely dehydrated or cant tolerate oral fluids

70
Q

Diagnosis of IBS

A

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

71
Q

Managment of IBS

A

Reassure isnt serious
Anti-spasmodics (Loperamide)
Anti-depressants (Amitriptyline) at lower does than depression intention

72
Q

Patient with explosive diarrorhoea whos been in hospital for ages on ABx

A

C diff

73
Q

Management of C diff

A

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

74
Q

ABx for C. Diff

A

Metronidazole for 2 weeks

Vancomycin reserved for those with severe disease

75
Q

What is pathophysiology of UC

A

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

76
Q

Presentation of UC

A

Painless bloody diarrorhoea
Red eye
Back and joint pain

77
Q

Associated conditions of UC

A

PSC
Adenocarcinoma- unlike crohns
Cholangiocarcinoma

78
Q

Management of UC

A

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

79
Q

Surgery for UC

A

Potentially curative as removes the symptomatic effects and risk of cancer however results in lifelong ileostomy
New ileal-pouch-anal-anastamosis development

80
Q

Presents with constipation and ocasional uncontrolled motions of just liquid

A

Overflow diarrorhoea

81
Q

Features of overflow diarrorhoea defaecaction

A

Liquid and gas can pass

Very hard to control

82
Q

What to ask about for query hyperthyroid diarrorhoea

A

Tremor
Palpitations
Anxious

83
Q

Renal complication of IBD

A

Kidney stones from reduced Ca

84
Q

Bone complication of IBD

A

Osteoporosis and osteomalacia from reduced Ca

85
Q

How does hyperthyroidism lead to diarrorhoea

A

Sensitisation of catecholamine receptors, over activation leads to diarrorhoea

86
Q

Biliary complication of crohns

A

Gallstones due to reduced reabsorption of bile salts

87
Q

Most likely cause of infectious diarrorhoea in institutions

A

Norovirus

88
Q

Most likely cause of infectious bloody diarrorhoea outbreak

A

Shigella or E coli

89
Q

Most likely cause of post BBQ diarrorhoea

A

Campylobacter

90
Q

Most likely cause of rapid onset infectious diarrorhoea

A

Staph aureus or bacillus cereus which have pre made toxins

91
Q

Systemic complication of IBD

A

Amyloid

Year 3 Conditions (33 decks)

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