Differential Diagnosis of Diarrhoea Flashcards
What are common conditions which present with diarrhoea as a main symptom?
· Coeliac Disease
· Inflammatory bowel disease
· Crohn’s and Ulcerative Colitis
· Irritable bowel syndrome
· Colorectal Cancer
· Infective gastroenteritis
Drugs
What are less common conditions which present with diarrhoea as a main symptom?
· Chronic pancreatitis
· Microscopic colitis
· Bile salt malabsorption
· Thyrotoxicosis
· Lactose intolerance
· Ileac/gastric resection
Bacterial overgrowth
What are rare conditions which present with diarrhoea as a main symptom?
· Autonomic neuropathy
· Addison’s
· Ischaemic colitis
· Amyloidosis
· Tropical sprue
· Gastrinoma and VIPoma
Carcinoid Syndrome
Most drugs have diarrhea as a side effect, what are some common ones?
Osmotic laxatives
Magnesium containing antacids
Antibiotics
NSAIDs
Metformin
Prostaglandins
Chemotherapy
What is gastroenteritis?
Bacterial or viral infection which causes diarrhoea
Casused by
-affecting the mucosal adherence causing effacement of intestinal mucosa or
-my mucosal invasion where bacterial penetrate into intestinal mucosa and destroy epithelial cells.
-Toxin production (enterotoxin production, and cytotoxin)
What bacteria cause watery diarrhea?
– Bacillus cereus (vomiting)
– Staphylococcus aureus (vomiting)
– Vibrio cholerae
– Enterotoxigenic E.Coli
– Enteropathogenic E.Coli
– Salmonella (usually an overlap)
– Campylobacter jejuni
– Clostridium perfringens
- Clostridium difficile
What bacteria cause dysentery diarrhea?
– Shigella
– Salmonella
– Campylobacter jejuni
– Enteroinvasive E.Coli
– Enterohaemorrhagic E.Coli
– Yersinia enterocolitica
– Vibrio parahaemolyticus
– Clostridium difficile
What are the key things to look out for in a salmonella question?
Found in raw chicken, eggs, less severe than raw chicken
Usually transmitted in infected foodstuffs
Symptoms vary from watery diarrhoea to dysentery 12-48hours after infection
Usually self-limiting and resolves spontaneously - but can cause overwhelming sepsis in elderly or immunosuppressed
What are the key things to look out for in a campylobacter jejuni question?
Common cause of sporadic food-borne outbreaks of diarrhea in the West…especially in Summer when undercooked BBQ burgers cause this
* Profuse watery diarrhea, sometimes cause dysentery, symptoms occur 2-4 days after infection
*Less severe symptoms than salmonella
What are the key things to look out for in a enterotoxigenic E.coli question?
Contaminated beef, unpasteurised milk, unwashed fresh produce.
watery diarrhoea
travellers diarrhoea
short recovery time
What are the key things to look out for in a staph aureus question?
common food-borne gastroenteritis in Europe and USA
vomiting 2-4 hours after followed by profuse watery diarrhea
What are the key things to look out for in a C.difficile question?
Spore-forming
Can cause mild diarrhea, haemorrhagic colitis or up Pseudomembranous colitis with yellow-ish plaques in the epithelium
Risk factors: elderly, hospitalized acid-suppressed medications
Infection occurs due to nosocomial antibiotic use
What are the key things to look out for in a shigella question?
Causes dysentery
Linked to poor hygine
self limiting but can cuase severe symptoms in children
What are the key things to look out for in a cholera question?
Focal oral contaminated by water supplies and foodstuff..raw fish or shellfish
Rice-water stools, and leg cramps
Common traveller’s diarrhoea - developing world mainly
What are the key things to look out for in a rotavirus question?
Common in children
More common in winter
Also seen in elderly wards and nurseries
Diaeehoea, vomiting fever and abdominal pain
What are the key things to look out for in a norovirus question?
More common in adults than rotavirus
Projectile vomiting
Outbreaks occur in semi-closed communities: care homes, cruise ships
What are the key things to look out for in a giardiasis question?
Infects the duodenum and jejunum -> malabsorption, weight loss
Found in freshwater - think recent campers
Risk factors: immunocompromised, travelers to tropics, anal sex, swimming, playgroups
What are the key things to look out for in a cryptosporidiosis question?
More symptomatic than Giardia
Found in freshwater, think recent campers
What are the key things to look out for in a drug-induced diarrhoea question?
antibiotics, NSAIDs, steroids, laxatives, metformin, quinine, alcohol, orlistat
Can have many symptoms, and can cause chronic diarrhoea!
What are the key things to look out for in an ulcerative colitis diarrhea question?
Bloody
Colicky pain
Think man and a non smoker for MCQ
What are the key things to look out for in a coeliac disease-induced diarrhea question?
Differential symptoms include osteoporosis, hyposplenism, faltering growth in children
Intolerance to dietary gluten. IgA deficiency. Typically presents in adulthood (but not that old in MCQs!)
What are the key things to look out for in a Crohn’s disease diarrhoea question?
Differential symptoms include Anaemia or malabsorption conditions, which can affect anywhere from the mouth to the anus
Think young woman who smokes with MCQ
What are the key things to look out for in a IBS diarrhoea question?
Can be triggered by anxiety, stress, diet, trauma PTSD/abuse
No direct treatment, only lifestyle management: diet, stress, exercise, managment
What are the key things to look out for in a chronic pancreatitis diarrhoea question?
Epigastric pain than radiates to the back.
Malabsorption symptoms
Commonly caused by chronic alcohol use
Eases when lying/sitting forward, the pain comes in waves
