List I - Act Core Conditions Flashcards

1
Q

How can patients with upper GI bleeding present?

A
  • Haematemesis and/or malaena
  • Epigastric discomfort
  • Sudden collapse
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2
Q

What are the oesophageal causes of bleeding?

A
  • Oesophagitis
  • Cancer
  • Mallory-Weiss Tear
  • Varices
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3
Q

What are the presenting features of oesophagitis?

A
  • Small volume of fresh blood
  • Often streaking vomit
  • Malaena is rare
  • Often ceases spontaneously
  • Usually there is a history of antecedent GORD type symptoms
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4
Q

What are the presenting features of cancer causing upper GI bleeding?

A
  • Usually small volume of blood - except pre-terminal event with major erosion of vessels
  • Often associated with dysphagia and constitutional symptoms such as weight loss
  • May be recurrent until the malignancy is managed
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5
Q

How does a Mallory Weis tear present?

A
  • Typically brisk small to moderate volume bright red blood following bout of repeated vomiting
  • Malaena rare
  • Usually ceases spontaneously
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6
Q

What are the presenting features of varicies leading to upper GI bleed?

A
  • Usually a large volume of fresh blood
  • Swallowed blood may cause malaena
  • Often haemodynamic compromise
  • May stop spontaneously but re-bleeds are common until appropriately managed
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7
Q

What are the gastric causes of upper GI bleeding?

A
  • Gastric cancer
  • Dieulafoy lesion
  • Diffuse erosive gastritis
  • Gastric ulcer
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8
Q

What are the features of gastric cancer leading to gastric bleeding?

A
  • Frank haematemesis or altered blood mixed with vomit
  • Usually prodromal features of dyspepsia and may have constitutional symptoms
  • Variable bleeding but erosion of major vessels may produce considerable haemorrhage
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9
Q

What is a Dieulafoy lesion?

A
  • Large tortuous arteriole (AV malformation) most commonly in the stomach wall (sub mucosa) that erodes and bleeds
  • Can be present in any part of the GI tract
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10
Q

What are the presenting features of a Dieulafoy lesion leading to gastric bleeding?

A
  • Often no prodromal features prior to haematemesis and malaena
  • May be difficult to detect endoscopically
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11
Q

What are the presenting features of diffuse erosive gastritis?

A
  • Usually haematemesis and epigastric discomfort
  • Usually there is an underlying cause such as recent NSAID use
  • Large volume haemorrhage may occur with considerable haemodynamic compromise
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12
Q

What are the presenting features of a gastric ulcer?

A
  • Small low volume bleeds more common so would tend to present as iron deficiency anaemia
  • Erosion into a significant vessel may produce considerable haemorrhage and haematemesis
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13
Q

What can cause major haemorrhage to the duodenum?

A
  • Most common cause of major haemorrhage to this site is a posteriorly sited duodenal ulcer
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14
Q

What are the presenting features of duodenal ulcer?

A
  • Haematemesis
  • Malaena
  • Epigastric discomfort
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15
Q

How is the pain of a duodenal ulcer different to the pain of a gastric ulcer?

A
  • Pain of a duodenal ulcer often occurs several hours after eating
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16
Q

What is the risk of patients with previous abdominal aortic aneurysm?

A
  • Rare but important complication is:

- Aorto-enteric fistulation is associated with cause of major haemorrhage associated with high mortality

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17
Q

Which risk stratification tools can be used for patients with acute upper GI bleeding?

A
  • Blatchford score (at first assessment)
  • Consider early discharge for all patients with a pre-endoscopy Blatchford score of 0
  • (full) Rockall score (after endoscopy)
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18
Q

What is the purpose and parameters of the Glasgow Blatchford score for upper GI bleeding?

A
  • Purpose - use for adult patients being considered for hospital admission due to upper GI bleeding
  • Parameters - haemoglobin, blood urea nitrogen (BUN), systolic BP, sex, HR, presence of malaena, recent syncope, hepatic disease history, cardiac failure present
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19
Q

What is the purpose and parameters of the Rockall score for upper GI bleeding?

A
  • Purpose - for patients with clinical upper GI bleeding who have undergone endoscopy
  • Parameters - age, shock, comorbidities, diagnosis, major stigmata of recent haemorrhage
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20
Q

What is the initial management of a patient with a suspected upper GI bleed?

A
  • Admission to hospital
  • A to E assessment
  • Cross matched blood, check FBC, LFT’s, U+E and clotting (as a minimum)
  • Patients with ongoing bleeding and haemodynamic instability are likely to require O negative blood pending cross matched blood (major haemorrhage protocol)
  • Early control of airway is vital (e.g. drowsy patient with liver failure)
  • Ideally all patients for upper GI endoscopy within 24 hours of admission (urgent after stabilisation in unstable patients)
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21
Q

How should patients with bleeding varices be managed?

A
  • Patients with suspected varices should receive terlipressin prior to endoscopy
  • Varices should be banded or subjected to scleropathy
  • If banding is not possible owing to active bleeding then a Sengaksten-Blakemore tube (or Minnesota tube) should be inserted
  • Should be done with care; gastric balloon should be inflated first and oesophageal balloon second, the balloon will need deflating after 12 hours (ideally sooner) to prevent necrosis, portal pressure should be lowered by combination of medical therapy +/- TIPSS
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22
Q

What medical management should patients with erosive oesophagitis / gastritis receive?

A
  • Proton pump inhibitor
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23
Q

How are Mallory Weiss tears managed?

A
  • Typically resolve spontaneously
  • Identifiable bleeding points should receive combination therapy of injection of adrenaline and either a thermal or mechanical treatment. All who have received intervention should receive a continuous infusion of a proton pump inhibitor (IV omeprazole for 72 hours) to reduce the re-bleeding rate
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24
Q

What are the indications for surgery for patients with upper GI bleeding?

A
  • Patients >60 years
  • Continued bleeding despite endoscopic intervention
  • Recurrent bleeding
  • Known CV disease with poor response to hypotension
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25
Q

What is constipation?

A
  • Symptom based disorder which describes defecation that is unsatisfactory because of infrequent stool, difficulty passing stools or the sensation of incomplete emptying
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26
Q

What diagnostic criteria can be used for constipation?

A
  • Rome IV criteria
  • Spontaneous bowel movements occurring less than 3 times per week
  • Stools often dry, hard or lumpy and may be abnormally large or small
  • In reality, constipation is often defined as passage of stools less frequently than the persons normal pattern
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27
Q

What is chronic constipation?

A
  • Symptoms which are present for at least 12 months in the preceding 6 months
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28
Q

What is faecal loading/impaction?

A
  • Describes retention of faeces to the extent that spontaneous evacuation is unlikely
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29
Q

What is overflow incontinence?

A
  • Encopresis or bypass soiling - leakage of liquid stool from the proximal colon around impacted faeces where small quantities of stool may be passed frequently and without sensation
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30
Q

What is functional (primary or idiopathic) constipation?

A
  • Chronic constipation without a known cause
  • Three physiological subtypes have been described which may overlap:
  • Normal transit - most common, where there is constipation with no time delay in passage of stool through the colon
  • Slow transit - prolonged delay in passage of stool through the colon
  • Outlet delay (or obstructed defecation) can be caused by pelvic floor dyssynergia (the pelvic floor muscles are uncoordinated and contract rather than relax during attempted defecation
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31
Q

What is secondary (organic) constipation?

A
  • Caused by medication or an underlying medical condition
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32
Q

How common is constipation?

A
  • 12/1000 in the UK
  • 40% more common in pregnancy
  • 2-3 times more common in women than in men
33
Q

What are the risk factors for developing constipation?

A
  • Social
  • Low fibre diet or low calorie intake
  • Difficult access to toilet or changes in normal routine or lifestyle
  • Lack of exercise or reduced mobility
  • Limited privacy when using the toilet
  • Psychological
  • Anxiety and/or depression
  • Somatisation disorders
  • Eating disorders
  • History of sexual abuse
  • Physical
  • Female sex
  • Older age
  • Pyrexia, dehydration, immobility
  • Siting position on a toilet seat compared with squatting position for defecation
34
Q

What are the possible secondary drug causes of constipation?

A
  • Antacids, iron or calcium containing supplements
  • Opiates and NSAIDs
  • Anti-muscarinics - procyclidine and oxybutynin
  • Anti-depressants - TCA’s, antipsychotics such as amisulpride, clozapine or quetiapine
  • Anti-epileptic drugs such as carbemazepine, gabapentin, oxcarbazepine, pregablin or pheytoin
  • Anti-histamines such as hydroxyzine
  • Anti-spasmodics such as dicycloverine or hyoscine
  • Diuretics such as furosemide, calcium channel blockers such as verapamil
35
Q

What are the possible secondary organic causes of constipation?

A

Endocrine

  • DBM with autonomic neuropathy
  • Hypercalcaemia and hyperparathyroidism
  • Hypermagnesaemia
  • Hypokalaemia
  • Hypothyroidism
  • Uraemia

Myopathic conditions

  • Amyloidosis
  • Myotonic dystrophy
  • Scleroderma

Neurological conditions

  • Autonomic neuropathy
  • Cerebrovascular disease
  • Hirschsprung’s disease
  • Multiple sclerosis
  • Parkinsons disease
  • Spinal cord injury tumours

Structural abnormalities

  • Anal fissures, strictures, haemorrhoids
  • Colonic strictures
  • IBD
  • Obstructive colonic mass lesions
  • Rectal prolapse or rectocele
  • Postnatal damage to pelvic floor or third degree tear

IBS
Slow transit constipation
Pelvic or anal dyssynergia

36
Q

What are the complications of chronic constipation?

A
  • Haemorrhoids or anal fissure
  • Progressive faecal retention, distention of the rectum and loss of sensory and motor function
  • Faecal loading and impaction
37
Q

What are the complications of faecal loading and impaction?

A
  • Faecal incontinence - can be embarrassing and distressing
  • Chronic dilatation of the colon may cause megacolon
  • Bowel obstruction, perforation or ulceration
  • Recurrent urinary tract infections, obstructive uropathy
  • Rectal bleeding
  • Rectal prolapse
38
Q

What features should suspect a diagnosis of constipation in an adult?

A
  • Defecation which is unsatisfactory because of infrequent stools, difficulty passing stools, or a sensation of incomplete emptying
  • Typically bowel movements occurring less than 3 times a week may be regarded as constipation
  • May be daily bowel movements but associated symptoms such as excessive straining
  • Additional symptoms may include lower abdominal pain or discomfort, distention or bloating
  • In reality, constipation is often defined as passage of stools less frequently than the person’s normal pattern
39
Q

When should a diagnosis of constipation be suspected in elderly patients?

A
  • Confusion or delirium, functional decline
  • Nausea or loss of appetite
  • Overflow diarrhoea
  • Urinary retention
40
Q

When should a diagnosis of faecal loading or impaction be suspected?

A

History of:

  • Hard lumpy stools which may be large and infrequent (for example passed every 7-10 days) or small and relatively frequent (for example passed every 2-3 days)
  • Having to use manual methods to extract faeces
  • Overflow incontinence or loos stools
41
Q

How should a person be assessed for constipation?

A
  • Screen for red flag symptoms of GI cancer
  • Ask what the person means by constipation and their normal pattern of defecation
  • Persons perception of a normal bowel habit may influence the diagnosis of constipation
  • Ask about duration, frequency, consistency of stools, nocturnal symptoms
  • Consider the Bristol stool chart to provide an objective record
  • Associated symptoms such as rectal discomfort, excessive straining, feeling of incomplete evacuation or rectal bleeding, abdominal pain or distention
  • Associated nausea, fever, vomiting, loss of appetite and/or weight
  • Associated urinary symptoms, urinary incontinence or retention, dyspareunia
  • Any self help measures tried including OTC medication and symptom response
42
Q

Which risk factors should a person with suspected constipation be assessed for?

A
  • Person’s diet, including fibre and fluid intake, normal routine or lifestyle, level of activity and mobility
  • Person’s toilet habits - hurried or being disturbed
  • Associated psychological or mental health conditions such as anxiety, depression, cognitive impairment or an eating disorder
  • Drug treatments
43
Q

How should assessment of faecal loading and/or impaction be done?

A
  • History or faecal incontinence e.g. underwear regularly soiled, excessive wiping or loose stools
  • Requirement of manual measures to relieve constipation
44
Q

How should a person with suspected constipation be examined?

A
  • Assess for signs of weight loss and general nutritional status
  • Perform an abdominal examination to check for abdominal pain, distention, masses or a palpable colon (suggesting retained faecal masses)
  • Perform an internal rectal examination checking for:
  • Anal fissures, haemorrhoids, skin tags, rectal prolapse, rectocele, skin erythema or excoriation
  • Resting anal sphincter tone, rectal mass lesions and retained faecal masses which may also be felt on external peri-anal palpation
  • Pelvic floor dysfunction (if appropriate)
  • Leakage of stool, rectal or anal pain
45
Q

How should a person with short term constipation be managed?

A
  • Reduce or stop any drug treatment that may be causing or contributing to symptoms if appropriate
  • Advise on lifestyle measures such as increasing dietary fibre, fluid intake and activity levels
  • If this measure are not effective offer the following:
  • Bulk forming laxative first line - Ispaghula (person needs to drink adequate fluid intake)
  • Osmotic laxative such as a macrogol second line
  • Stimulant laxative can be added if there is sensation of inadequate emptying or difficult to pass stools

NB if the person has opioid induced constipation do not prescribe bulk forming laxatives (offer osmotic and stimulant laxative)

46
Q

How should chronic constipation be managed?

A
  • Bulk forming laxative first line - Ispaghula (person needs to drink adequate fluid intake)
  • Osmotic laxative such as a macrogol second line
  • Stimulant laxative can be added if there is sensation of inadequate emptying or difficult to pass stools
  • Consider treatment with prucalopride if at least two laxatives from different classes have been tried at the highest tolerated recommended doses for at least 6 months and failed to relieve symptoms
  • Prucalopride is a selective, high affinity, serotonin (5HT4) receptor agonist and stimulates GI motility - offer a 4 week prescription
47
Q

How should a patient with faecal loading and/or impaction be managed?

A
  • Hard stools - consider a high dose of oral macrogol
  • Soft stools - consider adding an oral stimulant laxative
  • If response is too slow consider prescribing:
  • a suppository such as bisacodyl for soft stools, glycerol alone or glycerol plus bisacodyl for hard stools
  • mini enema such as docusate (softener and weak stimulant) or sodium citrate (osmotic)
  • If response is still inadequate, consider prescribing:
  • Sodium phosphate enema or arachis oil retention enema
48
Q

What are the bulk forming laxatives and how do they work?

A
  • Bulk forming laxatives (containing soluble fibre) act by retaining fluid within the stool and increasing faecal mass, stimulating peristalsis, also have stool softening properties
  • Examples include:
  • Ispaghula husk
  • Methylcellulose
  • Sterculia
49
Q

What are the osomotic laxatives and how do they work?

A
  • Osmotic laxatives work by increasing the amount of fluid in the large bowel producing distention which leads to stimulation of peristalsis, lactulose and macrogols also have stool softening properties
  • Examples include:
  • Lactulose
  • Macrogols (polyethylene glycols)
  • Phosphate and sodium citrate enemas
50
Q

What are the stimulant laxatives and how do they work?

A
  • Stimulant laxatives cause peristalsis by stimulating colonic nerves (senna) or colonic and rectal nerves (bisacodyl, sodium picosulfate)
  • Examples include:
  • Senna
  • Bisacodyl and sodium picosulfate
  • Docusate
51
Q

What are the prokinetic laxatives?

A
  • Prucalopride - a selective, high affinity, serotonin (5HT4) receptor antagonist which stimulates intestinal motility
52
Q

When should laxatives not be prescribed?

A
  • Intestinal obstruction or perforation
  • Paralytic ileus
  • Colonic atony or faecal impaction (bulk forming laxatives)
  • Crohn’s disease or UC
  • Toxic megacolon
  • Severe dehydration (bisacodyl)
  • Galactosaemia (lactulose)
  • History of hypersensitivity to peanuts (arachis oil enema)
53
Q

When should laxatives be prescribed with caution?

A
  • Fluid and electrolyte disturbances
  • History of prolonged use
  • Cardiovascular disease
  • Lactose intolerance
  • Ischaemic heart disease or arrhythmias (prucalopride)
  • Movicol is considered high in sodium and this should be taken into account for those people on a low salt diet
54
Q

What are the adverse effects of laxatives?

A
  • Bulk-forming laxatives — flatulence and bloating. Excessive doses or inadequate fluid intake may cause intestinal obstruction.
  • Osmotic laxatives — abdominal pain or cramps, bloating, flatulence, nausea and vomiting; less commonly dehydration, especially if inadequate fluid intake.
  • Stimulant laxatives — abdominal cramps, diarrhoea, nausea and vomiting. Senna may cause yellowish-brown discolouration of the urine.
  • Prucalopride — headache, nausea, diarrhoea, abdominal pain.

Note: excessive doses of laxatives may cause diarrhoea, which if prolonged, may cause electrolyte disturbances such as hypokalaemia

55
Q

What is diarrhoea?

A
  • Passage of 3 or more loose or liquid stools per day (or more frequent passage than is normal for individual)
56
Q

What is acute diarrhoea?

A
  • Defined as lasting for less than 14 days
57
Q

What is persistent diarrhoea?

A
  • Defined as lasting more than 14 days
58
Q

What is chronic diarrhoea?

A
  • Defined as lasting for more than 4 weeks
59
Q

What are the mechanisms that can cause diarrhoea?

A
  • Increased osmotic load in the gut lumen
  • When a soluble compound cannot be absorbed by the small intestine and thus draws fluid into the intestinal lumen e.g. osmotic laxatives, magnesium based antacids, foods containing mannitol, sorbitol or xylitol
  • Increased secretion
  • Infection with organisms such as vibrio cholerae, E coli, and c. difficile
  • Inflammation of the intestinal lining
  • Damage to intestinal mucosal cells affects absorption of fluid and electrolytes and results in fluid loss
  • Shigella infection and Crohn’s disease can cause inflammatory diarrhoea
  • Nocturnal symptoms are often present
  • Increased intestinal motility
  • May present with increased frequency of stool passage without an increase in volume e.g. DBM and hyperthyroidism
60
Q

What are the causes of acute diarrhoea?

A
  • Most commonly infection including:
  • Viruses
  • Bacteria
  • Parasites
  • Drugs
  • Others including:
  • Anxiety
  • Food allergy
  • Acute appendicitis
  • Pelvic radiation treatment
  • Intestinal ischaemia
  • Early presentation of a chronic cause e.g. IBD
61
Q

What are the viral causes of acute diarrhoea?

A
  • Norovirus (most common)
  • Sapovirus
  • Rotavirus
62
Q

What are the bacterial causes of acute diarrhoea?

A
  • Salmonella
  • Campylobacter jejuni
  • Shigella species
  • E coli
  • Clostridium difficile - can cause infectious diarrhoea in people who have taken anti-biotics
63
Q

What are the parasitic causes of acute diarrhoea?

A
  • Cryptosporidium
  • Giardia
  • Entamoeba histolytica
  • Cyclospora
64
Q

What can cause bloody diarrhoea?

A
  • Bacterial: Campylobacter jejuni, Salmonella, Escherichia coli O157:H7, Vibrio parahaemolyticus, Shigella, Yersinia, Aeromonas, Clostridium difficile.
  • Viruses: cytomegalovirus.
  • Parasites: Entamoeba histolytica, schistosomiasis
65
Q

Which drugs can cause diarrhoea?

A
  • Laxatives, allopurinol, angiotensin-II receptor blockers, antibiotics, chemotherapy, magnesium-containing antacids, metformin, nonsteroidal anti-inflammatory drugs, proton pump inhibitors, and selective serotonin reuptake inhibitors
66
Q

What are the possible causes of chronic diarrhoea?

A
  • IBS
  • Diet
  • IBD
  • Microscopic colitis
  • Coeliac disease
  • Lactose intolerance and pancreatic insifficiency
  • Colorectal cancer
  • Bile acid diarrhoea
  • Drugs
  • Constipation and faecal impaction
67
Q

How common is diarrhoea?

A
  • Acute - very common, 17 million cases in the UK every year

* Chronic - 14% in elderly, 7% in younger population (US study)

68
Q

What are the complications of diarrhoea?

A
  • Dehydration increases the risk of life threatening illness and death, particularly in young infants and children
  • Chronic diarrhoea can negatively impact on quality of life for example avoidance of travelling or going to new places where access to toilet facilities may be difficult and adaptation of food choices to avoid exacerbating diarrhoea
69
Q

What is the prognosis of diarrhoea?

A
  • Most infectious diarrhoea is of viral origin and is self limiting with nearly half of episodes lasting less than half a day
  • It is thought that:
  • Viral diarrhoea lasts around 2-3 days
  • Untreated bacterial diarrhoea has a duration of around 3-7 days
  • Protozoal diarrhoea can be present for weeks to months without treatment
  • Prognosis of chronic diarrhoea will depend on the underlying cause
70
Q

How should a person with acute diarrhoea be assessed?

A
  • Enquire about red flag symptoms:
  • Blood in stool
  • Recent hospital or antibiotic treatment
  • Weight loss
  • Evidence of dehydration
  • Nocturnal symptoms
  • Attempt to ascertain the underlying cause, assess for character of stools (watery, fatty, containing blood or mucus), features suggesting infection such as:
  • Fever
  • Vomiting
  • Recent contact with a person with diarrhoea
  • Exposure to possible sources of enteric infection (meals out, recent farm petting animals)
  • Travel abroad
  • Higher risk groups such as food handlers, nursing home residents and recently hospitalised people
  • New drugs such as antibiotics or laxatives
  • Stress or anxiety
  • Abdominal pain often present in IBD, IBs and ischaemic colitis
  • History of recent radiation treatment to the pelvis
  • Immunosuppression
  • Surgical or medical conditions
  • Diet and use of alcohol or substances such as sorbitol
  • Assess for complications of diarrhoea such as dehydration
  • Perform an abdominal examination
  • Consider a rectal examination
71
Q

What are the clinical features of mild dehydration?

A
  • Mild dehydration
  • Lassitude.
  • Anorexia, nausea.
  • Light-headedness.
  • Postural hypotension.
  • Usually no signs
72
Q

What are the clinical features of moderate dehydration?

A
  • Moderate dehydration
  • Apathy/tiredness.
  • Dizziness.
  • Nausea/headache.
  • Muscle cramps.
  • Pinched face.
  • Dry tongue or sunken eyes.
  • Reduced skin elasticity.
  • Postural hypotension.
  • Tachycardia.
  • Oliguria
73
Q

What are the clinical features of severe dehydration?

A
  • Severe dehydration
  • Profound apathy.
  • Weakness.
  • Confusion, leading to coma.
  • Shock.
  • Tachycardia.
  • Marked peripheral vasoconstriction.
  • Systolic blood pressure less than 90 mmHg.
  • Oliguria or anuria
74
Q

How should acute diarrhoea be investigated in primary care?

A
  • Send a faecal specimen for routine microbiology investigation if a person with diarrhoea is:
  • Systemically unwell, needs hospital admission and/or antibiotics
  • Blood or pus in the stool
  • Person is immunocompromised
  • Recent PPI treatment
  • Foreign travel
  • Amoebae, Giardia or cryptosporidium are suspected, particularly if diarrhoea is persistent (2 weeks or more or the person has travelled to an at risk area
  • Need to exclude infectious diarrhoea

Or if it is a public health indication such as:

  • High risk people - food handlers, healthcare workers, elderly residents in care homes
  • Suspected food poisoning
  • Outbreaks in the community
  • Contacts of people infected with certain organisms for example E coli 0157 or c.difficile
75
Q

How should a stool sample for acute diarrhoea be sent?

A
  • Single, quarter full specimen pot is the minimum needed for routine microbiology investigation - only loose stools will be examined
  • If occurs after exotic travel abroad, is recurrent or prolonged, request ova, cysts and parasites and give details of travel
  • Send 3 specimens a minimum of 2 days apart
  • Ensure the following details are included on the request:
  • Clinical features e.g. fever, bloody stool, severe abdominal pain
  • History of immunosuppression
  • Food intake (e.g. shellfish)
  • Recent foreign travel (specify countries)
  • Recent antibiotic therapy, PPI, or hospitalisation
  • Exposure to untreated water
  • Contact with other affected people or an outbreak
76
Q

What is the admission criteria for a person with acute diarrhoea?

A
  • Emergency admission if:
  • Vomiting and unable to retain oral fluids or
  • Features of severe dehydration or shock

Other factors influencing threshold for admission include:

  • Older age >60 years or older are more at risk of complications
  • Home circumstances and level of support
  • Fever
  • Bloody diarrhoea
  • Abdominal pain and tenderness
  • Increased risk of poor outcome - comrbidities
  • Drugs - immunosuppressants
  • Refer on a two week wait if they have unexplained weight loss and rectal bleeding and/or iron deficiency anaemia
77
Q

How should a person with chronic diarrhoea be investigated in primary care?

A
  • Request the following blood tests:
  • FBC
  • U and E’s
  • LFT’s
  • Calcium
  • Vitamin B12 and folate
  • Iron status (ferritin)
  • Thyroid function
  • ESR and CRP
  • Coeliac screen - IgA and tTG or EMA
  • Consider:
  • CA125 - if signs of ovarian cancer
  • HIV serology if underlying immunodeficiency suspected
  • C. diff testing if PPI or recent hospital
  • Faecal calprotectin testing to differentiate between IBD and IBS
78
Q

How does faecal calprotectin distinguish between IBS and IBD?

A
  • Marker of inflammation in the bowel
  • Raised in IBD
  • Threshold >100 mcg/g