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M104 Symposia > M104 Symposia Diarrhoea part 1 > Flashcards

M104 Symposia Diarrhoea part 1 Flashcards

1
Q

What is the criteria of diarrhoea according to the BSG?

A

loose or liquid stools more than 3x / day
and/or
a volume of stool greater than 200 g/day

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2
Q

What is the criteria for normal bowel openings?

A

between 3x/day and 3x times a week

However there is some variability

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3
Q

What are conditions that might be confused for?

A

Faecal incontinence

Functional bowel disorders e.g. IBS

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4
Q

What is something to look out for when diagnosing diarrhoea?

A

how much it has deviated from baseline occurance for that particular patient

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5
Q

What type of diarrhoea is usually pathological?

A

bowel opening at night

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6
Q

What might fatigue indicate when associated with diarrhoea?

A

inflammation or anaemia

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7
Q

What is the difference between acute and chronic diarrhoea?

A

acute - lasts less than 4 weeks and is mostly infectious and self limiting, should be investigated after 1 week
chronic - lasts more than 4 weeks, has chronic pathology and should always be investigated

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8
Q

What are the three causes of diarrhoea?

A

viral (very common)
bacterial
parasitic

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9
Q

What are three examples of viral pathogens responsible for diarrhoea?

A

Rotavirus
Norovirus
Enteric adenovirus

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10
Q

What are four examples of bacterial pathogens responsible for diarrhoea?

A

Salmonella
Shigella
Campylobacter
Staph.aureus

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11
Q

What is an example of a parasitic pathogen responsible for diarrhoea?

A

Cryptosporidium parvum

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12
Q

What are two examples of parasitic pathogen responsible for chronic diarrhoea?

A

Giardia lamblia

Entamoeba histolyti

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13
Q

What are the types of causes behind acute and / or chronic diarrhoea?

A

Colonic
Small bowel
Pancreatic
Endocrine

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14
Q

What conditions could cause acute colonic diarrhoea?

A

Ulcerative & Crohn’s colitis
Microscopic colitis
Colorectal cancer

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15
Q

What conditions could cause acute small bowel diarrhoea?

A 
Coeliac disease
Crohn’s disease
Bile salt malabsorption 
Lactose intolerance (uncommon)
Small bowel bacterial overgrowth
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16
Q

What conditions could cause acute pancreatic diarrhoea?

A

Chronic pancreatitis
Pancreatic cancer
Cystic fibrosis

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17
Q

What conditions could cause acute endocrine diarrhoea?

A

Hyperthyroidism
Type 1 Diabetes
Addison’s disease
Hormone secreting tumours

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18
Q

What are other factors that could cause acute colonic diarrhoea?

A

specific drugs
excessive alcohol use
laxatives - factitious - not telling dr they’re on laxatives

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19
Q

What are examples of hormone secreting tumours?

A

Carcinoid

VIPoma

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20
Q

What are the mechanisms of diarrhoea?

A

Osmotic e.g. lactose intolerance
Steatorrhoea
Secretory e.g.Cholera, E. Coli, gut hormones
Inflammatory e.g. UC, Crohn’s, infections
Neoplastic
Ischaemic
Post irradiation

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21
Q

What is Microscopic colitis characterised by?

A

profuse, watery diarrhoea

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22
Q

How is Microscopic colitis detected?

A

biopsies show microscopic changes of inflammation but the colon looks normal under a colonoscopy

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23
Q

What group suffers from microscopic colitis most commonly?

A

middle aged women

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24
Q

What is coeliac disease caused by?

A

protein

gluten in the diet

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25
Q

What are the sources of gluten?

A

rye, wheat and barley

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26
Q

What is the effect of subtotal villous atrophy?

A

atrophy on the enterocytes within the small bowel

leads to malabsorption and diarrhoea

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27
Q

What is subtotal villous atrophy caused by?

A

gluten from the diet

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28
Q

What is an under recognised cause of diarrhoea?

A

Bile salt malabsorption

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29
Q

How does enterohepatic circulation work?

A

bile salts enter the terminal ileum, which feeds it to the caecum where they are reabsorbed into the bloodstream and taken back the liver for recycling

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30
Q

How might a right hemicolectomy cause osmotic diarrhoea?

A

due to a portion of the LI being removed, the reabsorption of bile salts won’t happen as easily and readily and they will in the rest of the colon

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31
Q

What is included under the right hand portion of the colon?

A

the caecum
the ascending colon
a portion of the transverse colon

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32
Q

What are bile salts secreted into?

A

the small bowel

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33
Q

What percentage of the population will have lactose intolerance?

A

10%

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34
Q

What is lactose intolerance caused by?

A

an absence of lactase within the brush border of the enterocytes in the small bowel

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35
Q

How can lactose intolerance cause diarrhoea?

A

the absense of lactase means lactose won’t be digested, and will instead act as an osmotic laxative again and draw water into the lumen of the bowel, causing diarrhoea

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36
Q

What makes diarrhoea caused by lactose intolerance better?

A

stop eating dairy products

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37
Q

What is the bacteria spread like in the viscera?

A

the small bowel is essentially sterile
the stomach is full of acid so there are very few bacteria there and in the SI
towards the terminal ileum, the bacterial count starts to increase
in the caecum and colon, there are billions of bacteria

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38
Q

What causes small bowel bacterial overgrowth?

A

some circumstances cause bacteria to spill back into the small bowel and overgrow there
can cause diarrhoea

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39
Q

What circumstance in particular can cause small bowel bacterial overgrowth?

A

surgical resections

40
Q

What is the SI otherwise known as?

A

the small bowel

41
Q

How is small bowel bacterial overgrowth treated?

A

antibiotics

42
Q

What are the two main functions of the pancreas?

A

producing insulin and glucagon for glucose homeostasis

producing digestive enzymes

43
Q

What can chronic inflammation of the pancreas be caused by?

A

smoking and alcohol

44
Q

How does chronic inflammation of the pancreas and pancreatic cancer cause diarrhoea?

A

the body does not produce some digestive enzymes

which leads to malabsorption and diarrhoea

45
Q

How can cystic fibrosis cause diarrhoea?

A

mucus accumulates in the pancreatic ducts

46
Q

What is the category of chronic diarrhoea that is relatively rare?

A

endocrine

47
Q

How can Type 1 Diabetes cause diarrhoea?

A

over many years of having the condition, it can cause an autonomic neuropathy, which would affect SI motility

48
Q

What are the two deficiencies in Addison’s disease?

A

cortisol or aldosterone

49
Q

What is the role of cortisol?

A

helps regulate metabolism and the body to respond to stress

50
Q

What is the role of aldosterone?

A

helps control bp

51
Q

What is an example of a diarrhoea causing drug?

A

metformin

52
Q

How does metformin lower blood sugar levels?

A

by improving the way the body handles insulin

53
Q

When is metformin prescribed?

A

for type 2 diabetes when diet and exercise alone have not been enough to control blood sugar levels

54
Q

What is a side effect of metformin?

A

diarrhoea

55
Q

What are two examples of conditions that lansoprazole is used to treat?

A

ulcers or gastroesophageal reflux disease

56
Q

What are the different mechanism types behind diarrhoea? (PINS-ISO)

A 
Post irradiation
Ischaemic
Neoplastic
Steatorrhoea
Inflammatory 
Secretory  
Osmotic
57
Q

What are features of faeces from a patient with steatorrhoea?

A

often greasy, very light in colour, and will float

58
Q

What are features of faeces from a patient with steatorrhoea?

A

often greasy, very light in colour, and will float

59
Q

What are examples of conditions / substances that cause secretory diarrhoea?

A

Cholera
E. Coli
gut hormones

60
Q

What substance is produced by cholera bacteria and what does it do?

A

an enterotoxin - it pumps out water from enterocytes into the bowel lumen causing the so-called rice-water stools from cholera

61
Q

What is an example of a condition that causes osmotic diarrhoea?

A

lactose intolerance

62
Q

What are examples of conditions that cause inflammatory diarrhoea?

A

UC, Crohn’s, infections

63
Q

What is an example of a condition that causes ischaemic diarrhoea?

A

ischaemic colitis

64
Q

What causes ischaemic diarrhoea?

A

when the blood supply to part of the colon is abruptly cut off, sometimes by a blood clot from atrial fibrillation

65
Q

What happens to the blood clot in ischaemic diarrhoea?

A

in patients with atrial fibrillation, a bit of clot can break off from the left atrium
it passes down the aorta via the left ventricle and get stuck in one of the mesenteric arteries and

66
Q

What happens when one of the blood clots gets stuck in one of the mesenteric arteries?

A

it causes an ischaemia to the colon which will cause diarrhoea, often bloody diarrhoea

67
Q

Why might radiation cause cancer?

A

it can affect the bowel that causes radiation colitis

68
Q

Why might radiation cause cancer?

A

it can affect the bowel that causes radiation colitis

69
Q

What condition is smoking protective against?

A

ulcerative colitis

70
Q

What condition is smoking detrimental against?

A

Crohn’s disease - if someone with Crohn’s disease smokes, stopping can be very beneficial

71
Q

What’s in the right lower abdomen that can cause tenderness?

A

the appendix

inflammation of the terminal ileum and the caecum

72
Q

Is appendicitis a likely cause of chronic diarrhoea?

A

no

73
Q

What is a rigid sigmoidoscope like?

A

a plastic tube with a light source on the end and an air bulb

74
Q

How does a rigid sigmoidoscope work?

A

the air bulb is inflated in the rectum
look through the window
can see what the rectum mucosa looks like, and that can be quite useful
27:22
because we know that ulcerative colitis always affects the rectum.

75
Q

Why are rigid sigmoidoscopes used?

A

shows that the rectum mucosa looks like

76
Q

What condition always affects the rectum?

A

ulcerative colitis

77
Q

What instrument is used instead of a rigid sigmoidoscope these days and why?

A

a flexible sigmoidoscope
it is a much more informative procedure that involves the use of a flexible sigmoidoscope to get a bit higher in the colon

78
Q

What stool tests can be done to identify diarrhoea?

A

Microscopy & culture
Faecal elastase
Faecal calprotectin

79
Q

When are stool tests performed for diarrhoea?

A

at the GP’s early on in the disease course to exclude infection

80
Q

What does the faecal elastase test for?

A

a pancreatic enzyme

the proper functioning of the pancreas

81
Q

If a faecal elastase stool test is normal, will the patient have chronic pancreatitis?

A

its unlikely

82
Q

What’s a feature of the faecal elastase stool test?

A

it’s an easy test to perform

83
Q

What does the faecal calprotectin test for?

A

the presence of inflammation within the bowel

84
Q

What’s a feature of the faecal calprotectin stool test?

A

it’s very non-specific

it doesn’t tell you where the inflammation is or the cause, just that it is present

85
Q

How is the faecal calprotectin stool test useful?

A

diagnostically - when distinguishing IBS from e.g. IBD

for tracking the course of a known case of IBD

86
Q

How is ulcerative colitis monitored?

A

by using serial faecal calprotectins over the course of treatment
it will give an indicator of whether inflammation is still present without needing to use a colonoscope.

87
Q

What is a inflammation physiologically caused by?

A

an influx of WBCs

88
Q

Where is calprotectin found?

A

in the cytoplasm of WBCs

89
Q

How do faecal calprotectin stool tests work?

A

lots of WBCs are shed in the bowel
the calprotectin protein found within these WBCs can then be measured in the stool and give a relatively quantitative idea of degree of inflammation present

90
Q

What are examples of blood tests that can be done to identify diarrhoea?

A

FBC, CRP, TTG, TFT’s, B12

91
Q

What can a full blood count establish?

A

it will test the Hb level to see whether John is anaemic

92
Q

Where are C-reactive proteins produced and when?

A

by the liver in response to inflammation

93
Q

What does tissue transglutaminase test for?

A

antibodies associated with celiac disease

94
Q

What are the advantages of the tissue transglutaminase test?

A

has a very high specificity and sensitivity

if positive it’s extremely likely assuming the disease is present

95
Q

How does B12 levels influence diarrhoea?

A

B-12 is absorbed in the terminal ileum, so if there is disease within the terminal ileum such as Crohn’s disease, the patient may get a low B-12

96
Q

What are imaging types that can identify diarrhoea?

A

Colonoscopy
CT scan
video capsule
MRI of the small bowel

M104 Symposia (11 decks)

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