Red Book - Diarrhoea Flashcards
Define diarrhoea
No one definiition
WHO: passage of >3 loose or liquid stols per day
Brit Gastro Soc : passages of more than 200g stool per day
Bristol chart - passage of type 6 or 7
Incidence of diarrhoea in ICU
25-50%
Causes
Infective and non-infective
Infect Bacterial - e.coli, salmonella, shigella, c.jejuni, c.diff Viral - noro/rotaviruses Fungal - candida Protozoa - cryptospiridia, giardia
Non infect IBD - chrohns, UC Drugs - enteral feed, Abx, Mg, laxative, chemo, NSAIDS Mesenteric ischeamia Short gut Intolerance - Coeliac, lactose Bacterial overgrowth - bile salt malabsorption Post ileus
Pathophysiology
4 types:
Osmotic, Secretory, Inflammatory, Dysmotility
Osmotic
Failure to abosrb osmotically active solutes - water stays in gut
Enteral feed
Secretory
Increased secretion into the gut and reduced absorption —> large vol.
Enterotoxins, cholera, laxatives
Inflammatory
Loss of integrityt of GI mucose due to inflammation, impaired absorption
IBD
Dysmotility
Rapid trasnsit time, water and electrolyte load oveywhelms absorption in colon
Recover from ileus
Issues with diarrhoea in ICU
Patient:
Infection
Pressure sores
Need for a flexi seal
Organisational
Workload
Infecton control to other patietns
What is c.diff
Anaeorobic
Spore forming
Gram positive
Bacillus
Makes two toxins
A: enterotoxin, causes fluid sequestriation in bowel
B: cytotoxin, detected in the CDT test
Common and serious nosocomial infection, usually when gut flora eradicated —> broad spec abx
Spores not killed by alochol gel
Risk factors for CDT
Age > 60 Broad spec Abx use Underlying malignancy Albumin < 25g/L Renal/pulmonary disease PPI use
Approach to c.diff
Investigate and send samples
Isolate patient, tell ICT
Full barrier precautions, use soap and water
Tx. Oral or iv metronidazole or oral vanc
Progression of c.diff
Fulminant pseudomembranous colitis in 20%
Mortality here is 20%
Risk of toxic megacolon and perf
Managing Diarrhoea
ABCDE etc
Hx and O/E —> travel hx, sources of infection, drug use, immuno, systemic feature
abdominal pain
Ix - FBC, U&E, LFT, CRP, Coag, Blood gas, blood cultures
Stool sample - MC&S, CDT, Virology, cysts and parasites
Radiology - Abdo film, CXR erect, CT abdo pelcvis
Flexi sig/colon —> caution risk of perf
When is surgical review indicatedf
Immunosupressed patients
Significant tenderness
Raised WCC
Organ dysfunction
Treatment
Largely supportive
Maintain hydration, correct electrolytes and acid base
If approrpiate - Abx
Feed associated - change of feed, add fibre
if infection excluded —> lopirimide
Flexi seal
Infection control measures
