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General Medicine Pt1 > Severe acute diarrhoea > Flashcards

Severe acute diarrhoea Flashcards

1
Q

Name a common cause of a single episode of diarrhoea?

A

Dietary indiscretion

Anxiety

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2
Q

What is the significance of large-volume, watery stools?

A

There is always an organic cause

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3
Q

What are the implications of blood diarrhoea?

A

Colonic disease

Rectal disease

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4
Q

How long will an acute infective cause of diarrhoea last?

A

2-3 days

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5
Q

When should Inflammatory bowel disease be considered?

A

Severe or prolonged symptoms

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6
Q

What investigation is used to exclude infective causes of diarrhoea?

A

Stool culture

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7
Q

Name the 2 broad categories of aetiology of diarrhoea, and differentiate between them

A 
Organic cause (Stool >250g/d)
Functional cause
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8
Q

Which features suggest an infective cause of diarrhoea?

A

Sudden onset of bowel frequency
Crampy abdominal pain
Fever

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9
Q

Which features suggest an inflammatory cause of diarrhoea?

A

Bowel frequency
Loose, blood-stained stools
Pus

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10
Q

Which features suggest steatorrhoea?

A

Pale, offensive stools that float
Loss of appetite
Weight loss

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11
Q

What features suggest an organic cause of diarrhoea?

A

Nocturnal bowel frequency

Urgency

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12
Q

What features suggest a functional cause of diarrhoea?

A

Frequent

Small-volume stools

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13
Q

Define steatorrhoea

A

The presence of excess fat in faeces, due to fat malabsorption.

Produces a pale, offensive stool that floats.

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14
Q

Name 3 common causes of diarrhoea

A 
Gastroenteritis
Parasites/protozoa
Irritable bowel syndrome
Crohn's disease and Ulcerative Colitis
Coeliac disease
Colorectal cancer
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15
Q

Name 3 less common causes of diarrhoea

A 
Microscopic colitis
Chronic pancreatitis
Bile salt malabsorption
Laxative abuse
Lactose intolerance
Diverticular disease
Overflow diarrhoea
C. difficile
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16
Q

Name 2 non-GI or rare causes of diarrhoea

A 
Thyrotoxicosis
Autonomic neuropathy
Addison's disease
Ischaemic colitis
Gastrinoma e.g. Zollinger-Ellison syndrome
Carcinoid (neuroendocrine tumours)
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17
Q

Name 3 drugs that cause diarrhoea

A 
Antibiotics
Laxatives
NSAIDs
PPI
Alcohol
Psychotropic drugs: SSRIs etc.
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18
Q

State the different types of pathophysiology in diarrhoea

A

Osmotic
Secretory
Inflammatory
Abnormal motility

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19
Q

Describe the pathophysiology of osmotic diarrhoea

A

Presence of large quantities of hypertonic substances in the gut lumen ➔ fluid is drawn into the lumen

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20
Q

Describe the pathophysiology of secretory diarrhoea

A

Active intestinal secretion of fluid and electrolytes (Cl- secretion into lumen), and decreased absorption

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21
Q

Outline the causes of osmotic diarrhoea

A

Ingestion of non-absorbable substances e.g. MgSO4
General malabsorption
Specific absorptive defects e.g. Disaccharidase deficiency

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22
Q

Outline the common causes of secretory diarrhoea

A

Enterotoxins e.g. E. coli, cholera, C. difficile
Hormones e.g. VIPoma (Vasoactive intestinal peptide)
Bile salts following ileal resection
Fatty acids following ileal resection
Some laxatives

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23
Q

Describe the pathophysiology of inflammatory diarrhoea

A

Damage to intestinal mucosal cells ➔ fluid and blood loss, and defective fluid and electrolyte absorption

24
Q

Outline the common causes of inflammatory diarrhoea

A

Infective causes e.g. Shigella ➔ dysentry

Inflammatory bowel disease

25
Q

Name 2 medical conditions that cause diarrhoea due to abnormal motility

A

Diabetic diarrhoea
Hyperthyroid diarrhoea
Post-vagotomy diarrhoea

26
Q

What clinical features are associated with acute diarrhoea?

A

Fever
Abdominal pain
Vomiting
Dehydration and hypokalaemia (severe)

27
Q

Which patients are particularly susceptible to dehydration secondary to diarrhoea?

A

Very young

Very old

28
Q

What is the duration of acute diarrhoea?

A

Under 2 weeks

29
Q

Name 3 considerations if bloody diarrhoea occurs

A 
Campylobacter
Shigella/salmonella
E. coli
IBD
Colorectal cancer
Colonic polyps
Ischaemic colitis
30
Q

Name 2 consideration if mucus appear in diarrhoea

A

Irritable bowel syndrome
Colorectal cancer
Polyps

31
Q

Name 2 considerations if frank pus occurs

A

IBD
Diverticulitis
Fistula/abscess

32
Q

Name 2 considerations for explosive diarrhoea

A

Cholera
Giardia
Yersinia
Rotavirus

33
Q

When are investigations necessary for a presentation of diarrhoea?

A

If the diarrhoea has lasted more than 1 week

34
Q

What initial investigations should be taken in cases of diarrhoea?

A

Stool culture: bacterial pathogens, ova, cysts, parasites, C. difficile
FBC, CRP, U&E, TSH
Coeliac serology

35
Q

Following initial investigations for diarrhoea, what investigations should occur next?

A

Sigmoidoscopy
Rectal biopsy
(Colonoscopy if necessary)

36
Q

What is the maximum duration of viral/bacterial infective diarrhoea?

A

7-10 days

37
Q

What is the most likely cause of diarrhoea if duration exceeds 10 days?

A

Inflammatory bowel disease

38
Q

Outline the management of acute diarrhoea

A

Treat underlying cause
Food handlers should avoid work till stool samples -ve
Oral rehydration
Otherwise, 0.9% saline + 22mmol K+ per L
Codeine phosphate or Loperamide after each loose stool
Avoid antibiotics

39
Q

Why is Codeine phosphate or Loperamide taken during diarrhoea?

A

Anti-motility drugs: decrease the frequency of passing stool

40
Q

Why is colitis a contraindication for Codeine phosphate or Loperamide?

A

Both may precipitate toxic megacolon

41
Q

What can be given in Antibiotic-associated diarrhoea?

A

Probiotics (e.g. Lactobacilli)

42
Q

Describe the mechanism of action of Anti-motility drugs (Codeine phosphate and Loperamide)

A

Bind to opioid mu-receptors ➔ slow motility and increase anal tone

43
Q

What are the 3 commonest causes of gastroenteritis?

A

Norovirus
Rotavirus (children)
Contaminated food (Shigella, S. aureus, Salmonella etc.)

44
Q

How long does norovirus infection last?

A

Short-duration: 12-60 hours

45
Q

What is the typical presentation of norovirus infection?

A

Fever
Nausea
Projectile vomiting
Watery diarrhoea

46
Q

Describe the management of norovirus infection

A

Supportive management of fluids and electrolytes.

Norovirus is self-limiting.

47
Q

What measure should be taken if a norovirus outbreak occurs on the ward?

A

Healthcare quarantine, due to its highly infectious (faecal-oral and aerosol) nature up to 48hr after resolution.

48
Q

What is the typical presentation of rotavirus infection?

A

Vomiting
Watery diarrhoea
Hyperactive bowel sounds

(Adults have much milder symptoms)

49
Q

What intervention has reduced NaV due to rotavirus by 50%?

A

Rotavirus vaccinations - given to infants alongside other routine vaccinations.

50
Q

Define traveller’s diarrhoea

A

Any diarrhoea experience within the first two weeks of travelling abroad.

51
Q

What proportion of travellers experience traveller’s diarrhoea?

A

60%

52
Q

Why is Clostridium difficile difficult to contain in healthcare settings?

A

It is extremely contagious and resilient to both heat and alcohol-gel.

53
Q

What investigation should be taken in suspected C. diff infection?

A

Stool culture for C. diff enterotoxin

54
Q

What is the initial treatment for C. diff infection?

A

Stop causative antibiotic

If symptomatic, give metronidazole up to 400mg/8h PO for 10d max

55
Q

What can be given in severe C. diff infections?

A

Vancomycin 125mg/6hr PO

General Medicine Pt1 (25 decks)

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