what is diarrhoea?

Question 1

what is diarrhoea?

Answer 1

the abnormal passage of loose or liquid stools more than 3 times daily and/ or a volume of stool greater than 200g/day

Question 2

what should you beware when diagnosing people with diarrhoea? 3

Answer 2

• faecal incontinence
• functional bowel disorders
• what is the most important is what is normal for the patient, and if they have changed from their baseline

Question 3

describe acute diarrhoea? 3

causes? 3

Answer 3

• less than 4 weeks
• mostly infectious and self limiting
• investigate after 1 week

Viral (rotavirus, norovirus)
Bacterial (salmonella, shigella, campylobacter, S. aureus)
Parasitic (cryptosporidium parvum)

Question 4

describe chronic diarrhoea? 3

what are some causes for chronic diarrhoea?

Answer 4

• more than 4 weeks
• chronic pathology
• always investigate
• colonic (ulcerative and crohn’s colitis, microscopic colitis, colorectal cancer)
• small bowel (coeliac disease, Crohn’s disease, bile salt malabsorption, lactose intolerance, small bowel bacterial growth)
• pancreatic (chronic pancreatitis, pancreatic cancer, cystic fibrosis)
• endocrine (hyperthyroidism, diabetes, Addison’s disease, hormone secreting tumours)
• other (drugs, alcohol, factittous)

Question 5

what are the mechanisms of diarrhoea? 7

Answer 5

• Osmotic
• Steatorrhea
• Secretory
• Inflammatory
• Neoplastic
• Ischaemic
• Post irradiation

Question 6

what are the investigations for diarrhoea? 3

Answer 6

• Stool tests (microscopy and culture, faecal elastase, faecal calprotectin)
• Blood teste (FBC, CRP, TTG, TFT’s B12 etc)
• Imaging (colonoscopy, CT, video capsule, MRI small bowel)

Question 7

describe ulcerative colitis? 7

Answer 7

• Continuous mucosal inflammation of the colon without granulomas on biopsy, affecting the rectum and variable extent of the colon in continuity and characterised by a relapsing and remitting course
• often insidious onset
• Any age
• M: F 1:1
• Relapsing/remitting course
• Positive effect of smoking
• Appendicectomy protective

Question 8

describe the symptoms of ulcerative colitis? 7

Answer 8

• blood diarrhoea
• rectal bleeding
• mucous
• faecal urgency
• abdominal pain
• nocturnal defecation

-extra-intestinal maniac (arthritis, uvetitis, erythema, nodosum, pyoderma, gangrenosum)

Question 9

what tests are done to test for ulcerative colitis? 8

Answer 9

History and examination
Stool cultures
Faecal calprotectin
CRP
FBC
Albumin 
Flexible sigmoidoscopy/ colonoscopy

Question 10

what is given to ulcerative colitis patients who don’t respond to steroids? 3

Answer 10

• Infliximab
• Cyclosporin
• Colectomy

Question 11

what is the treatment for severe ulcerative colitis? 7

Answer 11

• Admit
• Hydrocortisone 100mg iv qds
• Heparin
• Stool chart
• AXR
• Daily CRP
• Avoid NSAID’s opiates, anti-motility agents

Question 12

what is the treatment for ulcerative colitis? 4

Answer 12

• Mesalazine
• Prednisolone
• Azathioprine
• Biologics= anti TNF agents’ infliximab, adalimumab/ alpha4beta7 integrin blockers vedolizumab/ tyrosine kinase inhibitor: tofacitinib (oral agent)

Question 13

what is crohn’s disease? 11

Answer 13

Discontinuous and often granulomatous transmural inflammation affecting any area of the GI tract

• Any age
• M: F 1:1
• Relapsing/remitting course
• Smoking
• Previous appendicectomy makes you more likely
• Family history
• Infectious gastroenteritis (increase risk in the following year)
• Inflammatory disease
• Stricturing disease
• Fistulating disease

Question 14

what is the treatment for crohn’s disease disease? 7

Answer 14

• Prednisolone/budesonide
• Azathioprine/ 6-mercaptopurine
• Methotrexate (inhibits folic acid metabolism)
• Nutritional therapy
• Antibiotics
• Biologics (infliximab, adalimumab, vedolizumab, ustenkinumab)
• Surgery