20. Diarrhoea Flashcards
What is the definition of diarrhoea?
Increase in amount of stool passed daily to over 300g- usually accompanied by increased frequency and loosening of the stools
What can cause diarrhoea?
Infection
Inflammation- IBD, Diverticular disease
Increased bowel motility- Hyperthyroidism, anxiety, IBS
Malabsorption- Coeliac, pancreatic insufficiency
Obstruction only allowing fluid through
Medications- laxatives- colchicine, digoxin, metformin, thiazide diuretics and some Abx
What are the most likely causes of diarrhoea in a young adult?
Going from most to least likely
Infective diarrhoea Irritable bowel syndrome Coeliac disease Crohn's disease UC Medications Hyperthyroidism
What are the most likely causes of diarrhoea and elderly patients?
Neoplastic disease, diverticular disease, overflow diarrhoea secondary to constipation, ischaemic colitis, microscopic colitis and bacterial overgrowth, IBD
What questions would you ask to characterise the stool?
Is it jelly like/ got mucus in it?
Does it smell worse and floating?
Are the faeces unusually pale
Is there any blood?
What might mucoid diarrhoea suggest?
Salmonella
What does foul smelling/ floating diarrhoea suggest?
Malabsorption
What does pale diarrheoa suggest?
Biliary obstruction
What would you ask about the patient’s bowel habit if they are presenting with diarrhoea?
Nocturnal diarrhoea? Do you rush to the toilet? Tenesmus? Varbaility in bowel habit How frequently do you open your bowels
What does urgency in opening bowel suggest?
Infection or IBD
What does tenesmus suggest?
space occupying lesion in the rectum- carcinoma
What associated symptoms will you ask about in someone with diarrhoea?
FLAWS
vomiting
abdo pain
eye, skin, joint symptoms- IBD
What will you ask about in the social history of someone with diarrhoea?
Travel
Close contacts
Changes in diet
What are the blood markers for coeliac disease?
TTG, IgA
In what condition do you get erythema nodosum?
IBD
