Diarrhoea

Question 1

What is diarrhoea? What are the causes?

Answer 1

frequent passing of watery stools

infective causes

• bacteria = Campylobacter, Escherichia Coli, Salmonella
• virus = Rotavirus
• protozoa/parasites: Giardia lamblia

causative agents irritate intestinal lining causing stools to absorb more water

non-infective causes

• anxiety
• alcohol
• caffeine

Question 2

What are symptoms of diarrhoea?

Answer 2

watery stools
-in the absence of blood suggests infective causes

abdominal cramps
loss of appetite
headache or fever
associated nausea and vomiting

Question 3

What are differential diagnosis?

Answer 3

inflammatory bowel diseases (UC and Crohn’s)
irritable bowel syndrome
faecal impaction – stool seepage 
adverse drug reaction 
- e.g. magnesium preparations
allergies

some will require referral

Question 4

Why does dehydration occur with diarrhoea? What are symptoms of sever dehydration?

Answer 4

water is not reabsorbed from the stool as it passes through the GI tract

symptoms 
- drowsiness
- confusion/dizziness
- passing very little urine
- dry mouth 
- sunken eyes
- cold hands and feet
= less blood circulating due to loss of water (dizziness), reduced perfusion of blood to hands and feet (cold)

Question 5

When should diarrhoea be referred?

Answer 5

signs of severe dehydration
recently returned from travelling
- high risk countries = Africa, S.Asia, S.America
- low risk countries = Europe, N.America

depends on duration

• babies (up to 1 year) = 24 hours
• children (1-3 yrs) = 48 hours
• adults = 3 days
• elderly = 48 hours

Question 6

What is the first line treatment for diarrhoea?

Answer 6

oral rehydration therapy

- dioralyte

Question 7

How does dioralyte work?

Answer 7

prevents dehydration
- replacing the water and salts lost from your body by increasing water reabsorption

can be given to all age groups
- first line treatment

can be stored in the fridge for up to 24 hours
- should not be made in advance

caution in diabetes
- increases blood glucose levels
= would use dioralyte relief instead which is rice based instead of glucose based

Question 8

What other drugs can be used to treat diarrhoea?

Answer 8

anti-motility drugs
- loperamide (Imodium)
= reduced duration of diarrhoea and stool frequency
= not available OTC for under 12 yrs

bismuth subsaliylate (pepto bismol)

• decreasing the flow of fluids and electrolytes into the bowel
• for over 16 yrs only
• side effects = blackened stool and tongue

kaolin
- absorbs water to bulk stool

morphine
- reduces gut motility