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Flashcards in 20. Diarrhoea Deck (27)
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1

What is the definition of diarrhoea?

Increase in amount of stool passed daily to > 300g- usually accompanied by increased frequency + loosening of the stools

2

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 + some Abx

3

What are the most likely causes of diarrhoea in a young adult?

Going from most to least likely

Infective diarrhoea
IBS
Coeliac disease
Crohn's disease
UC
Medications
Hyperthyroidism

4

What are the most likely causes of diarrhoea and elderly patients?

Neoplastic disease
Diverticular disease
Overflow diarrhoea secondary to constipation
Ischaemic colitis
Microscopic colitis
Bacterial overgrowth
IBD

5

What questions would you ask to characterise the stool?

Is it jelly like/ got mucus in it?
Are they foul smelling + floating?
Are the faeces unusually pale?
Blood?

6

What might mucoid diarrhoea suggest?

Salmonella

7

What does foul smelling/ floating diarrhoea suggest?

Malabsorption

8

What does pale diarrheoa suggest?

Biliary obstruction (lack of bile salts)

9

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?

10

What does urgency in opening bowel suggest?

Infection
IBD

11

What does tenesmus suggest?

space occupying lesion in the rectum- carcinoma

12

What associated symptoms will you ask about in someone with diarrhoea?

FLAWS
vomiting
abdo pain
eye, skin, joint symptoms- IBD

13

What will you ask about in the social history of someone with diarrhoea?

Travel
Close contacts
Changes in diet
Stress

14

What are the blood markers for coeliac disease?

TTG
IgA

15

What signs of IBD should you look for on examination of a patient with diarrhoea?

Clubbing
Iritis
Mouth ulcers (Crohn's)
Erythema nodosum
Anal ulcers/ fistulae (Crohn's)
Abdominal mass in RLQ (Crohn's)

16

What signs of coeliac disease may be found on examination

Clubbing
Dermatitis herpetiformis

17

What signs of malignancy should you look for on examination of a patient with diarrhoea?

Virchows lymphadenopathy
Abdominal masses

18

What can predispose you to C. difficile?

Antibiotics

19

Why should patients with UC be offered regular colonoscopies?

They have an increased risk of colon cancer

20

What is the most likely infective organism in an outbreak of vomiting and diarrhoea in an old persons nursing home?

Norovirus

21

What is the most likely infective organism in an outbreak of bloody diarrhoea at a primary school?

Shigella
E. Coli

22

What is the most likely infective organism in a student with watery diarrhoea a few days after a BBQ?

Campylobacter jejuni

23

What is the most likely infective organism in a group of people with sudden onset diarrhoea a few hours after a party?

Staphylococcus aureus
Bacillis cereus

24

What causes the rapid or slow onset of diarrhoea in infection?

Rapid: bacteria have excreted active toxins
Slow: Bacterial growth in the bowel

25

What is the most likely infective organism in an elderly patient in hospital receiving antibiotics for pneumonia?

Clostridium difficile

26

What is the most likely infective organism in a young woman who has just returned from Ghana and has right iliac fossa pain?

Yersinia enterocolitica

27

What are the 3 possible outcomes of a fluid challenge?

No response: hasn't received enough fluid or weren't hypovolaemic to begin with
Transient response: haven't given enough fluid or is losing them rapidly e.g. haemorrhage
Sustained response: restoration to normal fluid balance