Diarrhoea Flashcards
Define?
What would the score be on the bristol stool chart?
When is it classed as chronic?
> 3 loose stools per day
5-7
> 4 wks
What should be suspected if it is acute D?
What questions should you ask?
What should you expect if chronic?
Gastroenteritis
Recent travel? Diet change? Contact with D&V? Fever/pain HIV?
IBS Weight loss Nocturnal diarrhoea Anaemia IBD
Bloody diarrhoea - causes - 3
Mucusy diarrhoea - causes
Pussy diarrhoea - causes - 3
E.coli
IBD
Colorectal cancer
Polyps
IBS
Colorectal cancer
Polyps
IBD
Diverticulitis
Fistula/abscess
Explosive diarrhoea - causative pathogen
Steatorrhoea - features - 4
What does it suggest? - 2
Cholera
Giardia
Rotavirus
Increased gas
Offensive smell
Floating
Hard to flush
Pancreatic insufficiency
Biliary obstruction
Differential diagnosis:
GI:
- infection - 2
- Inflammation - 2
- Intolerances - 2
- One thing that changes bowel habit
- Diagnosis of exclusion
- Might happen after this
GE, tropical infections
IBD, diverticulitis
Coeliac disease or lactose intolerance
Colorectal carcinoma
IBS
Constipation with overflow
Differential diagnosis:
Endocrine - 2 issues which cause D
Drugs - 6
Thyrotoxicosis (hyperthyroidism)
Addison’s
ABs PPIs Metformin Laxatives CV: digoxin, propanalol Alcohol
Signs you’d look for:
Dehydration - 3
Sign of thyrotoxicosis
Dry mucous membranes
Reduced skin turgor
Raised CRT
Goitre/hyperthyroid signs
Investigations:
What will dictate the direction of inv?
The basic approach to inv:
- Bloods
- Other thing that needs to be ruled out
- What can be measured in the stool to differentiate between IBS and IBD?
Severity
Chronicity
Red flags
FBC and inflammatory markers (ESR/CRP)
Coeliac disease - Coeliac serology needed
Faecal Calprotectin - done initially to rule out or in
Investigations:
MAIN RED FLAG FOR 2WW
What red flags for further testing or when a referral is needed? - 5
What is done when they are referred?
New-onset change in bowel habit > 55 yrs old
Anaemia or PR bleeding Continuous or nocturnal D Raised CRP/ESR/faecal calprotectin FH of bowel or ovarian cancer Weight loss
Endoscopy to check for malignancy or precancerous lesions
Further investigations:
Stool - what tests can you do on stool samples? - 3
What can you look for in the stool that will indicate chronic pancreatitis?
What can be measured in the stool to differentiate between IBS and IBD?
Test for H.pylori causing D?
Test for lactose intolerance?
MC+S
Ova cysts and parasites
C. diff
Faecal elastase - malabsorption and steatorrhoea
Faecal calprotectin
13C breath test
Hydrogen breath test
Fermenting lactose in the intestines (a sign of lactose intolerance) creates lactic acid, which can be detected in stool.
Further investigations - blood:
FBC:
- What does a low MCV (mean corpuscular volume) indicate? - 2
- What does a high MCV indicate? - 1
- What does low B12 absorption suggest?
What does raised inflammatory markers to suggest? - 4
What in U&E’s would suggest severe D&V?
What endocrine disease can you also test for and how?
How would you test for coeliac disease?
Iron deficiency from coeliac/colon cancer
Alcohol abuse
Coeliac and Crohn’s disease
Infection - GE
Crohns
UC
Cancer
Hypokalaemia
Low TSH indicating thyrotoxicosis
Coeliac serology
Management - usually treat the cause
What happens in the majority of cases?
What needs to be done if severe and acute?
What medication can be given to help? - 2
When should ABs be given?
What can be suggested for AB associated D
Self-resolving
Oral rehydration therapy - IV + electrolyte replacement
Loperamide
Codeine
Infective D causing systemic symptoms
Probiotics
Loperamide
MOA
Indications - 3
Reduces smooth muscle tone
Water D that interferes with life
IBS
Travellers diarrhoea
Common causes of D
GE
Travellers D
C.diff
IBS
Cancer
IBD
Coeliac
Uncommon causes of D
Microscopic colitis
Chronic pancreatitis
Bile salt malabsorption
Laxative abuse
Lactose intolerance
