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Internal Medicine MD2 Lectures > Approach to Diarrhoeal illness > Flashcards

Approach to Diarrhoeal illness Flashcards

1
Q

acute diarrhoea

A

<14 days

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2
Q

persistent diarrhoea

A

more than 14 days

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3
Q

chronic diarrhoea

A

more than 30 days

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4
Q

blood tests

A

haemoglobin
urea and creatinine
electrolytes - sodium, K, magnesium
CRP
iron stores

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5
Q

causes of acute infectious watery diarrhoea

A

norovirus
rotavirus
campylobacter spp.
eschericia coli

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6
Q

causes of acute infectious inflammatory diarrhoea

A

clostridium deficile
escherichia coli
shigella spp.

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7
Q

positive stool sample

A

stool samples are only positive in 1-5% of cases

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8
Q

diarrhoea in pregnant women

A

listeria monocytogenes?

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9
Q

developed symptoms within six hours

A

performed toxins - staph aureus?

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10
Q

reheated rice

A

bacillus cereus

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11
Q

post ingestion of pork products

A

yersinia spp. (usually a few days incubation)

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12
Q

recent antibiotic therapy or hospitalisation

A

clostridium difficile

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13
Q

acute diarrhoea mananegemtn

A

most cases are self limiting and do not require antibiotics
fluid and electrolyte replacement

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14
Q

consider antibiotics if:

A

severe disease
immunosuppressed
significant comorbidities

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15
Q

anti diarrhoeals

A

not recommended as first line therapy

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16
Q

acute diarrhoea oral rehydration solutions (ORS)

A

SGLT-1 protein usually unaffected
relies on cotransport of sodium and glucose
pulls water into vascular system
low osmolarity solution recommended

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17
Q

what to test for in persistant diarrhoea

A

reasonable to test for parasitic organisms if not already done
often need to specifically request ‘ova and parasite’ exam

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18
Q

types of parasites that might be the cause of persistent diarrhoea

A

giardia (lol sam)
cryptosporidium
entamoeba histolytica
often associated with travel

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19
Q

causes of chronic diarrhoea

A

resource limited places: chronic bacterial Orr parasitic infections
resource rich areas: functional disorders, inflammatory bowel disease, malabsorption syndromes

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20
Q

nature of secretory chronic diarrhoea

A

watery, voluminous bowel movements, often with nocturnal symptoms and a lack of response to fasting
patients often have electrolyte disturbances and dehydration

21
Q

nature of secretory chronic diarrhoea

A

watery, voluminous bowel movements, often with nocturnal symptoms and a lack of response to fasting
patients often have electrolyte disturbances and dehydration
may be caused by medications such as lactulose, laxatives, magnesium supplements or ingestion of alcohol sugars (sorbitol, mannitol, xytol)

22
Q

nature of malabsorbtive chronic diarrhoea

A

the lack of uptake of luminal contents
coeliac disease, pancreatic insufficiency
small intestinal bacterial overgrowth which is associated with a variety of diseases eg. systemic sclerosis, diabetes, cirrhosis and portal hypertension, strictures, previous surgeries etc.

23
Q

nature of inflammatory chronic diarrhoea

A

not just IBD
microscopic colitis is divided into two subgroups
- lymphocytic colitis with has a lymphocyte predominant infiltrate
- collagenous colitis also features a sub epithelial collagen band
chronic inflammation in both leads to epithelial destruction

eosinophilic enteritis can be associated with other conditions like EO or atopic conditions. patients may need steroid therapy

24
Q

appropriate investigations for chronic diarrhoea

A

bloods for electrolytes, serum albumin and nutrient deficiencies
measurement of stool sodium osmotic gap
faecal elastase
faecal calprotectin to evaluate for IBD
faecal fat measurement is rarely done
gastroscopy and colonoscopy

25
Q

coeliac disease

A

an immune mediated enteropathy against dietary gluten

26
Q

patients with coeliac disease generate antibodies against

A

gliadin (which makes up gluten) and to tissue transglutaminase

27
Q

what happens after ingestion of gluten in coeliac people

A

mucosal immune response
1. increased intraepithelial lymphocytes
2. villous atrophy
3. crypt hyperplasia

28
Q

diagnosis of coeliac disease

A

sensitivity and specificity of the anti-TTG antibody assay is very high
duodenal biopsy remains gold standard because you can evaluate the severity of mucosal changes

29
Q

symptoms of coeliac disease

A

can be very non-specific
diarrhoea
abdo pain and bloating
unexplained iron deficiency
neurological symptoms
dermatitis herpetiformis

30
Q

coeliac disease management

A

lifelong adherence to a strict gluten free diet
replace nutrient deficiencies
prevention of bone loss
vaccination
monitoring for refractory disease and complications

31
Q

churns disease

A

a chronic inflammatory disease of the GI that can affect any part from mouth to anus
most typically characterised by transmural inflammation

32
Q

ulcerative colitis

A

a chronic inflammation disease of the colon that starts in the rectum and can extend proximally to involve all segments of the colon
most typically characterised by mucosal inflammation only

33
Q

pathogenesis of IBD

A

genetics
environment - smoking, emulsifiers
microbiome - loss of diversity
barrier defects - bacteria more easily more across the gut wall causing inflammation
innate and adaptive immune dysfunction - immune cells become less tolerant and produce more pro inflammatory cells

34
Q

clinical features of chrons disease

A

diarrhoea for more than 6 weeks
abdo pain
weight loss
perianal fistulas
systemic symptoms including malaise, anorexia, feverr

35
Q

clinical features of ulcerative colitis

A

blood in stools
rectal urgency
tenesmus
mucous in stools
nocturnal defecation
crampy abdo pain
left iliac fossa pain

36
Q

which IBD disease has fistulas

A

chrons

37
Q

which IBD disease has skip lesions

A

chrons

38
Q

which IBD disease affects colon only

A

ulcerative colitis
chrons is anywhere from mouth to anus

39
Q

which IBD disease has bloody diarrhoea

A

both but chrons is often non-bloody

40
Q

thickness of mucosal damage in IBD diseases

A

UC - involves the lining (mucosa) only
chrons - transmural

41
Q

impact of smoking on development of IBD disease

A

chrons - higher risk
UC - lower risk

42
Q

which IBD disease has cobblestone mucosa on colonoscopy

A

chrons

43
Q

medical therapies for IBD

A

steroids
immunomodular drugs
biologic drugs (infliximab, adalimumab, vedolizumab, ustekinumab)

44
Q

surgical therapies for IBD

A

limited small bowel resections in churn’s disease
colectomy for severe ulcerative colitis with restorative pouch
perianal abscess drainages and fistulotomy

45
Q

irritable bowel syndrome

A

chronically recurring abdo pain or discomfort and altered bowel habits
often co-exists with depression and anxiety and involves significant impairment to quality of life

46
Q

symptoms of irritable bowel syndrome

A

abdo pain
bloating
excess flatulence
diarrhoea
constipation

47
Q

things that are not features of IBS

A

bloody stools
weight loss
fever
signs of systemic inflammation

48
Q

subtypes of irritable bowel syndrome

A

IBS-C: constipation predominant
IBS-D: diarrhoea predominant
IBS-M: mixed type
IBS-U: undefined

49
Q

IBS syndrome management

A

largely lifestyle based
low FODMAP diet for diarrhoea predominant symptoms
laxative and increased soluble fibre for constipation dominant symptoms
anti-spasmodics
CBT

Internal Medicine MD2 Lectures (14 decks)

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