Diarrhoea

Question 1

When a patient presents with acute diarrhoea after foreign travel, what would be your first thoughts?

Answer 1

This is probably an infective cause that will need SPECIFIC treatment

Question 2

When someone has had recent Abx treatment for acute diarrhoea and their symptoms persist, what bacterial infection would you suspect?

Answer 2

Clostridium difficile

Question 3

How would you approach an examination of someone with acute diarrhoea?

Answer 3

• General appearance - how do they look?
• Observations - pulse, BP, RR, O2 sats, temperature ; always thinking about SEPSIS
• Hydration status - loss of volumes of fluid in the faeces
• Abdominal exam - check snt, if areas of tenderness think of underlying structures
• PR - if indicated, e.g. bleeding or mucus from the back passage, or pain

Question 4

What is ‘Campylobacter’?

Answer 4

A group of bacteria that cause food poisoning, often due to eating undercooked meat

Question 5

What should patients with campylobacter be advised?

Answer 5

• Avoid others for 48 hours
• No treatment is usually necessary as it is self-limiting
• Remain hydrated and continue drinking plenty of fluid

Question 6

Who must the GP contact when a patient has campylobacter diarrhoea?

Answer 6

Public Health England (or Wales)

Question 7

How long may a patient with campylobacter diarrhoea have looser bowel motions for?

Answer 7

A few weeks, if they experience it for longer they must seek further medical attention.

Question 8

In patients’ with chronic diarrhoea, what 7 tests should be arranged by the GP?

Answer 8

1. FBC - Normal Hb and WCC make coeliac and IBD less likely
2. TFT - Hyperthyroidism can be easily ruled out
3. Faecal calprotectin - if raised can be indicative of IBD
4. Tissue Tran-glutaminase antibodies - coeliac disease
5. U+Es
6. ESR - IBD
7. CRP - IBD

Question 9

What medication can be used to reduce muscle spasm in the bowel in the treatment of IBS?

Answer 9

Hyoscine butylbromide (buscopan)

Question 10

How is IBS diagnosed?

Answer 10

It is a diagnosis of exclusion, other more serious and treatable pathologies are excluded first. If tests return normal for these, we can be more confident that IBS is the diagnosis.

Question 11

What is the most common cause of acute diarrhoea in hospital inpatients?

Answer 11

C.difficile

Question 12

How does C.difficile become infective?

Answer 12

C.diff is present in healthy bowel. However, this becomes infective when the normal gut and intestinal bacteria flora are compromised (e.g. after abx or other medications like PPI).

Question 13

What is a common abx treatment for C.diff infection?

Answer 13

Metronidazole

Question 14

What are the 4C’s for preventing food poisoning caused by campylobacter?

Answer 14

Cleanliness - hands, utensils, work surfaces, tea towels. Do NOT prepare food if you have D+V

Cooking - do not reheat food more >1 time, ensure meat is cooked through, drink pasteurised or boiled milk, avoid unsafe water

Chilling - cooling leftover food quickly then refrigerate between 0-5 degrees celsius

Cross-contamination - bacteria can move from foods (most often raw meat) to other foods