Diarrhoea (4.6)

Question 1

What does diarrhea constitute? What causes it?

Answer 1

Change from ones normal bowel habit

• increase in frequency
• soft, watery stools
• associated urgency, nausea, cramps

Causes:

• Infection e.g. virus/bacteria/parasite
• Diseases e.g. diverticulitis, IBD
• Diet, hormonal, drugs, anxiety impaction

Question 2

What is the time course of diarrhoea? What is the main complication?

Answer 2

Time course:

> Acute: <7days (viral)

> Persistent: >14 days

> Chronic > 1 month

Dehydration = main complication

Question 3

What is the difference between mild, moderate and severe dehydration?

Answer 3

Mild dehydration (<5% loss of body weight)

• Increased thirst, dry mucuous membranes
• Dark yellow urine, decreased skin turgor, sunken eyes

Moderate dehyration (5-10% loss of body weight)

• Moderate thirst (drinks eagerly ), dry mouth, non-tearing eyes
• Decreased urination
• Dark amber or brown urine
• Decreased skin tugor, sunken fontanelle and eyes

Severe dehydration (>10% loss of body weight)

• Altered behaviour e.g. anxiety, confusion
• Extremely thirsty but may be too lehargic to say
• Drinking poorly or not at all
• Little or no urination
• Decreased skin turgor, sunken fontanelle and eyes
• Circulatory collapse (weak rapid pulse, cool or blue extremities or hypotension), rapid breathing

Question 4

For diarrhoea;

A) Who is the patient?

B) What are the symptoms

C) How long

D) Actions taken?

E) Medications?

G) Medical conditions?

Answer 4

A)

• Infant, young and elderly
• Pregnant and breastfeeding
• Traveled abroad recently –> risk of giardiasis infection

B)

• Frequency and nature of stools
• Onset of symptoms
• Blood or mmucus in motions
• Abdominal pain
• Other signs/symptoms:

> fever, vomitting, malaise, constipation, weight loss, signs of dehydration

• signs and dehydration

C)

• Children and elderly > 2-3 days
• Persistent change in bowel habit
• Previous history
• Overseas in past 2 months
• Food intake

D)

• Antidiarrheal
• Rehydration

E)

• Recent antibiotics

> pseudomembranous colitis (due to clostridium difiicile overgrowth –> refer)

• medication causing diarrhoea

F)

• Renal, liver or heart disease

Question 5

What medications cause diarrhoea

Answer 5

Question 6

Self care for diarrhoea?

Answer 6

• Increase fluids
• Resume normal food intake after rehydration
• Continue breastfeeding and bottle feeding
• Limit cows milk, sugar, alcohol, fatty/spicy food
• Increase starchy foods
• Live cultures (lactobacillus (GG))
• Wash hands well before food preparation and after toiletting