Diarrhoea

Question 1

What is Diarrhoea

Answer 1

It is the abnormal passage of loose or liquid stools more than 3 times daily and or a volume of stool greater than 200g/day

Question 2

what is acute/chronic diarrhoea

Answer 2

less than 4 weeks, mostly: infectious and self-limiting and chronic diarrhoea is more than 4 weeks

Question 3

give some causes of acute diarrhoea and give examples of each

Answer 3

viral- rotavirus, norovirus, enteric adenovirus
bacterial- salmonella, staph aureus, campylobacter
parasitic- cryptosporidium parvum, giardia lamblia

Question 4

give some causes of chronic diarrhoea:

Answer 4

colonic, small bowel, pancreatic, endocrine and other: drug, alcohol and factitious.

Question 5

give some examples of colonic causes of diarrhoea

Answer 5

UC, Crohn’s colitis, microscopic colitis and colorectal cancer

Question 6

give some small bowel causes of diarrhoea

Answer 6

coeliac disease, Crohn’s disease, bile salt malabsorption and lactose intolerance.

Question 7

give some pancreatic causes of diarrhoea

Answer 7

chronic pancreatitis, pancreatic cancer, cystic fibrosis

Question 8

give some endocrine causes of diarrhoea

Answer 8

diabetes, hyperthyroidism, Addison’s disease, hormone-secreting tumours.

Question 9

What are the mechanisms of diarrhoea

Answer 9

osmotic: lactose intolerance or steatorrhoea
secretory: cholera, e.coli and gut hormones
inflammatory: CD, infectious and post-irradiation.

Question 10

What investigations can be done for diarrhoea

Answer 10

stool tests: microscopy and culture, checking for faecal calprotectin (inflammation presence) and faecal elastase (pancreatic enzyme)

blood tests: FBC, CRP, TTG, TFT, B12

imaging: colonoscopy, CT, vid capsule, MRI for small bowel

Question 11

What are the two types of IBD

Answer 11

CD & UC

Question 12

What is UC

Answer 12

Ulcerative colitis is the mucosal inflammation of the colon, affecting the rectum and a variable extent of the colon.

Question 13

What is CD

Answer 13

Crohn’s disease is a discontinuous granulomatous inflammation affecting any area of the GI tract

Question 14

What are typical symptoms of UC

Answer 14

Bloody diarrhoea, rectal bleeding, mucus, faecal urgency, abdominal pain, nocturnal defecation

Question 15

History and examination of UC

Answer 15

Stool cultures: CDT, faecal calprotectin, FBC, albumin

flexible sigmoidoscopy and colonoscopy

Question 16

What are the treatments for severe UC

Answer 16

Admit to hospital, hydrocortisone, heparin, stool chart, AXR, daily CRP

Question 17

what are treatments for mild UC

Answer 17

Mesalazine, prednisolone, azathioprine,

biologics: anti TNF (infliximab), surgery

Question 18

What are the symptoms of CD

Answer 18

symptoms vary a lot from patient to patient

abdominal pain, weight loss, chronic diarrhoea, anaemia, growth stunts in children and perianal disease

Question 19

treatments for CD

Answer 19

nutritional therapy, antibiotics, biologics and surgery.