Diarrhoea Flashcards
(100 cards)
1
Q
What is diarrhoea?
A
Increased frequency and volume of stool and decreased consitency
2
Q
What would you want to establish in the history in someone who is presenting with acute diarrhoea?
A
Acute (<2 wks)
- Contact with D+V
- Fever/systemic upset
- Pain
- Blood/mucus
- Travel
- Diet change
- Contact with animals
- Associated symptoms
- Medications
- Social - drugs, alcohol
3
Q
What would you want to ask in the history in someone who is presenting with chronic diarrhoea?
A
- Fever/systemic upset
- Pain
- Blood/mucus
- Travel
- Diet change
- Weight loss
- Nocturnal diarrhoea
- Symptoms of anaemia
4
Q
What are causes of bloody diarrhoea?
A
- Campylobacter
- Shigella
- Salmonella
- E. Coli
- AMoebiasis
- IBD
- Colorectal cancer
- Colonic polyps
- Pseudomembranous colitis
- Ischaemic colitis
5
Q
What are causes of diarrhoea with mucus?
A
- IBS
- Colorectal cancer
- Polyps
6
Q
What are causes of diarrhoea with franck pus?
A
- IBD
- Diverticulitis
- Fistula/abscess
7
Q
What are causes of “explosive” diarrhoea?
A
- Cholera
- Giardia
- Yersinia
- Rotavirus
8
Q
What are causes of steatorrhoea?
A
- Pancreatic insufficiency
- Biliary obstruction
- Coeliac disease
- CF
9
Q
What are non-GI causes of diarrhoea?
A
- Thyrotoxicosis
- Autonomic neuropathy
- Addison’s Disease
- Amyloidosis
- Pellagra
- Drugs
10
Q
What are the common causes of diarrhoea?
A
- Gastroenteritis
- Traveller’s diarrhoea
- C. dioff
- IBS
- Colorectal cancer
- IBD
- Coeliac
11
Q
What drugs can cause diarrhoea?
A
- Antibiotics
- Propranalol
- Cytotoxics
- Laxatives
- PPI’s
- NSAIDs
- Digoxin
- Alcohol
12
Q
What bacteria can cause diarrhoeal illness?
A
- Salmonella
- Campylobacter
- E. coli 0157
- Shigella
- Clostridium Difficile
- Cholera
13
Q
How long after onset do symptoms of Salmonella associated Diarrhoea present?
A
<48hrs
14
Q
How long does Salmonella associated diarrhoea normally last for?
A
<10 days
15
Q
What are the different types of diarrhoea?
A
- Osmotic Diarrhoea
- Secretory Diarrhoea
- Inflammatory Diarrhoea
- Abnormal motility
16
Q
What can prolonged carriage of Salmonella be associated with?
A
Gallstone formation
17
Q
What can be a common problem post-infection for someone who has had Salmonella?
A
Irritable Bowel Syndrome
18
Q
What species of campylobacter is the main pathogen in diarrhoeal infection?
A
Campylobacter jejuni
19
Q
What are the most common sources of campylobacter infection?
A
- Contaminated Milk
- Chickens
- Puppies
- Water
20
Q
What is the incubation time for Campylobacter?
A
2-5 days
21
Q
What are the main symptoms of Campylobacter infection?
A
- Severe Abdominal Pain - often becomes continuous and radiates to right iliac fossa
-
Watery Diarrhoea
- Can become bloody
- Fever
- Nausea and Vomiting
22
Q
How long does it normally take for Campylobacter infection to clear?
A
3 weeks
23
Q
How long does it take stools to become negative in Campylobacter infections?
A
6 weeks
24
Q
What are some of the long term post-infective sequelae of Campylobacter infection?
A
- Guillain Barre Syndrome
- Reactive Arthritis
25
What is secretory diarrhoea?
Both active intestinal secretion of fluid and electrolytes as well as decreased absorption
Cholera toxin is regarded as the classic model of this
26
What are common causes of secretory diarrhoea?
* **Enterotoxins**
* **Hormones**
* **Bile salts (in the colon)** - following ileal resection
* **Fatty acids (in the colon) -** following ileal resection
* **Some laxatives**
27
What is the pathophysiology of diarrhoea caused by cholera?
* Increases cAMP levels
* Increases protein kinases
* Inhibit Na+ and Cl- absorption
* Cl- secretion
28
What bacteria cause secretory diarrhoea?
* **Cholera**
* **E. Coli**
* **C. Difficile**
31
How do you distinguish between secretory and inflammatory diarrhoea?
Inflammatory diarrhoea is accompanied by ***_PAIN AND FEVER_***
32
What is osmotic diarrhoea?
Gut mucosa acts as a semipermeable membrane and fluid enters the bowel if there are large quantities of non-absorbed hypertonic substances in the lumen
33
What is inflammatory diarrhoea?
Damage to the intestinal mucosal cell so that there is a loss of fluid and blood
In addition, there is defective absorption of fluid and electrolytes
34
What can cause osmotic diarrhoea?
* **Non-absorbable substance**
* **Malabsorption so that high concentrations of solute remain in the lumen**
* **Specific absorptive defect - coeliac disease**
35
How can you distinguish between osmotic diarrhoea and other types of diarrhoea?
* **Remove the malabsorptive substance**
* **Bloating?**
37
What are the causes of inflammatory diarrhoea?
* Infection (Shigella)
* Inflammatory conditions (UC, Crohn's)
38
What is the reservoirs of E. Coli O157?
Cattle
39
What can cause diarrhoea due to abnormal motility?
* Diabetic (arse)
* Post-vagotomy
* Thyrotoxicosis
40
What are the clinical features of Salmonella infection?
* **Diarrhoea**
* **Vomiting**
* **Fever**
* **Septicaemia**
41
What is Haemolytic Uraemic Syndrome (HUS)?
Shiga-Like Toxin (SLT) binds to globotriaosylceramide -\> platelet activation stimulated -\> microangiopathy
Platelets bind to endothelial, glomerular, tubular and mesangial cells
42
What type of E. Coli causes Enterohaemorrhagic E. Coli infection?
E. Coli O157:H7
44
What are the clinical features of E. Coli O157?
Frequent Bloody Stools
45
What can E. Coli O157 cause?
Haemolytic Uraemic Syndrome
47
Who does HUS most commonly occur in, if it does occur?
Children and the Elderly
48
How long after the onset of diarrhoea can it take for HUS to develop in E. Coli O157 infection?
5-9 days
49
What is the definition of Food Poisoning?
Illness caused by eating contaminated foodstuffs
50
What bacteria can cause food poisoning?
* **Staphylococcus Aureus**
* **Bacillus cereus (re-fried rice)**
* **Clostridium Perfringens**
51
What is Dysentery?
Infection of the intestine causing severe diarrhoea with blood and mucus
52
What causes bacillary dysentery?
Shigella
53
What are the symptoms of bacillary dystentery?
* **Abdominal pain**
* **Small volume Bloody diarrhoea + mucus**
* **Sudden fever**
* **Nausea**
54
What is the incubation period for bacillary dysentery?
1-6 days
55
How is bacillary dysentery spread?
Faecal-Oral
56
How is cholera spread?
Faecal-Oral route
57
Can you name the organism which causes cholera?
*Vibrio Cholerae* (Gram -ve rod)
58
How long does it take cholera to incubate?
A few hour to 5 days
59
What are the clinical features of Cholera?
* **Profuse watery stools (1L/h)**
* **Fever**
* **Vomiting**
* **Rapid dehydration**
* Associated Metabolic Acidosis
60
What can be a complication of Shigella Infection?
* **HUS**
* **Seizures**
61
What is the definition of Colitis?
Inflammation of the colon
62
What are colitic symptoms?
* **Recurring bloody diarrhoea +/- pus**
* **Lower Abdominal Pain**
* **Faecal Incontinence**
* **Fatigue**
* **Unexplained Weight loos**
63
What is Gastroenteritis?
Inflammation of the stomach and intestine
64
What can cause Gastroenteritis?
Usually due to viral, bacterial infection or food-poisoning toxins
65
How do you objectively determine if someone has developed Gastro-enteritis?
3+ stools in 24 hrs, plus one of
* **Fever**
* **Vomiting**
* **Pain**
* **Blood/mucus in stools**
66
How long does gastroenteritis normally last?
3-5 days
67
What are the main features of gastroenteritis?
Dirrhoea +/- vomiting
68
What are the 4 main pathogenic mechanisms of bacterial gastroenteritis?
* **Mucosal adherence** **-** effacement of intestinal mucosa
* **Mucosal invasion** - Penetration and destruction of mucosa
* **Toxin production enterotoxin** - Fluid secretion without mucosal damage
* **Cytotoxin** - Damage to mucosa
69
For each of the 4 pathogenic mechanisms of bacterial gastroenteritis, describe their clinical presentations
* **Mucosal adherence** - Moderate watery diarrhoea
* **Mucosal invasion** - Dysentery
* **Toxin Production** - Profuse Watery diarrhoea
* **Cytotoxin** - Dysentery
70
What bacteria can cause gastroenteritis?
* Salmonella
* Campylobacter
* Shigella
* EHEC
* ETEC
* Cholera
71
What organism causes pseudomembranous colitis?
C. Difficile
72
How does C. diff cause diarrhoea?
* **Toxin A - enterotoxin**
* **Toxin B - cytotoxic**
73
How does C. diff infection present?
* **Severe Bloody Diarrhoea**
* **Abdominal Pain**
* **Gut perforation**
* **Pyrexia**
* **Toxic Megacolon**
74
What are the 4 C's which put a patient at risk of C. diff colonisation?
* **Cephalosporins**
* **Clindomycin**
* **Ciprofloxacin**
* **Co-Amoxiclav**
75
How would you manage someone with C. diff infection?
Stop causative ABx
10 days of treatment
* **Non severe** - **Metranidazole** - 400 mg 8hrly
* **Severe - Oral Vancomycin** - 125 mg 6 hrly
76
What parasites can cause diarrhoea?
* **Cryptosporidium parvum**
* **Giardia lamblia**
* **Entamoeba histolytica**
77
What can be a complication of Entamoeba Histolytica?
Amoebic Liver Abscess
78
How does amoebiasis present?
* **Amoebic dysentry** - Similar to ulcerative colitis
* **Profuse Diarrhoea +/- blood**
* **Can have fever**
* **Abdo pain**
* **Amoebic colonic abscess**
* **Amoebic liver abscess**
* **High, swinging fever**
* **Sweats**
* **RUQ pain/tenderness +/- chest pain**
79
How does giardia infection present?
* **Explosive Diarrhoea**
* **Malabsorption**
* **Bloating**
* **Flatulence**
* **Weight loss**
80
Where does giardia colonise in the gut?
Duodenum and jejunum
81
How would you treat giardia infection?
* **Metranidazole**
* **Tinidazole**
82
How does Rotavirus cause diarrhoea?
Infects mature enterocytes of villous body and tip (not crypts) with cell death and lactose intolerance
83
How would you clinically assess someone with acute diarrhoea?
* **Assess hydration -** postural BP, skin turgor, pulse, mucus membranes, CRT
* **Features of infection -** fever, raised WCC, rashes
* **Consider PR exam**
84
How would you investigate someone with suspected gastro-enteritis?
* **Stool culture**
* **Blood culture**
* **Renal function**
* **Blood count -** neutrophilia, haemolysis
* **Abdominal X-Ray -** if abdomen distended, tender
85
What would make you suspect a non-infectious cause for diarrhoea?
\>2 weeks duration
86
How would you clinically assess someone with chronic diarrhoea?
* **Assess hydration** - postural BP, skin turgor, pulse, mucus membranes, CRT
* **Features of infection** - fever, raised WCC, rashes
* **Signs of underlying cause** - WL, clubbing, anaemia, oral ulcers, rashes, abdo mass/scars, thyroid status
* **Consider PR exam**
87
What investigations would you consider doing in someone with diarrhoea?
* **Bedside** - Basic observations
* **Bloods** - FBC, ESR, CRP, U+E's, TFTs, Coeliac serology
* **Other** - stool cultures, faecal elsatase, Lower GI endoscopy
88
What might decreased MCV on FBC in someone with diarrhoea suggest?
* **Bleeding**
* **Iron deficiency** - coeliac, colon cancer
89
What might increased MCV on FBC investigation indicate in someone with diarrhoea?
* **Alcohol abuse**
* **B12 deficiency due to coeliac/crohn's**
90
What might increased ESR/CRP indicate in someone with diarrhoea?
* **Infection**
* **Crohn's**
* **UC**
* **Cancer**
91
What might you see on U+E's in someone with diarrhoea?
* **Hypokalaemia** - if severe
* **Features of dehydration**
92
If someone presented with what you deemed to be infective diarrhoea, when would you consider symptomatic treatment without further investigation?
No systemic signs
93
If someone presented with what you deemed to be infective diarrhoea with systemic features (fever, dehydration, visible blood), how would you manage them?
Admit:
* **Oral fluids**
* **Consider empirical Abx unless non-infectious cause found**
* **Faecal culture**
94
How would you manage diarrhoea?
* **Treat cause**
* **Oral rehydration initially, unless severe -\> IV**
95
What is toxic megacolon?
Usually a complication of inflammatory bowel disease, such as ulcerative colitis and, more rarely, Crohn's disease, and of some infections of the colon, including C. diff infections (pseudomembranous colitis).
Other forms of megacolon exist and can be congenital (present since birth, such as Hirschsprung's disease). It can also be caused by Entamoeba histolytica and Shigella.
96
What is the major cause of traveller's diarrhoea?
Enterotoxigenic E. Coli
97
How would you detect c. diff?
* **FBC** - WBC
* **Stool PCR followed by specific ELISA immunoassay for toxins**
* **Consider AXR** - significant distention
98
What imaging would you consider in someone with c. diff infection?
AXR - look for toxic megacolon
99
What are infective causes of non-bloody diarrhoea?
* **Norovirus**
* **Rotavirus**
* **Anteric Adenovirus**
* **Enterotoxigenic E. Coli**
* **Enteropathogenic E. Coli**
* **Toxin-producing s. aureus**
* **Cholera**
* **C. perfingens**
* **Giardia**
* **Cryptosporidium**
100
How would you manage someone with cholera?
* **Oral rehydration salts** - may need 1L/hr initially
* **Consider IV fluids if severly dehydrated + ORS**
* **Consider Abx** - doxycycline/tetracycline
101
How would you investigate suspected amoebiasis?
* **Bloods** - LFT's, U+E's, serum antiamoebic antibody
* **Orifices** - Stool culture/microscopy, Faecal antigen
* **Imaging** - Abdo USS, CT +/- aspiration (abscess), sigmoidoscopy
* **Specific** - Stool/Liver pus PCR
102
What features might you see on sigmoidoscopy in amoebiasis?
* **Friable mucosa**
* **Mucosal ulceration**
* **Amoebomas**
* **Colonic abscesses**
103
How would you treat amoebiasis?
* **Metranidazole, then diloxanide fuorate** - to destroy gut cysts
* **Consider tinidazole** - severe infection or liver abscess
104
What might you see on microscopy of stool culture in amoebiasis?
Cysts and trophozoites
105
What might serology for amoebiasis show?
Antibody titres elevated
