Flashcards in Diarrhoea & Constipation Deck (33):
What is bowel habit?
- the pattern of defaecation; or the mechanism by which the waste products of digestion are excreted by the body
Explain the process of digestion
- Food is broken down mechanically --> chewing
- Then broken into molecules --> chemicals such as stomach acid and pancreatic enzymes
- Molecules are absorbed by small intentine and metabolised into energy
What happens to undigested material?
- passes as a liquid effluent into the large bowel where fluid is extracted and the effluent is converted to faeces.
What is a normal frequency of defaecation?
one every 2-3 days to 2-3 times a day.
What should you ask about bowel habit?
Because the frequency of defaecation is so varied in the general population, always as about CHANGES IN BOWEL HABIT
What is diarrhoea?
- diarrhoea denotes the frequent and excessive passing of watery unformed faeces
What is diarrhoea due to?
- diarrhoea is usually due to damage to the lining of the bowel that inhibits absorption of water from the waste products of digestion
What are the three classifications of diarrhoea?
- Acute, Progressive and Chronic
What is acute diarrhoea?
- diarrhoea that has an abrupt onset and a short duration
- mostly lasts a few days and is usually caused by an infection such as gastroenteritis or food poisoning
What is persistent diarrhoea?
- diarrhoea that lasts between 2 and 4 weeks
What is chronic diarrhoea?
- diarrhoea that is slow to develop and has a long duration of longer than four weeks
With reference to diarrhoea, What cardinal features would you use when interviewing a patient?
- Site of GI pain
- Time Course
- R/A Factors
- Associated Features
With reference to diarrhoea, What would you ask regarding Site?
- Where is your abdominal pain?
With reference to diarrhoea, What would you ask regarding Quality?
- How watery is it?
With reference to diarrhoea, What would you ask regarding Severity?
- Volume of Stool?
With reference to diarrhoea, What would you ask regarding Time Course?
- Acute vs. Chronic?
- Worsening over time?
With reference to diarrhoea, What would you ask regarding Context?
- Travel overseas?
With reference to diarrhoea, What would you ask regarding R/A Factors?
- Tried anything to relieve it? Effect?
With reference to diarrhoea, What would you ask regarding Associated Features?
- Acute: nausea, fever, vomiting, other people sick
- Other: abdo pain, symptoms of dehydration, weight loss
What is constipation? Due to?
Excessively hard stools usually caused by increase absorption of liquid as a result of slow transit through the large bowel
What is constipation associated with?
Reduction in the frequency of defecation and a feeling of incomplete evacuation of the bowels
What should you clarify is a patient is constipated?
Clarify exactly what they mean by the word constipation
What are some causes of constipation?
- low fibre diet
- medications such as codeine
- medical conditions
- bowel cancer
What is rectal bleeding?
Passage of blood or clots from the rectum
What should you ask about with regards to rectal bleeding?
Amount of blood?
What can rectal bleeding be a sign of?
- Haemorrhoids, anal fissure, colorectal cancer etc.
If there is blood in diarrhoea = can be inflammatory bowel disease
How can you tell the origin of the blood in rectal bleeding?
Bright Red = close to the anus
Darker/Maroon red= first regions of the large intestine
Black = upper GI tract
What is the medical term for black stools?
What are black stools an indication of?
- upper gastrointestinal bleeding
What does upper GI bleeding manifest as?
haeatemesis, melaena or rarely rectal bleeding
What should you enquire about if constipation or rectal bleeding are presenting?
- family Hx of bowel cancer
Why do the stools appear black?
Because the blood is oxidised by bacteria as it passes through the intestines.