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Year 3 Conditions > Diarrorhoea > Flashcards

Diarrorhoea Flashcards

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1
Q

What does diarrorhoea strictly mean

A

Increase in the amount of stools passed daily which normally coincides with increase in frequency and softening

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2
Q

What is name for bright red stools

A

Haematochezia

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3
Q

What can cause diarrorhoea categories

A 
Infection of bowel
Inflammation of bowel
Increased motility
Malabsorption of nutrients
Obstruction overflow
Medications
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4
Q

What happens in obstruction overflow diarrorhoea

A

Mass prevents only liquid stool to pass- constipation can counter-intuitively lead to overflow diarrorhoea

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5
Q

Common cause of overflow diarrorhoea in elderly people

A

Hard faeces

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6
Q

What can lead to hypermobility diarrorhoea

A

Hyperthyroid
Anxiety
IBS

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7
Q

What can lead to malabsorption diarrorhoea

A

Coeliac

Pancreatic insufficiency

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8
Q

What causes inflammation of the bowel diarrorhoea

A

IBD

Diverticular

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9
Q

What drugs cause diarrorhoea

A 
Colchicine
Laxatives
Digoxin
Thiazide diuretics
Metformin
Some abx
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10
Q

Differentials for diarrorhoea in young person

A 
IBS
Gastroenteritis
Coeliac
IBD
Medication
Hyperthyroidism
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11
Q

Differentials for diarrorhoea in older person

A 
Cancer
Diverticular disease
Overflow diarrorhoea secondary to constipation
Ischaemic colitis
Infective colitis
Bacterial overgrowth
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12
Q

What is bacterial overgrowth syndrome

A

Slowing down of bowel movements leads to bacterial overgorwth and diarrorhoea

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13
Q

Which patients is bacterial overgrowth syndrome very common

A

Elderly

Diabetics

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14
Q

What in diarrorhoea patient are you concerned about clinically

A

Shock- tachycardia and hypotension
Dehydration from loss fluid
Electrolyte imbalances

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15
Q

What could you check for on examination for hypovolaemia

A 
Tahycardia
Narrow MAP
Low BP
Postural drop
Mucous membranes
If feel thirsty
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16
Q

How do diarrohoea patients present with electrolyte imbalances

A

Loss of electrolytes in faeces

Secondary to hypovolaemia or ischaemia

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17
Q

How does ischaemia affect ABG

A

Metabolic acidosis

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18
Q

What is electrolyte response to metabolic acidosis

A

Hyperkalaemia

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19
Q

How would you exclude anxiety from diarrohoea

A

BP would also be high as well as HR

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20
Q

Which group of people has naturally low BP

A

Young females

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21
Q

Questions for characterising diarrorhoea

A 
Mucoid
Smell
Float
Colour
Blood
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22
Q

What does mucoid diarrorhoea suggest

A

Salmonella infection
Polyps
Or any disease causing inflammation of bowel generally

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23
Q

What does foul smelling and floating diarrorhoea suggest

A

Malabsorption

From coeliac, pancreatic insufficiency, recent cholecystectomy

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24
Q

What does pale diarrorhoea suggest

A

Blockage of biliary ducts preventing bile salts reaching duodenum- gallstones, chronic pancreatitis

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25
What must clarify about blood in faeces
If when wiping or is just streaked with blood- anal pathology such as haemorrhoids If blood mixed with blood- IBD, cancer, dysentry
26
What questions to ask about habit of diarrorhoea
``` Does have to rush to toilet Is it consistent habit Does feel that clear bowels properly Nocturnal? How often does suffer from diarrorhoea ```
27
What does rushing to toilet suggest about diarrorhoea
IBD or infective
28
What does nocturnal diarrorhoea suggest
Of organic cause such as IBD not functional like hyperthyroidism
29
What does altered bowel pattern suggest
Young people IBS | Older cancer
30
What does nausea with diarrorhoea suggest
Infective cause
31
What does RIF pain with diarrorhoea suggest
Damage to terminal ileum- Crohns, yersinia enterocolitica infection
32
What does LIF pain with diarrorhoea suggest
Diverticular disease
33
What does pain relieved by passing bowels suggest
IBS
34
What does weight loss suggest with diarrorhoea
Chronic pathology- IBD, cancer, chronic pancreatits
35
What does eye problems with diarrorhoea suggest
IBD
36
What does skin and joint problems suggest with diarrorhoea
IBD
37
Eye problems assocaited with IBD
Uveitis Episcleritis Scleritis
38
What is uveitis
Painful red eye with vision loss
39
What is scleritis
Painful red eye with no vision loss
40
What is episcleritis
Uncomfortable red eye with no vision loss
41
What joint problem comes with IBD
Enteric arthritis | Sacroilitis
42
Skin assocaitions of IBD
Erythema nodosum | Pyoderma gangrenosum
43
Risk factors to ask about with diarrorhoea
``` Travel Funny foods Family history of polyps, IBD Medications Stress and diet? ```
44
What are assocaited with IBS
Stress and low fibre diet
45
Why is regularity of diarrohoea important in the history young person
Intermittent rules out hyperthyroidism, ceoeliac and IBD, recurrent suggest IBS
46
diarrorhoea causes of clubbing
IBD Coeliac Hyperthyroidism
47
What does mass in RIF indicate with diarrorhoea
Crohns
48
What condition do you get dermatits herpetiformis
Coeliac
49
What is dermatitis herpetiformis and where is it found
Extensor surface of the limbs and scalp- itchy rash that often hard due to scratching
50
In diarrorhoea DRE what are you looking
Anal ulcers and fistulae from crohns | Malignancy cause of overflow diarrohoea
51
What condition frequently has anal fistulas and ulcers
Crohns
52
What diarrohoea conditions can cause anemia
Could be from Malabsorption- coeliac, cancer, IBD Blood loss- cancer, UC, ischaemic colitis, infective colitis
53
Inflammatory markers that can be raised
ESR CRP Platelets
54
Tests for coeliac
TTG IgA Anti endomysial Anti gliadin
55
Anaemia in coeliac
Microcytic
56
What will albumin be in IBD
Low from chronic diarrorhoea
57
What dos pus cells in faeces suggest
IBD
58
What is risk factor for C diff
Abx PPIs Immunocompromised
59
When cant you do FOBT
On aspirin or any AC- will give false positives
60
Believed pathophysiology of crohns
Mutation in genes responsible for clearing up phagocytosed bacteria leading. Inability to clear leads to cytokine release and walling off by other immune cells- granuloma
61
What is pathophysiology of crohns similar to
TB
62
Differences between UC and crohn presentation
UC more likely to be bloody Crohns causes weight loss Crohns pain RIF, UC LIF and diffuse Crohns patients fail to thrive between attacks and UC are well
63
What must be done with UC flare investigation
AXR to check for toxic megacolon
64
Investigations and findings for crohns
AXR showing signs of bowel inflammation | Colonoscopy with biopsy showing non caseating granuloma
65
Tx crohns
Steroid sparing medication such as methotrexate, azathioprine and infliximab Surgery if necessary
66
Why arent steroids used in crohns
To avoid side effects | Also they dont induce mucosal healing or modify disease state
67
What is difference between food poisoning and infective diarrorhoea
Food poisoning due to presence of toxins whereas infective diarrorhoea due to ingestion of pathogens
68
What does onset of sx soon after eating in infectious diarrorhoea suggest
Bacteria had pre formed toxins- staph aureus and bacillus cereus implied
69
Management of infectious diarrorhoea
Lots of hydration with rehydration salts too | IV fluids only considered if severely dehydrated or cant tolerate oral fluids
70
Diagnosis of IBS
ROME III criteria At least 3 months of recurrent abdo pain or discomfort with 2 of following - improvement on defaecation - onset noticed change in stool frequency - onset noticed change in form of stool
71
Managment of IBS
Reassure isnt serious Anti-spasmodics (Loperamide) Anti-depressants (Amitriptyline) at lower does than depression intention
72
Patient with explosive diarrorhoea whos been in hospital for ages on ABx
C diff
73
Management of C diff
Fluid resus Stool sample Isolation of ward with glove and gowning of all staff seeing the patient ABx Addresss precipitants such as ABx and PPIs to see if can be removed temporarily
74
ABx for C. Diff
Metronidazole for 2 weeks | Vancomycin reserved for those with severe disease
75
What is pathophysiology of UC
Actually a systemic inflammatory condition that mainly affects the bowel. Pathophysiology unknown but affects bowel in distal to proximal fashion from the rectum upwards with clear boundary between abnormal and normal
76
Presentation of UC
Painless bloody diarrorhoea Red eye Back and joint pain
77
Associated conditions of UC
PSC Adenocarcinoma- unlike crohns Cholangiocarcinoma
78
Management of UC
Drugs such as sulfasazine, methotrexate, azathioprine and corticosteroids Check regularly for adenocarcinoma During acute exacerbations do AXR to check for toxic megacolon Potential surgery see other card
79
Surgery for UC
Potentially curative as removes the symptomatic effects and risk of cancer however results in lifelong ileostomy New ileal-pouch-anal-anastamosis development
80
Presents with constipation and ocasional uncontrolled motions of just liquid
Overflow diarrorhoea
81
Features of overflow diarrorhoea defaecaction
Liquid and gas can pass | Very hard to control
82
What to ask about for query hyperthyroid diarrorhoea
Tremor Palpitations Anxious
83
Renal complication of IBD
Kidney stones from reduced Ca
84
Bone complication of IBD
Osteoporosis and osteomalacia from reduced Ca
85
How does hyperthyroidism lead to diarrorhoea
Sensitisation of catecholamine receptors, over activation leads to diarrorhoea
86
Biliary complication of crohns
Gallstones due to reduced reabsorption of bile salts
87
Most likely cause of infectious diarrorhoea in institutions
Norovirus
88
Most likely cause of infectious bloody diarrorhoea outbreak
Shigella or E coli
89
Most likely cause of post BBQ diarrorhoea
Campylobacter
90
Most likely cause of rapid onset infectious diarrorhoea
Staph aureus or bacillus cereus which have pre made toxins
91
Systemic complication of IBD
Amyloid

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