History + Exam

Question 1

Diarrhoea?

Answer 1

Diarrhoea is an increase in the amount of stool passed daily to over 300g, usually accompanied by increased frequency and loosening of stools.

Question 2

Malaena?

Answer 2

dark, tarry, smelly stools caused by digested blood

Question 3

Haematochezia?

Answer 3

bright red stools due to frank blood

Question 4

Steatorrhoea?

Answer 4

pale, floating stools from undigested lipid

Question 5

Loose Stools?

Answer 5

soft faeces with no increase in frequency or quantity

Question 6

Diarrhoea can be caused by?

Answer 6

1. infection of the bowel (infectious diarrhoea),
2. inflammation of the bowel (IBD or diverticular disease),
3. increased bowel motility (hyperthyroidism, anxiety, IBS),
4. malabsorption of nutrients (coeliac disease, pancreatic insufficiency),
5. obstruction overflow due to mass that only allows liquid stool to pass beyond it (hard faeces stuck in the bowel is a common cause of overflow diarrhoea, colon cancer and ovarian cancer can also cause overflow diarrhoea),
6. medications (laxatives, colchicine, digoxin, metformin, thiazide diuretics).

Question 7

Diarrhoea common diagnoses?

Answer 7

Question 8

Diarrhoea diagnoses in elderly?

Answer 8

Neoplastic Disease - villous polyps, colonic adenocarcinoma, pancreatic cancer

Diverticular disease
Overflow diarrhoea secondary to constipation

Ischaemic colitis

Microscopic colitis

Bacterial overgrowth

Question 9

Diarrhoea acute management?

Answer 9

ABC

Dehydration; main cause of mortality in this group, check HR, BP (postural drop, low BP, narrow mean arterial pressure), mucous membranes.

Electrolyte or pH disturbance; either excessive loss of ions in faeces or secondary to hypovolaemia.

Question 10

Consequences of severe diarrhoea?

Answer 10

Shock (tachycardiac and hypovolaemic)

Acidosis (pH<7.35); This can be due to loss of ions or due to the presence of extra acidic ions (e.g. lactic acidosis due to tissue ischaemia).

Hypokalaemia; due to loss in faeces, can be corrected with fluid rehydration if kidney function is normal.

Question 11

Characterise the stool; mucoid or jelly like?

Answer 11

infection by Salmonella or villous polyps in the colon, can be any disease causing inflammation of the bowel wall.

Question 12

Characterise the stool; foul smelling and floating?

Answer 12

suggests malabsorption,

due to coeliac disease, pancreatic duct obstruction (pancreatic cancer, cystic fibrosis) or biliary insufficiency (recent cholecystectomy).

Question 13

Characterise the stool; unusually pale?

Answer 13

lack of bile salts due to obstruction of biliary or pancreatic ducts (chronic pancreatitis, gallstones).

Question 14

Characterise the stool bloody faeces?

Answer 14

if on toilet paper then anal pathology (anal fissure, haemorrhoids). If mixed in and red suggests colorectal pathology (UC, dysentery, colorectal carcinoma).

Question 15

Change in bowel habit nocturnal diarrhoea?

Answer 15

suggests organic aetiology (rather than functional like IBS)

Question 16

Change in bowel habit; do they rush to the toilet?

Answer 16

Urgency to defecate likely infectious diarrhoea or IBD.

Question 17

Change in bowel habit; variable bowel habit?

Answer 17

IBS (in younger)

colorectal carcinoma (in older)

present as alternating normal, diarrhoea and constipation.

Question 18

Change in bowel habit; tenesmus?

Answer 18

space occupying lesion in rectum (carcinoma).

Question 19

Change in bowel habit; suffer from frequent diarrhoea?

Answer 19

infectious diarrhoea is typically one off.

Question 20

Diarrhoea + vomiting?

Answer 20

infectious gastroenteritis.

Question 21

Diarrhoea + abdo pain?

Answer 21

RIF pain is suggestive of terminal ileum inflammation (Crohns, Yersinia enterocolitica infection).

LIF pain is suggestive of diverticular disease.

Pain relieved by passing motion is IBS.

Question 22

Diarrhoea + significant weight loss?

Answer 22

chronic=IBD, acute=infection.

Question 23

Diarrhoea + eye problems, skin rashes, joint pain?

Answer 23

uveitis, scleritis, episcleritis, erythema nodosum, pyoderma gangrenosum, aphthous ulcers, enteric arthritis

= all features of IBD.

Question 24

Risk factors Travelled abroad, eaten something unusual, know anyone else with similar symptoms?

Answer 24

infectious diarrhoea.

Question 25

Risk factors stress/diet?

Answer 25

stress and low fibre are associated with IBS

Question 26

Risk factors medications?

Answer 26

diarrhoea is most common medication side effect, look out for PPIs.

Question 27

family history?

Answer 27

Of bowel disease; Crohns, UC, coeliac disease or rarer conditions like HNPCC

Question 28

Exam clubbing (4)?

Answer 28

Crohns disease, UC, hyperthyroidism, coeliac disease are all causes.

Question 29

Exam iritis, episcleritis, scleritis?

Answer 29

associated to Crohns and UC.

Question 30

Exam mouth ulcers?

Answer 30

Crohns produces ulcers anywhere from mouth to anus.

Question 31

Exam erythema nodosum?

Answer 31

(raised, tender, red nodules) Crohns or UC. But OCCP can also produce this is young women.

Question 32

Exam overview

Answer 32

1

Question 33

Exam Dermatitis herpetiformis?

Answer 33

itchy rash associated with coeliac disease, typically found over extensor surfaces of limbs.

Question 34

Exam Virchow lymphadenopathy?

Answer 34

in left supraclavicular fossa is strongly suggestive of bowel malignancy that has spread.

Question 35

Exam Abdominal masses?

Answer 35

in right lower quadrant is often found in Crohns.

Question 36

Exam Anal ulcers or fistulae?

Answer 36

Crohns causes both ulcers and fistulae around the anus.

Question 37

Exam DRE?

Answer 37

look for causes of obstruction that could lead to overflow diarrhoea.