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Flashcards in Acute Diarrhoea Deck (7)
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What is severe acute diarrhoea ?

Diarrhoea is defined as an increase in stool volume associated with reduced stool consistency. If it has lasted for less than 2 weeks it is considered acute, and after 2 weeks it is chronic


What are the common causes of Diarrhoea?

Acute - Gastroenteritis, Travellers’ diarrhoea, C. diff, Viral (Rotavirus, Norovirus, Adenovirus), Drugs, Ischaemic colitis, Diverticulitis

Chronic – Coeliac, Irritable bowel syndrome, Hyperthyroidism, Crohns, UC, Colorectal cancer (Or Polyps), Chronic Pancreatitis, Lactose intolerance


What will you ask about in a history for acute diarrhoea?

Associated Symptoms:
Blood in stool – Infection (Campylobacter, Shigella, Salmonella, E. coli), UC, Crohns, Colorectal cancer, Polyps, C. diff, Ischaemic colitis, Diverticulitis
Mucous in stool - IBS, IBD, Colorectal cancer, Polyps, Diverticulitis
Steatorrhea – Pancreatic insufficiency, Biliary Obstruction
Explosive Diarrhoea – Chorea, Giardia, Rotavirus
Projectile Vomiting (Norovirus)
Bloating and flatus (Giardia, IBS, Coeliac)
Fever – Infective cause or severe inflammatory bowel disease
Specific Abdominal Pain – Diverticulitis (LLQ), Pancreatitis (Epigastric Radiating to the back)
General Symptoms - Nonspecific Abdominal pain, Nausea

Risk Factors:
Infection - Recent travel, Abnormal food, Occupational exposure, Recent Hospital stay, contact with D&V.

Specific Questions to ask:
Asses Severity - how many stools per day and compare to their normal (to gauge severity). Infectious cause more frequent stools
Red Flags for further investigations – Weight loss, Nocturnal Symptoms, Anaemia, Recent Hospital Admission or antibiotic use
Any recent constipation? - Diverticulitis or IBS alternate between the two. Or could be overflow incontinence
Recent hospital/antibiotic treatment - C. diff
Any cardiovascular risk factors? - Ischaemic colitis
Occupational history- Are they allowed back to work and what risk factors have they been exposed too (hospital, care homes, day care etc)


What will you look for on examination of a patient with diarrhoea

Examination findings acute: The most important thing is to assess fluid status
End of the bed:
Reduced skin turgidity
Low urine output
Increased capillary refill
Weak peripheral pulses
Cold peripheries
Dry Mucous membranes
Weak peripheral pulses
Cold peripheries
Feel for any rectal masses or impacted faeces. Also examine for blood/mucous

Examination findings chronic: The most important thing is to assess signs of anaemia (indicating bleeding) and for any signs of an underlying cause
End of the bed:
Pale – Anaemia
Clubbing – Coeliac, IBD
Koilonychia – Iron Deficiency Anaemia
Goitre – And other signs of hyperthyroidism
Oral Ulcers – Crohns, Coeliac
Glossitis – Iron deficiency Anaemia
Raised Virchow’s Node – GI cancers
Feel for any rectal masses or impacted faeces. Also examine for blood/mucous


What investigations will you order for diarrhoea?

Investigations: Only patients with systemic signs (fever, dehydration, blood) require further investigation, or patients with red flags
Stool cultures (send multiple samples)– A negative stool culture is required for diagnosis, also helps to rule out infective causes.
Test stool sample for C. diff
Full set of observations

FBC - Looking for infection or anaemia (Iron define due to blood loss)
ESR/CRP- Looking for infection/Inflammatory response in IBD
U&E - Looking for dehydration or electrolyte losses
TSH - Rule out hyperthyroidism
Coeliac serology (Anti Tissue Transglutaminase) - Rule out coeliac disease
Faecal Elastase – Rule out Chronic pancreatitis

If severe may consider an Abdominal X-ray
Lower GI endoscopy - Do not do in acute stage if possible as increased risk of perforation


What is the emergency treatment of diarrhoea

What is the treatment emergency treatment:
A-E approach
Get IV Access/Give O2 to maintain sats of 94+ /Attach 12 lead ECG
Assessment with AMPLE history and brief examination
Get help - Medical reg on call
Frequent Observations - Constant or 15 minutely
Patients may need electrolyte/ fluid replacement


What is the non emergency treatment of diarrhoea?

What is the non-emergency treatment
No food handling until stool samples negative
Oral re-hydration if possible, if not then IV Fluids will be required
Stop any drugs that may be the cause

Anti-Diarrhoeal (if needed)- Codeine Phosphate or Loperamide (Imodium) after each loose stool. Careful with use in colitis as can predispose to toxic megacolon
Avoid antibiotics unless systemic features of infection
Anti-Emetic (if very severe) - Metoclopramide
C. Diff infection - Vancomycin and Metronidazole, stop other causative antibiotics and stop all drugs affecting the gut e.g. Opioids and PPI's