History / examination / investigations in diarrhoea patients

Question 1

Important points on history in patients with ACUTE diarrhoea

Answer 1

Food poisoning screen:
Where did you eat in the 24hrs before onset?
What did you eat during this time?
Chicken (salmonella), seafood (vibrio)?
Did anyone else have the same problem?

Travel:
Been overseas lately? Where?
In contact with anyone who has recetly travelled overseas?

Sx-specific:
Any blood or mucous in bowel motions?
Had any previous attacks?
Fever, weakness, or other sx?

Question 2

Important points on history of CHRONIC diarrhoea?

Answer 2

Blood / mucous in stools?
Overseas travel recently?
Anyone else in family have diarrhoea?

Any pain? And is it relieved by opening bowels or passing wind?

Any recent abdominal surgeries?
What meds are you taking?
Are you on Abx?

Do you take vitamin C?
Drink a lot of milk?
Yoghurt, icecream, thickshakes?
Do you take laxatives?

How much alcohol do you drink?

Do you get clammy, shaky, or have you lost weight?
Had any trouble with joint pain, eye trouble, back pain, mouth ulceration?

Have difficulty flushing your motions down the toilet?
Getting diarrhoea during the night?

Are you under a lot of stress?

Question 3

Stools of small volume?

Answer 3

Think colon: inflammation or carcinoma

Question 4

Large volume stools?

Answer 4

Small intestine: malabsorption, laxative abuse

Question 5

Profuse red bleeding in faeces?

Answer 5

Colon: Diverticulitis or carcinoma

Question 6

Small amounts of blood + mucous?

Answer 6

Inflammatory bowel disease

Question 7

Diarrhoea at night is suggestive of?

Answer 7

Organic disease

Question 8

Presence of blood in stools excludes what?

Answer 8

Functional bowel disorder

Question 9

Describe stools in steatorrhoea?

Answer 9

Pale, greasy, offensive, floating, difficult to flush

Small intestine affected

Question 10

Rice water stool?

Answer 10

Cholera

Question 11

Pea soup stool?

Answer 11

Typhoid fever

Question 12

Pellets or ribbons of faeces

Answer 12

Irritable bowel syndrome

Question 13

Key points for examination in patient presenting with gastritis / enteritis

Answer 13

Assess malnutrition or dehydration - especially in infants and young children whom can deteriorate quickly

Features of malabsorption - muscle weakness (hypokalemia/magnesemia), tetany (hypocalcemia), bruising (vit k loss)

Abdominal palpation for tenderness of inflammation, carcinoma mass

Skin changes associated with inflammatory bowel disease

Question 14

Specific investigations in diarrhoea

Answer 14

Stool: Microscopy and cultures

Bloods: Hb, MCV, WCC, ESR, Iron, Ferritin, Folate, Vit B12, Calcum, Electrolytes, TFTs, HIV tests

Antibody tests: Coeliac antibodies

Haemoagglutination tests for amoebiasis

C.difficile tissue culture test

Malabsorption studies

Endoscopy: small bowel biopsy for coeliac, colonoscopy, sigmoidoscopy

Radiology: Plain x-ray abdo, small bowel enima, barium enima, especially double contrast

Question 15

What does steatorrhoea tend to indicate?

Answer 15

Malabsorption