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Diarrhoea (Aetiology (Autoimmune
IBD (Crohn's, UC), Coeliac disease,
…
Diarrhoea
Aetiology
Autoimmune
IBD (Crohn's, UC), Coeliac disease,
chronic pancreatitis, amyloidosis
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Drugs
Abx, B-blockers, cyctotoxics, laxatives,
PPIs, NSAIDs, digoxin, alcohol
Infection
Bacteria - salmonella, shigella, campylobacter,
C. diff, E. Coli, cholera, Yersinia
Viruses - norovirus, rotavirus
Parasites - Giardia
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Pathophysiology
Osmotic
Non-absorbed hypotonic solution draws water into lumen
Stops when patient stops eating
E.g. laxative, malabsorption e.g. Coeliac)
Secretory
Active intestinal secretion of fluid and electrolytes
Continues irrespective of eating
E.g. infection (E Coli, cholera), bile salts/fatty acids (malabsorption, ileal resection), laxatives
Inflammatory
Damage to mucosa causes loss of fluid and blood
E.g. infection (C. difficile, salmonella, shigella), IBD
Motility
Abnormal motility causing increased frequency
(not true diarrhoea if there isn't a consistency change)
E.g. thyrotoxicosis, autonomic neuropathy
Clinical
presentation
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Abdo pain
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Character
Black, bloody, mucus, fatty, pus
Onset
Varies by cause,
often insidious
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Diagnosis
Examination
Abdo
Clubbing, anaemia, oral ulcers,
scars, tender abdo, abdo mass
PR
Impaction, masses,
blood/mucus/fatty
General
Dehydration, shock
Investigations
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Bloods
FBC (infection, anemia), CRP (inflamm),
U+E (electrolytes), LFTs, TFTs (thyrotoxicosis)
blood cultures (if septic), Coeliac serology
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Stool
Culture (MCS, C diff toxins)
History
PC
Mucus/blood,
fevers, weight loss
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SH
Smoking, diet,
travel/contacts,
job (chef!)
Management
Medical
Anti-diarrheal agents
Indication: non-infective diarrhoea
E.g. codeine, loperamide
MOA: anti-motility, reduce stool frequency
CI: colitis (toxic megacolon), acute IBD, infection
SEs: constipation, colic
Antibiotics
Indication: infectious cause
E.g. ciprofloxacin, metronidazole
Conservative
Hydration (oral sachets, IV saline)
Isolation if needed (e.g. C difficile)
Stop offending medications
Stay off work if a food handler
Definition
Gastrointestinal disorder of
reduced stool consistency
leading to passage of increased
amounts of loose stool
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