Diarrhoea (Admission (systemically unwell, signs of dehydration/shock,…
systemically unwell, signs of dehydration/shock, person unable to retain oral fluids
Increased risk of poor outcome. Comorbidities -immunideficiency, lack of stomach acid, IBD, Valvular heart disease, diabetes, renal impairment, rheumatoid disease, systemic lupus erythematosus
Abdominal pain and tenderness
Age 60 and over at risk of complications
Home circumstance and level of support
Drugs-immuno suppressants or systemic steroids, PPI, angiotensin-converting enzyme inhibitors, diuretics)
Onset, duration, frequency, severity of symptoms
Underlying cause- medication, infection, travel hx, stress & anxiety, changes in diet, eating out, fever, vomiting, recent surgery. Abdominal pain, bloating - IBD, IBS, colitis
Observations- BP, TPR, SpO2 sats, Abdominal examination, PR examination, stool chart, medication review. Food and Fluid chart. Weight- MUST score
signs of dehydration-increased pulse rate, reduced skin turgor, dryness of mucous membranes, delayed capillary refill time, decreased urine output, hypotension (check for postural changes), and altered mental status.
pain or tenderness, distension, mass, increased or decreased bowel sounds, or liver enlargement.
rectal tenderness, stool consistency, and for blood, mucus, and possible malignancy.
recent ABx or hospital admission
Blood in stool
Persistent (> 14 days)
Chronic (>4 weeks)
Acute (<14 days)
3 or more loose or liquid stools in per day, or more frequent than normal per individual (WHO, 2017)
Inflammation of intestinal lining
Increased intestinal motility
Stool sample if indicated- suspected diff, recent Abx therapy, hospital admission, blood or pus in stool, recent foreign travel.
Self care advice on fluids if unsuspected viral
Chronic- FBC, ESR,CRP, U&Es, LFTs, TFTs,Calcium, B12,Folate and ferritin, coealiac bloods. Consider CA125 if symptoms suggestive of ovarian cancer
IBD (Crohns & UC)
Drugs (laxatives, PPI, allopurinol, ABx, angiotensin II receptor blockers, SSRIs)
Other (Anxiety, food allergy, early signs of IBD, appendicitis, Intestinal ischaemia, pelvic radiation treatment)
Infection (Viruses 2-3 days, bacteria 3-7 days, parasites weeks to months)
Refer adults using a suspected cancer pathway referral (for an appointment within 2 weeks)
aged 40 and over with unexplained weight loss and abdominal pain
aged 50 and over with unexplained rectal bleeding with or without abdo pain, anaemia, weight loss, change in bowel habit
aged 60 and over with iron deficiency anaemia or changes in their bowel habit, or tests show occult blood in their faeces.
rectal or abdominal mass
if diagnosis remains uncertain after primary care assessment