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APPROACH TO CHRONIC DIARRHOEA - Coggle Diagram

- - - - Crohn's Disease
        
        Abdominal pain + LOW, blood/mucous in stools, constitutional sx, extra-intestinal manifestations
        
        Skip lesions, transmural inflammation
        
        mouth to anus
      - Ulcerative Colitis
        
        bloody diarrhoea +- mucous, remissions & relapses
        
        starts in rectum (spares anus) and extends continuously
        
        NB is primary sclerosing cholangitis!
      - Treatment: steroids, fluids, azathioprine
        Diagnosis: colonoscopy (sigmoidoscopy if flare because of risk of perforation)
    - - Colon cancer, Kaposi's sarcoma, lymphoma
    - - HIV POSITIVE
        
        Cryptosporidium
        
        most common, CD4 <200, treat with ART
        
        Microsporidium (cotrimoxazole)
        
        Isospora belli (cotrimoxazole)
      - HIV NEGATIVE
        
        Clostridium difficile
        
        in-hospital or regular Abx use. Complicates as toxic megacolon (>5cm on imaging). Rx: IV vancomycin
        
        Giardia,Campylobacter, Entamoeba histolytica
    - - can occur at time or a period of time later (months-years)
      - If can identify focus of injury then surgical resection may be an option
  - - - Diagnosed on biopsy (loss of villi), and auto-Abs: anti-transglutaminase, anti-endomysial Ab, anti-deamidated gliadin peptide
  - - - functional disorder, dx of exclusion
      - usually pain after meals which is relieved by bowel movements
      - alternation between diarrhoea and constipation
- - - - surgical scars (short bowel syndrome)
      - tenderness
        masses
      - PR exam: anal fissures/fistuale, masses