Diarrhoea | Cheat Sheet

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

114

Pages:

4
Author:

Mariam A. A.

Diarrhoea Definition Three or more stools per day or more frequent than normal for that patient Causes Category Causes Non-invasive gastroenteritis Viral: rotavirus, enteric adenovirus and astrovirus Bacterial: E. coli, Vibrio Chlora Infectious Parasitic: Giardia (from infected drinking water), lambila, Cryptosporidusm (from animals and livestock) Invasive gastroenteritis Shigella, C. jejuni, E. coli, Salmonella C. difficle IBD UC, CD, radiation enteritis or colitis Ischemic colitis -> secondary to mesenteric thrombosis, vascular embolus, vasculitis or volvulus Neoplasms Malabsorption syndromes Gastrointestinal Coeliac disease, short bowel syndrome, chronic pancreatitis and tropic spure Abdominal surgery Including bariatric or bowel resection Lactose intolerance IBS Faecal impaction Hyperthyroidism Systemic Medullary thyroid carcinoma Diabetes associated with autonomic neuropathy Laxatives Stool softeners Magnesium containing antiacids Medications Digoxin Colchicine Quinidine Antibiotics within the previous 10 weeks causing C. difficle diarrhoea Red flags of diarrhoea Systemic symptoms Severe dehydration Bloody stools Severe abdominal pain Chronic illness Immunocompromise Age more than 65 Recent antibiotic use More than 48 hours duration without improvement Hypoalbuminemia Bloody stools Wakes patient from sleep Unintentional weight loss Family history of GIT cancer Investigations Labs FBCs, U&E and LFTs Blood gas -> for acid-base status Blood culture Celiac disease -> serology Breath tests Hydrogen breath test C-D-xylose breath test Stool sample Occult blood at bedside Stool microscopy Best when evaluated fresh -> 6 hours within collection Faecal leucocytes -> infection, IBD and ischemia Oval and parasites -> Giardia, Entamoeba and Cryptosporidium Stool culture for PCR For patients with fever, abdominal pain and faecal leucocytes Stool toxin For C. difficle toxin for antibiotic-associated diarrhoea CT or MRI of abdomen Cause identification Endoscopic studies Management Fluid and electrolyte replacement IV rehydration For: Patients with significant volume depletion Do not tolerate fluids orally Review of medications Cessation of laxatives and stool softeners Withhold Mg containing antiacids or switch to aluminium containing preparations Look for medications causing non-specific diarrhoea e.g. antibiotics, PPIs, NSAIDs and chemotherapy Anti-diarrhoea medications E.g. loperamide Use when diarrhoea is disability But IBD and C. difficle cannot be the cause Antimicrobial therapy if indicated Manage as per cause Complications Major threats to life Intravascular volume depletion and hypovolemic shock Electrolyte imbalance Systemic infections Malnutrition Temporary faecal incontinence Dehydration Most common and most important