diarrhoea

• what is diarrhoea?


  feacal incontinence
• what can blood in stool indicate?

  malignancy
• viral causes of acute diarrhoea?

  • retrovirus
  • norovirus
  • enteric adenovirus
• bacteria causes of acute diarrhoea

  Salmonella

  E coli 
• parasitic causes of acute diarrhoea

  cryptosporidium parvum

  giarda lamblia
• what is IBS?


  irritable bowel syndrome, no irritation, functional disorder
• colonic causes of chronic diarrhoea?

  • Ulcerative & Crohn’s
  • colitis- microscopic colitis
  • colorectal cancer
• small bowel causes of chronic pooping

  • coeliac
  • chrons
  • bile salt malabsorption
• pancreatic causes of pooping loads

  • chronic pancreatitis
  • pancreatic cancer
  • cystic fibrosis
• endocrine causes of chronic pooping

  • hyperthyroidism
  • diabetes
  • addisons
  • hormone secreting tumours
• other causes of chronic pooping

  drugs

  alcohol

  pooping
• mechanisms of diarrhoea

  • osmotic eg lactose intolerance
  • steatorrhoea
  • secretory eg cholera, e coli, gut hormones
  • inflammatory eg UC, crohns - Smoking makes Crohn’s disease worse
• investigations

  • Stool tests:
  • microscopy & culture
  • faecal elastase
  • faecal calrpotectin
  • Blood tests: FBC, CRP, TTG, TFTs, B12 etc
  • Imaging: colonoscopy- CT, video capsule, MRI small bowel
• inflammatory bowel disease: ulcerative colitis

  continuous mucosal inflammation of the colon without granulomas on biopsy, affecting rectum and variable extent of the colon in continuity and characterised by a relapsing and remitting cause
• symptoms of UC

  bloody diarrhoea, rectal bleeding, mucus, faecal urgency, abdominal pain, nocturnal defecation
• extra intestinal manifestations of UC

  
  

  arthiritis, uveitis, erythema nosodum, pyoderma
• important UC statistics:

  • any age
  • affects males females equally
  • relapsing/remitting course
  • positive effect of smoking!
  • appendicectomy protective (before age 20)
  • 10-15 fold risk in 1st degree relatives
• treatment of severe UC

   admit: hydrocortisone

  heparin

  stool chart

  AXR

  daily CRP

  avoid: Nsaids, anti-motility agents, opiates
• treatment of mild to moderate UC

  • mesalazine
  • prednisolone
  • azathioprine
  • biologics: infliximab, adalimumab
• ulcerative colitis affects only the colon

  chrons affects any part of the GI tract
• chronic disease:

  • any age
  • affects males and females equally
  • relapsing/remitting course
  • smoking
  • previous appendicetomy
  • family history
  • infectious gastroentoritis
• symptoms of chron's

  • chronic diarrhoea most common
  • IBS type symptoms
  • abdo pain
  • weight loss
  • anaemia
  • growth failure
  • blood +/- mucus in stool
  • extra intestinal manifestations
• chron's disease:

  inflammatory disease

  stricturing disease: inflammatory/fibrotic

  fistulating disease

  perinatal disease
• treatment of chron's disease

  • prednisolone/budesonide
  • azathioprine
  • methotrexate
  • nutritional therapy
  • antibiotics
  • infliximab
  • surgery