Diarrhoea Differential Diagnosis PDF

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Summary

Diarrhoea loose stools per day) Acute days Bloody Dysentry Gastroenteritis (Food diarrhoea) Viral Bacterial Norovirus E Rotavirus Salmonella Adenovirus S Protozoa Giardiasis Bacillus aureus Cholera Chronic days Shigella Colonic causes Diverticulitis Campylobacter C Amoebiasis Constipation overflow C...

Description

Diarrhoea (>3 loose stools per day) Acute 1 flare up a year) – 1st Azathioprine; 2nd Methotrexate; 3rd Infliximab Maintaining remission • 1st line: Azathioprine; 2nd line: Methotrexate • Surgical – resection depends on site General • Education, support, stool bulking agents/laxatives, regular surveillance Inducing remission • Proctitis/Proctosigmoiditis – 1st : Mesalazine/Sulfasalazine PR +/- PO; 2nd Prednisolone • Left sided disease – 1st: Mesalazine/Sulfasalazine PO; 2nd Prednisolone PO Maintaining remission • Proctitis(+sigmoid): Mesalazine PO +/- PR; Left sided: Mesalazine PO • If uncontrolled, add 1st Azathioprine PO, 2nd Infliximab • Surgical – Colectomy (curative) Acute • IV fluids – rehydration, IV analgesia if pain uncontrolled • Broad spectrum ABx – co-amoxiclav or ciprofloxacin + metronidazole 7days Surgical – resection • Indicated for purulent/faecal peritonitis, uncontrolled sepsis, fistula, obstruction Conservative for diverticular disease • Advise high fibre diet, adequate fluid intake, bulk forming laxative, antispasmodic, paracetamol for pain, physical exercise Staging Surgery – definitive treatment 1. through inner • R-hemicolectomy – caecum, ascending, prox trans lining/into muscle wall • L-hemi – distal transverse/descending 2. further local spread but • High anterior – sigmoid no LN involvement • Anterior resection – low sigmoid/high rectum 3. lymph node • Abdominal perineal (AP) – low rectum/anal involvement Other treatment 4. metastases • Radiotherapy, chemotherapy, palliative If mets present – avoid precipitating factors – alcohol, chocolate, strenuous exercise • Surgical resection (local resection with nodal clearance) • Non-resectable – Somatostatin analogue – Octreotide, radiofrequency ablation, chemotherapy, external beam radiotherapy Liver transplant in selected case – young patients •

Irritable bowel syndrome

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6/12 history of abdo pain/discomfort, bloating, change in bowel habit Positive diagnosis if abdo pain relieved by defecation or associated with altered stool frequency/stool form + 2 of the following: o Altered stool passage, bloating, worse with eating, passage of mucus Lethargy, nausea, backache, bladder Sx

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Chronic/intermittent diarrhoea Failure to thrive in children Persistet/unexplained GI symptoms – N+V Prolonged fatigue Recurrent abdo pain/ cramping/distension Sudden weight loss Unexplained ↓Fe anaemia

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OTHERS

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Coeliac disease sensitivity to gluten

HIV infection – Cryptosporidium (most common) CMV

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Weight loss, opportunistic infections Sore throat, fever, maculopapular rash Lymphaedenopathy, Kaposi’s sarcoma Nausea, diarrhoea, headache, malaise

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FBC, ESR, CRP, Coeliac screen, CA125 for women (ovarian Ca), faecal calprotectin (IBD) Consider 2w urgent referral if: o PR bleeding o Unexplained weight loss o FHx of bowel/ovarian Ca o >60y

Prior to testing – reintroduce gluten diet for at least 6/62 Immunology – Tissue transglutaminase (TTG) IgA, endomyseal IgA Jejunal biopsy – villous atrophy, crypt hyperplasia, lymphocytes infiltrations FBC – Fe + folate anaemia B12, folate, ferritin, LFT, calcium HIV PCR serology ,P24 antigen HIV antibody test (ELISA test) Stool microscopy + culture (red cyst of Cryptosporidium)

General • Education and reassurance • Lifestyle and physical activity – relaxation, increase physical activity helps • Diet advice – regular meals, adequate fluid intake, restrict tea/coffee, reduce alcohol intake, limit high fibre food and resistant starches, low FODMAP diet • Consider referral to dietician, use of probiotics, CBT Medical • Diarrhoea – Loperamide; Constipation – laxatives • Abdo pain and spasms – Antispasmodics – Otilonium, hyoscine or Peppermint oil • TCA/SSRI – chronic pain General • Education + support – information on gluten food and alternatives, explanations of food labelling and allergens, info sources about GFDs + recipes, how to manage social situations and eating out, Coeliac UK (national support group) • Advise on dietary – supplements (calcium, vitamin D) Monitoring • Annual review for weight and height, symptoms, assess need for specialist diatetic and nutritional advice • DEXA or active management for bone disease – osteoporosis • Consider pneumococcal vaccine on individual basis – functional hyposplenism • Post-exposure prophylaxis (PEP) – start within 72 hours of contact • Antiretroviral medications...