🧻Diarrhoea

🔵 Diarrhoea #shortnote

●Definition

–>3 loose stools – scoring 5-7 on Bristol stool chart – per day.

–Chronic if >4 weeks.

●Differential diagnosis

GI:

-Infection: gastroenteritis, tropical infections.

-Inflammation: IBD, diverticulitis.

-Coeliac disease or lactose intolerance.

-Colorectal carcinoma.

-IBS

-Constipation with overflow.

Endocrine:

-Thyrotoxicosis

-Addison’s

Drugs:

-Antibiotics

-PPIs

-Metformin

-Laxatives

-CV: digoxin, propranolol.

-Alcohol

●Investigations

Basic approach:

-Extent of investigations depends on symptom severity, chronicity, and red flags.

-FBC, inflammatory markers, and coeliac serology are reasonable initial tests in someone with sustained, altered bowel habits. Faecal calprotectin if still not sure if IBS or IBD.

Red flags for further testing and/or secondary referral:

-Anaemia or rectal bleeding.

-Continuous or nocturnal diarrhoea.

-↑Inflammatory markers.

-Rectal or abdominal mass.

-Family history of bowel or ovarian cancer.

-New onset change in bowel habits >55 years old.

-Significant weight loss (>5 kg).

Further tests:

-Bloods: U+E, LFT, TSH, ↑Ca2+.

-Stool: MC+S, C. diff toxin, ova and parasites, faecal elastase (chronic pancreatitis), gut hormones (gastrinoma, VIPoma).

-Breath: 13C breath test (H. pylori), hydrogen breath test (lactose intolerance).

-Endoscopy.

●Management

-Usually resolves spontaneously.

-Manage underlying cause, including infection control if required.

-Oral rehydration solution (ORS) or IV fluids if severe.

-Consider loperamide.

●Loperamide

Mechanism

-μ-opioid receptor agonist in the myenteric plexus, reducing smooth muscle tone.

-Does not cross blood-brain barrier, so no CNS effects.

Indications

-Watery diarrhoea that interferes with daily life.

-IBS

-Traveller’s diarrhoea.

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