Diarrhoea
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Diarrhoea. Revision PBL. Definition. Diarrhoea is defined as: >3 bowel motions per day Looser than normal stools Stool volume > 300g May be associated with ugency. Types of diarrhoea. Secretory (non-invasive)

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Diarrhoea

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Diarrhoea

Diarrhoea

Revision PBL


Definition

Definition

  • Diarrhoea is defined as:

    • >3 bowel motions per day

    • Looser than normal stools

    • Stool volume > 300g

    • May be associated with ugency


Types of diarrhoea

Types of diarrhoea

  • Secretory (non-invasive)

    • Decreased intestinal absorption and increased intestinal secretion into the lumen resulting in watery diarrhoea

    • Commonly caused by:

      • Enterotoxins: eg cholera, E coli

      • Hormones: vasoactive intestinal peptide

      • Bile salts and fatty acids in the colon (following ileal resection)

      • Some laxatives (egdocusate sodium)

    • In watery diarrhoea, loss of fluids and salts often results in dehydration


Types of diarrhoea1

Types of diarrhoea

  • Invasive/Inflammatory

    • Caused by organisms invading the mucosa or inflammation primarily affecting the large bowel

    • This usually results in bloddy diarrhoea

    • There is also defective absorption of fluids & electrolytes

    • Common causes:

      • Infective conditions: dystenery due to Shigella and E Histiolytica

      • Inflammatory: UC and Crohn’s disease


Types of diarrhoea2

Types of diarrhoea

  • Osmotic

    • Caused by

      • generalised malabsorption so that high concentrations of solute remain in the lumen

      • Specific defect in absorption (eg disaccharide deficiency or glucose-galactosemalabsorption)

      • Ingested non-absorbed hypertonic substance (eg a purgative such as magnesium sulphate or Mg-containing antacid.

    • The volume of diarrhoea in this type is decreased by the absorption of fluid by the ileum & colon


Types of diarrhoea3

Types of diarrhoea

  • Abnormal motility

    • Generally of upper GIT so that frequency of defecation is high although volume is not (not true diarrhoea)

    • Caused by:

      • Diabetes

      • Removal of vagus nerve

      • Hyperthyroidism


Common infections

Common infections

  • Rotavirus

    • Self-limiting infection with watery diarrhoea

  • Shigella

    • Gram-negative bacteria causing abdominal cramping, high-grade fever and large volume watery diarrhoea lasting 3-7 days

  • Salmonella

    • Gram-negative anaerobes causing abdo cramping and self-limiting watery diarrhoea

  • Giardia

    • Protozoan parasite, water-borne causing acute and chronic watery diarrhoea, malabsorption, weight loss and abdo cramping

  • Other causes

    • staphylococcus, campylobacter jejuni, clostridium, Escherichia coli, adenoviruses, etc.


Drug treatment

Drug treatment

  • Rehydration is the most important therapy for diarrhoea!

  • Antibiotics for infective diarrhoea

  • Anti-diarrhoeal agents

    • Decreases gut motility

    • Muscarinic receptor antagonists – reduce spasms (e.g. Atropine)

    • Opiates (reduce motility) – main ones are codeine, diphenoxylate, loperamide

    • Loperamide – selective for GI tract, does not cross BBB, less SE


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