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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

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