DIARRHOEA AND CONSTIPATION. Diarrhoea. Definition: Abnormal passage of loose or liquid stools more than 3 times daily and/or a volume of stool greater than 200g/day (British Society of Gastroenterology) Acute diarrhoea : < 4 weeks, usually self-limiting Chronic diarrhoea : > 4 weeks .
Definition: Abnormal passage of loose or liquid stools more than 3 times daily and/or a volume of stool greater than 200g/day (British Society of Gastroenterology)
Acute diarrhoea: < 4 weeks, usually self-limiting
Chronic diarrhoea: > 4 weeks
3) Inflammation of the intestinal lining ie IBD
4) Increased intestinal motility
Can involve more than 1 mechanism!
According to Health Protection Agency and Health Protection Scotland: Most common cause:
Acute dysentry= frequent, small bowel movements, accompanied by blood and mucous with tenesmus or pain on defeacation
Invasive bacteria (most likely Campylobacter, Shigella, STEC) causes inflammatory invasion of colonic mucosa.Feacal leukocytes are present.
- usually typical of small intestinal infection, non-inflammatory process , confirmed by absence of feacal leukocytes
4) Tests for malabsorption:
Vitamin B12 and red blood cell folate.
Iron status (ferritin).
5) Thyroid function tests.
6) ESR & CRP — elevated levels may indicate IBD
7) Antibody testing for coeliac disease — immunoglobulin (Ig)A
tissue transglutaminase antibody (tTGA), or IgAendomysial
Consider sending stool for culture and sensitivity and
examination for ova, cysts and parasites, if an infectious cause is
suspected or there is a history of travel to high-risk areas.
Send three specimens (5 mL each) 2–3 days apart, as ova,
cysts, and parasites are shed intermittently.
Treat the cause!
Oral rehydration (better than IV), if impossible give 0.9% saline + 20 mmolK+/L IVI
Codeine phosphate 30mg/6 hrs
Loperamide 2mg PO
Avoid antibiotics except in infective diarrhoea causing systemic illness
= difficult or infrequent passage of stool ( <3x a week) , hardness of stool, or a feeling of incomplete evacuation.
Failure to pass any stools.
1) Functional/primary/idiopathic constipation=chronic constipation without a known cause
2) Secondary/organic constipation - caused by medical conditions or drugs ieopioids, TCA, antispasmodic, calcium supplement, aluminium antacids
3) Faecal loading/impaction
4) Overflow incontinence/ bypass soiling/encopresis leakage of loose stool around impacted faeces.
Progress of condition
How to interpret clinical findings:
How to differentiate Intestinal Obstruction & paralytic
IO – partial active, tinkling bowel sounds
complete absent bowel sounds & absent flatus,
usually severe vomiting
PI – absent bowel sounds & flatus is present
->3cm is abnormal
-paucity of gas in
bowel beyond site
-dilated large bowel loop >6cm
Depends on clinical findings:
If suspected malignancy, proceed with:
3) Stimulant laxative iebisacodyl, senna, sodium picosulfate
A: chronic gastritis
B: Cl. Difficile infection
D: gastric ca
F: ischaemic colitis
G: Colorectal Ca