Acute Diarrhoea

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Causes

COMMON: infective, Drugs, Food poisoning, Pseudomembranous colitis, colitis(inflammatory)

UNCOMMON: inflammatory bowels disease, ischaemic colitis, diverticular change

RARE: colon cancer

occur in less than 48 to 72 hours (2 to 3 days)

History

1)travel, contacts, food (sexual history) 2) recent medication: C.difficle toxin (2days - 1mnth)

Examinations

1)state of hydration 2)volume depleted(even in young) with tachycardia and postural hypertension. 3)infective cause, may present in severe collitis .4) abdominal examinations 5)sigmoidoscopy and rectal biopsy

SIGNS OF CHRONIC: 1)clubbing, 2)koilonychia 3)leukonychia 4)mouth ulcers 5)weight loss

investigations

a) blood test: 1)FBC; anaemia or thrombocytosis suspect its chronic. Low albumin tells severity but non-specific. 2)stool culture presence of toxin c.difficile 3) plain abdominal x-ray(show acute collitis

Management

1)rehydration- resting the gut and rehydrate 2)treat underlying cause: antibiotics or steroids is used with known pathogen

PSEUDOMEMBRANOUS COLLITIS;

~up to 50% mortality

~antibiotic associated

~diagnose by finding Clostridium difficile toxins in stool

~20% ascending colon only

~treatment: METRONIDAZOLE/VANCOMYCIN

Relapse occurs up to 20% and treated with oral vancomycin

Abdominial examinations may reveal non-specific tenderness.

Sig and rectal b mayb useful but does not distinguis btwn various cases

C. difficile bacteria are found 5% in normal individual. diagnosis therefore requires appropriate SYMPTOMS rather than the organisms alone!

Acute Diarrhoea

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