Diarrhoea
| Headline | |
|---|---|
| History | - consistency of stool - colour: fresh blood? malaena? pale? mucus? - urgency? incontinence? Tenesmus? disturbs sleep? - recent Abx? recent suspect/new food? laxative use? - Ill contacts, travel history, sexual history In children: - age? bilious vomiting? Severity: oral intake? Urine o/p? - Vax history - FHx, parental occupation |
| Examination | |
| Diagnostic investigations | |
| Differentials | |
| Immediate management | Is this Impending surgical doom or Impending septic doom? Approach to rehydration: oral rehydration (200-400ml after each loose stool for adults) in frequent small sips ⇒ normal diet after 24h or when hungry. ➥ Anti-diarrhoeals can ↑ N+V, cause ileus ➥ Abx frequently not required |
| Ongoing management |
ALARMS symptoms: anaemia, loss of weight, anorexia, recent progression, malaena/haematemesis, swallowing difficulty
Ddx in children
Risk strat: >3 vomits/24h or >6 episodes of diarrhoea = ↑ risk dehydration
- gastroenteritis – most commonly rotavirus
- rehydrate (ORS not juice/soft drinks)
- Diarrhoea lasts longer than vomiting
- May have temporary lactose intolerance
- inflammatory: Crohn’s/UC
- secretory: C. diff, cholera
- osmotic: lactose intolerance, Laxatives
- motility: thyrotoxicosis, ↓ in intussusception
- in well children: “toddler diarrhoea” – maturational delay in intestinal motility
Management:
- expect to last ~5d with gastroenteritis
- temporary lactose intolerance → explosive (!!) diarrhoea