Diarrhoea.

 

Definition:

Diarrhoea is the abnormal passing of loose or liquid stools, with increased frequency or increased volume. It occurs when the lining of the large intestine becomes inflamed, which prevents the removal of fluid from the food in the intestine. This section deals with 'acute' diarrhoea, which comes on suddenly and can last for five to ten days.

 

 

Causes:

Diarrhoea is usually related to a viral infection (e.g. norovirus), or a bacterial infection (e.g.

Salmonella, E. coli). Bacterial infections are often picked up during travel to foreign

countries as a result of drinking contaminated water, or by eating food which hasn't been

washed or cooked properly.

 

Other causes include stress or anxiety, drinking excessive amounts of alcohol or coffee

and also medications (such as certain antibiotics and antacids which contain magnesium)

may be a trigger.

 

Presentation:

A patient may describe themselves as having to go to the toilet more often than usual, and having

loose stools.

 

 

Differential Diagnosis:

Ask the patient whether they have undertaken any foreign travel recently, they have may gotten a virus and need referral to the doctor.

 

If they are suffering from other symptoms, such as fever, malaise or vomiting, they may also have a virus.

 

Check whether they have eaten any food which could have given them food poisoning (check whether

anyone else who ate the meal is suffering symptoms).

 

Red flag symptoms include unexplained weight loss, blood in the stools and if the diarrhoea has persisted

for a week or more-  in these cases the patient should be referred to their GP.

 

Treatment:

Antidiarrhoeals may be recommended- such as loperamide- to help slow down the passage of food in the

intestine. For example, Imodium can be given- TWO capsules initially, followed by ONE capsule after each

loose stool.

 

In all patient rehydration therapy should be commenced- this is especially essential in children and the

elderly. Oral rehydration sachets can be given, such a Dioralyte. ONE sachet should be dissolved in 200ml

of drinking water after every loose motion (or TWO sachets in 400ml).

 

 

Self Help Advice:

Drink plenty of water- diarrhoea can cause dehydration- and rest until symptoms subside.

 

Advise the patient to eat a light diet rather than starve themselves. Eat easily digestible foods such as soup,

bread and crackers. Avoid spicy or fatty foods.

 

Always cook food properly and follow good hygiene- regularly wash hands with hot, soapy water.

 

Clean the toilet with disinfectant after use.

 

 

Sample Question:

When questioning an adult who is asking for advice about the treatment of diarrhoea, which of the following factors would indicate that the patient should be advised to see their GP? You may select more than 1 answer if applicable.

 

a) presence of blood in the stool

b) abdominal cramps

c) flatulence

 

Answers to all sample questions can be found by following the link under the Test Yourself tab.