Sunday, 24 July 2016

Approach to Diarrhoea

A diagnostic approach

Probability diagnosis

Serious disorders not to be missed
  • Neoplasia
    • Colorectal cancer
    • Ovarian cancer
    • Peritoneal cancer
  • HIV infection (AIDS)
  • Infections
    • Cholera
    • Typhoid.paratyphoid
    • Amoebiasis
    • Malaria
    • Enterohaemorrhagic E.coli enteritis
  • Inflammatory bowel disease
  • Intussusception 
  • Pelvic appendicitis/pelvic abscess
  • Acute ischaemic colitis
Pitfalls
  • Coeliac disease
  • Faecal impaction with spurious diarrhoea 
  • Lactase deficiency 
  • Giardia lamblia infection 
  • Cryptosporidium infection 
  • Malabsorption states
  • Vitamin C and other oral drugs
  • Nematode infections
    • Strongyloides
    • whipworm
  • Radiotherapy
  • Diverticulitis
  • Post GIT surgery
  • Ischaemic colitis 
  • Rarities
    • Addison disease
    • Carcinoid tumours
    • short bowel syndrome
    • amyloidosis
    • toxic shock
    • Zollinger Ellison syndrome
Red flag pointers for diarrhoea 
  • unexpected weight loss
  • persistent/unresolved
  • Fever
  • Overseas travel
  • Severe abdominal pain 
  • Family history: bowel cancer, crohn disease

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