Diarrhoea
Diarrhoea is the abnormal passage of loose or liquid stools more than
three times daily and/or a volume of stool greater than 200 g/day. Patients may
use the term diarrhoea in different ways. Diarrhoea lasting for more than 4
weeks is generally considered chronic, likely to be of noninfectious aetiology
and warrants further investigation.
Acute diarrhoea occurs with viral gastroenteritis, food poisoning and
traveller’s diarrhoea. Other symptoms such as pain, fever and vomiting may be
present. In most cases specific treatments are unnecessary; however, adequate
hydration (preferably using oral rehydration solution) is essential.
Chronic diarrhoea may be caused by organic or functional bowel disorders
(e.g. irritable bowel syndrome). Functional bowel disease tends to cause a
prolonged history of intermittent diarrhoea, without weight loss. It should be
noted however that patients with inflammatory bowel disease might present in
this way. Organic disease is suggested by a history of diarrhoea of less than 3
months duration, continuous or nocturnal diarrhoea, or significant weight loss.
Malabsorption often causes steatorrhoea (stool that is frothy, foul smelling
and floats because of a high fat content).
History taking in chronic diarrhoea should include the following:
·
Previous gastrointestinal
surgery.
·
Any coexistent pancreatic,
endocrine or multisystem disease.
·
Family history of
gastrointestinal neoplasia, inflammatory bowel disease or coeliac disease.
·
Medication including previous
antibiotics.
·
Foreign travel.
Screening tests should include full blood count, ESR, CRP, urea and
electrolytes, liver function tests, calcium, vitamin B12, folate, iron studies, thyroid
function tests and coeliac serology. Infectious chronic diarrhoea is uncommon
in non-immunocompromised patients; how-ever, stool cultures and microscopy
should also be sent.
In young patients (under 45 years) with symptoms suggestive of
functional bowel disease, a normal examination and negative screening tests, no
further investigations are required. If atypical findings are present, a
sigmoidoscopy should be performed. In older patients colonoscopy with ileoscopy
should be performed with biopsy and histological examination of any suspicious
areas.
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