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Chapter: Medicine Study Notes : Gastro-Intestinal

Diarrhoea - Infectious Agents

Symptoms & Signs: o Dysphagia (e.g. Candida) o Flatulence, colic, distension, diarrhoea (watery, fatty, bloody)

Diarrhoea – Infectious Agents


·        = Acute Enterocolitis

·        Symptoms & Signs:

o   Dysphagia (e.g. Candida)

o   Flatulence, colic, distension, diarrhoea (watery, fatty, bloody)

o   Vomiting, fever

·        Investigations

o  Blood: eosinophilia, HIV

o  Faecal microscopy, parasitology, culture

o  H2 breath test

o  Endoscopy/Colonoscopy +/- biopsy

·        Pathology: Red, oedematous bowel (all look the same), microscopically non-specific inflammation

·        Differential

o  Drug induced diarrhoea: laxatives, magnesium compounds, diuretics

o  Severe alcohol intake

o  Diabetic autonomic neuropathy

o  IBD

o  Malabsorption: coeliac, lactose intolerance, lymphoma, pancreatitis, bilary/liver disease

·        Management:

o  Rehydration

o  Investigate cause

o  Monitor complications: anaemia (due to haemorrhage), septicaemia, perforation, appendicitis

o  Strict food hygiene 

o  Avoid milk ® ¯secondary hypolactasia

o  Antibiotic treatment


Infectious agents


·        Bacterial enteroinvasive:

o  Campylobacter Jejuni

§  Poultry

§  Haemorrhagic colitis 

§  Erythromycin (used to be ciprofloxacin but it‟s been put in chicken feed ® ­resistance)

o  Escheria Coli

§  Enterotoxic subspecies

§  Travellers diarrhoea

o  Salmonella/Shigella: Poultry

·        Bacterial enterotoxins:

o  Vibrio Cholerae

o  Staph Aureus: Food poisoning (eg cream buns)

o  Clostridium Botulinum

o  Some subtypes of E Coli

·        Protozoa

o  Giardia

§  Trophozoites reside mainly in duodenum, also small bowel

§  Cysts in faeces 

§  Small bowel diarrhoea ® diarrhoea during night (large bowel „sleeps‟)

o  Entamoeba histolytica: causes amoebic dysentery (colitis)

·        Cryptosporidium

o  Common in kids

o  Is chronic in immunocompromised

o  No effective antibiotic treatment


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