Diarrhoea Mechanisms and Intestinal Diseases

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Questions and Answers

What is a primary cause of Clostridium difficile-associated colitis?

  • Transient bacterial overgrowth
  • Antibiotic exposure (correct)
  • Viral infection
  • High fiber diet

Which investigation is most appropriate if colorectal cancer is suspected?

  • Upper GI endoscopy
  • MR enterography
  • Stool calprotectin test
  • Colonoscopy with biopsies (correct)

What dietary approach is recommended for managing Irritable Bowel Syndrome (IBS)?

  • High protein diet
  • High fiber diet
  • Low FODMAP diet (correct)
  • Gluten-free diet

Which of the following is a possible severe complication of a C. difficile infection?

<p>Toxic megacolon (D)</p> Signup and view all the answers

For suspected Coeliac disease, which procedure is indicated for diagnosis?

<p>Upper GI endoscopy with biopsy (D)</p> Signup and view all the answers

What is the primary mechanism that leads to secretory diarrhoea?

<p>Excess fluid secreted into the stool surpassing absorption (A)</p> Signup and view all the answers

Which condition is commonly associated with osmotic diarrhoea?

<p>Lactose intolerance (B)</p> Signup and view all the answers

What characterizes inflammatory diarrhoea?

<p>Release of blood, mucus, and protein due to inflammation (B)</p> Signup and view all the answers

Which of the following best describes altered motility as a cause of diarrhoea?

<p>Variable intestinal motility impacting absorption time (D)</p> Signup and view all the answers

What is a common symptom of Crohn’s disease?

<p>Transmural inflammation with patchy lesions (A)</p> Signup and view all the answers

Which mechanism underlies antibiotic-related diarrhoea caused by Clostridium difficile?

<p>Alteration of gut flora leading to overgrowth of harmful bacteria (B)</p> Signup and view all the answers

What is a characteristic symptom of coeliac disease?

<p>Fatty stools and significant weight loss (A)</p> Signup and view all the answers

What is the main feature of secretory diarrhoea caused by viral infections like Rotavirus?

<p>Destruction of enterocytes leading to excessive fluid secretion (D)</p> Signup and view all the answers

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Study Notes

Diarrhoea Mechanisms

  • Secretory diarrhoea: Excessive fluid secretion into the intestines, exceeding absorption.
    • Causes: Infections, laxatives, polyps.
  • Osmotic diarrhoea: Non-absorbable substances in the intestines draw water in, causing excess fluid.
    • Causes: Sugar substitutes, lactose intolerance.
  • Inflammatory diarrhoea: Inflammation in the intestines releases proteins, blood, mucus, and fluids into the stool.
    • Causes: Ulcerative colitis, Crohn's disease, tuberculosis, cancers.
  • Altered motility diarrhoea: Changes in intestinal motility disrupt absorption and digestion.
    • Slow motility: Bacterial overgrowth and malabsorption.
    • Fast motility: Reduced contact time for absorption.
    • Causes: Irritable bowel syndrome (IBS), diabetes mellitus (neuropathy), hyperthyroidism.

Intestinal Diseases with Diarrhoea

  • Ulcerative colitis: Continuous mucosal inflammation starting in the rectum and extending upwards.
    • Symptoms: Bloody diarrhoea, urgency, abdominal pain.
  • Crohn's disease: Transmural inflammation affecting any part of the gastrointestinal tract, with patchy "skip lesions".
    • Symptoms: Diarrhoea (sometimes bloody), abdominal pain, weight loss, fistula formation.
  • Coeliac disease: Autoimmune response triggered by gluten ingestion, leading to villous atrophy and malabsorption in the small intestine.
    • Symptoms: Diarrhoea, steatorrhoea (fatty stool), weight loss.
  • Infectious diarrhoea: Bacterial infections (Salmonella, Shigella, Campylobacter) and viral infections (Rotavirus, Norovirus) can disrupt the intestinal lining and cause diarrhoea.
  • Small intestinal bacterial overgrowth (SIBO): Excessive bacterial growth in the small intestine can lead to malabsorption and osmotic diarrhoea.
  • Clostridium difficile (C. diff) associated colitis: Overgrowth of pathogenic C. diff bacteria following antibiotic exposure.
    • Mechanism: Toxin production and infection.
  • Mild, non-specific osmotic diarrhoea: Transient loss of bacteria that normally absorb short-chain fatty acids.
  • Impact:
    • Mild diarrhoea: Discomfort, dehydration, and electrolyte imbalances.
    • Severe C. difficile infection: Toxic megacolon, perforation, sepsis, increased mortality (especially in older patients and those with comorbidities).

Management of Chronic Diarrhoea

  • Investigations:
    • Blood tests: CRP, FBE, iron studies, coeliac serology, TSH.
    • Stool analysis: Calprotectin, C difficile toxin, microscopy for ova, cysts, parasites.
  • Suspected colorectal cancer or IBD:
    • Colonoscopy and ileoscopy with biopsies.
  • Suspected coeliac disease:
    • Upper gastrointestinal endoscopy with biopsy.
  • Suspected small bowel IBD:
    • Magnetic resonance enterography or capsule endoscopy.
  • Management:
    • IBS: Dietary modifications (low FODMAP), psychological support, tricyclic antidepressants (TCA).
    • Coeliac disease: Dietician, gastroenterologist, gluten avoidance.
    • IBD: Gastroenterologist for treatment.

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