Diarrhoea & Constipation

Question 1

What is bowel habit?

Answer 1

• the pattern of defaecation; or the mechanism by which the waste products of digestion are excreted by the body

Question 2

Explain the process of digestion

Answer 2

• Food is broken down mechanically –> chewing
• Then broken into molecules –> chemicals such as stomach acid and pancreatic enzymes
• Molecules are absorbed by small intentine and metabolised into energy

Question 3

What happens to undigested material?

Answer 3

• passes as a liquid effluent into the large bowel where fluid is extracted and the effluent is converted to faeces.

Question 4

What is a normal frequency of defaecation?

Answer 4

one every 2-3 days to 2-3 times a day.

Question 5

What should you ask about bowel habit?

Answer 5

Because the frequency of defaecation is so varied in the general population, always as about CHANGES IN BOWEL HABIT

Question 6

What is diarrhoea?

Answer 6

• diarrhoea denotes the frequent and excessive passing of watery unformed faeces

Question 7

What is diarrhoea due to?

Answer 7

• diarrhoea is usually due to damage to the lining of the bowel that inhibits absorption of water from the waste products of digestion

Question 8

What are the three classifications of diarrhoea?

Answer 8

• Acute, Progressive and Chronic

Question 9

What is acute diarrhoea?

Answer 9

• diarrhoea that has an abrupt onset and a short duration

- mostly lasts a few days and is usually caused by an infection such as gastroenteritis or food poisoning

Question 10

What is persistent diarrhoea?

Answer 10

• diarrhoea that lasts between 2 and 4 weeks

Question 11

What is chronic diarrhoea?

Answer 11

• diarrhoea that is slow to develop and has a long duration of longer than four weeks

Question 12

With reference to diarrhoea, What cardinal features would you use when interviewing a patient?

Answer 12

• Site of GI pain
• Quality
• Severity
• Time Course
• Context
• R/A Factors
• Associated Features

Question 13

With reference to diarrhoea, What would you ask regarding Site?

Answer 13

• Where is your abdominal pain?

Question 14

With reference to diarrhoea, What would you ask regarding Quality?

Answer 14

• How watery is it?
• Blood?
• Mucus?

Question 15

With reference to diarrhoea, What would you ask regarding Severity?

Answer 15

• Frequency?

- Volume of Stool?

Question 16

With reference to diarrhoea, What would you ask regarding Time Course?

Answer 16

• Acute vs. Chronic?

- Worsening over time?

Question 17

With reference to diarrhoea, What would you ask regarding Context?

Answer 17

• Food?

- Travel overseas?

Question 18

With reference to diarrhoea, What would you ask regarding R/A Factors?

Answer 18

• Better/worse?

- Tried anything to relieve it? Effect?

Question 19

With reference to diarrhoea, What would you ask regarding Associated Features?

Answer 19

• Acute: nausea, fever, vomiting, other people sick

- Other: abdo pain, symptoms of dehydration, weight loss

Question 20

What is constipation? Due to?

Answer 20

Excessively hard stools usually caused by increase absorption of liquid as a result of slow transit through the large bowel

Question 21

What is constipation associated with?

Answer 21

Reduction in the frequency of defecation and a feeling of incomplete evacuation of the bowels

Question 22

What should you clarify is a patient is constipated?

Answer 22

Clarify exactly what they mean by the word constipation

Question 23

What are some causes of constipation?

Answer 23

• low fibre diet
• medications such as codeine
• medical conditions
• bowel cancer
• immobility
• hypothyroidism

Question 24

What is rectal bleeding?

Answer 24

Passage of blood or clots from the rectum

Question 25

What should you ask about with regards to rectal bleeding?

Answer 25

Amount of blood? | Colour?

Question 26

What can rectal bleeding be a sign of?

Answer 26

- Haemorrhoids, anal fissure, colorectal cancer etc. | If there is blood in diarrhoea = can be inflammatory bowel disease

Question 27

How can you tell the origin of the blood in rectal bleeding?

Answer 27

The colour: Bright Red = close to the anus Darker/Maroon red= first regions of the large intestine Black = upper GI tract

Question 28

What is the medical term for black stools?

Answer 28

Malaena

Question 29

What are black stools an indication of?

Answer 29

- upper gastrointestinal bleeding

Question 30

What does upper GI bleeding manifest as?

Answer 30

haeatemesis, melaena or rarely rectal bleeding

Question 31

What should you enquire about if constipation or rectal bleeding are presenting?

Answer 31

- family Hx of bowel cancer

Question 32

Why do the stools appear black?

Answer 32

Because the blood is oxidised by bacteria as it passes through the intestines.

Question 33

What are some useful ways to show that patient you are listening and understanding what they are saying to you?

Answer 33

- repetition of what they are saying exactly? - Paraphrasing - Summarising