What are key questions to ask someone presenting with diarrhoea?
- Temperature, lethargy, dysuria - determines how severe it is and whether it needs admission
- Foreign travel - more likely to be infective
- Contact with people with same symptoms - can indicate contagious and self-limiting cause
- Recent abx use - maybe C. diff
What are other symptoms to ask about?
- Blood or mucus in stools, dark stools
- Weight loss
- Abdo pain/cramps/bloating
- Fever
- Tenesmus (inclination to empty bowel)
- Vomiting
- Exacerbating factors
- Feel hot/cold, irregular periods, skin/nail/hair changes (thyroid issue)
- Keeping fluids down, how many times a day opening bowels
What is the most common cause of food poisoning in the UK?
Campylobacter. Giardia is also an infectious cause of diarrhoea but more common in tropical countries so associated with travelling.
What would you test for if suspecting travellers diarrhoea?
Stool sample for ova, cysts, parasites, culture and sensitivities
What is the management for campylobacter?
- If campylobacter is confirmed the GP is required by law to report this to the local Environmental or PHE - so it can be investigated and businesses which may have caused the infection can be investigated to prevent poor hygiene and other people being infected
- Try to keep away from people until 48hrs after your symptoms stop
- No treatment is usually necessary, campylobacter is usually from food poisoning
What can cause prolonged diarrhoea?
- Acute gastroenteritis can cause post-infectious IBS (can take years to go away)
- IBD
- Hyperthyroidism
- Anxiety
- Coeliac disease
What is C. diff?
C. diff is part of normal gut flora but in diarrhoea intestinal bacterial flora are compromised e.g. due to abx, including PPIs, which can lead to overgrowth of C.diff. This causes C.diff to grow enough to damage intestines causing ‘pseudomembranous colitis’/
What measures has the Food Standards Agency UK identified to prevent food poisoning?
- Cleanliness: hands, utensils, work surfaces, tea towels. Using waterproof plasters and not preparing food if you have diarrhoea or vomiting
- Cooking: not to reheat food more than once, ensure meat piping hot and cooked through (especially meat), drinking only pasteurised or boiled milk and avoid drinking water thought to be unsafe (including ice cubes)
- Chilling: cooling leftover food quickly and then refrigerating, making sure food is not left out and fridges arebetween 0-5 degrees Celsius.
- Cross-contamination: this is when bacteria move from foods (most often raw meat) to other foods e.g. from touching directly, dripping or from hands or utensils. This must be avoided.
What investigations would you do for persistence of loose stools?
- CRP, ESR
- U&Es
- Faecal calprotectin
- TFTs
- TTG antibodies
- FBC
