Diarrhoea Causes: Gastroenteritis (viral, bacterial, protozoae) Medication (antibiotics, metformin, others) IBS IBD Bowel cancer Alcohol

lcohol misuse Coeliac disease Diverticulosis Thyrotoxicosis Overflow from constipation Bowel cancer and diverticulosis become more common with advancing age Do not make a new diagnosis of IBS in anyone over 50 Strong seasonal variation in cases of gastroenteritis. Campylobacter is commonest cause of food poisoning in UK, - most common in summer History: What do they mean by diarrhoea? What is normal for them Duration (if >2 weeks consider a non-infectious cause) Speed of onset staph aureus and bacillus cereus have the quickest onset Blood in stool? suggests campylobacter, E-coli, shigella, inflammatory bowel disease, cancers Abdo pain/cramps pain intermittent in gastroenteritis. If continuous pain or pain at night, make sure to exclude more serious causes. If relieved by defaecation, IBS is more likely Aching joints common in campylobacter Headache may indicate dehydration Fever Weight loss over period of weeks/months suggests cancer or malabsorption Food what did you eat in the 24h before this started Travel have you been abroad recently? Amoebae and giardia most common in Asia and Africa Contacts has anyone else been ill Job what do you do for a living? does it involve handling food? Might need time off/sick notes Medication o May not be able to rely on contraceptive pill if they are on it advise extra precautions o Taking any medications that might cause diarrhoea

Examination Assess degree of dehydration and identify clues as to cause Conscious level Pulse ( if dehydrated or febrile) Temperature Jaundiced? obstruction due to pancreatic cancer/mets Abdo examination tenderness, guarding, masses, BS Rectal exam if suspect cancer Management Stool for MC+S if o Diarrhoea persists for >3 days o Person has been abroad o 2+ members of household have symptoms o 2+ people who ate the same food have symptoms o Their job involves handling food Lab will routinely test for salmonella, shigella, E-coli, campylobacter Lab may only test for giardia or parasites if asked for specifically Blood appropriate in a few cases o CRP/ESR?PV if suspect IBD o FBC if suspect cancer/IBD/alcohol misuse o LFTs if suspect alcohol misuse o TFTs if other symptoms of thyrotoxicosis o TTG if suspect coeliac Refer for barium enema or colonoscopy under TWW if indicated Stress importance of hygiene hand washing Oral rehydration Loperamide (immodium) not really recommended unless its important to stop diarrhoea (e.g. for long journeys) Only prescribe abx rarely even if causative agent e.g. campylobacter is found, patient is likely to recover spontaneously. o If still unwell when result arrives give ciprofloxacin for campylobacter, shigella o Metranidazole for giardia Food poisoning is a notifiable disease People whose job involves handling food should not return to work until 48h after last episode of diarrhoea