Diarrhoea

Differential diagnosis

Acute

  • Gastroenteritis
    • food, travel, contacts, antibiotics, fever
  • Diverticulitis
    • LLQ pain, PR bleeding, fever
  • Medications
    • antibiotics, metformin, orlistat, laxatives
  • Overflow
    • history of constipation

Chronic

  • Colorectal cancer
    • weight loss, PR bleeding
  • IBD
    • FH, weight loss, bloody diarrhoea, mouth ulcers, perianal disease, tenesmus
  • Coeliac
    • malabsorption, certain foods
  • Thyroid
    • palpitations, sweats, anxiety
  • IBS
    • bloating, anxiety

Data gathering

  • Examine
    • BP, pulse, temperature
    • weight
    • hydration status
    • abdomen
    • PR

Clinical management

  • Investigations
    • Stool
      • MC&S, ova/cysts/parasites
      • faecal calprotectin
    • Urine dip
    • Bloods – FBC, TFT, LFTs, ESR, anti TTG
  • Explanation
  • Treatment
  • Followup / Safety-net
    • 2ww
      • weight loss, anaemia, abdominal mass, strong FH
      • <40yo with PR bleeding + change in bowel habit persisting 6 weeks
      • >60yo with change in bowel habit persisting 3 weeks

Traveller’s diarrhoea

Red Whale NICE summary