Diarrhea :: PLAB 2 Symptomatic Differential Stations

• Suspected Colorectal Cancer:

  • Other presenting symptoms- 

    • Blood

    • Change in bowel habit

    • Mucus

    • Vomiting

    • Weight loss

    • fever

  • Past history and PMAFTOSA- 

    • Assess dehydration:

      • Are you thirsty

      • Are you passing urine

  • Social-

    • Work and life effects

  • Exam and Invs

    • GPE, vitals

    • Abdominal examination

    • Per rectal examination

    • Routine bloods

    • Stool test, occult blood in stool, and Calprotectin

    • abdominal x-ray

    • CT Scan of abdomen

    • Colonoscopy

  • Referral 

    • Cancer pathway

  • Treatment 

    • Manage diarrhea

      • ORS

    • Specialist treatment

  • Warning signs- 

    • Signs of dehydration

• Suspected IBD:

  • Other presenting symptoms- 

    • Alternating bowel habits

    • Lower abdominal pain, bloating relieved by defecation

    • Long history of diarrhea

    • No blood in stools 

    • Weight loss history

  • Past history and PMAFTOSA- 

    • Assess dehydration:

      • Are you thirsty

      • Are you passing urine

  • Social-

    • Work and life effects

  • Exam and Invs

    • GPE, vitals

    • Abdominal examination

    • Per rectal examination

    • Routine bloods

    • Stool test, occult blood in stool, and Calprotectin

    • Colonoscopy

  • Referral 

    • Gastro 2 week referral

  • Treatment 

    • Symptomatic management

    • Steroids

  • Warning signs- 

    • Blood in stools

    • Increasing weight loss

• IBS:

  • Other presenting symptoms- 

    • Alternating bowel habits

    • Lower abdominal pain, bloating relieved by defecation

    • Long history of diarrhea

    • No blood in stools 

    • Weight loss history

  • Past history and PMAFTOSA- 

    • Assess dehydration:

      • Are you thirsty

      • Are you passing urine

  • Social-

    • Work and life effects

  • Exam and Invs

    • GPE, vitals

    • Abdominal examination

    • Per rectal examination

    • Routine bloods

    • Stool test, occult blood in stool, and Calprotectin

  • Referral 

    • Gastro routine

  • Treatment 

    • Buscopan, and then amitriptyline/citalopram

    • General advice:

      • Maintain a food diary to detect triggers

      • Avoid difficult-to-digest foods like cabbage, cauliflower

      • Eat on time

      • Avoid caffeine

      • Exercise, stress management

  • Warning signs- 

    • Blood in stools

• Antibiotic associated diarrhoea:

  • Other presenting symptoms- 

    • Just diarrhea

    • History of taking antibiotics

  • Past history and PMAFTOSA- 

    • Contact history with C-diff patients

    • Allergy history

    • Assess dehydration:

      • Are you thirsty

      • Are you passing urine

  • Social-

    • Work and life effects

  • Exam and Invs

    • GPE, vitals

    • Abdominal examination

    • Per rectal examination

    • Routine bloods

  • Referral 

    • None

  • Treatment 

    • Stop antibiotic (seek senior opinion)

    • ORS

  • Warning signs

    • Dehydration

    • Blood in stools