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home - Colon - Colorectal and Anal Cancer - Diarrhoea Written by Dr Sebastian Zeki

Knows the pathology of benign and malignant tumours of the colon
and rectum
Has awareness of the molecular genetics of colorectal
carcinogenesis and the adenoma-carcinoma sequence
Knows the range of predisposing conditions including inherited
syndromes and acquired colonic diseases
Knows the range of clinical presentation and the means of
diagnosis, investigation, management and follow-up
Knows the strategy for prevention including procedures for

Uses clinical assessment and selects investigations to reach a rapid
conclusion as to whether a patient might have colorectal cancer and
arranges timely investigation.
Refers the patient to the multi-disciplinary team CbD, mini-CEX,

Shows ability to react to possible diagnosis of malignancy in a timely

Communicates with patient and family in a sympathetic and
understanding manner, explains next steps, involves other health
professionals (including the GP) as appropriate


Evaluation of acute diarrhoea (1-13 days duration);Persistent diarrhoea last for >2 weeks; Chronic diarrhoea > 1monthDiarrhoea= stool weight >200 g/day or +3 watery stools/ day Causes of acute diarrhoea Causes of gastroenteritis:Norovirus.Rotavirus.Enteric adenovirus.Astrovirus.Salmonella.Shigella.Campylobacter.E.coli.Vibrio, Listeria, Yersinia as well as protozoa. Traveller’s Diarrhoea Risk factors for traveller’s diarrhoea:Travel in underdeveloped countries.Hypochlorhydria due to surgery or medication.Immunocompromised.Young age. Give enough for 3 days therapy. Diagnosis Only send stool culture if fever and colitic symptoms.If mostly upper GI symptoms (eg, bloating, gas, nausea), do stool examination for G.lamblia and cyclospora. Treatment: Oral rehydration solution consisting of 1/2 teaspoon salt, 1/2 teaspoon baking soda, and 4 tablespoons sugar to 1L water. Antibiotics. Norfloxacin — 400 mg bd. Ciprofloxacin — 500 mg bd. Ofloxacin — 200 mg bd. Levofloxacin — 500 mg od. Azithromycin — 1000 mg od. Rifaximin — 200 mg tds. Prevention strategies:Improve food and drink selection.Avoid ice unless from boiled water.Alcohol does not sterilize water or ice.Carbonated/ bottled water/ hot tea or coffee is safe.Avoid uncooked food eg Fruit salads, lettuce, or chicken salads.Unpeeled fruits are fine.Avoid table condiments as can become contaminated.Avoid steam table buffets.Purify water.Boiling for 3 minutes followed by cooling to room tem-perature (no ice) to kill bacteria, parasites, and viruses Adding 2 drops of 5 % sodium hypochlorite (bleach) or 5 drop tincture of iodine/ 250ml water will kill most bacteria in 30 minutes.Use iodine impregnated compact water filters - these kill viral and bacterial pathogens Illness starts 4-14 days after arrival Usually lasts 1- days.Is self- limiting15 % have it for >1 wk 1% have it for > 1/1220% need bedrest for 1-2 days Bacteria ETEC, EAEC, Campylobacter jejuni , Salmonella species , Shigella species Also....C.difficile, Vibrio parahaemolyticus (V.cholerae less common) Aeromonas hydrophilia, Plesio-monas shigelloides, Yersinia enterocolitica Viruses Rotavirus - accounts for 10% OF td, Enteric adenovirus Parasites Giardia lamblia, Cryptosporidium parvum ,Cyclospora cayetanensis, Microsporidia ,Isos-pora belli, Entamoeba histolytica (not common) Persistent infection-giardia-acquired hypolactasia-hypogammaglobulinaemia-unrecognised disease -Infectious dysentery (blood and neutrophils in stool)ETEC 20-75% EAEC 100% EIEC 3% Shigella spp 15% Salmonella spp 15% Campylobacter jejuni 8% Vibrio parahemolyticus 15% Aeromonas hydrophila 15% Giardia lamblia 10% Entameba histolytica 2% Cryptosporidium sp 10% Rotavirus 18% Norwalk virus 5% -IBD-Ischaemic colitis Viral causes Bacterial causes Pathogens causing travellers' diar- Post infectious diarrhoea Written by Dr Sebastian Zeki .

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