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home - Colon - Diagnostic Pathways for Colonic Disease - Chronic Diarrhoea Algorithm Written by Dr Sebastian Zeki
Knowledge
Assessment
Methods GMP
Knows the physiology of intestinal absorption, secretion and motility SCE 1
Understands the biochemical processes occurring within the gut
lumen and at mucosal level

Has awareness of the factors controlling these processes – in
particular the neuro-endocrine influences

Understands the range of mechanisms by which diarrhoea can result
from disturbances in each of these processes

Knows the causes of both acute and chronic diarrhoea
Knows the range of investigations appropriate to determining the
cause of the patient’s diarrhoea and is aware of the range of
therapeutic possibilities

Skills
Makes a detailed clinical assessment of patients that present with
either acute or chronic diarrhoea

Recognises the potential need for urgent fluid replacement CbD,
Makes appropriate use of microbiology and other relevant laboratories in reaching a diagnosis

Shows ability to interpret results, reach a diagnosis and formulate a
treatment plan

Behaviours
Reacts appropriately to the urgency of the clinical presentation
Always shows sympathy and understanding especially when the
patient is distressed

Chronic Diarrhoea Algorithm

Basic Ix: FBC/ LFT/ Ca/ B12/ folate/ Fe status/ TFT/ coeliac serology History sounds organic/ abnormal basic Ix History sounds func-tional (<45yrs old with normal basic IX= IBS Malabsorption Symptoms: Small bowel: D2 Bx+ BaFT Enteroscopy/ bacterial over-growth tests for more detailPancreas: CT pancreas+ faecal elastase for pancreatic assess-mentERCP or MRCP for more detail Colonic/ TI symptoms: Flexi SIg if < 45/ Colonoscopy if >45 Difficult diarrhoea:Consider 24-72hr stool weight/ osmolality/ osmotic gap/ laxative screenGut hormone screen Investigation Of Chronic Diarrhoea Written by Dr Sebastian Zeki

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