Aetiology: Diarrhoea is the frequent passing of watery stools due to the lining being inflamed preventing sufficient fluid from being removed from the food in the intestine.
Symptoms:
Acute Diarrhoea
Usually around 5-10 days
Could be caused by:
Campylobacter
-Escherichia coli
-Salmonella
-Shigella
– Cryptosporidium
-Norovirus (the winter virus)
-It can be picked from travel from drinking contaminated water or food, stress, drinking too much alcohol/coffee or medications for example antacids that contain magnesium
Chronic Diarrhoea
Lasts more than 4 weeks
Could be caused by:
-Bacterial or viral infection
-Overuse of laxatives
-Poor diet
-Long term conditions such as ulcerative colitis, Crohns disease, irritable bowel syndrome, lactose intolerance and coeliac disease
Medicines causing diarrhoea
-ACE inhibitors
-Angiotensin II receptor blockers
-Non-steroidal anti-inflammatory drugs
-Diuretics
-Metformin
-Immunosuppressants or systematic steroids
-PPIs (frequent use more than a year especially in older patients)
Red Flags
Emergency 999 referral:
-Clammy/pale as these are signs of severe dehydration or shock
GP referral:
-Blood in stool
-Weight loss
-Recent treatment with antibiotics
-Nocturnal symtoms
-Fever (unwell systemically)
Referral in children
Referral in Children
The child should be taken to the doctor if there are concerns about duration and severity of the diarrhoea or if vomiting has lasted more than one day in addition to the diarrhoeal symptoms.
Otherwise, diarrhoea lasting more than than the following durations should be referred :
-24 hours in babies under one year or
-48 hours in children under three years
-72 hours in over 3 year olds
Referral In Adults
Refer adults using a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer if:
- Aged over over 40 with unexplained weight loss and abdominal pain
- Aged over 50 with unexplained rectal bleeding
- Aged over 60 with iron deficiency anaemia or bowel habit changes, or tests show blood in their faeces.
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in:
- Adults with a rectal or abdominal mass.
- Adults aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings:
- Abdominal pain.
- Weight loss
- Bowel habit change
- Iron-deficiency anaemia.