Epidemiology, Investigations and Management of DiarrhoeaJeeves

Epidemiology

• Incidence: almost 100%•The average adult gets around 4 bouts a yr•The majority of deaths occur in Africa

(707,000) and Asia (604,000). Compare this to Euorope (16,000).

•Diarrhoeal disease cause 18% of deaths under the age of 5.

•20-50% of international travellers get diarrhoea.

Investigations• Bloods:

▫ FBC: ↑MCV in Coeliac, alcohol abuse and ileal Crohn’s due to ↓B12 absorption

▫ U&E: Check for electrolytes that need correcting▫ CRP: Neoplasia, IBDs▫ TSH: Thyrotoxicosis▫ Anti-tTG (tissue transglutaminase) antibodies: Coeliac

• Stool: ▫ Microscopy & culture for bacteria and parasites▫ Test for Clostridium difficile toxin▫ Faecal fat excretion

• Rigid Sigmoidoscopy• Colonoscopy

Management

•Most cases require no treatment•If it persists treat the cause.•Food handlers shouldn’t work until stool

samples are negative.•Oral rehydration is preferred to IV. •If IV is needed give .9% saline +20mmol

K+/L.