Characteristic Features Of Conditions Causing Diarrhea

For the case scenarios of patients presenting with diarrhea chose a diagnosis form the list below:

A. Gastroenteritis
B. Crohn's disease
C. Ulcerative colitis
D. Colorectal cancer
E. Laxative abuse
F. Constipation causing overflow
G. Lactose intolerance
H. Diverticulitis
I. Irritable bowel syndrome
J. Coeliac disease

1. A 24-year-old smoker presents with intermittent diarrhea for the past 6 months. She feels bloated, especially around her periods. Bloods tests are normal.

Answer: Irritable bowel syndrome

2. A 23-year-old student is admitted due to a two-week history of bloody diarrhoea. He is normally fit and well and has not been abroad recently. His CRP is raised at 56 on admission

Answer: Ulcerative colitis
(The duration of his symptoms make a diagnosis of gastroenteritis less likely. The presence of blood in the diarrhoea points to a diagnosis of ulcerative colitis rather than Crohn's.)

3. A 72-year-old woman presents with a two day history of diarrhoea and pain in the left iliac fossa. Her temperature is 37.8ºC. She has a past history of constipation.

Answer: Diverticulitis

Discussion:
Characteristic Features Of Conditions Causing Diarrhea:

Acute Conditions:

1. Gastroenteritis: May be accompanied by abdominal pain or nausea/vomiting


2. Diverticulitis: Classically causes left lower quadrant pain, diarrhoea and fever

3. Antibiotic therapy: More common with broad spectrum antibiotics Clostridium difficile is also seen with antibiotic use.

4. Constipation causing overflow: A history of alternating diarrhoea and constipation may be given May lead to faecal incontinence in the elderly.

Chronic Conditions: 

1. Irritable bowel syndrome: Extremely common. The most consistent features are abdominal pain, bloating and change in bowel habit. Patients may be divided into those with diarrhoea predominant IBS and those with constipation predominant IBS. Features such as lethargy, nausea, backache and bladder symptoms may also be present.

2. Ulcerative colitis: Bloody diarrhoea may be seen. Crampy abdominal pain and weight loss are also common. Faecal urgency and tenesmus may be seen.

3. Crohn's disease: Crampy abdominal pains and diarrhoea. Bloody diarrhoea less common than in ulcerative colitis. Other features include malabsorption, mouth ulcers perianal disease and intestinal obstruction.

4. Colorectal cancer: Symptoms depend on the site of the lesion but include diarrhoea, rectal bleeding, anaemia and constitutional symptoms e.g. Weight loss and anorexia.

5. Coeliac disease: In children may present with failure to thrive, diarrhoea and abdominal distension In adults lethargy, anaemia, diarrhoea and weight loss are seen. Other autoimmune conditions may coexist.

Other conditions associated with diarrhoea include:

• thyrotoxicosis 
• laxative abuse 
• appendicitis