Definition

Diarrhoea is frequent and liquidy faeces.

History

Quality

  • How watery is the diarrhoea?
  • Is there any blood?
  • Is and whether the is any mucous?

Severity

  • How often do you go to the toilet?
  • How often do you normally have a bowel motion?
  • How much is there each time?

Time Course

Onset-Offset

  • Did it come on suddenly?

Duration

  • How long has the problem been happening for?

Temporal Profile

  • Is it getting worse?
  • Does it come and go?
  • Have you ever had this problem before?

Context

Think about:
  • Recent travel
  • Contacts that also have diarrhoea
  • Changes in diet
  • Changes in medication

Aggravating Factors

  • Is there anything that makes it worse?

Relieving Factors

  • Is there anything that makes it better?

Associated Features

Past History

Do you have Atrial Fibrillation?

Medications

Do you take any of the following medications:

Family History

Has anybody in your family ever had:

Social History

  • Where do you work? Do you work in a food industry? - May affect return to work?
  • Where do you live? - Living in a nursing home increases risk of gastroenteritis
  • Do you drink alcohol? - excessive alcohol can sometimes cause diarrhoea
  • Do you smoke? - Increases the risk of Colon Cancer and Crohn's Disease

Examinations and Investigations

Bloods

Other

  • Stool culture and serology - may determine pathogen

Differential Diagnosis

Red Flags

Management

Non-Pharmacological

  • Oral Rehydration
  • IV fluids (if there is associated vomiting)
  • Avoid antibiotics (usually)

Pharmacological

  • Antibiotics only if indicated
  • Codeine phosphate - reduces frequency

See also

Oxford Handbook of Clinical Medicine - 9th edition p246