Diarrhoea Colour Character: Ask generally. Ability to flush. Blood consistency. Blood Severity: Qualitative Quantitively Time course: Change over time. Duration Frequency of episodes Offset Onset Relieving factors Ask generally. Fasting Aggravating: Asking generally Context of onset Lifestyle changes Swimming Eating or drinking Infectious contacts. Associated factors: Fever Nausea Vomit Jaundice Weight loss Abdominal pain Appetite changes Abdominal distension Altered bowel habits: constipation, faecal urgency and incomplete faecal emptying. Loss of consciousness Ask about hydration status: Do you feel dehydrated? -> what makes you feel so? Dry mucus membrane Decreased tissue turgor. Polydipsia Increased breathing Tachycardia Decreased urine output. Irritable Drowsy Confusion Differentials for diarrhoea Diseases Questions and Physical Examination Findings Fever Vomit Joint pain Abdominal distension Usually, RLQ Palpable mass due to adhesions caused by inflammation. Altered bowel habits: Ask generally. Constipation. Defecating blood Diarrhoea (general patient presents with chronic diarrhoea) -> looser and more difficult to pass -> could be of various shapes and colours. Faecal urgency Low grade fever Weight loss Crohn’s disease Lower GI bleed -> uncommon Fatigue Features of Crohn’s disease complications: Malabsorption: weight loss, anaemia and failure to thrive. Enterocutaneous or perianal fistulas often associated with abscess formation. Extra-intestinal manifestations Enteropathy arthritis -> serogenerative sponadylaorthopay Eyes: uveitis, iritis, episcleritis Liver/bile duct: cholelithiasis Skin rashes Social history: Smoking Bloody diarrhoea with mucus Often very loose and watery stools Blood is a rare manifestation in ulcerative colitis. The bloody diarrhoea tends to happen with belly cramps a sudden urgent to have a bowel movement and sometimes fever. Faecal urgency Abdominal pain with cramps Ulcerative colitis Tenesmus Extraintestinal features: Fatigue and fever Skeletal (most common extra-intestinal manifestations) -> osteoarthritis, ankylosing spondylitis, sacroiliitis Ocular: uveitis, episcleritis, iritis Primary sclerosing cholangitis Cutaneous: erythema nodosum, pyoderma gangrenous, aphthous stomatitis Fever Nausea Vomit Acute onset Usually watery and non-bloody. Altered bowel habits: Gastroenteritis Ask generally. Diarrhoea Defecating blood Social history -> diet: Ask generally. Contaminated water Expired food. Intestinal amebiases -> 1 to 4 weeks. Extraintestinal amebiasis -> a few weeks to several years. Loose stools with mucus and bright red blood. Painful defecation Tenesmus Abdominal pain and cramps. Amoebiasis Weight loss and anorexia. Fever -> in 10 to 30% of cases Possible systemic symptoms such as fatigue. High risk of recurrence e.g. through self-inoculation -> hand to mouth. A chronic form is also possible and may manifest clinically similar to inflammatory bowel disease. Fever Shock Nausea Vomiting Appetite changes Appendicitis Altered bowel habits: Ask generally. Constipation Diarrhoea Past medical history Past surgical history