1. Epidemiology, Investigations and Management of Diarrhoea Jeeves

2. 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.

3. 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

4. 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.