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Prolonged Diarrhoea or Vomiting

Both vomiting and diarrhoea are often self-limiting and have a benign cause and prognosis. However it is essential to make a thorough assessment to ensure there is not a more serious aetiology requiring prompt intervention. The arbitrary use of symptomatic treatments without a clear diagnosis is inappropriate. Continued vomiting and diarrhoea require further reassessment and reconsideration of the previously assumed diagnosis.

Causes of prolonged vomiting
Causes of prolonged diarrhoea

There is no agreement on the duration of symptoms that define chronic as opposed to acute diarrhoea. However it is usually accepted that symptoms persisting for longer than four weeks suggest a non-infectious aetiology and therefore should be further investigated.1

Investigations
  • Investigation of the cause will depend on the age of the patient, presentation and associated features.
  • Most important is a careful and thorough history and examination.

Vomiting investigations include

Diarrhoea Investigations include

  • Blood tests: full blood count (raised white cell count with infection), ESR (raised in inflammation or malignancy); urea and electrolytes, liver function tests, thyroid function tests. Specific investigations for rare causes may include serum gastrin (Zollinger-Ellison syndrome), calcitonin (medullary carcinoma of thyroid) or vasoactive intestinal peptide (VIPoma).
  • Stool: M, C and S; faecal fats (malabsorption)
  • Ultrasound: liver metastases
  • Barium enema, small bowel enema
  • Sigmoidoscopy, colonoscopy
  • Biopsy: rectal biopsy (Crohn's), in association with colonoscopy (e.g. ulcerative colitis), jejunal biopsy (coeliac disease)
Management
  • Correction of fluid and electrolyte imbalance.
  • Treatment of any underlying cause.
  • Symptomatic treatment should only be used as part of a management plan with a definite diagnosis of the cause of the vomiting and/or diarrhoea.
Complications


Document references
  1. P D Thomas, A Forbes, J Green, P Howdle et al; Guidelines for the investigation of chronic diarrhoea (tests for malabsorption), 2nd edition (2003); British Society for Gastroenterology

Internet and further reading
  • Kinirons M, Ellis H; French's Index of Deifferential Diagnosis. 14th edition.
Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 2669
Document Version: 20
DocRef: bgp128
Last Updated: 21 Sep 2007
Review Date: 20 Sep 2009




















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