Diarrhoea

This condition is treated in the Gastroenterology clinic.

Pre-referral work-up

History

All referrals should comply to referral standards and include in particular:

• Patient and family history of gastrointestinal cancer
• Previous gastrointestinal investigations and results (date and report)

Tests

Pathology:

• LFT
• FBC
• U&E
• TSH
• iron studies
• Coeliac disease serology (where indicated / performed)
• Stool PCR for pathogens and parasites.
• Stool calprotectin (where suspicion of inflammatory bowel disease)

Imaging:

Any relevant

Investigations:

Nil

Interim/GP management

To refer a patient with this condition, please see the Gastroenterology clinic page for the full referral process and templates.

Recommended pre-referral treatment

Lifestyle Changes: Dietary review

Medical Management:

• Consider constipation with overflow
• Consider faecal incontinence
• Consider trial of anti-diarrhoeals - monitor as may be contraindicated if idiopathic IBD

For more information please see the HealthPathways Tasmania website.

Clinic appointments

? Red location flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency

? Potentially life-threatening symptoms suggestive of:

• acute upper GI tract bleeding
• acute severe lower GI tract bleeding
• oesophageal foreign bodies/food bolus
• bowel obstruction
• abdominal sepsis
• Acute Severe Colitis - see note

? Severe vomiting and/or diarrhoea with dehydration
? Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
? Biliary sepsis (to be referred to a centre with ERCP service)

Note- Acute severe colitis as defined by the Truelove and Witts criteria - all patients with greater than or equal to 6 bloody bowel motions per 24 hours plus at least one of the following:

• temperature at presentation of over 37.8°C,
• pulse rate at presentation of over 90 bpm,
• haemoglobin at presentation of under 105 gm/l, CRP over 30mg/dl at presentation (or ESR over 30 mm/hr)

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Urgent (Category 1)

Diarrhoea over 6 weeks that is affecting activities of daily living and with any of the following concerning features select those that apply:

• bloody or nocturnal diarrhoea
• weight loss, greater than or equal to5% of body weight in previous 6 months
• persistent abdominal pain
• iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
• patient and/or family history of bowel cancer or inflammatory bowel disease

We will endeavour to see these patients within four weeks

Urgent referrals should be accompanied by a phone call to the clinic and the relevant doctor for urgent assessment, or patient should be directed immediately to the Emergency Department.

Semi-urgent (Category 2)

Diarrhoea over 6 weeks without concerning features (as above)

Availability

North

Launceston General Hospital
Level 3 - Specialist Clinics

Phone: 1300 977 694
Fax: 03 6777 5227

North West

All North West referrals are managed via  Mersey Community Hospital
Phone: 03 6478 5222
Fax: 03 6441 5942

South

Wellington Clinics (Level 10)
Phone: 03 6166 0000
Fax: 03 6234 3982