Pass The Paces

🚀 Yasir Alam's PACES HACKS #7

Decoding Diarrhoea: Let the Stool Tell the Story

When assessing a patient with diarrhoea, the pattern of stool often points directly toward the diagnosis.

1. Large-Volume Watery Diarrhoea → Secretory

Clue: Continues despite fasting.
Think: The gut is actively secreting fluid.

Causes:

Cholera
Enterotoxigenic E. coli
VIPoma
Carcinoid syndrome

Memory Tip: "Still flowing even when not feeding."

2. Moderate-Volume Loose Stool → Osmotic

Clue: Improves or stops with fasting.
Think: Something in the bowel is drawing water in.

Causes :

Lactose intolerance
Magnesium-containing laxatives
Sorbitol ingestion

Memory Tip: "No food = no osmotic load = no diarrhoea."

3. Bloody Diarrhoea + Abdominal Pain → Inflammatory

Clue: Blood, mucus, pain, and urgency.
Think: Inflammation or ulceration of the bowel.

Causes:

Inflammatory bowel disease (IBD)
Infective colitis
Ischaemic colitis

Red Flag: Blood in stool is never normal.

4. Pale, Bulky, Greasy Stool → Steatorrhoea

Clue: Difficult to flush, foul-smelling, oily appearance.
Think: Fat malabsorption.

Causes:

Coeliac disease
Chronic pancreatitis
Pancreatic insufficiency

Memory Tip: "Fat in the stool = failure to absorb fat."

5. Urgency → Think Proctitis

Clue: Sudden, compelling need to open bowels.
Think: Re**al inflammation.

Causes:

Ulcerative colitis
Infectious proctitis
Radiation proctitis

Exam Pearl: Urgency often localizes pathology to the re**um.

6. Nocturnal Diarrhoea → Organic Disease

Clue: Wakes the patient from sleep.
Think: Genuine pathology rather than a functional disorder.

Causes:

Inflammatory bowel disease (IBD)
Diabetic autonomic neuropathy
Microscopic colitis

Exam Pearl: IBS rarely causes nocturnal symptoms.

YOUNG STROKE : Think Beyond Atherosclerosis
When a young patient presents with stroke, remember the approach

1. Cardiac Causes

The heart is a common embolic source.
🔹 CRHD with AF***
🔹 Mitral stenosis***
🔹 Patent foramen ovale (PFO)
🔹 Congenital heart disease
🔹 Infective endocarditis***
🔹 Mural thrombus
🔹 Atrial myxoma
🔹 Mitral valve prolapse

PACES pearl: Always ask yourself, "Could this be a cardioembolic stroke?"

2. Vasculitis

Inflamed vessels can cause cerebral ischemia.
🔹 SLE + APAS***
🔹 Polyarteritis nodosa (PAN)
🔹 Granulomatosis with polyangiitis (GPA)
🔹 Takayasu arteritis***
🔹 Giant cell arteritis (GCA)

PACES pearl: Look for systemic clues—rash, arthralgia, constitutional symptoms, pulse deficits.

3. Hematological Disorder

Abnormal blood = abnormal flow.
🔹 Polycythaemia rubra vera (PRV)***
🔹 Sickle cell disease
🔹 Thalassaemia
🔹 Leukaemia
🔹 Disseminated intravascular coagulation (DIC)
🔹 Thrombotic thrombocytopenic purpura (TTP)

PACES pearl: Check FBC and blood film in unexplained young stroke.

4. Hyper coagulable States

Think thrombophilia.
🔹 Antiphospholipid antibody syndrome (APAS)***
🔹 Protein C deficiency
🔹 Protein S deficiency

PACES pearl: Recurrent thrombosis or pregnancy losses should raise suspicion.

5. Drugs & Substance Abuse

Often overlooked in exams and clinical practice.
🔹 Co***ne***
🔹 Amphetamines
🔹 He**in
🔹 Phenyl propanol amine

PACES pearl: A careful drug history is essential in every young stroke patient.

Last but not the least don’t forget RUPTURED ANEURYSM In young stroke

In examination DON’T FORGET to examine the Pulse (in both hands) , Precordium & Carotid !

Tomorrow at 9 PM (through online zoom)

LCC case practice for PACES candidate

OPEN FOR ALL

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🌙 Eid Mubarak to Everyone

May Allah ﷻ accept our sacrifices, forgive our shortcomings, and shower us with endless mercy and blessings. 🤍

The Prophet ﷺ said:

*"The most beloved deeds to Allah are those that are consistent, even if they are small."

May we remain steadfast in our prayers, kindness, and good deeds even after Eid. May our hearts stay connected to faith, gratitude, and compassion. ✨

Eid Mubarak once again! 🌸

— Dr. Md. Yasir Alam
Pass The Paces

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An approach to a case of chronic diarrhoea - Systemic sclerosis Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.

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Pass The Paces

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