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What is Diarrheal Disease?
With is Dysentary?
- •Increase in stool mass, stool
- frequency, and/or stool fluidity is perceived as diarrhea by most patients
- •Dysentery: Low-volume, painful
- bloody diarrhea
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What is secretory Diarrhea?
- more than 500 ml of fluid stool per day and which is isotonic and persists during fasting, usually infectious,
- viral or enterotoxin
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What is Osmotic Diarrhea
- greater than 500mL per
- day and abates with fasting; stool is hypertonic to plasma by 50 or > mOsm, classically lactase
- deficiency
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What is Exudative disease
- •mucosal destruction leads to purulent, bloody stools that persist
- on fasting, usually bacterial or IBD
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What is Deranged motility
improper gut neuromuscular function, can be neural, hormonal, surgical
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What is Malabsorption and what classic disease will you see it in?
cannot absorb neutriants. See Steatorrea (fat in stool)
Associated with CELIAC disease and Giardia
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in Infectious Enterocolitis, what are the most common viral infections?
Rotavirus and Calcivirus
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Who does Rota virus target?
% of viral enterocolitis?
- Children 6-24 months
- 60% of cases
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What are the three mechanism of Bacterial attacts in Bacterial Enterocolitis?
1. Ingestion of Preformed toxins: (staph, vibrio, clostridium, botulinum)
2. Infection by toxigenic organism: (Ecoli, Cholerae, campylobacter)
3. Infection by enteroinvasive organism: (Shigella, salmonella, Campylobacter, E coli)
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Cholera
Where is it mot located?
What is the mechanism of the Virus?
What receptor is effected?
Located in South Asia
- Classic Toxogenic organism (Ab toxin, tuns Gs proteins on--> decreased Cl absorption)
- CFTR receptor inhibited.
-
See watery diarrhea, PIGBEL
Clostridium Perfringens
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Watery diarrhea, looks like acute apendesitis
Vibrio Cholerae
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What does Shigelle cause ?
Ritters syndrome (cannot See, pee or climb a tree)
Dysentary
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Typhoid Fever, think
Salmonella
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What is Antibiotic-Associated Colitis\Pseudomembranous Colitis?
What toxins cause it?
- -Acute colitis characterized by formation of an adherent layer of inflammatory cells and debris overlying sitesof mucosal injury-Clostridium Defficile
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 you detect Clostridium Difficile? What is this?
- Antibiotic-Associated Colitis
- Pseudomembranous Colitis
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Parasitic Enterocolitis
Most Common Nematode?
Two common unicellular parasites?
- Ascaris
- - Entameobba histolytica-->
- -Giardia Lamblia (most common)
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What will this present as?
RUQ tenderness
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Giardiasis, What are the Three common forms?
What does it present with?
- 1.Asymptomatic Carrier
- 2.Acute Diarrhea
- 3.Chronic Gastreintestinal disease
Presents with-- malabsorption, recurrent diarrhea, and with or with out abdominal pain
-
-
Giardia infection.
Who is targeted?
Where is it most commonly spread?
- - Young children
- -day cares, recreational water, developing countries
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What is Necrotizing Enterocolitis?
What do you do to treat?
What age?
acute necrotizing inflammation of the small and large intestines with the severe consequence of transmural necrosis of intestinal segments
- - Have to resect the bowel.
- - Neonates, when starting to eat (2-4 days), more frequent in premies
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What is Collagenous and Lymphocytic Colitis?
What ages are affected?
What do you see chilically?
- -Distinct disorder of the colon
- -Middle aged and older Women (Collagenous) and Older males and females (Lymphocytic)
-See chronic diarrhea
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50% of AID patients develope_____?
-what infection is the most common cause of this?
- -Diarheal illness
- •Cryptosporidia (most commonly) but also mycobacteria, CMV, microsporidiosis
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What is Cryptosporidium parvum?
what is this an improtant cause of?
- considered a very rare pathogen of immunodeficient individuals.Improtant cuase of Diarrhea
-
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Drug-induced Intestinal Injury, what happens?
Most offen caused by?
Injury leads to? Colon?
Drug adheres to the walls and releases it contents locally
- NSAIDS
- Malabsorption
- Diarrhea
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What are the Most Common Causes of Malabsorption in the US??
-
–Celiac disease
- –Pancreatic insufficiency
- –Crohn Disease
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What are the Least Common Malabsorption causes in the US?
- –Whipple Disease (PAS +)
- –Disaccharidase (Lactase) Deficiency
- –Abetalipoproteinemia
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What is Celiac Disease?
What is the Genetic Predisposition?
Inciting agent is?
B or T cells response?
- an inflammatory disease of the small bowel that results from gluten ingestion in genetically susceptible individuals. leads to diffuse severe atrophy and blunting of villi,
- - (HLA-DQ2 and DQ8).
- - Gluten (gliadin)
- - T cell response--- See High CD4 and 8
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In Celiac disease, what does it present with clinically?
Any skin disease associated?
Increased risk for?
- -Diarrhea and Steatorrhea, Malabsorption, Anemia, osteoporosis, infertility, myopathy and neuropathy
- - Dermatitis Herpetiformis
- -T cell Lymphoma, SI adenocarcinoma, esophageal SCC.
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Diagnose Celiac with?
IgA and Small Bowel Biopsy
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Picture of the Small Intestine, what is wrong?
- Celiac Disease
- shows diffuse severe atrophy and blunting of villi,
-
Celiac disease (dermatitis Herpetiformis)
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What is Tropical Sprue
What is it due to?
Celiac Like disease in the tropics
Bacterial overgrowth (e coli or Hemophillus)
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What is Whipple disease?
What occurs clinically?
What is it caused my?
What race, age and sex?
What will you see Hystologically and tests wise?
- -Chronic, relapsing multisystem illness involving the gastrointestinal tract
- - See Weight loss, Diarrhea and Polyarthritis
- -Tropheryma whippelii
- - effects White, Males 4th to 5th decade
- - See Foamy macrophages and PAS +
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See Foamy Macrophages in the Villi --> Whipples disease
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What is Disaccharidase (Lactase) Deficiency?
Clinically presents with?
Loss of brush border enzyme
- Osmotic Diarrhea and unabsorbed Lactose
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Irritable Bowel SYNDROME occurs in?
Females
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Albetalipoproteinemia
- Malabsorption of lipids--> babies Failure to thrive
- See Acanthocytes in blood smear
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