Acute Diarrhea & Gastroenteritis

Posted by e-Medical PPT Wednesday, November 7, 2012
Definitions
Diarrhea : excessive loss of fluids & electrolytes in stool
More than 5g /kg /day
Increase in liquidity & frequency
Pseudodiarrhea & hyperdefecation
Encopresis
Dysentery : small volume , frequent,bloody, tenesmus , urgency
9 liters of fluid enter the GI tract
4-5l absorbed in jejunum , 3-4 ileum, 800 ml in colon.
Water transport follows Na & nutrient active & passive transport .
The basis for ORS treatment

Mechanisms of diarrhea
Disturbed intestinal solute transport, water movement across intestinal wall.
Secratory
 Osmotic
Dysmotility
Inflammatory

Secratoy Diarrhea
Agent that binds to surface receptors , increasing cAMP,increased secretion.
Watery , large volume , normal osmolality( 2* Na+K )
Persists during fasting,no stool leukocytes.
Examples; cholera, toxigenic E.coli,carcinoid ,VIP, congenital chloride diarrhea,Clostridium difficile,cryptosporidium.

Osmotic Diarrhea
Occurs after ingesting a poorly absorbed solute .
Stools are of less volume, acidic, reducing substances, high osmolality > 2* Na + K.
Stops with fasting , increased breath hydrogen with malabsorption,no stool leukocytes.
Examples : lactase deficiency , glucose-galactose malabsorption,lactulose, laxative abuse.

Motility Diarrhea
Increased motility :
  decreased transit time.
  Stimulated by gastro-colic reflex
  Irritable bowel syndrome
  Thyrotoxicosis
  Post vagotomy
  Infections
Decreased motility:
  Stasis : bacterial overgrowth.
  Pseudo-obstruction, blind loop
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