Butt Pee Lecture Flashcards
what is the pathophys of butt pee aka diarrhea?
water malabsorption increasing intraluminal volume that exceeds the holding capacity of the fecal solids
clinically = 3 or more shits in a day and fluidy
What is the normal fluid intake and output of ingested fluids, gastric, liver, pancreatic, and small bowel secretions in the colon?
10L in /24 hrs
0.1L out in stool / 24 hours! (99%)
majority of which is absorbed in small bowel! (~85%)
How would a 1-2% decrease in absorption in the small intestine effect the stool?
It would cause an increase in stool fluid content by 50-100%!!! (ie 0.5 L out in 24 hours = diarrhea)… so it doesn’t take much of a decrease in small bowel absorption to cause a huge change in shit consistency
What is osmotic butt pee?
when little or no passive electrolyte absorption occurs in the gut… therefore it pulls water into the lumen…
*causes and increased stool osmotic gap! gap >50mg!
How do celiac sprue and lactose intolerance cause osmotic butt pee?
Celiac = typically causes blunted villi in the distal duodenum so increases the electrolytes in lumen drawing in water
lactase insufficiency –> build up of galactose which acts as an osmotic draw for water
*** also this is how laxatives acts… non-absorbable sweeteners (ie if the patient drinks alot of diet pepsi w/ aspartame those acts as an osmotic draw too)
What is Secretory butt pee? and how can u distinguish it from osmotic butt pee in CBC?
its a disrupted mucosal absorption and increased secretion secondary to driving forces which causes an increase in Cl- and HCO3- secretion…
On CBC… you would see a decreased Cl- and HCO3- w/ NO increased stool water osmotic gap; unlike osmotic butt pee.
What are 2 big causes of secretory diarrhea?
1) Bile acids - in something like crohn’s where terminal ileum doesn’t reabsorb bile… it travels down to colon and increase cAMP stimulating water secretion into lumen!
2) steatorrhea of any cause will typically induce secretion of water into the colon
Motility abnormalities create a 3rd type of butt pee… how its this type different?
due to a change in pressure gradients, increased flow and decrease transit time w/ contractions upstream and resistance to contractions downstream
What conditions would cause motility disorders?
functional IBS, diabetic neuropathy, bacterial overgrowth, bile acid deconjugation
What are a few extra-enteric clinical findings in IBD?
iritis/uveitis aphthous ulcers (crohns) erythema nodosum (w/ U.C.) large joint arthtralgias
If you suspect celiac sprue… what antibodies would you look for in the serum?
anti-endomysial
anti-tissue transglutaminase
*both IgA (cuz we’re in the gut)
