diarrhea Flashcards
4 types of diarrhea
osmotic
secretory
inflammatory
dysmotility
CAMP
increase in camp–> increase secretion and decreased absorption via phosphorylation of CFTR which prolongs its opening
Ne and SMS (Gi)-_>decrease camp
VIP, PG (Gs)–>incease camp
osmotic gap
elevated above 100 in osmotic diarrhea
reasons for secretory diarrhea
endocrine tumor (VIPoma, gastrinoma)
laxatives
lubiprostone (apical Cl channel activator)
cholera
inflammatory diarrhea
destruction of absorptive cells
bloody mucoid stool, increase in fecal WBC, fever
dysmotility diarrhea
decreased intestinal transit time which leads to both an osmotic shift (hypertonic intestinal content) and a secretory (rapid distention of bowel–>VIP–>fluid and extrolyte secretion) component
surgeries, diseases associated with dysmotility (scleroderma, DM)
bacterial overgrowth
slows intestinal transit–>bacterial overgrowth–>deconjugate bile–>decreased cholesterol absorption–>steatorrhea
mexico/south america
enterotoxic ecoli–traveler’s, ehec
asia
invasive salmonella, shigella
camping/hikes
giardia
fecal leukocyte and culture
positive: bacterial
negative: viral
bad part of antidiarrheal agents
can worsen inflammatory disease
acute vs chronic diarrhea
less than 3 weeks vs greater than 3 weeks
crohns spares the
rectum
ulcerative collitis
starts in rectum and cotninues proximally
special nonrisk factor in ulcerative collitis
smoking is protective
so is appendectomy
infiltration and crypts of UC
restricted to mucosa, do not spread to mucularis
crohn’s disease pathology
transmural lesions (all through the serosa) non-caseating granulomatous inf cobblestoning
CD ddx from IBS
pain awakens frm sleep
fistulas are unique to
crohn’s disease
5-ASAs
mesalamine
work well for UC but not CD
what is best for CD and UC
combo of immunomodulator and bilogic
