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admin | What Treats Bv | 18.08.2013
Activation of electrolyte secretion and mechanisms for diarrhea in infectious secretory diarrhea and inflammatory bowel disease.
For many people, diarrhea represents an occasional inconvenience or annoyance, yet at least 2 million people in the world, mostly children, die from the consequences of diarrhea each year. There are numerous causes of diarrhea, but in almost all cases, this disorder is a manifestation of one of the four basic mechanisms described below. Ingestion of a poorly absorbed substrate: The offending molecule is usually a carbohydrate or divalent ion.
Malabsorption: Inability to absorb certain carbohydrates is the most common deficit in this category of diarrhea, but it can result virtually any type of malabsorption.
A distinguishing feature of osmotic diarrhea is that it stops after the patient is fasted or stops consuming the poorly absorbed solute. Large volumes of water are normally secreted into the small intestinal lumen, but a large majority of this water is efficienty absorbed before reaching the large intestine. The epithelium of the digestive tube is protected from insult by a number of mechanisms constituting the gastrointestinal barrier, but like many barriers, it can be breached.
The immune response to inflammatory conditions in the bowel contributes substantively to development of diarrhea. In order for nutrients and water to be efficiently absorbed, the intestinal contents must be adequately exposed to the mucosal epithelium and retained long enough to allow absorption. Alterations in intestinal motility (usually increased propulsion) are observed in many types of diarrhea. A 32-year-old man is evaluated in the emergency department for a 5-day history of worsening crampy abdominal pain and eight to ten loose bowel movements a day. 55yo male with 1 month history of increasing flatulence and loose stools – BMs occurring 2-3x daily. A 68-year-old man with a history of osteoporosis and alcoholism is evaluated in the emergency department for a 7-month history of diarrhea during which he has noted an increased volume of stool and decreased consistency. 55 yo male evaluated for a 4-month history of frequent and urgent defecation with loose and bloody stool, mild abdominal cramping, and fatigue. A 45-year-old woman is evaluated for a 2-week history of right leg and flank pain and a slight limp. A 47-year-old woman is evaluated in the emergency department for 3 days of abdominal pain, distention, and constipation. A 75-year-old woman is evaluated in the emergency department for the acute onset of passage of bright red blood per rectum. Bacterial toxins produced by Yersinia enterocolitica and heat-stable Escherichia coli toxin increase intracellular cGMP by activating the membrane-localized guanylate cyclase.
Common examples include mannitol or sorbitol, epson salt (MgSO4) and some antacids (MgOH2). A common example of malabsorption, afflicting many adults humans and pets is lactose intolerance resulting from a deficiency in the brush border enzyme lactase.

Disruption of the epithelium of the intestine due to microbial or viral pathogens is a very common cause of diarrhea in all species. The patient has a 5-year history of ulcerative colitis treated with azathioprine and topical mesalamine; before this episode, he had one or two bowel movements of well-formed stool a day. He has had intermittent abdominal pain but not severe enough to prevent him from eating or drinking. Has 8 BMs daily and often wakes at night with symptoms; before this episode he had one bowel movement a day with well-formed stool. One year ago, she was diagnosed with pan-ulcerative colitis and responded well to initial and maintenance therapy with balsalazide.
He was hospitalized 5 days ago for chest pain and was found to be in rapid atrial fibrillation and a myocardial infarction was diagnosed. This morning she had crampy abdominal pain and had two episodes of diarrhea after which she passed bright red blood. He is asymptomatic and has no significant medical history, but he is concerned about his risk for colon cancer.
He has had recurrent 2 - or 3-day periods of black, tarry stool followed by normal stool for the next week.
She had an elective ileocolic resection with a primary anastomosis when her disease proved to be refractory to corticosteroid therapy. He underwent cardiac catheterization and double stent placement after which he has had intermittent hypotension and has remained in atrial fibrillation with a controlled ventricular rate. The patient has a history of hypertension and coronary artery disease, and her medications are aspirin, ramipril, metoprolol, and simvastatin.
He has otherwise been healthy and has not traveled recently, had contact with sick persons, or been noncompliant with medication. She has since been pain-free but has required intermittent courses of antibiotics and mesalamine for diarrheal flares of disease. She has had surveillance colonoscopy every 3 years since then and has had two additional polyps detected. During this time, he has developed anemia and required transfusions of a total of eight units of blood. On physical examination, there is mild lower abdominal tenderness without rebound or guarding; there are no palpable abdominal masses.
She has had routine colonoscopic examinations with biopsy specimens revealing non-necrotizing granulomas in the colon and neo-terminal ileum. She is otherwise healthy, and her only medication is an occasional over-the-counter laxative or stool softener.
His father has no history of colon polyps, and there is no family history of colorectal cancer.
The effects of CTX are also indirect, by stimulation of enteric nerves, which then secrete serotonin (5-HT), acetylcholine (ACh), vasoactive intestinal polypeptide (VIP), and nitric oxide (NO).

His wife says that he has never had any gastrointestinal problems, but that he has not had a bowel movement since he entered the hospital. The patient’s medical history includes hypertension and mild chronic obstructive pulmonary disease. The anorectal tone is normal, and on rectal examination, the patient is able to expel the examiner’s finger when asked to mimic a bowel movement. The abdomen is soft with tenderness in the left lower quadrant without rebound or guarding.
His exam (including vital signs) is benign except for rectal examination which reveals black, tarry stool that is positive for occult blood. A similar mechanism is used by the rotavirus toxin NSP4, which in addition may activate luminal Ca2+-dependent Cl? channels (CaCC).
Stimulation of CFTR by CTX and other bacterial toxins and increase in intracellular cAMP leads to inhibition of electroneutral absorption by NHE3 and electrogenic absorption by epithelial Na+ channels ENaC. Which of the following is the most appropriate next step in the management of this patient? Colonoscopy shows continuous erythema, friability, and loss of vascular pattern from the rectum to the splenic flexure; the rest of the colon and terminal ileum is normal. Which of the following is the most appropriate next step in the evaluation of this patient? Other bacterial toxins, such asClostridium difficile toxins act via small intracellular G proteins (Rho, Rac). After bowel decompression with a nasogastric tube and bowel rest, upper and lower gastrointestinal radiographic series shows no obstructive lesions. In inflammatory bowel disease, secretion and diarrhea are caused by loss of surface area for absorption, enhanced tight junction permeability, and an activation of luminal CFTR Cl? channels. Secretion is activated by metabolites of the arachidonic acid pathway and by inflammatory mediators such as TNF-?, interferon-? and IL-1.
Some enteropathogenic bacteria induce diarrhea via structural changes in parallel with an increase of inflammatory mediators. Tryptase is secreted by the nearby mucosa-associated lymphatic tissue (MALT) and binds to PAR2 receptors.
In parallel to the activation of Cl? secretion, reduced electrogenic and electroneutral Na+ absorption is observed, due to inhibition of NHE3 and ENaC.

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