© 2004 Current Medicine Group Ltd FISIOLOGIA DIGESTIVA (BCM II) Clase 12: Diarrea Dr. Michel Baró Aliste

© 2004 Current Medicine Group LtdDefiniciones Diarrea: aumento de la frecuencia y/o volumen de las deposiciones Mayor a 200 g/día PseudodiarreaIncontinencia Aguda (<2 semanas) Crónica (>4 semanas)

© 2004 Current Medicine Group Ltd Tipos de Diarrea -Osmótica (malabsortivas) -Secretora (alteración de transporte de electrolitos) -Alteración de la motilidad -Inflamatoria (disenterías)

© 2004 Current Medicine Group Ltd Water fluxes through the intestine

© 2004 Current Medicine Group Ltd Calculation of osmotic gap Diarrea Secretora vs. Diarrea Osmótica

© 2004 Current Medicine Group Ltd Typical features of secretory diarrhea

© 2004 Current Medicine Group Ltd Effects of resection of different parts of small intestine (a)

© 2004 Current Medicine Group Ltd Effects of resection of different parts of small intestine (b)

© 2004 Current Medicine Group Ltd Effects of resection of different parts of small intestine (c)

© 2004 Current Medicine Group Ltd Effects of resection of different parts of small intestine (d) Umbral catártico de las Sales biliares: 3 a 5 mmol/L

© 2004 Current Medicine Group Ltd Effects of resection of different parts of small intestine (e)

© 2004 Current Medicine Group Ltd Mechanisms of diarrhea in enteritis

© 2004 Current Medicine Group Ltd Bile acid malabsorption can be caused by various mechanisms (a) Ac. biliares en colon > 3 mmol/l = diarrea Diarrea secretora por Malabsorción de ac. biliares: Mecanismos: Tránsito aumentado Resección intestinal Daño mucosa del íleon

© 2004 Current Medicine Group Ltd Laxatives and detection methods

© 2004 Current Medicine Group Ltd Laxative abuse suspects

© 2004 Current Medicine Group Ltd Diarrheal syndromes related to circulating secretagogues

© 2004 Current Medicine Group Ltd Zollinger-Ellison syndrome results from secretion of gastrin

© 2004 Current Medicine Group Ltd Vasoactive intestinal polypeptide-secreting tumors (a) Sindrome de Verner-Morrison o Cólera pancreático -diarrea acuosa -hipokalemia -hipocloridia AMPc

© 2004 Current Medicine Group Ltd Vasoactive intestinal polypeptide-secreting tumors (b) VIPoma

© 2004 Current Medicine Group Ltd Vasoactive intestinal polypeptide-secreting tumors (c)

© 2004 Current Medicine Group Ltd Vasoactive intestinal polypeptide-secreting tumors (d)

© 2004 Current Medicine Group Ltd Medullary carcinoma of the thyroid products

© 2004 Current Medicine Group Ltd Drugs associated with diarrhea

© 2004 Current Medicine Group Ltd Longstanding diabetes mellitus and chronic diarrhea

© 2004 Current Medicine Group Ltd Malabsorción - Esteatorrea

© 2004 Current Medicine Group Ltd Diseases that impair nutrient absorption

© 2004 Current Medicine Group Ltd Stool fat concentrations as a clue to etiology <6 g/día>20 g/día 9,5%

© 2004 Current Medicine Group Ltd Effect of oral pancreatic enzyme replacement (A)

© 2004 Current Medicine Group Ltd Effect of oral pancreatic enzyme replacement (B)

© 2004 Current Medicine Group Ltd Intraduodenal bile acid concentrations and fecal fat output 2,5 umol/mL Bilirrubina pl >4,5 mg%

© 2004 Current Medicine Group Ltd Pathophysiology of bacterial overgrowth Inflamación Atrofia vellositaria - Daño histológico -Malabsorción de nutrientes -Producción de toxinas Reabsorción en yeyuno Absorción grasa

© 2004 Current Medicine Group Ltd Multiple jejunal diverticula

© 2004 Current Medicine Group Ltd Multiple small bowel diverticula

© 2004 Current Medicine Group Ltd Scleroderma

© 2004 Current Medicine Group Ltd Billroth I and II subtotal gastrectomy

© 2004 Current Medicine Group Ltd Radiograph of a patient with a Billroth II procedure

© 2004 Current Medicine Group Ltd Pathophysiology of lactase deficiency

© 2004 Current Medicine Group Ltd Intestinal fluid accumulation with a lactose-containing meal

© 2004 Current Medicine Group Ltd Effect of unabsorbed carbohydrate on stool water output 3,5 g H2O / mmol de molécula no absorbida (carbohidrato, ácido orgánico, catión)

© 2004 Current Medicine Group Ltd Celiac sprue (A) – Enfermedad Celíaca Gluten: trigo, centeno, avena

© 2004 Current Medicine Group Ltd Celiac sprue (B) Tres meses después de dieta libre de gluten

© 2004 Current Medicine Group Ltd Molecular pathophysiology of celiac sprue (A)

© 2004 Current Medicine Group Ltd Molecular pathophysiology of celiac sprue (B)

© 2004 Current Medicine Group Ltd Molecular pathophysiology of celiac sprue (C)

© 2004 Current Medicine Group Ltd Molecular pathophysiology of celiac sprue (D) HLA-DQ2 or HLA-DQ8

© 2004 Current Medicine Group Ltd Molecular pathophysiology of celiac sprue (E)

© 2004 Current Medicine Group Ltd Molecular pathophysiology of celiac sprue (F)

© 2004 Current Medicine Group Ltd Detecting celiac sprue (A)

© 2004 Current Medicine Group Ltd Detecting celiac sprue (B)

© 2004 Current Medicine Group Ltd Classic moulage pattern of celiac sprue

© 2004 Current Medicine Group Ltd Tropical sprue

© 2004 Current Medicine Group Ltd Whipple's disease

© 2004 Current Medicine Group Ltd Eosinophilic gastroenteritis

© 2004 Current Medicine Group Ltd Massive small-bowel resection

© 2004 Current Medicine Group Ltd Jejunal length and sodium-water absorption (A)

© 2004 Current Medicine Group Ltd Jejunal length and sodium-water absorption (B)

© 2004 Current Medicine Group Ltd Rehydration therapy enhances sodium and water absorption

© 2004 Current Medicine Group Ltd Sodium balance after different sodium-containing test solutions

© 2004 Current Medicine Group Ltd Oral rehydration therapy and high-volume ostomy output

© 2004 Current Medicine Group Ltd Radiation enteritis

© 2004 Current Medicine Group Ltd Lymphangiectasia

© 2004 Current Medicine Group Ltd Selected symptoms and signs of nutrient deficiencies

© 2004 Current Medicine Group Ltd D-xylose to evaluate small-intestine absorptive function

© 2004 Current Medicine Group Ltd Enfermedad Inflamatoria Intestinal Colitis Ulcerosa Enfermedad de Crohn

© 2004 Current Medicine Group Ltd Endoscopic features of active ulcerative colitis (B)

© 2004 Current Medicine Group Ltd Microscopic features of specimen in Fig 4-8 (B)

© 2004 Current Medicine Group Ltd Endoscopic features of Crohn's disease (A)

© 2004 Current Medicine Group Ltd Specimen from patient with Crohn's colitis (B)

© 2004 Current Medicine Group Ltd Inflammatory bowel disease etiology

© 2004 Current Medicine Group Ltd Infliximab

© 2004 Current Medicine Group Ltd