PATHOPHYSIOLOGY

AND PATHOGENESIS
OF DIARRHEA
 Osmotic Diarrhea
 Absorption of water in the intestines is dependent
on adequate absorption of solutes.
 Ingestion of a poorly absorbed substrate
 usually a carbohydrate or divalent ion.
 examples include mannitol or sorbitol, epson salt
(MgSO4) and some antacids (MgOH2).
 Malabsorption
 Inability to absorb certain carbohydrates
 lactose intolerance resulting from a deficiency in
the brush border enzyme lactase.
 The osmotically-active lactose is retained in the
intestinal lumen, where it "holds" water.
 Secretory Diarrhea
 Occurs when secretion of water into the int
estinal lumen exceeds absorption.
 secretory diarrhea associated with cholera
 Vibrio cholerae => cholera toxin => activat
es adenylyl cyclase => increase in intracel
lular concentration of cyclic AMP => prolon
ged opening of the chloride channels => sec
retion of water from the crypts
 Additionally, cholera toxin affects the ent
eric nervous system, resulting in an indepe
ndent stimulus of secretion.
Inflammatory and Infectious Dia
rrhea
 Destruction of the absorptive epithelium result
s exudation of serum and blood into the lumen.
 due to microbial or viral pathogens
 • Bacteria: Salmonella, E. coli, Campylobacter
 • Viruses: rotaviruses, coronaviruses, parvovi
ruses (canine and feline), norovirus
 • Protozoa: coccidia species, Cryptosporium, G
iardia
 immune response to inflammatory conditions -Rea
ctive oxygen species, inflammatory mediators an
d cytokines which can stimulate secretion.
Diarrhea Associated with Derang
ed Motility
 In order for nutrients and water to b
e efficiently absorbed, the intestina
l contents must be adequately exposed
to the mucosal epithelium and retaine
d long enough to allow absorption.
 accelerate transit time could decreas
e absorption
 Congenital Diarrheas
 Autosomal-recessive defects
 congenital chloride diarrhea -defect
in brush border Cl/HCO3 exchange
 congenital sodium-secretory diarrhea
-defect in brush border Na/H exchang
e
Pathophysiology of Dehydrati
on
The most common source of lost of intestinal fluid is from vom
iting and diarrhea. The negative fluid balances result from
increase output and decrease input. Decrease in body volume
causes reduction in both intracellular and extracellular flu
id volume. If dehydration progress, hypovolemic shock will o
ccur.

 Isonatremia dehydration: occur when lost of fluid is similar

in the sodium concentration to the blood. Sodium and water l
oss are of the same relative magnitude in the intravascular
and extravascular fluid compartment.

 Hyponatremia dehydration: lost of fluid contain more sodium

than in blood. Because more sodium is lost, the serum sodium
is low, intravascular water shift to the extravascular space
.
Pathogenesis
 simplest life cycles of all human parasites
 the trophozoite, which exists freely in the
human small intestine
 the cyst, which is passed into the environment
 no intermediate hosts are required
 Reference
 http://www.vivo.colostate.edu/hbooks/pathphys/digesti
on/smallgut/diarrhea.html
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC152597/
 http://www.jci.org/articles/view/18326/pdf
 http://www.msdlatinamerica.com/ebooks/TextbookofGastr
oenterology/sid957177.html
 http://emedicine.medscape.com/article/928598-overview
 http://www.biomedsearch.com/nih/Pathogenesis-traveler
s-diarrhea/7671645.html
 http://www.medindia.net/patients/waterborne/giardiasi
s_pathogenesis.htm
 http://www.giardiasis.org/Pathophysiology.aspx
 http://emedicine.medscape.com/article/176718-overview
Thank you ^^