Diarrhea (stool >250g/day)

High osmotic gap (>50) Abate with fasting Osmotic diarrhea No blood in stool Weight loss, vitamin deficiency, flatulence (undigested carbs) , pale foul smelling floating stools (undigested lipids) Malabsorptive osmotic diarrhea Lactose in take diarrhea Gas (H or CH4 , bloating, nausea Gas test (H >20ppm or CH4 >12 ppm,) Lactose intolerance 8 Incident of surgery on ileum Resected ileum 9 Just low RBC (pernacious anemia) <100 cm resected Pernaciousanemia with steatorrhea (fatty stool) >100 cm resected increased fecal fat content , decreased vit B12 absorbed, increased alkaline phosphatase Alcoholism: abdomen pain, mod increase WBC, increase plasma amylase and lipase (pancreatic enzymes) , Chronic pancreatitis (pancreatic insufficiency) 10 Jaundice, Gallstones (blocked pancreaitic duct or bile duct) Gluten triggers immune response Celiac sprue 5 Osmotic diarrhea

cramping (b/c SI volume too high and contracts) No fecal leukocytes Non-inflammatory infectious diarrhea 1 Raw fish/meat . noninfectious (inflammatory) Distal ileum and colon Ulcers in colonoscopy . maybe nausea/vomit. precipitates bile salts. no fever/pain. obstruction and perforation Peforation . autoimmune. less severe. internal obstruction. only mucosal damage Ulcerative colitis 7 Peptic ulcer (hist increase gastrin release)-endoscopy Mucosal damage. immunocompromised high risk (toxin related-(bacterial. inflammation of entire wall of intestinal mucosa. abscess.Destroy vili in small intestine= decreases surface area= less absorption Blood in stool Increase WBC Chronic. viral protozoa)-ie: raw meat/fish watery large volume diarrhea. internal bleed Arthritis/skin inflam disorder might be oresent Crohn s disease 6 Only colon infection No obstruciton/perforation. normal pancreases with inactive pancreatic enzymes = decreases Surface area Malabsorption Zolinger Ellison syndrome (neuroendorcrine) 4 Low osmotic gap (<50) Not abate with fasting Secretary diarrhea No blood in stool Infectious diarrhea: traveling.

fecal Cl. increase camp. fecal leukocytes. noninfectious . hypokalemia Large volume (3-20L/day) Long term > 3 weeks VIP secreting tumor Elevated cAMP = elevated gastrin levels=Hypersecretion See pancreatic mass on CT VIPoma (neuroendocrine) 3 Symptoms of both osmotic and secretary diarrhea Infectious diarrhea: mostly acute (traveling. modifies ion channels like CFTR. activates Cl channels ) Fecal bacteria Cholera toxin Elevated gastrin. ab pain. protozoa) Pathogen colonizes lumen but NOT invading mucosa releases secretagogues (enterotoxins activated adenylcyclase. small volume diarrhea (secretory not pronouced osmotic more) Pathogen invades mucosa. viral. immunicompromised high risk) fever. metabolic acidosis. proliferates and releases toxins that damage mucosa further (decrease SA) Inflammatory infectious diarrhea 2 Secretory due to increase cytokines Blood in stool (ischemia mucosal damage etc) Increase WBC count Chronic.Toxin-related (bacterial.

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