Diseases of the

Intestine

 Diarrheal Disease

Diarrhea alteration in
GI function in digestion,
absorption or secretion
 Mechanism of
Pathogenesis

Osmotic factors overfeeding,
malabsorption, ingestion of nonsoluble
compounds (lactulose/MgSO4)

Decrease absorption or increase

secretion of water & electrolytes
- infectious diarrhea, free bile acid &
hydroxyl fatty acid
accumulation,presence of humoral
factors, inflammatory bowel dse,

Diminished anatomic or functional
intestinal surface area
- short bowel syndrome, mucosal dse

Altered motility hypermotility,

hypomotility
 TYPES of DIARRHEA

Diarrhea can be: infectious or non-infectious

1. Infectious
> acute diarrhea are generally infectious
> viruses/bacteria/parasites/fungietc
a) Interactions of enteric pathogen to
intestinal mucosa

1. Adherence & enterotoxin production
- V. cholera & Enterotoxic E. coli (ETEC)

* adherenceexotoxin releaseadenyl cyclase

activationcAMPCl secretion, Na absorption

* ETEC heat stable toxinguanylate cyclase

activationcGMPNa absorption inhibition without Cl
secretion
- cAMP + cGMP = profuse, watery diarrhea &
dehydration


2. Enteroinvasion with damage to epithelial
cells
- Shigella dysenteriae
enteroinvasive E. coli (EIEC)
Yersinia enterolytica
Campylobacter jejuni
- mucosal inflammation with damage
enterocytes ensues = bloody, mucoid stools
3. Enteroinvasion with penetration of lamina
propria & systemic spread
- Salmonella sp.
- invades the lamina propria inflammation
(prostaglandin release) + enterotoxins lead to
increase intestinal fluid production which are
generally loose and watery and sometimes with
blood & mucus

4. Adherence without enterotoxin production
nor damage to enterocytes
- enteropathogenic E. coli (EPEC)
- disruption of microvilli and blunting of intestinal
villi = profuse & watery stool without blood/mucus
 b) Parasitic dses

- Entamoeba histolytica & Giardia lamblia ---
considered in a diarrheic child especially if the dse
course is chronic

E. histolitica enteroinvasive
- usually bloody, mucoid stools; with tenesmus and
abdominal pain

G. lamblia interaction not yet identified,

- acute watery, non-bloody gastroenteritis that may
become chronic (pale, bulky & malodorous stool)
c) Fungal infection

- associated with chronic debilitating
illnesses & prolonged intake of
antimicrobials, corticosteroids or
immunosuppresssives
- Candida albicans is the most
prevalent
 TYPES of DIARRHEA
2. Non-infectious

> intolerance (lactose/other CHO)
> overfeeding
> drug-induced(antibiotics)
> food allergy
> poisons
> inflammatory bowel dse
 2 Major Clinical Syndromes in
Diarrhea

1. Cholera like watery, non bloody
diarrhea
Vibrio Colera,
Rotavirus
ETEC
EPEC
C. Perfringens
B. cereus
S. aureus
C. difficile
G.Lamblia


Dysentery like blood- streaked or mucoid
diarrhea
S.dysenteriae
E.histolytica
EIEC
Salmonella sp.
Yersinia enterocolitica
C. jejuni

Persistent diarrhea- 3rd clinical syndrome by

WHO, under chronic diarrhea
 Principles:

Good description of diarrheic stool +
knowing the associated symptoms
classification into clinical syndromes
The character of the stools may
indicate the site of involvement of gut
and offending agent.
Pathogens affecting Upper gut watery,
non-bloody diarrhea + anorexia and
vomiting
Lower gut bloody or blood streaked,
mucoid diarrhea + abdominal pain abd
tenesmus
 PRACTICAL DIAGNOSIS OF ACUTE
DIARRHEA

Rests chiefly on the recognition of the
clinical syndromes in diarrheas
interactions of the enteropathogens
with the intestinal mucosa.

Bloody diarrheas have been describes

by studies to be predominantly
secondary to shigella.

Non-bloody diarrheas or so-called acute
watery diarrheas generally respond well to
fluid and nutritional therapy
no need to identify pathogen

Laboratory confirmation of amebiasis and

giardiasis
Detection of the vegetative form
(trophozoite) especially in the presence of
ingested RBC, is more specific for amebiasis.