1. © 2004 Current Medicine Group Ltd FISIOLOGIA DIGESTIVA (BCM II) Clase 12: Diarrea Dr. Michel Baró Aliste

2. © 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)

3. © 2004 Current Medicine Group Ltd Tipos de Diarrea -Osmótica (malabsortivas) -Secretora (alteración de transporte de electrolitos) -Alteración de la motilidad -Inflamatoria (disenterías)

4. © 2004 Current Medicine Group Ltd Water fluxes through the intestine

5. © 2004 Current Medicine Group Ltd Calculation of osmotic gap Diarrea Secretora vs. Diarrea Osmótica

6. © 2004 Current Medicine Group Ltd Typical features of secretory diarrhea

7. © 2004 Current Medicine Group Ltd Effects of resection of different parts of small intestine (a)

8. © 2004 Current Medicine Group Ltd Effects of resection of different parts of small intestine (b)

9. © 2004 Current Medicine Group Ltd Effects of resection of different parts of small intestine (c)

10. © 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

11. © 2004 Current Medicine Group Ltd Effects of resection of different parts of small intestine (e)

12. © 2004 Current Medicine Group Ltd Mechanisms of diarrhea in enteritis

13. © 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

14. © 2004 Current Medicine Group Ltd Laxatives and detection methods

15. © 2004 Current Medicine Group Ltd Laxative abuse suspects

16. © 2004 Current Medicine Group Ltd Diarrheal syndromes related to circulating secretagogues

17. © 2004 Current Medicine Group Ltd Zollinger-Ellison syndrome results from secretion of gastrin

18. © 2004 Current Medicine Group Ltd Vasoactive intestinal polypeptide-secreting tumors (a) Sindrome de Verner-Morrison o Cólera pancreático -diarrea acuosa -hipokalemia -hipocloridia AMPc

19. © 2004 Current Medicine Group Ltd Vasoactive intestinal polypeptide-secreting tumors (b) VIPoma

20. © 2004 Current Medicine Group Ltd Vasoactive intestinal polypeptide-secreting tumors (c)

21. © 2004 Current Medicine Group Ltd Vasoactive intestinal polypeptide-secreting tumors (d)

22. © 2004 Current Medicine Group Ltd Medullary carcinoma of the thyroid products

23. © 2004 Current Medicine Group Ltd Drugs associated with diarrhea

24. © 2004 Current Medicine Group Ltd Longstanding diabetes mellitus and chronic diarrhea

25. © 2004 Current Medicine Group Ltd Malabsorción - Esteatorrea

26. © 2004 Current Medicine Group Ltd Diseases that impair nutrient absorption

27. © 2004 Current Medicine Group Ltd Stool fat concentrations as a clue to etiology <6 g/día>20 g/día 9,5%

28. © 2004 Current Medicine Group Ltd Effect of oral pancreatic enzyme replacement (A)

29. © 2004 Current Medicine Group Ltd Effect of oral pancreatic enzyme replacement (B)

30. © 2004 Current Medicine Group Ltd Intraduodenal bile acid concentrations and fecal fat output 2,5 umol/mL Bilirrubina pl >4,5 mg%

31. © 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

32. © 2004 Current Medicine Group Ltd Multiple jejunal diverticula

33. © 2004 Current Medicine Group Ltd Multiple small bowel diverticula

34. © 2004 Current Medicine Group Ltd Scleroderma

35. © 2004 Current Medicine Group Ltd Billroth I and II subtotal gastrectomy

36. © 2004 Current Medicine Group Ltd Radiograph of a patient with a Billroth II procedure

37. © 2004 Current Medicine Group Ltd Pathophysiology of lactase deficiency

38. © 2004 Current Medicine Group Ltd Intestinal fluid accumulation with a lactose-containing meal

39. © 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)

40. © 2004 Current Medicine Group Ltd Celiac sprue (A) – Enfermedad Celíaca Gluten: trigo, centeno, avena

41. © 2004 Current Medicine Group Ltd Celiac sprue (B) Tres meses después de dieta libre de gluten

42. © 2004 Current Medicine Group Ltd Molecular pathophysiology of celiac sprue (A)

43. © 2004 Current Medicine Group Ltd Molecular pathophysiology of celiac sprue (B)

44. © 2004 Current Medicine Group Ltd Molecular pathophysiology of celiac sprue (C)

45. © 2004 Current Medicine Group Ltd Molecular pathophysiology of celiac sprue (D) HLA-DQ2 or HLA-DQ8

46. © 2004 Current Medicine Group Ltd Molecular pathophysiology of celiac sprue (E)

47. © 2004 Current Medicine Group Ltd Molecular pathophysiology of celiac sprue (F)

48. © 2004 Current Medicine Group Ltd Detecting celiac sprue (A)

49. © 2004 Current Medicine Group Ltd Detecting celiac sprue (B)

50. © 2004 Current Medicine Group Ltd Classic moulage pattern of celiac sprue

51. © 2004 Current Medicine Group Ltd Tropical sprue

52. © 2004 Current Medicine Group Ltd Whipple's disease

53. © 2004 Current Medicine Group Ltd Eosinophilic gastroenteritis

54. © 2004 Current Medicine Group Ltd Massive small-bowel resection

55. © 2004 Current Medicine Group Ltd Jejunal length and sodium-water absorption (A)

56. © 2004 Current Medicine Group Ltd Jejunal length and sodium-water absorption (B)

57. © 2004 Current Medicine Group Ltd Rehydration therapy enhances sodium and water absorption

58. © 2004 Current Medicine Group Ltd Sodium balance after different sodium-containing test solutions

59. © 2004 Current Medicine Group Ltd Oral rehydration therapy and high-volume ostomy output

60. © 2004 Current Medicine Group Ltd Radiation enteritis

61. © 2004 Current Medicine Group Ltd Lymphangiectasia

62. © 2004 Current Medicine Group Ltd Selected symptoms and signs of nutrient deficiencies

63. © 2004 Current Medicine Group Ltd D-xylose to evaluate small-intestine absorptive function

64. © 2004 Current Medicine Group Ltd Enfermedad Inflamatoria Intestinal Colitis Ulcerosa Enfermedad de Crohn

65. © 2004 Current Medicine Group Ltd Endoscopic features of active ulcerative colitis (B)

66. © 2004 Current Medicine Group Ltd Microscopic features of specimen in Fig 4-8 (B)

67. © 2004 Current Medicine Group Ltd Endoscopic features of Crohn's disease (A)

68. © 2004 Current Medicine Group Ltd Specimen from patient with Crohn's colitis (B)

69. © 2004 Current Medicine Group Ltd Inflammatory bowel disease etiology

70. © 2004 Current Medicine Group Ltd Infliximab

71. © 2004 Current Medicine Group Ltd