Diarrhea inflammatory

Several quite different mechanisms can lead to diarrhea. In carbohydrate malabsorption, the presence of unabsorbed solutes in the bowel causes an osmotic diarrhea as water enters the bowel from the tissue. By contrast, the diarrhea of most laxative abuse and in VIPomas is due to active secretion of water and electrolytes into the bowel, which is described as secretory diarrhea. Inflammatory bowel diseases (ulcerative colitis and Crohn s disease) cause diarrhea as a consequence of the inflammatory process with loss of fluid into the bowel. 

Vomiting, diarrhea, inflammatory exudate Renal loss ... 

Diarrhea is a common problem that is usually self-limiting and of short duration. Increased accumulations of small intestinal and colonic contents are known to be responsible for producing diarrhea. The former may be caused by increased intestinal secretion which may be enterotoxin-induced, eg, cholera and E. col] or hormone and dmg-induced, eg, caffeine, prostaglandins, and laxatives decreased intestinal absorption because of decreased mucosal surface area, mucosal disease, eg, tropical spme, or osmotic deficiency, eg, disaccharidase or lactase deficiency and rapid transit of contents. An increased accumulation of colonic content may be linked to increased colonic secretion owing to hydroxy fatty acid or bile acids, and exudation, eg, inflammatory bowel disease or amebiasis decreased colonic absorption caused by decreased surface area, mucosal disease, and osmotic factors and rapid transit, eg, irritable bowel syndrome. 

Very large doses can cause vomiting, diarrhea, and prostration. Dehydration and congestion occur in most internal organs. Hypertonic solutions can produce violent inflammatory reactions in the gastrointestinal tract. 

Antibiotics have been studied based on the rationale that they may interrupt the inflammatory response directed against endogenous bacterial flora. Metronidazole and ciprofloxacin have been the two most widely-studied agents.32 Metronidazole may benefit some patients with pouchitis (inflammation of surgically-created intestinal pouches) and patients with CD who have had ileal resection or have perianal fistulas. Ciprofloxacin has shown some efficacy in refractory active CD. Both drugs may cause diarrhea, and long-term use of metronidazole is associated with the development of peripheral neuropathy. 

Noninfectious causes of acute diarrhea include drugs and toxins (Table 18-3), laxative abuse, food intolerance, irritable bowel syndrome (IBS), inflammatory bowel disease, ischemic bowel disease, lactase deficiency, Whipple s disease, pernicious anemia, diabetes mellitus, malabsorption, fecal impaction, diverticulosis, and celiac sprue. 

Chronic diarrhea lasts for longer than 4 weeks. Most cases result from functional or inflammatory bowel disorders, endocrine disorders, malabsorption syndromes and drugs (including laxative abuse). In chronic diarrhea, daily watery stools may not occur. Diarrhea may be either intermittent or persistent. 

Inflammatory (or exudative) diarrhea results from changes to the intestinal mucosa that damage absorption processes and lead to an increase in proteins and other products in the intestinal lumen with fluid retention. The presence of blood or fecal leukocytes in the stool is indicative of an inflammatory process. The diarrhea of inflammatory bowel disease (e.g., ulcerative colitis) is inflammatory in nature. 

Stool may also be analyzed for mucus, fat, osmolality, fecal leukocytes, and pH. The presence of mucus suggests colonic involvement. Fat in the stool may be due to a malabsorption disorder. Fecal leukocytes can be found in inflammatory diarrheas including infections caused by invasive bacteria (e.g., E. coli, Shigella, and Campylobacter species). Stool pH (normally greater than 6) is decreased by bacterial fermentation processes. 

All of the tests described for acute diarrhea would be used to establish a diagnosis of chronic diarrhea because the differential diagnosis is more complicated. The data obtained can help categorize the diarrhea as watery, inflammatory, or fatty, narrowing the focus on a primary disorder. 

Fecal leukocytes can be found in inflammatory diarrhea, especially when due to invasive microorganisms. 

Blood in stool indicates the possibility of inflammatory mucosal disease of the colon. Enterohemorrhagic Escherichia coli (EHEC) is an important cause of bloody diarrhea in the United States. 

In Asia, this plant is valued as a remedy for fever, rheumatism, gout, and inflammatory illnesses. In China, the roots are used as febrifuges, deobstruents, and carminatives, and are used to assuage muscle pains, thoracic and abdominal inflammations, puerperal fever, and diarrhea. 

C. difficile history of antibiotic use, advanced age, underlying illness 5-10 days of antibacteria treatment (range 1st day to 10 weeks of antibiotics) mild to severe inflammatory diarrhea toxins A and B monoglucosylation of Rho protein - disruption of actin cytoskeleton —> mucosal disruption. - COX-2 - prostaglandin E2 —> synthesis of inflammatory cytokines... 

Intestinal infections that cause persistent diarrhea normally result in histopathological changes to the intestine including villus blunting, crypt hypertrophy and inflammatory infiltrate in the lamina propria. These histopathological disarrangements are seen in Cryptosporidium, Cy-clospora and microsporidial infections [28], Furthermore, it has been documented that there are substantial disruptions of intestinal barrier function as measured by lactu-lose mannitol permeability ratios in patients with AIDS... 

Lactoferrin, a protein found in secondary granules of polymorphonuclear cells, was observed to be mildly to moderately elevated in the stools of children with endemic cryptosporidiosis [91] and healthy adult volunteers with experimental infection [92], Indeed, in another study of malnourished children in Haiti, cryptosporidiosis was noted to stimulate an inflammatory response, as evidenced by elevated IL-8, TNF-a, lactoferrin, IL-13 and IL-10 [93]. Further studies are needed to elucidate the role of inflammatory mediators in the development of prolonged diarrhea, malabsorption and malnutrition in immunocompromised hosts and children in endemic areas. 

Rifaximin Rifamycin Antibiotic Gut bacteria Enteric infection Diarrhea, infectious Hepatic encephalopathy Small intestine bacterial overgrowth Inflammatory bowel disease Colonic diverticular disease Irritable bowel syndrome Constipation Clostridium difficile infection Helicobacter pylori infection Colorectal surgery Bowel decontamination, selective Pancreatitis, acute Bacterial peritonitis, spontaneous Nonsteroidal anti-inflammatory drug enteropathy... 

Alvisi et al. [21] open label adults acute diarrhea or bacterial superinfection of intestinal inflammatory diseases 1 Yersinia 2 patients with no pathogen various nonclassic enteric flora1 20 800 mg (5-10 days) NA NA NA... 

Burke DA, Axon ATR Adhesive Escherichia coli in inflammatory bowel disease and infective diarrhea. BMJ 1988 297 102-104. 

Loperamide is an opiate that is poorly absorbed from the G1 tract but still retains the ability to inhibit peristalsis It is useful in diarrheas that are just symptomatic and are not due to infection or organic pathology, such as inflammatory bowel disease. 

Inflammatory diseases of the GI tract can cause exudative diarrhea by discharge of mucus, proteins, or blood into the gut. 

Lithium toxicity can occur as a result of intentional overdose therefore, care must be taken when administering lithium to potentially suicidal patients with BPAD. Inadvertent lithium toxicity may also occur. For example, diuretics and nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) slow the excretion of lithium and can lead to accidental toxicity. Consequently, the patient should be advised not to take such commonly available medications while treated with lithium. In addition, dehydration resulting from varied causes such as diarrhea, vomiting, and profuse sweating can lead to accidental lithium toxicity. One should advise the patient who takes lithium to be careful to remain well hydrated at all times and to contact his/her physician if any medical condition arises that may cause rapid fluid losses (e.g., stomach virus, high fevers). 

Native to tropical America, sweet potato (I. batatas) is a perennial morning glory vine that has been cultivated for over 5,000 years for its edible tubers in Mexico, Central and lowland South America, and the West Indies. Today, sweet potato is cultivated around the world, especially in developing countries (Plate 4). A decoction made from the leaves of this plant is used in folk remedies as a gargle to treat mouth and throat tumors, and poultices are prepared for inflammatory tumors (64). In Mexico, leaf decoctions are considered to be of cold nature , to reduce excessive body heat, contemporarily defined as such illnesses as diarrhea, dysentery, heart disease, stomach distress, fever, and gastrointestinal infection. In Chinese traditional medicine, the tubers have been used as a medicinal herb to eliminate secretion in perceived abnormal quantities of blood or other body fluids (79). 

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