Diarrhea

Diarrhea

Is defined as three or more depositions on a day, or consistence changes making the depositions more fluid and take the recipient form. This last definition is not very useful in clinical practice, so is more common the first one.

Can be classificated according to:

Evolution

Acute: < 2 weeks
Persistent: between 2-4 weeks
Chronic: > 4 weeks

Mechanism

• Osmotic
• Secretory
• Inflammatory
• Malabsortive

Osmotic: Is an acuose diarrhea, very voluminouse, is usually painless, and the most important thing stops in fasting because the causal agent is not being eaten. The most usual agents are cations and anions that can't be taken up by the mucose and causes osmosis with ana elevation of the luminal osmotic presion that elicit diarrhea. The anti-acids ion-containers like phosphates, sulphates and magnesium. Otherway, people with lactase deficiency have abdominal distention, meteorism and diarrhea.

Secretory: Is an acuose diarrhea, very voluminouse, is usually painless and do not stops in fasting. Is caused due to mucose alteration with proteins damage. Is caused by medicaments like AINE's, ACEI, tricyclic anti-depressive's and others. Also is caused by neuroendocrinal tumoration like VIPoma's, Zollinger-Ellison syndrome, carcinoid syndrome. Lastly, bowel disection's like gastrectomy can elicit a secretory diarrhea due to decrease of absortive surface.

Malabsortive: Is steatorrheic, fetid, abdominal distention, and causes nutritional and vitaminic deficiencies. There is three types of diarrhea with malabsortion:

Luminal: in this type, there is deficiency of enzymes or bile acids and digestion is defective. This occurs in pancreatic insuficiency, cyrrhosis and coledocolithiasis.

Mucose: In this type, there is mucose alteration like epitellium atrophy due Celiac Sprue or tropical sprue. Also in Wipple's syndrome there is an infection with t. wipplei that causes absortive epitellium atrophy.

Pos-mucose: is due to lymphatic obstruction in congenital diseases, or tumorations or infections.

in malabsortion, the nutriotional deficiency can reflect as glositis, angular cheilitis, ecchymosis, blur vision, ascites, edema's.

Inflammatory: is a diarrhea accompanied of fever, malaise, abdominal pain, and depositions can be: hematic or not; with mucoid component or not.

IBD (inflammatory bowel disease) is caused principally by Chron's disease and ulcerative colitis. Ulcerative colitis cause edema, erythema and ulceration of the mucose down below right colon, with sigmoid and rectal compromise. Chron's disease cause inflammation since mouth till rectus, with transmural compromise, diferent from ulcerative colitis that only affect the mucose and submucose. Chron's disease can elicit uveitis, arthalgias and aphtas. A classical sign is leukocits present on the coprologic test.