Chronic diarrhea pathophysiology: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
The fundamental pathophysiology of all diarrhea is incomplete absorption of water from the lumen either because of a reduced rate of net water absorption (related to impaired electrolyte absorption or excessive electrolyte secretion) or because of osmotic retention of water intraluminally | The fundamental pathophysiology of all diarrhea is incomplete absorption of water from the lumen either because of a reduced rate of net water absorption (related to impaired electrolyte absorption or excessive electrolyte secretion) or because of osmotic retention of water intraluminally.<ref name="pmid22677080">{{cite journal| author=Sweetser S| title=Evaluating the patient with diarrhea: a case-based approach. | journal=Mayo Clin Proc | year= 2012 | volume= 87 | issue= 6 | pages= 596-602 | pmid=22677080 | doi=10.1016/j.mayocp.2012.02.015 | pmc=3538472 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22677080 }} </ref> The causes of chronic diarrhea include inflammatory, osmotic, secretory, iatrogenic, motility, and functional diseases. In general, no single cause of chronic diarrhea is truly unifactorial from a perspective of pathophysiology. For example, cholera is caused by secretion and altered motility<ref name="pmid8598871">{{cite journal| author=Goyal RK, Hirano I| title=The enteric nervous system. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 17 | pages= 1106-15 | pmid=8598871 | doi=10.1056/NEJM199604253341707 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8598871 }} </ref> whereas pseudomembranous colitis is said to be associated with secretion, inflammation, and motility<ref name="pmid7962537">{{cite journal| author=Kurose I, Pothoulakis C, LaMont JT, Anderson DC, Paulson JC, Miyasaka M et al.| title=Clostridium difficile toxin A-induced microvascular dysfunction. Role of histamine. | journal=J Clin Invest | year= 1994 | volume= 94 | issue= 5 | pages= 1919-26 | pmid=7962537 | doi=10.1172/JCI117542 | pmc=294602 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7962537 }} </ref>. | ||
Thus, diarrhea is a condition of altered intestinal water and electrolyte transport. The pathophysiologic mechanisms of diarrhea include osmotic, secretory, inflammatory, and altered motility. | Thus, diarrhea is a condition of altered intestinal water and electrolyte transport. The pathophysiologic mechanisms of diarrhea include osmotic, secretory, inflammatory, and altered motility. | ||
Revision as of 13:34, 6 June 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
Pathophysiology
The fundamental pathophysiology of all diarrhea is incomplete absorption of water from the lumen either because of a reduced rate of net water absorption (related to impaired electrolyte absorption or excessive electrolyte secretion) or because of osmotic retention of water intraluminally.[1] The causes of chronic diarrhea include inflammatory, osmotic, secretory, iatrogenic, motility, and functional diseases. In general, no single cause of chronic diarrhea is truly unifactorial from a perspective of pathophysiology. For example, cholera is caused by secretion and altered motility[2] whereas pseudomembranous colitis is said to be associated with secretion, inflammation, and motility[3].
Thus, diarrhea is a condition of altered intestinal water and electrolyte transport. The pathophysiologic mechanisms of diarrhea include osmotic, secretory, inflammatory, and altered motility.
- Osmotic diarrhea involves an unabsorbed substance that draws water from the plasma into the intestinal lumen along osmotic gradients.
- Secretory diarrhea results from disordered electrolyte transport and, despite the term, is more commonly caused by decreased absorption rather than net secretion.
- Inflammatory diseases cause diarrhea with exudative, secretory, or osmotic components.
- Altered motility of the intestine or colon may alter fluid absorption by increasing or decreasing the exposure of luminal content to intestinal absorptive surface.
However, from a pathophysiologic perspective, no single cause of diarrhea is truly unifactorial.
Pathogenesis
References
- ↑ Sweetser S (2012). "Evaluating the patient with diarrhea: a case-based approach". Mayo Clin Proc. 87 (6): 596–602. doi:10.1016/j.mayocp.2012.02.015. PMC 3538472. PMID 22677080.
- ↑ Goyal RK, Hirano I (1996). "The enteric nervous system". N Engl J Med. 334 (17): 1106–15. doi:10.1056/NEJM199604253341707. PMID 8598871.
- ↑ Kurose I, Pothoulakis C, LaMont JT, Anderson DC, Paulson JC, Miyasaka M; et al. (1994). "Clostridium difficile toxin A-induced microvascular dysfunction. Role of histamine". J Clin Invest. 94 (5): 1919–26. doi:10.1172/JCI117542. PMC 294602. PMID 7962537.