Internal medicine notes

Apr 16th, 2015
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DIARRHEADefinition Diarrhea is loosely defined as passage ofabnormally liquid or unformed stools at anincreased frequency. For adults on a typical Western diet, stool weightexceeding 200 g/d can generally be considereddiarrheal. Because of the fundamental importance ofduration to diagnostic considerations, diarrheamay be further defined as acute if <2 weeks,persistent if 2 to 4 weeks, and chronic if >4 weeksin duration.ACUTE DIARRHEA More than 90% of cases of acute diarrhea arecaused by infectious agents; these cases areoften accompanied by vomiting, fever, andabdominal pain. The remaining 10% or so are caused bymedications, toxic ingestions, ischemia, andother conditions.Infectious agents Most infectious diarrheas are acquired by fecaloral transmission via direct personal contact or,more commonly, via ingestion of food or watercontaminated with pathogens from human oranimal feces. Acute infection or injury occurs when theingested agent overwhelms the host's mucosalimmune and nonimmune (gastric acid, digestiveenzymes, mucus secretion, peristalsis, andsuppressive resident flora) defenses.Cont. The pathophysiology underlying acutediarrhea by infectious agents producesspecific clinical features that may also behelpful in diagnosis Profuse watery diarrhea secondary to smallbowel hypersecretion occurs with ingestion ofpreformed bacterial toxins, enterotoxinproducing bacteria, and enteroadherentpathogens

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