bacterial enterocolitis ingestion of bacterial toxins – staph – vibrio – clostridium ingestion...
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BACTERIAL enterocolitis• Ingestion of bacterial toxins– Staph– Vibrio– Clostridium
• Ingestion of bacteria which produce toxins– Montezuma’s revenge (traveller’s diarrhea), E.coli
• Infection by enteroinvasive bacteria– Enteroinvasive E. coli (EIEC)– Shigella– Clostridium difficile
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E. coli• Toxin, invasion, many subtypes• Food, water, person-to-person• Usually watery, some hemorrhagic• INFANTS often, in epidemics
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SALMONELLAFood, not hemorrhagic
SHIGELLA(person-to-person, invasive, i.e.,
often hemorrhagic)
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CAMPLYOBACTER• Toxins, Invasion
• Food spread
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YERSINIA (enterocolitica)
• Food• Invasion• LYMPHOID REACTION
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VIBRIO cholerae
• Water, fish, person-to-person• Cholera epidemics• NO invasion (watery)• ENTEROTOXIN
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CLOSTRIDIUM DIFFICILE
• CYTOTOXIN (lab test readily available)• NOSOCOMIAL• PSEUDOMEMBRANOUS (ANTIBIOTIC
ASSOCIATED) COLITIS
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MALABSORPTION
• INTRALUMINAL• BRUSH BORDER (microvilli)• (TRANS)EPITHELIAL• OTHER– REDUCED MUCOSAL AREA: Celiac, Crohns– LYMPHATIC OBSTRUCTION: Lymphoma, TB– INFECTION– IATROGENIC: Surgical
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INTRALUMINAL• PANCREATIC• DEFECTIVE/REDUCED BILE• BACTERIAL OVERGROWTH
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BRUSH BORDER• DISACCHARIDASE DEFICIENCY• BRUSH BORDER DAMAGE, e.g., by bacteria
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(Trans)EPITHELIAL• ABETALIPOPROTEINEMIA• BILE ACID TRANSPORTATION DEFECTS
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CELIAC DISEASE
• Also called SPRUE• Also called NON-tropical SPRUE• Also called GLUTEN-SENSITIVE ENTEROPATHY– Sensitivity to GLUTEN, a wheat protein, gliadin– Immobilizes T-cells– Also in oat, barley, rye– Progressive mucosal “atrophy”, i.e. villous flattening– Relieved by gluten withdrawal
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CELIAC DISEASE
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“TROPICAL” SPRUE
• Epidemic forms• NOT related to gluten, cause UN-known• RECOVERY with antibiotics
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WHIPPLE’s DISEASE
• DISTENDED MACROPHAGES in the LAMINA PROPRIA
• PAS positive• ROD SHAPED BACILLI
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WHIPPLE’s DISEASE
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DISACCHARIDASE DEFICIENCY
• LACTASE by far MOST COMMON• ACQUIRED, NOT CONGENITAL• LACTOSE GLUCOSE + GALACTOSE • LACTOSE (fermented)XXXXXXXXX• OSMOTIC DIARRHEA
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ABETALIPOPROTEINEMIA
• Autosomal recessive• Rare• Inability to make chylomicrons from FFAs
and MONOGLYCERIDES• Infant failure to thrive, diarrhea,
steatorrhea
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ANGIODYSPLASIA• NOT really “dysplasia”• NOT neoplastic• TWISTED, DILATED SUBMUCOSAL VESSELS, can
rupture!• Common X-ray finding