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Infectious Small Bowel Diarrhea

Infectious small bowel diarrhea: Pathogenesis and Signs/Symptoms Undercooked poultry, beef, pork, other foods Food, or travel to underdeveloped countries E. coli (ETEC) May produce Shiga toxins (a specific family of toxins that can lead to complications) Authors: Noriyah Al Awadhi Yan Yu Sara Cho Reviewers: Paul Ratti Jason Baserman Shahab Marzoughi Kerri Novak* * Indicates MD at time of publication Y. enterocolitica (also milk, cheese) Shellfish, undercooked seafood V. parahaemolyticus V. cholerae Enterohemorrhagic E. coli (EHEC) Daycare centers/nurseries Drinking/swimming in bad water — mountains/wells S. aureus B. cereus Noroviruses Rotavirus G. lamblia C. parvum May produce emetic toxins (toxins that cause vomiting) Adequate amount of organism and/or toxin is ingested Organism adheres to the intestinal liningàorganism colonizes the small intestine Organism releases enterotoxin (a toxin that affects the intestines) Binds to and disrupts intestinal transporters used in secretion and absorption of water and electrolytes Toxin enters systemic vasculature Shiga toxins inhibit ADAMTS13 (cleaving enzyme) Failure to cleave von Willebrand Factor (vWF) multimers Accumulation of vWF multimers Platelets and thrombi accumulate in microvasculature Hemolytic uremic syndrome (hemolytic anemia, thrombocytopenia, and acute renal damage) ↑ Water and electrolyte secretion ↓ Fluid absorption Chemoreceptor trigger zone in medulla detects circulating emetic toxins Nausea & vomiting Triggers release of inflammatory mediators and cytokines that travel to the central nervous system Prostaglandin is synthesized and released Neurotransmitter cyclic AMP (cAMP) is released cAMP ↑ hypothalamic thermoregulation set point Fever Large volume profuse diarrhea Loss of water Distention (swelling) of intestines stimulates visceral sensory pain fibers Visceral pain fibers crosstalk with somatic nerves from the same spinal cord level Occasional referred pain/cramping (typically diffuse pain around the abdomen) Loss of bicarbonate, sodium, potassium, magnesium, and chloride Dehydration Electrolyte deficiency Metabolic acidosis (pH < 7.4 & serum bicarbonate < 24) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Aug 7, 2012; updated Mar 25, 2024 on www.thecalgaryguide.com