Background: Gastroenteritis is a nonspecific term for various pathologic states of thegastrointestinal

tract. The primary manifestation is diarrhea, but it may be accompanied by nausea, vomiting,
and abdominal pain. A universal definition of diarrhea does not exist, although patients seem to have no
difficulty defining their own situation. Although most definitions center on the frequency, consistency,
and water content of stools, the author prefers defining diarrhea as stools that take the shape of their
container.
The severity of illness may vary from mild and inconvenient to severe and life threatening. Appropriate
management requires extensive history and assessment and appropriate, general supportive treatment
that is often etiology specific. Diarrhea associated with nausea and vomiting is referred to as
gastroenteritis.

Diarrhea is one of the most common reasons patients seek medical care. In the developed world, it is
the most common reason for missing work, while in the developing world, it is a leading cause of
death. In developing countries, diarrhea is a seasonal scourge usually worsened by natural phenomena,
as evidenced by monsoonfloods in Bangladesh in 1998. An estimated 100 million cases of acute
diarrhea occur every year in the United States. Of these patients, 90% do not seek medical attention,
and 1-2% require admission. Diarrheal diseases can quickly reach epidemic proportions, rapidly
overwhelming public health systems in even the most advanced societies.

Pathophysiology: Infectious agents usually cause acute gastroenteritis. These agents cause diarrhea by
adherence, mucosal invasion, enterotoxin production, and/or cytotoxin production.

These mechanisms result in increased fluid secretion and/or decreased absorption. This produces an
increased luminal fluid content that cannot be adequately reabsorbed, leading to dehydration and the
loss of electrolytes and nutrients.

Diarrheal illnesses may be classified as follows:

Osmotic, due to an increase in the osmotic load presented to the intestinal lumen, either through
excessive intake or diminished absorption

Inflammatory (or mucosal), when the mucosal lining of the intestine is inflamed

Secretory, when increased secretory activity occurs

Motile, caused by intestinal motility disorders

The small intestine is the prime absorptive surface. The colon then absorbs additional fluid,
transforming a relatively liquid fecal stream in the cecum to well-formed solid stool in the
rectosigmoid.

Disorders of the small intestine result in increased amounts of diarrheal fluid with a concomitantly
greater loss of electrolytes and nutrients.

Microorganisms may produce toxins that facilitate infection. Enterotoxins are generated by bacteria (ie,
enterotoxigenic Escherichia coli, Vibrio cholera) that act directly on secretory mechanisms and produce
typical, copious watery (rice water) diarrhea. No mucosal invasion occurs. The small intestines are
primarily affected, and elevation of the adenosine monophosphate (AMP) levels is the common
 mechanism.

Cytotoxin production by bacteria (ie, Shigella dysenteriae, Vibrio parahaemolyticus,Clostridium

difficile, enterohemorrhagic E coli) results in mucosal cell destruction that leads to bloody stools with
inflammatory cells. A resulting decreased absorptive ability occurs.

Enterocyte invasion is the preferred method by which microbes such as Shigella

andCampylobacter organisms and enteroinvasive E coli cause destruction and inflammatory diarrhea.
Similarly, Salmonella and Yersinia species also invade cells but do not cause cell death.
Hence, dysentery does not usually occur. However, these bacteria invade the bloodstream across
the lamina propria and cause enteric feversuch as typhoid.
Source(s):
Merck Manual
• 5 years ago