59

59 CASE 59


A 46-year-old man comes to the clinic complaining of abdominal cramping and severe diarrhea that has persisted for 36 hours.


The patient has just returned from a camping trip in the mountains. Both of his companions are also experiencing severe diarrhea. The diarrhea initially had loose feces but now is composed of mostly watery stools. The patient indicates he has not eaten in the past 24 hours, but he has consumed 2 L of a sports drink (Gatorade). The patient does not report nausea or a history of fever.



PHYSICAL EXAMINATION



VS: T 37°C, P 105/min, R 15/min, BP 90/70 mm Hg, BMI 29

PE: No significant findings


LABORATORY STUDIES



Plasma electrolytes:
• Sodium: 141 mEq/L (normal: 136-145 mEq/L)

• Potassium: 3.4 mEq/L (normal: 3.5-5.0 mEq/L)

• Chloride: 105 mEq/L (normal: 95-105 mEq/L)

Fecal analysis: Negative for the presence of leukocytes or blood but positive for the presence of enterotoxigenic E. coli.


DIAGNOSIS


Secretory diarrhea



PATHOPHYSIOLOGY OF KEY SYMPTOMS


The absorption of both dietary fluid intake and gastrointestinal secretions plays a major role in body fluid balance. In general, individuals consume 2 L of fluid each day and an additional 7 L of fluid is secreted into the lumen of the gastrointestinal tract. Of this total 9 L fluid load, only about 100 mL of fluid is lost each day in the feces.


The majority (7.5 L) of the fluid reabsorption occurs in the small intestine, and all but 100 mL of the remaining 1.5 L is absorbed in the large intestine. Chyme entering the large intestine through the ileocecal valve is predominantly fluid. There is a progressive absorption of water along the length of the small intestine, with the chyme progressing to solid feces during the 48-hour transit time through the large intestine (Fig. 59-1).


image

FIGURE 59–1 Absorptive and storage functions of the large intestine.

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Jul 4, 2016 | Posted by in PHYSIOLOGY | Comments Off on 59

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