alterations in the GI SYSTEM

Structures of the Upper GI system

• Mouth

• Esophagus

• Stomach

Major physiologic function of the GI system:

Digest food & absorb nutrients into the bloodstream.

Function of the Upper GI system

Intake source; initial digestive processes

Middle GI system structures:

• Duodenum

• Jejunum

• Ileum

What is the function of the Middle GI system

Most digestive and absorptive processes

What is the structures of Lower GI system

• cecum

• colon

• rectum

What is the functions of the Lower GI system

Storage channel for efficient elimination of waste

What are the acessory organs

• Salivary glands

• Liver

• Gallbladder

• Pancreas

What is the function of the acessory organs

Produce secretions that aid in digestion

What is the Movement of food and fluids along in the GI tract that promotes digestion and absorption.

Gastrointestinal motility

What is the molitilty of the GI tract controlled by

hormones and the ANS

What is being described

• Many different species of bacteria reside in the intestines

• These bacteria function to aid in digestion and metabolism, absorb vitamins/minerals, produce certain nutrients, and protect against “bad” bacteria

• Normal bacteria that reside in our GI tract

Intestinal Flora

What COMMON MANIFESTATION OF MANY GI DISORDERS is being described..

1.     Loss of appetite

2.     Factors influencing appetite:

• a.     Hunger

• b.     Smell

• c.     Emotional factors

• d.     Drug and disease states

• 3.     Often a forerunner of nausea

anorexia

What COMMON MANIFESTATION OF MANY GI DISORDERS is being described..

1.  Conscious sensation resulting from stimulation of the medullary vomiting center in the brain. May precede or accompany vomiting.

2.  May function as an early warning sign of a pathologic process

3 subjective

nausea

What are causes of nausea?

•    Motion sickness

•   Dizziness

•    Migraine

•      Fainting

•     Low blood glucose

• Gastroenteritis

•     Pain

•     Hypoxia

• Pregnancy (hormones)

• Side effect of medication

What are the manefestations of nausea (ANS manefestations, specifically SNS)

• watery salivation

• pallor(due to vasoconstriction)

• sweating

• tachycardia

What COMMON MANIFESTATION OF MANY GI DISORDERS is being described..

• Sudden, forceful expulsion of stomach contents (called vomitus). Protective mechanism from potentially noxious or damaging agents in the stomach and small intestine.

• Causes of this are similar to those producing nausea

vomiting

What are manefestations of vomiting (PNS manefestations)

• dizziness,

• light headedness,

• decreased blood pressure

• bradycardia

   

What COMMON MANIFESTATION OF MANY GI DISORDERS is being described..

• defintion: Excessively frequent passage of loose or unformed stools

• can be acute or chronic

diarrhea

What is acute diarrhea?

•  Commonly caused by infectious agents

• Non-inflammatory (large volume) diarrhea

  • Large volume watery, non-bloody stools

  • Cramps, bloating, nausea, vomiting also usually present

• Inflammatory (small volume) diarrhea

  • Presence of fever and bloody diarrhea

                     

What is chronic diarrhea

• > 4 weeks

• Associated w/ other conditions

What are causes of diarrhea

• Intestinal disorders (disorders affecting GI motility or causing inflammation)

•   Medications

• Microorganisms

• Foods

What COMMON MANIFESTATION OF MANY GI DISORDERS is being described..

•  Infrequent, incomplete, or difficult passage of stools.

• “Normal” bowel habits are subjective

  • Depends from person to person, we all have our own schedule for bowel movements

consitpation

What are causes of Constipation

o aging

o   Medications

o   Obstructing lesions of GI tract

o   Other GI disorders

o   Decrease in fluids

o   Decreased fiber in diet

•   Fiber bulks up the stool, makes it softer and fuller making it easier to pass, if you don’t have any stool is harder and smaller

o   Failure to defecate when the urge occurs (holding it in!)

o   Neurologic disorders

o   Sedentary lifestyle

o   Hypothyroidism

What COMMON MANIFESTATION OF MANY GI DISORDERS is being described..

•   May be diffuse or localized

• Caused by inflammation, ischemia, or mechanical problem

•    We want to know the location, it helps understand the problem

Abdominal Pain

What common gi complaction is being described

1.  GI organs are hollow- risk of formation of a hole with some GI conditions

2.  Very serious condition: Perforation—> contents that should normally remain in the GI tract can leak into the peritoneal cavity —> can lead to inflammation called Peritonitis

3.  Think of it as we have poked a hole in one of the hollow organs and now its leaking out into the peritoneal cavity

perforation

What common gi complaction is being described

• GI tract is very vascular, large amounts of blood can be lost with bleeding

• May be venous or arterial

• Risk of hypovolemic shock!

• Upper vs. Lower GI Bleed:

  • Both may lead to decreased H/H, hypotension, and fluid volume deficit!

• Hypovolemia —> Hypovolemic Shock

• Electrolyte Imbalances

Gastrointestinal Bleeding

What kind of GI bleed is being desrcibed

Esophagus, stomach, duodenum

Hematemeis(vomiting blood)- Bright red(fresh blood) vs. coffee ground(older blood)  Can be Life threatening

upper GI bleed- more common

What is Hematemesis (Upper GI bleed)

(vomiting blood)-

Bright red(fresh blood) vs. coffee ground(older blood)

What kind of GI bleed is this

Small/large intestines, rectum

Melena (dark purple-ish blood) Hematochezia(bright red blood, newer blood probably from descending colon or rectum) Maroon stool Can be life threatening

Lower GI Bleed

What is melena (lower GI bleed)

(dark purple-ish blood)

What is hemtochezia? (lower GI bleed)

(bright red blood, newer blood probably from descending colon or rectum)

What is the Tube connecting the oropharynx and the stomach.

esophagus

What is the function of the esophagus

Conduit for the passage of food and liquid from the pharynx to the stomach

Disorder of GI function: Disorders of the Esophagus

• Dysphagia

• Gastroesophageal Reflux

  •   Gastroesophageal Reflux Disease (GERD)

• Cancer of the Esophagus

What disorder of the esophagus is being described?

1.     difficulty swallowing

2.   May result from neuromuscular or structural causes

  Neuromuscular: Lesions of the CNS ex: having a stroke

 Structural: Cancer of the esophagus resulting in scarring. Scleroderma

• structural= something physically causing the problem

3.  May complain of choking, coughing, or sensation of food stuck in their throat/chest

Dysphagia

What disorder of the esophagus is being described?

• Backward movement of gastric contents into the esophagus.

• Most common disorder of the GI tract and seldom causes more serious problems

• The lower esophageal sphincter regulates the flow of food from the esophagus to the stomach.

• Causes pyrosis (“heartburn”)

• Meals high in fat increase the frequency of relaxation. (Of lower esophageal sphincter)

• Very common in infants- usually resolves by 2 years of age.

Gastroesophageal Reflux

“Gastro” = stomach; “Esophageal” = esophagus; “Reflux” = Backward movement

in Gastroesophageal Reflux Meals high in fat increase the frequency of relaxation (Of lower esophageal sphincter)

true

What is being described?

• Definition: Symptoms or mucosal damage from the reflux of gastric contents into the esophagus, oral cavity (including the larynx), and/or lungs.

• Acidic gastric fluids have a pH < 4.0 and are very damaging.

• More serious and longer lasting than GER and may lead to more serious problems. GER that occurs > twice a week for a few weeks may be GERD.

Gastroesophageal Reflux Disease (GERD)

What are manefestations of Gastroesophageal Reflux Disease (GERD)

• Pyrosis(heartburn, burning in chest) and regurgitation(feeling of food going back up and coming back down)

• Symptoms are usually worse 30 – 60 minutes after eating

• Usually made worse by bending at the waste and laying down.

• Often occurs at night

• Belching

• “Chest pain”

• May produce respiratory symptoms: asthma, chronic cough, laryngitis

  • the acid may irritate the upper airway

What are complications of GERD

•   Metaplasia(change in cell type) of the cells in the lower portion of the esophagus

  •   Over time they have had reflux ,now the cells in esophagus may resemble stomach cells so they can handle the acid

• Associated with the development of esophageal adenocarcinoma

What is being decribed

• 1% of all diagnosed cancers

• More common in adults > 65 years old

• Men > women

• Prognosis is poor- Usually it has already metastasized by the time the diagnosis is made.

• Two types: Squamous cell carcinoma and Adenocarcinoma

Cancer of the Esophagus

What desceribes Squamous cell Cancer of the Esophagus

• most common

• mostly attributed to alcohol and tobacco use

What desceribes adenocarcinoma Cancer of the Esophagus

•    Incidence is increasing

• Risk factors are Barrett esophagus and GERD

Manefestations of Cancer of the Esophagus (types: adenocarcinoma and squamous cell)

• Progressive dysphagia  

• Unintentional weight loss

• Anorexia

• Fatigue

• Pain when swallowing

Disorders of the stomach

• Gastritis

• Chronic Gastritis

• Peptic Ulcer Disease

  • peptic ulcers

    • duodenal ulcer

    • gastric ulcer

  •     Zollinger-Ellison Syndrome

  • stress ulcers

• stomach cancer

What is the Reservoir for contents entering the gastric tract.

stomach

stomach does what

• Food is churned, mixed with hydrochloric acid and pepsin before being released into the small intestine

• Gastric mucosal barrier of the stomach protects the lining from the damaging effects of the hydrochloric acid and pepsin.

 

What is the

Inflammation of the gastric mucosa(stomach lining)

gastritis

   Factors protecting the gastric mucosa (The Gastric Mucosal Barrier):

• Tight-fitting, impermeable epithelial cell surface covering

• Thick mucous secreted by cells

• Mucous secretes bicarbonate, neutralizing gastric pH

• Prostaglandins- Improve mucosal blood flow, decrease acid secretion, increase bicarbonate ion secretion, enhance mucous production

  • Increases blood flow to stomach and GI tract

What ..

• Improves mucosal blood flow, decrease acid secretion, increase bicarbonate ion secretion, enhance mucous production

  •   Increases blood flow to stomach and GI tract

 

Prostaglandins

What are some Factors that may cause gastric irritation:

a.     Certain medications (ex: Aspirin, NSAIDS)

b.     Alcohol

c.     Bile acids

d.     Decreased gastric blood flow

ex:    If SNS is being overly stimulated, we are not going to get good blood flow

a.     Acidosis (Metabolic & respiratory)

What is being descibred

a.   Characterized by an acute inflammatory process

b.  Usually a transient, self-limiting(run its course) disorder that resolves after causative agent is removed   

acute gastritis

Causes of acute gastritis?

• Most commonly associated with local irritants (meds such as aspirin or other NSAIDs, alcohol, or bacterial toxins)

• Serious illness or trauma accompanied by profound physiologic stress

• Uremia

• Chemotherapy and gastric radiation

Manefestation of acute gastritis

   i.     Emesis (mild to severe)

   ii.     Pain – heartburn or “sour stomach”

  iii.     Hemorrhage and ulceration (severe cases)

What is Chronic Gastritis

• No visible erosions

•   Characterized by chronic, inflammatory changes- atrophy of the epithelial cells of the stomach.

•    Three types: H. pylori; metaplastic atrophic gastritis; chemical gastropathy

What is Helicobacter pylori Gastritis

• H. pylori = most common cause of chronic gastritis

• Some people with H. pylori infection never develop clinical disease

• Chronic inflammation of the antrum and body of stomach

Pathogenesis of Helicobacter pylori Gastritis

• H. pylori colonize the mucus-secreting epithelial cells of the stomach

• Bacteria produce enzymes and toxins that interfere with the production of gastric mucosa, produce intense inflammation, and initiate an immune response

What is Chronic Atrophic Gastritis

• May be caused by multiple factors (H. pylori, environmental factors, diet)

• May be autoimmune (10% of cases)

• Usually causes few symptoms

What is Chemical Gastropathy

•    Chronic injury resulting from:

  •   Duodenal contents

  •   Pancreatic secretions

  • Bile

• More commonly seen with certain surgeries or other diseases

What is the term used to describe a group of ulcerative disorders in the upper GI tract that are exposed to acid-pepsin secretions

variety of causes: medications, H. pylori, disease processes, etc.

petic ulcer

What is being described

a.     May affect one or all layers of the stomach or duodenum

• May even penetrate the outer wall of the stomach or duodenum

b.     Spontaneous remissions and exacerbations

•   Regenerated, scarred mucosal tissue is not as good as the original tissue, which leads to repeated ulcerations

•   Ex: Ppl with this disease it will slightly heal, they will get sick with something else and it will flare up

c.     Most common types- Duodenal and gastric ulcers

peptic ulcers

What is a duodenal ulcer ?

·      Five times more common

·      Peak age: 30-50 years old

·      Males > Females

What is a gastric ulcer

Less common

Middle-age to older adults

Equally distributed between men & women

What is the Etiology & Pathogenesis of peptic ulcers

•     H. pylori- Bacteria induces inflammation→Inflammation of the stomach increases acid production → Mucosal damage occurs

• NSAIDs- Inhibition of prostaglandin synthesis

• Other factors that augment the effects of H. pylori and NSAIDs:

  • Advancing age

  •   Prior history of peptic ulcer

  •  Multiple NSAID use

  • Use of Warfarin (anticoagulant) along with corticosteroids

manifestations of peptic ulcers

•  Burning, gnawing, cramp-like pain, in midline

• Pain is relieved by food or antacids

• Usually rhythmic- between meals when the stomach is empty and between 1:00am – 2:00am

• Location- small area, midline, near the xiphoid process and may radiate to the costal margins, back, or right shoulder

• Pain may recur periodically at intervals of weeks to months and occur daily for several days and then remits

location of pain for peptic ulcers

small area, midline, near the xiphoid process and may radiate to the costal margins, back, or right shoulder

Complications of peptic ulcers

• Hemorrhage

  •   Hematemesis or melena

• Perforation and penetration

  • 1.     Significant mortality rate with perforation(poke a hole a stuff leaks our)

    2.     If ulcer penetrates, it penetrates another organ nearby

• Gastric outlet obstruction

  • 1.     Interference of the passage of gastric contents.

    2.     Caused by edema, spasm, or scar tissue

     

What is being described

a.     Rare

b.     Gastrin-secreting tumor (gastrinoma)- increase in gastric acid secretions leads to GERD or PUD

c.     Manifestations are similar to peptic ulcer. Diarrhea may also occur.

  Zollinger-Ellison Syndrome (one of the peptic ulcer diseases)

What do Gastrin-secreting tumor (gastrinoma) do

increase in gastric acid secretions leads to GERD or PUD(peptic ulcer disease)

Whatb is being described?

• GI ulcerations related to major physiologic stress

  • Severe illness

•   Major problem for hospitalized patients (especially the critically ill)

•    Results from ischemia to the mucosal tissue and alterations in the mucosal barrier

• prevented with medication

stress ulcers

What are risk factors of stress ulcers

• Large surface area burns (called Curling ulcer)

• Trauma

• Sepsis

• Acute respiratory distress syndrome

• Severe liver failure

• Major surgical procedures

• Intracranial injury (Cushing ulcer)

What is being described

• 5^th most common cancer worldwide

• Most common in East Asia and Eastern Europe

• Males 2x > Females

1.     Gastric ulcers tend to be irregularly shaped, large, and have irregular margins

cancer of the stomach

What are risk factors of stomach cancer

a.     Genetics

b.     Carcinogenic(cancer causing) factors in the diet (smoked and preserved foods)

c.     Autoimmune gastritis

d.     Gastric adenomas or polyps

e.     Possibly chronic H. pylori infection

Manefestations of stomach cancer

a.     Often asymptomatic until later stages

b.     Early stomach cancer signs: 

•  Indigestion or burning sensation

• Loss of appetite

• Abdominal discomfort

c. later signs   (enlarged, invaded tissue):

• weakness

• fatigue

• bloating after meals

• abdominal pain in upper abdomen

• weight loss

• hematemesis or melena (leading to anemia)

• dysphagia (tumor has invaded the esophagus)

Manefestations

Early stomach cancer signs:

•  Indigestion or burning sensation

• Loss of appetite

• Abdominal discomfort

Manefestaitions

later signs of stomach cancer  (enlarged, invaded tissue):

• weakness

• fatigue

• bloating after meals

• abdominal pain in upper abdomen

• weight loss

• hematemesis or melena (leading to anemia)

• dysphagia (tumor has invaded the esophagus)

Disorders of the Small and Large Intestines

• IBS

• Inflammatory bowel disease

  • conditons: Chron’s disease and ulcerative colitis

• infectious enterocolitis

• diverticular disease

  • diverticulosis

  • diverticulitis

• appencitits

• alterations in motilitiy

  • fecal impaction

  • intesinal obstruction

• peritonitis

• alterations in intestinal absorption

• colorectal cancer

What is being described (disorders of small and large intestines)

• Characterized by chronic & recurrent intestinal symptoms, not explained by structural or biochemical abnormalities.

  • Cant find physical reason and lab work looks normal but theres no explanation

• May affect 10%-15% of US population and 1 in 4 people worldwide

• Women > men

irritable bowel syndrome (IBS)

Etiology & Pathogenesis of Irritable Bowel Syndrome(IBS)

a.  Dysregulation of intestinal motor activity and central neural functions

b.  Increased motility/abnormal intestinal contractions in response to psychological and physiological stress

Manefestatiosn of Irritable Bowel Syndrome(IBS)

a. Abdominal pain relieved by defication*

b. change in consistency/frequency of stools*

c.     Flatulence

d.     Bloating

e.     Nausea and anorexia

f.      Constipation and/or diarrhea

g.     Possible anxiety & depression

h.     Abnormal stool passage

Diagnonsis of IBS

  Continuous or recurrent symptoms for at least 12 weeks with at least two of the following:

a.     Relief of abdominal pain with defecation

b.     Onset associated with change in bowel frequency

c.     Onset associated with change in stool form/appearance

 

What is being described

• two conditions : Chrons disease and Ulcerative colitis

• general similarities

  • o   Inflammation of the bowel

    o   No proven cause

    o   Familial tendency

    o   Systemic manifestations

Inflammatory Bowel Disease

Patho of Inflammatory Bowel Disease

Three features

1. Failure of immune regulation

2. Genetic predisposition

3. Environmental trigger (especially microbial flora)

   1. Smoking

a.   Normally, the GI tract produces an immune response to ingested pathogens and is unresponsive to normal intestinal flora

b. With IBD, there is an unregulated and exaggerated immune response. Homeostasis is interrupted.

Local manefestations of Inflammatory Bowel Disease

a.     Remissions & exacerbations of diarrhea, fecal urgency, weight loss

b.     Acute complications (obstructions) may occur

Systemic manefestations of Inflammatory Bowel Disease

a.     Arthritis(stiffening of joints) affecting joints

b.     Inflammatory conditions of the eye

c.     Skin lesions

d.     Stomatitis (inflammation of mouth and lips)

e.     Autoimmune anemia

f.     Hypercoagulability (too much clotting)

g.  Sclerosing cholangitis (scarring of the bile ducts)

h.     Possible growth retardation in children

•    They cant absorb nutients they need so may lead to this

What condition of Inflammatory Bowel Disease is being described

Overview ·      Granulomatous inflammatory response ANYWHERE in the GI tract (from mouth to anus it can occur anywhere) ·      Slow progression, disabling ·      Women > men ·      Age: 20s-30s ·      Not curable

Characteristics ·      “Skip lesions” in the bowel (lesions surrounded by normal tissue, like a patchy appearance)   ·      Involves all layers of the bowel; submucosal layer most affected ·      “Cobblestone” appearance of bowel ·      Bowel wall becomes thick and inflexible(like a pipe or rubber hose)q ·      Surrounding tissues and lymph nodes become inflamed ·      Periods of exacerbations and remission

Manifestations (depends on area involved) ·      Diarrhea (not usually blood in the diarrhea) ·      Ulceration of perianal skin (right around anus we see ulceration due to frequent diarrhea) ·      Abdominal pain ·      Weight loss ·      Fluid & electrolyte imbalances ·      Malaise ·      Low-grade fever ·      Nutritional deficiencies ·      Possible formation of fistulas(intestines join together and have like a tunnel between them) ·      Steatorrhea (excess fat in stool)

Chron’s disease

What condition of Inflammatory Bowel Disease is being described

Overview ·      Nonspecific inflammatory condition of the colon (ONLY IN COLON) ·      Confined to the rectum or colon ·      Curative with colectomy ·      Age: Any, mostly 15-25

Characteristics ·      Lesions in the base of the mucosal layer ·      Lesions à pinpoint hemorrhages à abscesses ·      Lesions may become necrotic and ulcerate ·      Involves only mucosa and submucosa of bowel ·      Pseudopolyps (tongue/worm like projections) ·      Bowel wall thickens in response to repeated inflammation(affects absorption) ·      Relapsing disorder (can get better or have problems later on)

Manifestations ·      Attacks of diarrhea that may persist for days, weeks, or months (when have flare ups they have lots of diarrhea, and it usually contains blood) ·      Stool usually contains blood and mucous ·      May have nocturnal diarrhea(may have incontinent episode or wake up to go poop) ·      Mild abdominal cramping ·      Fecal incontinence ·      Anorexia ·      Weakness ·      Fatigue ·      Mild (< 4 BM/day), to fulminant (> 10, severe toxic symptoms, at risk for toxic megacolon)

ulcerative colitis

Overview of Chron’s disease

·      Granulomatous inflammatory response

• ANYWHERE IN THE GI TRACT (from mouth to anus, it can occur anywhere)

·      Slow progression, disabling

·      Women > men

·      Age: 20s-30s

Not curable

Characterisitcs of Chron’s disease

•    “Skip lesions” in the bowel (lesions surrounded by normal tissue, like a patchy appearance)

• Involves all layers of the bowel; submucosal layer most affected

•   “Cobblestone” appearance of bowel

•    Bowel wall becomes thick and inflexible(like a pipe or rubber hose)

•     Surrounding tissues and lymph nodes become inflamed

• Periods of exacerbations and remission

Manefestations of Chron’s disease

·      Diarrhea (not usually blood in the diarrhea)

·   Ulceration of perianal skin (right around anus we see ulceration due to frequent diarrhea)

·      Abdominal pain

·      Weight loss

·      Fluid & electrolyte imbalances

·      Malaise

·      Low-grade fever

·      Nutritional deficiencies

·      Possible formation of fistulas(intestines join together and have like a tunnel between them)

·  Steatorrhea (excess fat in stool

Overview of Ulcerative colitis

·      Nonspecific inflammatory condition of the colon (ONLY IN THE COLON)

·      Confined to the rectum or colon

·      Curative with colectomy

Age: Any, mostly 15-25

Characterisitcs of Ulcerative colitis

·      Lesions in the base of the mucosal layer

·      Lesions —> pinpoint hemorrhages —> abscesses

·      Lesions may become necrotic and ulcerate

·      Involves only mucosa and submucosa of bowel

·      Pseudopolyps (tongue/worm like projections)

·      Bowel wall thickens in response to repeated inflammation(affects absorption)

·      Relapsing disorder (can get better or have problems later on)

Manefestations of ulcerative colitis

·      Attacks of diarrhea that may persist for days, weeks, or months (when have flare ups they have lots of diarrhea, and it usually contains blood)

·      Stool usually contains blood and mucous

·      May have nocturnal diarrhea(may have incontinent episode or wake up to go poop)

·      Mild abdominal cramping

·      Fecal incontinence

·      Anorexia

·      Weakness

·      Fatigue

·   Mild (< 4 BM/day), to fulminant (> 10, severe toxic symptoms, at risk for toxic megacolon)

What disorder of the small and large intestines is being described?

1.     Main concern: dehydration and fluid/ electrolyte imbalances

2.     Infection of the GI tract- may be virus, bacteria, or protozoa

3. can be a viral or bacterial infection

Infectious Enterocolitis

Viral infection of  

Infectious Enterocolitis

a.     Most effect the superficial epithelium of the small intestine

b.     Rotavirus- leading cause of severe diarrhea

• Oral, live vaccine available

• Mostly children 3 months – 24 months

• Spreads fecal/oral route

• Had feces on hand and makes it to the mouth

• Viral shedding 4 days before and after

• Incubation period 1-3 days

• How long itll take before we see symptoms

Manefestations

Viral infection of  Infectious Enterocolitis

1.     Mild to moderate fever and vomiting (usually disappears on 2^nd day)

2.     Diarrhea for 5-7 days

3.     Dehydration may develop rapidly due to diarrhea

Bacterial infection of  Infectious Enterocolitis

a.     May be caused by many different bacteria

b.     Symptoms generally more severe than viral

• Clostridium difficle colits

• Escherichia coli infection

• protozoan infection

Clostridium difficle colits (Bacterial infection of  Infectious Enterocolitis)

• Associated with antibiotic therapy (especially “broad spectrum” antibiotics for gram negative bacteria)

• Antibiotic medication kills normal flora that would usually fight C. diff bacteria

• After the normal flora are killed, C. diff is transmitted via the fecal/oral route

• C. diff spores are resistant to acidic stomach environment and convert to vegetative forms in the colon

• Usually acquired in the hospital

• Diarrhea usually begins 4-9 days after antibiotic therapy is started and subsides after the medication has been stopped

    Escherichia coli Infection (Bacterial infection of  Infectious Enterocolitis)

• E. coli found in contaminated milk, pork, poultry, and lamb

• Transmission may occur with undercooked meats

• May also be transmitted by swimming in contaminated lakes, coming in contact with contaminated animals (petting zoos), nursing homes, daycares, hospitals.

• Abdominal cramping and watery diarrhea (may progress to bloody diarrhea)