DIP Episode 512 - Mechanisms of Diarrhea (for Step 1-3)

Welcome, my name is Devine. This is episode 512 of the Divine Intervention Podcasts. And to this podcast we're going to be addressing a topic called the mechanisms of Dairia. The mechanisms of Dairia. And you may wonder, man, why do I need to know any of these things? This is one of these things that for whatever bizarre reason, our friends at the MBM is these days. They love to throw questions where you clearly know that it's Dairia. But then they will supply a lot of answers that have to do with pathophysiology. So I will strongly encourage you really pay attention to this podcast. This podcast, yes, I'll try to mix some integrations. But honestly, my big, big, big goal is to truly help you understand the content and understand how Dairia may be caused in these different situations. You know, I'm trusting that in the future, we will have the time to see some more things about Dairia. Dairia is actually a pretty high-year topic. So that's actually something that I really hope in the future I can mix some more podcasts on as I have the time. But today let's really try to focus on the mechanisms of Dairia. Again, I'm telling you, these are one of these podcasts that kind of looks non-descript with very, very high-year for your exams. And if you're interested in any of the review courses I have for Step 1, 2, Step 3, that are going to be team please over Zoom, that starts tomorrow.

You can shoot me an email through the website, or you can also listen to the podcast I've made on the topic, and I can give you some more information. Okay, let's get into it. So, well, we all know what Dairia is. Basically, believe it or not, there are four more definitions of Dairia. But essentially, in clinical practice, if a person is having a lot of loose tools every day, if they have like three or more loose tools every day, if I'll say like, more than three, then in that circumstance, you want to think about Dairia. For a person who has more than three loose tools per day, when think about Dairia, some people kind of try to measure it that, ooh, if you make more than 200 grams of stool, that's kind of ridiculous. But basically, Dairia is Dairia. I think it's something that pretty easily I recognize. You know, many of us, we don't think too much about Dairia. We're like, whatever, who cares? There's a restroom somewhere that I can go on, on load on, and it's not a big deal. But I kid you not, many people die of Dairia every year. Especially in developing countries, you know, and me being from a developing country can tell you for a fact, a lot of people die from Dairia every single year. A lot of people die from Dairia every single year. So, let's try to understand what are the different pathways that may lead to Dairia. Well, again, like many things in life is always helpful to try to understand the normal.

If you understand the normal, the abnormal will make a lot more sense to you, right? Because if you think about it, many people think of the kidneys as the only organ that reabsorbs water. But it's not. It's not. Your GI tract also reabsorbs a lot of water. I mean, let me ask you this. All that water that you drink, how do you think that it ultimately gets into your body, gets into your intravascular space? How? Does it just like, do you like Ivy inject yourself with water at home? No, that's ridiculous, right? You drink water and that water is reabsorbed. That water is reabsorbed. Now, what is one thing that helps with facilitating the absorption of water in the intestines? It's the solutes that you've consumed, being adequately absorbed, right? Like, literally, if you drink water, that water can generally not travel on its own, at least the mid, a lot of that water can not just travel on its own through your enterocytes into your bloodstream. No, it depends on solutes. It depends on solutes. Those solutes as they are absorbed, water follows them osmoticly. So if you have some situation where hmm, these solutes that you're consuming along with the water, you're not able to reabsorb it well, then those solutes will stain the lumen of the GI tract and they will keep water from being reabsorbed because since they're staining the lumen, then that water will stain the lumen and the air will result as a result of that, right?

So like, for example, what are some classic Mbimiviniate and stuff like this? Classic Mbimiviniate are going to be, for example, if you consume a sugar or a substrate of some sort, that is polyabsorbed, right? Like, for example, they can easily give you a question about a person that is being treated for a good, or you know, gastric reflux or whatever, and then the person has diarrhea. Antisids, some of them are not well reabsorbed, especially the ones that contain what? Magnesium. That's a very high-yield thing you kind of want to keep at the back of your mind for your exams. Magnesium-based antithids, right? Don't get me wrong, they're calcium-based antithids. They are aluminum-based antithids, but don't forget it's the magnesium-based antithids that really, really love to cause problems, right? Like, Epsom Sol, for example, can certainly cause diarrhea. It's like magnesium sulfate, right? Meaning, even some other antithids, again, just think of that magnesium focus. Those things are very, very big on causing diarrhea, right? Because those things are not very well absorbed. So, if they're not, since they're not being well absorbed, they're going to stain the lumen of the GI tract. So, they're going to hold onto water in the lumen of your GI tract. And you're going to get a nasty diarrhea as a result of that, right? Or you see someone that takes a lot of sugar-free candy? Why do you think the quality sugar-free, but let me ask you a question.

If candy sugar-free, do you think people are really going to like it? Probably not, right? That, even if it's sugar-free, technically, is sugar-free. It doesn't, sugar-free does not mean sweet-tasting-free. Let us say that again. The fact that something is sugar-free does not mean that it is sweet-tasting-free. So, sometimes in these candies, they add certain things that may be zero-coloury, but may try to give some taste to the candy, right? Those things sometimes are not well-reabsorbed. So, since they are not well-reabsorbed, they are going to hold onto water. And that's going to cause you to have a nasty diarrhea. It's going to cause you to have a nasty diarrhea. I mean, to be honest, with you, that's one of the big reasons why I avoid candy these days. Because it is probably four years. I have candy every now and then, but it calls me a lot of GI problems. So, I'm just going to stay away from that stuff, right? Or they can give you a question about a person, right? That can, you know, they seem to have diarrhea whenever they consume milk or whatever. That's lactose intolerance. That's also going to fall under this mechanism of diarrhea, where you have some solute or some substrate that is not well-reabsorbed, is steeping the element of your GI tract in a tract's water, and then you get diarrhea, right? Because if you think about it, right? Like, for example, for patients lactose intolerance, right?

Again, let's kind of break it down, because again, many people just lactose intolerance, lactose intolerance. They're like, oh, it causes a stomach diarrhea, but like, let's have you break this down. Like, what in the world does this mean? Lactose intolerance is an enzyme deficiency, right? In fact, our friends at the MBM is they are not stupid. Again, you've heard me say so many times on this podcast, the importance of derivatives. Instead of putting lactose intolerance as an answer choice on the exam, they can put enzyme deficiency as an answer choice on your exam, or they can put brush-border enzyme deficiency, right? If you, if they put those kinds of answers, it requires you to think a little more beyond just the surface to answer those questions correctly. So please just kind of keep that in the back of your mind as you're studying. Don't just memorize buzzwords, don't just memorize associations. Make sure you actually understand pathophysiology. I'm telling you this, this is something I can almost promise you you're going to see a lot this year. People getting caught down where they know a lot of stuff, where they know a lot of facts, but you have absolutely no context, absolutely no understanding. It's going to get you in trouble on your exams, right? But think about this. Lactose intolerance, what's the pathophase? Well, the big problem is that you have a lactase deficiency. Lactase is a brush-border enzyme. What is the job of lactase?

Lactase basically takes lactose, right? Which we usually find in milk. And it basically hydrolysis it into glucose and galactose. So if you have a lactase deficiency, right? Your brush-border has been, you know, you don't have enough lactase along your brush-border. Your intestinal brush-border, which we're following, finding the small intestine. Then that lactose is not going to be effectively hydrolyzed, right? So the lactose is going to be retained in the lumen of your GI tract, in the lumen of your intestines, and it's going to hold water. That water it holds, that water it holds, right? It's going to cause you to have a lot of diarrhea. And the thing is, many people always wonder, like, man, divine, like I've noticed that people that are lactose intolerance, they tend to say that, man, they have a lot of bloating and stuff. Well, let me tell you something. The thing is your colonic bacteria. And do you think they don't like lactose? These certainly love lactose, right? So what are you going to do to it? They're going to ferment it. And remember, when you ferment something, you produce gases of byproduct. All those gases that are produced as byproducts, right? That's going to cause you to have that bloating and flotulence, right? And one critical clue, because again, I don't know. They do this a lot on step one, step two, step three. But also they do this weirdness on the surgery show, whatever bizarre reason.

They'll write these diarrhea questions, these diarrhea mechanism questions so well, to where it's really hard to differentiate one from the other. Let me tell you one very unique feature that I'll tell you that, oh, yes, this person probably has an osmotic diarrhea. Here's the critical thing. You'll notice that if this person stops consuming the thing that causes them trouble, or this person fasts for a while, the diarrhea disappears. Many people intuitively know this, right? You know that you're feeling bloated and everything. You're like, you know, farting all over the place. You're just like, man, I'm not going to eat anything for a while. And you notice after like 12-ish or whatever hours, you start feeling a lot better, right? Because you stop consuming the thing that's causing you problems. So if you see a diarrhea that improves with fasting, or when you stop consuming the stuff that's not good, that's very likely some kind of osmotic diarrhea that you're dealing with. Okay, now let's talk about another normal so that we can understand the abnormal, right? So another normal, I think I want to emphasize here is this, right? The thing is, you're small intestine is kind of like a unique place where a lot of things are absorbed. And the thing is sometimes you want things to be a little watery to facilitate, like, break down and whatnot, right?

I just kind of like to think of it this way, like, say for example, if you think something that's very hard, and you put it like in water, it kind of dissolves it out, makes it a little softer, makes it easier to manipulate and work with. So the thing is, believe it or not, your small intestine actually enables ions and water to be secreted into its lumen. Okay? Just to facilitate digestion and break down of food. You know, you have all these chloride channels and what notes that you used to put water, you know, put ions and put water in the lumen of your small intestine. But your body is not stupid, your body is like, hmm, okay, all this water I've secreted, okay, I see Donnie's job, I see help with digestion, okay, great it has, right? So what's going to happen? You're going to reabsorb all that water back, right? After it's done, it's deeds, you reabsorb that water back. And you try to reabsorb that water before you get to the large intestine, right? Before you get to the large intestine. So again, now that you understand that normal, then you may begin to see why that process if it's disrupted, it calls diarrhea. So say for example, if you have a situation where you're secreting all these ions into the lumen of the GI tract, but that's take back of the water before you get to the large intestine. If it doesn't happen, that's certainly going to cause a person to have diarrhea, right? So like for example, think of cholera, right?

You're going to give this as a question from a person that, you know, developing a country kind of a situation. But basically, how does cholera cause diarrhea, right? Well cholera causes excessive secretion. It causes a secretory diarrhea if you may, right? So what does vibrial cholera do? Basically, it produces the cholera toxin, right? It produces the cholera toxin. And this is one of these things where the deep mechanism behind, so step two may say, oh cholera, a secretory diarrhea. What's step one and step three? And two, a lesser extent, step two, then we're going to a little more detail to see if you know the actual pathophase, right? But cholera, the toxin, what does it do? It pretty much activates adenylil cyclase, right? And if you actually develop adenylil cyclase, remember your signaling cascades? It's going to convert ATP to cyclic AMP. So cyclic AMP will increase within the lumen of your enterocytes. It's going to increase. And if that happens, cyclic AMP, one of the things it does, is that it triggers the opening of chloride channels. It triggers the opening of chloride channels. And if you open those chloride channels, you're going to secret excessive amounts of chloride into the lumen of the GI tract. Water is going to follow that excessive chloride, and you're going to have diarrhea as a result of that, right? You're going to have diarrhea as a result of that. And believe it or not, the, you know, many of us are familiar with the myenteric plexi, right?

Those myenteric plexi, those nerves in your GI tract, they also promote secretion of stuff, right? The thing is cholera, the toxin also stimulates those nerves in your myenteric plexi, so that you can secret more ions and water into the lumen of the GI tract, right? That will obviously also cause you to have problems, right? And again, many people just think of cholera, but again, don't forget, if they give you like a developed contrary question, you may want to think about etech and teratoxigenic equal-ly. Remember, teratoxigenic equal-ly has a hip-li-bal toxin that also activates a delineal cyclase, right? Remember, there's the hip-li-bal and the heat-stable toxin. There's the heat-li-bal toxin that activates a delineal cyclase. There's the heat-stable toxin that activates a guanileal cyclase, right? So, if you activate these cyclases, again, you're going to make a lot of cyclic AMP, you're going to make a lot of cyclic GMP, it's going to keep ion channels open, you're going to secret more ions into the lumen of the GI tract, more water is going to follow, and you're going to have a nasty nasty barrier, right? And generally, when people have these kinds of barriers, you aggressively, aggressively, aggressively want to use oral rehydration therapy, right? Like a salt sugar solution, because the thing is, basically, by giving a salt sugar solution, you're encouraging the activity of sodium glucose-link transporter 1, right?

Many of us are familiar with SGLT2 inhibitors, that is, for diabetes. SGLT2, the transporter, is found in the proximal convoluted tubule of the kidneys. But SGLT1 is found in the GI tract. Now, how does SGLT1 work? Remember, sodium is primarily an extracellular ion. Why? Because of the activity of the sodium potassium ATP is pump. That pump puts three sodiums out of the cell and two potassiums into the cell. So because it puts more sodiums out of the cell, you're going to have a sodium being an extracellular ion. A sodium flows down its gradient back into the cell. You can use that gradient energy of sodium to pump things, like glucose, into the lumens of enterocytes. That's the function of the sodium glucose-link transporter 1. So what happens in that case? Well, the thing is going to happen is that if you give a salt sugar solution, by giving that salt, you are augmenting the gradient energy of the SGLT1 transporter, and by augmenting that gradient energy, you're going to augment glucose absorption. So you can give that person some electrolytes and stuff. And as that glucose is very absorbed, water is going to follow us. Well, that's literally the pathophase behind why a salt sugar solution can be very helpful in people that have cholera or people that have secretory diarrhea for any reason. And again, remember, it's not just a febriacolory or E. coli and teratoxigenic E. coli that can cause these problems. No.

There are many other things that can cause you to have a secretory diarrhea, right? Like some laxatives, believe it or not, they promote intestinal secretion of ions, right? And as those ions are secreted in excess measure, what are we going to have there? Believe it or not, they can even give you a question about a person that has a pancreatic neuroendocrine tumor, like a viperma, visual active intestinal peptide, right? When a person has a viperma, viperma is believed or not, because you have to secret excess ions into the lumens of your GI tract, water follows, and you're going to get diarrhea. Remember, many times when people have a viperma, sometimes the coli WDH, a syndrome, WDH, a little instance for WDH, hypokillemia and echlohedria. What do you think that WDH comes from? It's a kind of secretory diarrhea, right? And the thing is, believe it or not, there are many, many drugs, many, many drugs that cause a nasty, nasty diarrhea, right? Like for example, some asthma drugs, believe it or not, they can cause diarrhea, right? Some of these cardiac drugs, believe it or not, they can cause diarrhea. Some of these antibiotics, believe it or not, they can cause diarrhea, right? In fact, one of these ones that I'm sure that many people in medicine, because we're heavy coffee drinkers, will probably be intimately familiar with is a caffeine. Caffeine is a powerful stimulant of intestinal ions secretion. It's going to cause you to have diarrhea.

I mean, this is one of the many reasons why I do not take coffee and greed measure, because I've noticed whenever I take coffee, I get a ton of diarrhea, it's not very helpful to me. So you don't want to be having diarrhea on the job, but anyhow, okay, right? And again, one, I think, critical thing to keep in mind with these secretory diaries is again, I say that, ooh, osmotic diaries, if you're fast or you stop exposing yourself to the nasty thing, the diary will stop within hours. You'll notice that. But the thing is, for secretory diaries, they don't necessarily resolve because you've stopped consuming the substance. As long as that toxin is being elaborated in you or the cause of the issue is still there, you're going to still keep having problems. Right? Okay. Now, another thing to also keep in mind, so let's describe another normal. Let's describe another normal. Another normal situation is that the thing is, many people don't think about this, but the epithelium of your GI tract has immune properties. It's literally like a barrier function. Literally, it's probably one of the biggest, most important parts of your innate immune system. Right? It constitutes a barrier. Your GI tract barrier constitutes a barrier for many things to not come into your body. Right? But again, think about it. Like any barrier, what can happen? Well, you can always breach any barrier. You can always damage any barrier. Right?

So, if these barriers are disrupted by some bacteria or some virus or whatever, then that can certainly cause a person to have a barrier. You destroy this barrier, you're going to get a lot of trouble. Why? Because the stuff that is kept in the body, like for example, like your blood, your serum, is kept away from the lumen of your GI tract. Those things are very stimulatory to the GI tract. If that intestinal barrier is damaged, then blood serum and what not can leak into the lumen of your GI tract, is going to stimulate the mutility of your GI tract. You're going to get a very, very nasty barrier. Or think about it. Again, I said that, wow, one of the big functions of your intestines, especially your small intestines, is to make your reabsorbed ton of water in your GI tract. So, if the barrier has been messed up, you may not reabsorb water efficiently. If you don't reabsorb water efficiently, you're going to get the area. You're going to get the area. I think I'm going to maybe talk about this in more detail in a future podcast. This is basically the mechanism behind people getting issues from inflammatory infectious areas. Things like salmonella, e coli, Campilo-Bacteria, Jionai, in kids' rotavirus. Believe it or not, coronaviruses also cause this area. Or you see people like neurovirus and that cushy dissociation, or cryptosporodium, parvinum, people that have HIV or GRD, or ETECH. All these things, they can cause infection and inflammation.

Sorry, not ETECH, ECH, enterohemorrhagic e coli. All these things can cause inflammation in your GI tract, a lot of infection. And that can disrupt the barrier and that can cause you to have diarrhea. Okay, that can cause you to have diarrhea. And again, many people just think that man is just a bug that causes this problem. It's not just a bug that causes this problem. No, no, right? Again, this delved a little deeper into the pathophase. Remember, when your body sees bugs, what does your body do to bugs? Your body does inflammation, right? And remember, when inflammation happens, one of the hallmarks of inflammation is a dima, right? Things like bradykine and histamines, these things cause a dima. If you have a dima, your enterocytes are going to be distended. And if you had distended, remember your enterocytes, if you look like a cartoon diagram of your enterocytes, they have these indentations on their apical surfaces. Like up, down, up, down, up, down, up, down, up, down, up, down, up, down, where you basically have your microv-light. Well, here's the thing. If your intestinal enterocytes become a dimanos, they're going to get fat, they're going to get bigger. As they get bigger, it's almost like they're stritting out all those indentations, the house, your microv-light. If you're stritting those things out, guess what? You've pretty much destroyed the... You've pretty much messed up your brush border, right? Your intestinal brush border helps your absorption.

That's going to cause you to know your absorption stuff well. You're going to get the areas as a result of that. And believe it or not, these white blood cells, the cytokines that they release, the inflammatory mediators, they release, these things are very powerful stimulators of secretion. So they basically like insert a secretory component of diarrhea in the setting of inflammation and infection within the GI tract. And also think about it. Remember, again, those are really want to make sure you understand these things. Think about it. Many of us have heard of neutrophils. And how do you do these oxydiliv bursts? Well, do you think... What do you think comes from that oxydiliv burst pathway? Well, it's going to be reactive oxygen species. It's going to be these free radicals. What do you think free radicals do the pandemic cells? As the tear and a rape apart during intestinal cells? Again, your body is going to be like, oh, okay, let me try to make up, right? So it's almost like you then put out immature interocytes that are not very... they don't have enough brush border enzymes. They don't have enough microbial eye. Because they are not mature. They are not mature. So because they are not mature, they are not as efficient as we are at the absorption of stuff. And that can ultimately cause problems. So the person will basically also have like a malabsorption in a sense. Right? And again, another thing that can cause diarrhea again, let's talk about another normal.

Another normal in this situation is the thing is it takes time for things to be reabsorbed. I like to think of it this way. It takes time for things to be reabsorbed. Right? I just like to think of it this way. Like, let me give an analogy. I think it's going to make a lot of sense if you really pay attention. Say for example, you want to learn like coluses. You want to learn it in detail. Understand the way you know can cranny of it. You should probably invest like, I don't know, like a half hour trying to get that stuff down. But think about trying to master that stuff in 30 seconds. Are you really going to get much from that? No. Are you going to really master that subject? No, you're not. Because you just spend too little time trying to assimilate that information. Right? So the same things happens with food. Food has to stay in your GI tract for a certain time. Food to be properly reabsorbed. Food to be efficiently reabsorbed. Right? So the adequate exposure to the epithelium of your small intestines. Right? And again, those things just have to be there for at least a good amount of time. So the appropriately reabsorbed. Right? But if you have issues with GI tract motility, where like your transit time is accelerated, that can cause a person to have diarrhea. Right? Like for example, some people when they have diarrhea, they have it because while their GI tract are just hypermotile, hypermotile, hypermotile. Right? Their GI tract are just working too well.

They're going too fast. So it's just not enough time for nutrients to be reabsorbed. So those nutrients, they're just going to essentially be in the GI tract. Keep water and cause you to have a nasty nasty diarrhea. Right? So again, that's another very big pathophase behind diarrhea. Right? Another thing that can also cause diarrhea, just like things can go too fast. Kind of going along with this motility issue. Is that things may go too slow. Things may go too slow. Because the thing is your GI tract, right? That peristalces is pretty helpful in keeping things moving. Right? Keep it moving. Keep it moving. Right? But especially like bacteria and all these things. Because you have no more flour in your GI tract. Right? But whenever your GI tract has been paralyzed by whatever situation, like scleroderma, right? Or see for example, a person has diabetes gastro parisis, or see for example, a person is taking an anticholinergic drug, right? That has basically paralyzed GI motility. Then those bugs in the lumen of your GI tract, they're just going to chill. They're going to be like, hmmm. Okay. Because there is no peristols that is happening, right? The person's GI tract has become epistoltic. So the bugs just sit. Sit. Sit. Sit. Well, when they sit around, they're going to start proliferating like crazy.

And as they proliferate like crazy, what maybe, oh, maybe for this particular kind of bacteria, or you're supposed to only have like a thousand per square feet or whatever of GI tract. Again, I'm just trying to make an example here. But because they're all, because of that, that's the thesis, right? They then start growing, they start proliferating to like, oh, 10,000, 100,000, one million per square feet. Because there's so many of them, because there's so many of them, that bacterial overgrowth is going to cause you to have diarrhea, right? Because a lot of these intestinal bacteria, they do a lot of fermentation, that's going to cause bloating, it's going to cause flotcholence, you're going to have a lot of trouble, right? And the thing is sometimes those things also begin to destroy your brush border. As you destroy the brush border, you're not going to be able to reabsorb things properly, right? And if you don't reabsorb things properly, you're certainly going to have diarrhea. You're certainly going to have diarrhea. And just a quick throwback to this inflammatory and infectious diarrhea business I talked about. Remember things like Crohn's disease, right? Those are not necessarily infections, but the inflammatory conditions of the GI tract, right? Inflammatory bowel disease, like Crohn's disease, like Australian colliders. All those things can certainly lead to diarrhea, right?

And also remember that inflammation, you know, I kind of talked about like osmotic diarrhea where like, ooh, if you don't reabsorb stuff, well, think about it, celiac disease, where you make auto-antibodies against gliadin, right? Anti-gliadin, anti-inflammatory, one-tactythrotransplotaminis antibodies. Well, what in the world happens with those? Well, the thing is, if you make those auto-antibodies, they're going to damage your microbiology. If you damage the microbiology, you will not be able to reabsorb stuff. If you're not able to reabsorb stuff, guess what? Those things are going to stain the lumen of your GI tract. Many times you're going to have fat malabsorption, and that's going to lead to a person having diarrhea, right? So, kidney is just pretty important to make sure that you truly understand these mechanisms, right? And, you know, malabsorption may not always be caused by just celiac disease. Well, see, for example, you have pancreatic insufficiency for whatever reason, or you have an obstruction in your biliary treat, right? So, see, for example, you have chronic pancreatitis, or you have cystic fibrosis, or you have, like, some kind of malignancy that is preventing pancreatic enzymes or bile from coming into your small intestine from being secreted into the wardnam. Well, guess what's going to happen? The thing that's going to happen is, those things are supposed to be helpful with you digesting and reabsorbing a lot of stuff.

If those things are not being secreted, then you're going to have a lot of trouble with absorption, right? And, since you're having issues with absorption, those things that are supposed to be reabsorbed, they will stain the lumen of the GI tract, they will hold water, and that's going to cause you to have diarrhea, right? So, again, just kind of think of all these things. So, you may even notice that, man, you see a person that has a chronic history of, like, they have, like, a history of peripheral arterial disease, right? Or they tell you that, man, whenever the eating hurts, right? So, if a person has chronic dysentery, you can scheme it. Again, think about it. Your GI tract for you to be able to, I'm just giving, like, different mechanisms that may not fit into the standard classifications I've talked about. But, say, for example, if a person has chronic dysentery, schemia, it's almost like intestinal angina. It's like atherosclerosis of your GI tract, right? Of the vessels that feed your GI tract, like your dysentery gardeners. So, think about this. If, for example, you're not able to supply an off-broad and nutrients to your GI tract, do you think that those cells will have properly functioning pumps? No. Do you think that those cells, I'm going to be able to reabsorb stuff efficiently? No. So, since those things do not work properly, stuff will sting the lumen of your GI tract. It's going to hold water and you're going to have a nasty, nasty, nasty diary, right?

Another classic one. This one, honestly, is kind of weird, but I'm going to try to discuss it. And this will be a person that has nasty, chronic diarrhea. And it did with that man. This person has had some kind of gastric bypass. If you see something like this, I want you to think of something called blind loop syndrome. Believe it or not, you'll be like, wait, what? I promise you, this stuff is very, very high-youtu-no for the USMLE exams. They call it blind loop syndrome. Sometimes they call it stagnated, like stagnant bowel, or sometimes they even call it like stagnant loop syndrome. But basically, the thing that happens here is that, you know, in the process of doing surgery on the GI tract, like a gastric bypass, especially like these, or some of these things, they call them like Bell Roth procedures, BILL, ROTH. These Bell Roth procedures, they can damage certain parts of the GI tract, or they can bypass certain parts of the GI tract. So those parts of the GI tract that are damaged, maybe like, denervated, or they are bypassed. Because those areas are not getting fed with food or they've been denervated. Then you have a lot of stasis, or you have a lot of stagnancy in those regions of the GI tract. As you have that stagnancy, what do you think is going to happen? The thing that's going to happen is that you're going to have bacterial overgrowth. And that bacterial overgrowth is going to lead to problems. Okay? That bacterial overgrowth is going to lead to problems.

Okay, so I'm going to go ahead and stop here. Again, if you're interested in any of my review courses, or any of my one-on-one tutoring for any of the USMLE, or complex exams, or help with ERAS applications and what-not, just feel free to email me through the website. I can give you some more information. And these podcasts are on Apple Google and Spotify. I view You Tube channel. You can check out. And then I have another website called, divided interventionallifelessons.com. Basically every week, I post like two podcasts. I'm from a biblical perspective. I try to address that life lesson. So there's actually an Apple podcast associated with that as well. So thank you for listening to me today. I will see you in episode 513. Have a wonderful day. We show the best on your exams. God bless you. Bye for now. Thank you.

The presence of unabsorbed solutes in the intestinal lumen that draw water osmotically.

Osmotic diarrhea.

SGLT1 (Sodium-Glucose Linked Transporter 1).

Cholera toxin.

Osmotic diarrhea resolves when the offending solute is removed; Secretory diarrhea continues as long as the toxic stimulus or cause remains active.

Paralytic ileus (stasis) or following procedures like gastric bypass/Billroth II procedure.

Lactase deficiency; a brush-border enzyme deficiency.

Cholera toxin.

Autoantibodies against gliadin damage the microvilli/brush border, impairing nutrient absorption (malabsorption).

They signal open ion channels ($\text{Cl}^-$), leading to excessive secretion of ions and water.

Lack of peristalsis allows bacteria to proliferate, fermenting contents and causing malabsorption/diarrhea.

It augments the gradient energy of SGLT1, promoting sodium absorption, which in turn pulls water osmotically into the body.

Lactase deficiency; a brush-border enzyme deficiency.

Cholera toxin.

Autoantibodies against gliadin damage the microvilli/brush border, impairing nutrient absorption (malabsorption).

They signal open ion channels ($\text{Cl}^-$), leading to excessive secretion of ions and water.

Lack of peristalsis allows bacteria to proliferate, fermenting contents and causing malabsorption/diarrhea.

It augments the gradient energy of SGLT1, promoting sodium absorption, which in turn pulls water osmotically into the body.