15

Question 1

what nervous system innervates the gut

Answer 1

enteric nervous system (extrinsic and intrinsic innervation)

Question 2

explain the basis of intrinsic innervation of the gut

Answer 2

intrinsic bc its within the gut.
submucosal plexus
myenteric plexus

Question 3

explain the basis of extrinsic innervation of the gut

Answer 3

include autonomic (simp and parasympathetic )

connects to CNS via VAGUS.

Question 4

which part of the gut has greatest microbiome population

Answer 4

colon

Question 5

what are the dominant bacterial strains in gut

Answer 5

clostridium clsotridioform

facelibacterium peronitz

Question 6

how do we think bacteria interacts with the brain

Answer 6

by activating microglial cells.

Question 7

goal of focal microbiota transfer

Answer 7

increase diverisyt

useful in obesity

Question 8

whats the only infection for which focal transfer is approved un the uk

Answer 8

c difficile. by giving more strains, it reduces population of c diff bc competition for food.

Question 9

what are prebiotics

Answer 9

non digestible food ingredients. promote growth and survival of bacteria. eg. inulin, asparagus….

Question 10

what are probiotics

Answer 10

live cultures in dairy products. maintains normal bacterial quorum where no one bacteria dominates

Question 11

what causes GERD

Answer 11

increase in transient LOS relaxation.

Question 12

GERD treatment

Answer 12

alginates, antacids, PPI

Question 13

whats gastroparesis and Dx and Tx?

Answer 13

delayed gastric emptying
Dx: using fluoresent carbon.
Tx: domperidone or erythomicin to stimulate stomach contraction.

Question 14

diabetic gastroparesis

Answer 14

caused by neuropathy of vagus nerve that innervates the stomach

Question 15

IBD and Cx

Answer 15

all inflammation of lower GIT unknown Cx

Question 16

crohns most common location
Dx:
Tx:

Answer 16

small bowel
Dx: fecal caprotectin (250 ug/g)
and colonospy to asses severity
Tx: pediatric: enteral nutrition using modulen for 4 weeks to promote epithelial healing

adults: corticosteroids which impeded growth :/ like prednisone
immunosuppressants
if very severe you give biological agents like antibodies…

Question 17

ulcerative colitis

Answer 17

inflammation of colon
bloody diarrhoea
 Dx: fecal caprotectin (250 ug/g)
Tx: sulphazalure (aminocyalate) corticosteroids (prednisolone)
severe: biological therapies

Question 18

IBS Dx

Answer 18

rome IV questionnaire

Question 19

IBS Cx

Answer 19

often arises after gastroenteritis

Lower GIT IBS symptoms often arise after gastroenteritis​
​
Leaky gut epithelium?​
​
Change to the microbiome quorum? ​
​
Increased sensitivity to pain (visceral hypersensitivity) ​
​
Abnormal activity of enteric neurons leading to changes in motility (diarrohea and constipation)

Question 20

IBS treatment

Answer 20

diet control FODMAP diet
Treat specific symptoms e.g. diarrhoea with loperamide, constipation with fibre/laxatives, anti-depressants (depression is comorbidity), pain medication (e.g. pregabalin)​
​
Specific IBS treatments:​
Linaclotide: increase fluid secretion and pain relief​
Lubiprostone: increase fluid secretion​
Rifaximin: antibiotic to treat bacterial overgrowth​
​
On-going research:​
New molecular targets for visceral pain