15 Flashcards
what nervous system innervates the gut
enteric nervous system (extrinsic and intrinsic innervation)
explain the basis of intrinsic innervation of the gut
intrinsic bc its within the gut.
submucosal plexus
myenteric plexus
explain the basis of extrinsic innervation of the gut
include autonomic (simp and parasympathetic )
connects to CNS via VAGUS.
which part of the gut has greatest microbiome population
colon
what are the dominant bacterial strains in gut
clostridium clsotridioform
facelibacterium peronitz
how do we think bacteria interacts with the brain
by activating microglial cells.
goal of focal microbiota transfer
increase diverisyt
useful in obesity
whats the only infection for which focal transfer is approved un the uk
c difficile. by giving more strains, it reduces population of c diff bc competition for food.
what are prebiotics
non digestible food ingredients. promote growth and survival of bacteria. eg. inulin, asparagus….
what are probiotics
live cultures in dairy products. maintains normal bacterial quorum where no one bacteria dominates
what causes GERD
increase in transient LOS relaxation.
GERD treatment
alginates, antacids, PPI
whats gastroparesis and Dx and Tx?
delayed gastric emptying
Dx: using fluoresent carbon.
Tx: domperidone or erythomicin to stimulate stomach contraction.
diabetic gastroparesis
caused by neuropathy of vagus nerve that innervates the stomach
IBD and Cx
all inflammation of lower GIT unknown Cx
crohns most common location
Dx:
Tx:
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…
ulcerative colitis
inflammation of colon bloody diarrhoea Dx: fecal caprotectin (250 ug/g) Tx: sulphazalure (aminocyalate) corticosteroids (prednisolone) severe: biological therapies
IBS Dx
rome IV questionnaire
IBS Cx
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)
IBS treatment
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
