Concepts of GI Disease Flashcards

1
Q

3 major stomach functions

A

filling

mixing

emptying

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2
Q

gastric filling

A
  • acts as a reservoir for food and liquid
  • two components
    • receptive relaxation
    • accommodation
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3
Q

accommodation

A

stomach adjusts size to increase volume without increasing intragastric pressure

its mediated by vagal inhibitory fibers

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4
Q

receptive relaxation

A

when bolus of food enters stomach and vagal inhibitory fibers decease the lower esophageal sphincter pressure and fundic contractions

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5
Q

gastric filling dysfunction

A
  • inflammatory and neoplastic disease
    • failure to relax
    • increase in postprandial intragastric pressure causes pain, nausea and vomiting
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6
Q

gastric mixing

A
  • mix food with gastric secretions
    • begins intragastric digestion
  • fundus and body are the receptacle for food
  • antrum is distal “pump”
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7
Q

gastric emptying

A
  • stomach empties only when intragastric pressure exceeds duodenal pressure and pyloric resistance
  • influenced by the physical and chemical composition of a meal and by food type, pH and osmolarity
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8
Q

dysfunction of gastric emptying

A
  • gastric and small intestinal diseases
    • most delay emptying and cause vomiting
  • gastric outlet obstruction results in gastric distention and stasis
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9
Q

How much time after eating will the stomach empty in a dog?

A

12-14 hours

the final determinant is the caloric content of the meal

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10
Q

gastric mucosal barrier

A
  • protects stomach from autodigestion
  • anatomic and chemical defense mechanisms
    • surface mucus
    • bicarb
    • epithelial cells
    • mucosal blood flow
    • prostaglandins
    • basal membrane
  • gastric juice is not secreted continuously
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11
Q

for each hydrogen ion secreted:

A

a molecule of CO2 is made

the CO2 combines with water to make bicarb and goes into interstitial fluid where its taken up by mucosal capillaries

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12
Q

What cells secrete acid?

A

parietal cells

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13
Q

gastric barrier dysfunction

A
  • damage allows H+ to leak back into the mucosa
    • it saturates the buffers and cell pH decreases causing injury and cell death
  • result is local ischemia, hypoxia, vascular stasis, leakage of plasma proteins and blood into the lumen, mucosal erosions or ulcers
  • common in dogs but less so in cats
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14
Q

vomiting

A
  • a spontaneous forceful ejection of gastric contents through the mouth
  • occurs when vomiting center receives sufficient stimulation to reach threshold and initiate the reflex
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15
Q

vomiting reflex

A
  • three phases
    • nausea
    • retching
    • vomiting
  • well developed in dogs and cats
  • mediated through the emetic center in the medulla
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16
Q

How can the emetic center be activated?

A
  • directly and indirectly from higher centers, cerebellum, viscera, extra visceral sources (HW, tonsils), drugs or toxins
17
Q

what are some drugs or toxins that can cause vomiting?

A

apomorphine

uremic toxins

hepatotoxins

endotoxins

cardiac glycosides

18
Q

the emetic center can be directly stimulated by:

A

the cerebral cortex, chemoreceptor trigger zone, oculovestibular system (cats only) or the GI tract

19
Q

where is the chemoreceptor trigger zone located and how is it stimulated?

A
  • outside the BBB so it can sample chemicals in the blood without it getting to the brain
    • usually responsible for repeat vomiting
  • directly stimulated by emetic toxins and the oculovestibular system of dogs only
20
Q

diarrhea

A

increased fecal water content which results in change of frequency, fluidity and volume of bowel movements

21
Q

How much of the fluid in the intestines comes from the diet and how much from endogenous secretions of the GI tract?

A

20% from the diet

80% from endogenous secretions

22
Q

What are the potential causes of fluid exchange disruption?

A

increased secretion or decreased absorption

23
Q

where is the most water absorbed in GI tract?

A

50% in the upper small intestines

90% of what is presented to the colon (more efficient)

24
Q

How do cereal based diets affect fecal water volume?

A

increased fiber, more water absorbed

doubles volume of fecal water output

25
Q

which diseases are associated with more fluid loss (proximal or distal tract disease)?

A

proximal small intestine

26
Q

what determines the efficiency of absorption of the GI tract and what can disrupt this?

A

tightness of intercellular junctions (tighter in distal SI and colon)

disrupted by inflammation

27
Q

why are most acute diarrheal disease self-limiting?

A

rapid cell turnover rate in villus, bad cells get replaced quickly

if cause is eliminated and crypts aren’t severely damaged, function is restored in 2-3 days

28
Q

what are the 3 main areas of the villus?

A

crypt: secretory cells, undifferentiated cells that migrate to tip

maturation zone

tip: absorptive cells, slough off after 3-5 days

29
Q

what are the four pathophysiologic mechanisms of diarrhea?

A

osmotic

secretory

exudative

disordered motility

30
Q

what are the characteristics and causes of osmotic diarrhea

A
  • excess of poorly absorbable osmotically active solutes
  • occurs when nutrients are maldigested or malabsorbed
  • seen with pancreatic/enteric disease (EPI), laxatives, other disorders, SIBO/dysbiosis
31
Q

what are the characteristics and causes of secretory diarrhea?

A
  • stimulation of excess secretion overwhelms absorption (usually SI)
  • caused by E. coli heat labile toxin (LT) and fat malabsorption (hydroxyl fatty acids)
32
Q

what are the characteristics and causes of exudative diarrhea?

A
  • increased mucosal permeability causes leakage of fluid, electrolytes, and proteins (also ulcers leaking blood and mucus)
  • IBD, parasite or bacteria infections, lymphangiectasia, hypoalbuminemia, increased hydrostatic pressure (R sided CHF or portal hypertension)
  • diseases associated with this mechanism cause PLE
33
Q

what are the characteristics and causes of disorder motility diarrhea?

A
  • inflammation suppresses phasic contractions and stimulates giant migrating motor complexes
  • makes fluid move faster than it can be absorbed
34
Q

most cases of diarrhea are what kind?

A

mixed