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GI 05 Flashcards

1
Q

How NSAID cause stomach injury?

A

NSAID inhibits prostaglandin production as a result, it stops a natural process, because naturally prostaglandin produces mucus and reduces acid from the proton pump. These 2 pathways will stop so both will increase as a result can cause stomach injury.

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2
Q

How PPIs activate and bind?

A

Activated in low pH
IRREVERSIBLY bind to the H+ K+ ATPase pump.
Works on actively secreting proton pumps

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3
Q

f

A

f

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4
Q

What is the CTZ mean ?

A

Chemo receptor Triger Zone

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5
Q

What medulla include ?

A

Medulla include CTZ
Vomiting centre.

So the vomiting centre is the place when you see blood or other nasty things and want to vomit.

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6
Q

What does CTZ do ?

A

CTZ (Chemoreceptor trigger zone) sends signals to the vomiting center

It has a Vomiting centre which is a big collection of neurons. 
Like 
Chemoreceptors 
D2 receptors 
5HT receptors
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7
Q

Why motion sickness work ?

A

Motion sickness happen because of vestibular system, Central nervous system, (Cranial nerve IX) which connected to the stomach

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8
Q

What makes you vomit ?

A

Emetic stimuli include:
Chemicals or Drugs in the blood or intestine itself which put neuronal input to labyrinth (inner ear) and CNS.

Pathway include: CTZ sends signal to the Vomiting centre where is lots of chemical transmitters like Ach, Dopamine, Muscarinic receptors respectively monitor different response coming from different systems and landing on those receptors.

Enkephalins implicated in the mediation of vomiting: There are some other Opioid receptors and endocannabinoids receptors possibly delta or Meu into our CTZ and vomiting centres as well.

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9
Q

Mechanism of Vomiting ?

A

Chemoreceptors Triggers Zone sends signals to the vomiting centre after receiving signals from body.

CTZ is sensitive to chemical stimuli and main site of action for many emetic and antiemetic drugs.

BBB around the CTZ is relatively permeable therefore CTZ can monitor blood outside our brain that what is going on into our blood all the time. So it can monitor too much alcohol or drugs or other sensitive things relevant for the vomiting.

Local irritants like stomach Bug, Small intestine & blood borne sensitive things as a result we receive signals by CTZ into the vomiting centre into medulla

Vomiting centre is the incidence commander for vomiting. So it triggers inside and outside the brain
Sends out the signal to the vagus nerve ( down to the oesophagus, stomach and duodenum)
The phrenic nerve to the diaphragm and Spinal nerve down to the intercostals and abdominal rectum. And this series of coordination lead to complex act of vomiting

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10
Q

Where is the vomiting centre ?

A

Into the medulla

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11
Q

For pharynx we start

A

feeling Nauseas and we gaging.

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12
Q

What is Nausea?

A

You feel sick but you do not vomit.

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13
Q

What are the Reason of Nausea ?

A

Can be Chemotherapy or other reason.

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14
Q

Which one is easier to treat Nausea or vomiting ?

A

The mechanism of nausea is unknown and the treatment also not less successful compared with vomiting.

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15
Q

Emetic Factors which can cause vomiting ?

A 
1. Drug therapy induced emisis like
Opioids 
Chemotherapy agents 
Digoxin
NSAIDS
Antibiotics
  1. Others
    Odours
    Tastes
    Noxious stimuli like visual or physical

3.Motion sickness
Induced by motion
Epigastric discomfort
Increasing salivation and belching, sweating nausea and vomiting
Common cause Car, Air, Ship during rough seas.

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16
Q

Which motion sickness is most common to people ?

A

Ship 100% during rough seas
Car 58%
Air 29%

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17
Q

Why we worried about vomiting ?

A

It leads to some medical complications like
Dehydration
Acid base imbalance
Malnutrition Oesophageal tears
Dental caries
Patient discomfort
Pregnancy at risk as might get dehydrate.

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18
Q

For motion sickness which receptors are responsible

?

A

H1 & mACh receptor

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19
Q

Motion sickness induced emisis

A

H1 receptor antagonist i.e. Cyclizine works on

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20
Q

What is H1 antagonist (antihistamine)?

(Promethazine, Cyclizing, funded) Meclozone

A

(Promethazine, Cyclizing, (PC) funded) Meclozone

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21
Q

H1 antagonist medicines will work against only which receptors?

A

H1 is effective for nausea and vomiting for Motion sickness

will only work on H1 and a little bit on mACh receptors but it will not be effective for other receptors.

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22
Q

What are the Adverse Effects of H1 antagonist ?

A

Drowsiness and sedation is common.

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23
Q

What drug is the mACh receptor antagonist?

A

Hyoscine (Scopolamine) effective for nausea and vomiting of vestibular origin and stimuli from stomach. Similar like H1 receptor.

mACH receptor antagonist will not effective against substances acting on CTZ

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24
Q

What are the Adverse effect of mACh receptor antagonist?

A

Dry mouth and blurred vision, feeling drowsy and sleepy as well.

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25
Q

What is the 5 HT3 antagonists?

A

Ondansetron, Tropisetron, granisetron.

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26
Q

What 5HT3 blocks to prevent nausea and vomiting?

A

Blocks serotonin at 5 Ht3 receptors in stomach and at the CTZ

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27
Q

Adverse effects of 5 HT3 receptor antagonist ?

A

Constipation, headache, dizziness.

28
Q

What is D2 dopamine antagonist ?

A

Metoclopramide & domperidone

Act at CTZ but also work on the GI/stomach which increase motility of oesophagus, stomach and intestine.

29
Q

Metoclopramide combined with paracetamol can treat?

A

Migraine treatment and reduce the chance of nausea and vomiting

30
Q

Adverse effect of D2 dopamine receptor antagonist ?

A

Cause movement disorder in children.

Stimulation of Prolactin release with high doses (menstrual disorder).

31
Q

When planning to administer metoclopramide this drug should be given

A

30 minutes before meal and at bedtime.

32
Q

List Antiemetics drugs

A 
Hyoscine
Ondansetron
Tropisetron 
Granisetron
Promethazine 
Meclozine
Cyclizine
Domperidone
Metoclopramide
33
Q

Which of the following receptors is involved in nausea and vomiting ?

A

Muscarinic
Dopamine
Serotonin

34
Q

The vagus nerve is what kind of nerve ?

A

Parasympathetic nerve

35
Q

What does parasympathetic nerve?

A

in charge of many varied tasks like heart rate GI sweating, some muscle movement mouth and speech.

36
Q

What is the chemoreceptor trigger zone CRT zone?

A

In the medulla and lies outside the BBB
Can sense unwanted chemicals in the blood

CTZ act to stimulates vomiting centre.

37
Q

Gastro Intestinal system controls by

A

little brain. also called Autonomic Nervous System

So If someone has cut into the spinal cord cut so no functioning from their Central NS, but as they have little brain/ENS they can still work for the digestive system.

38
Q

Enteric Nervus System lies within the wall of the GI track organized into two networks they are

A
  1. Myenteric plexus

2. Submucosal plexus

39
Q

What is Myenteric plexus:responsible for ?

A

for Motor control

So can move intestine and stomach control fluid and electrolyte
Absorption secretion and moving

40
Q

What is Submucosal plexus responsible for ?:

A

Location in the sub mucosa, responsible for secretion fluid transport and blood flow.

41
Q

How much water we can intake through our small intestine in 24 hours ?

A

10L

42
Q

What is the main volume in our stool and what is its percentage ?

A

Fluid is the main determinant of stool volume and consistency
Around 70-85%

43
Q

What is the daily challenging work for our GUT is to form stool excrete?

A

It is a daily challenge for GUT of extracting water, minerals and other nutrients from luminal contents via the process of defecation

44
Q

What is the process called for gut absorb different staffs from colon to form stool ?

A

Defecation

45
Q

What is Constipation:

A

Infrequent defecation Less then 3 time in a week hard uncomfortable and difficult to pass.

46
Q

Why we treat constipation?

A

Because It is stopping a natural process
May lead to other complications like haemorrhoids
To avoid straining like ischaemic heart disease, Postoperative.

47
Q

What are the alterntive words for Laxatives

A

Cathartics, purgatives, evacuants, aperients.

48
Q

What are the Bulk laxatives?

A

i.e. Metamucil can( buy from supermarket)

Example: Methylcellulose, psyllium

49
Q

How bulk laxative work ?

A

It has a polysaccharide polymers, attract water and hydrate the mass and promote peristalsis. (Wave)
Take few days to work.

50
Q

What Osmotic Laxatives do ?

A

Absorb solutes. Change osmotic balance by using Mg. So Mg attracts water and solve the constipation. They are very fast acting but some time it may cause diarrhoea & cramps

51
Q

What docusate does & how ?

A

Stool softener. Work like a detergent and coat the stool like a detergent type thing and make it easy to come out.

52
Q

What is Stimulant laxatives ?

A

Senna and bisacodyl.

53
Q

How Senna works ?

A

Stimulate myenteric plexus and increase peristalsis and defecation.

Should not be on this medication more than 10 days.

54
Q

How Bisacodyl works ?

A

Orally but it has suppository as well.
Quick acting within 15- 30 min
May require medical supervision
Can cause electrolyte imbalances for longer application so quite dangerous.

55
Q

How Laxative abuse work ?

A

If you take Laxative too much what they empty your whole colon instead of part of the colon. as a care giver or aged people feel may be they again in constipation as they do not feel to go to toilet for further 2-3 days as a result repeated use. As a result electrolyte (water and salt) imbalance occur and cause hypokalaemia which reduces peristalsis and misinterpreted as constipation and repeated use again.

56
Q

Mechanism of hypokalaemia by using laxative abuse ?

A

Prolong use of laxatives patinet losses of endogenous water and salts Which causes release of ALDOSTERONE(water salt balance kory aldosterone) => continue reabsorpton in intestine which increase renal excreation K+ => Double loss causing hypokalaemia.

57
Q

What is called diarrhoea ?

A

More then 3 lose bowel movement each day called diarrhoea

58
Q

Types fo Diarrhoea ?

A

i) Osmotic diarrhoea: Heaps of water drawing out from body into the bowel. Ex: Dietetic candy
ii) Secretory diarrhoea: When body is releasing water into bowel but normally it not supposed to do Ex: Medicine or infection.
iii) Exudative diarrhoea: presence of blood and pus in the stool. In Crohn’s disease.

59
Q

What is Osmotic diarrhoea?

A

Heaps of water drawing out from body into the bowel. Ex: Dietetic candy

60
Q

What is Secretory diarrhoea?

A

When body is releasing water into bowel but normally it not supposed to do Ex: Medicine or infection.

61
Q

What is Exudative diarrhoea?

A

Blood and pus in the stool specially in Crohn’s disease.

62
Q

What are the Anti-diarrhoeal agents:

A

i) absorbent: preparation contain Kaolin, pectin, chalk, charcoal, and methyl cellulose
Absorb toxins and micro organisms as well as they Protect intestinal microflora too.

ii) Morphine and codeine: Side effects of morphine and codeine is constipation
So use its side effect as antidiarrheal effect but lower in dose compared than analgesic.
a) Decrease stomach emptying: which allows more time for intestinal absorption
b) By decrease contractions: through decrease Ach in the gut as a result less movement and slow down the propulsion. And overall increase fluid & electrolyte retention.

iii) Loperamide : OTC
People buy when they go to Asia or other part of the planet because to treat travellers diarrhoea.

63
Q

Does Loperamide cross BBB?

A

Can not cross BBB, act on GI tract

64
Q

How morphine decrease contraction of bowel as antidiarrheal agent.

A

Decrease ACh release as a result slows down propulsion through the small and large intestine.

65
Q

Where is the vomiting centre located ?

A

In the medulla

66
Q

Where Dopamine antagonists work ?

A

Block Dopamine (D2) receptor in the CTZ

67
Q

What is constipation

A

Infrequent defecation, less then 3 bowel movements per week.

GI (16 decks)

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