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PMCOL 344 > GI - diarrhea > Flashcards

GI - diarrhea Flashcards

1
Q

what is diarrhea

A

frequent passage of liquid feces

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2
Q

what might diarrhea be accompanied with

A

abdominal cramps and nausea

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3
Q

what is the physiological point of diarrhea

A

mechanism to rid gut of irritating substances

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4
Q

what are 4 causes of diarrhea

A

infection, anxiety, drugs, inflammatory disease

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5
Q

can diarrhea be deadly

A

yes, primary cause of death in infants in developing countries

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6
Q

what happens with water and electrolytes in diarrhea

A

disordered water and electrolyte transport in small intestine

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7
Q

what happens to gut motility in diarrhea

A

increased

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8
Q

what happens to fluid secretion in diarrhea

A

increased

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9
Q

what happens to fluid absorption in diarrhea

A

decreased

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10
Q

what happens to electrolytes in diarrhea

A

loss

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11
Q

which electrolytes are mostly lost with diarrhea

A

Na+

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12
Q

how much fluid does an adult take in every day

A

2+

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13
Q

how many litres of water does saliva and secretions from stomach, pancreas and liver add to small intestine every day

A

7 more litres

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14
Q

how many litres enter the small intestine every day

A

9

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15
Q

is there normally more absorption or secretion in the intestine

A

more absorption

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16
Q

what % of fluid entering the small intestine is absorbed

A

more than 90%

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17
Q

how much fluid usually reaches the large intestine

A

about 1 litre

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18
Q

how many mls of H2O end up being excreted in stool

A

100-200mL

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19
Q

what happens when there is a change in 2 directional flow of H2O and electrolytes in small intestine

A

causes an increased volume of fluid to enter large intestine

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20
Q

what happens when the volume of fluid in LI exceeds absorptive capacity

A

diarrhea

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21
Q

what kind of things are on intestinal epithelial cells (3)

A

ion channels, pumps and transporters

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22
Q

where are the ion channels, pumps and transporters on intestinal epithelial cells

A

both luminal and basolateral membranes

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23
Q

what causes absorption of H2O from small intestine

A

osmotic gradients created when solutes are absorbed from lumen

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24
Q

how does Na+ enter epithelial cells in the gut

A

via ENaC channels in the gut

or can be co-transported with glucose or amino acids

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25
Q

how does Na+ exit epithelial cells into the extracellular fluid

A

Na+/K+ ATPase

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26
Q

how does water enter epithelial cells

A

via aquaporins

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27
Q

why does water follow Na+ in epithelial cells

A

because Na+ goes into ECF, increases osmolarity, H2O follows passively through water channels

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28
Q

does water move alone? why?

A

it never moves alone, it always follows the movement of ions

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29
Q

how does H2O get secreted in the small intestine

A

NaCl is pumped back, Cl- creates osmotic gradient (h2o and other electrolytes follow)

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30
Q

how does Na+ enter the epithelial cells (from the ECF)

A

it is pumped in by a Na+ / Cl- co transporter

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31
Q

what happens after Na+ re-enters the epithelial cell (in secretion)

A

they return back via the Na+/K+ ATPase

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32
Q

how does Na+ enter the epithelial cells (from the ECF)

A

it is pumped in by a Na+ / Cl- co transporter

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33
Q

what happens after Cl-enters the epithelial cell (in secretion)

A

it passes into the lumen via the CFTR channel

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34
Q

what happens once Cl- gets secreted into the lumen

A

it creates an osmotic gradient and H2O and other electrolytes flow passively from the ECF via intercellular channels

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35
Q

what is secretory diarrhea

A

abnormal secretion of H2O and salts into SI

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36
Q

what causes secretory diarrhea (like molecule wise)

A

absorption of Na+ is impaired while secretion of Cl- continues or is increased

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37
Q

what happens with Na+ in secretory diarrhea

A

absorption is impaired

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38
Q

what happens with Cl- in secretory diarrhea

A

secretion is continued or increased

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39
Q

what is the net result of secretion in secretory diarrhea

A

net fluid secretion, leading to loss of H2O and salts as watery stools

40
Q

what may cause secretory diarrhea

A

action of the bowel mucosa of bacterial toxins

41
Q

what causes the net fluid secretion in secretory diarrhea

A

Cl- going into lumen, drawing water into it too

42
Q

what kind of diarrhea does cholera cause

A

secretory

43
Q

how do cholera toxins work

A

they irreversibly activate Gs proteins to increase cAMP and thus activate CFTR (Cl- channel)

44
Q

what is osmotic diarrhea/ what causes it

A

when poorly absorbed osmotically active substance is ingested

45
Q

what are examples of things that cause osmotic diarrhea

A

sorbitol, mannitol

46
Q

why do you get water entering lumen when you eat things like sorbitol or mannitol

A

H2O moves from ECF into gut lumen until osmolarity of intestinal content = that of ECF

47
Q

does secretory or osmotic diarrhea have more to do with NaCl

A

secretory

48
Q

does osmotic diarrhea cause dehydration

A

yes

49
Q

does secretory diarrhea cause dehydration

A

yes

50
Q

what is the main difference with secretory and osmotic diarrhea

A

secretory-water moves because of Na+ and Cl-

osmotic- water moves because of osmotic load in the gut

51
Q

what is a bad thing that may happen with osmotic (besides dehydration)

A

hypernatremia

52
Q

why can you get hypernatremia with osmotic diarrhea

A

because loss of h2o is greater than the loss of nacl

53
Q

what is the first priority treatment

A

oral rehydration

54
Q

what do you wanna restore the balance of

A

fluid and electrolyte

55
Q

how can you help enhance absorption when treating diarrhea

A

addition of glucose and some amino acids enhances Na+ absorption via a co-transporter and thus also H2O uptake

56
Q

what kind of infection usually causes diarrhea

A

viral

57
Q

do they often use anti-infectives with diarrhea and why

A

no, usually viral. if bacteria, they resolve quick

58
Q

what are 4 common bacteria that cause diarrhea

A

e.coli, salmonella, shigela, campylobacter

59
Q

why would you use a spasmolytic for diarrhea (4 steps)

A

relax gut smooth muscle –> decrease motility –> increase transit time –> increase time for water reabsorption

60
Q

what kind of NT is ACh (Stimulatory or inhibitory) in the gut

A

stimulatory

61
Q

what is an example of a muscarinic antagonist

A

atropine

62
Q

what does atropine do to gut and how

A

bocks action of ACh so it relaxes gut muscle and decreases motility

63
Q

do they often use atropine for diarrhea and why

A

no because significant side effects

64
Q

what happens to gut contraction if you increase ACh

A

it increases

65
Q

what happens to gut contraction if you decrease ACh

A

it decrease

66
Q

what is the primary stimulatory NT in gut

A

ACh

67
Q

where are natural opioid peptides released

A

locally

68
Q

where do natural opioid peptides act

A

locally

69
Q

why can using opioids confuse the system if trying to fix diarrhea

A

because they act much more widely

70
Q

what GI functions do opioid agonists affect

A

motility, secretion, transport of electrolytes and fluid

71
Q

how do opioid agonists affect GI functions (which . receptors)

A

activating mu kappa delta

72
Q

why are there a number of diff mechanisms with opioid agonists

A

because receptors are localized in several cell types within the GI tract

73
Q

where is the primary site of action of opioid agonists

A

probably at ENS inhibitory presynaptic receptors to reduce ACh release

74
Q

what happens to ACh release when opioids act presynaptically

A

less ACh release

75
Q

what happens to contraction when opioids act presynaptically + why

A

less contraction cause less ACh release

76
Q

what is the net effect of opioid agonists on segmentation

A

increase segmentation

77
Q

what is the net effect of opioid agonists on peristalsis

A

decreases

78
Q

what is the net effect of opioid agonists on propulsive movements

A

decrease

79
Q

what is the net effect of opioid agonists on transit time

A

increase

80
Q

what is the net effect of opioid agonists on water absorption

A

increase

81
Q

what is the major unwanted effect of morphine (usually, not when talking diarrhea)

A

constipation

82
Q

why dont we use morphine for diarrhea

A

because you dont need CNS actions (controlling pain)

83
Q

what is a good opiate for diarrhea

A

loperamide

84
Q

what is loperamide

A

opiate used for diarrhea

85
Q

what is the structure of loperamide like

A

similar to pethidine (synthetic opioid agonist)

86
Q

what is diff with loperamide vs morphine

A

loperamide does not cross the BBB

87
Q

does loperamide have actions at CNS

A

no

88
Q

what causes the effects of loperamide

A

actions on peripheral opioid receptors in GI muscle and ENS

89
Q

when is loperamide most commonly used

A

travellers diarrhea

90
Q

what kind of dairrhea is travellers

A

secretory (pathogen causes it)

91
Q

what are 3 things that loperamide causes

A
  • reduction of cramps
  • shortens duration of illness
  • constipation
92
Q

how do adsorbents work

A

they soak up H2O in the gut

93
Q

how can adsorbents help diarrhea (3)

A

they do symptomatic relief, maybe help adsorb pathogens/ toxins, and maybe coat and protect mucosa

94
Q

what are 2 things that are not great about adsorbents

A

they do not reduce dehydration and not proved effective in clinical trials

95
Q

what are 3 examples of adsorbents

A

chalk, charcoal, methylcellulose

there is also pectin and kaolin

PMCOL 344 (27 decks)

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