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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
how does Na+ exit epithelial cells into the extracellular fluid
Na+/K+ ATPase
26
how does water enter epithelial cells
via aquaporins
27
why does water follow Na+ in epithelial cells
because Na+ goes into ECF, increases osmolarity, H2O follows passively through water channels
28
does water move alone? why?
it never moves alone, it always follows the movement of ions
29
how does H2O get secreted in the small intestine
NaCl is pumped back, Cl- creates osmotic gradient (h2o and other electrolytes follow)
30
how does Na+ enter the epithelial cells (from the ECF)
it is pumped in by a Na+ / Cl- co transporter
31
what happens after Na+ re-enters the epithelial cell (in secretion)
they return back via the Na+/K+ ATPase
32
how does Na+ enter the epithelial cells (from the ECF)
it is pumped in by a Na+ / Cl- co transporter
33
what happens after Cl-enters the epithelial cell (in secretion)
it passes into the lumen via the CFTR channel
34
what happens once Cl- gets secreted into the lumen
it creates an osmotic gradient and H2O and other electrolytes flow passively from the ECF via intercellular channels
35
what is secretory diarrhea
abnormal secretion of H2O and salts into SI
36
what causes secretory diarrhea (like molecule wise)
absorption of Na+ is impaired while secretion of Cl- continues or is increased
37
what happens with Na+ in secretory diarrhea
absorption is impaired
38
what happens with Cl- in secretory diarrhea
secretion is continued or increased
39
what is the net result of secretion in secretory diarrhea
net fluid secretion, leading to loss of H2O and salts as watery stools
40
what may cause secretory diarrhea
action of the bowel mucosa of bacterial toxins
41
what causes the net fluid secretion in secretory diarrhea
Cl- going into lumen, drawing water into it too
42
what kind of diarrhea does cholera cause
secretory
43
how do cholera toxins work
they irreversibly activate Gs proteins to increase cAMP and thus activate CFTR (Cl- channel)
44
what is osmotic diarrhea/ what causes it
when poorly absorbed osmotically active substance is ingested
45
what are examples of things that cause osmotic diarrhea
sorbitol, mannitol
46
why do you get water entering lumen when you eat things like sorbitol or mannitol
H2O moves from ECF into gut lumen until osmolarity of intestinal content = that of ECF
47
does secretory or osmotic diarrhea have more to do with NaCl
secretory
48
does osmotic diarrhea cause dehydration
yes
49
does secretory diarrhea cause dehydration
yes
50
what is the main difference with secretory and osmotic diarrhea
secretory-water moves because of Na+ and Cl- | osmotic- water moves because of osmotic load in the gut
51
what is a bad thing that may happen with osmotic (besides dehydration)
hypernatremia
52
why can you get hypernatremia with osmotic diarrhea
because loss of h2o is greater than the loss of nacl
53
what is the first priority treatment
oral rehydration
54
what do you wanna restore the balance of
fluid and electrolyte
55
how can you help enhance absorption when treating diarrhea
addition of glucose and some amino acids enhances Na+ absorption via a co-transporter and thus also H2O uptake
56
what kind of infection usually causes diarrhea
viral
57
do they often use anti-infectives with diarrhea and why
no, usually viral. if bacteria, they resolve quick
58
what are 4 common bacteria that cause diarrhea
e.coli, salmonella, shigela, campylobacter
59
why would you use a spasmolytic for diarrhea (4 steps)
relax gut smooth muscle --> decrease motility --> increase transit time --> increase time for water reabsorption
60
what kind of NT is ACh (Stimulatory or inhibitory) in the gut
stimulatory
61
what is an example of a muscarinic antagonist
atropine
62
what does atropine do to gut and how
bocks action of ACh so it relaxes gut muscle and decreases motility
63
do they often use atropine for diarrhea and why
no because significant side effects
64
what happens to gut contraction if you increase ACh
it increases
65
what happens to gut contraction if you decrease ACh
it decrease
66
what is the primary stimulatory NT in gut
ACh
67
where are natural opioid peptides released
locally
68
where do natural opioid peptides act
locally
69
why can using opioids confuse the system if trying to fix diarrhea
because they act much more widely
70
what GI functions do opioid agonists affect
motility, secretion, transport of electrolytes and fluid
71
how do opioid agonists affect GI functions (which . receptors)
activating mu kappa delta
72
why are there a number of diff mechanisms with opioid agonists
because receptors are localized in several cell types within the GI tract
73
where is the primary site of action of opioid agonists
probably at ENS inhibitory presynaptic receptors to reduce ACh release
74
what happens to ACh release when opioids act presynaptically
less ACh release
75
what happens to contraction when opioids act presynaptically + why
less contraction cause less ACh release
76
what is the net effect of opioid agonists on segmentation
increase segmentation
77
what is the net effect of opioid agonists on peristalsis
decreases
78
what is the net effect of opioid agonists on propulsive movements
decrease
79
what is the net effect of opioid agonists on transit time
increase
80
what is the net effect of opioid agonists on water absorption
increase
81
what is the major unwanted effect of morphine (usually, not when talking diarrhea)
constipation
82
why dont we use morphine for diarrhea
because you dont need CNS actions (controlling pain)
83
what is a good opiate for diarrhea
loperamide
84
what is loperamide
opiate used for diarrhea
85
what is the structure of loperamide like
similar to pethidine (synthetic opioid agonist)
86
what is diff with loperamide vs morphine
loperamide does not cross the BBB
87
does loperamide have actions at CNS
no
88
what causes the effects of loperamide
actions on peripheral opioid receptors in GI muscle and ENS
89
when is loperamide most commonly used
travellers diarrhea
90
what kind of dairrhea is travellers
secretory (pathogen causes it)
91
what are 3 things that loperamide causes
- reduction of cramps - shortens duration of illness - constipation
92
how do adsorbents work
they soak up H2O in the gut
93
how can adsorbents help diarrhea (3)
they do symptomatic relief, maybe help adsorb pathogens/ toxins, and maybe coat and protect mucosa
94
what are 2 things that are not great about adsorbents
they do not reduce dehydration and not proved effective in clinical trials
95
what are 3 examples of adsorbents
chalk, charcoal, methylcellulose | there is also pectin and kaolin

PMCOL 344 (27 decks)

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