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Pharm Y2S2 Patient > GI Physiology and Therapeutics > Flashcards

GI Physiology and Therapeutics Flashcards

1
Q

What does the alimentary canal comprise of?

A

Specialised organs, tissues and accessory structures

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2
Q

What is the GIT made up of?

A 
Mouth 
Pharynx
Oesophagus
Stomach 
Small intestine (duodenum, jejunum, ileum)
Large intestine 
Rectum 
Colon
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3
Q

What are the functions of the salivary glands?

A
  • Secrete amylase and lipase

- produce mucin to help with lubrication

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4
Q

What are the 3 sets of salivary glands?

A

Sublingual
Submandibular
Parotid

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5
Q

What is mumps?

A

An infection of glands including salivary, testes and pancreas

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6
Q

How is swallowing coordinated?

A

Through complex tactile receptors that relay information to the medullar oblongata

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7
Q

Which nerves re involved in swallowing?

A 
Trigeminal
Facial 
Glossopharyngeal 
Vagus 
Spinal accessory  
Hypoglossal
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8
Q

What can happen in stroke patients in terms of swallowing?

A

If there is damage to the nerves it can result in dysphagia

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9
Q

How does food get to the diaphragm?

A

From the oesophagus - leads to the top of the stomach

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10
Q

What kind of cells is the oesophagus lined with?

A

squamous epithelial cells

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11
Q

What is the purpose of the oesophageal sphincter?

A

Contracts and seals the top of the stomach preventing acid / enzymes from passing into the oesophagus

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12
Q

What is Barrett’s oesophagus?

A

Erosion of the oesophagus cells which occurs when exposed to stomach fluid - the cells are replaced with abnormal cells which are pre-cancerous

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13
Q

What happens to abnormal cells in Barrett’s oesophagus is reflux is controlled?

A

The oesophagus heals but the abnormal cells remain - high risk of adenocarinoma

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14
Q

What is a hiatus hernia?

A

Hernia that occurs when the stomach gets through the diaphragm - associated with acid reflux

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15
Q

What do G cells do?

A

secrete gastrin

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16
Q

What do chief cells do?

A

secrete pepsinogen / lipase

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17
Q

What is pepsinogen?

A

an inactive form of pepsin

- acid cleaves pepsinogen to produce pepsin

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18
Q

What do parietal cells do?

A

secret HCl

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19
Q

What effect does the sight or smell of food have?

A

Triggers impulses causing a reaction in the stomach, Ache is released - this binds to a receptor leading to the release of HCl

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20
Q

What does distention of the stomach cause?

A

Release of histamine which binds to its receptor causing HCl release

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21
Q

What do H2 antagonists do?

A

Bind to histamine receptor / inhibit the effects of histamine

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22
Q

Give examples of 2 H2 antagonists

A

Limetidine

Ranitidine

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23
Q

Which drug is used to inhibit the gastric proton pump?

A

Omeprazole

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24
Q

What is the process of HCl production / release

A
  • HCl needs to get from blood and into the lumen.
  • Cl- moves out of the blood and into the cell, they diffuse across the cytosol.
  • CO2 + H20 (from living cells) - the reaction is catalysed by carbonic anhydrase to prodcce carbonic acid. This splits to carbonate ions (taken out of the cell) and H+.
  • The protons are pumped out of the cell.
  • H+ and Cl- combine to form HCl
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25
What is the pH of the stomach and why is this a problem ?
1-2 - leads to drug inactivation
26
What is the stomach made up of?
Proteases and pepsinogen
27
What is the purpose of pepsinogen?
It prevents self-digestion - the cells are not exposed to the active protease
28
Why doesn't the stomach digest itself?
1. Foveolar cells produce mucus which is alkaline so neutralises HCl 2. Tight junctions: protein complexes lock epithelial cells together which restricts movement of acid / protease 3. High cell turnover: damaged ells are replaced every 2-3 days
29
What would happen if the mucus barrier of the stomach broke down?
Stomach / duodenal cells would be exposed to HCl / pepsin leading to a gastric / duodenal ulcer
30
How is peritonitis caused?
When food secretions and bacteria move into the peritoneal cavity - in case of perforated ulcer
31
What does Helicobacter pylori do?
Infects gastric mucosa reduced barrier efficacy - leads to an ulcer. If eradicated ulcer recurrence is low.
32
What is the treatment for H.pylori?
2 antibiotics and a PPI - Clarithromycin, amoxicillin or metronidazole - Omeprazole (or esomeprazole, lansoprazole etc)
33
How can H.pylori be detected?
1. Urea breath kit - patient swallows 13C labelled urea solution, urease activity by the organism produces labelled CO2 2. Mucosal biopsies test urease 3. Histopathology 4. Cultures
34
What do high antibody titres (H.pylori) indicate?
There is an active infection
35
How long should H.pylori treatment last?
7 days | Max of 2 months if symptoms recur
36
What is chyme?
Contents of stomach emptied into the duodenum
37
What is peristalsis?
a wave of muscular contraction that goes through the intestines
38
What do circular muscles of the small intestine do?
Contract to narrow lumen preventing back flow
39
What do longitudinal muscles of the small intestine do?
contract to squeeze bolus along the GIT
40
What does a gastric sleeve leave?
~15% of the original stomach
41
What does a gastric band do?
Reduces stomach capacity - the top part of the stomach is bound
42
What is diarrhoea?
Excessive fluid and ion loss
43
What is the myenteric plexus?
A layer of the intestine containing nerves. Inhibits reduce longitudinal muscle.
44
How does loperamide work?
Targets µ opioid receptors of MP which reduces muscle tone | It ↑ salt and water reabsorption by reducing motility of gut muscles
45
Where does bile acid synthesis happen and where are they stored?
Synthesised in the liver | Stored in the gall bladder
46
What do bile acids do?
Emulsify lipids allowing them to be absorbed
47
How is the small intestine adapted for digestion and absorption?
1. Pilcae increase surface area 2. Epithelium is only one cell thick 3. Enzymes conver macromolecules into small molecules
48
What does SGLT1 transport?
Glucose and galatose into enterocytes - it is a Na+ dependent process
49
What does GLUT5 transport?
Fructose - not sodium dependent
50
How are monosaccharides transported out of enterocytes?
By transporters in the basolateral membrane
51
What does PEPT1 transport?
Small peptides and amino acids - H+ dependent
52
What do drug efflux transporters do?
Remove drugs from cells, they are effluxes into the gut lumen resulting in reduced absorption
53
Give examples of 2 efflux transporters
P-glycoprotein | Breast cancer resistance protein
54
What is extravasation?
When a drug leads out of capillaries and comes in contact with tissue - leads to cell death
55
What is GORD?
Gastro oesophageal reflux disease, it causes chronic heart burn symptoms, it can cause chronic cough, laryngitis and is associated with asthma
56
The danger eliminations of GORD?
``` Anaemia loss of weight anorexia recurrent problems melaena / haematemsis swallowing ```
57
What can give symptomatic relief from GORD?
- Alginates, they have antacid properties | - Antacids
58
What effects can alienates and antacids have?
Can affect absorption of other drugs if taken at the same time. They increase pH which can damage enteric coating
59
What are the side effects of H2 antagonists?
Headaches Diarrhoea Dizziness
60
What does cimetidine interact with?
Warfarin - inhibits metabolism Phenytoin, carbamazepine and valproate - ↓ metabolism Theophylline - ↓ metabolism Sildenafil - ↑ plasma concs
61
What is the treatment for NSAID associated ulcers?
If H.pylori negative stop NSAID but if still needed: - PPI long term at same dose - PPI and when healed which to misoprotol - PPI and switch to selective COX2 inhibitor (ibuprofen) - Give combo of naproxen / esomeprazole OR ketoprofen / omeprazole
62
What are the types of stool on the Bristol Stool Chart?
- Type 1 & 2 → indicate constipation - Type 3 & 4 → easiest to pass - Type 5 & 6 → symptomatic of diarrhoea - Type 7 → sign of cholera or food poisoning
63
What is diarrhoea caused by?
- Failure to absorb fluids (infective cause or IBD) - Osmotic effects (unabsorbed food / enzyme deficiencies) - Motility problem
64
What are red flag diarrhoea symptoms?
- Unexplained weight loss - Rectal bleeding - Persistent diarrhoea - Systemic illness - Recent hospital - Following foreign travel
65
What could travellers diarrhoea be caused by?
- Enterotoxigenic E.coli - Campylobacter - Salmonella - Shigella - Parasites - Viruses
66
What is the aim of diarrhoea treatment?
Prevent / revere fluid and electrolyte loss and manage dehydration
67
What properties should ORS solutions have?
- Enhance absorption - Replace electrolytes - Simple to use - Be palatable and acceptable - Readily available
68
What function does dextrose or rice powder have in ORS?
Act as carbohydrates for active absorption of electrolytes
69
Which 2 drugs can be used as treatment for diarrhoea?
Naloxone and Loperamide

Pharm Y2S2 Patient (2 decks)

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