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metabolism > gut health > Flashcards

gut health Flashcards

1
Q

what are the roles of the GI tract?

A 
intake of food for energy
water absorption
waste removal (e.g. by-products of digestion and indigestible components)
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2
Q

at what point in the GI tract are sugars broken down?

A

oral cavity by enzymes

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3
Q

at what point in the GI tract are fats broken down?

A

stomach

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4
Q

at what point in the GI tract are proteins broken down and what are they broken down by?

A

stomach

substrate specific enzymes

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5
Q

what substances mediate digestion (and specify which part of digestion)

A

enzymes and stomach acid - breakdown sugars, fats and proteins
bile salts - fat absorption

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6
Q

what parts of the body secrete enzymes and give specific examples

A

mouth - amylase secreted in saliva

stomach - pepsin
pancreas - trypsin, amylases and lipases

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7
Q

what is stomach acid made up of?

A 
salts
pepsin
mucus
intrinsic factor
bicarbonate
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8
Q

what is the function of mucus in stomach acid?

A

forming a layer of the gastric epithelium to prevent the breakdown of the epithelium

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9
Q

what is the function of intrinsic factor in stomach acid?

A

B12 absorption

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10
Q

what is the function of bicarbonate in stomach acid?

A

maintaining the pH7 of gastric epithelium

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11
Q

where are bile salts secreted and stored?

A

secreted by hepatocytes

stored in the gall bladder

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12
Q

Where is the ENS found in the GI tract?

A

between the oesophagus and rectum

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13
Q

what is the main innervation between the brain and ENS?

A

vagus innervation

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14
Q

what are the roles of the ENS?

A 
Motility – peristalsis
Hormone and enzyme release
Nutrient uptake
Appetite regulation
Vascular flow
Immune cell activity
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15
Q

what is the intrinsic innervation?

A

communication only within the gut

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16
Q

what are the two plexi in the intrinsic innervation?

A

myenteric

sub-mucosal

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17
Q

where is the myenteric plexus found?

A

in between outside longitudinal muscle and inside circular muscle

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18
Q

what is the function of the myenteric plexus?

A

coordinating the contraction and relaxation of muscle to coordinate peristalsis

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19
Q

what can lack of coordination of muscle in the GI tract lead to?

A

constipation
diarrhoea
motility disorder

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20
Q

where is the submucosal plexus found?

A

beneath the mucosa

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21
Q

what are the functions of the submucosal plexus?

A

deal with secretions
nutrient uptake
respond to outside environment through activity of microbiota, nutrients and immune cells

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22
Q

what is the role of interneurons?

A

allowing connectivity between different types of neurons

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23
Q

which nerve mediates the extrinsic innervation?

A

vagus

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24
Q

why is the extrinsic innervation known as extrinsic?

A

its plexiglass lie outside of the gut

communication between the GIT and the brain

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25
Q

what are examples of the plexi of the extrinsic innervation?

A

oesophageal
coeliac
hypergastric

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26
Q

what do the central terminals synapse with when they enter the brainstem?

A

neurons of the nucleus tracts solitarus

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27
Q

what effect does the sympathetic nervous system have on the body?

A

prepares body for stressful responses

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28
Q

what effect does the parasympathetic nervous system have on the body?

A

controls body during normal situation

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29
Q

where is the largest microbial colony found?

A

in the colon

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30
Q

what is decreased diversity in the microbiome associated with?

A

poor health

increased risk of obesity and inflammation

31
Q

how can bacteria interact with the epithelium?

A

directly

via their byproducts

32
Q

how do the microbiota affect the synaptic activity in the brain microglia?

A

more prone to development of plaques and debris

leads to neurodegenerative diseases

33
Q

what is the purpose of faecal microbiota transfer?

A

increase microbial diversity

34
Q

what are the types of FMT donor?

A

healthy relative
super donors
artificially produced probiotics

35
Q

what is FMT used to treat?

A

C.difficile infection following failure of antibiotic therapy

36
Q

what % of the population is C.difficile found in?

A

2-5%

37
Q

what causes C.difficile infection?

A

broad-spectrum antibiotic usage

allows for opportunistic over-growth

38
Q

what are symptoms of C.difficile infection?

A

abdominal pain

watery diarrhoea

39
Q

what are the treatments of C.difficile?

A

stop antibiotic use
vancomycin or metronidazole
FMT

40
Q

what are prebiotics?

A

promote growth and survival of bacteria and fungi in the gut

41
Q

what are probiotics?

A

live cultures found in dairy products or fermented foods

42
Q

name common upper GI symptoms

A

acid reflux, nausea, vomiting, belching, gastroparesis and bloating

43
Q

name common lower GI symptoms

A

bloating, constipation, diarrhoea, abdominal pain

44
Q

what causes GERD

A

movement of stomach contents from the fungus to the distal oesophagus

occurs when the LOS is relaxed and allows the passage of acid

45
Q

what is the lower oesophageal sphincter

A

anatomical valve

46
Q

what is GERD associated with?

A

weight gain
stress
gastroparesis

47
Q

what conditions can GERD lead to?

A

ulcer formation, inflammation and Barratt’s esophagus

48
Q

how is GERD treated?

A 
over the counter medications - antacids and alginates (Gaviscon)
prescription treatments (e.g. proton pump inhibitors)
49
Q

what is gastroparesis

A

Chronic condition where gastric emptying is delayed

50
Q

what are symptoms of gastroparesis?

A

nausea, vomiting, rapid feeling of fullness, reflux, pain and bloating

51
Q

what causes diabetic gastroparesis?

A

neuropathy of vagal endings innervating the stomach

52
Q

what can gastroparesis lead to?

A

malnutrition
formation of bezoars (hardened mass of undigested food)
changes to blood sugar

53
Q

explain how gastroparesis is diagnosed

A

Gastric emptying study

  • C13 labeled meal is ingested
  • Released C13 exhaled in breath - used as marker of food movement through stomach
  • Time-course compared to normal values – looking for faster/slower gastric emptying
54
Q

how is gastroparesis treated?

A

Domperidone or erythromycin: stimulate stomach muscle contraction
Anti-emetics for nausea
Dietary changes e.g. smaller, more frequent meals, soft foods

55
Q

what is inflammatory bowel disease and what diseases does it include?

A

collective term that refers to chronic inflammation of the lower GIT
Crohn’s Disease
Ulcerative Colitis

56
Q

what are potential causes of inflammatory bowel disease?

A

altered epithelial barrier integrity
changes to microbial quorum
gut brain interactions (e.g. cortisol released via stress mechanisms)

57
Q

what is Crohn’s disease?

A

chronic inflammatory condition

damage to epithelium and high levels of uncontrolled inflammation

58
Q

what complications can Crohn’s disease lead to?

A

changes to bowel epithelium –> scarring –> bowel obstruction
mouth and perineum ulcers
fistulas

59
Q

what area does Crohn’s disease normally affect?

A

small bowel

60
Q

what are active disease symptoms of Crohn’s disease?

A 
diarrhoea
abdominal pain
fatigue
fever
blood in stool
61
Q

how is Crohn’s diagnosed?

A

fecal calprotectin

colonoscopy - most definitive method of diagnosis

62
Q

how is crohn’s treated?

A

Paediatric; enteral nutrition for 4 weeks
Adult: Corticosteroids, Azathioprine & mercaptopurine – commonly used IBD immunosuppressant
Biological therapies – antibodies that neutralise TNF

63
Q

what is ulcerative colitis?

A

chronic inflammatory condition restricted to the colon

Damage to colonic epithelium leading to ulcer-like appearance of mucosa

64
Q

what can ulcerative colitis lead to?

A 
perforation of the colon
severe bleeding
dehydration
systemic inflammation
colon cancer
65
Q

what are the active disease symptoms of ulcerative colitis?

A 
bloody diarrhoea
urgency
abdominal pain
fatigue
fever
weight loss
66
Q

how is ulcerative colitis diagnosed?

A

feral calprotectin

colonoscopy

67
Q

how is ulcerative colitis treated?

A

Mild/moderate; 5-ASAs – oral, suppository or enema

Severe symptoms; biological therapies, ciclosporin

Surgery (colectomy) - remove diseased colon suffering from severe damage caused by long-term inflammation

68
Q

what is the cause of IBS?

A

unknown

69
Q

what is IBS?

A

umbrella term for FGIDS (functional gastrointestinal diseases) where pathophysiology is unknown but with a defined set of symptoms

70
Q

in IBS, if the FGID occurs in the upper GIT, what symptoms are seen?

A

functional GERD, functional dyspepsia, bloating, pain

71
Q

in IBS, if the FGID occurs in the lower GIT, what symptoms are seen?

A

abdominal pain, cramping, constipation and diarrhoea

72
Q

how is IBS diagnosed?

A

ROME IV questionnaire after other causes excluded e.g. IBD, anemia, gastroenteritis

73
Q

how is IBS treated?

A

dietary control - FODMAP diet or removing triggers
treating specific symptoms - laxatives for constipation, diarrhoea with loperamide
specific IBS treatments

74
Q

name and explain some of the specific IBS treatments

A

Linaclotide: increase fluid secretion and pain relief
Lubiprostone: increase fluid secretion
Rifaximin: antibiotic to treat bacterial overgrowth

metabolism (23 decks)

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