Gut health and Disease Flashcards
Which enzymes does the pancreas produce?
trysin, amylases & lipases, protease
Which cell produces bile salts? Where are bile salts stored?
Hepatocytes
Gallbladder
What does the enteric nervous system do in the gut?
Motility Nutrient uptake Hormone and enzyme release Appetite regulation Vascular flow Immune cell activity
What is the intrinsic innervation of the gut? What mediates this?
Intrisnsic innervation- communication within the gut only
Mediated by ganglionated plexi: myenteric (longitudinal and circular muscle) and submucosal plexi (circular muscle and mucosa)
Which nerve mediates communication between the gut and CNS? Which nucleus does it synapse with for this?
Vagus
Central terminalis synapses with nucleus tractus solitarus.
What part of the GI tract does the vagus nerve innervate?
Mouth- transverse colon
Where is gut microbiota found?
Colon
some in small intestines
What can an abnormal gut microbiota cause?
IBD (inflammation) and IBS (non-digestible carbohydrates)
What is the purpose of Faecal Microbiota Transfer? What condition is it approved to treat?
Increase microbial diversity
Donors: Healthy relative, ‘super donors’ or artificially produced probiotics
Only approved for treatment of C.difficile infection following failure of antibiotic therapy
What does Clostridium difficile do to the gut? How does it occure? what are the symptoms? How is it treated?
Effect- changes to the microbiome
Cause- broad-spectrum antibiotic (opportunistic)
Symptoms- watery diarrhoea, abdominal pain
Treatment-
1. Stop antibiotic use
2. Vancomycin or metronidazole
What is the function of pre-biotics?
Which bacteria does it help promote
promote growth and survival of bacteria
Stimulate Bifidobacterium & Lactobacillus
Give some examples of pre-biotics
Non-digestible food ingredients-
Fructans
Galactans
Dietary fibres
What are probiotics?
live cultures found in dairy products and fermented food
Give examples of Upper GI symptoms
acid reflux, nausea, vomiting, belching, gastroparesis and bloating
Give examples of lower GI symptoms
bloating, constipation, diarrhoea, abdominal pain
Describe Gastroesophageal Reflux Disease (GERD) and its common causes
Occurs when the lower esophageal spincter is weak or relaxed abnormally
Causes- weight gain- stress
What are the symptoms and treatment options for Gastroesophageal Reflux Disease (GERD)?
Symptoms- ulcer formation, inflammation and Barratt’s esophagus
Treatment: antacids + alginates (gaviscon)
sever- Proton Pump Inhibitors (block stomach acid production)
Which drug can block stomach acid production?
Proton Pump Inhibitors
What is Gastroparesis? What are the symptoms?
Delayed gastric emptying.
Symptoms: nausea, vomiting, rapid feeling of fullness, reflux, pain and bloating
Can cause malnutrition and changes to blood sugar
How does Diabetes cause Gastroparesis?
causes neuropathy of vagal endings innervating the stomach
How is Gastroparesis diagnosed?
Gastric emptying study:
C13 labeled meal is ingested
Released C13 is exhaled in breath and is used as marker of food movement through stomach
Time-course compared to normal values
What is the treatment for Gastroparesis?
Domperidone or erythromycin: stimulate stomach muscle contraction
Anti-emetics for nausea
Dietary changes- smaller more frequent meals
What is Inflammatory Bowel Disease?
Collective term that refers to chronic inflammation of the lower GIT-
Crohn’s Disease (CD) Ulcerative Colitis (UC)
Describe the main features of Crohn’s Disease (CD) and symptoms
can affect the whole GIT but is often localised to small bowel Symptoms- Diarrhoea Abdominal pain Fatigue Fever Blood in stool
How does Crohn’s Disease (CD) effect the bowel?
How is it diagnosed?
Scaring of bowel epithelium Bowel obstruction Ulcers Fistulas (hole in bowel) Diagnosis- Colonosocopy Fecal calprotectin
Treatment of Crohn’s Disease paediatric and adult
Paediatric-
Enteral nutrition for 4 weeks
replaces normal diet
promotes epithelial healing
Adult-
Corticosteroids- Prednisolone
Immunosupresssants- Azathioprine & mercaptopurine
Antibodies which neutralise TNF
Describe the main features of Ulcerative Colitis (CD) and symptoms
Chronic inflammatory restricted to the colon
Symptoms Bloody diarrhoea Urgency Abdominal pain Fatigue Fever Weight loss
How does Ulcerative Colitis (CD) effect the bowel?
How is it diagnosed?
ulcer-like appearance of mucosa
Perforation of the colon (can be fatal)
Severe bleeding
Colon cancer
Diagnosis: Colonscopy
Fecal calprotectin
Treatment of Ulcerative Colitis mild and sever
Mild- Corticosteroids - Prednisolone
5-ASAs
Sever- antibodies that neutralise TNF
Ciclosporin – IV
Surgery (colectomy)
Symptoms of Irritable Bowel Syndrome?
Upper GI- functional GERD, functional dyspepsia, bloating, pain
Lower GI- abdominal pain, cramping, constipation and diarrohea.
How is Irritable Bowel Syndrome diagnosed?
ROME IV questionnaire after excluding all biolgical causes
List some possible causes of Irritable Bowel Syndrome?
gastroenteritis? Leaky gut epithelium? Increased sensitivity to pain? Changes to gut microbiota Enteric neuron abnormalities causes issues with gut motility
What are the treatments for IBS?
Dietary control e.g. FODMAP diet Treat sysmptoms (laxatives, pain medication)
Linaclotide: increase fluid secretion and pain relief
Lubiprostone: increase fluid secretion
Rifaximin: antibiotic to treat bacterial overgrowth
What can be found in gastric juices?
HCl, Salts, Pepsin, Mucus , water, intrinsic factor (critical for B12 absorption), bicarbonate (maintains pH7 at gastric epithelium with mucosal gel).
How many neurones are in the enteric nervous system?
400-600
What are bezoars? What condition causes them?
Hardened mass of undigested food
Gastroparesis
