HECK CCP Flashcards
Why does gas collect in gut because of pneumatosis intestinalis
bacteria byproduct
What is the major cause of SBS
necrotizing enterocolitis
What is the clinical presentation of NEC
bloody stools, distended abdomen, radiographic presentation pneumatosis intestinalis
Why does NEC not occur before birth
because before birth the intestine is sterile, no bacteria colonization
What are risk factors for necrotizing enterocolitis
prematurity
intestinal ischemia
bacterial colonization
enteral feeding (milk and formula)
What parts of the intestine are involved in NEC
terminal ileum, cecum and right colon
Microscopically what does NEC look like
mucosal or transmural necrosis, ulceration and or submucosal gas bubbles
Ischemia can lead to what in cells
decreases oxidative phosphorylation in mitchondria which leads to dec Na pump so influx and swelling/bursting also dec ATP so increase anaerobic glycolysis so lactic acidosis and decreaed protein synthesis
What are the results of mitchondrial dysfunction
necrosis and apoptosis
What cells are responsible for innate immune defense in intestines
paneth cells in the crypts
What type of control is there for proinflammatory and proapoptotic signaling pathways
neg feedback
Describe intrinsic and extrinsic paths for apoptosis
extrinsic through MAMPs and caspase 8
intrinsic through cytochrome C and caspase 9
What is secreted in SI and what is absorbed
secreted: Pancreatic secretions, bile, HCO3
absorbed: water, Na, K, Cl
What is secreted in SI and what is absorbed
secreted: Pancreatic secretions, bile, HCO3
absorbed: water, Na, K, Cl
What transport occurs in duodenum and proximal jejunum
Nutrient coupled Na Na/H exchanger (without Cl-HCO3) Passive Cl absorption Cl secretion through CFTR Carbs, prteins, lipids, Ca Fe, Folate
What transport occurs in duodenum and proximal jejunum
Nutrient coupled Na Na/H exchanger (without Cl-HCO3) Passive Cl absorption Cl secretion through CFTR Carbs, prteins, lipids, Ca Fe, Folate
Where is folate exclusively absorbed
duodenum
Where is folate exclusively absorbed
duodenum
What pancreatic secretions are very important to micelles
pancreatic lipase and phospholipase A2
What pancreatic secretions are very important to micelles
pancreatic lipase and phospholipase A2
What biliary secretions are important to micelles
bile salts
What biliary secretions are important to micelles
bile salts
Where are majority of GI hormones released
duodenum and proximal jejunum
Where are majority of GI hormones released
duodenum and proximal jejunum
What hormone is secreted still in ileum
CCK
What hormone is secreted still in ileum
CCK
What hormone is secreted in stomach
gastrin
What hormone is secreted in stomach
gastrin
What most patients who lost duodenum and jejunum be monitored for
Na, H2O, Fat soluble Vitamins, Ca, Mg, PO4 and Fe3+
What most patients who lost duodenum and jejunum be monitored for
Na, H2O, Fat soluble Vitamins, Ca, Mg, PO4 and Fe3+
What absorption secretion happens in the ileum
Na absorption through NaH and Cl-HCO3 exchangers
Cl absorption Cl-HCO3 exchanger, parallel exchangers (electroneutrality)
K absoprtion, passive
What absorption secretion happens in the ileum
Na absorption through NaH and Cl-HCO3 exchangers
Cl absorption Cl-HCO3 exchanger, parallel exchangers (electroneutrality)
K absoprtion, passive
What foods and nutrients occur in the ileum
carbs, proteins, lipids, Ca, iron and folate, bile acids and cobalamin
What foods and nutrients occur in the ileum
carbs, proteins, lipids, Ca, iron and folate, bile acids and cobalamin
what are major problems with consequences of loss of ileum
Vit B12 déficience
steatorrhea(no bile salts)
diarrhea (increased bile salts in colon
what are major problems with consequences of loss of ileum
Vit B12 déficience
steatorrhea(no bile salts)
diarrhea (increased bile salts in colon
What will the diarrhea contents be in cases of loss of ileum
increase H2O, Na, and Cl
What will the diarrhea contents be in cases of loss of ileum
increase H2O, Na, and Cl
What ions are secreted/absorbed in colon
secreted: K
absorbed: water, Na, Cl
What ions are secreted/absorbed in colon
secreted: K
absorbed: water, Na, Cl
What mechanisms are in the colon
parallel NaH and ClHCO3 exchangers epithelial Na channel passive Cl absorption ClHCO3 exchanger and parallel ones passive/active K secretion active K absorption
What mechanisms are in the colon
parallel NaH and ClHCO3 exchangers epithelial Na channel passive Cl absorption ClHCO3 exchanger and parallel ones passive/active K secretion active K absorption
What type of fatty acid does the colon absorb
short chain fatty acid
product of bacterial metabolism
exchanged for bicarb
What type of fatty acid does the colon absorb
short chain fatty acid
product of bacterial metabolism
exchanged for bicarb
What are the consequences with loss of colon
inability to salvage lost water and Na
decreased intestinal transit time
What are the consequences with loss of colon
inability to salvage lost water and Na
decreased intestinal transit time
consequences of losing ileocecal valve
bacterial overgrowth syndrome
colonic bacteria in small intestine
results in D lactic acidosis
consequences of losing ileocecal valve
bacterial overgrowth syndrome
colonic bacteria in small intestine
results in D lactic acidosis
when absorption adapts after resection what occurs to that area
hypertrophy and hyperplasia
when absorption adapts after resection what occurs to that area
hypertrophy and hyperplasia
over time how does the bowel change after fast adaptation
bowel will lengthen and dilate
over time how does the bowel change after fast adaptation
bowel will lengthen and dilate
What transporters specifically increase in adaptive changes after SBS resection
SGLT1 PepT1 and NHE-3(NaH)(with ClHCO3)
What transporters specifically increase in adaptive changes after SBS resection
SGLT1 PepT1 and NHE-3(NaH)(with ClHCO3)
How can a baby be fed with SI removed
parental(IV)
How can a baby be fed with SI removed
parental(IV)
What is the determining factor for survival of SI after resection
length of small bowel and presence of the ileocecal valve
What is the determining factor for survival of SI after resection
length of small bowel and presence of the ileocecal valve
