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MBChB221 Digestive > Intestine Physiology > Flashcards

Intestine Physiology Flashcards

1
Q

What senses content of the duodenum

A
  • Vagal afferents
  • I cells and S cells (apical surface)
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2
Q

I cells secretion

A

CCK

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3
Q

S cells secretion

A

Secretin

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4
Q

What do I cells sense

A

Fat/protein in duodenum lumen

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5
Q

What do S cells sense

A

pH (HCl)

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6
Q

CCK and secretin functions

A

Inhibit gastric emptying
Inhibit gastric acid secretion

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7
Q

Enterochromaffin cell secretion

A

Serotonin

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8
Q

How do anti-nausea meds work

A

Decreased serotonin (some by inhibiting enterochromaffin)

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9
Q

Enterochromaffin-like cell secretion

A

Histamine

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10
Q

Coeliac Genetic Rule-out Test

A

Two genes that almost all Coelaic have = rules out if negative (but non Coelaic also have it, so doesnt confirm Coelaic if positive)

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11
Q

Coeliac Symptoms

A

Can be anything!

Mostly IBS, nausea, vomiting, steatorrhoea etc

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12
Q

Coeliac Blood Test

A

Anti-TTG IgA
- Must be eating gluten when doing it = can be harmful

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13
Q

Gold standard for coeliac

A

Biopsy of small intestine
- Take from many (8) locations

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14
Q

Even if asymptomatic why should Coelaics not have gluten

A

Inflammation builds over time = in long term as elderly will lead to malabsorption problems in the small intestine
- Micronutrients first

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15
Q

Genetic markers for Coelaic

A

DQ2 DQ8

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16
Q

DGBI

A

Disorder of gut-brain interaction
- Tests normal but still symptoms and disease

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17
Q

IBS location

A

Any part of the GI tract

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18
Q

Causes of IBS

A

Many reasons (Microbiome, stress, mucosa etc), not 100% sure

Main cause is visceral hypersensitivity

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19
Q

Microbiome of IBS

A

Increased enterobacteriacaea

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20
Q

IBS severity

A

Low mortality

Very high morbidity - time off work, social stigma

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21
Q

IBS symptom criteria

A
  1. Recurrent abdominal pain
  2. Changes with defecation
  3. Change in stool consistency (Bristol chart)

Must be chronic (3-6 months)

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22
Q

Types of IBS

A

IBS-C (constipation, hard stools)
IBS-D (diarrhoea, watery stools)
IBS-M (mixed, hard and watery stools)
IBS-U (unclassified)

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23
Q

What symptoms suggest it might be something more than IBS

A

Rectal bleeding
Iron deficiency
Weight loss
Vomiting
Familial history of other disease eg Coelaic, colorectal cancer

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24
Q

IBS Management

A
  1. Explain no evidence of cancer, inflammation
  2. Don’t say its all in your head, say “Sensitive gut”
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25
Q

FODMAP Diet

A

Fermentable sugars

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26
Q

If IBS what diet should you consider

A

Low FODMAP (but dont cut out all FODMAP as need a diverse diet)

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27
Q

Why might you give someone with ‘diarrhoea’ laxatives / fibre

A

They have hard stools blocking the colon, and only the watery stools can actually get out. But the root of the problem is the constipation from hard stools

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28
Q

Gut-brain neuromodulators

A

TRC
SSRI

Anti-depressants change the way your body responds to discomfort

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29
Q

IBD vs IBS

A

Inflammable Bowel Disease v Irritable Bowel Syndrome

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30
Q

IBD risk groups

A

30s, and 60s
Non-Maori

31
Q

Cause of IBD

A

Environmental factors in genetically susceptible individuals

  • Western diet
  • Antibiotics in childhood
  • Smoking Crohn’s
32
Q

Symptoms of IBD

A

Diarrhoea - frequency, urgency
Blood in stool
Tenesmus

33
Q

Tenesmus

A

Incomplete defecation

34
Q

Where else does IBD present other than the bowel

A

Eyes, skin, joints

35
Q

Types of IBD

A

Ulcerative Colitis
Crohns

36
Q

Ulcerative Colitis

A

Limited to colon
Inflammation down whole colon

37
Q

Crohn’s

A

Any part of the GI tract, mainly colon and ileum
Inflammation
Narrowing
Fistula = joining
Perianal fissures

38
Q

Different symtpoms of Chrons and Ulcerative colitis

A

UC - Always diarrhoea, bleeding

Chrons - Not always diarrhoea, bleeding = harder to detect

39
Q

Normal stools on the Bristol Stool Chart

A

2-4

40
Q

As Bristol Stool number increases, what happens to consistency

A

More loose

41
Q

Acute Diarrhoea cause

A

Infection!

42
Q

Chronic diarrhoea types

A
  1. Inflammatory
  2. Osmotic
  3. Secretory
  4. Fatty
43
Q

If blood in diarrhoea what type is it

A

Inflammatory

44
Q

Campylobacter causes ______ diarrhoea

A

Inflammatory

45
Q

Giardia causes ______ diarrhoea

A

Osmotic

46
Q

E. coli causes ____ diarrhoea

A

Secretory

47
Q

Main cause of acute diarrhoea

A

Campylobacter

48
Q

Inflammatory Diarrhoea cause

A

Inflammation of the bowels = rupture to mucosa
- eg IBD Coeliac cancer

49
Q

What causes osmotic diarrhoea

A

Fluid drawn into lumen (eg. By lactose, IBS, Coeliac)

50
Q

What causes secretory diarrhoea

A

Bile acid in the lumen = H2O secretion increased = diarrhoea

51
Q

What causes fatty diarrhoea

A

Undigested fat in stool

52
Q

SIBO stands for

A

Small intestinal bacterial overgrowth

53
Q

What types of diarrhoea caused by SIBO

A

All

54
Q

Ileostomy

A

Ilium diverted to outside of body, circumvent the anus = need holding bag

55
Q

How much fluid consumed / excreted daily

A

8.5L consumed
6.5L absorbed by small int
2L absorbed by large int
~100mL excreted

56
Q

Small intestine electrolyte secretion

A

HCO3-

57
Q

Large intestine electrolyte secretion

A

K+ and HCO3-

58
Q

Transcellular movement

A

Across two membranes, therefore must be active across at least one

Solutes

59
Q

Paracellular Movement

A

Passive via tight junctions

60
Q

Where does absorption of water mostly occur

A

Jejunum

61
Q

How does Na+ absorption occur

A

Exchanges and cotransporters down conc grad into cell

62
Q

How does Cl- absorption occur

A

Follows Na+ absorption for charge balance

By exchangers (with HCO3-) and absorption on its own

63
Q

What does CFTR do

A

Active channel that moves Cl-

64
Q

What regulates absorption and secretion

A

Mainly Aldosterone
Also enteric nervous system, paracrine hormones etc

65
Q

Difference between secretory and osmotic diarrhoea

A

Secretory =contents added to the lumen eg Na+ causing solvent drag

Osmotic = contents remain in the lumen from malabsorption

66
Q

How does oral rehydration therapy work

A

Na+ and glucose absorbed
= Cl- absorbed to balance charge
= H2O absorbed due to osmotic gradient
= Less diarrhoea

67
Q

What is a polyp

A

Circumscribed growth projecting above the mucosa

Can be neoplastic or not

68
Q

Types of non neoplastic polyps

A

Hyperplastic (common)
Inflammatory

69
Q

Adenoma

A

Pre-malignant polyp

70
Q

Types of adenomas

A

Tubular (common)
Villus
Tubulovillous

71
Q

Main risk factor for neoplastic adenoma becoming carcinoma

A

Size of the polyp (larger = increased risk)

72
Q

Adenocarcinoma leads to which nutrient deficiency

A

Iron, due to chronic bleeding

73
Q

How to stage tumours

A

TNM

T - Extent of invasion of bowel wall
N - Number of lymph nodes
M - Metastatic?

74
Q

Familial Polyposis Syndromes lead to higher rates of carcinomas because

A

Higher likelihood of adenoma becoming carcinoma (no increase in numbers of polyps themselves)

MBChB221 Digestive (9 decks)

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