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Block 15 Ellen > L8: physiology and pharmacology of the bowel > Flashcards

L8: physiology and pharmacology of the bowel Flashcards

1
Q

vast majority of nutrients are taken up by

A

small intestine

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2
Q

what does the large intestine mainly take up

A

water

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3
Q

what prevents back flow in the large bowel

A

tight junctions

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4
Q

on average how many litres enter the small intestine everyday

A

10 L

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5
Q

% absorbed by small intestine

A

70-80%

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6
Q

% of material reaching the large intestine

A

10%

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7
Q

small intestine dysfunction leads to

A

large increase in fecal material (large intestine not designed to take yo nutrients from a large volume)

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8
Q

large intestine dysfunction leads to

A

moderate increase in fecal material

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9
Q

2 types of wave movement

A

peristalsis

segmentation

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10
Q

peristalsis=

A

movement of material in one direction

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11
Q

what movement is mainly involved in defecation

A

peristalsis

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12
Q

segmentation=

A

breaking up of material

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13
Q

use of segmentation

A

to increase SA and nutrient absorption

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14
Q

ileocecal valve role

A

prevents movement of food back into small intestine

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15
Q

parts of large bowel

A 
cecum 
ascending colon 
transverse colon 
descending colon 
sigmoid colon 
rectum
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16
Q

most absorption in large bowel happens in

A

ascending colon

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17
Q

most storage in large bowel happens in

A

descending colon

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18
Q

2 histology parts of small intestine

A

microvilli

crypts

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19
Q

type of crypts in small intestine

A

can be branches

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20
Q

crypts in small intestine contain

A

goblet cells

paneth cells

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21
Q

paneth cells produce–>

A

innate mucosal defences

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22
Q

crypts in the large intestine

A

no longer branched

more associated with goblet cells (less enzy,es for digestion)

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23
Q

3 absorptions in colon

A
  • NaCI
  • short chain fatty acids/Na symporter
  • Na channel
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24
Q

aldosterones effect on colon

A

increases the level of sodium channels present increasing movement of water into cells

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25
Q

composition of faeces

A

75% water

25% solids

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26
Q

colour of poo determined by

A

stercobilin

urobilin

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27
Q

stercobilin=

A

breakdown of heme in RBCs

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28
Q

bristol stool chart constipation=

A

1-2

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29
Q

bristol stool chart ideal stool=

A

3-4

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30
Q

bristol stool chart diarrhoea

A

5-7

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31
Q

what is the wall of the rectum like

A
  • highly compliant wall
  • anal-rectal angle
  • anal sphincters
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32
Q

what does the anal-rectal angle prevent

A

unwanted fecal defecation

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33
Q

holding position=

A
  • anal-rectal angle
  • external anal sphincter contracted
  • fecal material being stored
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34
Q

what maintains the anal-rectal angle

A

contracted puborectalis muscle

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35
Q

what does the parasympathetic defecation reflex cause

A

peristaltic waves

relaxation of the external anal sphincter

36
Q

what causes the intrinsic myenteric defecation reflex

A

faeces causing distension of the rectal wall send signals to descending and sigmoid colon

37
Q

what happens in the intrinsic myenteric defecation reflex

A
  • increased peristaltic waves in the descending and sigmoid colon so fecal matter moves closer to anus
  • and internal sphincter relaxes
38
Q

what muscles contract in GI evacuation

A

diaphragm

rectus muscles

39
Q

what muscles relax in GI evacuation

A

puborectalis muscle
external sphincter
internal sphincter

40
Q

preganglionic neurotransmitter in sympathetic NS

A

Ach

41
Q

post ganglionic neurotransmitter in sympathetic NS

A

Nor adrenaline

42
Q

5 effects of sympathetic NS

A 
increases HR
dilates pupils 
dilates trachea 
inhibits peristalsis 
inhibits contraction of bladder and rectum
43
Q

course of parasympathetic NS

A

long preganglionic, post ganglionic near effector organ

44
Q

5 functions of parasympathetic NS

A

slows HR
constricts pupils
increase blood flow to skin and viscera
increased peristalsis

45
Q

pelvic nerve is controlled by

A

parasympathetic

46
Q

effect of pelvic nerve

A

brings about explosive movements of distal colon and sustained contraction

47
Q

pudendal nerve controls

A

external anal sphincter

48
Q

what is the pudendal nerve controlled by

A

somatic

49
Q

reflex of pudendal nerve

A

defection reflex

50
Q

symptoms of IBS

A

stomach bloating
altered bowel habit
abdominal pain

51
Q

treatment for IBS

A

antispasmodics

52
Q

2 antispasmodics

A

diculoverine

propantheline

53
Q

do you give antidiarrhoea for cholera

A

no

54
Q

3 treatments for crohns disease

A

aminosalicylates
glucocorticoids
cytokine inhibits

55
Q

suphasalazine used for

A

mild to moderate UC

56
Q

what transforms suphasalazine into its active form

A

bacteria in colon

57
Q

2 treatment for IBD

A

sulphasalazine

mesalazine

58
Q

3 anti-motility drugs for diarrhoea

A

loperamide
codeine
diphenoxylate

59
Q

what is loperamide

A

mu-opioid agonist

60
Q

what does loperamide and codeine do in GI

A

decreased peristalsis
increase transit time
increasing water absorption

61
Q

codeine=

A

mu-opioid receptors in neural plexus of intestines

62
Q

co-phenotrope is made up of

A

diphenoxylate

atropine

63
Q

diphenoxylate=

A

opiate

does not cross BBB

64
Q

kaolin combined with

A

calcium carbonate and morphine

65
Q

what does kaolin do

A

absorbs toxic molecules

66
Q

calcium carbonate=

A

antacid

67
Q

morphine=

A

opioid decreases peristalsis and increases transit time

68
Q

3 types of laxatives

A

bulk forming
osmotic
stimulant

69
Q

bulk forming laxative=

A

ispagula husk and methylcellulose

70
Q

what should bulk forming laxatives be taken with

A

lots of water

71
Q

when do you give bulk forming laxatives

A

when fibre content in diet cannot be increased

72
Q

time of onset of ispaghula husk and methylcellulose

A

full effect takes some days

73
Q

what is lactulose

A

osmotic laxative

74
Q

how does lactulose work

A

releases osmotically active sugars to increase levels of water in stool

75
Q

stimulant laxatives=

A

senna, sennosoids (senokot)
sodium picosulphate
bisacodyl

76
Q

how does senokot work

A

stimulates nerve endings in small bowel and activate myenteric plexus to increases bowel movements
-less time for water absorption so softens faeces

77
Q

how long does senokot take to work

A

8-12 hours

78
Q

what can senokot be combined with

A

ispaghula

79
Q

what can sodium picosulphate be described as

A

irritant

80
Q

how does sodium picosulphate work as an irritant

A

decreases water absorption and softens faeces

81
Q

oral sodium picosulphate work in

A

6-12 hours

82
Q

suppository sodium pico-sulphate works in

A

1 hour

83
Q

what is used prior to radiological investigations of the bowel

A

sodium picosulphate

84
Q

2 things you can get from excessive use of laxatives

A

melanosis coli

tolerance

85
Q

what is melanosis coli

A

areas of lipofuscin pigmentation

colon looks like tiger

Block 15 Ellen (11 decks)

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