LOWER GIT Flashcards
Neurotransmitter that relaxes lower esophageal sphincter
GABA (Gamma-amino butyric acid)
Neurotransmitter that decreases motility
Norepinephrine
Sites of release for the norepinephrine
CNS, spinal cord, sympathetic nerves
Neurotransmitter that increases contraction of sphincters
Norepinephrine
Neurotransmitter that inhibits secretions
Norepinephrine
Neurotransmitter that inhibits secretions
Norepinephrine
Site of release of acetylcholine
Central nervous system, autonomic system, other tissues
Neurotransmitter that increases motility
Acetylcholine
Neurotransmitter that relaxes sphincters
Acetylcholine
Neurotransmitter that stimulates secretion
Acetylcholine
Neurotransmitter that stimulates secretion
Acetylcholine
Differentiate acetylcholine and norepinephrine
Norepinephrine decreases motility, increases contraction of sphincters, inhibits secretion and is released at the CNS, spinal cord, and sympathetic nerves
Acetylcholine increases motility, relaxes sphincters, stimulates secretion and is released at the CNS, autonomic system, and other tissues
Neurotransmitter that inhibits release of gastric emptying and acid secretion
Neurotensin
Neurotransmitters that inhibits acid secretion
Neurotensin
Primary action of neurotensin
Inhibits release of gastric emptying and acid secretion
Neurotransmitter that facilitates secretion and peristalsis
Serotonin (5-HT)
Site of Release of GABA
CNS
Site of release of serotonin (5-HT)
GI tract and spinal cord
Site of release of neurotensin
GI tract and CNS
Neurotransmitter that released at the CNS and GI tract
Nitric oxide, neurotensin
Primary actions of nitric oxide (3)
Regulates blood flow
Maintains muscle tone
Maintains gastric motor activity
Neurotransmitter that increases sensory awareness
Substance P
Primary actions of substance P
Increases sensory awareness (mainly pain)
Peristalsis
Site of release of substance P
Gut, CNS, skin
7 examples of neurotransmitters
GABA (Gamma Amino Butyric Acid)
Norepinephrine
Acetylcholine
Neurotensin
Serotonin (5-HT)
Nitric Oxide
Substance P
Major Gastrointestinal Hormones (7)
Gastrin
Secretin
CCK (Cholecystokinin)
GIP (Gastric Inhibitory Polypeptide)
Motilin
GLP-1 (Glucagon-like peptide-1)
GLP-2 (Glucagon-like peptide-2)
Site of release of gastrin
G cells of gastric mucosa and duodenum
Hormone that is released due to stimulants like interdigestive periods and alkaline pH in the duodenum
Motilin
Hormone and its stimulant that affects the stomach, small bowel, and colon
Hormone: Motilin
Stimulant:
Interdigestive periods, alkaline pH in duodenum
Primary action of motilin on the stomach, small bowel, and colon
Promotes gastric emptying and GI motility
Site of release of motilin
M cells of duodenum and jejunum
Hormone released at the site of L cells of small intestine and colon (density increases in distal GIT)
GLP-1 and GLP-2
Hormone stimulated by presence of glucose, fat, and SCFA
GLP-1 and GLP-2
Hormone that affects the stomach and pancreas
GLP-1
Hormone that affects the small intestine and colon
GLP-2
Hormone that affects stomach such that it promotes gastric emptying
GLP-1
Hormone that affects the pancreas by inhibiting glucagon release and stimulating insulin release
GLP-1
Primary action of GLP-2 in the intestine and colon
Stimulates intestinal growth and nutrient digestion and absorption
Site of release of Gastrin
G cells of gastric mucosa and duodenum
Stimulants of gastrin that can affect the stomach, esophagus, and GIT in general
peptides, amino acids, and caffeine
distention in antrum
some alcoholic beverages and vagus nerve
Organs that are affected when gastrin is stimulated by alcoholic beverages
stomach, esophagus, and GIT in general
gallbladder
pancreas
primary action of gastrin to the stomach, esophagus, and GIT in general when stimulated by peptides amino acids and caffeine
stimulates secretion of HCl and pepsinogen
primary action of gastrin to the stomach, esophagus, and GIT in general when stimulated by antrum distention
Increase in gastric antral motility
primary action of gastrin to the stomach, esophagus, and GIT in general when stimulated by alcoholic beverages and vagus nerve
increases lower esophageal sphincter tone
primary action of gastrin in the gallbladder
weakly stimulates contraction of gallbladder
primary action of gastrin in pancreas
weakly stimulates secretion of bicarbonate
affected organs of secretin
pancreas and duodenum
primary action of secretin in pancreas
increase in water and bicarbonate production
increase in pancreatic enzyme and insulin production
hormone whose site of release is the S cells of the duodenum
secretin
Hormone that is released due to a stimulant such as acid in small intestine
secretin
primary action of secretin in the duodenum
decreases it motility and increases mucus output
site of release of CCK
I cells of duodenum
organs affected by CCK when stimulated by peptides, amino acids, fat, and HCl
pancreas, gallbladder, stomach, colon
CCK effect on pancreas
stimulates secretion of pancreatic enzymes
CCK primary action on stomach
slows gastric emptying
CCK primary action on gallbladder
causes gallbladder contraction
CCK primary action on colon
increases motility and may mediate feeding behavior
Hormone whose site of release is K cells of duodenum and jejunum
GIP
stimulants for GIP release
glucose and fat
Organ affected by the GIP
Stomach
primary action of GIP
reduce intestinal motility
symptoms in the cognitive area as an effect of enteroimmune disease
Mental log, poor concentration, learning difficulties, poor memory, lethargy, apathy, rage, restlessness, hyperactivity
symptoms in the sensory area as an effect of enteroimmune disease
Vertigo, lightheadedness, tinnitus
symptoms in emotionally as an effect of enteroimmune disease
Anxiety, moodiness, depression, aggressiveness, irritability
symptoms experienced somatically as an effect of enteroimmune disease
Headaches, insomnia, fatigue, joint pain, muscle pain, stiffness, weakness, weight gain, fluid retention, non-ischemic chest pain
symptoms experienced in the gastrointestinal tract as an effect of enteroimmune disease
Dyspepsia, bloating, belching, constipation, abdominal cramping, nausea, excessive flatulence
symptoms experienced in respiratory system as an effect of enteroimmune disease
Congestion, excessive phlegm and mucous, dyspnea, chronic cough, gagging
Neurologic Diseases associated with enteroimmunopathies
Autism
Alzheimer’s disease
Parkinson’s disease
Multiple sclerosis
Depression
Bipolar disorder
Schizophrenia
Migraine headaches
Cerebellar ataxia
Certain seizure disorders
Diseases associated with inflammation
Cancer
Diabetes
Cardiovascular Disease
Neurological Diseases
Alzheimer’s Disease
Autoimmune Disease
Arthritis
Pulmonary Diseases
Factors that affect the microbiome
Geography
Birth route
Genetics
Hygiene
Diet/Nutrition
Stress
Drugs
What happens if there is healthy microbiome complexity and stability?
Protection against pathogens
Immune function is traned/stimulated
Nutrients, Energy, Vitamin, SCFA are supplied
What happens if there is perturbation in microbiome complexity and stability
Inflammation (local>systemic)
Oxidative stress
Increase in Gram-negative bacteria
Infection (opportunistic/pathogenic)
Altered metabolite production
These are considered parameters in the nutrition assessment for the lower GIT
medical history
medications
The 4 Nutrient Assessment for Lower GIT
Food/Nutrient Intake
Anthropometrics
Laboratory
Physical Signs
appetite, intolerance to milk and gluten, fiber, fluid and calcium intake are associated with what aspect of the nutritional assessment for lower GIT?
Food/Nutrient intake
Laboratory data associated with the nutritional assessment for lower GIT
fecal fat, malabsorption, anemia
Physical signs associated with the nutritional assessment of the lower GIT
dehydration, PEM, B12 deficiency
7 tests for malabsorption
Stool examination
Chemical analysis of fecal fat
Fecal nitrogen
D-xylose
Serum calcium
Serum carotene
Schilling test
Fecal fat results that would indicate malaborption
> 5-7 g when given 100 g of fat or
7 g when given 100 g fat
Fecal nitrogen results that would indicate malaborption
> 2 g/day
D-xylose is used to test the malabsorption of?
Carbohydrates
Schilling test is used to test the malabsorption of?
B12
How many types of stool are there based on the Bristol Stool Chart?
7
What type of stool based on the Bristol Stool chart is characterized by separate hard lumps?
Type 1
What does seperate hard lumps of stool indicate based on the Bristol Stool Chart?
Severe constipation?
What type of stool based on the Bristol Stool chart is characterized by lumpy and sausage-like?
Type 2
What does seperate lumpy and sausage-like indicate based on the Bristol Stool Chart?
Mild constipation
What does stool that is characterized by a sausage-shape with cracks in the surface indicate based on the Bristol Stool Chart?
Normal
What type of stool is characterized by a sausage-shape with cracks in the surface based on the Bristol Stool Chart?
Type 3
What type of stool is characterized by its similarity to a smooth, soft sausage or snake based on the Bristol Stool Chart?
Type 4
What does stool that is characterized by its similarity to a smooth soft sausage or snake indicate based on the Bristol Stool Chart?
Normal
What does stool that is characterized by soft bulbs with clear cut edges indicate based on the Bristol Stool Chart?
Lacking fiber
What type of stool is characterized by separate hard lumps based on the Bristol Stool Chart?
Type 5
What type of stool is characterized by mushy consistency with ragged edges based on the Bristol Stool Chart?
Type 6
What does stool that is characterized by mushy consistency with ragged edges indicate based on the Bristol Stool Chart?
Mild diarrhea
What does stool that is characterized by liquid consistency with no solid pieces based on the Bristol Stool Chart?
Severe diarrhea
What type of stool is characterized by liquid consistency with no solid pieces based on the Bristol Stool Chart?
Type 7
Diagnostic criteria used to assess functional constipation
Rome IV Diagnostic Criteria for Functional Constipation
How long is the period of fulfillment for the Rome IV Diagnostic Criteria for Functional Constipation
the last 3 months
What are the three criterias of the Rome IV Diagnostic Criteria for Functional Constipation?
- Must include two or more of the following:
- Straining during more than 25% of defecations
- Lumpy or hard stools (Bristol stool scale 1 to 2) in more than 25% of defecations
- Sensation of incomplete evacuation for more than 25% of defecations
- Manual maneuvers to facilitate more than 25% of defecations (i.e., digital evacuation, support of the pelvic floor)
- fewer than three defecations per week - Loose stools are rarely present without the use of laxatives
- There are insufficient criteria for irritable bowel syndrome
What is a treatment for constipation?
Adding fiber to the diet slowly and adding fluids
How does fiber treat constipation?
It adds volume and weight to the stool which normalizes the transit of undigested materials and minimizes pressure
Infection & inflammation of the membrane lining of the abdominal cavity caused by leakage of infectious organisms through a perforation
Peritonitis
Food component that comes from plant foods and are not digestible by human enzymes
Fiber or roughage
Component that pertains to fecal contents
Residue
What are included in the fecal contents in residue
Bacteria and net remains after ingestion of food, secretions into GI tract, and absorption
Treatement for diarrhea
- drink plenty of fluids
- adequate salt in food
- food with soluble fibers
- eat small frequent meals
- avoid insoluble fiber
- avoid caffeine and lactose
- avoid highly seasoned food
- avoid high fat food
- avoid foods that cause gas
Treatment for diarrhea for adults
- repopulate GI tract with microorganisms (prebiotics in modest amounts and probiotics)
examples of prebiotics
- pectin
- oligosaccharides
- inulin
- oats
- banana flakes
examples of probiotics
- cultured food
what type of food is a source of beneficial gut flora
probiotics
What diet is characterized by foods completely digested, well absorbed
Low- or minimum residue diets
What diet is characterized by foods that do not increase GI secretions
Low- or minimum residue diets
When (or in what conditions) is low- or minimum residue diet used?
- maldigestion
- malabsorption
- diarrgea
- temporarity after some surgeris like hemorrhoidectomy
Foods to Limit in a Low- or Minimum Residue Diet
- Lactose
- Fiber that is > 20 g/day
- Resistant starches
—Raffinose, stachyose in legumes - Sorbitol, mannitol, xylitol that are > 10 g / day
- Caffeine
- Alcohol (esp. wine and beer)
When to use restricted-fiber diets
- When reduced fecal output is necessary
- When GI tract is restricted or obstructed
- When reduced fecal residue is desired
Foods restricted in restricted-fiber diets
- fruits
- vegetables
- coarse grains
How much fiber intake a day is allowed in a restricted-fiber diet?
< 10 g fiber/day
What are obstructions in the stomach lining that result from ingestion of plant foods?
Phytobezoars
In which individuals are phytobezoars common in?
- Edentulous patients
- Patients w/ poor dentition
- Patients w/ dentures
What are examples of foods associated with phytobezoars
Potato skins, oranges, grapefruit
Intestinal Disorders that need MNT
- Irritable Bowel Syndrome
- Lactose Intolerance
- Fat Malabsorption
- Steatorrhea (>5 g / day based on fecal exam)
- Flatus (intestinal gas)
pertains to a functional GI disorder
Irritable Bowel Syndrome (IBS)
Characterized by unexplained abdominal discomfort or pain that is associated with changes in bowel habits
Irritable Bowel Syndrome (IBS)
Symptoms of IBS
Gas
Bloating
Diarrhea
Constipation
Increased GI distress associated with psychosocial distress
What disorder does this pertain to?
ROME IV criteria is recurrent abdominal pain at least 1 day/week in the last 3 months and associated with two or more of the following conditions:
- related to defecation
- associated with a change in stool frequency
- associated with a change in stool form or appearance
IBS
What are the FODMAP sugars
- fermentable sugars
- oligosaccharides
- disaccharides
- monosaccharides
- polyol sweeteners
Foods that may cause flatulence
apples, beer, broccoli, cabbage, corn, cucumber, fructose, high-fat meats, legumes, nuts, peppers (green), radishes, sorbitol wheat, milk products, asparagus, bran, brussel sprouts, cauliflower, cream sauces, fried foods, gravy, honey, mannitol, onions, punces, raisins, soybeans, soda
Diseases of the small intestine
Celiac Disease
Brush Border Enzyme Deficiencies
Crohn’s Disease
other names for the celiac disease
Gluten-sensitive enteropathy
Non-tropical sprue
Where is gliadin found
in the gluten
the celiac disease has a negative reaction to what?
gliadin
this is caused by inappropriate autoimmune reaction to gliadin
celiac disease
prevalence of celiac disease
1 in 133 persons in the US
T or F: celiac disease is not as common as peoplpe think
False; it is much more common than formerly believed
T or F: celiac disease is easy to diagnose
False; celiac disease frequently goes undiagnosed
What does the damaged villi of intestinal mucosa with celiac disease cause?
- atrophy
- flattening
T or F: the celiac disease involves potential or actual malabsorption of all nutrients
True
List down the conditions that may accompany celiac disease
- Dermatitis herpetiformis
- anemia
- bone loss
- muscle weakness
- polyneuropathy
- follicular hyperkeratosis
Individuals are in greater risk of what malignancies if they have celiac disease?
- type 1 diabetes
- lymphomas
- other malignancies
T or F: fatigue is an early presentation (symptom) of celiac disease
False; it is a later presentation (symptom)
List down the early presentation symptoms of celiac disease
- diarrhea
- steatorrhea
- malodorous stools
- abdominal bloating
- poor weight gain
List down the later presentation (symptoms) of celiac disease
Other autoimmune disorders
Failure to maintain weight
Fatigue
Consequences of malabsorption
- Anemia
- Osteoporosis
- Coagulopathy
This is often misdiagnosed as IBD or other disorders
celiac disease
Gold standard in diagnosing the celiac disease
intestinal mucosa biopsy
What are used for the diagnosis of celiac disease?
- positive family history
- pattern of symptoms
- serologic tests
- intestinal mucosa biopsy
what are serologic tests use for celiac disease diagnosis?
- Antiendomysial antibodies(AEAs)
- Immunoglobulin A (IgA)
- Antigliadin antibodies (AgG-AGA)
- IgA tissue transglutaminase
T or F: In celiac disease therapy, diet is not included
False; diet IS the therapy
how is diet utilized in the acute phase of the celiac disease
electrolyte and fluid replacement
what vitamin and mineral supplementation may be needed during celiac disease?
- fat-soluble vitamins (ADEK)
- calcium
- iron
- folate
- B12
How to use diet therapy in celiac disease?
- electrolyte and fluid replacement (acute phase)
- vitamin and mineral supplementation
- delete gluten sources
- substitute some food (rice, corn, potato)
- see dietitian familiar with this disease
- read labels carefully
what are the common problem additives that may contain gliadin?
- fillers
- thikeners
- seasonings
- sauces
- gravies
- vegetable protein
- coatings
List down ailments wherein medicine practitioners may recommend gluten-free diets.
- fatigue
- depression
- schizophrenia
- arthritis
- digsestive upsets
this disorder has an unknown cause
tropical sprue
this imitates celiac disease
tropical sprue
what disorder results in the atrophy and inflammation of villi but is not necessarily characterized by gluten sensitivity
tropical sprue
Sx of tropical sprue
- diarrhea
- anorexia
- abdominal distention
Rx of tropical sprue
- tetracycline
- folate 5 mg/day
- B12 IM
characterized by deficiency of brush border disaccharides
intestinal brush border enzyme deficiencies
Disaccharides not hydrolyzed at mucosal cell membrane
Intestinal Brush Border Enzyme Deficiencies
Intestinal Brush Border Enzyme Deficiencies can occur as:
- rare congenital defects
- effects of diseases that damage intestinal epithelium
- genetic form
list down rare congenital defects that the intestinal brush border enzyme deficiencies can manifest as:
lack of sucrase, isomaltase, and lactase in newborns
List down diseases that damage the intestinal epithelium that intestinal brush border enzyme deficiencies occur secondary to.
- Chron’s disease
- Celiac disease
Give an example of a genetic form that the deficiency of intestinal brush border enzymes can occur as:
lactas deficiency
How many adults (in percentage) worldwide are lactase deficient?
70%
From what regions are lactase deficiencies most prevalent
South America, Africa, Asia
This is diagnosed based on the history of GI tolerance to dairy products
lactase deficiency
What test is used as lactose intolerance diagnostics?
Lactose breath hydrogen test
Explain the lactose breath hydrogen test mechanism.
- the baseline breath hydrogen is measured
- patient consumes 25 to 50 g lactose
- breath hydrogen is remeasured in 3-8 hours
- increase greater than 200 ppm indicates lactose malabsorption (90% sensitivity)
What test is used as lactose deficiency diagnostics?
lactose tolerance test
Explain the lactose tolerance test mechanism.
- Baseline serum glucose is measured after an 8-hour fast
- Patient consumes 50-100 g lactose
- Remeasurement of serum glucose is done 30, 60, and 90 minutes after
- No increase in blood glucose levels suggests lactose malabsorption
T or F: lactase-deficient individuals cannot tolerate even small amounts of lactose without symptoms
False; most lactase-deficient individuals can tolerate small amounts of lactose without symptoms, particularly with cultured products (yogurt or cheese)
How is lactose intolerance distinct from protein allergy?
- allergy would require a milk-free diet
What are the inflammatory bowel diseases (IBD)
- ulcerative colitis
- chron’s disease
- autoimmune diseases with unknown origin
is characterized by inflammation and ulceration of the colon
ulcerative colitis
characterized by inflammation and ulceration of the GIT with granulomas
Chron’s disease
T or F: IBDs can be linked with genetic and environmental factors
True
what age rage is usual onset of IBDs
15 to 30 years old
Clinical features of IBDs
Food intolerances
Diarrhea
Fever
Weight loss
Malnutrition
Growth failure
Extraintestinal manifestations
- Arthritic
- Dermatologic
- Hepatic
Tests used for initial diagnosis of IBD
- Colonoscopy
- Lower gastrointestinal (GI) series with barium enema
- ASCA (Antisacchromyces Antibodies)
(Dubinsky, 2003) - ANCA (Antineutrophil Cytoplasmic Antibodies)
(Dubinsky, 2003) - Biopsy
Tests for Diagnosis, Exacerbation, and Response to Therapy
- C-reactive protein
- Erythrocyte Sedimentation Rate (ESR)
- Lactoferrin
- White blood count and differential
- Stool assessment for presence of leukocytes
