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Gastrointestinal > Small Intestine > Flashcards

Small Intestine Flashcards

1
Q

what are the three areas of the small intestine called

A

duodenum
jejunum
ileum

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2
Q

what substances does the small intestine receive

A

chyme from stomach
bile from gallbladder
pancreatic enzymes

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3
Q

what are some adaptions the small intestine has to allow for maximum absorption

A

villi
microvilli
circular folds of Kerchring

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4
Q

what is segmentation

A

mixing and churning of chyme driven by sympathetic activity

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5
Q

what hormones are secreted into the small intestine and from what cells

A

gastrin from G cells
secretin from S cells
CCK
ghrelin

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6
Q

what does secretin stimulate

A

promotes gastric secretions and biliary HCO3

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7
Q

what does CCK stimulate secretion of

A

bile through relaxing sphincter of Oddi and contracting gallbladder

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8
Q

what are ghrelin and leptin

A

ghrelin - hunger signal

leptin - decreases appetite

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9
Q

the basolateral membrane of enterocyte faces the

A

lumen/blood vessel

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10
Q

the apical membrane of enterocyte faces the

A

opposite side of the lumen

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11
Q

what is digestion

A

enzymatic conversion of complex dietary substances into smaller form that can be absorbed

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12
Q

what mediates luminal digestion

A

pancreatic enzymes - secreted into the duodenum

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13
Q

what enzymes are involved in membrane digestion

A

brush border enzymes

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14
Q

what is absorption

A

what absorbable products are transferred across apical and basolateral membranes

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15
Q

carbohydrates make up what % of total food intake

A

45%

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16
Q

name 2 polysacchardies and % total intake of carbohydrates

A

starch
glycogen
(50%)

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17
Q

name 2 oligosaccharides and % total intake of carbohydrates

A

lactose
sucrose
(30-40%)

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18
Q

name 3 monosaccharides and % total intake of carbohydrates

A

glucose
fructose
galactose
(10%)

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19
Q

what happens to carbohydrates to allow them to be absorbed

A

complex carbohydrates are all converted into monosaccharides

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20
Q

what is the function of alpha-amylase

A

breaks down polysaccharides into oligosaccharides such as maltose

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21
Q

why does alpha-amylase not break carbohydrates completely down into monosaccharides

A

it can only break internal alpha 1,4 glycosidic bonds and not terminal alpha 1,4 glycosidic bonds

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22
Q

name two oligosaccharidases

A

sucrase

lactase

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23
Q

sucrase breaks sucrose into

A

glucose

fructose

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24
Q

lactase breaks lactose into

A

glucose

galactose

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25
Q

what is lactose intolerance

A

form of lactase insufficiency with lacking enzyme

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26
Q

describe the three types of lactose intolerance

A

primary - lack of lactase persistence allele
secondary - development post infection
congenital - rare autosomal recessive condition

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27
Q

at the brush border membrane how are glucose, fructose and galactose absorbed

A

glucose and galactose - SGLT1 transporter

sucrose - GLUT5 transporter

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28
Q

at the basolateral membrane how are glucose, fructose and galactose absorbed

A

all absorbed via GLUT2 transporter

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29
Q

what are proteins broken down to before they can be absorbed

A

oligopeptides and amino acids

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30
Q

where does the most important part of protein digestion occur and what happens

A

duodenum - pancreatic proteases convert oligopeptides into amino acids

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31
Q

how are amino acids absorbed in the enterocyte

A

via secondary active transport mediated by Na+ dependent transport

32
Q

define malabsorption

A

failure of the small intestine to absorb nutrients correctly

33
Q

what are the main causes of malabsorption

A 
coeliac disease
chronic pancreatitis 
Crohn's disease 
primary biliary cholangitis 
infection
34
Q

what are the main symptoms of malabsorption

A

steatorrhoea
diarrhoea
fatigue
weight loss

35
Q

what is a sign of vitamin C and K deficiency

A

easy bruising

36
Q

what is kolonychia and what is it a sign of

A

spooning of the nails

sign of iron deficiency

37
Q

what is leukonychia and what is it a sign of

A

white patches on the nails

sign of calcium and zinc deficiency

38
Q

what is glossitis and what is it a sign of

A

swollen tongue

sign of vitamin B12 or iron deficiency

39
Q

what is angular cheilitis a sign of

A

sign of vitamin B12 or iron deficiency

40
Q

what is Coeliac disease

A

autoimmune response causing reaction to a component to gluten (wheat, flour)

41
Q

what is the overall effect of coeliac disease on absorption

A

damages enterocytes and reduces absorptive capacity

42
Q

what immune cells produce the response in Coeliac disease and what structures change

A

T cells produce response

causes villous atrophy, flat duodenal mucosa and reduced SA for absorption

43
Q

what are the symptoms of Coeliac disease

A 
smelling stools that wont flush away (steatorrhoea)
diarrhoea 
abdo pain and bloating 
apthous ulcers 
weight loss and fatigue
44
Q

what investigations are carried out to diagnose Coeliac disease

A

biopsy but avoided in children
serology - IgA anti-TTG (anti-transglutaminase)
or TTG if someone has IgA deficiency

45
Q

what is the main treatment for Coeliac disease

A

gluten free diet - available from pharmacist

46
Q

what is the most common type of emergency operation to occur

A

appendicitis

47
Q

what causes appendicitis

A

aetiology unknown but could be due to faecal obstruction or irritation - can lead to oedema, necrosis and perforation

48
Q

appendicitis most commonly presents in which age group

A

children but also in the elderly

49
Q

what are the main symptoms of appendicitis

A

periumbilical pain that moves to RIF
mild fever and tachycardia
anorexia
possible nausea and vomiting

50
Q

on examination what is found if someone has an appendicitis

A

abdominal guarding
pain on percussion
Rosvings sign

51
Q

what is Rosvings sign

A

pain in RIF when palpating the LIF

52
Q

what investigations are required for appendicitis

A

ultrasound - gold standard
CRP and WCC
urinanalysis

53
Q

what is the treatment for appendicitis

A

analgesia
antipyretics
urgent lap appendicectomy

54
Q

what treatment is required after surgery for appendicitis

A

antibiotics and IV fluids

55
Q

what is Meckels diverticulum and are the complications of it

A

congenital condition which when becomes irritated can mimic the symptoms of appendicitis - complications include bleeding, obstruction and diverticulitis

56
Q

what are the two classifications for mesenteric ischaemia

A

acute and chronic

57
Q

what causes acute mesenteric ischaemia

A

embolus formed elsewhere travels to the SMA and becomes lodged causing infarction

58
Q

what causes chronic mesenteric ischaemia

A

angina of the gut - SMA becomes atherosclerosed

59
Q

what are the symptoms of mesenteric ischaemia

A

severe abdominal pain (possibly colicky) with no obvious signs on examination
possible signs of hypovolaemic shock

60
Q

what investigation is carried out for suspected mesenteric ischaemia

A

abdominal contrast CT - will show gasless abdomen

61
Q

what is the treatment and complications of mesenteric ischaemia

A

surgical resection and re-anastomose

62
Q

what are the three ways the small bowel can become obstructed and examples of each

A

in the lumen - food, gallstone, bezoar
in the wall - tumour, radiation, Crohn’s
outside wall - adhesions, herniation

63
Q

what happens to bowel proximal to the obstruction during bowel obstruction

A

becomes distended due to formation of gas that cannot pass through

64
Q

what are the signs and symptoms of bowel obstruction

A 
extreme vomiting (possibly faeculent)
absolute constipation 
distension 
burping
no bowel sounds
65
Q

what is the treatment for small bowel obstruction

A 
nil by mouth 
IV fluids 
NG tube for draining not feeding 
antibiotics and anticoagulants 
surgery if becomes strangulated
66
Q

what is intestinal failure

A

umbrella term to describe conditions where there is an inability to maintain adequate nutrition or fluid status

67
Q

lipids make up what % of total energy intake

A

50%

68
Q

lipids are soluble true/false

A

false - either poorly soluble or completely insoluble

69
Q

what two areas are lipids digested

A

stomach and small intestine

70
Q

what enzyme breaks down lipids in the stomach

A

gastric lipase

71
Q

what enzyme breaks down lipids in the small intestine and when is it released

A

pancreatic lipase and released in response to CCK

72
Q

what is the function of bile salts

A

released from gallbladder into duodenum to help emulsify large fat droplets into small ones

73
Q

what is the function of colipase

A

allows access of lipase to hydrophobic core of small droplets

74
Q

what is B12 required to bind to for correct absorption and where is it released from

A

intrinsic factor - released from parietal cells

75
Q

what are the fat soluble vitamins

A

A, D, E, K

76
Q

what are the water soluble vitamins

A

B (except B12) C and H

Gastrointestinal (7 decks)

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