4C-THA LAAAGE Intestine

Question 1

The fibers of the L.I.’s external muscular layer are collected into longitudinal bands called ______.

Answer 1

teniae coli

Question 2

The colon wall forms outpouchings (_______) between the teniae.

Answer 2

haustra

Question 3

What are the 4 cells of the LI? HINT they have the same names as the SI!!

Answer 3

1.Absroptive cells 2.Goblet Cells 3.Endocrine cells 4.Regenerative Cells

Question 4

What are the 4 functions of the LI?

Answer 4

1.Storage 2.Bacterial Housing 3.Some Absorption 4.Defecation

Question 5

What is the main difference between the SI and LI luminal surfaces??

Answer 5

LI is a FLAT luminal surface… SI is VERY full of villi

Question 6

How many different species of bacteria call the LI home?

Answer 6

500!!

Question 7

The intestinal flora do fermentation of undigestible dietary fiber to generate _______, which are a major nutritional source for the colon and have trophic effects to promote normal mucosal growth and development.

Answer 7

fatty acids…

Question 8

What pH range is the stool?

Answer 8

Slightly Acidic! 5.0-7.0

Question 9

What are three main functions of the intestinal flora?

Answer 9

1.Take up space! 2.Metabolize things 3.Make 3 vitamins!

Question 10

What are the three vitamins synthesized by the intestinal flora? What are the roles of these three vitamins?

Answer 10

Vit K-clotting factors, B12-RBC formation, and Folic Acid(B9)-RBC formation

Question 11

What are the 4 mechanisms causing DIARRHEA?

Answer 11

1.increased OSMOTIC load 2.Increased SCRETION 3.inflammation(EXUDATIVE) 4.decreased absorption TIME

Question 12

_______ diarrhea occurs when unabsorbable, water-soluble solutes remain in the bowel, where they retain water. What is an example?

Answer 12

Osmotic diarrhea…ex: lactose intolerance

Question 13

_______ diarrhea occurs when the small and large bowel secrete more electrolytes and water than they absorb. What is an example?

Answer 13

Secretory diarrhea…EXAMPLE-INFECTIONS!!! Secretagogues include bacterial toxins (e.g. – in cholera), enteropathogenic viruses, bile acids & unabsorbed dietary fat.

Question 14

________ diarrhea occurs with several mucosal diseases (e.g. – regional enteritis, ulcerative colitis, lymphoma, cancer) that cause mucosal inflammation, ulceration, or tumefaction. The resultant outpouring of plasma, serum proteins, blood, and mucus increases fecal bulk and fluid content. Involvement of the rectal mucosa may cause urgency and increased stool frequency because the inflamed rectum is more sensitive to distention.

Answer 14

Exudative

Question 15

___________ occurs when chyme is not in contact with an adequate absorptive surface of the GI tract for a long enough time so that too much water remains in the feces. Factors include small- or large-bowel resection, gastric resection, vagotomy, surgical bypass of intestinal segments, and drugs that speed transit by stimulating intestinal smooth muscle (as a side effect).

Answer 15

Decreased absorption time

Question 16

What is tough about diagnosing constipation?

Answer 16

It is infrequent pooping, which is different for everyone

Question 17

What can all of these lead to? failure to respond to the urge to defecate inadequate fiber in the diet, inadequate fluid intake, weakness of the abdominal muscles, inactivity and bed rest, pregnancy, hemorrhoids

Answer 17

Constipation!

Question 18

Disorders associated with chronic constipation include ________ diseases such as spinal cord injury, Parkinson’s disease, multiple sclerosis; endocrine disorders such as hypothyroidism or diabetic neuropathy; and obstructive lesions in the GI tract. Drugs such as _______, anti-cholinergic agents, calcium channel blockers, diuretics, iron supplements and aluminum antacids tend to cause constipation.

Answer 18

neurologic….opiates

Question 19

The term _______ _______ _______ (___) is used to describe a functional GI disorder characterized by a variable combination of chronic and recurrent intestinal symptoms not explained by structural or biochemical abnormalities. There is evidence to suggest that 10-20% of people in Western countries have the disorder, although most do not seek medical attention.

Answer 19

irritable bowel syndrome (IBS)

Question 20

What is the HALLMARK of IBS? What is believed to be the cause?

Answer 20

Pain is relieved with defecation….Caused CNS malfunction (stress!)

Question 21

Who is affected more by IBS, women or men?

Answer 21

Women, also related to hormones(menses)

Question 22

Because ________ lacks anatomic or physiologic markers, diagnosis is usually based on signs and symptoms of abdominal pain or discomfort, bloating, constipation, diarrhea, or an alteration between both.

Answer 22

IBS

Question 23

What are the two inflammatory intestinal disorders that make up Inflammatory Bowel DISEASE (not syndrome!!)

Answer 23

1.Crohn’s Disease 2.Ulcerative Colitis (UC)

Question 24

WHAT IS THE HALLMARK OF CROHN’S DISEASE?

Answer 24

COBBLESTONE

Question 25

Which IBDisease has skip lesions instead of one common area of inflammation?

Answer 25

Crohns has the skip lesions. UC tends to be in one place

Question 26

Which IBDisease has oral manifestations?

Answer 26

Crohn’s!

Question 27

Which IBDisease ALWAYS involves the rectum and is therefore “down the line” more often then not?

Answer 27

Ulcerative Colitis

Question 28

What is a condition in which the mucosal layer of the colon herniates through the muscular is layer?

Answer 28

DiverTicUlosis

Question 29

Which part of the LI is most common to have Diverticulosis? Therefore where is a Pt going to feel pain if inflammation arises?

Answer 29

The sigmoid…Pain in Lower Left Quad!

Question 30

What is the name of the disease when diverticula become inflamed?

Answer 30

Diverticulitis

Question 31

Which condition is signaled by Lower Right Quadrant REBOUND tenderness?

Answer 31

Acute Appendicitis

Question 32

What are the 4 examples of intestinal obstruction?

Answer 32

1.Hernia 2.Adhesion 3.Volvus(twist) 4.Intussuscepion

Question 33

Pooping is a spinal cord- mediated __________ reflex that causes the walls of the sigmoid colon and the rectum to contract and the internal anal sphincter (smooth muscle) to relax. WHICH nerves are involved here?

Answer 33

parasympathetic…S2,S3,S4 keep the poo off the floor!!

Question 34

What is the only sphincter we can control during pooping?

Answer 34

External Anal Sphincter

Question 35

__________ refers to blood in the vomitus. It may be bright red or have a “coffee-ground” appearance because of the action of the digestive enzymes. WHY?

Answer 35

Hematemesis…Red=from up high in the GI tract vs Coffee=down low in the GI tract

Question 36

Blood that appears in the stool may range in color from bright red to tarry black. Bright red blood usually indicates that the bleeding is from the _____ bowel. When it coats the stool, it often is the result of _______ ________.

Answer 36

lower…bleeding hemorrhoids

Question 37

Where do MELENA stools indicate bleeding?

Answer 37

Above the ILEOCECAL VALVE!

Question 38

Occult, or hidden, blood can only be detected by chemical means. It can be caused by ______, ________, or ______ of the intestine.

Answer 38

gastritis, peptic ulcer, or lesions of the intestine.

Question 39

What is “one of the most common cancers in the Western World?

Answer 39

AdenoCarcinoma of the Colon & Rectum

Question 40

What are the 4 progressions to AdenoCarcinoma of the colon/rectum?

Answer 40

Normal Mucosa–>Polyp—->Cancer—->Metastatic tumor

Question 41

When is the most common age for adenocarcinoma of the colon/rectum to occur?

Answer 41

60-70 yrs

Question 42

What are the 4 predisposing factors for adenocarcinoma of the colon/rectum?

Answer 42

1. Polyps 2. Long standing UC 3.Genetic 4.High animal fat diet