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Week 237 - Chronic Diarrhoea Flashcards

1
Q

Week 237 - Chronic Diarrhoea: What is the time frame for diarrhoea to be classed as chronic?

A

> 4 weeks

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2
Q

Week 237 - Chronic Diarrhoea: How much fluid enters the GI system per day? Where does this come from? How much stool is created?

A

• 8-9L/day

  • Ingest 1-2L
  • Produce 7L (saliva, biliary, pancreatic)

• 100-200g/day of stool

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3
Q

Week 237 - Chronic Diarrhoea: What are the two main types of diarrhoea? Give a brief description of each.

A
  • Osmotic diarrhoea - Caused by ingestion of poorly absorbed osmotically active substance that retains fluid within the lumen.
  • Secretory diarrhoea - Disordered electrolyte transportation, net secretion of anions, causes a net inhibition of sodium absorption and therefore water.
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4
Q

Week 237 - Chronic Diarrhoea: What are the causes of secretory diarrhoea?

A
  • Exogenous (Cholera toxin)
  • Endogenous (e.g. neuroendocrine tumour)
  • Absence of ion transporter
  • Loss of intestinal surface area.
  • Intestinal ischaemia
  • Rapid intestinal transit
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5
Q

Week 237 - Chronic Diarrhoea: What exocrine cells can be found in the body/corpus of the stomach? What do they secrete?

A
  • Chief Cells - Pepsinogen

* Parietal Cells - HCL, Intrinsic factor

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6
Q

Week 237 - Chronic Diarrhoea: What exocrine cells can be found in the antrum? What do they secrete?

A
  • Chief cells - Pepsinogen

* Endocrine cells - G Cells - Gastrin, D cells - somatostatin.

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7
Q

Week 237 - Chronic Diarrhoea: What is absorbed in the duodenum?

A
  • Iron

* Ca, Mg, Zn

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8
Q

Week 237 - Chronic Diarrhoea: What role does the liver play in digestion?

A

Bile salts cause fats to form into micelles.

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9
Q

Week 237 - Chronic Diarrhoea: What are the two exocrine functions of the pancreas?

A
  • Duct cells - Produce bicarbonate and water to neutralise stomach acid.
  • Acinar cells - Produce pancreatic juice for digestion of macronutrients (Proteases, Amylases, Lipases)
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10
Q

Week 237 - Chronic Diarrhoea: What does the jejunum absorb?

A
  • Proteins
  • Monosaccharides
  • Some fat and fat soluble vitamins (ADEK)
  • Water and water soluble vitamins
  • Folate
  • Ca, minerals, trace elements
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11
Q

Week 237 - Chronic Diarrhoea: What does the proximal ileum absorb?

A
  • Fats and fat-soluble vitamins (ADEK)

* Water and water-soluble vitamins

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12
Q

Week 237 - Chronic Diarrhoea: What does the distal ileum absorb?

A
  • Bile salts

* IF / vitamin B12 complex

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13
Q

Week 237 - Chronic Diarrhoea: What is the role of the ileo-caecal valve?

A
  • Regulates/ delays flow of chyme from ileum.

* Prevents bacterial contamination of ileum.

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14
Q

Week 237 - Chronic Diarrhoea: What does the colon absorb?

A
  • Water
  • Electrolytes
  • Short chains FAs (Produced from microbial fermentation of dietary fibre)
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15
Q

Week 237 - Chronic Diarrhoea: Where is cholecystokinin secreted from? What is its function?

A
  • Duodenum, jejenum, ileum, colon.

* Increases pancreatic secretion and causes contraction of the gall bladder.

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16
Q

Week 237 - Chronic Diarrhoea: Where is gastrin secreted from? What is its function?

A
  • G-cells in the gastric antrum.

* Stimulates parietal cells in the gastric body to secrete H+.

17
Q

Week 237 - Chronic Diarrhoea: Where is gastrin releasing hormone secreted from? What is its function?

A
  • Vagal nerves

* G cells in gastric antrum, increasing gastrin release.

18
Q

Week 237 - Chronic Diarrhoea: Where is glucagon released from? What is its function?

A
  • Produced by alpha cells in islets of Langerhans.

* Act on the liver to increase the production of glucose and breakdown of glycogen.

19
Q

Week 237 - Chronic Diarrhoea: Where is somatostatin released from? What is its function?

A
  • D cells in the stomach and duodenum, and delta cells of the islets of Langerhans.
  • Causes multiple effects;
  • Reduces production of gastrin in the stomach.
  • Increases fluid absorption in the intestine.
  • Reduces endo and exocrine secretions of the pancreas.
  • Reduces bile flow.
20
Q

Week 237 - Chronic Diarrhoea: Where is Guanylin secreted from? What is its function?

A
  • Ileum, Colon

* Increases fluid absorption in the intestines.

21
Q

Week 237 - Chronic Diarrhoea: What is the role of Vasoactive intestinal peptide? (VIP) Where is it secreted from?

A
  • ENS neurones.
  • Causes increased secretions of the small intestine and pancreas.
  • Relaxes the smooth muscle of the small intestine.
22
Q

Week 237 - Chronic Diarrhoea: What is the SGLT1 transporter responsible for? What is the co-transporter?

A
  • Transport of Glucose and Galactose.

* Na is the co-transporter.

23
Q

Week 237 - Chronic Diarrhoea: Which transporter is responsible for glucose and galactose?

A

• SGLT1

24
Q

Week 237 - Chronic Diarrhoea: Fructose is transported out of the gut by which transporter?

A

GLUT5

25
Q

Week 237 - Chronic Diarrhoea: Starch and maltose breakdown into which monosaccharide?

A

Glucose

26
Q

Week 237 - Chronic Diarrhoea: Lactose breaks down into which two monosaccharides?

A

Glucose and Galactose

27
Q

Week 237 - Chronic Diarrhoea: Sucrose breaks down into which monosaccharides?

A

Glucose and Fructose

28
Q

Week 237 - Chronic Diarrhoea: What is the effect of unabsorbed lactose in the colon?

A
  • Osmotic effect - Draws in water causing diarrhoea.

* Fermented by bacteria causing gas, and organic acids (acidic stools)

29
Q

Week 237 - Chronic Diarrhoea: How is lactose intolerance diagnosed?

A

• Lactose breath test.

- Increased H2 exhaled after laxtose ingestion.

30
Q

Week 237 - Chronic Diarrhoea: What are the causes of primary lactase deficiency?

A

Both genetic.
• Congenital - Extremely rare, osmotic diarrhoea from birth.

• Late-onset - After the age of 5 years, more common in asians and africans.

31
Q

Week 237 - Chronic Diarrhoea: What is needed to absorb fats (and fat-soluble vitamins)?

A
  • Bile salts to emulsify fats into micelles.
  • Pancreatic lipase for digestion.
  • Ileum for fat absorption.
  • Terminal ileum for bile salt absorption (an intact ICV is needed for this.)
32
Q

Week 237 - Chronic Diarrhoea: Deficiency of vitamin A can cause what?

A
  • Compromised mucosa including xerophthalmia.
  • Night blindness.
  • Benign intracranial hypertension.
33
Q

Week 237 - Chronic Diarrhoea: What are the complications of Vitamin D deficiency?

A

• Rickets/osteomalacia.

34
Q

Week 237 - Chronic Diarrhoea: What are the complications of Vitamin E deficiency?

A
  • Increased susceptibility to oxidative stress.
  • Haemolysis.
  • Neurological effects: peripheral neuropathy, ataxia, external ophthalmoplegia.
35
Q

Week 237 - Chronic Diarrhoea: What are the complications of vitamin K deficiency?

A

Coagulopathy - prolonged PT.

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