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MBChB - year 2 > Week 4 GI Lectures > Flashcards

Week 4 GI Lectures Flashcards

1
Q

What happens if there is a large number of osmotically active molecules in the gut?

A

It starts to draw water at the cost of interstitial fluid which can lead to cellular dehydration

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2
Q

What does fluid accumulation in the gut cause?

A

Increased intestinal transit time which leads to a self propelling series of events that cause diarrhoea

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3
Q

What is osmotic diarrhoea?

A

When there are still solutes left in the lumen of the intestine which draw water into the lumen

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4
Q

What can cause osmotic diarrhoea?

A
  • Laxatives, antacids,
  • Acarbose(alpha-glucosidase inhibitor)
  • Orlistat (lipase inhibitor)
  • Digestive enzyme deficiencies (lactase)
  • Pancreatic insufficiency
  • Inflammatory disease
  • Short bowel syndrome
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5
Q

What type of patient is more prone to electrolyte imbalances?

A

People who have had colon problems/ colon removed

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6
Q

What are the different types of ion transporter?

A

ATP driven pump
Co-transporter - symporter
Exchange carrier - antiporter
Ion channel

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7
Q

What drives the absorption of water in the intestine?

A

Sodium

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8
Q

What provides energy for the active transport of minerals, vitamins and metabolites in the intestine?

A

The sodium gradient

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9
Q

What happens if you introduce less osmotically active molecules to the gut?

A

There is less fluid movement

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10
Q

What is ORS?

A

Oral Rehydration Solution

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11
Q

What is secretory diarrhoea?

A

Endotoxins stimulate colonic electrolyte secretion which causes fluid to be drawn into the intestine

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12
Q

What is inflammatory diarrhoea?

A

The intestinal wall is damaged so causes diarrhoea as it cannot perform its function properly

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13
Q

What causes inflammatory diarrhoea?

A

Inflammatory bowel disease
Infectious disease
Irritable colon

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14
Q

How much potassium is outside the cells?

A

Only about 5%. The healthy potassium level must remain within a very specific limits.

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15
Q

What can high potassium levels cause?

A

Arrhythmias

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16
Q

What is key when undertaking FRT (fluid replacement therapy)?

A

Establishing a fluid balance chart – a record of intake and loss of fluid is important
Need to know if just dealing with loss of electrolytes and fluid or is it a shift between cells?
Once condition has been assessed need to think about replacing the fluids.

17
Q

What are the different types of IV fluid replacement therapies?

A
  • Colloids

- Crystalloids

18
Q

What is the difference between colloids and crystalloids?

A

They stay in the vascular bed in different ways

19
Q

How much of each fluid stays in the intravascular bed after infusion?

A
  • colloids - initially nearly 100%
  • saline - 25%
  • dextrose - 10%
20
Q

When would colloids be used?

A

When someone is bleeding a lot and you are trying to fill in the vascular bed (after acute haemorrhage)

21
Q

When would saline be used?

A

If a patient is dehydrated but has not suffered an acute shock/haemorrhage

Saline has a higher retention than other crystalloids

22
Q

When is dextrose used?

A

Good for giving water (cant give water directly IV).

Dextrose enters cells very quickly so leaves a lot of water behind

23
Q

What are examples of isosmotic fluids?

A
  • Saline (0.9%)
  • Dextrose (5%)
  • Sodium bicarbonate (1.96%)
24
Q

What are examples of hyperosmotic fluids?

A

Sodium bicarbonate 8.4% is extremely hyperosmotic

25
Q

What is an example of a hypoosmotic fluid?

A

Saline 0.45%

26
Q

What happens if there are more osmotically active molecules in the cells than in the hypoosmotic plasma?

A

causes cells to draw in more water and can cause them to swell

27
Q

What is the standard postoperative regimen?

A

Saline and dextrose (2:1) (two bags of saline to one bag of dextrose)

28
Q

When are lactate containing fluids used?

A

In people with chronic acidosis.
A substantial amount of bicarbonate is produced during lactate metabolism: Thus Ringer-lactate solution may be used in metabolic acidosis caused by bicarbonate loss

29
Q

what are examples of lactate containing IV fluids?

A

Ringer-lactate

Hartmann’s

30
Q

How is IV potassium prescribed?

A

in mmol, indicating final volume of the solution: e.g. “20 mmol/L in saline, over 8h”

31
Q

What is the maximum concentration for peripheral administration of potassium?

A

40mmol/l

32
Q

What is the general rate and amount of fluid used for emergency re-hydration?

A

2-hourly 500ml bags

6L over 24hours

33
Q

What is the general rate and amount of fluid used for a standard regimen?

A

6-hourly 500ml bags

2L over 24hrs

34
Q

What is the general rate and amount of fluid used for slow rehydration?

A

8-hourly 500ml bags

1.5l over 24hrs

35
Q

What factors should be taken into account when using fluid therapy?

A
  • Age
  • CV status
  • Renal function
  • Severity of dehydration
  • How long it took for dehydration to develop

MBChB - year 2 (25 decks)

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