Gut health and Disease

Question 1

Which enzymes does the pancreas produce?

Answer 1

trysin, amylases & lipases, protease

Question 2

Which cell produces bile salts? Where are bile salts stored?

Answer 2

Hepatocytes

Gallbladder

Question 3

What does the enteric nervous system do in the gut?

Answer 3

Motility 
Nutrient uptake
Hormone and enzyme release 
Appetite regulation
Vascular flow
Immune cell activity

Question 4

What is the intrinsic innervation of the gut? What mediates this?

Answer 4

Intrisnsic innervation- communication within the gut only

Mediated by ganglionated plexi: myenteric (longitudinal and circular muscle) and submucosal plexi (circular muscle and mucosa)

Question 5

Which nerve mediates communication between the gut and CNS? Which nucleus does it synapse with for this?

Answer 5

Vagus

Central terminalis synapses with nucleus tractus solitarus.

Question 6

What part of the GI tract does the vagus nerve innervate?

Answer 6

Mouth- transverse colon

Question 7

Where is gut microbiota found?

Answer 7

Colon

some in small intestines

Question 8

What can an abnormal gut microbiota cause?

Answer 8

IBD (inflammation)
and IBS (non-digestible carbohydrates)

Question 9

What is the purpose of Faecal Microbiota Transfer? What condition is it approved to treat?

Answer 9

Increase microbial diversity
Donors: Healthy relative, ‘super donors’ or artificially produced probiotics
Only approved for treatment of C.difficile infection following failure of antibiotic therapy

Question 10

What does Clostridium difficile do to the gut? How does it occure? what are the symptoms? How is it treated?

Answer 10

Effect- changes to the microbiome
Cause- broad-spectrum antibiotic (opportunistic)

Symptoms- watery diarrhoea, abdominal pain
Treatment-
1. Stop antibiotic use
2. Vancomycin or metronidazole

Question 11

What is the function of pre-biotics?

Which bacteria does it help promote

Answer 11

promote growth and survival of bacteria

Stimulate Bifidobacterium & Lactobacillus

Question 12

Give some examples of pre-biotics

Answer 12

Non-digestible food ingredients-
Fructans
Galactans
Dietary fibres

Question 13

What are probiotics?

Answer 13

live cultures found in dairy products and fermented food

Question 14

Give examples of Upper GI symptoms

Answer 14

acid reflux, nausea, vomiting, belching, gastroparesis and bloating

Question 15

Give examples of lower GI symptoms

Answer 15

bloating, constipation, diarrhoea, abdominal pain

Question 16

Describe Gastroesophageal Reflux Disease (GERD) and its common causes

Answer 16

Occurs when the lower esophageal spincter is weak or relaxed abnormally

Causes- weight gain- stress

Question 17

What are the symptoms and treatment options for Gastroesophageal Reflux Disease (GERD)?

Answer 17

Symptoms- ulcer formation, inflammation and Barratt’s esophagus

Treatment: antacids + alginates (gaviscon)

sever- Proton Pump Inhibitors (block stomach acid production)

Question 18

Which drug can block stomach acid production?

Answer 18

Proton Pump Inhibitors

Question 19

What is Gastroparesis? What are the symptoms?

Answer 19

Delayed gastric emptying.

Symptoms: nausea, vomiting, rapid feeling of fullness, reflux, pain and bloating

Can cause malnutrition and changes to blood sugar

Question 20

How does Diabetes cause Gastroparesis?

Answer 20

causes neuropathy of vagal endings innervating the stomach

Question 21

How is Gastroparesis diagnosed?

Answer 21

Gastric emptying study:
C13 labeled meal is ingested

Released C13 is exhaled in breath and is used as marker of food movement through stomach
Time-course compared to normal values

Question 22

What is the treatment for Gastroparesis?

Answer 22

Domperidone or erythromycin: stimulate stomach muscle contraction

Anti-emetics for nausea

Dietary changes- smaller more frequent meals

Question 23

What is Inflammatory Bowel Disease?

Answer 23

Collective term that refers to chronic inflammation of the lower GIT-

Crohn’s Disease (CD)
Ulcerative Colitis (UC)

Question 24

Describe the main features of Crohn’s Disease (CD) and symptoms

Answer 24

can affect the whole GIT but is often localised to small bowel
Symptoms- 
Diarrhoea
Abdominal pain
Fatigue
Fever
Blood in stool

Question 25

How does Crohn’s Disease (CD) effect the bowel? | How is it diagnosed?

Answer 25

``` Scaring of bowel epithelium Bowel obstruction Ulcers Fistulas (hole in bowel) Diagnosis- Colonosocopy Fecal calprotectin ```

Question 26

Treatment of Crohn’s Disease paediatric and adult

Answer 26

Paediatric- Enteral nutrition for 4 weeks replaces normal diet promotes epithelial healing Adult- Corticosteroids- Prednisolone Immunosupresssants- Azathioprine & mercaptopurine Antibodies which neutralise TNF

Question 27

Describe the main features of Ulcerative Colitis (CD) and symptoms

Answer 27

Chronic inflammatory restricted to the colon ``` Symptoms Bloody diarrhoea Urgency Abdominal pain Fatigue Fever Weight loss ```

Question 28

How does Ulcerative Colitis (CD) effect the bowel? | How is it diagnosed?

Answer 28

ulcer-like appearance of mucosa Perforation of the colon (can be fatal) Severe bleeding Colon cancer Diagnosis: Colonscopy Fecal calprotectin

Question 29

Treatment of Ulcerative Colitis mild and sever

Answer 29

Mild- Corticosteroids - Prednisolone 5-ASAs Sever- antibodies that neutralise TNF Ciclosporin – IV Surgery (colectomy)

Question 30

Symptoms of Irritable Bowel Syndrome?

Answer 30

Upper GI- functional GERD, functional dyspepsia, bloating, pain Lower GI- abdominal pain, cramping, constipation and diarrohea.

Question 31

How is Irritable Bowel Syndrome diagnosed?

Answer 31

ROME IV questionnaire after excluding all biolgical causes

Question 32

List some possible causes of Irritable Bowel Syndrome?

Answer 32

``` gastroenteritis? Leaky gut epithelium? Increased sensitivity to pain? Changes to gut microbiota Enteric neuron abnormalities causes issues with gut motility ```

Question 33

What are the treatments for IBS?

Answer 33

``` Dietary control e.g. FODMAP diet Treat sysmptoms (laxatives, pain medication) ``` Linaclotide: increase fluid secretion and pain relief Lubiprostone: increase fluid secretion Rifaximin: antibiotic to treat bacterial overgrowth

Question 34

What can be found in gastric juices?

Answer 34

HCl, Salts, Pepsin, Mucus , water, intrinsic factor (critical for B12 absorption), bicarbonate (maintains pH7 at gastric epithelium with mucosal gel).

Question 35

How many neurones are in the enteric nervous system?

Answer 35

400-600

Question 36

What are bezoars? What condition causes them?

Answer 36

Hardened mass of undigested food | Gastroparesis