MOTILITY Flashcards
(161 cards)
1
Q
is the movement helping the stool
move through and out the body.
A
Motility
2
Q
FUNCTION OF THE LARGE INTESTINE
A
- Absorbs salt and water from waste.
- Moving waste/feces.
- Storing waste.
- Evacuating the waste through defecation.
3
Q
The main function of the colon is to
A
remove water to make the stool firmer.
4
Q
PARTS OF THE LARGE INTESTINE
A
CECUM
ASCENDING COLON
TRANSVERSE COLON
DESCENDING COLON
SIGMOID COLON
RECTUM AND ANUS
5
Q
absorbs digestive fluids passing out the
ileum of the small intestine.
A
Cecum
6
Q
Push up any undigested food products
from the cecum.
A
Ascending Colon
7
Q
Majority of water reabsorption take
place.
A
Transverse Colon
8
Q
Descends transverse colon to sigmoid
colon.
A
Descending Colon
9
Q
Hold feces until it is time to defecate.
(Storage of stool.)
A
Sigmoid Colon
10
Q
place where residual waste
accumulates.
A
Rectum
11
Q
port of exit.
A
Anus
12
Q
PHYSIOLOGY OF DEFECATION is controlled by
A
neurological reflexes and
sphincters
13
Q
Defecation, commonly known as a
A
bowel
movement
14
Q
_____such as only
having bowel
movements
once or twice a
month
A
Infrequent defecation
15
Q
Infrequent defecation, such as only
having bowel
movements
once or twice a
month, can lead
to
complications
like?
A
severe
constipation.
16
Q
Filling of meal triggers?
A
Gastrocolic reflex
17
Q
When you wake up after sleep, stretching, sitting and standing this is triggered
A
Orthocolic reflex
18
Q
Gastrocolic and orthocolic reflex result to the ____ of the colon, which eventually stretches the rectum called___
A
muscle contraction; defacation reflex
19
Q
controlled by the Enteric Nervous System
A
Internal defacation reflex
20
Q
controlled by the Parasympathetic Nervous System
A
Parasympathetic defacation reflex
21
Q
2 Neurological Reflexes are:
A
Gastrocolic reflex
Orthocolic reflex
22
Q
A physiological
reflex that controls the motility of the
_________ following a
meal. This reflex is triggered after
eating.
A
lower gastrointestinal tract; Gastrocolic reflex
23
Q
This involves
mass movements in the left colon as a
reflex response to certain stimuli.
A
Orthocolic reflex
24
Q
The muscular contractions cause
_____ in the walls of the
colon. Once the stool reaches the
rectum, the urge to defecate
develops.
A
peristaltic waves
25
The 2 Defecation Reflex are:
Internal
and Parasympathetic Defecation
Reflex.
26
controlled through the _____
of the colon wall. Stretch signals are
generated here, activating peristaltic
waves that drive feces down to the
rectum.
enteric plexus; Internal defecation reflex
27
This is transmitted to the spinal
cord. Stretch signals are also present,
but they are conducted by the spinal
cord. The signals then return to the
rectum through the _____ or
via the parasympathetic nervous
system. This occurs through the _____, intensifying peristalsis and
relaxing the _____.
visceral reflex; pelvic
nerves; internal anal sphincter; Parasympathetic defecation reflex
28
refers to difficulty in defecating or
having infrequent, painful bowel movements.
CONSTIPATION
29
A _____ sitting position is not
ideal because it can block the rectum,
causing the muscles to become
constricted, which may hinder proper
defecation.
90-degree
30
A ______ position is considered
healthier because it allows the rectum
to be more relaxed and dilated,
facilitating easier defecation.
squatting
31
Accumulation of hard fecal material
in the large intestine.
CONSTIPATION
32
is not a disease but a
symptom of an underlying disease or a
problem.
Constipation
33
PATHOPHYSIOLOGY
Constipation commonly results from a
_____ or from use of
_____.
diet low in fiber; constipating drugs such as opiates; psychogenic disorders
34
refers to a disorder that
cannot be explained by any identifiable
physical damage, and is believed to be
caused by psychological factors.
Psychogenic
35
originate in the mind and are often
linked to emotional or mental conflicts.
Psychogenic disorders
36
CAUSES OF CONSTIPATION
poor H2O intake & poor dietary
habits
ignoring the urge
fecal impaction
bowel obstruction
chronic laxative use
neurologic disorders (paraplegia)
lack of exercise
selected drugs
Neurogenic constipation (Head
trauma, CNS tumors, spinal cord
injury, cerebrospinal accidents,
Parkinson’s disease)
Pregnancy
Inappropriate bowel habits
37
occurs when there is
a blockage or obstruction in the
intestines, preventing normal bowel
movements.
Fecal impaction
38
is paralysis of the lower
half of the body, usually resulting
from a spinal cord injury that
prevents signals from reaching the
lower body, leading to paralysis.
Paraplegia
39
selected drugs that may induce constipation:
anticholinergics, narcotics, and antacids
40
In Parkinson’s disease, _____ (the
absence of movement) occurs,
leading to a lack of motility in the
digestive system, which can cause
constipation.
akinesia
41
refers to the
clinical manifestations of Parkinson’s
disease.
TRAP (Tremor, Rigidity, Akinesia,
Postural Instability)
42
DRUGS CAUSING CONSTIPATION
1. Analgesics
2. Anticholinergics
3. Antacids containing calcium carbonate
or aluminum hydroxide
4. Barium sulfate
5. Calcium channel blockers
6. Clonidine
7. Diuretics (nonpotassium-sparing)
8. Ganglionic Blockers
9. Iron preparations
10. Muscle blockers (d-tubocurarine,
succinylcholine)
11. Nonsteroidal anti-inflammatory agents
12. Polysterene sodium sulfonate
43
Inhibitors of prostaglandin synthesis
Analgesics
44
inhibits acid production
therefore stimulates mucus
production, that’s why they are also
responsible for GIT contractions.
Prostaglandin
45
Analgesic opiates:
Morphine, Codeine, Heroine
46
can cause dryness,
making it difficult to defecate, as water
is needed for proper bowel movements.
The opposite of constipation is dryness,
which can interfere with the normal
defecation process.
Anticholinergics
47
Antiparkinsonian agents
benztropine or trihexyphenidyl
48
examples of anticholinergics:
Antihistamines
Antiparkinsonian agents (e.g.,
benztropine or trihexyphenidyl)
Phenothiazines
Tricyclic depressants
49
Ganglionic Blockers
hexamethonium (has
mecamylamine) nicotine, and lobeline
50
Muscle blockers and their distinction:
➢ Tubocurarine – a nondepolarizing
muscle blocker.
➢ Succinylcholine – a depolarizing
muscle blocker.
51
52
This is
a compensatory mechanism of the body.
Feeling of fullness (bloated stomach)
53
DIAGNOSIS FOR CONSTIPATION
Sigmoidoscopy
Colonoscopy
Barium enema
Thyroid function test
54
A procedure used
to examine the insides of the rectum
and the anus.
Sigmoidoscopy
55
An exam used to
detect changes or abnormalities in
the colon or
large
intestine.
Colonoscopy
56
necessary to
determine the presence of colorectal
pathology.
Barium enema
57
are injection of fluids used to
cleanse or stimulate the emptying of
the bowel.
Enema
58
determine the
presence of metabolic disorder that may
cause the constipation.
Thyroid function test
59
NON-PHARMACOLOGIC TREATMENT of constipation
1. Diet that contains fiber
2. Water
3. Exercise
4. Routine bowel habits
5. Stretching after waking up
6. Eating breakfast (30-45 mins after
waking up)
60
Diet that contains fiber:
whole grains,
vegetable such as broccoli, carrots and
sweetcorn and fruits such as berries, pears,
orange and pineapple
61
may only be effective for mild to
moderate constipation.
Fibers
62
Promote and facilitate bowel evacuation by:
➢ Acting locally to stimulate intestinal
peristalsis
➢ To soften bowel contents or both.
LAXATIVES
63
LAXATIVES
Promote and facilitate bowel evacuation by:
➢ Acting locally to stimulate intestinal
peristalsis
➢ To soften bowel contents or both.
64
Uses of laxatives:
1. Ease defecation in patients with painful
hemorrhoids or other rectal disorder.
2. Avoid potentially hazardous rises in blood
pressure during defecation in patients with
hypertension, cerebral arterial diseases.
3. Relieve acute constipation.
4. Remove solid material from the intestinal
tract prior to certain roentgenographic
studies.
65
often causing pain or
inflammation, similar to having an
incision or irritation in the area, or
inflamed anus.
Hemorrhoids
66
refer to
diagnostic procedures that use X-rays to
examine different parts of the body, with
the results typically exposed on
photographic film.
Roentgenographic studies
67
_____ eases defecation.
______ accelerates defecation.
Laxatives; Cathartic
68
CLASSIFICATION OF LAXATIVES
1. Luminally active agents
2. Nonspecific stimulants or irritants (with
effects on fluid secretion and motility)
3. Prokinetic agents (acting primarily on
motility)
69
They act by promoting an increase in the
fluid accumulation in the bowel as they
would increase the luminal volume
stimulated by peristaltic reflexes.
Luminally active agents
70
Luminally active agents:
a. Hydrophilic colloids; bulk-forming agents
(bran. Psyllium, etc.)
b. Osmotic agents (nonabsorbable
inorganic salts or sugars)
c. Stool-wetting agents (surfactants) and
emollients (docusate, mineral oil)
71
2. Nonspecific stimulants or irritants (with
effects on fluid secretion and motility) :
a. Diphenylmethanes (Bisacodyl)
b. Anthraquinones (Senna and Cascara)
c. Castor oil
72
3. Prokinetic agents (acting primarily on
motility) :
a. 5-HT4 receptor agonists
b. Opioid receptor agonists
73
Insoluble and non-absorbable
substances that expand on taking up
water in the bowel
BULK-FORMING LAXATIVES
74
BULK-FORMING LAXATIVES
Consist of _____ and
_____ derivatives that are
undigestible. Because they absorb
water, they increase the bulk of stool
and, in so doing, provide a
physiological stimulus to defecation.
polysaccharides; cellulose
75
BULK FORMING LAXATIVE
Increase stool bulk causing
peristalsis
76
is resistant to digestive
enzymes. It tends to absorb all the
water content, drawing water into the
lumen.
Cellulose
77
EXAMPLES AND USES OF BULK-FORMING
LAXATIVES
A. Dietary fiber
B. Hydrophilic colloids
C. Synthetic fiber
D. Cellulose derivatives
78
is the edible broken seed coat of
cereal grains, separated from flour or
meal.
BRAN
79
DIETARY FIBERS:
BRAN & LINSEED
80
Hydrophilic colloids AND DISTINCTION
➢ Psyllium (C-lium), karaya gum
✓ Plantago psyllium - psyllium’s natural
source.
✓ Sterculia urens - Karaya gum’s natural
source.
81
Synthetic fiber
polycarbophil
82
Cellulose derivatives
methylcellulose (Citrucel)
83
management of chronic constipation.
Produce laxation after 2-4 days and adequate
hydration is required.
BULK-FORMING
LAXATIVES
84
Soluble but non-absorbable particles
that retain water in the bowel by virtue
of their osmotic action and cause a
reflex increase in peristalsis.
OSMOTIC LAXATIVES
85
Salt containing
✓ Also known as
saline purgatives
86
Salt containing osmotic laxatives:
Magnesium sulfate - Epsom salt
Magnesium citrate - Citrate of
Magnesia
Sodium biphosphate - Fleet Enema
Sodium sulfate - Glauber’s salt
Potassium sodium tartrate -
Rochelle’s salt
Sodium bitartrate - Cream of tartar
or Seignette Salt
87
are used in high
doses for a rapid cathartic effect, and in
lower doses for a laxative effect.
Saline purgatives
88
Elicit a watery bowel discharge 1–3
hours after administration.
OSMOTIC LAXATIVES
89
retain water in the
intestines through osmosis, increasing
the bulk of the stool. This stool bulk
stimulates the intestinal muscles to
contract, causing the feces to move
toward the anus.
Saline laxatives
90
corresponds to the
extracellular space or intestinal
mucosa.
Osmotic pressure or osmotic
absorption
91
If the osmotic pressure in the
luminal content cannot be maintained
(either higher or lower), an _____is maintained.
iso-osmotic state
92
is always the
process involving the movement of
salt and water.
Osmotic absorption
93
1. Magnesium Sulfate
(Bitter salt; Epsom salt)
o The laxative action probably results
from two factors:
(1) SO4 ion
(2) Magnesium Ion
94
Not absorbed from the
GI tract and, thus, draws water into
the lumen of the bowel to make an
isotonic solution
SO4 ion
95
Release of
cholecystokinin-pancreozymin, which
causes an accumulation of fluid and
electrolytes within the small intestine
Magnesium Ion
96
Magnesium Ion - Release of
______, which
causes an accumulation of fluid and
electrolytes within the small intestine
cholecystokinin-pancreozymin
97
A
neurotransmitter in the enteric
nervous system.
Cholecystokinin
98
a small protein that
facilitates digestive processes by an
unknown mechanism.
Pancreozymin
99
A pregnancy
complication characterized by high
blood pressure that occurs during
pregnancy, and other organ systems
may be affected or damaged.
Pre-eclampsia
100
One of the most palatable of the
saline laxatives
Sodium Biphosphate
(NaH2PO4. H2O)
101
Its major use, however, is for
diagnostic procedures such as
proctoscopy, colonoscopy, or barium
enema
Sodium Biphosphate
(NaH2PO4. H2O)
102
Sodium Biphosphate
(NaH2PO4. H2O)
Its major use, however, is for
diagnostic procedures such as :
proctoscopy, colonoscopy, or barium
enema
103
It also is used in the form of the oral
solution as an antihypercalcemic
Sodium Biphosphate
(NaH2PO4. H2O)
104
Used also in cystitis (combined with
Methenamine)
Sodium Biphosphate
(NaH2PO4. H2O)
105
Rectal solution - also known as
Fleet
Enema
106
Oral solution -
Fleet Phospho-Soda
107
The medical term for
inflammation of the bladder.
Cystitis
108
taken to manage hypotension
in such cases.
ferrous
sulfate
109
Used also as laxative to evacuate
bowel prior to surgery
Sodium Sulfate
(Glauber’s salt)
110
Used also electrolyte replenisher
and isused inisosmotic solutions so
that administration does not disturb
normal electrolyte balance and does
not lead to absorption or excretion of
water and ions
Sodium Sulfate
(Glauber’s salt)
111
General Uses:
1. for acute evacuation of the bowel before
surgery or diagnostic procedures.
2. for elimination of parasites after
antihelminthic administration.
Sodium Sulfate
(Glauber’s salt)
112
Sodium Sulfate
(Glauber’s salt) side effects:
Hypermagnesemia
Hypernatremia
Dehydration
113
Magnesium containing - _____
Caution: _____
Hypermagnesemia; renally impaired patient
114
Sodium containing - _____
Caution: _____
Hypernatremia; Patients with Cardiovascular
Disorder
115
Salt-free osmotic agents
* Lactulose
* Mannitol
* Sorbitol
* Polyethylene glycol-electrolyte solutions
116
Used for complete colonic cleansing
before an endoscopic procedure.
Polyethylene glycol-electrolyte solutions
117
Polyethylene glycol-electrolyte solutions contains:
sodium chloride (NaCl),
potassium chloride (KCl), and sodium
bicarbonate (NaHCO3).
118
Osmotic laxative in
oral doses larger than
20 g
Mannitol
119
is a diuretic used to
increase urine
production, and to
treat or prevent medical
conditions that are caused by an
increase in body fluids/water (e.g.,
cerebral edema, glaucoma, kidney
failure)
Mannitol I.V.
(mannitol injection)
120
Lactulose brand name
(Cholac®, Lilac®)
121
cannot be
hydrolyzed by
digestive
enzymes,
therefore
unabsorbed
Lactulose
(Cholac®, Lilac®)
122
_____ of lactulose by colon
bacteria to lactic acid leads to
acidification of bowel contents and a
reduced number of bacteria.
Fermentation
123
Lactulose depends on its breakdown by colonic bacteria to _____, _____, ______, which acidify the
contents of the colon.
carbon dioxide, lactic
acid, and small amounts of acetic and
formic acids,
124
In Lactulose
The acidic environment converts
______,
which cannot be absorbed.
ammonia to ammonium ion (NH4+)
125
Ammonia is lipophilic and can
partially cross the blood-brain barrier. Aside from being a laxative, lactulose
also has an effect in?
hepatic encephalopathy, or portal
systemic encephalopathy.
126
a
nervous system disorder caused by
severe liver disease. When the liver
doesn't function properly, toxins build
up in the body, and these toxins,
including ammonia, can travel to the
brain and affect its function.
Hepatic encephalopathy
127
Lactulose Adverse Effect:
gas generated in the
stomach or bowels. due to fermentation in the
gut producing CO2
Flatus & cramps
128
Lactulose Drug Interaction:
eliminate colonic bacteria
reducing the fermentation of lactulose to lactic
acid thus decreasing the acidification of colon
Neomycin
129
Lactulose Contraindication:
Used with caution to patients with diabetes (it
contains monosaccharide 1 molecule of
galactose and 1 molecule of fructose).
130
STIMULANT LAXATIVES
Also known as
Irritant Laxatives
131
STIMULANT LAXATIVES:
A. DIPHENYLMETHANES
* Phenolphthalein
* Bisacodyl
* Sodium picosulfate
B. ANTHRAQUINONES
* Aloe
* Cascara sagrada
* Senna
C. CASTOR OIL
132
Direct stimulation of the enteric nervous
system and colonic electrolyte and fluid
secretion.
STIMULANT LAXATIVES
133
Decreases water absorption from the
bowel lumen and stimulate intestinal
secretions.
STIMULANT LAXATIVES
134
A small tear in the anus,
which is why there may sometimes be
blood in the anus.
Fissure
135
Osmotic and stimulant laxatives
share the common ability to increase the
amount of water in the stool.
136
Stimulant laxatives/Irritant laxatives, also known as
Contact laxatives
137
DIPHENYLMETHANES
Limitation to use:
Reabsorbed via enterohepatic circulation and
have:
1. Increased risk of abuse and overdose
2. Cardiotoxic
138
converted by
gut bacteria
into the active
colon-irritant
principle.
Bisacodyl (Dulcolax)
139
✓ It tends to act longer than other
laxatives because it enters the
enterohepatic circulation and is re
excreted in bile into the intestine
Phenolphthalein
140
In susceptible individuals,
phenolphthalein may cause allergic
reactions, including
SJS (Stevens
Johnson Syndrome) and lupus
erythematosus.
✓ It also may cause a Bartter’s-like
syndrome.
141
A kidney
disorder that typically appears during
childhood and is characterized
primarily by a decreased level of
potassium (hypokalemia).
Bartter’s-like syndrome
142
High levels of
aldosterone, which is a symptom of
Bartter's syndrome.
Hyperaldosteronism
143
Phenolphthalein – Colors
alkaline
urine red.
144
Irritant laxatives process is?
Glucuronidation
145
_____a condition usually
associated with chronic
laxative use in which
dark pigment is
deposited in the _____
Melanosis coli; lamina propria
146
There has been concern that long-term
use of cathartic agents, like
Diphenylmethanes, can lead to dependence and damage to the ______ particularly the____
enteric
nervous system; myenteric plexus
147
dependence and damage to the enteric
nervous system (ENS), particularly the
myenteric plexus can result in?
colonic atony (loss of muscle tone or
contraction)
148
Cascara sagrada
Scientific name:
Synonym:
Use:
Rhamnus purshiana
Nature’s Remedy; Sacred Bark; Chittem
transient constipation; cathartic
149
It has very little action on the small
intestine but promotes peristalsis in
the large intestine.
Cascara sagrada
150
Sennosides
✓ Example:
Calcium sennosides
(Senokot)
151
Sennosides
✓ A natural complex of anthraquinone
glycosides found in senna, isolated
from ______ as calcium
salts, contains _____ of the
calcium salts.
Cassia angustifolia; 55% to 65%
152
Sennosides chronic use:
Melanosis coli (Brown
pigmentation of the colon)
153
CASTOR OIL
✓ obtained from the seed
of
✓ Brand:
usE:
Ricinus communis Linné
Emulsoil; Neoloid; Purge
Small bowel irritant laxative
154
Castor oil is hydrolyzed to?
Toxic component of castor bean?
ricinoleic acid
Ricin
155
STOOL SOFTENER
Also known as
Emollient Laxatives
156
Emollient Laxatives included in this category are
surface-acting or wetting agents
157
____surface tension permit the intestinal
fluids to penetrate the fecal mass more
readily produce soft, easily passed stools.
Lowering
158
EXAMPLES OF STOOL SOFTENER (Emollient
Laxatives)
Docusate (Colace, Surfak), Glycerin, Mineral Oil
159
✓ Used to produce short-term laxation
and to reduce straining at defecation.
✓ They are used to prevent constipation.
DOCUSATE (Colace, Surfak), GLYCERIN
160
prevent and treat fecal impaction
in children and debilitated adults.
✓ Decreases the absorption of fat-soluble
vitamins (long-term use) and causes
lipid pneumonitis can develop if
aspirated.
MINERAL OIL
161
SEROTONIN AGONIST
o Stimulation of 5HT4 also activates cAMP
dependent chloride secretion from the colon, leading to increased stool liquidity
o Promotes gastric emptying and
enhances small and large bowel
transit.
TEGASEROD
