WEEK 10: Gastrointestinal Health

Question 1

What does “motility” refer to?

Answer 1

Motility refers to contraction and relaxation of walls and sphincters of gastrointestinal tract to move (propel) content.

Question 2

Gastric motility is regulated by what types of contractions?

Answer 2

gastric motility is regulated by a combination of tonic and phasic (also called rhythmic) contractions.

Question 3

What is the purpose of gastrointestinal motility?

Answer 3

Gastrointestinal motility serves to fragment and mix food boluses for digestion and absorption along with propelling contents along the tract.

Question 4

In what way are phasic contractions physiologically different from tonic contractions?

Answer 4

phasic contractions are characterised by periods of relaxation and contraction, rather than being sustained.

Question 5

T or F
Tonic contractions are sustained contractions that are maintained for several minutes to hours.

Answer 5

T

Question 6

Where anatomically are tonic contractions typically observed?

Answer 6

These are usually observed at the sphincters separating the different parts of the gastrointestinal tract.

Question 7

All tonic contractions happen subconsciously except for…

Answer 7

the sphincters that control defecation

Question 8

Defecation centres in the …. allow for conscious input when defecating.

Answer 8

lumbro-sacral spinal cord

Question 9

Phasic contractions occur through … signaling generated by interstitial cells of Cajal in the enteric nervous system.

Answer 9

autonomic

Question 10

Phasic contractions occur through autonomic signaling generated by …. in the enteric nervous system.

Answer 10

interstitial cells of Cajal

Question 11

Phasic contractions occur through autonomic signaling generated by interstitial cells of Cajal in the …. system.

Answer 11

enteric nervous

Question 12

Constipation is clinically defined as…

Answer 12

small/infrequent/difficult bowel movements

Question 13

T or F
Constipation can have a variety of causes.

Answer 13

T

Question 14

Occasional bouts of constipation can be caused by…

Answer 14

dehydration, a lack of fibre or a particular drug regimen.

Question 15

Chronic constipation is defined as having fewer than … bowel movements per week.

Answer 15

3

Question 16

T or F
Neurological problems can cause chronic constipation.

Answer 16

T
Specifically, neurological problems that affect the nerves that control the colon and rectum.

Question 17

What type of patients could you expect to have chronic constipation caused by neurological problems?

Answer 17

Patients with a spinal cord injury, a previous stroke, diabetes, multiple sclerosis, Parkinson’s disease, and dementia are at higher risk of chronic constipation.

Question 18

What is anismus?

Answer 18

A type of pelvic floor dysfunction where patients are unable to relax their pelvic muscles.

Question 19

What is dyssynergic defecation?

Answer 19

A disorder caused by physical problems with the muscles involved in defecation such as defects in the coordination of relaxation and contraction.

Question 20

What type of patients could you expect to have chronic constipation caused by physical problems?

Answer 20

Patients with blockages in the colon or rectum such as bowel obstructions, rectal cancer or another abdominal cancer that puts pressure on the colon.

Question 21

T or F
Conditions leading to dehydration such as chronic hyperglycaemia as a result of diabetes and thyroid imbalances, can cause chronic constipation.

Answer 21

T

Question 22

What are the four different types of interventions that are frequently used to try and provide symptomatic relief of chronic constipation? (that don’t involve drugs passing into circulation)

Answer 22

Stool softeners,
osmotics,
stimulants, and
bulk-forming agents.

Question 23

Chronic diarrhoea is defined as having at least …/… of stools being loose or watery for a period of … months or more.

Answer 23

one quarter
3

Question 24

Acute diarrhoea is typically associated with ….

Answer 24

viral or bacterial infections or the effects of a course of antibiotics.

Question 25

How can diarrhoea kill someone?

Answer 25

Through dehydration

Question 26

What are the indications of serious dehydration in adults?

Answer 26

No urination or low urination with dark-colour, dry skin & mouth, excessive thirst, fatigue, weakness, confusion and/or disorientation

Question 27

What are the indications of serious dehydration in young children and infants?

Answer 27

No or low urination (in infants not having a wet nappy for 3 or more hours), dry skin, mouth and tongue. Fever above 39*, no tears when crying, drowsiness, lack of response, or grumpiness, Sunken eyes, cheeks, or abdomen

Question 28

T or F Chronic diarrhoea is almost always a symptom of another underlying condition.

Answer 28

T

Question 29

What conditions could chronic diarrhoea be a sign of?

Answer 29

IBS or IBD condition, such as Crohn’s or Ulcerative Colitis.

Question 30

In children and infants, ... species are the most common cause of acute diarrhoea.

Answer 30

Rotavirus

Question 31

In the general Australian population, ... is the most common cause of acute diarrhoea with an estimated 1.8 million infections per year.

Answer 31

norovirus

Question 32

What viruses may produce acute diarrhoea?

Answer 32

Rotavirus, norovirus, enteric adenovirus, astrovirus, viral hepatitis and cytomegalovirus

Question 33

What two bacteria are most commonly the cause of travellers diarrhoea?

Answer 33

E. coli and C. coli

Question 34

What is dysbiosis?

Answer 34

An imbalance between the types of organism present in a person's natural microflora, especially that of the gut.

Question 35

Antibiotics can lead to ... resulting in diarrhoea.

Answer 35

dysbiosis

Question 36

Why can artificial sweeteners cause diarrhoea?

Answer 36

because they are neither absorbed nor digested and are osmotically active, drawing water into the gastrointestinal tract, particularly the colon resulting in loose stools.

Question 37

Why can lactose cause diarrhoea in those without lactase in their gut microbiota?

Answer 37

Undigested lactose is osmotically active, causing osmotic diarrhoea and can also be used by certain types of gut flora which have a propensity to promote diarrhoea

Question 38

Surgery involving partial resection of the intestine can sometimes cause diarrhoea due to changes in ...

Answer 38

nutrient absorption

Question 39

Why can gallbladder removal cause diarrhoea?

Answer 39

gallbladder removal, which results in a large decrease in bile acid delivery to the gastrointestinal tract reduces fat absorption, which can result in diarrhoea.

Question 40

T or F Irritable bowel syndrome and irritable bowel disease are interchangeable terms.

Answer 40

F IBS is functional gastrointestinal disorder and is thus defined by a series of symptoms (rather than a specific cause) IBD is a category of gastrointestinal disorders such as Crohn's disease and ulcerative colitis

Question 41

IBS is defined as recurrent ... pain on average at least ...day/week in the last ... months, associated with ... or more of the following Rome IV criteria: ... ... ...

Answer 41

abdominal, 1, 3, 2 Related to defecation Associated with a change in frequency of stool Associated with a change in form (appearance) of stool

Question 42

IBS classified into at least ... different types.

Answer 42

4

Question 43

How many types of stool are recognised in the bristol stool scale?

Answer 43

7

Question 44

What stool types in the bristol stool scale are considered abnormal?

Answer 44

1, 2, 6 and 7

Question 45

What is IBS subtype C?

Answer 45

IBS with predominant constipation

Question 46

In order to be classified as having IBS subtype C patients must have greater than ...% of bowel movements with Bristol stool types ... or ... and less than ...% of bowel movements with Bristol stool types ... or ...

Answer 46

25%, 1 or 2, 25%, 6 or 7

Question 47

What is IBS subtype D?

Answer 47

IBS with predominant diarrhea.

Question 48

What is IBS subtype M?

Answer 48

IBS with mixed bowel habits

Question 49

What is IBS subtype U?

Answer 49

Unclassified

Question 50

In order to be classified as having IBS subtype D patients must have ... than 25% of bowel movements with Bristol stool types ... or ... and ... than 25% of bowel movements with Bristol stool types ... or ...

Answer 50

greater, 6 or 7, less, 1 or 2

Question 51

In order to be classified as having IBS subtype M patients must have ... than 25% of bowel movements with Bristol stool types 1 or 2 and ... than 25%% of bowel movements with Bristol stool types 6 or 7.

Answer 51

greater, greater

Question 52

T or F Since the cause(s) of IBS are unknown, all treatment is focussed on symptomatic relief.

Answer 52

T

Question 53

The first line of treatment for IBS is...

Answer 53

lifestyle modification.

Question 54

T or F Triggers for IBS are generally thought to be causative.

Answer 54

F!

Question 55

T or F There is some evidence that people with IBS-D who are not coeliac may benefit from reducing gluten.

Answer 55

T

Question 56

T or F All current treatments for Crohn's Disease are targeted at altering immune system function.

Answer 56

T

Question 57

T or F IBS has a strong autoimmune component

Answer 57

F The causes of IBS are unknown. IBD has a strong autoimmune component.

Question 58

What does NAFLD stand for?

Answer 58

Non-alcoholic Fatty Liver Disease

Question 59

What does NASH stand for?

Answer 59

Non-alcoholic Steatohepatitis

Question 60

Non-alcoholic fatty liver disease (NAFLD) can progress to what?

Answer 60

Non-alcoholic steatohepatitis (NASH)

Question 61

.... is the most common alcoholic liver disease or alcoholic hepatitis.

Answer 61

Drug induced liver disease

Question 62

T or F The outcomes for Drug induced liver disease are the same as for NASH.

Answer 62

T

Question 63

The consumption of which drug is most commonly associated with drug induced liver disease?

Answer 63

paracetamol

Question 64

.... is the most frequent cause of acute liver failure in Western countries.

Answer 64

Drug-induced liver disease

Question 65

The most common symptom of drug induced liver injury is...

Answer 65

jaundice

Question 66

T or F Most cases of drug-induced liver injury are accompanied by debilitating symptoms.

Answer 66

F Most cases of DILI are asymptomatic.

Question 67

T or F Dili is more common in men than women.

Answer 67

F DILI is more common in women

Question 68

T or F A liver biopsy is required for the diagnosis of DILI

Answer 68

F

Question 69

Do clinical presentations of hepatocellular (cytotoxic) injury have a predictable or idiosyncratic mechanism of hepatotoxicity?

Answer 69

Predictable

Question 70

Do clinical presentations of cholestatic injury have a predictable or idiosyncratic mechanism of hepatotoxicity?

Answer 70

idiosyncratic

Question 71

If a patient has Hepatocellular (cytotoxic) injury, their histologic findings will show...

Answer 71

hepatitis

Question 72

If a patient has Cholestatic injury, their histologic findings will show...

Answer 72

Cholestasis

Question 73

If a patient has mixed DILI, their histologic findings will show...

Answer 73

Steatosis

Question 74

What is Steatosis?

Answer 74

Fatty liver.

Question 75

What is Cholestasis?

Answer 75

the slowing or stalling of bile flow from your liver.

Question 76

What is Hepatitis?

Answer 76

Inflammation of the liver tissue.