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Compare normal movement of ions and nutrients across intestinal epithelium to that of secretory diarrhea.
Water is absorbed on osmotic gradient; water follows solute. Secretory diarrhea: solute (such as Cl-) secreted into lumen--> water follows--> diarrhea
What are the most common causative agents of traveler's diarrhea?
Enterotoxigenic Escherichia coli (ETEC), Campylobacter jejuni, Shigella spp., Salmonella spp., other E. coli strains
Describe the MOA of loperamide and bismuth compounds.
Loperamide: binds peripheral mu in enteric NS--> slow colonic transit (no BBB); Bismuth: salicylate inhibits intestinal prostaglandin and Cl- secretion
Explain the pathophysiological effects of Enterotoxigenic Escherichia coli (ETEC) AB toxins in the stomach and intestinal tract.
increases cAMP--> upregulate CFTR and NKCCI cotransporter crypt cells--> secrete Cl- into lumen--> H2O and Na follow--> watery diarrhea
Describe the relationship between gut flora and IBS, including how it relates to use of probiotics.
Dysbiosis (high ratio Firmicutes :Bacteroidetes, few Lactobacilli &Bifidobacteria-> activation gut immune system-->inflammation; attempt to restore symbiosis
Explain how motor and sensory abnormalities can provoke symptoms of IBS.
Visceral hypersensitivity (distention); Visceral mesenteric nerves respond to distention and serotonin&bradykinin; histamine activates pain fibers
Describe the major motor patterns that occur in the small intestines and colon during FED and FASTED conditions.
Fed: motility mix contents to absorb nutrients; isolated contraction->segmentation->peristalsis; Fasted: MMC, I-quiescence II-contractions III-rapid propulsions
List recommended lifestyle approaches for people with IBS.
incr. fluids, fiber, exercise; avoid FODMAPs, alcohol, coffee, spicy & fatty food; manage stress; regular meal pattern; squatting for defecation
Describe the role of the lower esophageal sphincter and list factors that affect its functioning.
control entry of bolus--> stomach & prevent gastric contents from entering esophagus; RF: truncal obesity, nicotine,
Relate positive behavioral modifications to their affect on the LES and GERD.
Weightloss (decreased pressure), avoid cigarettes (they relax LES), avoid alcohol (reduces LES tone), stay upright after meals/don't eat late
What are some alarm (red flag) symptoms for esophagogastroduodenoscopy?
Dyspepsia: weight loss, iron-deficiency anemia, GI bleeding, persistent vomiting, dysphagia, epigastric mass
What are potential long-term risks of prolonged gastric acid suppression?
increased risk of acid-labile bacterial infection; pepsinogen can't convert to pepsin--> poor digestion
Characterize H. pylori (structure, physiology, mode of transmission).
Gram-, urease+, flagellum, oxidase+, curved helico rod, ingestion--> gastric antrum
Describe the pathogenesis of H. pylori infection.
ingestion--> antrum(no invasion)--> urease VF-->inflammation--> mucosal damage--> acute gastritis
What is the MOA, indications, and an example of a proton-pump inhibitor?
irreversibly block H+/K+ ATPase enzyme--> prevents movement of H+ ions; Indication: ++gastric acid; Omeprazole
Describe how the effects of NSAIDs, alcohol, cigarette smoke, and stress lead to the development of gastritis.
Decrease mucosal lining in stomach--> cells exposed to acid--> cell damage--> inflammation
