large intestine+liver - GI disorders

main functions of large intestine (colon)

• store faecal material

• regulates its release to external environment

• involved in water and electrolyte reabsorption

what are the roles of bacteria found in the large intestine

• digesting bile acids

• provides environment for bacteria that are important in synthesising certain vitamins

• good bacteria provides barrier to invasive microbes

what vitamins do the bacteria in large intestine synthesise

vitamin B

vitamin K 

calcium

iron

what effect does bad bacteria in the large intestine have

• obesity - high concentrations of bad bacteria in obese patients

• inflammation - plays major role in development of IBD and colitis

what is the main functions of the liver

• processing nutrients from food

• providing bile acids and alkaline fluid for absorption of fats and neutralisation of gastric acids

• conjugation, degradation and excretion of waste products of metabolism

• detoxification of poisonous substances

true or false: liver can regenerate new cells

true

but this function can be limited due to prolonged bad lifestyle choices

structure of liver: what are canaliculi

minute tubules which are grooves in surfaces between 2 liver cells

what does the bile contain

• electrolytes

• HCO₃^- ions

function of bile

• to neutralise gastric acid

• helps in digestion of dietary fats

what pigment is the breakdown product of haemoglobin

bilirubin

what can impaired liver function lead to digestive problems. what does this include

• immune disorders

• abnormal absorption of fats

• impaired blood sugar levels - hypogycaemia

• gall stones

• haemorrhoids

• constipation, bloating

• acid reflux

impaired liver function can also lead to nervous system disorder. what can the change in mood result in

• depression

• anxiety

• anger

• poor concentration

• cognitive ability

• migraine

what are the different types of liver diseases

• hepatitis - A,B,C

• liver fibrosis/cirrhosis

• primary liver cancer

• hereditary disease

• alcoholic liver disease

what are the 2 most common inherited liver disease

• haemochromatosis

• alpha 1 antitrypsin deficiency

what is haemochromatosis

excess iron absorbed from the diet and deposited in the liver

what is alpha 1 antitrypsin deficiency

alpha 1 antitrypsin is a liver protein important for normal lung function - a lack of this would cause compromised lung function

what is hepatitis

• chronic condition that lasts less than 6 months

• inflammation of the liver

what causes hepatitis

• group of viruses known as hepatitis viruses

• toxic substances e.g. alcohol, meds, organic solvent

true or false: hepatits is never a self limiting condition

false - can be a self limiting condition

if not self limiting, what can hepatitis progress to become

1) fibrosis

2) cirrhosis

symptoms of hepatitis

• asymptomatic

• leads to jaundice, anorexia, malaise

• diarrhoea

• vomiting

symptom of hepatitis - jaundice

• yellowish pigmentation of skin, conjunctival membranes over sclerae (whites of eyes) and other mucous membrane

what is hepatitis - jaundice caused by

hyperbilrubinemia

what can hyperbilirubinemia cause

increased level of bilirubin in extracellular fluid

• conc higher than 2.5mg/dl leads to jaundice

how is hepatitis A transmitted

by mouth

e.g. direct contact, poor personal hygiene, unsafe sexual practices, street drug use

how is hepatitis B transmitted

through sex and blood

e.g. hemodialysis, exposure to blood, needle stick injury, sexual activity with multiple partners, IV drug use

how is hepatitis C transmitted

spread by blood

e.g. hemophilia, hemodialysis, organ transplant, tattooing

true or false: there are no vaccines to protect against hepatitis A and B

false - there are vaccines to protect against hep A and B

there are no vaccines available for hep C,D,E

which types of hepatitis can cause long lasting problems like liver cirrhosis and cancer

hep B,C,D

what is liver fibrosis

• scarring process that represents liver’s response to injury

• common outcome in chronic liver disease

liver damage causes liver stellate cells to be over active, what can this trigger

triggers extracellular matrix synthesis to increase

true or false: fibrosis can be reversed of the trigger factor and inflammation is controlled

true

what can liver fibrosis lead to

cirrhosis

what is liver cirrhosis

replacement of liver tissue by fibrosis, scar tissue and regenerative nodules, leading to loss of liver function

true or false: cirrhosis can develop independently without fibrosis

false - cirrhosis is always developed from fibrosis

lifestyle advice for treatment of liver cirrhosis

• prevent further damage to liver

• consume balanced diet

• multivits

• avoid drugs

• avoid alcohol

what are the complications of cirrhosis

• oedema

• ascites

how to treat oedema and ascites

reduce salt in diet by using diuretics as they promote the elimination of salt and water into urine

which hepatitis indicate liver cancer

hep B and C

what to do to detect liver cancer earlier on

screen yearly or biyearly with ultrasound examination

what is the only curative treatment for end stage cirrhosis

liver transplant

what is fatty liver disease caused by

large vacuoles of triglyceride fat accumulation in liver cells or abnormal retention of lipids

true or false: fatty liver disease is considered as ‘benign’

true

true or false: non-alcoholic fatty liver disease is associated with diabetes

false - assocaited with obesity which can be inlammatory leading to cirrhosis

symptoms of fatty liver disease

• dull or nagging pain in abdominal area

• weakness, nausea

• bloating

• high cholesterol 

• high bp

• weight gain

• yellowness in skin

risk factors of fatty liver disease

• diabetes mellitus

• protein malnutrition

• hypertension cell toxicity

what are the causes of fatty liver disease

• taking certain meds

• gastric bypass surgery

• high cholesterol 

• high triglycerides in blood

how can fatty liver disease be treated

only treated naturally though diet and exercise

what is alcoholic liver disease

overconsumption of alcohol which damages liver

diagnostics of liver disease

what are the main treatments for constipation

1. Bulk forming laxatives

2. Osmotic laxatives

3. Stimulant laxatives

4. Stool softeners

what are the main treatments for diarrhoea

• Loperamide

• Morphine

• Adsorbents

• Bismuth

• Bulk forming agents

what is vomiting (emesis)

ejection of gastric contents through mouth

what is the advantage of vomiting

protects stomach as it removes toxic substances from the body

how is vomiting controlled

controlled by the vomiting centre and chemoreceptor trigger zoon in the brain

chemoreceptor trigger zone is permeable, what does this mean for drugs used to treat vomiting

can be affected by drugs circulating systemically that do not cross blood brain barrier

what drugs affect vomiting

what are the main neurotransmitters involved in the vomiting reflex

Ach, 5-HT,, histamine, dopamine and substance P and its is the receptors they act on that provide targets for most commonly used anti-emetic drugs (anti-vomiting drugs)