GI part 2

what are two forms of congenital malformation in the upper GI?

esophageal atresia TEF

what is the most common congenital malformation in the upper GI?

TEF (tracheoesophageal fistula)

what is esophageal atresia?

esophagus fails to elongate and connect to the stomach

what is TEF?

connection between trachea and esophagus

what happens in esophageal atresia?

food will not advance into the GI, we will see vomiting, aspiration

what are the two congenital GI anomalies?

esophageal atresia TEF

is the esophagus and trachea normally separate?

yes

what often occurs together?

esophageal atresia TEF

when are the two diseases diagnosed?

immediately after the birth of a baby, inborn error

what are the S&S of the two diseases?

aspiration coughing choking inadequate respiration pale sweaty arching (babies)

how long is the small intestine?

20 feet long (6m) 1 inch in diameter

what are the 3 parts of the small intestine?

duodenum jejunum ileum

what is the longest part of the small intestine?

ileum

where do most drugs get absorbed in?

jejunum of the small intestine

what parts are part of the upper GI?

duodenum

which part of the small intestine is part of the lower GI?

ileum

jejunum

what are the associated organs of the small intestine? (juice)

pancreatic juice (alkaline) has an entry duct into the duodenum

what is the major function of the small intestine?

absorption of nutrients

where are paneth cells located in the small intestine?

in crypts of lieberkuhn they try to keep the small intestine healthy

what do vilis produce?

vilis are lined with specialized cells that can produce alkaline fluid

wehre do we See goblet cells producing mucous?

small intestine

how long is the large intestine?

5 feet long (1.5m) 3 inch in diameter (7cm)

what are the 4 parts of the large intestine?

ascending colon transverse colon descending colon sigmoid colon

what are the major functions of the large intestine?

• reabsorption of water by simple columnar cells

• host flora: vitamin B and K synthesis

how does vitamin K become activated?

it becomes activated once it reaches the large intestine

intestinal motility is affected by which 2 nervous systems?

ANS: PSNS, SNS enteric nervous system

what does the enteric nervous system respond to?

• receives input from mechanoreceptors (GI stretch)

• chemoreceptors: (food presence/osmolality/Ph

do the ANS and enteric nervous system work in unison?

yes

which nervous system does peristaltic movement related to?

PSNS: rest and digest, high secretion of pancreatic enzymes, HcL SNS: opposite

what is one example of an innervation issue?

Hirschsprung disease

when is Hirschsprung disease caused?

when parasympathetic ganglion cells in the wall of the large intestine (Colon) do not develop before birth

what happens when the parasympathetic ganglion cells do not develop?

without these nerves, the affected segment of the colon lacks the ability to relax and move bowel contents along

which part of the large intestine does Hirschsprung disease affect?

affects the distal portion of the sigmoid colon

when is Hirschsprung disease diagnosed?

very early on in infancy because we will not see initial passing of stool in expected volume

how much do newborns feed in the first 3 days of life?

every hour

what is the pull-through procedure?

• surgically cut the intestine, reanastamose the healthy portion with the distal healthy portion to make the intestines healthy

• cutting out the diseased section

where is the healthy section of the intestine connected to?

connected to the anus so the child can have normal bowel movements

what are the two inflammatory disorders of the GI?

crohns disease ulcerative colitis

where does crohns disease occur?

may affect any part of the GI

what disease is transmural?

crohns disease, affects the full thickness of the bowel wall

what happens during crohns disease ?

• discontinuous patchy inflammation

• ulceration in the mouth, stomach,

• skipped lesions occurring anywhere in the GI

how do we diagnose crohns?

endoscopy and colonoscopy

what will we see in biopsy?

we will see the flattening out of the cells

where does ulcerative colitis happen?

happens only in the large intestine

what is ulcerative colitis?

continous inflammation

what layers are affected during ulcerative colitis?

mucosal and submucosal layers are affected

what are the common S&S of inflammatory disorders?

anorexia, diarrhea, nausea

what is FTT?

failure to thrive in kids

what is another word for the celiac disease?

gluten sensitive enteropathy

what happens during celiac disease?

gluten triggered immune disorder--> overt T-cell mediated immune response to alpha-gliadin (gluten component)--> inflammation --> severe inflammation causes loss of vili

where does celiac disease occur?

in the small intestine

which disease is more common than crohns and ulcerative colitis ?

celiac disease

what are the S&S of celiac disease?

anorexia, bloating, diarrhea, malnutrition

how does bloating happen?

build up of gas caused by ingestion of CO2

what is flatus?

people passing gas

what are the complications of celiac disease?

malnutrition (eg. weight loss, anemia)

what is the diagnosis for celiac disease?

serology; biopsy (endoscopic)

what is serology?

looking at blood to see if antibodies are present

what is the treatment of celiac disease?

avoidance of gluten

what kind of bacteria is C-dif?

gram + bacterium that secretes toxins which damage the lining of the GI tract

what are the S&S of C-diff?

diarrhea, pain

what are the treatment options for C-diff?

metronidazole, vancomycin (PO)

what is a treatment option after the antibiotics for C-diff?

probiotics (Bio K+)

what kind of bacteria is E.coli?

gram negative bacteria

do all e.coli cause infection?

many strains of e-coli are some endogenous to GI tract in small number and some produce toxins

what are the causes of Ecoli?

ingestion of E.coli in undercooked meats, contaminated vegetables, contaminated water, unwashed hands

what are the S&S of ecoli?

diarrhea, pain, fever

what are the complications of ecoli?

bacterial toxin-caused "hemolytic ureic syndrome" (life threatening)

what is hemolytic ureic syndrome (HUS)?

a type of E.coli bacteria process toxins that can destroy the red blood cells and block the kidneys filtering system

what is the toxin for E.coli?

• e-coli strain

• shiga-toxin destroys endothelial cells, platelets, RBC

what is the shiga-toxin?

destroys cells of all sort of blood vessels in the kidneys and can cause acute renal failure

what do we see in acute renal failure?

pain, peeing blood, very little urine proceed

what is the treatment Ecoli that do not produce toxins?

• we give supportive treatment

• dialysis: cleansing blood, making urine for them

• oxygenation and ventilation, IV, perfuse kidneys

which antibiotic do we give for ecoli?

fluoroquinolones bioavailability is high with oral

is diarrhea a sign or symptom?

diarrhea is a symptom

what is diarrhea?

increased frequency and fluidity of loose or unformed stool

what is diarrhea caused by?

caused by inflammation or infectious organisms

what kinds of things causes diarrhea?

food intolerances, intestinal disease, pathogen, drugs

what is a common side effect with antibiotics?

diarrhea

what is acute diarrhea?

less than 2 weeks, sudden onset

what is chronic diarrhea?

more than 4 weeks, related to longterm disease or drug treatment

what are the complications of diarrhea?

electrolyte balance (K, Na, Ca) dehydration malabsorption

when is rehydration a must?

during diarrhea

how do we rehydrate in a hospital?

• isotonic IV solution (eg. Normal saline, NS)

• check serum electrolytes

what is saline?

water and sodium, widely available and cheap

what can we analyze to see what electrolytes we are losing?

urine

what are most diarrhea and vomiting?

normonatremia

what are two things diarrhea will do?

hypernatremic: sodium is being retained hyponatremic: losing sodium

what are some at home rehydration methods?

rehydration solution: gastrolyte, pedialyte

what are some in no-mans-and methods of rehydration?

1L water, 80 mL glucose, 7mL NaCl

what are antidiarrheals?

opioid- based

do antidiarrheals have high efficacy?

yes

what do antidiarrheals do?

mu2 receptor agonism--> decreased peristalsis

what is Mu2 known for doing?

constipation

what are the side effects of antidiarrheals?

CNS depression in high doses addition (will secrete dopamine)

where is mu2 found?

in Gi's ENS

what do the antidiarrheal medications consist of?

opioid (mu2 agonist)+ atropine

what is atropine?

antimuscarinic agent

what does atropine do?

blocks parasympathetic system, stimulates SNS

what are the antidiarrheal drugs?

Lamotil: diphenoxylate + atropine Imodium: meperidine + atropine