GI part 2

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

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1

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

esophageal atresia TEF

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2

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

TEF (tracheoesophageal fistula)

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3

what is esophageal atresia?

esophagus fails to elongate and connect to the stomach

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4

what is TEF?

connection between trachea and esophagus

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5

what happens in esophageal atresia?

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

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6

what are the two congenital GI anomalies?

esophageal atresia TEF

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7

is the esophagus and trachea normally separate?

yes

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8

what often occurs together?

esophageal atresia TEF

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9

when are the two diseases diagnosed?

immediately after the birth of a baby, inborn error

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10

what are the S&S of the two diseases?

aspiration coughing choking inadequate respiration pale sweaty arching (babies)

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11

how long is the small intestine?

20 feet long (6m) 1 inch in diameter

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12

what are the 3 parts of the small intestine?

duodenum jejunum ileum

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13

what is the longest part of the small intestine?

ileum

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14

where do most drugs get absorbed in?

jejunum of the small intestine

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15

what parts are part of the upper GI?

duodenum

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16

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

ileum

jejunum

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17

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

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

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18

what is the major function of the small intestine?

absorption of nutrients

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19

where are paneth cells located in the small intestine?

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

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20

what do vilis produce?

vilis are lined with specialized cells that can produce alkaline fluid

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21

wehre do we See goblet cells producing mucous?

small intestine

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22

how long is the large intestine?

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

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23

what are the 4 parts of the large intestine?

ascending colon transverse colon descending colon sigmoid colon

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24

what are the major functions of the large intestine?

  • reabsorption of water by simple columnar cells

  • host flora: vitamin B and K synthesis

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25

how does vitamin K become activated?

it becomes activated once it reaches the large intestine

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26

intestinal motility is affected by which 2 nervous systems?

ANS: PSNS, SNS enteric nervous system

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27

what does the enteric nervous system respond to?

  • receives input from mechanoreceptors (GI stretch)

  • chemoreceptors: (food presence/osmolality/Ph

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28

do the ANS and enteric nervous system work in unison?

yes

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29

which nervous system does peristaltic movement related to?

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

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30

what is one example of an innervation issue?

Hirschsprung disease

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31

when is Hirschsprung disease caused?

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

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32

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

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33

which part of the large intestine does Hirschsprung disease affect?

affects the distal portion of the sigmoid colon

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34

when is Hirschsprung disease diagnosed?

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

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35

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

every hour

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36

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

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37

where is the healthy section of the intestine connected to?

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

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38

what are the two inflammatory disorders of the GI?

crohns disease ulcerative colitis

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39

where does crohns disease occur?

may affect any part of the GI

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40

what disease is transmural?

crohns disease, affects the full thickness of the bowel wall

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41

what happens during crohns disease ?

  • discontinuous patchy inflammation

  • ulceration in the mouth, stomach,

  • skipped lesions occurring anywhere in the GI

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42

how do we diagnose crohns?

endoscopy and colonoscopy

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43

what will we see in biopsy?

we will see the flattening out of the cells

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44

where does ulcerative colitis happen?

happens only in the large intestine

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45

what is ulcerative colitis?

continous inflammation

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46

what layers are affected during ulcerative colitis?

mucosal and submucosal layers are affected

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47

what are the common S&S of inflammatory disorders?

anorexia, diarrhea, nausea

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48

what is FTT?

failure to thrive in kids

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49

what is another word for the celiac disease?

gluten sensitive enteropathy

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50

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

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51

where does celiac disease occur?

in the small intestine

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52

which disease is more common than crohns and ulcerative colitis ?

celiac disease

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53

what are the S&S of celiac disease?

anorexia, bloating, diarrhea, malnutrition

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54

how does bloating happen?

build up of gas caused by ingestion of CO2

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55

what is flatus?

people passing gas

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56

what are the complications of celiac disease?

malnutrition (eg. weight loss, anemia)

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57

what is the diagnosis for celiac disease?

serology; biopsy (endoscopic)

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58

what is serology?

looking at blood to see if antibodies are present

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59

what is the treatment of celiac disease?

avoidance of gluten

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60

what kind of bacteria is C-dif?

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

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61

what are the S&S of C-diff?

diarrhea, pain

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62

what are the treatment options for C-diff?

metronidazole, vancomycin (PO)

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63

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

probiotics (Bio K+)

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64

what kind of bacteria is E.coli?

gram negative bacteria

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65

do all e.coli cause infection?

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

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66

what are the causes of Ecoli?

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

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67

what are the S&S of ecoli?

diarrhea, pain, fever

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68

what are the complications of ecoli?

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

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69

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

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70

what is the toxin for E.coli?

  • e-coli strain

  • shiga-toxin destroys endothelial cells, platelets, RBC

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71

what is the shiga-toxin?

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

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72

what do we see in acute renal failure?

pain, peeing blood, very little urine proceed

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73

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

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74

which antibiotic do we give for ecoli?

fluoroquinolones bioavailability is high with oral

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75

is diarrhea a sign or symptom?

diarrhea is a symptom

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76

what is diarrhea?

increased frequency and fluidity of loose or unformed stool

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77

what is diarrhea caused by?

caused by inflammation or infectious organisms

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78

what kinds of things causes diarrhea?

food intolerances, intestinal disease, pathogen, drugs

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79

what is a common side effect with antibiotics?

diarrhea

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80

what is acute diarrhea?

less than 2 weeks, sudden onset

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81

what is chronic diarrhea?

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

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82

what are the complications of diarrhea?

electrolyte balance (K, Na, Ca) dehydration malabsorption

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83

when is rehydration a must?

during diarrhea

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84

how do we rehydrate in a hospital?

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

  • check serum electrolytes

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85

what is saline?

water and sodium, widely available and cheap

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86

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

urine

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87

what are most diarrhea and vomiting?

normonatremia

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88

what are two things diarrhea will do?

hypernatremic: sodium is being retained hyponatremic: losing sodium

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89

what are some at home rehydration methods?

rehydration solution: gastrolyte, pedialyte

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90

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

1L water, 80 mL glucose, 7mL NaCl

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91

what are antidiarrheals?

opioid- based

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92

do antidiarrheals have high efficacy?

yes

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93

what do antidiarrheals do?

mu2 receptor agonism--> decreased peristalsis

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94

what is Mu2 known for doing?

constipation

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95

what are the side effects of antidiarrheals?

CNS depression in high doses addition (will secrete dopamine)

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96

where is mu2 found?

in Gi's ENS

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97

what do the antidiarrheal medications consist of?

opioid (mu2 agonist)+ atropine

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98

what is atropine?

antimuscarinic agent

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99

what does atropine do?

blocks parasympathetic system, stimulates SNS

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100

what are the antidiarrheal drugs?

Lamotil: diphenoxylate + atropine Imodium: meperidine + atropine

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