General Medicine - Carbohydrate metabolism

16 important questions on General Medicine - Carbohydrate metabolism

What is the function of the GI tract?

Digestion of food and absorption of the resulting nutrients, peptides, carbs , fats and nucleic acids.

What can you tell about the small intestine?

Area where the most digestion and absorption of nutrients takes place. Extends from the pyloric sphincter (a ring of muscle that controls the movement of food between stomach and small intestine), to ileocecal valve (the passageway between small and large intestine that prevents backflow).

Divided into three sections:
  1. duodenum: chemical digestion of foods
  2. jejunum: nutrient absorption
  3. ileum: nutrient absorption

What can you tell about the large intestine?

Absorbs any remaining water and nutrients from the undigested food mass and eliminates the waste as feces.
Divided into...
  1. cecum: appendix hangs on this
  2. colon: longest section
  3. rectum: storage site for feces
  4. anal canal
  5. anus 
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What is coeliac disease (sprue)?

Autoimmune disorder of the small intestine.
  • genetically predisposed/hereditary
    • first-degree relatives have 1 in 10 risk
  • ingestion of gluten leads to damage in small intestine
  • affect 1 in 100 people
  • more women than men
  • symptoms: long diarrhea, bloating, steatorrhea, decreased appetite, failure to thrive and grow
  • cure: eat gluten-free diet

How do you diagnose coeliac disease?

Gluten causes the immune system to produce antibodies called anti-tissue transglutaminase, gliadin peptide, and endomysial antibodies.
2 tests:
  • Anti-tissue transglutaminase (tTG)-IgA test. 95% of patients will have this antibody.
  • Intestinal biopsies to confirm presence of flattened villi.

What is Inflammatory Bowel Disease?

A term for two immune-mediated conditions:
1. Crohn's disease and 2. Ulcerative Colitis
characterized by chronic inflammation of the GI tract. Prolonged inflammation results in damage to the GI tract. Most likely in < 30 yrs in Europeans.

Why does IBD occur? So what are the risk factors?

Exact cause is unknown. It is a result of a defective immune system.
  1. The immune system responds incorrectly to environmental triggers, which causes inflammation of GI tract.
  2. Genetics play a role: someone with a family history of IBD is more likely to develop IBD, due to genetic mutations
  3. use of Non-Steroidal Anti-Inflammatory medications (NSAIDs) may increase risk or worsen disease

Risk factors for Crohn's disease?

  • Smoking
  • bacteria such as E. Coli, pseudomona, mycobacteria have been linked to increasing risk

How to diagnose IBD?
And how to treat it?

Diagnose with combi of...
  • endoscopy (for Crohn)
  • colonoscopy (for ulcerative colitis)
  • imaging studies (e.g., radiography, MRI, CT)
  • stool samples to exclude infection
  • blood tests

Treat with...
  • medications such as
    • amino salicylates, corticosteroids, immune modulators, biologics
  • vaccinations to prevent infections
  • in severe cases: surgery to remove damaged parts of GI tract

What is irritable bowel syndrome (IBS) ?

Long-ter or recurrent disorder of GI functioning. Involves the large intestine (colon) and small intestine with disturbances of intestinal/bowel (gut) motor function(motility) and sensation. All regulated by the brain.
10-10% of the population has IBS. It affects people of all ages, but mostly < 50yrs. 2 in 3 are female.

What are symptoms of IBS?

  • Abdominal pain or discomfort
  • altered bowel habit
  • pain is relieved by defecation
  • pain is associated with increase/decrease in bowel movement frequency
  • pain is associated with the bowel movements becoming harder/softer in consistency

How to treat IBS?

  • low FODMAP diet: to control symptoms associated with IBS
    • group of short-chain carbs are problematic because poorly absorbed in small intestine and fast fermented by bacteria in the gut -> gas production
it does not cure, but allows successful drug-free management of symptoms through diet

What is diarrhoeal disease?
3 types...

Diarrhea is the passage of three or more loose or liquid stools per day. It is often a symptom of an infection in the GI tract, which can be caused by bacterial, viral and parasitic organisms.
Infection can spread through contaminated food or water, or from person-to-person (poor hygiene). It can lat several days.
3 types...
  1. acute watery diarrhea - lasts several hours/days, and includes cholera
  2. acute bloody diarrhea - dysentery
  3. persistent diarrhea - lasts 14 days or longer

Symptoms of diarrhoeal disease...

  • Dehydration: most severe
    • water and electrolytes (sodium, chloride, potassium, bicarbonate) are lost through stool, vomit, sweat, urine, breathing.
the degree of dehydration is rate on a scale of 3:
  1. no dehydration: not enough signs to classify as some or severe dehydration
  2. some dehydration: two or more of the following: restlessness, irritability, sunken eyes, drinks eagerly, thirsty
  3. severe dehydration: at least two of the following: lethargy/unconsciousness, sunken eyes, unableto drink/drink poorly, skin pinch goes back very slowly

Who is at risk of getting diarrhea disease?

It's the second leading cause of death in children under five yrs. Responsible for filling 525000 children every year. Children who are malnourished or have impaired immunity and people with HIV are most at risk.

How to prevent, diagnose and treat diarrhea?

- safe drinking-water, use of improved sanitation and handwashing with soap
- oral rehydration solution (ORS), clean water, sugar and salt. 10-14 day supplemental treatment of 20 mg zinc

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