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58 Cards in this Set
- Front
- Back
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From wehre does amylase come?
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salivary glands and pancreatic acini
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What does amylase do?
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starts digestion of complex carbs
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What stimulates pancreatic amylase?
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CCK from the duodenum
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Where do you find disaccharidases?
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intestinal brush border
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What causes lactose intolerance?
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deficiency of disaccharidases
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What monosaccharides are not absorbed?
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sorbitol, lactulose
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What enzymes start protein digestion?
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pepsin and acid
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Where does protein digestion start?
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stomach
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What causes pancreatic enzymes to release?
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CCK and vagus nerve
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What pancreatic enzymes digest protein?
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trypsinogen, chymotrypsinogen, procarboxypeptidase
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What duodenal enzyme does protein digestion?
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enterokinase
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What does enterokinase do?
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activates trypsin and carboxypeptidase
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Where do sugars and AAs go after absorption?
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portal circulation
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Where are fats emulsified?
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stomach
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How are fats lipolysed?
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TG to FA and B-monoglyceride, phospholipases
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How do micelles form?
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with bile acids
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How do chylomicrons form?
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intestinal cells uptake FAs, re-esterification, chylomicrons are formed
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Where is CCK released?
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duodenal cells
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What does CCK do?
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stimulates lipase and bile salt release
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What enzymes do lipolysis?
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lipase and phospholipase
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Where do fatty acids go from the enterocyte?
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TGs are re-esterified, packaged with lipoproteins into chylomicrons and VLDL, enter lymphatics through lacteal
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Where are fats absorbed?
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duodenum and jejeunum
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What is the ileal brake?
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if FFA reac the ileum, motility will be slowed to allow time for digestion/absorption
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What can cause fat malabsorption?
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lack of bile, lack of lipase activity mucosal disease, lymphatic issues
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What are bile acids?
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detergents/emulsifiers
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How do you get bile acids?
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made from cholesterol, recycled by absorption in terminal ileum
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What happens in chronic pancreatitis?
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lack of enzymes
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How do you diagnose chronic pancreatitis?
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fat droplets in stool, 24h stool collection with low fat diet
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How does Zollinger-Ellison cause maldigestion?
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excess acid impairs enzyme function
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How much lipase do you need to fully digest fats?
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40,000U lipase/meal
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Why does Celiac Disease cause malabsorption?
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flattened mucosa, high tissue transglutaminase
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What diseases cause malabsorption?
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lack of bile, pancreatic insufficiency, celic disease, post gastroenteritis, alcohol, small bowel overgrowth
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What are the fat soluble vitamins?
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A, D, E, K
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What do you need to absorb fat soluble vitamins?
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bile acids for micelle formation/absorption
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What do you need to absorb Vitamin A?
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pancreatic enzyme hydrolysis
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How much stool do you excrete?
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< .3L
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What ist he colonic transit time?
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12-96h
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What is the oral-celcal transit time?
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2-3h
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What does bloody diarrhea suggest?
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mucosal injury
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What does watery stool suggest?
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secretion or colonic absorption issue
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What does greasy stool suggest?
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malabsorption or maldigestion
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What causes acute bloody diarrhea?
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shigella, campylobacter, c. diff, amoeba infection
ischemic injury |
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What causes chronic bloody diarrhea?
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inflammatory bowel disease, vascular injury, radiation proctitis
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What are the symptoms of "colitic" diarrhea?
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small volume stools, blood, mucous, urgency, tenesmus
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What is tenesmus?
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rectal spasm, feeling of incomplete emptying
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How do you diagnose bloody diarrhea?
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colonoscopy with or without biopsy, stool cultures
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What do you evaluate for secretory watery diarrhea?
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persistant with fasting, large volume, abdominal cramping
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What do you evlauate for hormonal watery diarrhea?
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carcinoid, mastocytosis, VIPoma or gastrinoma
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What are the causes of watery diarrhea?
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secretory, hormonal, excess bile acids entering the colon, TI resection, ifnectious, drugs, osmotic
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What causes infectious watery diarrhea?
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severe HIV/AIDS acute infectious toxins
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What drugs cause watery diarrhea?
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quinidine, colchicine, misoprostol, vit C
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What causes osmotic diarrhea?
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non-absorbable sugars or sweeteners, laxatives
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What do you evaluate for osmotic diarrhea?
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stool electrolytes, osmolality
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How do you calculate stool osmolality?
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2 x (Na + K)
>50 is osmotic diarrhea |
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What are the signs of greasy stool?
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bulky or loose, higher volume, hard to flush, oil drops
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What are the symptoms of greasy stool?
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mild abdominal cramping
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How do you diagnose greasy stool?
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10g or more on a 100g fat diet, image liver, pancreas with CT, assess small bowel, trial of antibiotics
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How do you assess the small bowel for greasy stool?
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endoscopy with biopsy for GSE and rare casues
radiograph for GSE, Crohn's |
