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32 Cards in this Set
- Front
- Back
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Who are most susceptible to IBS
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20% of ppl worldwide have irritable bowel syndrome
mot pop. in woman - due to progesterone in 2nd 1/2 of menstral cycle |
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IBS symptoms
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- abdom pain/discomfort (relieved w. defecation)
- irreg pattern of defectation 25% of the time 3 or more of....FFPMB -altered stool FREQUENCY -altered stool FORM -altered stool PASSAGE - passage of MUCOUS -BLOATING, abdom distension |
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IBS diagnosis
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by exclusion -eliminate other possibilities (org. disease) for symptoms
criteria ; Manning & Rome questionaires |
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etiology of IBS (3)
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hypotheses
1) underlying disorder of intestinal motility (increased or decreased) 2) emotion tension / stress 3) low tolerance for pain/ excessive response to normal signals from GI tract |
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Pathophysiology of IBS (due to having disease...)
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- visceral hypersensitivity
- altered motility - exag. response to eating / increased sensitivity to CCk- increases muscle contraction/motility - abnormal transit of stool and gas- bloating (due from bacteri breakdown of food in colon?) - stress - CRF cause increase transit colon, decrease gastric emptying - increase in IL-1 (inflam cytokines) - inflammation |
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Effect of Serotonin
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5-HT in IBS
controls peristalsis increasesbinds 5-HT4 receptors - enhances peristalic activity w/o receptor, colonic motility slows |
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CRF
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corticotrophic releasing factor
released when stressed (IBS) increase colon transit, delay gastric emptying acts on mast cells & compromises barrier that protects epithelium (bacteria/toxins/pathogens pass) |
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therapy IBS
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-pharmacological therapies - 5-TH3/5-HT4 agoiists relieve many symptoms
-behavioral therapy - biofeedback(computer) -acupuncture -body awareness -cog. behaviorl therapy - |
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exteroceptive stress
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pyschological stressors
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interoceptive stress
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from experiencing symptoms
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NMD for IBS
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neonatal materal deprivation
early trama alters GI homeostasis -dysregulation of HPA reactivity to stress (hypothalamic-pituitary-adrenal axis) deprived rats show increased hyperalgesia& colon motility& epithelium permeability |
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hyperalgesia
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IBS
increaed pain sensitivity |
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living organisms affect host by...
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probiotics
- modulating mucous and systemic immunity - improve nutrition and microbial balance in GI tract |
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VSL#3
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probiotics
"medical supplement"- a medical food contains 450 million bacteria/dose contains bifidobacteria, lactobacilli, streptococcus trend: reduce bloating& flatulence |
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biological effects of probiotic bacteria
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1) modulate host immune system - increase antibody product. NKC activity, alter cytokine activity
2) enhance epithelial barrier function - better tight junctions, increase IgA product. 3)antimicrobial effects - decreased lumen pH, inhibit pathogen bacteria |
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probiotic bacteria (2) and what they do
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lactococcus lactis - increase IL10 (increase good IL10/12 ratio)
bifidobacterium infantis - normalize IL10/12 ratio alleviate symptoms if IBS |
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medical food
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specially formulated and processed product for the partial or exclusion feeding of a patient (oral or enteral tube feeding)
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Pathophyiology of IBD
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stage 1 - infection? - initiates uncontrolled immune response in genetically suseptible person
stage 2 - amplified immune response - macrophages/neutrophils/lymphocytes (WBCs) - Tcells and proinflam molecules : cytokines, eicosanoids, NO, platelet activating factor, proteases |
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MAP
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mycobacterium avium paratuberculosis
infectious, possible trigger for IBD cause strong assoc. w. Crohn's - susceptibility genes that encode proteins of innate immunity to intracel. bacteria |
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integrins
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in crohn's disease
protein - in extracellular matrix, cell-to cell signal |
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selectins
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in crohn's disease
protein after cytokines...slows Immune response |
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Crohn's disease
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mouth to anus
penetrate full intestinal wall (transmeural) strictures, fistulae onset: acute & severe not curative |
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ulcerative colitis
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colon & rectum (only)
mucosa & submucosa (localized) onset: chronic and slow curative (surgury remove portion) |
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granulomatous tissue
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in Crohn's disease
collection of cells, macrophages, inflamatory & immune cells and extracellular matrix cells are not being removed non-caseating in Crohn's disease |
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Damages in Crohn's disease (3)
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- inflammatory - procytokines increase inflam response
- stenotic strictures- narrow blockages and ballooning - decrease abs and increase bacteria, overgrowth - fistulizing - attachments - block slow movement |
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cause of Malunutrtion in IBD
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1) decreased oral intake - avoid to avoid symptoms, theapeutic fasting, lactrogenic
2) malabsorbtion- SI diseased/ removed 3) increased nutrient loss - protein loss: inflam, permeability, blood loss, turnover of mucosal cells...electrolytes in diarhhea 4)increased nutrient needs -inflam, rapid turnover |
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symptoms of malnutrion in IBD (5)
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1) weight loss
2) anemia 3) hypoalbuminemia 4) poor wound healing 5) prone to infection |
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medical therapy (drug) for IBD
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- anti-inflam
- anti-bacterica (for Crohn's) - anti-diarrheal - immunomodulators (reg. good/bad cytokine ratio) |
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5-ASA
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drug therapy of IBD
- anti-infam & anti-bacter -compet. inhibitor of FOLATE 1mg/day - cause nausea, vomit, taste altered, dyspepsia |
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Cholestyramine
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drug therapy for IBD
- binds bile salts - for patients with ileum resection -anti diarrheal -indice fat soluble vitamin deficiency - binds bile acids and are excreted (bile acids not abs in ileum enter L.I and cause water > diarrhea) osteomalacia - softened bones due to low vit D |
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steroid IBD
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drug therapy for IBD
prednisone - anti inflam affects, bones resorption, Ca abs, excret, reduced protein turnover |
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immunosuppression agents IBD
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drug therapy
- for remission and maintenance -cyclosporin - remission -AZA & 6MP - maintenance headache, nausea, upper resp infections, opportunistic infection, pancreatitis, toxicity |
