A_B+2010+UpperLowerGI

A_B+2010+UpperLowerGI - Small & Large Intestine...

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* * * Reading: Chpt. 17
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Organization of the Small Bowel Maximizes Absorptive Surface Area Mucosa Villus Intestinal Absorptive Cell Microvilli
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Duodenum- mesentery
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Normal duodenal mucosa Normal jejunal mucosa
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Common Intestinal Problems Intestinal gas and flatulence Constipation Malabsorption is common: primary cause can be Malabsorption is common: primary cause can be impaired digestion (maldigestion) followed by impaired digestion (maldigestion) followed by malabsorption; or primary cause can be an malabsorption; or primary cause can be an absorption problem alone absorption problem alone Symptom: Diarrhea (usually related to CHO, possibly Protein) Steatorrhea (related to FAT) Gastrointestinal strictures and obstruction
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Diarrhea Diarrhea Definition : Frequent, liquid stools More than 3-4 watery stools a day Pathogenesis : Rapid transit of intestinal contents through the small intestine Poor enzymatic digestion of foods Altered secretion of GI tract fluids
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Diarrhea Diarrhea Acute Symptoms very common poor water absorption bicarbonate loss, so metabolic acidosis Chronic Symptoms >14 d weight loss, malnutrition poor child growth long term: night blindness (A def), poor blood clotting (K def), bone disease (Ca and D def) ZINC supplementation reduces duration in developing countries
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Osmotic Diarrhea Osmotic Diarrhea Pathogenesis : Excessive number of osmotic-active particles present in the intestine (usually CHO) and draw water with them Examples : Dumping syndrome Lactose Intolerance Chronic antacid use (Milk of Magnesia) Hyperosmotic enteral feeding Treatment : NPO - Fast
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Secretory diarrhea Secretory diarrhea Pathogenesis : Active secretion of electrolytes and water by the intestinal epithelium. Occurs in small or large intestine. Examples: E. Coli, Staph food poisoning, Cholera toxins Viral – XS secretion from tip of villi and villi damaged Reduced CHO absorption and SECONDARY osmotic diarrhea Exudative – due to mucosal damage & inflammation Plasma proteins and blood loss Active secretion of electrolytes and water by the intestinal epithelium Continue to feed – fasting is no help
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Treatment for diarrhea Treatment for diarrhea General Management: General Management: Treat underlying cause; Antidiarrheal agents may only treat Treat underlying cause; Antidiarrheal agents may only treat symptoms, can be dangerous symptoms, can be dangerous Correct fluid and electrolyte imbalances Correct fluid and electrolyte imbalances (including use of Oral (including use of Oral Rehydration Therapy); Rehydration Therapy); If severely dehydrated, give IV fluids Check for lactose intolerance Check for lactose intolerance Dietary Management: Dietary Management: 1. Soft, regular and small, digestible meals 2. Do not restrict fat, as fat has no osmotic effect
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A_B+2010+UpperLowerGI - Small & Large Intestine...

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