Digestive Health and IBS Overview
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Questions and Answers

Which of the following best explains the lack of CNS distribution of loperamide?

  • It is actively pumped back into the blood by P-glycoprotein. (correct)
  • It is rapidly metabolized in the liver.
  • It has a higher affinity for peripheral receptors.
  • It is a full mu opioid receptor agonist.

    • What is the primary determinant of the lack of abuse potential for loperamide?

  • P-glycoprotein's role in blocking its transit into the CNS. (correct)
  • Its classification as a controlled substance.
  • The presence of the anticholinergic drug atropine.
  • The low dose required for effectiveness.

    • Which of the following statements about diphenoxylate is true?

  • It is primarily used as a dietary supplement.
  • It can distribute into the CNS at high doses, leading to abuse potential. (correct)
  • It has a formulation that includes loperamide.
  • It is a full agonist with no potential for abuse.

    • How is diphenoxylate formulated to discourage abuse?

    <p>It is combined with atropine in Lomotil®.</p> Signup and view all the answers

    Which of the following opioids is specifically recognized as a full opioid agonist?

    <p>Meperidine</p> Signup and view all the answers

    What is the primary mechanism by which P-glycoprotein affects drug pharmacokinetics?

    <p>It mediates drug efflux from cells.</p> Signup and view all the answers

    Why is loperamide not classified as a controlled substance by the FDA?

    <p>It lacks significant CNS effects linked to addiction.</p> Signup and view all the answers

    In what way do loperamide and diphenoxylate differ in their classification regarding abuse potential?

    <p>Loperamide is a partial agonist with no abuse potential while diphenoxylate has high abuse potential.</p> Signup and view all the answers

    What is the primary characteristic that defines irritable bowel syndrome (IBS)?

    <p>Abdominal discomfort associated with altered bowel habits</p> Signup and view all the answers

    What percentage of adults in the United States is estimated to be affected by IBS?

    <p>10 to 15%</p> Signup and view all the answers

    Which of the following factors is NOT associated with the exacerbation of IBS symptoms?

    <p>Excessive hydration</p> Signup and view all the answers

    Which part of the small intestine is the first to receive chyme from the stomach?

    <p>Duodenum</p> Signup and view all the answers

    What is a common characteristic of bowel movement frequency that can lead to misdiagnosis of constipation?

    <p>A wide range of normal frequency among individuals</p> Signup and view all the answers

    How does the prevalence of IBS typically differ between men and women?

    <p>It affects women almost twice as much as men</p> Signup and view all the answers

    Which factors contribute to the development of IBS?

    <p>Visceral hypersensitivity and dysmotility</p> Signup and view all the answers

    What physiological role does the small intestine serve in relation to chyme?

    <p>It is the main site for digestion and absorption of nutrients</p> Signup and view all the answers

    What is the primary function of goblet cells in the intestinal mucosa?

    <p>Producing mucus to protect and lubricate the epithelial surface</p> Signup and view all the answers

    Which type of cells primarily make up the surface epithelial layer of the villi?

    <p>Enterocytes</p> Signup and view all the answers

    What structural feature increases the absorptive surface area of the small intestine?

    <p>The microvilli forming the brush border</p> Signup and view all the answers

    Where are the crypts of Lieberkuhn located in relation to the villi?

    <p>At the base of the villi</p> Signup and view all the answers

    What is contained within the villi to assist in digestion and absorption?

    <p>A network of capillaries and lymphatic vessels</p> Signup and view all the answers

    What is a major characteristic of the small intestine that enhances its digestive capability?

    <p>Substantial surface area due to villi and microvilli</p> Signup and view all the answers

    Stem cells located in the crypts of Lieberkuhn primarily function to:

    <p>Differentiating into various cell types that replenish the epithelial surface</p> Signup and view all the answers

    What specific feature of the microvilli aids in the digestive process?

    <p>Containment of digestive enzymes within their plasma membrane</p> Signup and view all the answers

    Which neurotransmitter is primarily associated with causing muscular contractions in the gut?

    <p>Serotonin (5HT)</p> Signup and view all the answers

    What type of Irritable Bowel Syndrome (IBS) is characterized by predominant diarrhea?

    <p>IBS-D</p> Signup and view all the answers

    Which factor is NOT commonly associated with contributing to Irritable Bowel Syndrome?

    <p>Age</p> Signup and view all the answers

    Which signaling molecule is secreted by G cells and plays a role in gut activity?

    <p>Cholecystokinin (CCK)</p> Signup and view all the answers

    Which of the following is a consequence of overactivity in the enteric nervous system (ENS)?

    <p>Increased secretion of ATP</p> Signup and view all the answers

    What is considered a hallmark symptom of IBS-C (Constipation Predominant Irritable Bowel Syndrome)?

    <p>Difficulty passing stools</p> Signup and view all the answers

    Which of the following pathways is least likely to be involved in the pathophysiology of gastrointestinal disorders?

    <p>Enhanced gut flora diversity</p> Signup and view all the answers

    Which neurotransmitter is primarily responsible for transmitting pain sensations in the gastrointestinal system?

    <p>Substance P</p> Signup and view all the answers

    What is the primary reason SSRIs may be prescribed for patients with IBS?

    <p>To address comorbid depression and/or anxiety.</p> Signup and view all the answers

    Which treatment is suggested for patients primarily suffering from IBS-C?

    <p>Dietary fiber intake.</p> Signup and view all the answers

    What effect does polyethylene glycol (PEG) have in patients with IBS-C according to the evidence?

    <p>It increases stool frequency without improving pain.</p> Signup and view all the answers

    How should dietary fiber be introduced in patients with IBS-C to minimize side effects?

    <p>Gradually as tolerated to prevent gas and bloating.</p> Signup and view all the answers

    What do stimulant laxatives primarily target in treating constipation?

    <p>Stimulating colonic smooth muscle directly.</p> Signup and view all the answers

    What is a common misconception about SSRIs in managing IBS symptoms?

    <p>They are effective for treating abdominal pain specifically.</p> Signup and view all the answers

    What should be done when IBS symptoms are minor?

    <p>Focus on eliminating certain foods or psychological treatments.</p> Signup and view all the answers

    Why might the American College of Gastroenterology advise against PEG for global IBS symptom relief?

    <p>It can lead to abdominal discomfort and does not improve pain.</p> Signup and view all the answers

    Study Notes

    Normal Bowel Movements

    • The frequency of bowel movements varies significantly, with some people defecating several times per day and others only a few times per week.
    • This variation can make constipation difficult to diagnose accurately.

    Irritable Bowel Syndrome (IBS)

    • IBS is characterized by abdominal discomfort associated with altered bowel habits.
    • Common symptoms include abdominal pain, altered bowel function, flatulence, bloating, nausea, anorexia, constipation, diarrhea, anxiety, and/or depression.
    • IBS is caused by a combination of factors, including dysmotility, visceral hypersensitivity, and brain-gut dysfunction.
    • IBS affects 7 to 10% of the global population and approximately 10 to 15% of adults in the United States.
    • IBS is more prevalent in women than men, and is usually diagnosed before the age of 50.
    • Symptoms often worsen during the premenstrual period.
    • Stress can exacerbate IBS symptoms.

    Small Intestine

    • The small intestine consists of three sections: the duodenum, jejunum, and ileum.
    • Chyme (food and digestive enzymes) from the stomach enters the duodenum.
    • The small intestine is the primary site for mixing chyme with secretions from the bile duct and pancreatic duct.
    • The small intestine has a large surface area for digestion and absorption.
    • Villi and crypts of Lieberkuhn are vital structures in the small intestine.
    • Goblet cells, located in the villi and crypts, secrete mucus to protect the mucosal surface and lubricate intestinal contents.
    • Enterocytes, the main type of epithelial cells in the villi, contain microvilli, which form the brush border.

    Enteric Nervous System (ENS)

    • The ENS regulates various functions in the gastrointestinal tract, including secretions and motility.
    • Neurotransmitters and hormones like norepinephrine, serotonin, cholecystokinin, substance P, vasoactive intestinal peptide, somatostatin, leu-enkephalin, met-enkephalin, and bombesin play key roles in ENS communication.
    • ENS dysfunction can lead to abnormal secretions, motility, and pain.

    Pathophysiology of IBS

    • The exact cause of IBS is unknown.
    • Contributing factors include diet, genetics, motility factors, inflammation, colonic infections, mechanical irritation to local nerves, stress, and psychological factors.
    • IBS can be classified into subtypes based on predominant symptoms: IBS-D (diarrhea-predominant) and IBS-C (constipation-predominant).

    Treatment of IBS

    • Pharmacotherapy is often required for IBS symptom management.
    • Treatment strategies vary depending on whether the patient has IBS-C or IBS-D.

    IBS-C Treatment

    • Soluble fiber, such as psyllium, may improve overall symptoms and constipation.
    • Osmotic laxatives like polyethylene glycol (PEG) may increase bowel movement frequency in chronic idiopathic constipation (CIC), but evidence for its effectiveness in IBS-C is limited.
    • Stimulant laxatives can be effective for CIC and may stimulate colonic smooth muscle and increase fluid secretion.

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    Related Documents

    Irritable Bowel Syndrome, Diarrhea, and Constipation (RHCHP School of Pharmacy) PDF

    Description

    This quiz explores key concepts related to normal bowel movements, irritable bowel syndrome (IBS), and the structure of the small intestine. Participants will learn about the variation in bowel frequency, symptoms of IBS, and factors influencing digestive health. It's a comprehensive overview aimed at increasing awareness of gastrointestinal health.

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