Transcript Title slide - AGA Institute GastroSlides

Digestive Health and
Disease in W men
Senior Author
Suzanne Rose, MD, MSEd
Professor of Medical Education and Medicine
Mount Sinai School of Medicine
GASTROSLIDES Project Director
Jean-Pierre Raufman
GASTROSLIDES Art Director
Jerry Schoendorf, MAMS
Professor of Medicine
University of Maryland School of Medicine
Duke University Medical Center
Authors
Lin Chang, MD
Jennifer Christie, MD
Rosemarie Fisher, MD
Rebekah Gross, MD
Amy Foxx-Orenstein, MD
Asma Khapra, MD
Caroline Loeser, MD
Suwebatu T. Odunsi, MD
Ann Ouyang, MBBS
S. Devi Rampertab, MD
Robin Rutherford, MD
Pratima Sharma, MD, MS
Grace L. Su, MD
Trinh Truong, MD
Jacqueline Wolf, MD
Rebecca Van Dyke, MD
GERD / Dyspepsia
Pathophysiology of GERD
Decreased salivation
Lower esophageal
sphincter (LES)
Transient LES
relaxation
Impaired esophageal
acid clearance
Impaired tissue
resistance
Decreasing
resting tone of
LES
Duodenum
Delayed gastric
emptying
Castell Do et al. Aliment Pharmacol Ther 2004; 20 (Suppl 9):14
II-4
Constipation
Pelvic Floor Musculature
At rest
Straining to defecate
Symphysis
pubis
Coccyx
Puborectalis
Anorectal
angle
Anorectal
angle
Rectum
External
anal
sphincter
Descent of
pelvic floor
IV-9
Deeply Infiltrating Endometriosis of the
Digestive Tract: Anatomical Distribution
Omentum
1.7%
Small bowel
4.7%
Cecum and
ileocecal junction
4.1%
Appendix
6.4%
Chapron C et al. Human Reproduction 2006: 21:1839
Sigmoid colon
17.4%
Rectosigmoid
junction and rectum
65.7%
V-54
Pregnancy and Liver Disease
Effects of Estrogens/Pregnancy on Transporters
Involved in Cholesterol Excretion
OATPs
NTCP
Sinusoid
Na+
Bile Acids
Bilirubin
ABC B11
ABC C2
Liver
ABC B4
Phosphatidylcholine
(PC)
Gall
bladder
Common
bile duct
Geier A, et al. BBA 2007; 1773:283
ABC G5/G8
Cholesterol
Hepatocyte
to bile duct
VII-79
Mitochondrial b-Oxidation and Oxidative Phosphorylation
Mitochondrial b-Oxidation and Oxidative
Phosphorylation
Outer membrane
H+
H+
H+
H+
Inner
membrane
ATP
NADH
CO2
H2O
ADP+Pi
Citric acid
cycle
Acetyl Co-A
e-
O2
b
oxidation
Fatty acids
VIII-61
Special Issues - Colon Cancer
Barriers to Successful Colonoscopy
in Women
 Completion Rates
 Women
 Men
88-96%
94.3-99.8%
 Anatomical differences
 Low BMI
 Previous pelvic surgery
 Hysterectomy
 Diverticulosis in women
Church JM. American Journal of Gastroenterology 1994; 89(4):556
Anderson JC et al. Gastrointestinal Endoscopy 2001; 54(5):558
IX-12
Nutrition
Vitamin D Absorption
UVB
Diet
vitamin D3 and D2
Skin
Vitamin D3
7-dehydroxycholesterol
Vitamin D3 + VDBP
or albumin
Small
intestine
Bile salts and
conjugated vitamin D
25-hydroxylase
Terminal
ileum
Enterocyte
Chylomicron
+
vitamin D
Reabsorption
of bile salts
and
conjugated
vitamin D
metabolites
25-OHD
1-hydroxylase
1,25-(OH)2 vitamin D
Active form of vitamin D
X-3