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IMF-021-01-0001-en	Why is rapid renewal of the gut epithelium both protective and a source of vulnerability?	Rapid renewal helps repair injury, but it also makes the mucosa vulnerable to antimetabolites, radiation, inflammation, and ischaemia.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0002-en	What distinguishes the general effects of parasympathetic and sympathetic activity on the gut?	Parasympathetic activity generally promotes digestion, whereas sympathetic activity generally inhibits motility and secretion and constricts vessels.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0003-en	How do interstitial cells of Cajal contribute to organised gut contraction?	They generate electrical slow waves, and these slow waves organise smooth-muscle contraction.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0004-en	How does cholecystokinin coordinate the response to a meal rich in fat and protein?	Responding particularly to fat and protein, it stimulates pancreatic enzyme secretion, contracts the gallbladder, and slows gastric emptying.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0005-en	What distinguishes the lower oesophageal sphincter problem in achalasia from that in reflux?	In achalasia the sphincter fails to relax, impairing entry to the stomach; in reflux, inappropriate retrograde flow exposes squamous epithelium to acid.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0006-en	Why does gastric emptying slow when the duodenum contains acid, fat, or hypertonic chyme?	These signals, together with distension, indicate that processing capacity is exceeded, so the distal stomach meters chyme into the duodenum more slowly.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0007-en	How do segmentation, peristalsis, and the fasting migrating motor complex divide the work of small-intestinal motility?	Segmentation mixes chyme, peristalsis advances it, and after absorption the fasting migrating motor complex clears residue.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0008-en	How is parietal-cell acid secretion balanced between stimulation and restraint?	Histamine, acetylcholine, and gastrin stimulate parietal cells through converging pathways, while somatostatin and prostaglandins restrain secretion and support mucosal defence.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0009-en	Why are pancreatic proteases secreted as inactive precursors?	Because they are activated in the intestinal lumen rather than in the gland, which reduces the risk of pancreatic autodigestion.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0010-en	Why does pancreatic insufficiency particularly cause steatorrhoea and fat-soluble vitamin deficiency?	The pancreas supplies the digestive enzymes, including lipase with colipase for triglyceride, so its failure causes maldigestion that shows particularly as fat loss and fat-soluble vitamin deficiency.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0011-en	Why do bile acids matter for fat absorption, and what follows when the enterohepatic cycle is interrupted?	Their amphipathic structure emulsifies fat and forms micelles that carry lipids to the brush border; most are reclaimed in terminal ileum, so interruption can cause diarrhoea, fat malabsorption, or both.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0012-en	Why does oral rehydration solution remain effective in many secretory diarrhoeas?	Because of sodium-coupled glucose transport: glucose uptake pulls sodium and water with it.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0013-en	How does the absorptive route of long-chain fatty acids differ from that of shorter fatty acids?	Long-chain fatty acids and monoglycerides are re-esterified in enterocytes, packaged into chylomicrons, and delivered through lymph, whereas shorter fatty acids enter portal blood more directly.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0014-en	Why can disorders of either the gastric parietal cells or the terminal ileum impair vitamin B12 absorption?	Parietal cells secrete intrinsic factor, vitamin B12 must bind intrinsic factor, and the bound vitamin is absorbed in the terminal ileum.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0015-en	How does the response to fasting help distinguish osmotic from purely secretory diarrhoea?	Fasting tends to improve osmotic diarrhoea, which is driven by unabsorbed osmoles, but not purely secretory diarrhoea.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0016-en	Why does an association between a microbial pattern and a disease not prove that the microbes cause it?	Antibiotics, diet, infection, inflammation, and altered transit can themselves disrupt the microbial ecology, so association alone does not establish causation.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0017-en	Why are villus tips especially vulnerable to hypoxia?	Villi are efficient exchange structures, but their countercurrent circulation leaves the tips poorly protected against hypoxia.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0018-en	In intestinal ischaemia, why is pain disproportionate to early examination findings an important warning?	Peritonism and systemic collapse come later with infarction, so the early examination can appear deceptively mild despite severe ischaemia.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0019-en	Why are hepatocytes exposed to orally administered drugs before systemic distribution?	Absorbed substances reach the liver in portal blood, which traverses sinusoids where hepatocytes exchange across fenestrated endothelium before blood drains to central veins.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0020-en	Why are centrilobular hepatocytes more vulnerable to hypoxia and selected toxins than periportal cells?	Centrilobular cells have lower oxygen exposure and prominent drug-metabolising activity, whereas periportal cells receive more oxygen and support oxidative metabolism and urea formation.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0021-en	Why is hepatic biotransformation not simply a detoxifying process?	Although metabolism can inactivate drugs, it can also activate prodrugs or create toxic intermediates.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0022-en	How does the predominant bilirubin fraction help locate the underlying problem?	Predominantly unconjugated elevation suggests overproduction or impaired conjugation, whereas conjugated elevation suggests impaired excretion or obstruction, although mixed patterns are common.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0023-en	Why can refeeding after prolonged undernutrition be dangerous, and how is the risk managed?	It drives phosphate, potassium, and magnesium into cells, causing arrhythmia, weakness, respiratory failure, and neurological injury; identify risk, replace thiamine and electrolytes, start cautiously, and monitor closely.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending
IMF-021-01-0024-en	Why is enteral feeding generally preferred to parenteral nutrition when the gut works?	Enteral feeding generally preserves mucosal function, whereas parenteral nutrition carries catheter infection, thrombosis, metabolic disturbance, and hepatobiliary complications.	Integrated Medical Foundations; chapter 21, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 39045fdea18b65c48e6b06e275b7af73f895a4d4d8b425393c229b0160f84498; editorial review pending	imf lang::en chapter::021 module::021-01 review::pending