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IMF-021-02-0001-en	Why can stronger gut contraction without coordination worsen symptoms instead of improving transit?	Slow waves set windows for contraction, but propulsion requires spatial coordination, so stronger uncoordinated activity can worsen pain or obstruction.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0002-en	What distinguishes mechanical obstruction from ileus, and why does the distinction matter?	Obstruction creates a transition point with proximal distension, whereas ileus is diffuse failure of propulsion; both cause vomiting, sequestration, aspiration, and perforation, but definitive treatment differs.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0003-en	Why is blocking the gastric proton pump effective acid suppression, and why should long-term use be reviewed?	The pump is the final step of the histamine, acetylcholine, and gastrin pathways, so blocking it overcomes several upstream signals; long-term suppression can alter mineral or vitamin handling, infection risk, and drug absorption.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0004-en	Why can non-steroidal anti-inflammatory drugs injure the mucosa throughout the gastrointestinal tract?	They reduce prostaglandin support for the mucosal barrier, which also depends on mucus, bicarbonate, epithelial restitution, tight junctions, and blood flow.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0005-en	Why does modest ileal dysfunction cause diarrhoea, whereas extensive ileal loss causes steatorrhoea?	Modest dysfunction sends excess bile acids into colon, stimulating secretion; extensive loss depletes the total bile-acid pool, so fat is malabsorbed.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0006-en	Why does fat malabsorption from bile-acid loss increase kidney-stone risk?	Unabsorbed fatty acids bind calcium, leaving oxalate available for colonic absorption.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0007-en	How does the stool osmotic gap help separate secretory from osmotic diarrhoea?	A low gap means measured electrolytes account for most stool osmolality, supporting secretion; a high gap suggests unmeasured osmoles. Contamination, fermentation, and collection difficulty limit its use.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0008-en	Why does high-volume diarrhoea cause more than dehydration?	Loss of bicarbonate and potassium produces normal-gap acidosis and weakness, and magnesium loss, malnutrition, kidney injury, and medication malabsorption can follow.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0009-en	How does portal hypertension reduce hepatic clearance of ammonia and drugs and lower the platelet count?	Collaterals form oesophageal or gastric varices that shunt ammonia and drugs around hepatic clearance, and splenic congestion causes thrombocytopenia.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0010-en	Why is ascites not explained by low albumin alone?	It also reflects portal hydrostatic pressure, renal sodium retention, lymph formation, and reduced effective arterial filling after splanchnic vasodilation.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0011-en	Why can falling aminotransferases after massive elevation mislead, and what better describes acute liver failure?	Falling values may mean recovery or loss of viable hepatocytes; rising bilirubin, clotting impairment, hypoglycaemia, acidosis, encephalopathy, and kidney dysfunction better describe failure.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0012-en	Why does post-pyloric feeding not remove aspiration risk?	Aspiration also depends on consciousness, reflux, positioning, oral hygiene, and airway protection, and post-pyloric feeding does not prevent aspiration of oral secretions.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0013-en	Why should a normal lactate not delay assessment when intestinal ischaemia is suspected?	It does not exclude early localised ischaemia; peritoneal signs, acidosis, and organ failure appear only as the process advances, so contrast imaging and surgical and vascular review are not delayed.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending
IMF-021-02-0014-en	Why does bilirubin in the urine point toward impaired bile flow rather than haemolysis?	Urinary bilirubin reflects the water-soluble conjugated form, which rises with biliary obstruction or failed hepatocyte excretion, whereas haemolysis increases the unconjugated load.	Integrated Medical Foundations; chapter 21, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 6370b601f922a9a3cec3ca5559e9d83aa8505a8447c293e596a7833ef2a57a56; editorial review pending	imf lang::en chapter::021 module::021-02 review::pending