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  <head>
    <title>021-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Digestion, absorption, liver, and nutrition">
      <outline text="Organisation and control">
        <outline text="Mucosa, submucosa, muscle, serosa"/>
        <outline text="Folds, villi, microvilli amplify surface"/>
        <outline text="Tight junctions and selective transporters"/>
        <outline text="Rapid renewal repairs injury">
          <outline text="Vulnerable to antimetabolites, radiation, ischaemia"/>
        </outline>
        <outline text="Enteric plexuses coordinate local function"/>
        <outline text="Parasympathetic promotes digestion"/>
        <outline text="Sympathetic inhibits and constricts vessels"/>
        <outline text="Cajal cells generate slow waves"/>
        <outline text="Hormones coordinate regions">
          <outline text="Gastrin: acid and mucosal growth"/>
          <outline text="Secretin: bicarbonate for duodenal acid"/>
          <outline text="Cholecystokinin: enzymes, gallbladder, slow emptying"/>
          <outline text="Incretins and motilin"/>
        </outline>
      </outline>
      <outline text="Motility from mouth to colon">
        <outline text="Swallowing reflex protects airway"/>
        <outline text="Impaired sphincter relaxation causes achalasia"/>
        <outline text="Inappropriate reflux exposes squamous epithelium"/>
        <outline text="Proximal stomach accommodates, distal grinds"/>
        <outline text="Duodenal signals slow emptying"/>
        <outline text="Vomiting loses chloride, potassium, volume"/>
        <outline text="Segmentation mixes, peristalsis advances"/>
        <outline text="Migrating complex clears fasting residue"/>
        <outline text="Haustra absorb water, mass movements propel"/>
        <outline text="Defecation combines reflex and voluntary control"/>
      </outline>
      <outline text="Secretion and digestion">
        <outline text="Saliva lubricates, buffers, starts digestion"/>
        <outline text="Parietal cells: acid and intrinsic factor">
          <outline text="Histamine, acetylcholine, gastrin converge"/>
          <outline text="Somatostatin, prostaglandins restrain"/>
        </outline>
        <outline text="Mucosal defences prevent self-digestion"/>
        <outline text="Pancreas: bicarbonate and enzymes">
          <outline text="Inactive protease precursors limit autodigestion"/>
          <outline text="Insufficiency causes steatorrhoea"/>
        </outline>
        <outline text="Bile acids emulsify and form micelles">
          <outline text="Reclaimed in terminal ileum"/>
          <outline text="Broken cycle: diarrhoea, fat malabsorption"/>
        </outline>
      </outline>
      <outline text="Absorption">
        <outline text="Sugars as glucose, galactose, fructose"/>
        <outline text="Sodium-glucose coupling explains oral rehydration"/>
        <outline text="Long-chain fats: chylomicrons via lymph"/>
        <outline text="Shorter fatty acids enter portal blood"/>
        <outline text="Vitamin B12 needs intrinsic factor and ileum"/>
        <outline text="Iron proximal, regulated by hepcidin"/>
        <outline text="Colon salvages water and sodium"/>
        <outline text="Diarrhoea mechanisms">
          <outline text="Fasting improves osmotic, not secretory"/>
          <outline text="High volume: hypovolaemia, acidosis, kidney injury"/>
        </outline>
      </outline>
      <outline text="Barrier, microbiome, and splanchnic flow">
        <outline text="Mucus, epithelium, antimicrobials, immune cells, microbes"/>
        <outline text="Microbiome ferments and modifies bile acids"/>
        <outline text="Association does not prove causation"/>
        <outline text="Countercurrent flow leaves villus tips hypoxic"/>
        <outline text="Ischaemia from hypotension, occlusion, thrombosis">
          <outline text="Pain out of proportion to examination"/>
          <outline text="Later infarction: peritonism, collapse"/>
        </outline>
      </outline>
      <outline text="Liver architecture and zonation">
        <outline text="Portal and hepatic arterial inflow"/>
        <outline text="Sinusoids drain toward central veins"/>
        <outline text="Bile flows opposite toward ducts"/>
        <outline text="Hepatocytes see oral drugs first"/>
        <outline text="Periportal: oxygen, oxidation, urea"/>
        <outline text="Centrilobular: low oxygen, drug metabolism">
          <outline text="Vulnerable to hypoxia and toxins"/>
        </outline>
        <outline text="Stellate activation drives fibrosis"/>
      </outline>
      <outline text="Metabolic, synthetic, and detoxifying roles">
        <outline text="Glycogen and gluconeogenesis buffer glucose"/>
        <outline text="Albumin, clotting factors, complement">
          <outline text="Albumin supports oncotic pressure, binds drugs"/>
        </outline>
        <outline text="Phase one exposes, phase two conjugates">
          <outline text="Inactivate, activate prodrugs, or form toxins"/>
        </outline>
        <outline text="Exposure altered by induction, genetics, shunting"/>
        <outline text="Bilirubin from haem breakdown">
          <outline text="Unconjugated: overproduction or poor conjugation"/>
          <outline text="Conjugated: impaired excretion or obstruction"/>
        </outline>
      </outline>
      <outline text="Nutrition and clinical assessment">
        <outline text="Energy balance: intake to losses"/>
        <outline text="Malnutrition reduces muscle, immunity, reserve"/>
        <outline text="Obesity with deficiency and sarcopenia"/>
        <outline text="Assessment integrates trajectory and function">
          <outline text="Albumin not a standalone marker"/>
        </outline>
        <outline text="Refeeding after prolonged undernutrition">
          <outline text="Phosphate, potassium, magnesium enter cells"/>
          <outline text="Replace thiamine, start cautiously, monitor"/>
        </outline>
        <outline text="Enteral feeding preserves mucosa"/>
        <outline text="Parenteral: lifesaving but catheter risks"/>
      </outline>
    </outline>
  </body>
</opml>
