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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 Professor of Medicine University of Maryland School of Medicine.

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  1. Digestive Health and Disease in W men Senior AuthorSuzanne Rose, MD, MSEdProfessor of Medical Education and Medicine Mount Sinai School of Medicine GASTROSLIDES Project Director Jean-Pierre Raufman Professor of Medicine University of Maryland School of Medicine GASTROSLIDES Art Director Jerry Schoendorf, MAMS Duke University Medical Center Authors 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 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

  2. GERD / Dyspepsia Pathophysiology of GERD Decreased salivation Impaired esophageal acid clearance Lower esophageal sphincter (LES) Impaired tissue resistance Transient LES relaxation Decreasing resting tone of LES Duodenum Delayed gastric emptying Castell Do et al. Aliment Pharmacol Ther 2004; 20 (Suppl 9):14 II-4

  3. Constipation Pelvic Floor Musculature At rest Straining to defecate Symphysis pubis Coccyx Anorectal angle Anorectal angle Puborectalis Rectum External anal sphincter Descent of pelvic floor IV-9

  4. Deeply Infiltrating Endometriosis of the Digestive Tract: Anatomical Distribution Omentum 1.7% Small bowel 4.7% Chapron C et al. Human Reproduction 2006: 21:1839 Cecum and ileocecal junction 4.1% Sigmoid colon 17.4% Appendix 6.4% Rectosigmoid junction and rectum 65.7% V-54

  5. 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 G5/G8 ABC B4 Cholesterol Phosphatidylcholine (PC) Gall bladder Common bile duct Hepatocyte to bile duct Geier A, et al. BBA 2007; 1773:283 VII-79

  6. Mitochondrial b-Oxidation and Oxidative Phosphorylation Mitochondrial b-Oxidation and Oxidative Phosphorylation Outer membrane H+ H+ H+ H+ Inner membrane H2O O2 ADP+Pi ATP NADH e- Citric acid cycle b oxidation CO2 Acetyl Co-A Fatty acids VIII-61

  7. Special Issues - Colon Cancer Barriers to Successful Colonoscopy in Women • Completion Rates • Women 88-96% • Men 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 Endoscopy2001; 54(5):558 IX-12

  8. Nutrition Vitamin D Absorption Diet vitamin D3 and D2 UVB Skin Vitamin D3 7-dehydroxycholesterol Enterocyte Chylomicron + vitamin D Vitamin D3 + VDBP or albumin Small intestine Reabsorption of bile salts and conjugated vitamin D metabolites Bile salts and conjugated vitamin D Terminal ileum 25-hydroxylase 25-OHD 1-hydroxylase 1,25-(OH)2 vitamin D Active form of vitamin D X-3

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