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GIGU - Week 2 > 15- Secretions of GI Tract & Pancreas > Flashcards

15- Secretions of GI Tract & Pancreas Flashcards

1
Q

The function of this is for initial digestion of starches and lipids. It dilutes and buffers ingested food and lubricates ingested food with mucus.

A

Saliva

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2
Q

This major salivary gland is composed of serous cells. It secretes fluids composed of water, ions, and enzymes (rich in amylase). Secrete 25% of daily output of saliva.

A

Parotid Glands

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3
Q

These major salivary glands are composed of serous and mucous cells (mixed glands). They secrete aqueous fluid and mucin glycoprotein for lubrication. Secrete most of the rest 75% of daily output of saliva.

A

Submandibular Glands
Sublingual Glands

***Remember, Submandibular are predominantly serous and Sublingual are predominantly mucous.

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4
Q

In the structure of salivary glands, ________ cells secrete initial saliva. ________ cells have motile extensions and when they are stimulated by neural input they contract to eject saliva into the mouth.

A

Acinar

Myoepithelial

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5
Q

In the structure of salivary glands, saliva in the _________ ________ is similar in ionic composition to plasma. This comes after the acinus.

A

Intercalated Duct

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6
Q

In the structure of the salivary glands, the ________ ________ is lined by columnar epithelial cells called _______ _______. These cells modify the initial saliva to produce the final saliva (hypotonic). They also alter the concentration of various electrolytes.

A

Striated Duct
Ductal Cells

***Striated Duct comes after the Intercalated Duct!

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7
Q

What is saliva composed of?

A 
Water
Electrolytes
Alpha-amylase
Lingual Lipase
Kallikrein
Mucus
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8
Q

Saliva is hypotonic (compared to plasma), which means it has increased concentrations of _______ and _______, and decreased concentrations of _______ and ______.

A

K+ (active secretion)
HCO3- (secretion)
Na+ (active absorption)
Cl- (passive absorption)

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9
Q

There are two main steps in the formation of saliva, which are…

A

1) Formation of isotonic plasma-like, solution by acinar cells
2) Modification of the isotonic solution by the Ductal Cells (Na+ and Cl- goes out, K+ and HCO3- go in)

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10
Q

What are the mechanisms of salivary secretion on the luminal or apical side of Ductal Cells?

A

Na+/H+ exchange
Cl-/HCO3- exchange
H+/K+ exchange

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11
Q

What are the mechanisms of salivary absorption on the blood (basolateral) side of Ductal Cells?

A

Na+/K+ ATPase

Cl- channels

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12
Q

The combined action is (SECRETION/ABSORPTION) of Na+ and Cl- and (SECRETION/ABSORPTION) of K+ and HCO3-.

A

Absorption

Secretion

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13
Q

There is net (SECRETION/ABSORPTION) of solute, meaning more NaCl is (SECRETED/ABSORBED) than KHCO3 (SECRETION/ABSORPTION).

A

Absorption
Absorbed
Secretion

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14
Q

HCO3- leaves the Ductal Cells to the lumen via cAMP-activated _______ _______ _______ or via the Cl-/HCO3- exchange.

A

CFTR Cl- channel

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15
Q

How does saliva become hypotonic as it flows through the ducts?

A

Ductal cells are water impermeable.

***Water stays within the lumen of the duct, causing it to dilute the solutes within it making it hypotonic.

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16
Q

For parasympathetic innervation of salivary glands, presynaptic nerves originate at what nerves?

A

Facial N. (via Submandibular Ganglion)

Glossopharyngeal N. (via Otic Ganglion)

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17
Q

For parasympathetic innervation of salivary glands, postsynaptic fibers in ________ ________ innervate individual glands.

A

Autonomic Ganglia (Submandibular and Otic Ganglia)

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18
Q

For sympathetic innervation of salivary glands, preganglionic nerves originate at the _______ _______, whose postganglionic fibers extend to the glands in the periarterial space.

A

Cervical Ganglion

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19
Q

Describe the pathway for parasympathetic stimulation of saliva production.

A

Parasympathetics —

CN VII and CN IX lead to ACh release —

ACh binds to mAChR on Acinar or Ductal Cells —

IP3 and Increased Calcium within these cells —

Leads to saliva production

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20
Q

What stimulates and inhibits the parasympathetics for saliva production?

A

Stimulatory = Conditioning, Food, Nausea, Smell

Inhibitory = Dehydration, Fear, Sleep

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21
Q

Describe the pathway for sympathetic stimulation of saliva production.

A

Sympathetics —

T1-T3 lead to NE release —

NE binds to Beta-AR on Acinar of Ductal Cells —

Causes increased cAMP within these cells —

Leads to saliva production

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22
Q

_______ and _______ modify the composition of saliva by decreasing its Na+ concentration and increasing its K+ concentration.

A

ADH

Aldosterone

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23
Q

Salivary is exclusively under the control of the ANS, and secretion is (INCREASED/DECREASED) by both parasympathetic and sympathetic stimulation.

A

Increased

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24
Q

The cells of the gastric mucosa secrete gastric juice, which is composed mainly of…

A 
HCl (H+)
Pepsinogen
Mucus
Intrinsic Factor (IF)
Water
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25
Q

Together with Pepsin, this initiates protein digestion. It is also necessary for the conversion of Pepsinogen to Pepsin. Kills a large number of bacteria that enter the stomach.

A

HCl

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26
Q

This is an inactive precursor within gastric juice. Has to be converted to active form via HCl.

A

Pepsinogen

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27
Q

This lines the wall of the stomach and protects it from damage. It is a lubricant, and together with HCO3- it neutralizes acid and maintains the surface of the mucosa at a neutral pH.

A

Mucus

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28
Q

This is required for the absorption of Vitamin B12 in the ileum.

A

Intrinsic Factor (IF)

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29
Q

This is the medium for the action of HCl and enzymes. It solubilizes much of the ingested material.

A

Water

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30
Q

The gastric mucosa is divided into the _______ _______ area and the ________ ________ area.

A

Oxyntic Gland

Pyloric Gland

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31
Q

This area of gastric mucosa is located in the proximal 80% of the stomach (body and fundus). It secretes acid.

A

Oxyntic Gland

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32
Q

This area of gastric mucosa is located in the distal 20% of the stomach (antrum). It synthesizes and releases gastrin.

A

Pyloric Gland

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33
Q

Cells in the gastric mucosa secrete the components of the gastric juice. What are these cells and what do they secrete?

A

Parietal Cells = HCl and IF

Chief Cells = Pepsinogen

G Cells = Gastrin

Mucus Cells = Mucus, HCO3-, and Pepsinogen

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34
Q

A major function of Parietal Cells is the secretion of HCl. The number of Parietal Cells determines the…

A

Maximal Secretory Rate

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35
Q

The function of the low gastric pH (1-2) is to convert ________ to ________.

A

Pepsinogen

Pepsin

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36
Q

_______ is formed at the villus-like membranes of the canaliculi within Oxyntic (Parietal) Cells.

A

HCl

***Remember, this is what converts Pepsinogen to Pepsin!

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37
Q

This can inhibit the binding of ACh to its mAChR on Acinar or Ductal cells (parasympathetic).

A

Atropine

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38
Q

This enzyme within Parietal Cells will break down CO2 and H2O to give us H+ and HCO3-.

A

Carbonic Anhydrase

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39
Q

In Parietal Cells, there is a net (ABSORPTION/SECRETION) of HCl and (ABSORPTION/SECRETION) of HCO3-.

A

Secretion
Absorption

***H+ is secreted, but Cl- follows it making HCl.

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40
Q

Gastric juice can be seen as a mixture of two separate secretions, _________ which is a basal alkaline secretion of constant and low volume, and _________, which is slightly hyperosmotic.

A

Non-parietal

Parietal

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41
Q

Non-parietal secretions primary constituents are Na+ and Cl-, K+ is present at the same concentration as in plasma. ________ is secreted at a concentration of about 30 mEq/L.

A

HCO3-

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42
Q

Parietal secretions contain H+ and K+, and ________ is the only anion present. As the secretion rate increases, the concentrations of electrolytes begin to approach those of pure parietal cell secretion.

A

Cl-

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43
Q

Knowledge of the composition of gastric juice is required in the treatment of patients suffering from _________ or patients maintained with ________.

A

Vomiting

IV

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44
Q

This inhibits the H+/K+ exchange to secrete H+ for HCl.

A

Omeprazole

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45
Q

There is a passive feedback mechanism regulating HCl secretion. As the pH falls, ________ release is inhibited, which decreases HCl secretion.

A

Gastrin

***Gastrin is secreted into the blood and normally stimulates the release of HCl!

46
Q

Describe the DIRECT pathway for Vagus N. stimulation of HCl secretion by Parietal Cells.

A

Vagus N. releases neurotransmitter ACh, which binds to Parietal Cells and stimulates HCl release.

***Atropine CAN block this pathway!

47
Q

Describe the INDIRECT pathway for Vagus N. stimulation of HCl secretion by Parietal Cells.

A

Vagus N. releases neurotransmitter GRP, which binds to G Cells. This stimulates release of Gastrin into the blood, which travels to Parietal Cells and stimulates HCl secretion.

***Atropine CAN NOT block this pathway because the neurotransmitter is GRP!

48
Q

This acts on G Cells to inhibit Gastrin release.

A

Somatostatin

49
Q

Vagal activation stimulates Gastrin release by releasing GRP and inhibiting the release of _________.

A

Somatostatin

50
Q

Gastrin has a negative feedback mechanism, where Gastrin itself will stimulate increased Somatostatin. _______ in the gastric lumen will also stimulate the release of Somatostatin.

A

H+

51
Q

This is the term for a combined response to two stimulants that exceed the sum of their individual responses. It requires the presence of separate receptors on the target cell for each stimulant.

A

Potentiation

52
Q

_________ potentiates the actions of ACh and Gastrin.

A

Histamine

53
Q

_________ potentiates the actions of Histamine and Gastrin.

A

ACh

54
Q

Antagonists of _________ (i.e., cimetidine) block the direct action of Histamine and also block potentiated effects of ACh and Gastrin.

A

H2 Receptors

55
Q

Antagonists of ________ (i.e., Atropine) block the direct effects of ACh and the Ash-potentiated effects of Histamine and Gastrin.

A

mAChRs

56
Q

This is an antagonist of H2 receptors, used to treat duodenal and gastric ulcers, gastroesophageal reflux disease, etc.

A

Cimetidine

57
Q

This inhibits the H+/K+ ATPase, and is used in the treatment of ulcers to reduce H+ secretion.

A

Omeprazole

58
Q

Gastric HCl secretion is divided into 3 phases, which are…

A

Cephalic Phase
Gastric Phase
Intestinal Phase

59
Q

This phase accounts for about 30% of the total HCl secreted in response to a meal. Stimuli include smelling and tasting, chewing, swallowing, and conditioned reflexes.

A

Cephalic Phase

60
Q

Describe the Cephalic Phase for HCl secretion.

A

This phase occurs via the Vagus N.

1) Direct Pathway = Vagus releases ACh to Parietal Cells. ACh stimulates secretion of HCl from Parietal Cells.
2) Indirect Pathway = Vagus releases GRP to G Cells, and G Cells release Gastrin into the circulation. Gastrin is delivered back to stomach to stimulate HCl secretion from Parietal Cells.

61
Q

What can abolish the Cephalic Phase for HCl secretion?

A

Vagotomy

62
Q

This phase accounts for about 60% of the total HCl secreted in response to a meal. Stimuli include distention of the stomach and presence of breakdown of proteins, amino acids, and small peptides.

A

Gastric Phase

63
Q

Describe the Gastric Phase for HCl secretion.

A

Distention activates mechanoreceptors in the mucosa of oxyntic and pyloric glands.

1) Vagus N. releases ACh which stimulates HCl secretion from Parietal Cells.
2) Vagus N. releases GRP, which stimulates Gastrin release into blood from G Cells. Gastrin goes back to stomach and stimulates HCl secretion from Parietal Cells.
3) Distention of the Antrum causes local reflexes. Releases ACh, which stimulates G Cells and Parietal Cells.
4) Amino acids and small peptides stimulate Gastrin release, which goes to Parietal Cells.

64
Q

________ (caffeinated and decaffeinated) also stimulates gastric HCl secretion.

A

Coffee

65
Q

This phase accounts for about 5-10% of the total HCl secretion in response to a meal.

A

Intestine Phase

66
Q

Describe the Intestine Phase for HCl secretion.

A

1) Distention of small intestine stimulates acid secretion.
2) Digested proteins stimulate acid secretion via direct effect on Parietal Cells and by stimulating Gastrin (intestinal G Cells) which go on to Parietal Cells.

67
Q

_________ is secreted secreted by Chief Cells and by Mucus Cells in the Oxyntic Glands. It requires H+ secretion from Parietal Cells to lower the pH of gastric contents (pH < 5).

A

Pepsinogen

***Pepsin will convert even more Pepsinogen to Pepsin!

68
Q

_______ _______ stimulation is the most important stimulus for Pepsinogen secretion.

A

Vagus N.

69
Q

H+ triggers local cholinergic reflexes that stimulate _______ _______ to secrete Pepsinogen.

A

Chief Cells

70
Q

Pepsin is a proteolytic enzyme that splits interior peptide linkages. Its optimal pH is ________, its pH for reversible inactivation is ________, and its pH for irreversible inactivation is ________.

A

1.8-3.5
> 3.5-5.0
> 7-8

71
Q

This is a mucoprotein secreted by Parietal Cells. It binds to Vitamin B12 and is the ONLY secretion by the stomach that is required (essential). Failure to secrete it is associated with achlorhydria (absence of HCl in gastric secretions) and with absence of Parietal Cells.

A

Intrinsic Factor (IF)

72
Q

This occurs if the stomach does not produce enough IF, causing decreased Vitamin B12 absorption. This disease is difficult to study because the liver stores enough Vitamin B12 to last for several years.

A

Pernicious Anemia

73
Q

This can be a cause of Pernicious Anemia, and is defined as chronic inflammation of the stomach mucosa that leads to loss of Parietal Cells.

A

Atrophic Gastritis

74
Q

This can be a cause of Pernicious Anemia, and occurs when the immune system attacks IF protein or gastric Parietal Cells.

A

Autoimmune Metaplastic Atrophic Gastritis

75
Q

This surgical procedure can cause a loss of Parietal Cells (source of IF).

A

Gastrectomy

76
Q

This surgical procedure can cause exclusion of the stomach, duodenum, and proximal jejunum which alters absorption of Vitamin B12.

A

Gastric Bypass

77
Q

Gastric epithelium secretes _______ and _______ to form the gel-like mucosal barrier. Mucous cells secrete _______ and Surface Epithelial cells secrete _______.

A

Mucus
HCO3-
Mucus
HCO3-

78
Q

The mucosal barrier protects the gastric mucosal epithelium against what?

A

HCl

Pepsin

79
Q

What protects the gastric mucosa?

A 
HCO3-
Mucus
Prostaglandins 
Mucosal Blood Flow
Gastrin
Growth Factors
80
Q

What damages the gastric mucosa?

A 
Acid 
Pepsin
NSAIDs (i.e., aspirin)
Helicobacter Pylori
Alcohol
Bile
Stress
81
Q

This disease occurs due to a large secretion of Gastrin by duodenal or pancreatic neuroendocrine tumors (gastrinomas). Causes increased H+ secretion by Parietal Cells, as well as increased Parietal Cell mass (trophic effect). H+ secretory rates are the highest, and inhibits the absorption of sodium and water by the small intestine (secretory diarrhea).

A

Zollinger-Ellison Syndrome

82
Q

When excessive H+ arrives to the duodenum, it overwhelms the buffer capacity of HCO3- in pancreatic juice, creating an _______. This occurs in Zollinger-Ellison Syndrome.

A

Ulcer

83
Q

In this disease, the low pH of intestinal contents leads to:

    • Inactivates pancreatic digestive enzymes
    • Interferes with the emulsification of fat by bile acids
    • Damages intestinal epithelial cells and villi
    • Leads to maldigestion and malabsorption (both result in steatorrhea)
A

Zollinger-Ellison Syndrome

84
Q

This is used in the diagnosis of Gastrin-secreting tumors. Under normal conditions, it inhibits Gastrin release. However, in Gastrinomas, injection of it will cause a paradoxical increase in Gastrin release.

A

Secretin

***Called Secretin Stimulation Test!

85
Q

In the US, Helicobacter pylori infection and the use of NSAIDs are the predominant causes of this. It could be the results of loss of protective mucosal barrier, or excessive H+ and Pepsin secretions.

A

Peptic Ulcer Disease

86
Q

There are two types of Peptic Ulcers, which are…

A

Gastric Ulcers

Duodenal Ulcers

87
Q

A major acquired factor in the origin of both gastric ulcer and duodenal ulcer is Helicobacter pylori. It releases cytotoxins that breakdown the mucosal barrier and underlying cells. The enzyme ________ allows the bacteria to colonize the gastric mucosa.

A

Urease

88
Q

In H. pylori, urease converts urea to _________ which alkalinizes the local environment. The resulting production of this is believed to be a major cause of cytotoxicity. It allows for damage of epithelial cells and breaks the mucosal barrier. A diagnostic test is based on urease activity.

A

Ammonia (NH3)

89
Q

These form on the lining of the stomach, and form mainly because gastric mucosal barrier is defective, as opposed to increased acid secretion.

A

Gastric Ulcers

90
Q

These form on the lining of the duodenum, and are more common. They usually do not become malignant and H+ secretion rates are higher than normal.

A

Duodenal Ulcers

91
Q

What disorder of gastric H+ secretion is being described below?

– Decreased H+ secretion

– Increased Gastrin levels (because of decreased H+ secretion)

– Causes damage to protective barrier of gastric mucosa

A

Gastric Ulcer

92
Q

What disorder of gastric H+ secretion is being described below?

– Increased H+ secretion

– Increased Gastrin levels (gastrin response to ingestion of food)

– Increased Parietal Cell mass due to increased Gastrin levels

A

Duodenal Ulcer

93
Q

What disorder of gastric H+ secretion is being described below?

– Highly increased H+ secretion

– Highly increased Gastrin levels

– Gastrin is secreted by pancreatic tumor

– Increased Parietal Cell mass due to trophic effect of increased Gastrin levels

A

Zollinger-Ellison Syndrome

94
Q

_________ juice contains HCO3- for the neutralization of H+ from the stomach, and enzyme secretions to digest carbohydrates, proteins, and lipids into absorbable molecules.

A

Pancreatic

95
Q

What provides sympathetic innervation to the exocrine pancreas?

A

Postganglionic nerves from the celiac and superior mesenteric plexuses

96
Q

What provides parasympathetic innervation to the exocrine pancreas?

A

Vagus N.

    • Preganglionic fibers synapse in ENS
    • Postganglionic fibers synapse on the exocrine pancreas
97
Q

In contrast to the salivary glands, in general, parasympathetic activity (INHIBITS/STIMULATES) pancreatic secretion and sympathetic activity (INHIBITS/STIMULATES) pancreatic secretion.

A

Stimulates

Inhibits

98
Q

Secretions of the exocrine pancreas has two main components, which are…

A
    • Aqueous solution containing HCO3-

- - Enzymatic secretion

99
Q

Exocrine pancreas is organized like salivary glands. The ________ has cells that synthesize and secrete major enzymes for digestion.

A

Acinus

***The cells are Acinar Cells!

100
Q

In the exocrine pancreas, ducts are lined by ductal epithelial cells and extends to the region in the acinus containing ________ ________. These cells secrete the aqueous solution containing HCO3-.

A

Centroacinar Cells

101
Q

Pancreatic enzymatic secretion by acinar cells include _______ _______ and _______ _______ in their active form. ________ ________ are secreted in inactive forms and converted to their active forms in the lumen of the duodenum.

A

Pancreatic Amylases
Pancreatic Lipases
Pancreatic Proteases

102
Q

The pancreatic aqueous secretion by the Centroacinar and Ductal Cells secrete a _______ rich fluid that alkalinizes and hydrates the protein-rich primary secretions of the Acinar cell. The initial secretion is modified by transport processes in the ductal epithelial cells.

A

HCO3-

103
Q

Pancreatic ductal cells have a net result of (SECRETION/ABSORPTION) of HCO3- into pancreatic ductal juice and net (SECRETION/ABSORPTION) of H+ into the blood.

A

Secretion

Absorption

104
Q

What is the difference between salivary and pancreatic ducts regarding tonicity?

A 
Salivary = Hypotonic
Pancreatic = Isotonic
105
Q

This disease is caused by mutations in the CFTR, which is a regulated Cl- channel in the apical surface of the duct cell. In this disease, the Pancreas is one of the 1st organs to fail. Some CFTR mutations seem to be associated with a loss of HCO3- secretion. Ability to flush active enzymes out of the duct may be lost and may lead to recurrent acute and chronic pancreatitis.

A

Cystic Fibrosis

106
Q

Like gastric secretion, pancreatic secretion is divided into what 3 phases?

A

Cephalic Phase
Gastric Phase
Intestinal Phase

107
Q

What phase of pancreatic secretion is being described below?

    • Initiated by smell, taste, and conditioning
    • Mediated by the Vagus N.
    • Produces mainly an enzymatic secretion
A

Cephalic Phase

108
Q

What phase of pancreatic secretion is being described below?

    • Initiated by distention of the stomach
    • Mediated by the Vagus N.
    • Produces mainly an enzymatic secretion
A

Gastric Phase

109
Q

What phase of pancreatic secretion is being described below?

    • Accounts for 80% of pancreatic secretion
    • Enzymatic and aqueous secretions are stimulated
A

Intestinal Phase

110
Q

_______ induces the release of pancreatic enzymes into the duodenal lumen.

A

CCK

111
Q

_______ induces the secretion of HCO3- from pancreatic cells into the duodenum.

A

Secretin

GIGU - Week 2 (10 decks)

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