2. Secretions of GI Tract and Pancreas Flashcards

1
Q

What are the key functions of saliva

A
  • Initial digestion of starches and lipids
  • Dilution and buffering of ingested food
  • Lubrication of ingested food with mucus
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2
Q

What is the serous salivary gland and what is its function

A

Parotid Gland

  • Secrete fluids composed of water, ion and enzymes (rich in AMYLASE)
  • 25% of daily saliva
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3
Q

What are the mixed salivary glands and what are their functions

A

Submandibular and Sublingual

  • Secrete aqueous fluid and mucin glycoprotein for lubrication
  • Secrete MOST of the saliva (75%)
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4
Q

What cells secrete the initial saliva and saliva with similar composition to plasma

A

Initial- acinus

same composition as plasma- intercalated duct

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5
Q

What cells modify the initial saliva to produce the final saliva

A

In the striated duct, Ductal cells modify the intial salica into the final HYPOTONIC saliva

(Ductal cells are H2O impermeable)

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6
Q

How does saliva compare to plasma

A

Hypotonic

  • Increased potassium and bicarb
  • Decreased sodium and chloride
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7
Q

What are the two main steps in the formation of saliva

A
  1. Formation of isotonic plasma-like solution by acinar cells
  2. Modification of the isotonic solution by the ductal cells
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8
Q

What is the net movement of molecules for salivary secretion

A

Net absorption of solute with NaCl being absorbed and secretion of K and HCO3

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9
Q

In salivary secretion how does bicarb leave the cell

A

HCO3 leaves the cell to the lumen via cAMP activated CFTR Cl- channel or via the Cl-/HCO3- exchanger

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10
Q

What are the innervations of the salivary glands

A

Parasympathetic- facial and glossopharyngeal

Sympathetic- T1 to T3 via superior cervical ganglion

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11
Q

What is the role of ADH/Aldosterone in saliva compositon

A

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

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12
Q

What are the two unusual features of salivary secretion regulation

A
  • Salivary is EXCLUSIVELY under the control of the ANS

- Salivary secretion is INCREASED by BOTH parasympathetic and sympathetic stimulation

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13
Q

The gastric mucosa is divided into the oxyntic gland area and pyloric gland area. Describe the oxyntic gland

A
  • Located in the proximal 80% of the stomach (body and fundus)
  • Secretes acid
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14
Q

The gastric mucosa is divided into the oxyntic gland area and pyloric gland area. Describe the pyloric gland

A
  • Located in the distal 20% of the stomach (antrum)

- Synthesizes and releases gastrin

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15
Q

What is the major function of parietal cells

A

SECRETION of HCl and absorption of HCO3-
(catalyzed by carbonic anhydrase)

Low pH is required to convert pepsinogen to pepsin

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16
Q

What does Omeprazole do

A
  • Inhibits the H+/K+ ATPase

- Used in the treatment of ulcers to reduce H+ secretion

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17
Q

What is important about the parietal component of gastric secretion

A

As the secretion rate increase, the concentrations of electrolytes begin to approach those of pure parietal cell secretion

18
Q

What agents stimulate H+ secretion by gastric parietal cells

A
  • Acetylcholine
  • Gastrin
  • Histamine
19
Q

What agents inhibit H+ secretion by gastric parietal cells

A
  • Somatostatin (acts on G cells to inhibit gastrin release)

- Prostaglandins

20
Q

Does atropine work on the direct or indirect pathway of vagal stimulation of HCl secretion by parietal cells

A

Direct- atropine blocks the direct pathway of vagal stimulation
Indirect- atropine will not block the vagal effects on gastrin secretion because the neurotransmitter at the synapse on G cells is GRP

21
Q

What does Cimetidine do

A

Antagonist of H2 receptors used to treat duodenal and gastric ulcers, GERD

22
Q

What are the three phases of Gastric HCl secretion

A
  1. Cephalic phase via vagus
  2. Gastric phase
  3. Intestinal phase
23
Q

Describe the cephalic phase of Gastric HCl secretion and how to abolish this phase

A
  • Accounts for 30% of total HCl secreted in response to a meal
  • Stimulated by smelling, tasting, chewing and swallowing

Vagotomy abolishes this phase

24
Q

Describe the gastric phase of Gastric HCl secretion and how to abolish this phase

A
  • Accounts for 60% of total HCl secreted in response to a meal
  • Stimulated by distension of the stomach

(coffe stimulates gastric HCl secretion)

25
When is pepsinogen secreted
- ONLY when the gastric pH is acidic enough to convert it to pepsin - Vagus nerve stimulation is the most important stimulus
26
How does pH change pepsin
Optimal = 1.8 - 3.5 Reversibly inactivated = 3.6 - 5.0 Irreversibly inactive = pH greater than 7
27
What is Intrinsic Factor required for and what secretes it
- Required for absorption of Vitamin B12 in the Ileum | - Secreted by parietal cells
28
What leads to pernicious anemia and what are its common causes
Failure to secrete IF leads to pernicious anemia Common causes: - Atrophic gastritis (loss of parietal cells) - Autoimmune metaplastic atrophic gastritis (immune cells attack IF protein)
29
What procedures can disrupt the absorption of vitamin B12
Gastrectomy- loss of parietal cells | Gastric Bypass
30
What protects the gastric mucosa
- HCO3 and mucus - Prostaglandins (misoprostol) - Mucosal blood flow - Gastrin and growth facotrs
31
What damages the gastric mucosa
- H+ and Pepsin - NSAIDs - Helicobacterpylori - Alcohol and Smoking - Bile and stress
32
What is Zollinger-Ellison Syndrome
- Large secretion of gastrin by gastrinomas | - When excessive H+ arrives to duodenum it overwhelms the buffer capacity of HCO3- in pancreatic juice creating an ulcer
33
What is used to diagnose a gastrin-secreting tumor
Secretin stimulation test
34
What are the predominant causes of Peptic Ulcer Disease and what are they the result of
Causes- H Pylori infection and NSAIDs Result of- loss of protective mucosal barrier, excessive H+ and pepsin secretions
35
What allows H Pylori to colonize gastric mucosa
The Enzyme UREASE
36
When comparing disorders of gastric H+ secretion what is different between gastric ulcers, duodenal ulcers and Zollinger-Ellison syndrome
Gastric- decreased H+ secretion Duodenal- increased H+ secretion Zollinger- VERY INCREASED H+ secretion All have increased gastrin levels
37
How is the exocrine pancreas innvervated differently from salivary glands
Parasympathetics stimulate still but sympathetics inhibit
38
What are the two components of pancreatic secretions
Active enzymes- amylases and lipases | Inactive enzymes- proteases converted into active form in lumen of duodenum
39
What is the first organ to fail in Cystic Fibrosis
Pancreas
40
What are the key secretions from the three phases of pancreatic secretion
Cephalic- mainly enzymatic secretion Gastric- mainly enzymatic secretion Intestinal- 80% of secretion, enzymatic and aqueous secretions