65 - GI Digestion and Absorption Flashcards

1
Q

Describe the general pathway of carbohydrate digestion

A
  • Carbohydrate digestion is initiated in the mouth by salivary amylase
  • Subsequently, pancreatic amylase continues digestion in the lumen of
    the intestines.
  • Further digestion of oligosaccharides by specific enzymes at the intestinal brush border yields monosaccharides
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2
Q

Describe the basics of carbohydrate absorption

A
  • Following digestion, glucose and galactose are transported into the intestinal enterocyte by the sodium-glucose transporter (SGLT-1) and fructose via the glucose transporter, GLUT-5
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3
Q

What are the three main transporters of carbohydrates and what do they transport?

A
  • SGLT-1: sodium-glucose transporter
  • GLUT-5: fructose via the glucose transporter
  • GLUT-2: responsible for the transport of all three monosaccharides across the basolateral membrane
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4
Q

Where does most carbohydrate absorption occur?

A

Carbohydrates are absorbed throughout the small intestines; however the greatest uptake occurs in the duodenum

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5
Q

Describe the basic pathway of protein digestion

A
  • Gastric peptidases (pepsin) initiate protein digestion in the stomach
  • Once chyme enters the duodenum, pancreatic peptidases (trypsin, etc.) continue to digest proteins to oligopeptides
  • When these peptides reach the intestinal brush border, they can be absorbed by enterocytes or be completely digested to amino acids and subsequently absorbed
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6
Q

Describe the basic pathway of protein absorption

A
  • There a multiple transporters that mediate oligopeptide and amino acid uptake in the small intestine
  • For example, the oligopeptide transporter (PEPT1) and the amino acid transporter B mediated uptake across the apical membrane of intestinal enterocytes
  • Like the carbohydrates, proteins are absorbed throughout the small intestine; however the greatest uptake occurs in the duodenum
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7
Q

Describe lipid digestion

A
  • Initiated in the stomach
  • Lingual lipase and gastric lipase digest lipids in the stomach
  • Both are enzymatically active at the relatively low pH in the stomach and are resistant to pepsin digestion
  • Once in the lumen of the duodenum, the lipases will be degraded by pancreatic proteases (trypsin)
  • Pancreatic lipases then digest the lipids further, releasing more free fatty acids
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8
Q

Describe lipid emulsification

A
  • Gastric churning also helps with emulsifying the lipid droplets in the stomach
  • In the duodenum, bile is mixed with the emulsified lipid droplets forming micelles
  • Micelles: bile salt, cholesterol, other lipids
  • Micells increase solubility of lipids by forming a spherical droplet with a hydrophilic border and hydrophobic core
  • This dramatically increases delivery of lipids through mucus/water layer to the brush border for absorption
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9
Q

Describe lipid absorption

A
  • Once the micelle reaches the mucosal surface, the lipid content of the micelle can be absorbed and the bile salts are recycled
  • Absorption of many lipids is mediated by simple diffusion through the lipid bilayer whereas cholesterol can be taken up by a specific transporter
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10
Q

What is the cholesterol-specific transporter?

A

Neimann Pick C1 Like1 (NPC1L1)

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11
Q

What else is taken up similarly to lipids?

A

In addition to dietary lipids, it should be noted that fat soluble vitamins such as Vitamin A, D, E, and K partition into the micelle for delivery to the absorptive enterocytes

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12
Q

What happens once lipids have been taken up?

A
  • Following cellular uptake of dietary lipids, the lipids are packaged with a family of proteins known as lipoproteins
  • These lipoproteins along with the lipids form a chylomicron
  • Chylomicrons eventually make their way into the circulation
  • The chylomicrons will then be taken up by the liver
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13
Q

Where does the greatest amount of lipid absorption occur?

A

Lipids are also absorbed throughout the small intestines; however the greatest uptake occurs in the duodenum

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14
Q

Where is folic acid absorbed?

A

Primarily in the duodenum

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15
Q

How is folic acid absorbed?

A

The uptake of folic acid is mediated by an exchange protein expressed on the surface of enterocytes

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16
Q

Where is vitamin B12 absorbed?

A

In the ileum

17
Q

Describe the mechanism for vitamin B12 absorption

A
  • Intrinsic factor (IF) secreted by the parietal cells of the stomach is required for the absorption of Vitamin B12
  • Once IF and Vitamin B12 pass from the stomach into the duodenum they form a complex
  • The IF-Vitamin B12 complex is then taken up by receptor-mediated process in the ileum
  • Once the Vitamin B12 is inside the cell it binds to the carrier protein transcolbalmin II
  • The transcolbalmin II-Vitamin B12 complex is secreted into the blood and taken up by the liver for storage
18
Q

Where is calcium absorbed?

A

Calcium absorption occurs primarily in the duodenum

19
Q

Describe the mechanism for vitamin B12 absorption

A
  • The uptake of calcium by the absorptive enterocyte requires the expression of a calcium channel
  • The presence of this channel is regulated at the level of transcription by the fat soluble vitamin, Vitamin D
20
Q

What happens when there is a vitamin D deficiency in relation to Ca++?

A

Nutritional deficits resulting in impaired Vitamin D uptake or synthesis will also result in impair calcium channel expression in the duodenum and a resulting hypocalcaemia.

21
Q

Where is iron absorbed?

A

Small intestine

22
Q

Iron is available in two forms. What are they?

A

Iron is available in two forms, ferrous iron (Fe+2) and ferric iron (Fe+3).

23
Q

Why is calcium needed for iron absorption?

A
  • The ferric form of
    iron precipitates at pHs greater than 3.
  • Therefore, in the neutral environment in the small intestines ferric iron will precipitate and is unabsorbable
  • Vitamin C-dependent reduction of ferric iron to ferrous iron will render the iron soluble
24
Q

How is soluble iron taken up?

A
  • Similar to Vitamin B12 absorption, ferrous iron uptake in the small intestines is mediated by a receptor that binds and internalizes the soluble transferrrin-Fe+2 complex
  • Ferrous iron can also be taken up by the divalent cation transporter 1 (DCT1)
  • Iron is transferred into the blood where it complexes with plasma transferrin and is carried to the liver
25
Q

What is lactose intolerance?

A
  • The inability to digest lactose (lactose intolerance) results in an increased liquidity of the stool or diarrhea
26
Q

How does lactose intolerance cause diarrhea?

A
  • Accumulation of luminal lactose from dairy products results in changes in osmotic pressure that cause water to remain in lumen of the intestine
  • Additionally, intestinal bacteria will breakdown lactose liberating gas which causes pain and discomfort for the patient.
27
Q

What is celiac sprue?

A

Celiac sprue (Gluten-sensitive enteropathy) is a loss of mature villi of the duodenal and jejunal epithelium following ingestion of gluten (protein component of cereal grains)

28
Q

Describe the pathophysiology of celiac sprue

A
  • The damage to the intestinal mucosa is due to a hyperactive immune response stimulated by gluten.
  • Ultimately this response causes significant cell death to the intestinal epithelial cells.
  • As a result of the intestinal cell death the villi shorten.
  • Consequently, the surface area of the small intestines is greatly reduced which ultimately decreases the absorptive capacity of the small intestine
29
Q

What is pernicious anemia?

A

Pernicious anemia is a Vitamin B12 deficiency often caused by atrophy of gastric mucosa and parietal cells resulting in a loss of intrinsic factor production

30
Q

Descibe the pathophysiology of celiac sprue

A
  • Vitamin B12 and folic acid (FA) are important for DNA synthesis, impaired absorption of these nutrients results in a decrease in cell growth.
  • This has a significant effect on hematopoiesis.
  • The result is a decrease in the quantity of blood cells; however the blood cell actually increases in size but does not divide resulting in a megaloblastic anemia.
31
Q

Onto case #7…

A

Go read case #7

32
Q

What does the diagnostic information indicate?

A

Absorption problem

33
Q

Given the information from the diagnostic tests, what is the impact on digestive processes (gastric, pancreatic, intestinal)?

A

Histological examination

  • Showed a flattening of the villi (indicates Celiac sprue)
  • This explains all of the other symptoms
  • Symptoms include slow growth is a result of the malabsorption

X-ray of hand
- The bones are thin (vitamin D problem)

Family history

  • Rickets fits in with a celiac diagnosis
  • He couldn’t absorb B12 so he got shots, which may have put cell replication into overdrive and resulted in B cell lymphoma
34
Q
  1. What is the cause of diarrhea (osmotic vs. secretory)?
A

Diarrhea is osmotic because he isn’t absorbing much of the material eaten. This shifts the osmotic gradient causing water retention in the lumen.