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Advanced Patho UC > Exam #4 GI > Flashcards

Exam #4 GI Flashcards

1
Q

saliva composed of…

A

water w/mucus, sodium chloride, bicarb, K+, and salivary amylase (carb digestion) and is controlled by ANS

also contains IgA - prevents orally ingested microorganisms

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2
Q

What fibers stimulate the salivary glands? what meds inhibit?

A

cholinergic parasympathetic fibers stimulate salivation

anticholinergic meds inhibit salivation

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3
Q

stimulation of what decreases salivary secretion

A

sympathetic beta-adrenergic stimulation decreases salivary secretion - none, little, or little with rich protein content

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4
Q

normal pH of saliva

A

pH of 7.4 which neutralizes bacterial acids aiding to prevent infections

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5
Q

prevents air entry into the esophagus during respiration

A

upper esophageal sphincter

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6
Q

also called the cardiac sphincter - prevents acidic content regurgitation from the stomach

A

lower esophageal sphincter

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7
Q

what increases the tone of the lower esophageal sphincter? two things

A

cholinergic vagal stimulation and the digestive hormone gastrin

*Gastrin helps the pancreas produce enzymes for digestion and helps the liver produce bile. It also stimulates the intestines to help move food through the digestive tract.

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8
Q

what decreases the tone/relaxes the lower esophageal sphincter

A

non-adrenergic, non-cholinergic vagal impulse and the hormones progesterone, secretin, and glucagon

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9
Q

sphincters & chyme…

A

lower esophageal (chyme enters from esophagus into the stomach), pyloric (chyme exits stomach into duodenum of small intestines

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10
Q

the stomach can absorb very few substances, but can absorb?

A

alcohol, aspirin, NSAIDS

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11
Q

gastric hydrochloric acid does what? secreted by? converts what to what? stimulated by (what medication comes into play)? inhibited by?

A
  • secreted by parietal cells of the stomach
  • dissolves food fibers
  • acts as bactericidal agent
  • converts pepsinogen to pepsin (breakdown of proteins)
  • stimulated by: acetylcholine via vagus nerve, caffeine, calcium, gastrin (stimulates secretion of gastric acid by parietal cells), histamine
  • inhibited by: prostaglandins (mucus), gastric inhibitory peptide, somatostatin, secretin
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12
Q

two things that protect the mucosal barrier? mucus works to do what?

A

prostaglandins and nitric oxide: protect the mucosal barrier by stimulation of mucous and bicarbonate to inhibit acids

mucus protects against aspirin, NSAIDS, H.pylori, ethanol, regurgitated bile, and ischemia to prevent inflammation and ulceration

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13
Q

Gastric glands: primary secretory units contain what type(s) of cell(s)

A 
parietal cells 
chief cells 
G cells 
Enterochromaffin-like cells
D cells
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14
Q

parietal cells secrete?

A

secrete HCl acid and intrinsic factor, gastroferrin

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15
Q

chief cells secrete?

A

The primary function of gastric chief cells is the synthesis and release of the proenzyme pepsinogen, which subsequently, in an acid environment, is converted to the acid protease pepsin. Pepsin breaks down proteins in the stomach

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16
Q

g cells secrete?

A

gastrin (hormone) - *Gastrin helps the pancreas produce enzymes for digestion and helps the liver produce bile. It also stimulates the intestines to help move food through the digestive tract.

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17
Q

enterochromaffin-like cells produce

A

produce and secrete histamine

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18
Q

D cells

A

somatostatin

Somatostatin produces predominantly neuroendocrine inhibitory effects across multiple systems. It is known to inhibit GI, endocrine, exocrine, pancreatic, and pituitary secretions, as well as modify neurotransmission and memory formation in the CNS

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19
Q

phases of gastric secretion

A

celiac phase
gastric phase
intestinal phase

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20
Q

celiac phase of gastric secretion

where does it begin? what is secreted? mediated by? what is a strong stimulus to gastric secretion?

A

mouth

  • begins with smelling, seeing, tasting, chewing, swallowing
  • mediated by the vagus nerve
  • acid, pepsinogen, gastrin secreted
  • insulin secreted by pancreas to hyperglycemia and is strong stimulus to gastric secretion
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21
Q

gastric phase of gastric secretion

mediated by? blocked by?
2 major stimuli?

A

stomach

-begins with arrival of food to stomach
-2 major stimuli to secretory effect – distension of stomach and presence of digested protein
-vagus nerve stimulated by distension – contributes
to secretion stimulus
-mediated by acetylcholine and can blocked by
atropine

*distension causes PSNS activation of the vagus nerve which continues the signal to secrete HCl and pepsin

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22
Q

_____ levels higher in gastric secretions than in plasma

what is this important to note with?

A

potassium

important in vomiting, suctioning, etc.

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23
Q

______ allows for relaxation of lower esophageal sphincter during swallowing

A

vagus nerve

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24
Q

what two things enhance relaxation of the stomach. Remember that one of them normally increases tone of LES

A

gastrin and cholecystokinin

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25
what three things increase peristalsis contractions of the stomach
gastrin, motilin, and low blood glucose enhance peristalsis
26
what three things inhibit peristalsis
sympathetic activity, secretin, and cholecystokinin inhibit peristalsis
27
the vagus nerve stimulates (parasympathetic) _____ and ______
stimulates gastric secretion and motility
28
gastric emptying is increased by? decreased by?
increased gastric emptying occurs d/t large volume consumption delayed by solids, fats, and non-isotonic solutions *slowed down by fats d/t cholecystokinin -- inhibits intake, gastric motility, decreases gastric emptying so that fats do not exceed rate of bile and enzyme secretion
29
Intestinal phase - begins with? does what? what inhibits gastric secretions?
- begins with movement of chyme from stomach to duodenum - decelerates gastric secretion -- when chyme enters alkaline environment of duodenum -- inhibitory vagal reflexes decrease gastric motility - secretin and cholecystokinin stimulate pancreatic secretions and inhibit gastric secretions
30
• Peritoneum – serous membrane surrounding the organs of the abd and pelvic cavity • Visceral – lies over the organs • Parietal – lines the wall of the abd cavity • Inflammation of the peritoneum, peritonitis, occurs with perforation of the intestine or after surgery • Peritoneal cavity: Space between the two layers of the peritoneum
Know these remember it's visceral peritoneum and parietal peritoneum
31
________ within the small intestine slow the passage of | food providing more time for digestion and absorption (more numerous in the jejunum and upper ileum)
Mucosal folds (plica) - part of the muscular layer of the small intestines
32
Myenteric plexus and mucosal plexus of the small intestines
site of intrinsic motor innervation mediation • Parasympathetic – secretion, motility, pain sensation, and intestinal reflexes mediation • Sympathetic – inhibits motility and produces vasoconstriction
33
Villi in the SI - what occurs here?
– cover the mucosal folds and are the functional units of the intestine • Absorption occurs through the villi
34
Villus composed of two things?
absorptive columnar cells (enterocytes) and mucus | secreting goblet cells of the mucosal epithelium
35
Surface of each columnar epithelial cell contains ______ _____ with microvilli increase surface area for absorption
contains microvilli remember there's a villi and microvilli that cover it villi and microvilli increase surface area for absorption
36
All nutrients are absorbed in the _______ as well as 85% of the water and fluid intake
small intestines
37
Carbohydrates digested into? What breaks it down? Sugars absorbed where?
- digested into monosaccharides and disaccharides - salivary and pancreatic amylase break down starches - sugars are primary absorbed in the duodenum and in the upper jejunum (so first two parts of SI)
38
Proteins digested into? Where are they broken down by hydrolysis? Carboxypeptidase?
- digested into amino acids and peptides - pancreatic enzymes accomplish major protein hydrolysis in small intestines (trypsin and chymotrypsin hydrolyze the bonds or large molecules - endopeptidase) - carboxypeptidase: breaks away the end amino acids (exopeptidase)
39
Fats digested into?
fatty acids and monoglycerides
40
fat digestion step 1
1. emulsification: emulsifying agents cover the small fat particles and prevent them from reforming into fat droplets - fats are then ready for lipolysis - LIPASE (from pancreas) breaks down triglycerides; PHOSPHOLIPASE cleaves fatty acids from phospholipids; CHOLESTEROL ESTERASE breaks down cholesterol esters
41
fat digestion step 2 - 4 see notes, not bolded
...
42
Most minerals are absorbed by _______ or ______ Most ________ vitamins are passively absorbed or by sodium-dependent active transport
most minerals are absorbed by passive diffusion or active transport (requires energy) or are actively transported with a carrier protein most water-soluble vitamins are passively absorbed or by sodium-dependent active transport
43
Large intestines do what?
Massages fecal mass; absorbs water and electrolytes mucus secreting goblet cells are in the LI, but no villi
44
Intestinal motility: Contractions of the circular muscles, called ________, mixes the chyme and promotes digestion
segmentation
45
_______ inhibits gastric motility when the ileum is distended
Ileogastric reflex
46
The _________ reflex inhibits intestinal motility when one intestinal segment is over distended
intestinointestinal
47
_________ increases intestinal motility when gastric motility increases • Initiates propulsion in the entire colon, usually during or immediately after eating, when chyme enters from the ileum • Causes fecal mass to pass rapidly into the sigmoid colon and rectum, stimulating defecation • Stimulates the reflex: Gastrin and cholecystokinin • Inhibits the reflex: Epinephrine • Increased intra abdominal pressure facilitates defecation
Gastroileal reflex
48
Liver produces __________ necessary for fat digestion and absorption • Receives nutrients absorbed by the small intestine; which are metabolized and synthesized into forms that can be used by the body’s cells • Then releases them into the bloodstream or stores them for later use
bile, with salts
49
Exocrine pancreas produces what?
enzymes needed for complete digestion of carbohydrates, proteins, and fats • Also produces an ALKALINE FLUID that neutralizes chyme and produces duodenal pH necessary for enzymatic function *These enzymes include trypsin and chymotrypsin to digest proteins; amylase for the digestion of carbohydrates; and lipase to break down fats.
50
Contractions of circular muscles (_______) mixes chyme and promotes digestion
segmentation
51
Inhibits gastric motility when the ileum is distended
Ileogastric reflex
52
Inhibits intestinal motility when one intestinal segment is over distended
intestinointestinal reflex
53
Increases intestinal motility when gastric motility increases
gastroileal reflex - stimulates gastrin and cholecystokinin and decreases epinephrine - initiates propulsion in the entire colon, usually during or right after eating
54
Liver lobules contain plates of hepatocytes that are the functional cells of the liver...what do they do?
hepatocytes synthesize 700-1200mL of bile per day and secrete into bile canaliculi -- small channels b/w hepatocytes that can drain bile into the common bile duct and then into the duodenum through the sphincter of Oddi
55
What are canaliculi
small channels b/w hepatocytes that can drain bile into the common bile duct and then into the duodenum through the sphincter of Oddi
56
Star shaped cells that store lipids including vitamin A
lipocytes in the liver
57
mononuclear phagocyte system in the liver central to innate immunity
Kupffer cells - phagocytic cells in the liver
58
contain retinoids (vitamin A) - are contractile in liver injury, regulate sinusoidal blood flow, may proliferate into myofibroblasts, participate in liver fibrosis, remove foreign substances from the blood, and trap bacteria
stellate cells
59
pit cells in the liver are what? why are they important?
Natural killer cells - important in tumor defense
60
alkaline, bitter-tasting, yellowish green fluid that contains bile salts, cholesterol, bilirubin, electrolytes, and water
bile secretion
61
conjugated bile acids that are required for the intestinal emulsification and absorption of fats
bile salts
62
synthesized from cholesterol by the hepatocytes and are required for intestinal emulsification and absorption of fats
primary bile acids - primary acids are then conjugated to form bile salts
63
product of bile salts deconjugation by bacteria in the intestinal lumen
secondary bile acids
64
enterohepatic circulation
recycling of bile salts, also called choleresis
65
choleretic agent | strong?
substance that stimulates the liver to secrete bile strong stimulus: high concentration of bile salts other cholerectic agents? secretin, cholecystokinin, vagal stimulation
66
pigment which is the by-product of the destruction of aged red blood cells in the liver and spleen
bilirubin *bilirubin gives bile a greenish black color and produces the yellow tinge of jaundice
67
unconjugated bilirubin
is lipid soluble and can cross the cell membrane, present in the circulation, bound to plasma protein
68
conjugated bilirubin
liver changes bilirubin to a water-soluble form that can now be excreted primary method of bilirubin excretion is in the bile
69
urobilinogen
in the ileum and colon, conjugated bilirubin is deconjugated by bacteria and then converted gives feces its brown color
70
higher percentage of unconjugated bilirubin = ?
heme breaking down, or inability of liver to conjugate *ex. missing enzyme (congenital), hemolytic anemia
71
higher percentage of conjugated bilirubin = ?
problem with secretion into bile *ex. biliary obstruction, hepatitis
72
liver functions
- vascular and hematologic functions: stores bloods, removes bacteria or foreign particles, synthesizes clotting factors - metabolizes fats (bile) - synthesizes phospholipids and cholesterol - metabolizes proteins - deamination: the removal of ammonia (converted to urea and secreted in urine); converts amino acids into carbohydrates - metabolizes carbohydrates: liver releases glucose during hypoglycemia; takes up glucose during hyperglycemia; stores glucose as glycogen (glyconeogenesis) or converts it to fat - detoxification through biotransformation - storage of minerals and absorption of fat-soluble vitamins *vit K - essential for synthesis of clotting factors; absorption depends on adequate bile production

Advanced Patho UC (14 decks)

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