gastric physiology 2 Flashcards

1
Q

which cells secrete protease

A

chief cells produce pepsinogen

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2
Q

why is pepsin secreted as inactive zymogen

A

it is stored this way to prevent it digesting the chief cells and the rest of the body

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3
Q

how is pepsin secreted

A

synthesised i’m inactive form (zymogen)

pepsinogen mediated by input from enteric nervous system (ACh)

secretion parallels HCL secretion

luminal activation

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4
Q

how is protease activated

A

conversion of pepsinogen to pepsin is pH dependent

When pepsinogen is released into the stomach lumen, the low pH (generated by HCL) of the stomach activates a rapid autocatalytic process in which pepsin is produced from pepsinogen

  • Once some pepsin is prodcued, it can be used to produce more since it can aid in the cleavage of pepsinogen - positive feedback

most efficient when pH <2

positive feedback loop (pepsin also catalyses the reaction)

pepsin only active at low pH
irreversible inactivation in small intestine by HCO3-

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5
Q

what does HCO3- do

A

HCO3- released in the duodenum irreversibly inactivates pepsin

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6
Q

role of pepsin in protein digestion

A

not essential (protein digestion can occur if the stomach is removed)

accelerates protein digestion

breaks down collagen in meat - helps shred meat into smaller pieces with greater surface area for digestion

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7
Q

how much of total protein digestion does pepsin account for

A

about 20%

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8
Q

what happens if pepsin is removed

A

no vitamin B-12 absorption can occur in the small intestine since the
stomach parietal cells produce intrinsic factor

  • essential for vitamin B-12
    absorption in the small intestine
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9
Q

volume of empty stomach

A

about 50mL

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10
Q

volume of stomach when eating

A

when eating, the stomach can accommodate about 1.5L with little increase in luminal pressure

it does this by smooth muscles in body and fundus undergoes receptive relaxation

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11
Q

what is receptive relaxation

A

mediated by parasympathetic nervous system acting on enteric nerve plexuses

with coordination provided by afferent input from the stomach via the vagus nerve and by the swallowing centre in the brain

nitric oxide and serotonin released by enteric nerves mediate relaxation

Acetyl choline activates parietal & chief cells & initiates receptive relaxation

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12
Q

what is peristalsis

A

a series of wave-like muscle contractions that move food through the digestive tract

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13
Q

where does peristalsis begin

A

in the stomach

it produces peristaltic waves in response to the arriving food

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14
Q

describe peristalsis process

A
  1. each wave begins in the body of the
    stomach producing a ripple as it proceeds towards the antrum
  2. the initial contraction in the body is too weak to produce much mixing of luminal contents with acid and pepsin
  3. there are more powerful contractions in the antrum which enables better mixing of the luminal contents
  4. The pyloric sphincter closes as peristaltic waves reach it
  5. this contraction, every time a wave reaches it means little chyme (smooth, somewhat orange coloured liquid = the end result of stomach digestion and peristalsis) enters the duodenum
  6. It also means that the antral contents are forced back towards the body meaning there is more mixing and thus digestion
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15
Q

what determines the frequency of peristaltic waves

A

pacemaker cells
(INTERSTITIAL CELLS OF CAJAL) in the muscular propria (longitudinal smooth
muscle layer) and is constant (3 every minute)

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16
Q

what is the pyloric sphincter

A

a ring of smooth muscle and connective tissue between the atrium and duodenum

17
Q

what is basic electrical rhythm

A

frequency of peristaltic waves determined by pacemaker cells in muscularis propia and is constant (3/minute)

pacemaker cells undergo slow depolarisation - repolarisation cycles

depolarisation waves are transmitted through gap junctions to adjacent smooth muscle cells

these cells do not cause significant contraction in empty stomach

18
Q

why does strength of peristaltic contractions vary

A

excitatory neurotransmitters and hormones further depolarise membranes

action potentials generated when threshold reached

The interstitial cells of cajal are active all the time, but the action potential threshold for muscle contraction can be altered by the enteric nervous system

19
Q

what increases strength of peristaltic contractions

A

gastrin

gastrin distension (mediated by mechanoreceptors)

20
Q

what decreases strength of peristaltic contractions

A

duodenal distension
- increase in duodenal luminal fat
- increase in duodenal osmolarity
- decrease in duodenal pH
- increase in sympathetic NS action
- decrease in parasympathetic NS action

21
Q

what is gastric emptying

A

capacity of stomach > capacity of duodenum

overfilling of duodenum by a hypertonic solution causes dumping syndrome : vomiting, bloating,c cramps, diarrhoea, dizziness, fatigue, weakness, swelling

22
Q

causes of delayed gastric emptying

A

idiopathic (unknown cause)
autonomic neuropathies (eg in diabetes mellitus)
drugs
abdominal surgery
parkinson’s disease
multiple sclerosis
scleroderma
amyloidosis
female gender

don’t need to know all of these

23
Q

what kind of drugs cause delayed gastric emptying

A

gastrointestinal agents

anticholinergic medications

miscellaneous

24
Q

symptoms of delayed gastric emptying

A

nausea
early satiety
vomiting undigested food
GORD
abdo pain / bloating

25
Q

what happens to pH as gastric contents enter the duodenum

A

as gastric contents enter duodenum, duodenal pH falls

26
Q

what regulates gastric emptying

A

the same things that regulate parietal & chief cells

27
Q

what is gastroparesis

A

delayed gastric emptying

can cause matter in the stomach to rot and smell and become a similar
appearance to faeces

28
Q

summary of peristalsis

A

Produced in response to arriving food

  1. Ripple movement begins in body
  2. More powerful contraction wave in antrum
  3. Pyloric sphincter closes - Not much chyme can enter duodenum
  4. Antral contents forced back to body – mixing