Gastrointestinal physiology Flashcards
What are the four basic processes of the GI system?
Motility
Secretion
Digestion
Absorption
What is the purpose of digestive secretion?
Moisten the food so that it is more easily absorbed
Secretions usually contain digestive enzymes which breakdown the food chemically.
Which food/minerals is unabsorbableand what happens when it isn’t absorbed?
Complex carbohydrates
Sometimes food isn’t totally absorbed leading to diarrhoea.
What are the key organs of the GI tract?
Mouth
Oesophagus
Stomach
Small intestine
Large intestine
Rectum
Anus
Also:
Pancreas
Liver
Bile duct
Salivary glands
Why may we think of the lumen of the gut being outside of the body?
Hostile environment:
pH 2.2, gut tissue would be destroyed
Gut microbiome in the large intestine some in the small intestine.
If these bacterium crossed into the body may cause septic shock.
Release of proteases into gut lumen, in the body it would breakdown the protein in the body.
Leaky gut, food that is not broken down is seen as foreign material and if it got into the body, it would mount an immune response.
If acid gets through to the gut what happens?
Peptic ulcers
How many layers in the gut wall and what are they called?
Mucosa (next to lumen)
Submucosa (vasculature and nerves)
Musclaris externa (between the inner and outer layer of the gut is the myenteric nerve plexus)
Serosa (lining secretes mucus to stop it sticking)
What are the different layers within the mucosa (small intestine)?
Lining cells - line the lumen (epithelial cells)
Goblet cells - mucus
Food products travel through this layer to get to the capillaries in the lamina propria.
What is the structure of the lamina propria?
Layer of connective tissue which also contains lymphatic nodules.
What is the structure of the muscularis?
Layer of muscle, responsible for changes in folds. Also a thin layer of nerve plexus.
What is found in the submucosa?
Rich blood supply, branches of lacteals also a layer of muscle
What is beneath the submucosa?
Layer of inner circular muscle which is required for contracting the diameter of the lumen
Layer of outer longitudinal muscle which is required for propelling the food substances forward, controls the length of the gut.
Myenteric nerve plexus is in between.
Function of the serosa?
Wet moist substances preventing sticking. Continuous with the mesentery.
What is the myenteric nerve plexus?
The gut’s own nervous system
Describe the structure of the mucosa layer and how does that link to its function?
The mucosa is different depending where it is in the gut. In the small intestine the mucosa has lots of villi (vascular projections) which increases the surface area of the small intestine, maximising absorption.
Villi are only present in the small intestine.
What does the serosa do to stop it sticking to other organs?
Produces a fluid to keep its layer moist.
Describe how the mucosa in the oesophagus would be different to that of the mucosa in the small intestine.
No absorption occurs in the oesophagus, food is only there for a couple of seconds, therefore to ease the movement of food down the tube you would ideally want a flat mucosa. The cells here would produce mucus for lubrication.
Which type of muscle makes up the gut?
Most of the gut is smooth muscle (involuntary control), skeletal muscle (under voluntary control) makes up swallowing muscles and the external anal sphincter.
What is the role of intrinsic nerve plexus in the gut?
They are nerves controlling motility between the circular and longitudinal muscle.
What is the main extrinsic nerve that controls digestion?
Vagus nerve - parasympathetic (rest and digest)
Where is the palate located?
It forms the roof of the oral cavity separating the mouth from the nasal passage.
What is the function of the Uvula?
Separates the mouth from the nasal passage during swallowing (it is the bit that drops down at the back of the mouth).
Respiratory system in the brain stops breathing in those couple of seconds.
How many teeth do adults have?
32 teeth, many only have 28 due to absence of wisdom teeth.
What is the function of molar teeth?
It crush and grind - grains and seeds for example, needed less now for adult diets.
What is the split of our adult teeth?
Permanent (or adult) teeth of which there are 32 in total, made up of 8 incisors, 4 canines, 8 premolars and 12 molars.
What are the different taste buds found on the tongue?
Sweet
Sour
Bitter - associated with toxicity
Salty
Enomy
How many taste receptors are present per taste bud?
50 taste receptors per taste bud
What are the functions of the tongue?
It forms the floor of the oral cavity
Made of skeletal muscle
Helps aid speech
Role in chewing and swallowing
What is the function of the pharynx?
It is the cavity at the rear of the throat, is the passageway for digestion and respiratory.
How much saliva is produced daily?
1-2 litres (0.5ml a minute - basal)
What is the main secretion in the mouth?
Saliva
Where are the palatine tonsils found?
At the back of the mouth.
What drugs inhibit the salivary glands and hence cause dry mouth?
Main drugs:
Antimuscarinics
Antihistamines
Tricyclic antidepressants
Some diuretics
What are the three main glands that produce saliva?
Parotid glands
Sublingual gland
Submandibular gland
What makes up saliva?
99.5% water
0.5% amylase and bicarbonate (amylase needs a neutral pH)
Mucus to moisten food
Lysozyme (antibacterial)
What are the main functions of the saliva?
Digest carbohydrates
Lubricates food
Antibacterial action
Solvent for taste buds, dissolves chemicals in food, makes them more available
Aids speech
Keeps mouth clean
Explain the control of saliva secretion.
Either a simple reflex where it is picked up by pressure or chemoreceptors in the mouth that food has arrived, signal to salivary centre in the medulla in the brain, stimulating autonomic nervous system.
The complex/conditioned reflex - triggered by smell, sight of food
What drugs are absorbed in the mouth?
Sublingual drugs
Buccal - antiemetics
Describe the process of swallowing.
Food is pushed to the back of the mouth with the tongue after chewing, then swallowing occurs. Skeletal muscle with the tongue which is under voluntary control until the back of the mouth then smooth muscle control (involuntary).
What are the two phases of swallowing and how long do they last?
Oropharyngeal (one second)
Oesophageal (five to nine seconds) time of peristalsis
What are the two sphincters found in the oesophagus?
At the top of the oesophagus there is a sphincter known as the pharynoesphagus sphincter which stops the food from going back up to the pharynx.
The gastroesophageal sphincter prevents acid reflux or food into the oesophagus.
Explain how food is pushed down the oesophagus.
Peristaltic waves push bolus of food down, pressure receptors pick up when food gets stuck and so there is a second peristaltic wave.
What is the three sections of the stomach?
Fundus at the top- stores air
Body in the middle - for storage, salivary amylase in continuing to work, secretions
Antrum at the bottom - contains thicker muscle for mixing (peristaltic waves) and secretions, moving food towards the pylori sphincter
What is the function of the pylori sphincter?
Prevent food entering the small intestine until it is ready.
What are the three main functions of the stomach?
Store food until it is moved to the small intestine
Secretes HCl and other enzymes to aid digestion. Stomach produces pepsin for protein breakdown
Mixing movements produce chyme
What is the product of the stomach?
Chyme
What type of meal stays in the stomach for longer?
Fatty meals, sits there for 6-8 hours. Body says you are still satisfied.
What is the four aspects of the motility?
Filing- receptor relaxation mediated by the Vagus nerve
Storage
Mixing
Emptying - controlled by factors in the duodenum
What are some of the factors that control emptying?
In the stomach:
Amount of chyme, more chyme the longer it takes for emptying.
In the duodenum:
High fatty meals, takes longer for absorption, emsulfication of fat globules
Unneutralisation of stomach acid- hostile environment, must be neutralised by bicarbonate from the pancreas
Hypertonicity - when osmolality rise, one carb molecule but multiple glucose molecules. Osmo receptors signals back and slows down motility.
Distension- too much chyme slows down the emptying of the stomach.
The duodenum factors mentioned above determining gastric emptying rate - what type of signals are used?
Either neural signals via the intrinsic nerve plexus (short-term) or the autonomic nerve plexus (long-term).
Hormonal signals involve the release of hormones from the duodenal mucosa known as enterogastrones (secretin, cholecystokinin)
What other factors determine gastric motility?
Emotions:
Sadness and fear and pain- decrease
Anger and aggressive - increase
Impact on the hormones
What is the two types of gastric mucosa?
Oxyntic mucosa - body
Pyloric gland area - antrum
What are the three types of gastric exocrine secretory cells and what do they secrete?
Mucus cells - mucus
Chief cells - pepsinogen
Parietal cells - HCl and intrinsic factor (Vitamin B12 absorption in terminal ileum) - ATPase pump, hydrogen gets secreted also hydroxide ions from water.
Describe the structure of the mucosa in the stomach.
Flat but with gastric pits lined with mucus cells to prevent acid damaging the mucosa. Hormones are produced here and mucus.
At the bottom chief and parietal cells are present.