Gastrointestinal Physiology - Theoretical Questions Flashcards
What are the components of the Gastrointestinal Nervous system:
Intrinsic - Enteric Nervous system (Aka “Peripheral Brain”)
Extrinsic - Sympathetic and Parasympathetic (ANS)
What are the Gastrointestinal plexuses? Where are they located?
1) Myenteric Plexus (Auerbach’s) - Between Inner-Circular and Outer Longitudinal parts of Muscularis Externa
2) Meissner Plexus - in the Submucosa layer
How is the Autonomic nervous system acts on GI system - Generally?
Sympathetic - Inhibits Digestion
Parasympathetic - Activates Digestion
What are the Short Reflexes coming through the Meissner Plexus:
Meissner Plexus:
1) Stimulation of Glands and Enteroendocrine Cells
2) Dilation of Blood Vessels
What are the Short Reflexes coming through the Myenteric Plexus:
Myenteric Plexus:
-Motility reflexes for stomach and Peristaltic contractions of Intestinal tract
Long Reflexes Parasympathetic:
Passage of Stimulus, Border between paths
Long Reflexes Parasympathetic: (Vagovagal)
From Vagal or Pelvic Nerves to the Enteric Plexuses.
Cannon-Bohm point is the edge of Vagal stimulation and the Beginning of Pelvic nerve.
Long Reflexes Parasympathetic: Neurotransmitter used (Postganglionic)
Substance P, VIP and Ach
Long Reflexes - Sympathetic:
Passage of Stimulus
Long Reflexes - Sympathetic:
Celiac, SM, IM and Hypogastric ganglions are carrying the fibers to Greater, Lesser and Lumbar splanchnic Nerves. These could stimulate directly the muscles of the GI tract with/Without Synapsing with Enteric Plexuses.
Long Reflexes - Sympathetic: Neurotransmitter used (Postganglionic)
Norepinephrine
Long Reflexes - Sympathetic:
Direct Innervation
Alpha-2 : NE - SMC relaxation
Long Reflexes - Sympathetic:
Indirect Innervation
Alpha-1 : NE - SMC contraction (Sphincters) and Vasoconstriction.
Beta-2 : NE - SMC relaxation
What are the Local Stimuli that start the Long and Short Reflexes?
GI Chemoreceptors (Epithelium) - pH, Food Content GI Mechanoreceptors (Epithelium) - Sterch
What makes GI hormone unique?
What are the four ones fall to this specific category?
Released by GI Mucosa Endocrine cells travel into the portal circulation, enter the general circulation, and have physiologic actions on target cells.
Gastrin, Cholecystokinin (CCK), Secretin, Glucose Dependent Insulinotropic Peptide (GIP)
Gastrin:
Family type, Site of Secretion
Gastrin:
Gastrin-CCK Family
G-Cells of Stomach
Gastrin:
Stimuli, Actions
Stimuli of Gastrin:
Peptides and Amino acids, Stretch signal (GRP), Inhibited by H+ and SST.
Actions (Gq): Parietal Cells H+ Release, Histamine secretion from ECL cells.
CCK:
Family and Secretion sites
CCK:
Gastrin-CCK family
Secreted from I cells of Duodenum and Jejunum
CCK:
Stimulus
CCK Stimulus:
Peptides, Amino and Fatty acids.
CCK: Actions
CCK:
1) Contraction of gallbladder and Relaxation of sphincter of Oddi
2) Pancreatic Enzymes and Bicarbonate secretion↑
3) Growth of Exocrine Pancreas and Gallbladder ↑
4) Inhibits gastric emptying
Secretin:
Family and Secretion sites
Secretin-Glucagon Family
S cells of Duodenum
Secretin:
Stimulus and Actions
Stimulus - H+ and FA in Duodenum
Actions - Pancreatic bicarbonate secretion↑, Biliary bicarbonate secretion↑, Gastric H+ secretion↓
GIP:
Family and Secretion sites
GIP:
Secretin-Glucagon Family
Duodenum and Jejunum
GIP:
Stimulus and Actions
GIP:
Stimulus -FA and Amino acids, and Oral Glucose (an Incretin Function) .
Actions - ↑ Insulin secretion,
↓ Gastric H+ secretion
What are the Paracrine Hormones: Enterochromaffin (EC)
SST - D cells; Inhibition of H secretion and SMC contraction.
HIstamine - ECL cells; Acid Production
Serotonin - SMC Contraction
What are the “Candidate” Hormones?
Motilin - SMC ↑
GLP - Epithelial Proliferation↑
Leptin (from Adipose) and Ghrelin (from Stomach)
What are the types of contraction of the gastrointestinal tract smooth muscle layers?
Tonic (Basal) contractions and Phasic Contractions
What is the neurogenic basis for the Tonic contractions?
The Tonic contractions are the result of general fluctuations of the potential levels of the SMCs. They originate from the Interstitial Cajal cells that are linked by Gap junctions to the SMCs. This keeps a Basal level of “Slow waves” of Repol. and Depol. thae allow for these weak contractions.
What type of SMCs are the ones that are found in the GI tract?
Single unit, they are connected via gap junctions meaning that they excite each other and contraction practically simultaneously.
What is the molecular basis for Slow wave production in the interstitial cajal cells?
Special Slow Na+ Channels are responsible for the Depolarization and Repolarization is caused simply by general K channels.
What is the molecular basis for the SMC contractions once depolarized by the Slow waves?
Ca2+ VDC
What are the rhythm of the contractions in the Stomach (Lowest) and in the Duodenum (Highest)?
Stomach - 3 per Min
Duodenum - 12 per Min
Where can we find the Interstitial Cajal Cells?
Myenteric Plexus, Part of the ENS (Intrinsic)
What is the cause of the Phasic contractions in the GI tract?
Phasic contractions or Peristalsis are caused by Gq mechanisms of Muscarinic Ach receptors (M1/3/5) that cause Ca2+ channels to open and form an AP on top of the Slow wave electrical amplitude. (Extrinsic NS)
What are the Phases of Swallowing?
Oral Phase
Pharyngeal Phase
Esophageal Phase
Chewing:
Muscles involved and Reflexes
Masseter, Medial Pterygoid and Temporalis are responsible for Opening mouth and Lateral Pterygoid for closing it. The Masseteric reflex (V3) coordinates and Senses the voluntary movement (proprioception)
What happens in the Oral phase of Swallowing?
Voluntary movement of the Tongue - Tip goes forwards and Base goes backwards. This pushes the Food bolus backwards to the Oropharynx.
What happens in the Sensory Part of Pharyngeal phase of Swallowing?
Esophageal, Palatal and Pharyngeal Mechano- and Thermo - and Taste receptors detect the bolus and send via V3+IX+X the information to Swallowing center in the Medulla oblongata .
What happens in the Motor Part of Pharyngeal phase of Swallowing?
This is a Involuntary directed by the Medulla Oblongata center - 3 muscle actions: 1) Soft palate elevation 2) Epiglottis depression 3) Upper esophageal sphincter relaxes.
What happens in the Esophageal phase of Swallowing?
The vagovagal reflexes cause of the tube distension cause release of VIP to the SMCs of the Esophagus guide the bolus way to the Lower Esophageal sphincter.
How long does it take for Solid and Liquid foods to reach the stomach?
Solid - 10 sec
Liquid - 1 Sec
What is the Receptive Relaxation ?
Vagovagal reflex allowing the relaxation of the Lower Esophageal Sphincter and Orad part of Stomach. Destination causes the reflex and VIP is the Neurotransmitter (Like in rest of esophagus)
What is the Intraesophageal pressure equal to?
It is Equal to the Intrathoracic pressure
What happens if the Primary peristaltic wave doesn’t push all the bolus to below?
Vagovagal Reflex cause Secondary Peristaltic reflex
What is the names of the Proximal and Distal parts of the stomach (Not Pyloric Antrum/Body/Fundus)
Proximal - Orad Part
Distal - Caudad Part
What is the name of the digested food that leaves the stomach?
Chyme
What are the cell kinds on the different positions of the Mucosa of the stomach?
Fundus - Parietal cells
Body - Chief cells
Pyloric Antrum - Mucus and G cells
What extra lamina are in the inner part of the Muscularis externa?
Oblique layer
What are the Particle size of chyme able to pass through the Pylorus? What happens if they are bigger?
1 mm particles can go through the Pylorus, if they are smaller they get pushed back (Repulsion) for further mechanical and chemical breakdown.
What is the muscular part responsible for the mechanical breakdown in the stomach? although the rhythm is pretty (constant 3 per min ) what elevates the contraction forces?
Cauded part is a strong contraction area which is further increased upon Gastrin stimulation (AP -f higher) when there is Amino acids or Peptides present, and is decreased by Secretin and GIP action.
What determines the length of stomach emptying time? Generally how long does it take?
1) Liquids travel faster
2) Volume of the food
3) Very Fatty or Acidic Chyme will empty more slowly.
How will Very Fatty or Acidic Chyme will empty more slowly?
High Fat will cause CCK release (Duodenum - I cells) that decreases Gastric Motility (SMC relaxation).
Acidic Chyme will cause Secretin (Duodenum - S cells) and Sympathetic action to also decrease Gastric Motility ( SMC relaxation)