Gastrointestinal tract Flashcards

1
Q

GI organs and accessory organs

A

-oral cavity, esophagus, stomach, small and large intestine
a-salivary glands, liver, gallbladder, pancreas

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2
Q

4 process of GI

A

digestion
secretion- (endocrine, exocrine, paracrine) from epithelial cells
absorption- moves food from lumen through epithelial cells in blood (transcellular movement)
motility- muscle moves food

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3
Q

layer of the GI tract

A

mucosal, submucosa, muscularis externa, serosa

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4
Q

mucosa

A

inside of lumen
mucous membrane -single layer of epithelial cells

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5
Q

submucosa

A

between mucosa + muscularis externa
has submucosal plexus

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6
Q

muscularis externa

A

2 layers of smooth muscle
has myenteric plexus

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7
Q

serosa

A

outer most layer
-protective with mesentery/connective tissue that lines abdominal cavity

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8
Q

enteric nervous system

A

-autonomous (PSNS +SNS)
-at least 30 diff neurotransmitters
allows for co-ordinate multiple organs
-controls motility of GI using myenteric plexus
-controls secretions of GI using submucosal plexus

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9
Q

oral cavity absorption

A

minimal
-some drugs and glucose

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10
Q

oral cavity secretion

A

-saliva from salivary glands 3 each side
-parotid, submandibular, sublingual gland

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11
Q

parotid gland’s saliva

A

high volume of watery, with salivary amylase and lingual lipase

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12
Q

submandibular gland’s saliva

A

thicker saliva with more mucus and less salivary amylase and lingual lipase

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13
Q

sublingual gland’s saliva

A

high in mucus, almost no amylase and lingual lipase

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14
Q

oral cavity digestion

A

mech- mastication
chem-salivary amylase digest amylose/ complex carb
lingual lipase digests lipids (activated in stomach)

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15
Q

stages of swallowing

A

voluntary, pharyngeal, esophageal

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16
Q

bolus

A

food converted into a soft mass

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17
Q

voluntary stage of swallowing

A

produces bolus through mastication, then pushes in back of oral cavity using tongue

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18
Q

pharyngeal stage of swallowing

A

involuntary
sensation of bolus at pharynx triggers swallowing
-sensory neurons will activate, closing off nasopharynx by lifting uvula of soft palate. the epiglottis bends over the glottis to prevent food and liquids from entering trachea. upper esophageal sphincter relaxes allow bolus down esophagus

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19
Q

esophageal stage of swallowing

A

involuntary
-bolus is pushed down esophagus through peristalsis.
lower esophageal sphincter opens

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20
Q

peristalsis vs. secondary peristalsis

A

contracting + relaxing esophageal circular and longitudinal muscle to move bolus
-if bolus doesn’t make it, a stronger contractions pushes the bolus down

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21
Q

xerostomia

A

caused inability or reduction in salivary production/ dry mouth
-often has infections in oral cavity

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22
Q

sjogren’s disease

A

causes xerostomia
-body’s immune system attracts salivary glands. damaging them

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23
Q

stomach absorption

A

-minimal absorption bc of protective mucus, except small drugs and alcohol

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24
Q

fundus

A

upper portion of the stomach
-receives bolus
-stretches in response to bolus called receptive relaxation

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25
Q

rugae

A

folds of mucosa layer which help expand the stomach

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26
Q

4 layers of the stomach

A

mucosa: secretions by epithelial cells will dictate function
-no other section has acid secreting cells
-thick layer of protective mucus
muscularis externa: has circular longitudinal and oblique layers
rest norm

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27
Q

mucus neck cells

A

on mucosal layer
secrete mucus and hco3 to protects stomach from hcl
-exocrine in stomach

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28
Q

parietal cells

A

secrete cells (h and Cl)
intrinsic faction (absorbs b12)
exocrine
in stomach

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29
Q

chief cells

A

secrete gastric lipase + pepsinogen
exocrine
in stomach

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30
Q

pepsinogen

A

-zymogen
active becomes pepsin which digests proteins
in stomach

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31
Q

g cells

A

secrete hormone gastrin
endocrine
in stomach

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32
Q

d cells

A

secretes somatostatin
endocrine
in stomach

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33
Q

acids role in stomach

A

HCl activates or inactivates enzymes
in-salivary amylase
act- lingual lipase, pepsin
-aids in denatures of proteins
-destroys microbes

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34
Q

motility of stomach

A

–receptive relaxation
-gastric emptying
-propulsion
-grinding
-retropulsion

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35
Q

propulsion

A

smooth muscles push contracts of stomach from upper to lower regions

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36
Q

grinding

A

vigorous muscular contractions of stomach to make bolus into chyme

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37
Q

retropulsion

A

movement of chyme back in stomach’s body
-more mixing

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38
Q

gastric emptying

A

pyloric sphincter opens allowing chyme to enter small intestine

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39
Q

pyloric stenosis

A

abnormally thick pyloric sphincter
-blocks and narrow opening
-projectile vomiting
treatment: pyloromyotomy

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40
Q

small intestine digestion

A

uses brush border cells that are on enterocytes membrane

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41
Q

duodenum

A

-can increase or decrease motility
-does most chem digestion
-villi

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42
Q

Jejunum

A

2nd portion
villi
-many absorptive epithelial cell with needed transporters

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43
Q

ileum

A

longest and last segment
-enterocytes to assist in absorption
less villi
b12 and bile salts are mainly absorbed here

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44
Q

layers of small intestine

A

mucosa layer -no rugae but villi
-has enterocytes
rest similar to stomach

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45
Q

enterocytes

A

absorptive epithelial cells
have villi and micro villi to increase SA
bushed border/ apical membrane
-basolateral membrane is close to capillary and lymphatic vessels

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46
Q

goblet cells

A

secrete s mucus to aid in lubricating
-exocrine
in SI

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47
Q

intestinal gland cells

A

secretes a watery mucus with hco3 to neutralize chyme
-this protects mucosa layer
-interstitial
in SI

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48
Q

s cells

A

secrete hormone secretin
in SI

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49
Q

i cells

A

releases hormone Cholecystokinin/cck
in SI

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50
Q

k cells

A

secretes hormone glucose dependent insulinotropic peptide/GI
in SI

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51
Q

brush border enzymes

A

-on the apical membranes of microvilli
-also called disaccharidase
-causes nutrient to be absorbable

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52
Q

lactase

A

BBE
make lactose into glucose and galactose

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53
Q

sucrase

A

BBE
sucrose digest into glucose and fructose

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54
Q

maltose

A

BBE
maltose digest into 2 glucose

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55
Q

alpha-limit dextrinase

A

BBE
branches polymers of glucose in linear glucose polymers
ex. amylopectin

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56
Q

dipeptidase

A

protease that digest dipeptide into 2 single AA

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57
Q

aminopeptidase

A

protease
digest peptide by remove 1 single AA from protein strand

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58
Q

protease

A

protein digesting enzyme

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59
Q

enterokinase/enteropeptidase

A

protease
digest peptides
trypsinogen into trypsin

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60
Q

small intestine motility fed state

A

segmentation
peristalsis

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61
Q

segmentation

A

localized mixing contractions to help absorption

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62
Q

small intestine motility fasted state

A

-absent chyme solution
-migrating motility complex/MMC > a type of peristalsis where pushes out any particle of food that remain in stomach or small intestine
-autonomic unlike regular peristalsis

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63
Q

peptic ulcer disease

A

-open sores within GI tract
-caused by imbalance in mucosa layer or more acidic
-treatments depends on cause

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64
Q

large intestine absorption

A

finishes absorption
mainly water

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65
Q

large intestine’s layers

A

-mucosa have haustra
>pocket structures that force lumen contents to churn making chyme expose to mucosa’s surface
norm

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66
Q

large intestine secretions

A

mainly secretes mucus from goblet cells
-some electrolytes (k, cl)
-no other digestive enzymes are secreted

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67
Q

large intestine motility

A

-moves slowly
-peristalsis
-haustral churning
-gastrolienal reflex

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68
Q

gastrolienal reflex

A

presence of new bolus in stomach will stimulate opening of ileocecal valve

69
Q

large intestine digestion

A

bacteria break down and salvage undigested nutrients
-produces vitamins (K)

70
Q

flatus

A

intestinal gases which is a byproduct of bacteria
-tooting

71
Q

oral cavity motility

A

mastication, swallowing and peristalsis

72
Q

stomach digestion

A

pepsin breaks down proteins

73
Q

stomach secretion

A

mucus, hco3, hormones, HCl

74
Q

small intestine absorption

A

very effective
carbs, proteins and lipids

75
Q

small intestine secretions

A

mucus, hc03, hormones,

76
Q

pancreas anatomy

A

the exocrine secretions from the pancreas move though the body of the pancreas via pancreatic duct
-pancreatic duct joins the common bile duct which connects to gallbladder and liver
-hepatopancreatic sphincter opens to allow secretions to enter duodenum
-accessory pancreatic duct also allows for secretion to enter duodenum

77
Q

zymogen activation in pancreas

A

zymogens are secreted by acinar cells then secreted in lumen of small intestine. Then enterokinase activates trypsin. This then activity of trypsin converts zymogen into active enzymes. then the enzymes break down the nutrients

78
Q

pancreatic amylase

A

enzyme that digest amylose (starch)

79
Q

pancreatic lipase

A

enzyme that digests triglycerides

80
Q

trypsinogen

A

zymogen that converts into trypsin to digest proteins

81
Q

zymogen

A

inactivate pre cursor of enzymes

82
Q

Chymotrypsinogen

A

a zymogen that is converted into the enzyme chymotrypsin, chymotrypsin digests proteins

83
Q

Procarboxypeptidase

A

a zymogen that is converted into the enzyme carboxypeptidase, carboxypeptidase digests proteins

84
Q

Proelastase

A

a zymogen that is converted into the enzyme elastase, elastase digests proteins

85
Q

Prophospholipase

A

a zymogen that is converted into the enzyme phospholipase, phospholipase digests phospholipids

86
Q

Procolipase

A

inactive protein that is converted into the coenzyme colipase, colipase helps pancreatic lipase more efficiently digest triglycerides

87
Q

pancreas secretions

A

zymogen, enzymes, hco3, water, insulin, glucagon,

88
Q

acinar cells

A

secretes many diff enzymes and zymogen
exocrine
pancreas

89
Q

ductal cells

A

secrets hco3 and h2o
exocrine
pancreas

90
Q

liver function

A

removes waste, makes bile secretions which is stored in gallbladder
-converts nutrients into useable forms/ metabolism

91
Q

liver’s anatomy

A

hepatocytes
hepatic ducts
cystic duct and common hepatic duct form common bile duct
connects to gallbladder via cystic duct
-secretions from the pancreatic duct connect to the common bile duct
-hepatopancreatic sphincter opens in allowing secretions in common bile duct then enter duodenum

92
Q

liver vasculature

A

-hepatic artery gives blood to liver
-hepatic portal vein gives nutrient rich blood from GI tract to liver
-leaves liver via hepatic vein

93
Q

liver lobule

A

-special arrangement of hepatocytes
-hexagonal shape
- a branch of hepatic artery, hepatic portal vein and bile duct
-each lobule has in its center a central vein
-sinusoids
-bile solution collected bile canaliculi

94
Q

hepatocytes

A

-cells in liver
exposed to both blood via the sinusoids, and the bile canaliculi.
produces and secretes bile solutions and help with absorbing lipids

95
Q

sinusoids

A

leaky capillary bed that has hepatic portal vein, hepatic artery

96
Q

gallbladder

A

-under liver that made of smooth muscle
-connected to liver via cystic duct
-stores and concentrates bile solution from liver
-when chyme enters duodenum, gallbladder will contract to push bile through cystic duct, down common bile duct in duodenum when hepatopancreatic sphincter opens

97
Q

path of bile salts

A

idk i think
-hepatocytes, bile canaliculi, common hepatic duct, cystic duct

98
Q

bile solution

A

-helps metabolism lipids and excretes waste
-has bile salts > amphipathic (hydrophobic and philic, function as detergents to solubilize lipids
-secreted in duodenum from common bile duct
-stored in gallbladder

99
Q

gall stone

A

small crystals from hyper concentrated solutions in bile
-painful
-if blockage is in common bile duct, it can prevent liver secretions from entering duodenum

100
Q

cholecystectomy

A

removal of gallbladder

101
Q

ANS in GI tract

A

SNS, PSNS
enteric nervous system, can share and receive info from SNS and PSNS

102
Q

Sensory neurons of ENS

A

part of submucosal plexus
3 diff types of sensory neurons

103
Q

mechoreceptors in GI tract

A

sensory neurons that detect stretching in GI organ, if there is a contents, detect if solid or liquids

104
Q

chemoreceptors

A

sensory neurons detect contents including nutrients density and types of macronutrients

105
Q

nociceptors

A

sensory neurons can transmit pain, identifying damages like injury or inflammation

106
Q

gastrin

A

peptide hormone secreted by g cells of stomach
-triggered for release bc of activation of ACh, stretching of stomach bc of bolus or AA in bolus

107
Q

cholecystokinin (CCK)

A

stimulates enzyme secretion from pancreas, causing gallbladder to contract and releasing bile in small intestine
-peptide hormone secreted by I cell of small intestine
-released bc protein or lipids in chyme

108
Q

somatostatin

A

peptide hormone secreted by D cells of stomach
-released bc of low pH
inhibits gastrin

109
Q

secretin

A

peptide hormones released by s cells of small intestine
-released bc low pH
- stimulates hco3 from pancreas and liver

110
Q

Glucose dependent insulinotropic GIP

A

-stimulates the release of insulin
-peptide hormone secreted by k cells of small intestine
-released when there is carbs, lipids and proteins in chyme

111
Q

hepatic ducts

A

collects bile in liver

112
Q

bile canaliculi

A

bile collecting vessels
-bile solution collected by small vessels

113
Q

short loop reflex and their effects

A

Local reflexes can begin and end within the wall of the GI tract
Can increase motility
Sensory neurons detect lumen contents, k detect stretching of GI tract, if f protein AA, or lipid in bolus/chyme are presence, consistency of contents.
Induces secretes enzyme, and acid
-no CNS

114
Q

long loop reflex

A

-Any reflex that is integrated in the CNS
ex/
when bolus enters stomach, CNS detects it bc stretching of stomach bc vagus nerve

115
Q

salivary gland regulation

A

SNS and PSNS stimulate salivary secretion
SNS saliva- increase mucus and less enzymes
each gland is innervation by spinal nerve t1-t3
PSNS saliva- increase volume of saliva
-parotid gland innervated by glossopharyngeal
nerve
-submandibular and sublingual by facial nerve

116
Q

MMCs

A

Migrating Motility Complex
-types of peristalsis
ensure that no remaining meal contents remain
- empties contents towards the large intestine, preparing the fed state of motility.

117
Q

Regulation of stomach motility

A

Has interstitial cells cause smooth muscle contraction by self basal electrical rhythms

-When no bolus, MMC initiates and goes through the stomach, and small intestine.

-When bolus enters the stomach
-BER halt
-propulsion, grinding and retropulsion are triggered by neurotransmitters on smooth muscles cells
- gastrin, reinforces muscular contractions .

118
Q

regulation of stomach’s acid secretions

A

maximum HCl causes by 3 stimuli
ACh, histamine, gastrin

gastrin: released if there are AA by G cells or gastrin releasing peptide from neural stimulation
-stimulates parietal or ECL cells

Histamine: released by gastrin binding to ECL cell or neural stimulation
-stimulates parietal or ECL cells

ACh: released by long loop reflex triggered by thinking of food
-or by short loop reflex triggered by bolus entering stomach
-stimulates parietal or ECL cells

119
Q

How to stop stomach acid secretions

A

-if pH is too low, somatostatin is released stopping gastrin release

120
Q

Regulation of gastric emptying

A

-increase vagus nerve activity and gastrin, opening pyloric sphincter more
-increase sympathetic nerve activity and CCK, less open the pyloric sphincter will

121
Q

regulation of small intestine motility

A

absence of chyme results in slow, waves of contractions moving down the small intestine, due to the MMC from stomach

-when bolus enters stomach, motility patterns change to segmentations and peristalsis
-MMC stops

122
Q

regulation of pancreatic secretions

A

-CCK stimulates secretions from acinar cells and secretin
secretin will increase hco3 and h2o by ductal cells stimulation
-both acinar and ductal cells are activated by efferent neurons from vagus nerve

123
Q

regulation of bile secretions

A

neural and hormonal inputs regulate bile from liver
-CCK stimulates gallbladder to contract and relax hepatopancreatic sphincter, stimulation secretions from hepatocytes
-secretin stimulation secretions of hco3 and h2o from ductal cells that line common bile duct

124
Q

phases of GI tract

A

cephalic phase, gastric phase, intestinal phase

125
Q

Cephalic phase

A

Stimulus: taste, thought and smell of food
-medulla oblongata activates submucosal and myenteric plexus neuron
-response is increase salivary and acid secretions, increase intestine mucus, increase motility of stomach and small intestine

126
Q

Gastric phase

A

stimulus: bolus stretching stomach and presence of AA
-medulla oblongata activates submucosal and myenteric plexus neuron
-hormonal regulation by G cells releasing gastrin
-increase hcl, intestine mucus, stomach’s motility, and opening of pyloric sphincter

127
Q

Intestinal phase

A

-hormonal regulation of secretion, CCK, GIP
-stimulus: chyme in intestine
-medulla oblongata activates submucosal and myenteric plexus neuron
-increase intestine mucus, increase hco3, digestive enzymes, insulin from pancreas, increase motility of intestine, gallbladder contraction
-decrease hcl, stomach’s motility and gastric emptying

128
Q

ECL cell

A

enterochromaffin like cell

129
Q

basal electrical rhythms

A

self generate electrical signals

130
Q

order of energy sources

A

carbs, triglycerides, aa

131
Q

chemical digestion of carbs

A

not monosaccharide as they are absorbs
oral cavity: salivary amylase (starch (amylose + amylopectin) > maltose)
stomach: salivary amylase stops working
SI: lactase (lactose > glucose + galactose)
Maltase (maltose > 2 glucose)
sucrase (sucrose > glucose + fructose)
Pancreas: pancreatic amylase (starch (amylose + amylopectin) > maltose)

132
Q

carb absorption

A

enterocytes (SI) bc it has monosaccharide transporters
-glucose and galactose move in absorptive cells by Na symporter on apical membrane, while fructose moves in bcc of fructose uniporter
-monosaccharides move out basolateral membrane by, monosaccharide uniporter into interstitial fluid > blood

133
Q

lactose intolerance

A

-GI discomfort
-caused by loss of lactase so lactose can’t be absorbed
-bacteria in LI can metabolism lactose but produces gases
-not allergy

134
Q

proteins

A

composed of 20 diff AA
-denature by low pH
-also called polypeptide
di- 2 AA, tri- 3 AA, peptide 4-50, poly >51
one end of a protein is called amino terminus and other carboxy terminus

135
Q

protein chemical digestion

A

oral cavity: n/a
stomach: pepsin (polypeptides > peptides)
SI: aminopeptidase (polypeptides > polypeptides + single AA)
dipeptidase (dipeptides > 2 single AA)
pancreas: trypsin, chymotrypsin, elastase (polypeptides > peptides)
carboxypeptidase (polypeptides > peptides)

136
Q

exopeptidase

A

enzyme that recognizes either end of a polypeptide
ex. aminopeptidase removes last AA on amino terminus
carboxypeptidase removes last AA on carboxy terminus

137
Q

endopeptidase

A

proteases cut peptides based on AA sequence
ex. trypsin cuts carboxy side of lysine or arginine if it isn’t followed by proline

138
Q

protein absorption

A

-works best with single AA
-apical Na/AA symporter moves many AA across apical membrane
-DI and tri peptides can cross by apical H symporter
-in cell, cytosolic peptidase can digest single AA for basolateral membrane
-AA uniporter moves AA through basolateral membrane

139
Q

lipids

A

mostly triglycerides
-difficult bc enzymes are hydrophilic while lipids phobic
-enzymes only act on surface of fat droplet

140
Q

lipid chemical digestion

A

oral cavity: lingual lipase (inactive)
stomach: lingual + gastric lipase (triglycerides > monoglycerides + fatty acids)
Liver: bile
Pancreas: pancreatic lipase (triglycerides > monoglycerides + fatty acids)
phospholipase ( phospholipids > fatty acids)

141
Q

triglyceride and lipase vs. biglyceride and lipase

A

lingual, gastric and pancreatic lipase removes 1 fatty acid making di glyceride
lipase removes 1 fatty acid making mono glyceride

142
Q

bile salts

A

amphipathic to make lipid droplets soluble
-they cover smaller lipid droplets so they stop getting bigger + stay soluble called emulsification and droplets called micelles

143
Q

lipid absorption

A

free fatty acids and monoglycerides from micelles diffuse across apical membrane of enterocytes by protein carrier
-then they are moved to smooth ER and recombined into triglycerides, packaged into proteins called chylomicron.
-then the chylomicron exocytosis across basolateral membrane and absorbed in small lymphatic vessel then enter venous blood

144
Q

h2o soluble vitamin absorption

A

B and C
-absorbed by protein carriers in plasma membrane of absorptive intestinal cells

145
Q

fat soluble vitamin absorption

A

A, D, E, K
-transport in large lipid droplets and micelles
-when they are near plasma membrane of intestinal cells, vitamins cross without protein carrier then exported by chylomicrons for distribution

146
Q

metabolism

A

process of enzymes converting biomolecules into other forms
-makes ATP
-result of catabolism

147
Q

building blocks for carbs

A

glucose is biomolecule in production of ATP or creates glycogen

148
Q

building blocks for proteins

A

aa is biomolecule in production of ATP or creates new proteins

149
Q

building blocks for lipids

A

fatty acids and glycerol can be metabolized to make ATP or new lipids

150
Q

cellular respiration

A

36 atp= 1 glucose, by product co2+h2o
1)glycolysis (in cytosol)
glucose > pyruvate using 2 atp and enzymes
-anaerobic
2)pyruvate biotransformation (mito)
pyruvate > acetyl coenzyme A
3)citric acid cycle (mito with acetyl coenzyme A)
-aerobic
-2 atp produced
4)electron transport chain (mito)
aerobic
produces 34 atps

151
Q

lactic acid

A

-low o2
-pyruvate > lactic acid (less atp than usually)
reversible
-produced by skeletal muscles

152
Q

rxt that is not reversible

A

pyruvate> acetyl coenzyme A

153
Q

what happens to monosaccharide

A

glucose mainly absorbs
galactose > glucose by hepatocytes
fructose> glycogen by hepatocytes and enterocytes

154
Q

fed state: carbs

A

1) glycolysis: glucose > glucose-6-phosphate, makes ATP
2) glycogen synthesis: glycogenesis
glucose 6-phosphate > glycogen
3) triglyceride synthesis: excess AA will concert into triglycerides
glucose>glycerol >
»»»»»»»»»»triglyceride
glucose>pyruvate>Acetyl coenzymes A > fatty acids
4)AA synthesis:
subset of AA > acetyl coenzyme A >
»»»»»»»»» fatty acids
subset of AA > pyruvate>

155
Q

fasted state: carbs

A

1)glycogen breakdown: glycogen in hepatocytes >glucose-6-phosphate which finishes off glycolysis to produce ATP

glycogen (skeletal) > glucose 6-phosphate> (liver)> glucose
2) gluconeogenesis
-triglycerides get catabolized > glycerol
-catabolism of proteins > glucose
-lactic acid > glucose
mostly by liver

156
Q

fed state: lipids

A

used to produce ATP, phospholipids and myelin sheaths
-triglycerides are stored adipose tissues for energy source

157
Q

fasted state: lipids

A

-lipolysis
-gluconeogenesis
-ketogenesis

158
Q

lipolysis

A

-produce ATP by catabolized triglycerides > acetyl coenzymes A when glycogen is low
-in hepatocytes

159
Q

ketogenesis

A

2 acetyl coenzyme A can form a ketone
-in hepatocyte
can reverse ketone> 2 acetyl coenzyme A >citric acid cycle
-heart muscles and renal cortex prefer ketones for ATP production

160
Q

fed state: proteins

A

protein anabolism
lipogenesis

161
Q

Fasted state: proteins

A

-protein catabolism
gluconeogenesis

162
Q

what controls the regulation of metabolism

A

insulin and glucagon

163
Q

hormone produced in fed state vs. fasted state

A

insulin
glucagon

164
Q

what is regulated by insulin

A
  • increase glucose uptake
    -increase glycogenesis
    -increase lipogenesis
    -increase protein anabolism
165
Q

what is regulated by glucagon

A

-increase glycogenolysis
-increase lipolysis
-increase gluconeogenesis
-increase ketogenesis

166
Q

Glycogenesis

A

glucose> glycogen

167
Q

Lipogenesis

A

production of lipids from non-lipids

168
Q

protein anabolism + catabolism

A

-forms new proteins
-breaks down proteins to make ATP

169
Q

gluconeogenesis

A

-triglycerides get catabolized > glycerol
-catabolism of proteins > glucose
-lactic acid > glucose
-making glucose from non carb sources