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BDS Stage 1 > Gastrointestinal Tract > Flashcards

Gastrointestinal Tract Flashcards

1
Q

Where do the fleshy fibres of the central tendon of the diaphragm converge ?

A

at the central tendon

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2
Q

What type of muscle is the diaphragm ?

A

skeletal muscles

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3
Q

What are the 2 recesses of the diaphragm ?

A

the costomediastinal and the costodiaphragmatic recess

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4
Q

What are the attachments of the diaphragm ?

A

sternal
costal
vertebral

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5
Q

What is the sternal attachment of the diaphragm ?

A

the xiphoid process

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6
Q

What is the costal attachment of the diaphragm ?

A

lower 6 costal cartilages

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7
Q

What are the vertebral attachments of the diaphragm ?

A

the left and right crus and the lumbocostal arches

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8
Q

What are the parts of the diaphragm that arise from the vertebra known as ?

A

the right and left crus

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9
Q

Where does the right crus arise from ?

A

arises from L1-L3 and some fibres of the oesophageal opening

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10
Q

Where does the left crus arise from ?

A

arises from L1-L2

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11
Q

What are the types of lumbocostal arches ?

A

the median and lateral

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12
Q

What are the 3 diaphragmatic apertures ?

A

aortic , caval and oesophageal

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13
Q

What is the vertebral level of the aortic opening ?

A

T12

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14
Q

What is the vertebral level of the oesophageal opening ?

A

T10 - it passes through the right crus not the central tendon of the diaphragm ?

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15
Q

What is the vertebral level of the caval opening ?

A

T8- though the central tendon

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16
Q

What structures pass through the caval hiatus ?

A

Inferior vena cava

right phrenic nerve

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17
Q

What structures pass through the oesophageal hiatus ?

A

oesophagus
right and left Vagus
Left gastric artery and vein

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18
Q

What structures pass through the aortic hiatus ?

A

aorta
thoracic duct
azygous vein
sympathetic chain

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19
Q

What is the motor innervation of the diaphragm ?

A

c3,c4 and c5 anterior ramii that form the phrenic nerve

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20
Q

What is the sensory Innervation of the Diaphragm ?

A

Centrally- phrenic nerve

laterally- lower 5 intercostal nerves

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21
Q

What are the functions of the diaphragm ?

A

ventilation - pull down the central tendon to increase thoracic volume

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22
Q

What are the muscles of the anterior abdominal wall ?

A

rectus abdominis
external oblique
internal oblique
trasnversus abdominis

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23
Q

What runs deep to the transversus abdominis

A

the transvercalis fascia

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24
Q

What are the directions of the fibres of external oblique ?

A

Inferomedially

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25
Q

What are the directions of the fibres of the internal oblique ?

A

superomedially

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26
Q

What are the attachments of the rectus abdominis ?

A

attaches between the rib cage and the pubic bone

has 3 transverse tendinous bands that join to the linea alba

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27
Q

What are the attachments of external oblique ?

A

arises from the lower 8 ribs

and inserts into the linea alba , pubic bone , inguinal ligament and the iliac crest

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28
Q

What are the attachments of Internal oblique ?

A

Arises from below the pelvis and the ilia crest and inserts into the costal margin and linea alba

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29
Q

What are the attachments of the transversus abdominis ?

A

arises from the lower 6 ribs , lumbar fascia , iliac crest , inguinal ligament and inserts into the linea alba

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30
Q

What is the innervation of the muscles of anterior abdominal wall ?

A

T7-L1 intercostal nerves between internal oblique and transversus abdominis

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31
Q

What are the functions of the muscles of the anterior abdominal wall ?

A

trunk movements
abdominal pressure regulation
expiration

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32
Q

What is peritoneum ?

A

A lining tissue that covers the primitive gut cavity

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33
Q

What are the types of peritoneum ?

A

visceral and parietal

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34
Q

What is the parietal peritoneum ?

A

lines the inner abdominal body walls

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35
Q

What is the visceral peritoneum ?

A

covers the viscera of the abdomen

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36
Q

What is the peritoneal space ?

A

between the visceral and parietal peritoneum and is occupied by peritoneal fluid that lubricates the viscera

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37
Q

What are the functions of the peritoneum ?

A

fixes organs
provides mobility
immune system

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38
Q

What are the intraperitoneal organs ?

A

they are covered with visceral peritoneum in folds away from the anterior abdominal wall
the organ is covered in peritoneum anteriorly and posteriorly

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39
Q

What are the retroperitoneal organs ?

A

not associated with visceral peritoneum

only covered with parietal peritoneum on the nateiror surface

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40
Q

What are mesenteries ?

A

double layered fold of visceralperitoneum that suspend organs in the peritoneal space

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41
Q

What do the mesenteries do ?

A

they connect intraperitoneal organs as well as providing a pathway for NV bundles

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42
Q

What is the order that food travels within the GI tract ?

A 
Duodenum 
Jejunum 
Ileum 
cecum 
Ascending colon
transverse colon 
descending colon 
sigmoid colon
rectum
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43
Q

What are the anatomical features of the stomach ?

A 
Oesophagus
Fundus 
greater curvature 
Pylorum 
Antrum
the stomach is continuous with the duodenum inferiorly 
body
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44
Q

What are the features of the pancreas ?

A 
Common bile duct 
Head 
body 
tail 
pancreatic duct 
near the duodenum
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45
Q

What are the 2 terminal branches of the abdominal aorta ?

A

the right and left common iliac arteries

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46
Q

What do the common iliac arteries divide into ?

A

the right and left external iliac arteries

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47
Q

What do the external iliac arteries divide into ?

A

the right and left internal iliac arteries

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48
Q

What are the 3 unpaired arteries to the gut ?

A

the superior mesenteric
the coeliac trunk
inferior mesenteric

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49
Q

Where is the coeliac trunk located ?

A

just below the diaphragm at T12

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50
Q

What are the 3 branches of the coeliac trunk ?

A

the hepatic branch
splenic branch
left gastric branch

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51
Q

What does the superior mesenteric artery do ?

A

arises below the coeliac trunk and supplies the midgut

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52
Q

What does the inferior mesenteric artery do ?

A

Arises at L3 and supplies the hindgut

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53
Q

What is the arterial supply to the genitourinary system >

A

Renal arteries -

testicular and ovarian arteries

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54
Q

What unites to form the common iliac veins ?

A

the external and internal iliac arteries

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55
Q

How is the inferior vena cava formed ?

A

the unison of the common iliac arteries

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56
Q

Where does the inferior vena cava go ?

A

the right atrium

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57
Q

What are the veins that return from the gut called ?

A

the portal veins

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58
Q

Where do the portal veins go ?

A

to the liver carrying deoxygenated nutrient rich blood

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59
Q

What drains the liver ?

A

hepatic veins

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60
Q

Where do the hepatic veins go ?

A

enter the inferior vena cava

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61
Q

What are the muscles of the posterior abdominal wall ?

A

Psoas major
iliacus
quadratus lamborum

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62
Q

What are the attachments of Psoas major ?

A

arises from the T12-L5 and attaches inferiorly to the femur

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63
Q

What are the actions of Psoas major ?

A

it flexes the hip

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64
Q

What are the attachments of Iliacus ?

A

It attaches to the internal surface of the pelvic bone and superiorly to the femur

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65
Q

What are the actions of Iliacus ?

A

it flexes the hip and the thighs

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66
Q

What are the actions of quadratus lamborum ?

A

It attaches to the 12th rib and to the transverse processes of L1-L5 and inferiorly to the iliolumbar ligament and iliac crest

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67
Q

What are the actions of quadratus lamborum ?

A

it is a rotator and stabiliser of the hip

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68
Q

What provides the parasympathetic supply to the abdominal viscera ?

A

the vagus

pelvic parasympathetic splanchnic nerves from S2,S3,S4

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69
Q

Where do the postganglionic parasympathetic fibres go ?

A

to the walls of the viscera near the intramural ganglia

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70
Q

What is the sympathetic supply to the gut ?

A

greater , lesser and least splanchnic nerves from the thoracic and lumbar sympathetic chains

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71
Q

Where do the sympathetic fibres go ?

A

thoracic splanchnic nerves synapse in the coeliac and superior mesenteric ganglia
lumbar splanchic nerves synapse in the inferior mesenteric ganglia

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72
Q

What does the thoracic splanchnic nerves supply ?

A

foregut and midgut

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73
Q

What do the lumbar splanchnic nerves supply ?

A

hindgut

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74
Q

What is the arterial supply to the stomach ?

A

coeliac trunk

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75
Q

What is the venous drainage of the stomach ?

A

hepatic portal vein

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76
Q

Which veins unite to form the vena cava ?

A

common iliac veins

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77
Q

What is the arterial supply to the pancreas ?

A

coeliac trunk and superior mesenteric artery

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78
Q

What type of organ is the pancreas ?

A

retroperitoneal

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79
Q

Which muscle does the ureter lie on ?

A

psoas major

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80
Q

Why is quadratus lamborum important for ventilation ?

A

it fixes the 12th rib in place

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81
Q

What are the 4 main functions of the gut?

A

Digestion and Absorption
Excretion
Defence
Communication

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82
Q

What are the two main groups of organs in the GI tract?

A 
Alimentary canal (Coiled hollow tube)
Accessory Digestive organs
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83
Q

What are the layers of the mucosa in the GI tract?

A

Epithelium
Lamina Propria
Muscularis Mucosa

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84
Q

What is found in the Lamina Propria?

A

Glands, Lymphatics, Capillary Plexus

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85
Q

What is found in the Submucosa?

A

Glands, Lymphatics

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86
Q

What is found in the Muscular externa?

A

Smooth muscle, inner circular, outer longitudinal, myenteric plexus

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87
Q

What is found in the Serosa?

A

Loose connective tissue or mesothelium

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88
Q

What is the order of the layers in the GI tract? (innermost to outermost)

A

Mucosa,
Submucosa,
Muscularis Externa
Serosa

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89
Q

What are the features of columnar epithelium?

A

Absorptive
Single Layer of cells
Secretory

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90
Q

Where are you likely to find columnar epithelium?

A

Gut epithelium and exocrine pancreas

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91
Q

What are the features of stratified squamous epithelium?

A

Flat and scale-like
Can be several cells thick
Protective

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92
Q

Which epithelium is found in the oesophagus?

A

Stratified squamous (non-keratinised) epithelium

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93
Q

What are the layers of the stomach?

A

Gastric pits

Gastric Glands

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94
Q

What do parietal cells in gastric glands do?

A

They secrete HCL and KCL (gastric acid)

They secrete the intrinsic factor

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95
Q

What other cells are there in gastric glands?

A

Mucous secreting cells

Chief cells

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96
Q

What do chief cells do?

A

Secrete pepsinogen, renin, lipase

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97
Q

What are the layers of the duodenum?

A

Villi
Crypts of Lieberkuhn (Mucosal glands)
Brunners Glands 6(in submucosal layer)
Myenteric Plexus

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98
Q

What is a crypt?

A

The ‘pit’ of a villi

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99
Q

What are paneth cells?

A

Found in the crypt, they secrete antimicrobial peptides and lysozymes.

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100
Q

What features does the large intestine have?

A

No villi
Many intestinal glands containing goblet cells and columnar cells
Lymphoid tissue in lamina propria

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101
Q

What s the function of the large intestine?

A

Absorption of water fat and salts

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102
Q

What are the accessory digestive organs?

A 
Teeth,
Salivary Glands
Pancreas
Liver
Gall Bladder
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103
Q

What are accessory glands?

A

They are derived from epithelial tissue

Connected to epithelial surface through ducts

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104
Q

What are unicellular glands?

A

They are individual cells within an epithelium.

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105
Q

What are examples of unicellular glands?

A

Type II alveolar cells

Goblet Cells

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106
Q

What are multicellular glands?

A

Glands made up of more than one cell

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107
Q

What are examples of multicellular glands?

A 
Tubular glands (Cells lie along ducts)
Acinar Glands (cells in sac at end of duct)
Compound tubulo-acinar
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108
Q

What is an example of a compound tubulo-acinar glands?

A

Submandibular

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109
Q

What is an example of a compound acinar gland?

A

Parotid

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110
Q

Which glands produce saliva?

A

Parotid
Submandibular
Sublingual

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111
Q

What does the parotid gland secrete?

A

Serous secretions

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112
Q

What does the submandibular gland secrete?

A

Mixed secretions (mainly serous)

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113
Q

What does the sublingual gland secrete?

A

Mixed secretions (mainly mucous)

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114
Q

What are the minor salivary glands?

A

They are small aggregates in submucosa of oral cavity. (NOT gingiva and hard palate)

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115
Q

What do the minor salivary glands secrete?

A

Mixed secretions (mainly mucous)

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116
Q

What are the uses of saliva?

A

It helps to form a food bolus
It moistens and lubricates
Aids digestion of food

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117
Q

What are myoeptihelial cells

A

They sit on top of the acinar cells. Their contraction stimulates ejection of saliva.

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118
Q

What do acinar cells do?

A

They produce primary saliva

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119
Q

What happens to primary saliva as it travels along the ducts?

A

It gets modified

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120
Q

What medications can decrease salivary production?

A 
CNS depressants
Decongestants
Muscle Relaxants
Antinauseants
CV drugs
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121
Q

Which diseases can decrease salivary production?

A 
Sjogren Syndrome
Cystic Fibrosis
Diabetes Mellitus
Thryoid Disorders
HIV
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122
Q

What other causes can decrease salivary production?

A

Radiation therapy
Malnutrition
Depression/Anxiety
Ageing

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123
Q

What affects saliva composition?

A

Flow rate
Diet
Individual Variation
Relative contribution of glands

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124
Q

What are the organs of the digestive system ?

A

alimentary canal and the accessory digestive organs

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125
Q

What are the 4 layers of the gut wall ?

A

mucosa
submucosa
muscularis externa
serosa

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126
Q

What is the mucosa ?

A

inner lining of the GI tract - it is made of 3 further layers
mucosal epithelium
lamina propria
muscularis mucosa

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127
Q

What does the mucosal epithelium do ?

A

varies with region and function - constains transporting cells as well as endocrine and exocrine cells

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128
Q

What is the lamina propria ?

A

capillary plexus , glands and lymphoid tissue

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129
Q

What is the muscualris mucosa ?

A

thin layer of smooth muscle - contraction increases surface area for absorption

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130
Q

What is the Submucosa ?

A

another layer of the GI wall
made of connective tissue
contains meissners plexus
glands and lymphatics

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131
Q

What is muscularis externa ?

A

2 layers of smooth muscle
inner circular layer
outer longitudinal layer
contains the myenteric plexus (auerbachs plexus) between the layer s

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132
Q

What is the serosa ?

A

the layer most distant from the lumen and is continuous with the peritoneum
it is loose connective tissue

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133
Q

What are the 2 types of epithelium found in the GI tract ?

A

stratified squamous

columnar epithelium

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134
Q

What is the function of stratified squamous epithelium ?

A

protection

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135
Q

What is the function of columnar epithelium ?

A

absorption

has invaginations that increase surface area

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136
Q

What are the features of the columnar epithelium ?

A

can have a brush border
secrete mucus and enzymes
exocrine function

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137
Q

Where does the oesophagus run from ?

A

the pharynx to the diaphragm - it pierces the diaphragm at t10

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138
Q

How does the oesophagus conduct food ?

A

by peristalsis

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139
Q

What is the purpose of keratinisation ?

A

protection

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140
Q

Is the oesophagus keratinised or not ?

A

not keratinised

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141
Q

In the oesophagus which Gi wall layer can you find glands ?

A

submucosa

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142
Q

What is the type of epithelium in the oesophagus ?

A

stratified squamous

non keratinised

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143
Q

How many layers of muscularis externa are there in the oesophagus ?

A

2

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144
Q

What type of epithelium lines the stomach ?

A

simple columnar

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145
Q

How many layers of muscularis externa are there in the stomach ?

A

3

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146
Q

What are gastric pits ?

A

indentations in the stomach which denote entrances to tubualkr gastric glands

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147
Q

What are the cells types found in the gastric glands ?

A

parietal cells
mucous secreting cells
chief cells
enteroendocrine APUD cells

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148
Q

What do parietal cells do ?

A

secrete HCL and KCL - gastric acid

secrete intrinsic factor

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149
Q

What are other cells in the gastric glands ?

A

Mucous secreting cells
Chief cells
Enteroebdocrine APUD cells

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150
Q

What do chief cells do ?

A

Secrete pepsinogen , renin , lipase

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151
Q

What are differences between the stomach and oesophagus ?

A

Simple columnar epithelium in stomach And stratified squamous epithelium in oesophagus

Glands in the stomach are in mucosa abs glands in oesophagus are in sub mucosa

3 layers of muscularis externa in stomach and 2 layers of muscularis externa in oesophagus

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152
Q

What are the 3 parts of the small intestine ?

A

Duodenum
Jejunum
Ileum

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153
Q

What is a landmark of the small intestine ?

A

Villi

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154
Q

What do villi do ?

A

Provide a larger Surface area for absorption

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155
Q

What are between the villi ?

A

Crypts of lieberkuhn

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156
Q

What do the crypts of lieberkuhn do ?

A

Extend to the muscularis mucosa and they are glands

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157
Q

Where are the crypts of lieberkuhn found ?

A

In the duodenum

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158
Q

What are brunners glands ?

A

Submucosal glands
Found in the duodenum
Produce alkaline mucous for neutralisation
Provide correct conditions for enzymes

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159
Q

What does the duodenum also contain ?

A

Auerbach And myenteric plexus

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160
Q

What epithelium covers villi ?

A

Simple columnar epithelium

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161
Q

What do goblet cells do ?

A

Secrete mucus

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162
Q

What does mucus do ?

A

Creates a micro environment
Important for defence
Lubrication
Movement of digested substances

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163
Q

What are microvilli ?

A

Provide a brush border on epithelial cells - increase surface are for absorption

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164
Q

Where do you find paneth cells ?

A

Reside at bottom of intestinal crypts

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165
Q

What do paneth cells secrete ?

A

Antimicrobial peptides such as cryptidins

Lysozyme And phospholipase A2

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166
Q

What are enterocytes ?

A

Simple columnar epithelial cells found in small intestine

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167
Q

What do enterocytes do ?

A

Migrate up the crypt and along the villus

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168
Q

What does the large intestine do ?

A

Caecum
Appendix
Colon
Rectum

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169
Q

What does the large intestine do ?

A

Frames internal abdomen
Involved in absorption of water ,
Fat and salts

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170
Q

What is NOT present in the large intestine ?

A

Villi

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171
Q

What does the large intestine contain ?

A

Crypts of lieberkuhn
Auerbach plexus
Myenteric plexus

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172
Q

Where are exocrine Glands derives from ?

A

Epithelial tissue

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173
Q

What are unicellular glands ?

A

Individual cells with an epithelium
Type II alveolar cells - secrete surfactant
Goblet cells

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174
Q

How do goblet cells secrete mucus ?

A

Merocrinic secretion Via exocytosis

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175
Q

What are the 3 types of multicellular glands ?

A

tubular glands
acinar glands
compound tubulo-acinar glands

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176
Q

What are tubular glands ?

A

cells lie along ducts and secrete along the ducts

they can be simple or compound ducts

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177
Q

What is a simple duct ?

A

single unbranched duct (intestinal glands)

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178
Q

What is a compound duct ?

A

branched duct (gastric glands)

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179
Q

What are acinar glands ?

A

cells that are in the sac at the end of the duct (shaped like a grape)

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180
Q

What are the 2 types of acinar glands ?

A

simple and compound

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181
Q

What are simple acinar glands ?

A

sebaceous glands

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182
Q

What are compound acinar glands ?

A

parotid gland

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183
Q

What is an example of a compund tubulo-acinar gland

A

submandibular gland

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184
Q

What type of secretions does the parotid gland secrete ?

A

serous secretions

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185
Q

What is the innervation of the parotid gland ?

A

glossopharyngeal nerve

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186
Q

Where does the parotid duct run ?

A

around the masseter and opens opposite the 2nd maxillary molar

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187
Q

What type of secretions does the submandibular gland have ?

A

mixed but mostly serous

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188
Q

Where is the deep lobe of the submandibular gland ?

A

wrapped around the free border of the mylohyoid

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189
Q

Where does the submandibular duct run ?

A

runs forward above mylohyoid and into the oral cavity beneath the tongue
duct opens lateral to the lingual frenulum

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190
Q

What type of secretions does the sublingual gland have ?

A

mixed but mostly mucous

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191
Q

Where is the sublingual gland located ?

A

anterior part of the floor of the mouth

between the oral mucosa and the mylohyoid

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192
Q

Where are the sublingual ducts ?

A

small ducts open along the sublingual fold

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193
Q

What are the minor salivary glands ?

A

600-1000
found in small aggregates in the oral cavity
except gingiva and the hard palate
mixed (mainly mucous)

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194
Q

What is located at the end of each mucous tubule ?

A

mucous demilune

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195
Q

What are the types of cells found in salivary glands ?

A

acinar and myoepithelial cells

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196
Q

What are myoepithelial cells ?

A

sit on top of the serous demilunes
have a contractile apparatus
contraction generates salivary ejection

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197
Q

What is the main excretory duct ?

A

lobes produce saliva which enters the oral cavity through the main excretory duct

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198
Q

What are excretory ducts ?

A

interlobular ducts transport saliva between lobes

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199
Q

What are striated ducts ?

A

within lobules (intralobular ducts)

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200
Q

What are intercalated ducts ?

A

connect acini with striated ducts (ionic modification)

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201
Q

What are acini ?

A

secretory end pieces that share a lumen

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202
Q

What extends the lumen of an acinus ?

A

intercellular canaliculi

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203
Q

What do intercellular canaliculli do ?

A

increase secretory surface area

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204
Q

What type of saliva do excretory ducts contain ?

A

modified saliva

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205
Q

Where are excretory ducts found ?

A

in the connective tissue septa

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206
Q

What is the type of epithelium in excretory ducts ?

A

pseudostratified columnar epithelium

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207
Q

Why do striated ducts have striations ?

A

membrane folds

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208
Q

What type of epithelium is in striated ducts ?

A

simple columnar epithelium

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209
Q

What is the main role of striated ducts ?

A

saliva modification - absorb electolytes to turn the saliva from isotonic to hypertonic

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210
Q

What is the lumen of the acinus continuous with ?

A

lumen of an intercalated duct

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211
Q

What is the epithelium in intercalated ducts ?

A

simple cuboidal epithelium

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212
Q

What is the flow of saliva through ducts ?

A

intercalated - striated- excretory - main duct

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213
Q

What are serous end pieces ?

A

acinus

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214
Q

What are mucous end pieces ?

A

alveolus

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215
Q

What shape is the serous acinus ?

A

spherical

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216
Q

What shape is the mucous alveolus ?

A

tubular shape

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217
Q

What type of nuclei do serous acinus have ?

A

large spherical

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218
Q

What type of nuclei do mucous alveolus have ?

A

compressed nuclei

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219
Q

Which end pieces have intercellular canaliculi ?

A

serous acinus

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220
Q

Which glands can you find serous demilunes ?

A

mixed glands - submandibular

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221
Q

How are myoepithelial cells joined ?

A

desmosomes

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222
Q

What is the main role of myoepithelial cells ?

A

expel primary saliva
maintain cell polarity and structural integrity of the acinus
tumour suppressor activity

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223
Q

What is the function of the oesophagus ?

A

transport food to the stomach

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224
Q

What is the function of the stomach ?

A

storage
mechanical disruption
chemical disruption
protection from pathogens and auto-digestion

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225
Q

What type pf pH is found in the small intestine ?

A

basic pH

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226
Q

What is the function of the large intestine ?

A

absorb water and electrolytes

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227
Q

What are the digestion processes that happen in the mouth ?

A

chemical digestion
mechanical digestion
use of lingual lipase

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228
Q

What happens in mechanical digestion ?

A

mastication mixes food with saliva to form a bolus

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229
Q

What happens in chemical digestion in the mouth ?

A

alpha amylase begins strarch digestion in the mouth
hydrolysis of sugars releases acid
when the pH reaches 2.5 gastric secretion stops and the salivary glands release bicarbonate which neutralises

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230
Q

What is the pH in the mouth ?

A

6.5-7.0

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231
Q

What is the role of lingual lipase ?

A

secreted by glands in the tongue into the mouth

begins the breakdown of triglycerides into fatty acids and glycerol

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232
Q

What does the stomach do besides storage ?

A

regulates the flow of chyme into the small intestine

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233
Q

What is the role of Hcl ?

A

destroys bacteria

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234
Q

What does the mucosa of the stomach generate and why ?

A

bicarbonate to protect it from auto-digestion

this neutralises the gastric acid found in the glands close to the stomach wall

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235
Q

What is the major part of the stomach called ?

A

fundus

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236
Q

Where does most digestion in the stomach take place ?

A

pyloric region

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237
Q

What is the other function of the stomach ?

A

the pyloric antrum regulates the flow of chyme into the small intestine

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238
Q

What does the stomach do in terms of absorption ?

A

It prevents malabsorption- eg of cellulose

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239
Q

What do the smooth muscle cells of the stomach show ?

A

electric syncytium

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240
Q

Where do gentle mixing waves travel ?

A

between smooth muscle cells there are

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241
Q

Approximately how long is the small intestine?

A

6-9 metres long

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242
Q

What are the parts of the small intestine?

A

Duodenum
Jejunum
Ileum

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243
Q

What is the approximate length of the duodenum

A

2.5m

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244
Q

What is the approximate length of the jejunum?

A

2.5m

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245
Q

What is the approximate length of the ileum?

A

3.5m

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246
Q

What are the functions of the small intestine?

A

Mechanical and Chemical digestion. Absorption of nutrients.

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247
Q

How does mechanical digestion work in the SI?

A

Weak peristalsis occurs.

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248
Q

What does pancreatic juice contain?

A

Proteases,
Lipases,
Amylase
Sodium Bicarbonate

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249
Q

What is the role of sodium bicarbonate in the small intestine?

A

Neutralizes the chyme

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250
Q

What regulates the pancreatic juice production?

A

The hormones: Cholecystokinin (CCK) and secretin

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251
Q

What are incretins?

A

They are hormones that stimulate decrease of blood glucose levels.

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252
Q

What is bile’s function in the SI?

A

IT acts as an emulsifier for fats.

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253
Q

What regulates the secretion of bile?

A

The hormone CCK

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254
Q

What is the role of goblet cells in the SI?

A

They secrete mucus for protection and lubrication

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255
Q

What regulates the secretion of mucus?

A

The hormone Vasoactive intestinal polypeptide (VIP)

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256
Q

What does lactase do?

A

Hydrolyses lactose –> Glucose + galactose

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257
Q

What does enterokinase do?

A

It partially hydrolyses pancreatic zymogen proteases to release the active enzyme.

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258
Q

What is the importance of tight junctions in the epithelium?

A

It means materials must enter through diffusion/active transport. Which gives control of what substances can enter.

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259
Q

What are the exocrine cells in the pancreas arranged as?

A

A raspberry shape of about 12 cells called acini.

They are arranged around a central lumen.

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260
Q

What is the function of acinar cells?

A

They produce inactive enzyme precursors

They can modify ionic composition of secretion

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261
Q

What do acinar cells synthesise?

A

Amylases
Protease
Lipases
Nucleases

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262
Q

What are the enzymes produced by acinar cells stored as?

A

Zymogens

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263
Q

What is the basolateral membrane?

A

The ‘base’ of the acinar ells that transports nutrients into the cell for synthesis of digestive enzymes.

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264
Q

What controls pancreatic exocrine secretion?

A

Neural (vagus) and endocrine controls

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265
Q

Where does CCK bind on the acinar cells?

A

They bind to the basolateral membrane of acinar cells.

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266
Q

When is secretin secreted?

A

Response to acid in duodenum

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267
Q

What does secretin do?

A

Causes secretion of bicarbonate from pancreas after binding to the receptor on the basolateral membrane.

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268
Q

How are proteases secreted by the pancreas?

A

In secretory vesicles as inactive proenzymes (trypsinogen and chymotrypsinogen)

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269
Q

What is the role of enteropeptidase?

A

It cleaves inactive proteases into their active forms

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270
Q

What enzyme digests phospholipids?

A

Phospholipase A2

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271
Q

Which part of the GI tract has the largest area?

A

Small intestine

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272
Q

Which part of the GI tract has the lowest pH?

A

Stomach

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273
Q

Which phase of digestion is insulin secretion stimulated?

A

Intestinal Phase

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274
Q

What is the major precursor of the bile acids?

A

Cholesterol

275
Q

What is the definition of digestion?

A

Process in which ingested food is converted into a form which can enter the blood or lymph

276
Q

What is the definition of absorption?

A

Process by which nutrient molecules are transported through the intestinal epithelial cells into the blood or lymph

277
Q

What are our dietary carbohydrates?

A

Fibre (mostly cellulose)
Sugars
Starch

278
Q

What two types of sugars of we eat?

A

Disaccarides

Monosacchairides

279
Q

What two forms of starch do we consume?

A

Amylose

Amylopectin

280
Q

Why is amylopectin different to amylose?

A

It is branched with higher molecular wight, containing α-1,4 and α1-6 linked glucose.

281
Q

What does amylase do?

A

It hydrolyses α-1,4 glucose links.

282
Q

What CANT amylase do?

A

Hydrolyse α-1,6 links

Hydrolyse α-1,4 links adjacent to branch points

283
Q

Where does Carbohydrate digestion occur?

A

In the mouth and the duodenum

284
Q

Why can’t CHO digestion occur in the stomach?

A

The acidic pH inhibits α-amylase.

285
Q

What are oligosaccaridases?

A

They are enzymes that complete CHO digestion on the brush border of the duodenum and jejunum

286
Q

What examples of oligosaccaridases are there?

A

Isomaltase
Maltase
Lactase
Sucrase

287
Q

What does lactose hydrolyse to form?

A

Glucose and Galactose

288
Q

What does maltase hydrolyse to form?

A

Maltotriose and Glucose

289
Q

What mechanism absorbs Glucose and Galactose?

A

Active transport through ‘sodium glucose transporter 1’ (SGLT-1)

290
Q

How is fructose absorbed?

A

By facilitated transport

291
Q

What occurs in lactose intolerance?

A

Deficiency of lactase
Undigested lactose enters colon causing osmotic diarrhoea
Metabolised by colonic bacteria in colon causing flatulence

292
Q

What causes glucose-galactose malabsorption syndrome?

A

A mutation of SGLT 1, only fructose can be given

293
Q

Where is psoas major in relation to quadratus lamborum ?

A

psoas major is medial to quadratus lamborum

294
Q

What do the abdominal muscles do in terms of abdominal opressure ?

A

they incease abdominal pressure and this raises the diaphragm

295
Q

What are the 3 branches off the aortic arch ?

A

bracicoephalic
left common carotid
left sublclavian

296
Q

How is the superior vena cava formed ?

A

the unison of the right and left braciocephalic veins

297
Q

Where can you find the vagus nerve and what is its route ?

A

in the carotid sheath between the internal jugular and common carotid artery
it gives off the right recurrent laryngeal in the neck
the left recurrent laryngeal given off at the aorta and curls around the aorta to go back to the larynx
vagus is parasympathetic to the abdominal and thoracic viscera

298
Q

What are the gentle mixing waves ?

A

every 15-25 seconds

turn the bolus into chyme

299
Q

What are the more vigorous waves ?

A

moves chyme from the body towards the Pylorus

more efficinet mixing

300
Q

What are the intense waves ?

A

near the pyloric region - open the sphincter and aquirt chyme into the duodenum

301
Q

What does Hcl do ?

A

denatures protein molecules

transforms pepsinogen into pepsin

302
Q

What is the fat digestion in the stomach ?

A

gastric lipase

303
Q

What happens to protect the gastric mucosa ?

A

mucous secreting cells release mucus as a physical barrier and bicarbonate as a chemical barrier

304
Q

What are th 2 reflexes that regulate GI secretions ?

A

long cephalic reflexes- vagus and braisntem - emotional reflexes
short cephalic reflexes- mediated through the ENS- regulation of motility and secretions

305
Q

What re the 3 phases of gastric activity ?

A

cephalic phase
gastric phase
intestinal phase

306
Q

What happens in the cephalic phase /

A

stomach getting ready
responds to sight,smell and the taste and thought of food
vagus stimulated which activates the Parasympathetic nervous system to increase gastric secretion and motility

307
Q

What is the gastric phase ?

A

stomach working

respond to swallowed food and part digested protein

308
Q

What are the receptors stimulated in the gastric phase ?

A

stretch receptros and chemoreceptors

309
Q

What are the actions of the gastric phase ?

A

gastric secretions
gut motiltiy and vigorous peristalsis to continue
chyme released into the duodenum

310
Q

What is the endocrine influence on the Gastric phase ?

A

Gastrin released in the gastric glands release gastrin which causes increased gastric secretion and churning
Enterochromaffin like cells -increase gastric acid production
Somatostatin - released from protons acts as the negative feedback signal to stop pepsin and acid release

311
Q

What is the intestinal phase ?

A

duodenum responds to arriving chyme

312
Q

What are the receptors in the intestinal phase ?

A

stretch receptors
slow down gastric activity and increase intestinal activity
signal the sympathetic system - slow down

313
Q

What is the endocrine influence on the intestinal phase ?

A

Secretin - decreases stomach secretions
CCK- decreases stomach emptying
GIP- decreases stomach secretions and motility

314
Q

Wheree is gastrin released from ?

A

G cells

315
Q

What is the cycle that food triggers ?

A

food
leads to increased acid secretion via Gastrin via direct or indirect action on parietal cells or on histamine
increased pepsinogen
somatostatin release by protons
modulates the acid and pepsinogen release

316
Q

Where does the small intestine end ?

A

at the ileocecal valv3e

317
Q

What are the functions of the small intestine ?

A

chemical digestion
mechanical digestion
absoroption

318
Q

What mechanical digestion takes place in the small intestine ?

A

weak peristalsis

chyme mixed with intestinal juices in segmetns as released from the stomach

319
Q

What are the 4 hormones present in the small intestine ?

What is their role ?

A 
gastrin 
GIP
GLP-1
CCK
inhibit gastric acid secretion and increse insulin
320
Q

Where is secretin released from ?

A

s cells of the duodenum

321
Q

Where is GIP produced and released ?

A

K cells of the duodenum and the jejunum

322
Q

Wheere is CCK produced ?

A

enteroendocrine cells

323
Q

What does CCK do ?

A

stimulate the release of digestive enzymes and bile from the panceas and teh gall baldder
hunger supressant

324
Q

Where is GLP-1 produced ?

A

produced by intestinal enteroendocrine L cells

325
Q

What are GIP and GLP-1 ?

A

incretins

326
Q

What are incretins ?

A

stimulate insulin secretion from pancreatic beta cells
inhibit glucagon secretion from pancreatic alpha cells
decrease blood glucose levels
released at the start of the inteestinal phase and signal that food is about to enter the blood

327
Q

What regualtes pancreatic juice production ?

A

CCK and secretin

328
Q

Where is the brush border ?

A

on the apical membrane

329
Q

What ar ethe brush border enzymes for carbohydrate digestion ?

A

sucrase isomaltase

lactase

330
Q

What does sucrase isomaltase hydrolyse ?

A

sucrose into glucose and fructose

331
Q

What does lactase hydrolyse ?

A

lactose into glucose and galactose

332
Q

What do peptidases do ?

A

act on the small peptides from stomach digestion

333
Q

What are the brush border proteases and what are their origin ?

A

chymotrypsin and trypsin

they are derived from pancreatic precursors chymotrypsinogen and trypsinogen

334
Q

What is the role of enterokinase ?

A

cleaves the inactive pancreatic precursors into active enzymes

335
Q

What is the purpose of pancreatic precursors ?

A

prevent auto digestion

336
Q

Where does lipid and nucleic acid digestion take plave ?

A

in the lumen no the brush border

337
Q

What are the functions of the large intestine ?

A

chemical digestion
mechanical digestion
faeces foramtion
absorption of water and electrolutes

338
Q

What ar ethe 3 waves in the large intestine ?

A

hasustral churning
gastroilial reflex
gastrocolic reflex

339
Q

What does haustral churning do ?

A

relaxed puches are filled with muscular contraction

340
Q

What is the gastrolilal reflex ?

A

stomach full
gastrin relaxes the iliocecal sphincter
make room for more food

341
Q

What is the gastrocolic reflex ?

A

stomach full

strong peristaltic waves move contents of the transverse colon into the rectum

342
Q

Are any enzymes secreted in the large intestine ?

A

no

343
Q

What is secreted in the large intestine ?

A

mucus by goblet cells

344
Q

What do bacteria ferment in the large intestine ?

A

undigested carbohydrate - co2 and methane
undigested proteins - indoles
bilirubin metabolims

345
Q

What vitamisn do bacteria produce in the colon ?

A

vitmain B and K

346
Q

After how long is 90% of water reabsorbed from chyme ?

A

3-10 hours

347
Q

What does faeces contain ?

A

dead epithelial cells

undigested food - cellulose and bacteri a

348
Q

Which reflex moves faeces into the rectum ?

A

gastrocolic reflex

349
Q

Which receptors signal in the gastrocolic reflex ?

A

stretch receptors

350
Q

What happens in defecation ?

A

parasympathetic nerves contract muscles of rectum and relax the internal anal sphincter

351
Q

How is the external anal sphincter controlled ?

A

voluntarily

352
Q

What is the blood supply of the liver ?

A

hepatic artery from the abdominal aorta

portal vein - nutrient rich blood from the GI tract

353
Q

How are hepatocytes arrnaged ?

A

hexagonally

354
Q

What are the hepatocytes in contact with ?

A

bile canaliculi on one side and the blood stream on the other

355
Q

What are between hepatocytes ?

A

vascular spaces called sinusoids

356
Q

What are kupffer cells ?

A

phagocytic macrophages which attach to sinusoids and play a protective roole

357
Q

What does a portal triad conssit of ?

A

hepatic artery
portal vein
bile duct

358
Q

What are the functions of the liver ?

A 
filtering of blood
protein synthesis 
carb metabolsim 
lipid metabolsim 
secretion of bile
359
Q

How can the liver remove hormones , drugs and active molecules from the blood ?

A

excretion into the bile
phagocytosis by kupfer cells
chemical alteration

360
Q

How is ammonia produced in the liver ?

A

deamiantion by amino acids

361
Q

What does the liver do with ammonia ?

A

convert it intp urea to be excreted into the urine

362
Q

How is ammonia released from glutamate ?

A

deamination of glutamate into alpha ketoglutarate produced ammonium ions
glutamate dehydrogenase

363
Q

How is ammonia turned into urea ?

A

in the urea cycle

364
Q

What is the route for the production and release of bile ?

A

bile is made in the liver
secreted into the hepatic duct
joins the cystic duct from the gall baldder
enters the duodenum through the common bile duct which goes through the pancreas

365
Q

What does bile act for fats ?

A

emulsifier

366
Q

What hormone regulates bile production ?

A

CCK

367
Q

Where are chylomicrons produced ?

A

in the intestinal mucosa

enoplasmic reticulum of enterocytes

368
Q

Where are chylomicrons found ?

A

in the blood and the lymph

369
Q

Where are newly formed chylomicrons secreted from ?

A

through the basolateral membrane

into lymphatic vessels to veins

370
Q

What is the role of chylomicrons ?

A

transport fat from the intestine top the liver and the adipose tissue

371
Q

What do chylomicrons consist of ?

A

95% TAG
5% cholesterol
Apo B48

372
Q

What are chylomicrons recognised by ?

A

lipoprotein lipases on the lining of blood vessels

373
Q

What happens in chylomicron breakdown ?

A

broken down into FFA- oxidiesed for energy
LDL
HDL - taken up by the liver
reminants - taken up by the liver

374
Q

What is the bile production rate in the liver ?

A

250-1500 ml a day

375
Q

What is bile pigment ?

A

bilirubin

376
Q

Where is bilirubin formed ?

A

spleen
bone marrow
liver

377
Q

What is bilirubin a derivative of ?

A

haem groups without iron

378
Q

What does bilirubin combine with ?

A

glucorinic acid - conjugated bilirubin

379
Q

What is conjugated bilirubin converted into ?

A

urobilogen

by intestinal bacteria

380
Q

What is urobilogen absorbed by ?

A

intestine into the hepatic vein

381
Q

What does bile consist of ?

A

bile acids and bile salts
detergents for fat ingestion
glucoronic acid

382
Q

95% of bile acid is reabsorbed by?

A

ileum

383
Q

What is the sphincter oddi ?

A

betwene the bile duct and thre duodenum

384
Q

What is the pancreas an outgrowth from ?

A

duodenum

385
Q

What are the 2 types of glands found in the pancreas ?

A

endocrine and exocrine glands

386
Q

What is the arrangement of cells in the exocrine pancreas ?

A

arranged as raspberry like acini around a central lumen

compound acinar

387
Q

Many lumens contact each other to form what ?

A

ductules - coalesce to form the pancreatic duct

388
Q

What do acinar cells form from ?

A

invagination of embryonic endoderm

389
Q

What do the acianr cells open into ?

A

pancreatic duct

390
Q

What is the apical membrane orientated towards ?

A

lumen

391
Q

What is the basolateral membrane orientated towards ?

A

blood stream

392
Q

Which hydrolytic enzymes do acinar cells synthesisie ?

A

amylases
proteases
lipases
nucleases

393
Q

What are enxymes usually sotred as in the exocrine acinar cells and how are they released ?

A

as zymogens

as secretory vesivles in the apical membrane

394
Q

What does the basolaterla membrane contain ?

A

receptors which hormones bind to to regualte zymogen secretion from the secretory vesicles in the apical membrane

395
Q

What is the neural control of the exocrine pancreas ?

A

vagus in anticipation of a meal

396
Q

As chyme nters the duodenum what doe CCK do ?

A

circualtes to the basoalterla membrane of acinar cells and binds to a specific receptor

397
Q

What is secretin released from ?

A

enteroendocrione cells

398
Q

What is secretin reelase din repsonse to ?

A

acid in the duodenum

399
Q

What does secretin do ?

A

activates the secretion of bicarbinate from the pancreas

as pH increases bicarbonate release is stopped

400
Q

What is the secretin receptor on the basolaterla membrane of the acinar cells like n?

A

7 pass trans membrane structure

GPCR

401
Q

How are proteases sotred in the exocrone pancreas ?

A

as zymogen sin the secretory vesicles in the apical membrane of the acianr cell s

402
Q

What are tehe enzymes released from the exocrine pancreas ?

A

lipases
phospholipas A2
amylases

403
Q

Where is bicarbiante relesed from in the oancres ?

A

epithelial cells in the pancreatic duct

404
Q

What are the endocrine cells in the pancreas arranged as ?

A

isleets of langerhans

405
Q

What are the hormones released from the endocrine opancreas and where from ?

A

alpha cells - glucagon
beta cells - insuklin
delta cells - somatostain - GHIH

406
Q

What is vomiting controlled by ?

A

emetic centre in the chemoreceptor trigger zone in an area of the meduall oblangata

407
Q

What is the process of vomiting ?

A

increaseed parasymapthetic acrtivity leads to increased salivation
retroperistalsis
increase in abdominal pressure and decrease in intrathoracic pressure
propel stomach contents into the oesophagus

408
Q

What is the sympathetic resposne in vomiting ?

A

sweating and increased HR

409
Q

What are the cell to cell junctions in the apical membrane ?

A

tight junctions
claudin and occludin
adaptor proteins which link to underlying actin- Z0-1 AND Z0-2

410
Q

What are the cell0 cell junctions in the basolateral membrane ?

A

adherens junctions
E-cadherin
A AND BETA CATENIN

411
Q

What is the gut assocaited lymphoid tissue ?

A

protects agaisnt antigens entering across the intestinal mucosal barrier
aggregates of lymphoid tissue

412
Q

What are peyers patches ?

A

bumps of lymphoid tissue in mucosa of GI tract

macrophages , dendritic cells and B and T lymphocytes found within

413
Q

What are M cells ?

A

microfold cells

414
Q

What are the role of M cells ?

A

specialised epithelial cells that overly peyers patches

provide info about the contents of the gut lumen to the immune cells of the GALT

415
Q

What does the apical surface of the M cells contain ?

A

clathrin coated pits with embedded receptors

416
Q

What happens when antigens bind to the receptor ?

A

transcytosis to basolateral membrane
released to intestinal fluid macrophages and lymphocytes
trigger inflammatory response

417
Q

What do M cells transport microbes by ?

A

endocytosis
phagocytosis
transocytosis

418
Q

What do dendriticc cells do ?

A

convert T cells into T reg cells - release IL10

supresses unecessary immune response

419
Q

Damage to the intestinal epithelium leads to what ?

A

epithelial cells release signalling molecules
inhibition of IL10
D and T cells produce IL and TNF
neutrophils undergo NETosis and Apoptosis

420
Q

How does food poisoning occur with M cells ?

A

some bacteria have evolved receptors which bind to M cell receptors
bacteria transported acorss M cells
immune system react- diarrhoea and vomiting

421
Q

Good intestinal bacteria ?

A

biotin
vitamin K
intestinal flora

422
Q

Good bacteria generate which antomicrobial peptides ?

A

lysoxymes
lactoferrin
defensins

423
Q

What are the 2 types of multicellular glands ?

A

acinar and tubular

424
Q

What is the epithelium in the excretory duct ?

A

pseudostratified columnar epithelium

425
Q

Which salivary duct has pseudostratified columnar epithelium ?

A

excretory duct

426
Q

Which parts of the salivary duct has simple cuboidal epithelium ?

A

intercalated dcut

427
Q

What are serous demilunes ?

A

mixture of mucous and serous cells

428
Q

What nutrients are abosrbed by the stomach ?

A

water , drugs , electrolytes and alcohol

429
Q

What are some proteins produced in the liver ?

A

lipoproteins

plasma proteins- albumin, fibrinogen, globulin,transferrin

430
Q

In what form is pigment secreted int the bile ?

A

conjugated bilirubin

431
Q

What are the gut defence mechanisms ?

A 
taste and mouth fell 
vomiting 
gastric acid 
hydrolytic enzymes 
mucosal epithelial barrier 
GALT 
intestinal bacteria
432
Q

What controls vomiting ?

A

the emetic centre in the chemoreceptor trigger zone in the medulla oblanagata

433
Q

What initiates vomiting ?

A

chemoreceptors and the CNS

434
Q

What is the parasympathetic contribution to vomiting ?

A

increased salivation

retroperistalsis

435
Q

Describe the pressure changes in vomiting ?

A

abdominal muscles contract- increase in abdominal pressure
lowering of thoracic pressure
propels stomach contents into the oesophagus

436
Q

What is the sympathetic response in vomiting ?

A

increased HR and sweating

437
Q

What type of junctions are in the mucosal epithelial barrier ?

A

tight junctions

438
Q

What is the role of the mucosal epithelial barrier ?

A

keeps the ECF around the apical and basolateral memebranes separate
prevents diffusion through fucntional domians

439
Q

What is the compostion of fibre ?

A

beta 1-4 glycosidic links

cant be digested as dont have the necessary enzymes

440
Q

What is the structure of amylose ?

A

linear polymer of alpha 1-4 glycosidic links

441
Q

What is the structure of amylopectin ?

A

branched polymer with alpha 1-4 and alpha 1-6 glycosidic links

442
Q

Where can you find alpha amylase ?

A

pancreatic juice and saliva

443
Q

What does amylase hydrolyse and what cant it ?

A

hydrolyses alpha 1-4 links

cant hydrolyse alpha 1-6 links or alpha 1-4 linkks close to terminal branches

444
Q

Starch digestion release what ?

A

maltose
maltotriose
alpha limit dextrins

445
Q

What are alpha limit dextrins?

A

branched polymers of glucose 5-9 units long

formed due to the inability of amylase to hydrolyse alpha 1-4 links next to branch points

446
Q

What happens to alpha limit dextrins in the mouth ?

A

they can be taken up by bacteria and used as an energy source

447
Q

The length of time food is in the mouth detemrines what ?

A

how much maltose and maltotriose is released

they are carcinogenic

448
Q

What carbohydrate digestion takes place in the stomach ?

A

none- acidic pH inhibits alpha amylase

449
Q

What carbohydrate digestion takes place in the duodenum ?

A

pancreatic alpha mylase

digests remaining starch into maltose , maltotriose and alpha limit dextrins

450
Q

Which is faster salivary alpha amylase or pancreatic alpha amylase ?

A

pancreatic alpha amylase

451
Q

What is the role of oligosaccharidases ?

A

on the brush border

they further digest the maltose, maltotriose and the alpha limit dextrins

452
Q

Where can you find oligosaccharidases ?

A

in the duodenum and the jejunum

453
Q

What does isomalatase (alpha dextrinase) do ?

A

hydrolyse alpha 1-6 links that amylase csnt

454
Q

What does maltase do ?

A

hydrolyse maltose and maltotriose into glucose

455
Q

What does lactase do ?

A

hydrolyse lactose into glucose and galactose

456
Q

What does sucrase do ?

A

hydrolyse sucrose into glucose and fructose

457
Q

What are the end products of digestion with oligosaccharidases ?

A

monosaccahrides- glucose , fructose and galactose which can be absorbed by the duodenum and jejunum

458
Q

Where does the absorption of monosaccahrides occur ?

A

duodenum and upper jejunum

459
Q

How are glucose and galactose actively uptaken ?

A

by sodium-glucose transporter 1

460
Q

What type of active transport does the sodium-glucose transporter use ?

A

secondary active transport

461
Q

What creates the electrochemical gradient in sodium-glucose active transport ?

A

Na/K ATPase

basolateral membrane

462
Q

How do glucose and galactose leave the epithelial cell ?

A

glucose transporter protein 2

463
Q

How is the entry of galactose and glucose into the epithelial cell mediated ?

A

by the presence of sodium in the GI lumen

464
Q

How does fructose enter and leave the intestinal epithelial cell ?

A

enters using facilitated diffusion - glucose transporter 5

exits using glucose transporter 2

465
Q

What is sucrase-isolmaltase deficiency ?

A

low levels of sucrase and isomaltase in the brush border
intolereane to starch and sucrose
fructose and glucose are tolerated

466
Q

What is glucose-galactose malabosprtion syndrome ?

A

mutation in SGLT-1

fructose can be given

467
Q

What type of transport is SGLT?

A

secondary active trnasport

symport

468
Q

What is the type of transport with GLUT proteins ?

A

facilitated diffusion

uniport

469
Q

What are alpha limit dextrins hydrolysed by ?

A

isomaltase

470
Q

How is pepsinogen converted to pepsin ?

A

by protons

471
Q

How much protein does pepsin digest ?

A

15%

472
Q

What is pro elastase ?

A

converted to elastase

digests serine in elastin

473
Q

What are the peptidases ?

A

aminopeptidase
dipeptidase
dipetidyl aminopeptidase- cleaves a dipeptide from end of the dipeptide

474
Q

How can small peptides be further hydrolysed ?

A

by peptidases in the cytosol

475
Q

What is present on the apical membrane to provide gradients for peptide transport ?

A

Na/H transporters

476
Q

What are the amino acid transport systems on the apical membrane ?

A

5 dependent on Na - active
2 are facilitated
7 in total

477
Q

What are the amino acid transport systems on the basolateral membrane ?

A

5
3 are Na independent - efflux of amino acids into blood
2 are Na dependent - active

478
Q

How do fat soluble vitamins diffuse ?

A

diffuse acorss the brush border membrane

479
Q

Where is vit B12 absorbed ?

A

ileum

480
Q

How is B12 found in foods ?

A

bound to proteins

481
Q

What happens to b12 in the stomach ?

A

released and binds to R proteins - high affinity

482
Q

What is intrinsic factor ?

A

vitamin b12 binding protein
secreted by gastric parietal cells
binds to B12 with less affinity than R proteins

483
Q

What degrades the R - protein B12 complexes ?

A

pancreatic proteases

484
Q

What happens to the B12 afte degradation from R proteins ?

A

binds to IF- resist protease degradation

485
Q

What does the brush border of the ileum contain ?

A

receptors for B12- IF complexes

486
Q

What might happen in pancreatic insuffficinecy ?

A

no degradation from R proteins

B12 deficiency might occur

487
Q

What is the B12 carrier ?

A

transcobalamine II

488
Q

What inhibits gastric emptying locally ?

A

CCK - lipid present in the duodenum

489
Q

What emulsifies lipids ?

A

bile salts and lecithin

490
Q

What is the purpose of emulsification ?

A

increase the surface area for water soluble enzymes to act

491
Q

What are the lipolytic enzymes found in pancreatic juice ?

A

pancreatic lipase
co-lipase
cholesterol esterase
phospholipase A

492
Q

How is pancreatic lipase inhibited ?

A

bile salts bind to fat surface and prevent lipase binding

493
Q

What does co lipase do ?

A

displaces bile salts on the fat surface enabling lipase to fucntion

494
Q

What are the products of triglyceride break down ?

A

2-monoglyceride

2 x NEFA

495
Q

What does cholesterol esterase do ?

A

cleaves a fatty acid from cholesterol esters

496
Q

What does phospholipase A2 do ?

A

turns phsopholipids into lypophospholipid and NEFA

497
Q

What is micelle formation ?

A

bile salts form micelles with the products of fat digestion

498
Q

What do the bile salts act as in micell formation ?

A

surfactant

499
Q

What is the structure of micelles ?

A

lipid molecules arranged in a spherical form

500
Q

Where does absorption of lipids take place ?

A

in the ileum and the jejunum

501
Q

What is the unstrirred layer ?

A

mucus layer
with microvilli between the lumen and the brush border
molecules pass through and become more disorgansied as they approach the apical membrane

502
Q

What lipid transport occurs at the brush border membrane ?

A

cholesterol transporter mediates facilitated transport
microvilli membrane fatty acid binding protein transports long chain fatty acids by secondary active transport - Na/K ATPase

503
Q

What is the role of cytosolic transport membrane ?

A

transport the products of lipid digestion to the smooth endoplasmic reticulum

504
Q

What are the cytosolic lipid transport proteins ?

A

fatty acid binding protein and sterol carrier

505
Q

What happens to lipids in the smooth endoplasmic reticulum ?

A

they are esterified again
enter pre chylomicrons
go to golgi
too large to leave across the basement membrane
lacteals - lymphatic capillaries- large enough - empty into the lymph and the the blood by the thoracic duct

506
Q

Where does absorption of bile salts occur ?

A

in the terminal ileum

507
Q

How are conjugated bile salts actively taken up ?

A

by an Na bile duct co transporter

508
Q

How do bile salts enter the blood ?

A

they re enter the portal blood
bound to albumin
return to the liver

509
Q

How does fructose get from the gut to the blood ?

A

enters via facilitated diffusion and then leaves bu GLUT 5

510
Q

What are the brush border peptidases ?

A

aminopeptidase
dipeptidase
dipeptidyl aminopeptidase

511
Q

Where does lipid break down occur in the GI tract ?

A

stomach
duodenum
jejunum

512
Q

What 2 substances are responsible for emulsification ?

A

bile salts and lecithin

513
Q

What is the role of R protein ?

A

to protect IF from gastric acid

514
Q

Which compounds predominantly contribute to micelle formation ?

A

bile salts

515
Q

What is the mechanism whereby lipids in the duodenum prevent gastric emptying ?

A

CCK

516
Q

What are the functions of the kidney ?

A

Excretion
Homeostasis
Hormone production

517
Q

What does the kidney excrete ?

A

foreign substances and products of metabolsim
urea
creatinine
hormones and drugs

518
Q

What does the kidney regulate in homeostasis ?

A 
ECF volume 
blood pressure 
osmolarity 
ion levels- calcium and potassium 
regulation of pH
519
Q

What hormones does the kidney produce ?

A

renin

520
Q

Urine produced by the kidney travels where ?

A

out of the kidney via the ureter and into the bladder where it is expelled by the urethra

521
Q

Where does the renal vein drain back into ?

A

inferior vena cava

522
Q

What are the 2 types of nephrons ?

A

Cortical nephrons- Superficial cortical and the midcortical
Juxtameduallry nephrons- penetrate deeply into the medulla and surrounded by the vase recta - a dense network of capilalries
loop of henle is longer in the juxtameduallry nephrons therefore th urine id more cocnentrated

523
Q

What is the glomerulus ?

A

a cluster of blood vessels

water and solutes flter from the blood into the renal tubule through the glomerulus

524
Q

What is the glomerulus bounded by ?

A

the afferent and the efferent arterioles

525
Q

What is the purpose of the afferrent and the efferent arterioles ?

A

they contain smooth muscle which contracts to increase blood pressure

526
Q

What is the nephron surrounded by ?

A

the peritubular capillaries

527
Q

What happens in the renal corpuscle ?

A

the production of filtrate

528
Q

What happens in the loop of henle ?

A

urinary concnetration

529
Q

What happens in the distal tubule ?

A

control of water and Na balance

530
Q

What happens in the collecting duct ?

A

control of water and sodium balacne

531
Q

What is the average GFR ?

A

125 mL a min

180 L a day

532
Q

What does the filter cocnsit of ?

A

fenestrated endothelium
collagen basement membrane
epithelium of bowmans capsule which has podocyte filtration slits

533
Q

How does the filter restrict solute movement ?

A

based on size and charge

534
Q

What is the first step in the production of urine ?

A

production of ultrafiltrate - contains no cellulr elements or proteins (RBCs and albumin)

535
Q

The concentrations of solutes in the ultrafiltrate is similar to ?

A

the plasma

536
Q

What is filtered out of the plasma ?

A

all plasma constituents except for RBCs and serum albumin

537
Q

What is proteinuria ?

A

the presence of proteins in the urine as they are more readily filtered

538
Q

What is haematuria ?

A

the presence of RBCs in the urine

539
Q

What are the 3 pressures that determine the overall net pressure in the bowmans capsule ?

A

Hydrostatic pressure in the glomerular capillaries- outward
Hydrostatic pressure in the bowmans capsule - inwards
Colloid osmotic pressure gradient - inwards

540
Q

What are the 2 mechanisms of autoregulation of the GFR ?

A

myogenic response

tubuloglomerular feedback

541
Q

What is the myogenic response ?

A

arterial pressure increases the renal afferent arteriole is stretched and flow increases
vascular smooth muscle responds by contracting and thus increasing resistance
flow returns to normal

542
Q

Where is the loop of henle situated between ?

A

the afferent and the efferent arterioles

543
Q

What is communication between the tubules and the arterioles mediated by ?

A 
Macula densa- plaque of epithelial cells adjacent to the arterioles in the tubules  - they sense flow rate
Granular cells (juxtaglomerular cells) in the afferent arteriole they secrete renin
544
Q

What happens if there is an increase in GFR ?

A

Flow through the tubule increases
Flow past the macula densa increases
Paracrines are sent from the macula densa to the afferent arteriole
Afferent arteriole constricts and afferent arteriole pressure increases
Hydrostatic pressure in the glomerulus decreases
GFR decreases

545
Q

How can we measure GFR ?

A

by using a substance that isnt excreted or absorbed into the tubules

546
Q

What is inulin ?

A

a polymer of glucose that is not indogeneous

547
Q

What is GFR and what is it measured in ?

A

rate of filtrate production

ml/min

548
Q

What is the equation for GFR ?

A

Amount filtered=Amount excreted

Pinulin x GFR=V x Uinulin

549
Q

What are the units for the plasma and the urine concentrations of the inulin ?

A

mg/ml

550
Q

What is the unit for the rate of urine production ?

A

ml/min

551
Q

What are the requirements for a substance to be able to measure GFR ?

A

must be freely filtered at the glomerulus
must not be abosrorbed or secreted into the nephron
Must not be subject to metabolsim or produced by the kidney
Must not alter the GFR

552
Q

What are suitable substances for the measurement of GFR ?

A

Creatinine and Inulin

553
Q

What is creatinine ?

A

product of skeletal muscle metabolism
Amount produced is proportional to the muscle mass
constantly produced therefore constantly excreted

554
Q

What is the need for the GFR ?

A

allows us to assess the perfomrance of the kidney
see any signs of kidney disease
analyse the way the kidney handles solute

555
Q

What is the clearance rate ?

A

mls of plasma totally cleared of a given solutein 1 minute

556
Q

What is the equation for clearance rate ?

A

Px x Cx=Ux x V

557
Q

If there is no reabsorption no secretion what is the relationship of the CR and the GFR ?

A

GFR=CR

eg. inulin

558
Q

If there is total reabsorption and no secretion what is the relationship of the GFR and the CR ?

A

CR= 0

559
Q

If there is net absorption what is the relationship between the GFR and the CR ?

A

GFR>CR

560
Q

If there is net secretion what is the relationship between the GFR and the CR ?

A

CR>GFR

561
Q

What affect does diabetes have on the urine ?

A

Excess plasma glucose means that more glucose is filtered out of the blood- not all of this can be reabsorbed therefore theire is glucose in the urine
increased osmolarity in the tubule meas that fluid is drawn in - triggers the thirst response and more urine is produced

562
Q

What are the anatomical features of the kidney ?

A 
renal artery 
renal vein 
urteter
renal medulla and the renal cortex
papilla
563
Q

What is the journey through the oesophageal sphincter ?

A 
Mouth 
pharynx and the larynx 
upper oesophageal sphincter 
oesophagus 
lower oesophageal sphincter 
stomach
pyloric sphincter 
Dudoenum 
jejunum 
ileum 
ileocecal valve 
large intestine
564
Q

What is dysphagia ?

A

difficulty swallowing
related to the oropharynx
leads to choking and unable to swallow

565
Q

What is oesophageal stricture ?

A

narrowing of the oesophagus
lack of peristalsis
failure of the loweer oesophageal sphincter to relax
food stick to the oesophagus

566
Q

What is gastroesophageal reflux disease ?

A

reflux of the gastric contenets through the lower oesophageal sphincter
intrinsic acids from the stomach can travel to the mouth and can damage enamel and the dentine

567
Q

What is the laryngo-pharyngeal reflex ?

A

refluxate travels above the upper oesophageal sphincter

568
Q

What is hiatus hernia ?

A

widening of the hiatus in the diaphragm

stomach enters the chest cavity

569
Q

What is dydpepsia ?

A

indigestion
any food related pain in the upper abdomen
can be due to a gastric or duodenal peptic ulcer
can be caused by the H pylori bacteria

570
Q

How can peptic ulcers lead to anaemia ?

A

perforation of the ulcers leads to anaemia

571
Q

What is common treatment for Dyspepsia ?

A

antibiotics and PPI therapy

572
Q

What is pernicious anaemia ?

A

Most common cause of vitamin B12 deficinecy
Autoimmune deficiency in which Gastric parietal cells which produce IF are destroyed
cant absorb b12 from the diet
leads to megaloblastic anaemia
treatement is b12 injections

573
Q

What are some oral symptoms of pernicious anaemia ?

A

angular chellitis

atrophic glossitis- beefy tongue

574
Q

What is coeliac disease ?

A

autoimmune response to gluten and Gliadin proteins
Causes damage to the villi which affects their ability to absorb
Intolerance to rye, wheat, oats and barley

575
Q

What is Crohns disease ?

A

Inflammatory bowel disease
Causes are though to be genetic , environmental and an autoimmune response to commensal bacteria
can affect all GI areas and layers

576
Q

What are the symptoms of Crohns disease ?

A

cobblestone effect in the ileum
mouth sores and ulcers
fistulae
anal fissures

577
Q

What is diverticular disease ?

A

pockets created by the lining of the GI tract trapping food and becoming inflamed
due to muscular hypertrophy

578
Q

What is IBS ?

A

disorder of the motor activity of the bowel
abdominal pain and altered bowel movement
diarrhoea and constipation

579
Q

What is ulcerative colitis ?

A

inflmmatorry bowel disease

similar to crohns but more superficial

580
Q

What is type 1 diabetes ?

A

autoimmune disease destroying pancreatic beta cells

requires lifelong insulin therapy

581
Q

What is type 2 diabetes ?

A

Insulin resistance - insulin is produced and not recognised

body compensated by producing more insulin and eventually leads to insulin deficiency

582
Q

Is the cortex or the medulla more densely supplied by the renal artery ?

A

cortex

583
Q

How is urine concentrated ?

A

More water abosorption through the CD as it is permeable to water
increases the concentration inside the tubule and urine is hyperosmotic

584
Q

Where is ADH produced ?

A

in the supraoptic and paraventricular nuclei of the thalamus

585
Q

Where is ADH released from ?

A

posterior pituitary gland

586
Q

What stimulates ADH release ?

A

increased plasma osmolarity

decreased blood pressure and blood volume

587
Q

What are the actions of ADH ?

A

increases permeability of the CD
increases urea permeability of the CD
increases NaCl resbsorption in the TAL

588
Q

What is the net effect of ADH ?

A

increases water absorption

589
Q

What are changes in osmolarity detected by ?

A

osmoreceptors in the hypothalamus

590
Q

Where do the osmoreceptors of the hypothalamus send a message to ?

A

posterior pituitary to release ADH

591
Q

If there is an increase in plasma osmolarity ?

A

ADH secretion increases

592
Q

How is ADH destroyed ?

A

liver and the kidneys

593
Q

What is the cellular mechanism by which ADH increases water absorption ?

A

ADH binds to receptors on the basolateral membrane
stimulates the production cyclic AMP from ATP by adenylyl cyclase
activates protein kinse
insertion of AQP2 channels on the CD membrane - apical cell membrane
water permability increases and water is taken into the blood

594
Q

If ADH is present what is the condition of urine ?

A

ADH increases water reabsorption from the CD therefore the urine is hyperosmotic

595
Q

What happens if ADH is absent ?

A

there is no stimulation of the downstream aquaporin production therefore no water reabsorption and the urine is dilute

596
Q

What is the the role of the supraoptic and paraventricular nuclei of the hypothalamus ?

A

stimulate ADH secretion from the posterior pituitary

597
Q

What happens if there is a decreased ECF osmolarity ?

A

ADH release is supressed
thirst response is supressed
CD not permeable

598
Q

What is the effect of ANP on ADH ?

A

ANP inhibits ADH

599
Q

What is the affect of alcohol on ADH ?

A

alcohol inhibits ADH

600
Q

What is the effect of nicotine on ADH ?

A

nicotie promotes ADH

601
Q

What is the main role of aldosterone ?

A

Aldosterone is the main hormone regualting sodiium balance

602
Q

Where is aldosterone released from ?

A

Zona Glomerulosa of the adrenal cortex

603
Q

What stimulates aldosterone ?

A

hyperkalaemia
low blood pressure
angiotensin II in the RAS

604
Q

What are the actions of aldosterone ?

A

increase potassium secretion into the DT and the CD
Increases sodium reabsorption in the DT and the CD
leads to increased blood volume and pressure

605
Q

What is the cellular mechanism of aldosterone action ?

A

Aldosterone binds to receptors in the cytoplasm
initiates transcription of sodium channels
number of sodium channels on apical surface increases
increased sodium uptake
sodium goes through the basolateral membrane into the blood and inreases blood pressure

606
Q

What are the 3 stimuli of aldosterone ?

A

Increased potassium
Decreased blood pressure
Decreased flow past the macula densa

607
Q

What is the inhibitor of aldosterone release ?

A

Increased plasma osmolarity

608
Q

What are the 3 components of the juxtaglomerular apparatus ?

A

Juxtglomerular cells
macula densa
extraglomerualr mesangial cells

609
Q

Where do the extraglomerular mesangial cells sit ?

A

between the TAL and the afferent arteriole

610
Q

What is the mode of activity in resposne to Sympathetic activity of the heart ?

A

high HR
to return to normal the wall tension in the afferent arterioles decreases
sodium delivery to the macula densa decreases
low blood volume

611
Q

What does angiotensin II do to renin ?

A

it acts as a negative feedback loop and stops renin release

612
Q

What is ANP ?

A

anti-natriuretic peptide

613
Q

Where is ANP produced from ?

A

atria when stretched

614
Q

What is the effect of ANP ?

A

increases water and sodium excretion

615
Q

What affect does ANP have on the adrenal cortex ?

A

it stops aldosterone release

616
Q

What affect does ANP have on the kidney ?

A

stops renin
increases GFR
inhibis sodium chloride and water reabsorption

617
Q

What is the affect of aldosterone on the hypothalamus ?

A

stops ADH release from posterior pituitary

618
Q

What is secreted into the proximal tubule ?

A

urea and creatinine

619
Q

What is reabsorbed in the proximal tubule ?

A

Glucose
proteins
aminaoacids
lactate

620
Q

What is reabsorbed from the descending limb ?

A

water

621
Q

What is secreted into the loop of henle ?

A

urea

622
Q

What is absorbed from the ascending limb ?

A

sodium and chloride

623
Q

What is absorbed from the distal tubule ?

A

ions

624
Q

What is secreted into the distal tubule ?

A

protons

ammonium ions

625
Q

What is reabsorped from the collecting duct ?

A

water

urea

626
Q

What percentage of water and solutes of the filtrate are reabsorbed into the PCT ?

A

70%

627
Q

What is the average GFR ?

A

125 ml/min

628
Q

What are the 3 layers of the glomerualr filter ?

A

Collagen basement membrane
fenestrated enothelium
epithelium of bowmans capsule with podocyte slits

629
Q

How does the macula dens work ?

A 
increased flow past the macual densa
paracrine released from the macula densa and acts on the affferent arteriole 
increases resistance 
reduces hydrostatic pressure 
GFR reduces
630
Q

What is the normal blood osmolarity ?

A

290 mOsmoles

631
Q

What is the affect of nicotine on ADH production ?

A

inhibits ADH

632
Q

What are the channels that Aldosterone promotes ?

A

ENACC channels

Na/K pump

633
Q

What is reabsorbed i the proximal convuluted tubule ?

A

70% water and solutes

634
Q

What is present on the apical surface of PCT ?

A

microvilli

635
Q

What are the functions of the PCT ?

A

Reabsorption of the bulk of filtered NaCl
Reabsorption of glucsoe,amino acids
Secretion or organic molecules
pH homeostasis

636
Q

What is the for, of Na+ transport on the apical membrane ?

A

Na transport acorss the apical membrane is mediated by glucose and amino acids in secondary active transport
counter exchange of Na/H exchanger

637
Q

What is the form of Na transport in the basolateral membrane ?

A

Na is rmeoved by the Na/K ATPase on the basolateral membrnae
this is followed by chloride and water by a paracellualr route

638
Q

What happens in the descending limb of the loop of henle ?

A

Water moves out

NaCl stays

639
Q

What happens in the ascending limb of the loop of henle ?

A

Water stays

NaCl moves out

640
Q

What are the mechanisms of Sodium transport in the loop of henle ?

A

Na/Cl/L transporter
Na/H transporter - allows the acidification of urine
Na/K ATPase on the basolateral membrane

641
Q

What happens in the DCT ?

A

NaCl moves out the blood and H20 stays

642
Q

What are the mechanisms of Na transport in the DCT ?

A

NaCl moves into the blood

Na/Cl transproter and then Na/K ATPase on the basoalterla membrane

643
Q

What happens in the collecting duct ?

A

NaCl movemenrt

644
Q

What are the 2 types of cells in the collecting duct ?

A

Principal cells

Intercalated cells

645
Q

What do principal cells do ?

A

regulate ion balance based on expression of channels on the apical membrane

646
Q

What are examples of the action of principal cells ?

A

aldosterone increases ENac Channels on the apical membrane

ADH increases aquaporins on the CD membrane

647
Q

What are the actions of intercalated cells ?

A

Acid/base homeostasis

648
Q

What are the two types of intercalated cells ?

A

Alpha and beta

649
Q

What is the role of alpha intercalated cells ?

A

excrete protons into the urine and reabsorb bicarbonate into the blood

650
Q

What channels does the alpha intercalated cells use ?

A

secrete protons by the H ATPase and H/K exchanger

Cl/HCO3 exchanger on the basolateral membrane

651
Q

What is the role of beta intercalated cells ?

A

they excrete bicarbonate and reabsorb protons into the blood

652
Q

What channels do the beta intercalated cells use ?

A

Cl/HCO3 exchanger

H ATPase

653
Q

What happens after a high water load ?

A

water must be excreted in excess - dilute urine that is hyposmotic to the plasma

654
Q

What is the normal plasma osmolarity ?

A

290 mOsml

655
Q

What happens after a water restriction ?

A

water msut be retained

hyperosmotic urine to the plasma is produced

656
Q

How is excretion of a dilute or concentrated urine achieved ?

A

by the countercurrent mechanism

657
Q

What acts as the countercurrent multiplier ?

A

loop of henle

658
Q

What acts as the countercurrnent exchanger ?

A

vasa recta

659
Q

What does countercurrent flow mean ?

A

2 parallel limbs with fluid moving in opposite directions

660
Q

What is the osmolarity of the PCT compared to the interstitial fluid ?

A

isotonic

661
Q

What happens in the ascending limb of the loop of henle and what is the consequence ?

A

solutes move into the interstitium

increases the osmolarity of the interstitium

662
Q

What happens in the descending limb of the loop of henle ?

A

fluid becomes more concentrated as water move out to equilibrate the interstitium

663
Q

What happens as more fluid enters the loop of henle ?

A

more concentrated fluid is formed in the descending limb and enters the ascending limb
a gradient forms from top to bottom in the interstitium

664
Q

What is the condition of the fluid at the bottom of the loop of henle ?

A

Hypertonic as water had moved out

665
Q

What is the condition of the fluid at the DCT ?

A

hypotonic as solute has moved out

666
Q

What are the vasa recta ?

A

long extensions of the peritubular capilaaries

run parallel to the loop of henle in juxtamedulalry nephrons

667
Q

What are the functions of the vasa recta ?

A

water and solutes are reabsorbed by the vasa recta

provides o2 to the medulla

668
Q

What happens in the descending vasa recta ?

A

solutes move into the VR down their conc gradient

water moves out the VR

669
Q

What happens in the ascending vasa recta ?

A

water moves into the VR

Solutes move out the VR

670
Q

What is the role of urea ?

A

important for maintaining medullary concentration gradient

671
Q

What are the 3 mechanisms of pH control ?

A

buffers
respiratory control
renal control

672
Q

What happens if the metabolic rate increases ?

A

co2 increases - equilibrium pushed to the right
increased protons cant be buffered by bicarbonate but can be buffered by non bicarb buffers such as Hb
bicarb is much higher now and can buffer protons from non resp sources

673
Q

What is the consequence of increased protons in metabolism being released from organic acids ?

A

bicarbonate can act as a buffer

674
Q

How is respiratory control of pH carried out ?

A

high levels of co2 signalled by the carotid and aortic peripheral chemoreceptors and they go to the respiratory centre and signal an increased VR

675
Q

How is pH controlled in acidosis ?

A

H is high in the interstitial space reacts with bicarbonate to make co2 and water which dissociates into protons and bicarbonate and the protons are excreted by a H/K ATPase
alpha intercalated cells

676
Q

How is pH controlled in alkalosis ?

A

beta intercalalted cells
carbon dioxide and water in the cell are reacted into protons and bicarbonate and the cl/HC03 exchanger excretes bicarbonate into the urine

677
Q

What does contraction of the afferent arteriole lead to ?

A

reduces renal blood flow and reduces GFR and hydrostatic pressure

678
Q

What does contraction of the efferent arteriole lead to ?

A

reduces RBF

increases hydrostatic pressire and increases GFR

679
Q

What does dilation of the afferent arteriole lead to ?

A

increases RBF and increases GFR and hydrostatic pressure

680
Q

What does dilation of the efferent arteriole lead to ?

A

increases RBF but decreases hydrostatic pressure and GFR

681
Q

What does the macula densa do if therie is increases GFR ?

A

increased NaCl in the distal tubule
macual densa sense an increased flow
release paracrine that act on afferent arterioles
increases ressitance of the afferent arteriole and therefore reduce plasma flow

682
Q

What are renal arterioles innervated by ?

A

sympathetic neurones

683
Q

What are he sympathetic neurones activated in response to ?

A

fear
pain
response to fall in blood pressure

684
Q

What does the sympathetic inenrvation cause ?

A

constriction of renal blood arterioles

BDS Stage 1 (39 decks)

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