GI Flashcards
Swallowing stage 1: voluntary phase
- Mastication leads to a bolus of food produced. During this stage, the back of the tongue is elevated and the soft palate is pulled anteriorly against it. This keeps the food within the oral cavity and allows the airway to remain open. The duration of this stage varies.
- Inspiration is inhibited and the bolus of food is moved to the oropharynx by the tongue. This leads to the stimulation of the swallowing reflex.
- The buccinator and supra hyoid muscles manipulate food during chewing. They also elevate the hyoid bone and flatten the floor of the mouth.
Swallowing Stage 2: involuntary (pharyngeal) phase
- Once the bolus has been moved to the pharynx, pressure receptors are activated in the palate and anterior pharynx. This signals the swallowing centre in the brain stem which:
- inhibits respiration
- raises the larynx
- closes the epiglottis
- opens the upper oesophageal sphincter
- The soft palate is elevated to close the nasopharynx to allow the passage of food. The true vocal cords also close to prevent aspiration.
- The pharynx is also shortened and widened using longitudinal muscles by the elevation of the hyoid bone via the actions of the muscles of the floor of the palate which depress the mandible if the hyoid bone is fixed, or elevate the hyoid bone and larynx if the mandible is fixed.
- After this, the bolus is moved towards the oesophagus via peristalisis of the pharyngeal constrictor muscles.
- As the tongue forces the food farther back into the pharynx the food tilts the epiglottis backward to cover the closed glottis - this prevents aspiration of food which is a dangerous situation where food travels down the trachea and can cause choking or regurgitated stomach contents are allowed into the lungs causing damage.
Swallowing Stage 3: involuntary oesophageal phase
- The sequential contraction of the circular constriction muscles followed by the depression of the hyoid bone and pharynx.
- Pharyngeal constrictor muscles: 3 overlapping muscles that form the posterior and lateral sides of the pharynx, innvervated by the vagus nerve. They contract sequentially from above down to drive the bolus into the oesophagus.
- Depression of the hyoid bone and pharynx is carried out by the infra hyoid muscle of the neck - they fix the hyoid bone enabling the opening of the mouth. They also depress the hyoid bone and larynx.
The next stage of swallowing occurs in the …
oesophagus
What are the muscles in the oesophagus?
- the skeletal muscle surrounds the upper third of the oesophagus
- smooth muscle surrounds the lower 2/3rds of the oesophagus
Pressure differences in the pharynx and oesophagus?
The luminal pressure in the pharynx at the opening to the oesophagus is equal to the atmospheric pressure and the pressure at the opposite end of the oesophagus in the stomach (in the stomach) is slightly greater than atmospheric pressure. Thus, these pressure differences tend to force both air from above and gastric contents from below into the oesophagus, however this does not occur due to the presence of sphincter muscles at both ends of the oesophagus.
What are the upper and lower oesophageal sphincters? What do they do during swallowing?
- a ring of skeletal muscle surrounding the oesophagus just below the pharynx, and the lower oesophageal sphincter is a ring of smooth muscle surrounding the oesophagus at the last portion of it
- Before food can enter the oesophagus, the upper oesophageal sphincter relaxes. Immediately after the food has passed through, the sphincter closes, the glottis opens, and breathing resumes.
What is the gag reflex?
- The reflex elevation of the pharynx - often followed by vomiting caused by irritation of the oropharynx (the back of the tongue)
- Reflex arc between the glossopharyngeal (IX) and the vagus (X) nerve
Constituents of saliva
water electrolytes bicarbonate bacteriostats mucus enzyme
What is the concentration of sodium, chloride, potassium, calcium and iodide ions in saliva compared to plasma?
sodium and chloride are lower than in plasma
potassium, calcium and iodide are usually higher than in plasma
What is the concentration of bicarbonate in saliva compared to plasma?
a higher concentration in saliva than in plasma to maintain an alkaline environment
What are bacteriostats?
chemicals that prevent the multiplication of bacteria
What enzyme can be found in saliva?
salivary amylase
What are 9 functions that affect the composition and amount of saliva produced?
- Flow rate
- Circadian rhythm (Sleep cycle)
- Type and size of gland
- Duration and type of stimulus that causes saliva to be produced
- Diet
- Drugs
- Age
- Gender
- Time of day
3 glands produce saliva … what percentage is each?
Parotid - 25%
Sublingual - 5%
Submandibular - 70%
Secretion of parotid glands
serous saliva: water secretion rich in enzymes
Secretion of sublingual glands
mucous saliva; viscous secretion containing NO enzymes and large amounts of mucous
Secretion of submandibular glands
MIXED sero-mucous secretion
Which cells are responsible for the volume of saliva secreted and what cells are responsible for the composition of saliva?
acinar = volume duct = composition
Saliva is a –tonic solution
hypotonic
The fluid secreted from the – cells is overall –tonic within the ECF
acini cells
isotonic
-> [Na+]=[K+]
Iodide ions are present at an increased concentration; chloride ions are present at a decreased concentration; bicarbonate is present at the same concentration
During ductal modification, there is little change to volume however concentrations of some of the ions change:
- sodium concentration decreases
- potassium concentration increases
- bicarbonate concentration decreases at rest and increases when stimulated
Resting saliva characteristics
At rest, the acinar secretion ishighly modifiedand has the following characteristics:
- Low volume
- Very hypotonic
- Neutral or slightly acidic
- Few enzymes
Stimulated saliva characteristics
When the production of saliva is stimulated, flow exceeds the ductal cells maximum rate of modification and so the acinar secretion ismodified less:
- High volume
- Less hypotonic than resting saliva
- Alkaline
- Many enzymes
The sympathetic control of salivary production is via the … and results in the release of which neurotransmitter, which acts upon which receptors?
- superior cervical ganglion
- noradrenaline
- alpha and beta-adrenergic receptors
What does the sympathetic control of saliva production result in?
- Decreased production of saliva by acinar cells
- Increased protein secretion
- Decreased blood flow to the glands
Where are the centres which co-ordinate parasympathetic innervation?
medulla
Parasympathetic innervation occurs via which cranial nerves? Which neurotransmitter is released onto which receptors?
- facial and glossopharyngeal
- ACh (acetylcholine)
- M3 muscaronic receptors
(Saliva) What are the results of parasympathetic innervation?
- Acinar cells increase the secretion of saliva
- Duct cells increase HCO3- secretion
- Co-transmitters result in increased blood flow to the salivary glands
- Contraction of myoepithelium to increase the rate of expulsion of saliva
- OVERALL, increased parasympathetic stimulation results in an increased flow of saliva that is more watery in comparison
How long do glycogen stores for a adult male are roughly sufficient to last how many hours?
12
Lipid stores are sufficient to last for
3 months
When can tissue protein be a source of energy supply?
prolonged starvation
The brain and liver represent about 4.6% of body weight yet consume about X% of energy requirement at rest
40%
What fuels does brain use
glucose
ketone bodies
What fuels do muscles use?
glucose
ketone bodies in starvation
tracyglycerol
branched-chain amino acids
What fuels does liver use
amino acids, fatty acids (including short chain acids), glucose and alcohol
What fuels do kidneys use
glucose and ketone bodies (Cortex) and only glucose in medulla
What fuels do small intestines use
ketone bodies (mainly in starvation) and glutamine (amino acid)
What fuel does large intestine use
short chain fatty acids, glutamine
What is the Basal Metabolic Rate? (BMR)
Minimum amount of energy required to keep the body alive at rest
How is BMR measured?
Usually measured by O2 consumption in a person who is awake, restful and fasts for 12 hours
What does BMR decrease with?
age, hypothyroidism, women, period of starvation, decreased muscle mas
What is the unit of BMR measurement?
kcal expended/hr/m2
Where is vitamin A stored?
ito cells in the space of Disse of the liver
What are the functions of vitamin A?
- cellular growth and differentiation
- process of vision
- healthy skin
- reproduction
- embryonic development
- maintenance of bodies mucus membranes
- used in lymphocyte production - immune system
What are sources of vitamin A?
- liver
- dairy products
- oily fish
- margarine
What are symptoms of vitamin A deficiency?
- night blindness
- xerophthalmia (eye fails to produce tears)
- stunted growth
- keratinisation of epithelia
- impaired hearing, taste and smell
- increased susceptibility to infection
What is the solubility of vitamin A?
fat soluble
What are the functions of vitamin C?
- synthesis of collagen, neurotransmitters and carnitine (used in beta oxidation)
- Antioxidant ability - can donate electrons to radical O2 compounds
- Absorption of non-haem iron
What are sources of vitamin C?
- citrus fruits
- green leafy vegetables
- potatoes
- kidney
What are symptoms of vitamin C deficiency?
- initial signs are NON-SPECIFIC
- weakness
- bleeding gums
- hyperkeratosis
- 50-100 days without vitamin C = signs of scurvy
What is the solubility of vitamin C?
water soluble
What are the functions of vitamin B?
important in cell metabolism (synthesis of proteins, DNA and fatty acids) and energy production
Where is B-12 absorbed?
in the terminal ileum
What is required for B-12 absorption?
intrinsic factor
What are symptoms of vitamin B deficiency?
less erythrocyte formation: pernicious anaemia
What is the solubility of vitamin B?
water soluble
Types of vitamin D
- Vitamin D = a group of closely related compounds
- Vitamin D3 (cholecalciferol) is formed by the action of UV radiation from sunlight on a cholesterol derivative in the skin
- Vitamin D2 is derived from plants
How is vitamin D metabolised
Its metabolised by the addition of hydroxyl groups, first in the liver and then in certain kidney cells; the end result of these changes is 1,25-dihydroxyvitamin D - the active hormonal form of vitamin D
Deficiency of vitamin D
Major consequence is decreased intestinal Ca2+ absorption resulting in a decreased plasma Ca2+
- This decrease in detected via a plasma membrane Ca2+ receptor in the parathyroid glands (embedded in the posterior surface of the thyroid gland)
- Resulting in the parathyroid glands releasing PARATHYROID HORMONE (PTH) which exerts multiple actions that increase extracellular Ca2+ concentration:
Solubility of vitamin E
fat soluble
Main function of vitamin E
antioxidant
Vitamin K main function
essential for production of clotting factors
What is malabsorption?
- the inadequate absorption of nutrients from the intestines
- failure to absorb certain minerals, carbohydrates, proteins or facts
What is malabsorption chiefly caused by?
disease of the small bowel
What is giardiasis?
infection which causes the villi to atrophy thus reducing absorption