GI Flashcards
VIP
VASOACTIVE INTESTINAL PEPTIDE
Neuromodulator
Relaxation of smooth muscle; increased intestinal and pancreatic secretion
Substance P
Neuromodulator
Co-secreted with Ach
Contraction of smooth muscle; increased salivary secretion
GERD
Gastroesophageal Reflux Disease
Increased Intra-abdominal pressure. LES unable to prevent gastric acids from refluxing. Can degrade esophageal lining.
Treated with:
- H2 receptor antagonists to reduce gastric acid secretion
- Proton pump inhibitors
Hiatal Hernia
Upper portion of stomach is sticking through the diaphragm, into the chest cavity.
Causes pain and acid-reflux. LES no longer functions properly.
Achalasia
Smooth muscle layer of esophagus lacks normal peristalsis and LES does not relax normally in response to swallowing,
Treatment is surgical. Pt’s also treated with Ca2+ channel blockers, botox to the LES, and other muscle relaxants.
6 type of secretory cells of the fundus/antrum AND what they secrete
(1) Parietal/oxyntic cells: hcl and intrinsic factor
(2) Mucous Neck cells: mucus
(3) Peptic/Chief cells: pepsinogens
(4) ECL cells: histamine
(5) D cells: somatostatin
(6) G cells: gastrin
Intrinsic Factor
Glycoprotein
Required for normal absorption of vitamin B12 in the ileum.
ONLY ESSENTIAL COMPONENT OF GASTRIC JUICE in a healthy human
3 substances which stimulate H+ secretion by parietal cells:
◦Acetylcholine (neurocrine)
◦Histamine (paracrine)
◦Gastrin (endocrine)
Potentiation
The rate of H+ secretion can be regulated by each His, Ach, and Gastrin independently, as well as by interactions among the three.
Inhibition of Gastric Acid Secretion by Parietal Cells
Negative Feedback Loop
Acidic chime in the distal stomach inhibits acid secretion via direct and indirect somatostatin effects + effects of prostaglandins
Retropulsion
Process in which much of the chyme which does not empty into the duodenum is propelled back to the stomach for further mixing and breakdown. This allows them to be small enough to enter duodenum.
Gastric Pits
The lining of the stomach contains columnar epithelium folded into these gastric pits.
Each gastric pit is the OPENING WHERE GASTRIC GLANDS EMPTY
Zolliger-Ellison Syndrome
aka gastrinoma
Usually a tumor (or gastrinoma)located in the pancreas secretes high quantities of gastrin. Increases H+ secretion by parietal cells and parietal cell mass.
Produces duodenal ulcer and leads to fatty stool (steatorrhea).
Gastric emptying happens after what 4 conditions?
(1) An increase in tone (intraluminal pressure) in the proximal portion of stomach
(2) Increased strength of antral contractions
(3) Opening of the pylorus so the contents can move
(4) Simultaneous inhibition of duodenal segmental contractions
Function of pancreatic secretions
2 main components:
(1) Aqueous component, high in HCO3-.
- functions to neutralize the H+ delivered to the duodenum from incoming chyme
(2) Enzymatic component
- enriched with enzymes that digest carbohydrates, proteins and lipids into absorbable molecules.
Control of Pancreatic Ductal Secretion
SECRETIN
When the luminal pH is below 4.5, S-cells are triggered to release secretin.
This triggers bicarb release from ducts. It is ultimately shut off via a negative feedback loop.
How does Secretin function?
(1) Increases cAMP in duct cells
(2) Opens CFTR Cl- channels, causing outflow of Cl- into lumen of duct
(3) High Cl- levels trigger Cl- - HCO3- anti-porter, causing HCO3- to be pumped into lumen (in exchange for Cl-)
What secretes CCK?
I cells (in the small intestinal epithelium)
2 methods by which CCK stimulates acinar secretion.
(1) As an endocrine factor which binds to acinar cell CCK1 receptor
(2) stimulation of neural reflexes which activate vagovagal reflex, leading to secretion of ACh, GRP and VIP
Mechanism of Acinar Enzyme Secretion
CCK, ACh and GRP acts via mobilizing intracellular Ca2+ to cause the release of granules into lumen.
Granular contents = pre-synthesized and stored secretory products.
Pancreatitis
Premature activation of proteases (by TRYPSIN) before they reach the appropriate site of action.
CCK and Bile
CCK stimulates the contraction of the Gallbladder and relaxation of the Sphincter of Oddi. This allows for Bile release into the small intestine.
Brunner Glands
Small Intestine
Secretes mucus and Bicarb
Lieberkuhn Glands
Small Intestine
Secrete Peptidases and Enzymes that digest carbohydrates