GI Flashcards
How is swallowing initiated?
When pressure receptors in the wall of the pharynx are stimulated by food or drink, and forced into the rear of the mouth by the tongue
What is the nervous supply to the nasopharynx?
Maxillary nerve (V2- second branch of trigeminal nerve V)
What is the nervous supply to the oropharynx?
Glossopharyngeal nerve (IX)
What is the nervous supply to the laryngopharynx?
Vagus nerve X
What muscles manipulate food during chewing and elevate the hyoid bone?
The buccinator and supra hyoid
How is the pharynx shortened and widened during swallowing?
Elevation of the hyoid bone via actions of the muscles of the floor of the palate
How is food prevented from entering the trachea?
Impulses from the swallowing centre close the glottis. Food tilts the epiglottis over the closed glottis.
What is the nervous supply to the pharyngeal constrictor muscles?
Vagus X
Is the upper third of the oesophagus skeletal or smooth muscle?
Skeletal
Is the lower two thirds of the oesophagus skeletal or smooth muscle?
Smooth
What is the ring of skeletal muscle around the oesophagus just below the pharynx?
The upper oesophageal sphincter
What is the ring of smooth muscle surrounding the oesophagus in the last portion of the oesophagus?
The lower oesophageal sphincter
What is a peristaltic wave?
Waves of muscle contractions that proceed along the oesophagus, compressing the lumen and forcing the food ahead
How long does one oesophageal peristaltic wave take to reach the stomach?
9 seconds
What is the nervous supply that allows the gag reflex?
A reflex arc between the glossopharyngeal (IX) and Vagus (X) nerves
What are the functions of saliva?
Lubricant for mastication
Maintaining oral pH (maintained at 7.4) by the bicarbonate/carbonate buffer system
Release digestive enzyme- salivary alpha amylase released from parotid gland
What is the daily secretion of saliva?
800-1500 ml
What is serous secretion?
Alpha amylase for starch digestion
What is mucous secretion?
Mucins for lubrication of mucosal surfaces
What secretion does parotid glands release?
Serous
What secretion does submandibular glands secrete?
Mucous and serous
What secretion does sublingual glands secrete?
Mucous and serous but mainly mucous
What secretion does minor glands secrete?
Predominantly mucous but some serous
What factors affect the composition and amount of saliva produced?
Flow rate Circadian rhythm Type and size of gland Duration and type of stimulus Diet Drugs Age Gender Time of day
What are the defences of the oral cavity provided by?
The mucosa
The salivary glands
Palatine tonsils
Which salivary glands are continuously active?
Submandibular, sublingual and minor glands
What are the epithelial tissues present in salivary glands?
Acinar Cells and ducts
What do the ducts do in salivary glands?
Collect to form the large cut entering the mouth. Equipped with channels and transporters in the apical and basolateral membranes enabling transport of fluid and electrolytes
What are the two types of acini?
Serous and mucous
What do serous acini secrete?
Water and alpha amylase
Where are serous acini mainly found?
Parotid glands
What do mucous acini secrete?
Mucous (water and glycoproteins)
Where are mucous acini found?
Submandibular and sublingual glands
What are the two types of intralobular ducts?
Intercalated and striated
Describe intercalated ducts
Short narrow duct segments with cuboidal cells that connect acini to larger striated ducts
Describe striated ducts
Striated like a thick lawn, and major site for reabsorption of NaCl. Appear striated at the basal end. Basal membrane is highly folded into microvilli for active transport of HCO3 against conc gradient.
What ions do ducts secrete?
K+ and HCO3-
What ions do ducts reabsorb?
Na+ and Cl-
Why is saliva hypotonic?
The epithelium of the ducts reabsorb water
How much of the salivary flow are from the major glands?
80%
Where are the minor saliva glands found?
The submucosa or oral mucosa of the lips, cheeks, hard and soft plate and the tongue
Where is the parotid gland?
Superficial triangular outline between the zygomatic arch, sternocleidomastoid and ramus of mandible
Where does the parotid gland enter the mouth?
Near the second upper molar
What is the sympathetic sensory innervation of the parotid gland?
Auriculo-temporal nerve which is a branch of the mandibular nerve
What is the parasympathetic innervation of the parotid gland?
Glossopharyngeal nerve (stimulates secretion)
What are the structures that pass through the parotid gland?
External carotid artery, retromandibular vein and facial nerve
What are the two lobes of the submandibular gland, and how are they seperated?
Seperated by the mylohyoid muscle, larger superficial lobe and a smaller deep lobe
Where does the submadibular gland empty into the oral cavity?
The sublingual papillae- under tongue
What is the parasympathetic innervation of the submandibular gland?
Chorda tympani branch of facial nerve VII
What is the sympathetic innervation of the submandibular gland?
Lingual nerve which is derived from the facial nerve VII
Where is the sublingual gland?
Located on the floor of the mouth between mylohyoid muscles and oral mucosa of the floor of the mouth
What is the parasympathetic innervation of the sublingual gland?
Chorda tympani branch of the facial nerve VII
What is the sympathetic innervation of the sublingual gland?
The lingual nerve which is derived from the facial nerve VII
Does sympathetic or parasympathetic stimulation inhibit salivary secretion in the minor glands?
Sympathetic
What is xerostomia?
Dry mouth
Where do salivary calculi (stones) normally form?
Submandibular gland
What are the functions of the stomach?
Store and mix food Dissolve and continue digestion Regulate emptying into the duodenum Kill microbes Secrete protease Secrete intrinsic factor Activate proteases Lubrication Mucosal Protection
What do parietal cells produce?
Gastric acid and intrinsic factor
What do chief cells produce?
Pepsinogen
What do ECL cells release?
Histamine
What do G cells release?
Gastrin
What do D cells release?
Somatostatin
What do glands in the thin walled upper portions of the body of the stomach secrete?
Mucous, hydrochloric acid and pepsinogen
What do the glands in the thick walled antrum secrete?
A little acid, mainly gastrin
How much hydrochloric acid is produced per day?
2 litres
Describe how HCl is made in the stomach
H2O in the parietal cell breaks down into OH- and H+
H2CO3 rapidly disassociates into HCO3- and H+
The H+ ions produced can then react with OH- to regenerate H2O
The H+ ions are actively pumped into the stomach lumen. They pump 1 k+ into the cell for every 1 H+ out.
The K+ ions diffuse back out through K+ channels.
The HCO3- is secreted into the capillary for the exchange of Cl- ions. These Cl- ions then enter the stomach through Cl- channels. In the stomach the H+ ions and Cl- ions react to form HCl.
How is H2CO3 produced?
CO2 and H2O from respiration are converted via the enzyme carbonic anhydrase
Describe the cephalic phase to increase gastric acid production
This is a parasympathetic response initiated by sight, smell, taste or chewing. Acetyl choline is released and it acts indirectly in parietal cells, triggering the release of gastrin and histamine. These both increase the number of H+/K+ATPase pumps, to increase gastric acid production
Describe the gastric phase to increase gastric acid production
Gastrin is released which acts directly on parietal cells, and triggers the release of histamine. These both increase the number of H+/K+ATPase pumps on the membrane of parietal cells, increasing gastric acid production
How is the cephalic phase to increase gastric acid production initiated?
Smell, sight, taste or chewing
How is the gastric phase to increase gastric acid production initiated?
Gastric distension from the volume of ingested material and the presence of peptides and amino acids
How do proteins in the stomach increase acid production?
The proteins act as a buffer thereby reducing the amount of H+ ions, increasing the pH, resulting in decreased secretion of somatostatin which increases parietal cell activity, increasing gastric acid production
What is the gastric phase to decrease gastric acid secretion?
A low luminal pH directly inhibits gastrin secretion thereby indirectly inhibiting histamine release. The pH also stimulates somatostatin release which inhibits parietal cell activity.
What does somatostatin do?
Inhibit parietal cell activity- less gastric acid secretion
What initiates the intestinal phase to decrease gastric acid secretion?
Duodenal distension, low pH, hypertonic solutions, the presense of amino acids and fatty acids
What is the intestinal phase to decrease gastric acid secretion?
Locally produced chemical messengers called enterogastrones such as secretin and cholecystokinin (CCK) are released. They also trigger short and long neural pathways which reduce ACh release.
What is secretin?
A enterogastrone which inhibits gastrin release and promotes somatostatin release
What is an ulcer?
A breach in a mucosal surface
Describe helicobacter pylori infection
A bacteria that lives in gastric mucus. It secretes urease which splits urea into CO2 and ammonia. The ammonia reacts with H+ to produce ammonium, which is toxic to gastric mucosa resulting in less mucous being produced. Secreted proteases, phospholipase and vacuolating cytotoxin A can then begin attacking the gastric epithelium, further reducing mucous production. Results in inflammatory response.
What is the treatment for helicobacter pylori infection?
Eradicate organism using triple therapy; proton pump inhibitor (increases gastric pH making conditions inhospitable), and antibiotics
What does NSAID stand for?
Non-steroidal anti-inflammatory drugs
How can NSAIDs cause a stomach ulcer?
NSAIDs inhibit cyclo-oxygenase 1 thus reducing mucosal defence?
How is mucous secretion stimulated?
Prostaglandins (cyclo-oxygenase 1 is needed for prostaglandin synthesis)
What are the chemical irritants that can cause gastric ulcers?
Alcohol, bile salts (can be refluxed from duodenum)
What is a gastrinoma?
A rare tumour of parietal cells causing excessive gastrin release (can cause increased attack on gastric mucosa causing gastric ulcers)
What are the synthetic ways to reduce gastric acid secretion?
Proton-pump inhibitors or H2 receptor agonists
What are examples of proton-pump inhibitors?
Omeprazole, lasoprazole and esomeprazole
What are examples of H2 receptor agonists?
Cimetidine and ranitidine
What do H2 receptor agonists do?
Block the receptors for histamine thereby reducing acid secretion
What are the protective mechanisms of gastric mucosa?
Alkaline mucus on luminal surface, tight junctions between epithelial cells, replacement of damaged cells, feedback loops
Why is pepsin secreted as pepsionogen?
To prevent it digesting the chief cells
What ion irreversibly inactivates pepsin?
HCO3-
What is essential for vitamin B-12 absorption?
Intrinsic factor
What percentage of total protein digestion does pepsin account for?
20%
What is the volume of an empty stomach?
50ml
What volume can a full stomach accommodate?
1.5L
How does the stomach increase in volume?
The smooth muscles in the body and fundus receptive relax
What is the nervous supply mediating receptive relaxation?
Parasympathetic nervous system acting on the enteric nerve plexuses with co-ordination provided by afferent input from the stomach via the vagus nerve and the swallowing centre
What chemicals mediate receptive relaxation?
Nitric oxide and serotonin
What is the direction of the peristaltic waves in the stomach?
From the body towards the antrum
What is the pyloric sphincter?
A ring of smooth muscle and connective tissue between the antrum and the duodenum
What is the frequency of peristaltic gastric waves determined by?
Pacemaker cells -interstitial cells of cajal, in the muscular propria
What is the frequency of peristaltic gastric waves?
3 per minute
What can increase the strength of gastric contractions?
Gastrin, gastrin distension
What can decrease strength of gastric contractions?
Duodenal distension, increase in duodenal fat, increase in duodenal osmolarity, increase in duodenal pH, increase in sympathetic stimulation, decrease in parasympathetic stimulation
What are the symptoms of dumping syndrome?
Vomiting, bloating, cramps, diarrhoea, dizziness, fatigue, weakness, sweating
What causes dumping syndrome?
Overfilling of the duodenum by a hypertonic solution
What is gastroparesis?
Delayed gastric emptying
What happens to the pH of the duodenum, when gastric contents enter?
Duodenal pH falls
What are the symptoms of gastroparesis?
Nausea, early satiety, vomiting undigested food, GORD, abdominal pain, anorexia
What drugs can cause gastroparesis?
H2 receptor antagonists, proton pump inhibitors, opiod analgesics, diphenhydramine, beta-adrenergic receptor agonists, calcium channel blockers, levodopa
What can cause GORD?
Pregnancy, Hiatus hernia, obesity and smoking
What percentage of water is absorbed in the small intestine?
80%
Which part of the small intestine absorbs the most amount of water?
The jejunum
How much of the fluid load is reabsorbed?
98%
How is potassium reabsorbed?
K+ is absorbed by passive diffusion in the colon
How is chloride reabsorbed?
Cl- is actively reabsorbed in exchange for bicarbonate resulting in the intestinal contents becoming more alkaline
What is the absorpitive state?
Ingested nutrients enter the blood from the GI tract. During this state, some of the ingested nutrients provide the energy requirements of the body and the remainder is added to the body’s energy stores to be called upon during the post absorptive state
What is the postabsorptive state?
The GI tract is empty of nutrients and the body’s own stores must supply energy
What is the average daily intake of lipid?
70 to 100 ml per day
What are the three main important fatty acids we absorb?
Palmitic, stearic and oleic acid
Where does triglyceride digestion begin?
In the mouth
Where is lipase synthesised?
Pancreas
What are triglycerides seperated into under the action of lipase?
Monoglycerides and fatty acids
What are examples of emulsifying agents?
Phospholipids, bile salts
What does the process of emulsification require?
Mechanical distruption of the large droplets into smaller droplets, and an emulsifying agent
How are bile salts formed?
Formed from cholesterol in the liver
What are bile salts formed from?
Bile salts, fat soluble vitamins, cholesterol, fatty acids, monoglycerides, and phospholipids
What are chylomicrons formed from?
Phospholipids, cholesterol and fat-soluble vitamins
What are the three main sources of fatty acids for triglyceride synthesis?
Glucose that enters adipose tissue and is broken down to synthesise fatty acids
Glucose that is used in the liver to form VLDL triglycerides
Ingested triglycerides transported in the blood in chylomicrons and taken up by adipocytes
What vitamins are fat soluble?
Vitamin A, D, E and K
Where is vitamin C and B (not B12) absorbed and how?
They are absorbed by diffusion in the jejunum
Where is vitamin B12 absorbed and how?
It is bound to intrinsic factor and absorbed in the lower portion of the ileum via endocytosis
Where is the main site of protein digestion and absorption of protein?
The duodenum
How many amino acids are essential?
8
Where does protein digestion begin?
The stomach