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Phase 2 1. Gastroenterology > GI physiology > Flashcards

GI physiology Flashcards

1
Q

What are the layers of the GI tract

A
  • serosa
  • muscularis propria
  • submucosa
  • mucosa
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2
Q

Describe the serosa

A

Outermost layer of GI tract

  • several layers of connective tissue
  • covered by simple squamous epithelium called mesothelium
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3
Q

Describe the muscularis externa

A
  • outer longituidinal muscle layer
  • inner circular muscle layer
  • site of Auerbach’s (myenteric) plexus
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4
Q

Describe the submucosa

A

loose connective tissue with collagen and elastin fibers

- site of Meissner’s (submucosal) plexus

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5
Q

Describe the mucosa

A

Innermost layer comprised of

  • muscularis mucosa
  • lamina propria
  • epithelium
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6
Q

Where is the myenteric plexus

A

(Auerbach’s plexus)

- between inner and outer muscle layers of muscularis externa

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7
Q

What is the function of the myenteric plexus?

A

Because the motor neurons of the myenteric plexus supply the longitudinal and circular smooth muscle
layers of the muscularis, this plexus mostly controls GI tract motility, particularly the frequency and
strength of contraction of the muscularis.

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8
Q

Where is the submucosal plexus?

A

(Meissner’s plexus)

- located in the submucosa

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9
Q

What is the function of the submucosal plexus?

A
  • Senses the environment within the lumen
  • Regulates GI blood flow
  • Controls epithelial cell function

The motor neurons of the submucosal plexus supply the secretory cells of the mucosal epithelium, controlling the secretions of the organs of the GI tract.

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10
Q

Describe the action of the circular smooth muscle

A

contraction causes constriction of the gut

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11
Q

Describe the action of the longitudinal smooth muscle

A

contraction causes shortening of gut

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12
Q

How is peristalsis achieved?

A

Smooth muscle functions to move the food bolus along the GI tract. The two types complement each
other to achieve peristalsis

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13
Q

Name the three salivary glands

A
  • parotid gland
  • submandibular gland
  • sublingual gland
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14
Q

Which nerves innervate the salivary glands

A

CN VII and IX

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15
Q

How much saliva is produced per day?

A

0.5L

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16
Q

What do salivary secretions contain?

A
  • mucus (lubricate)
  • amylase
  • bicarbonate
  • thiocyanate & lysosyme
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17
Q

What is the function of amylase?`

A

digest starch

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18
Q

what is the function of bicarbonate

A

neutralise acid

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19
Q

what is the function of thiocyanate and lysosyme?

A

bacteriocidal agents

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20
Q

What is the purpose of mastication?

A
  • reduces particle size
  • mixes with saliva (lube and enzymes)
  • increases surface area
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21
Q

How is mastication controlled?

A

voluntary and involuntary (mostly latter)

Once started it becomes involuntarily

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22
Q

Where is the swallowing centre found?

A

within the reticular formation of the brainstem

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23
Q

What are the voluntary movements of swallowing?

A

Tongue pushes food bolus in oropharynx superiorly and posteriorly

Bolus is pushed against the soft palate, so that it does not enter the nasopharynx

After this point (past soft palate), swallowing is involuntary

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24
Q

What is the function of the oesophagus?

A

Acts as a conduit to propel bolus from pharynx to stomach

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25
Q

What features are found on the oesophagus?

A

an upper and lower sphincter (thickened band of circular and some longitudinal muscle)

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26
Q

What is the function of the striated muscle in the oesophagus?

A

mostly voluntary control (initial swallowing)

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27
Q

What is the function of smooth muscle in the oesophagus?

A

automated peristalsis, towards the distal end of the oesophagus

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28
Q

What is the innervation of the oesophagus?

A

Afferent and efferent vagal pathways
o Mechanoreceptors in the oesophagus stimulate afferent vagal pathways
o Contractions are mediated by efferent vagal pathways

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29
Q

What is achalasia?

A

disease of the muscle of the lower esophageal body and the lower esophageal sphincter that prevents relaxation of the sphincter and an absence of contractions, or peristalsis, of the esophagus

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30
Q

What imagine is used to confirm achalasia?

A

barium swallow

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31
Q

What is the appearance of achalasia on a barium swallow x ray?

A

Dilated oesophagus on either side that fails to contract

Very tight LES

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32
Q

What are the symptoms of achalasia?

A

Inability to swallow causes regurgitation and vomiting

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33
Q

What is the treatment of achalasia?

A

balloon dilation on endoscopy to widen LES

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34
Q

What is the side effect of treatment for achalasia?

A

Patients tend to suffer from heartburn afterwards (due to reflux)

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35
Q

Describe the innervation of the oesophagus

A

Innervated by both sympathetic and parasympathetic nervous systems
 Parasympathetic regulates peristalsis via the vagus nerve (CN X)
 Myenteric plexus – major nerve supply to circular and longitudinal muscle

36
Q

What is the arterial supply of the oesophagus?

A

 Superior & inferior thyroid arteries
 Branches of bronchial, intercostal, descending aorta arteries
 Branches of left gastric, left inferior phrenic and splenic arteries
 Dense anastomosis within submucosa, meaning infarction of oesophagus is very rare because of dense
collateral circulation

37
Q

Describe the venous drainage of the oesophagus

A

 More clinically significant than arterial supply
 Portal vein – main route of portal system
o Left gastric vein, splenic gastric vein, short gastric veins

38
Q

What is the result of cirrhosis on the venous drainage of the oesophagus?

A

 Cirrhosis causes portal hypertension, which causes an extension of HTN to the left gastric and splenic
veins
o Causes splenomegaly and oesophageal varices

39
Q

What is a sengstaken tube and its use?

A

 Goes down the oesophagus into the stomach
 Tube is inflated and pulled to create traction against
the cardia
 Tampenades the vein to stop bleeding
 50% of patients re-bleed when the balloon is
deflated because it does not really address the
underlying HTN

40
Q

What is the function of the stomach?

A

 Functions primarily as a reservoir to store large quantities of ingested food
 Initiates the digestive process
 Acid secretion (via proton pump)
 Releases contents in a controlled fashion into the duodenum, which has a smaller capacity

41
Q

How is motility of the stomach controlled?

A

vagus nerve

42
Q

Describe the stomach at rest

A

contracted at rest and there is very little or no
peristalsis

Vago-electrical rhythm has a sub-threshold amplitude at this
point

43
Q

What happens to the stomach on eating

A

Stomach distends when food is swallowed

 Distension is sensed by mechanoreceptors = activate vagus
afferents
 Vago-vagal reflex as vagal efferents are activated
 This increases the amplitude of the vaso-electrical rhythm  motility increases resulting in peristalsis
 As food moves to duodenum, enterogastrin and secretin cause negative feedback

44
Q

What are the gastric secretions?

A
  1. Hydrogen ions (produced by parietal cells)
  2. Pepsin (precursor ‘pepsinogen’ produced by peptic or chief cells)
  3. Intrinsic factor  forms a complex with B12 to aid absorption
  4. Mucus
  5. Water
45
Q

Why is gastric acid necessary?

A

o Converts inactive pepsinogen to the active enzyme pepsin

o Kills a large number of bacteria that enter the stomach

46
Q

What is the normal pH of blood?

A

7.4

47
Q

What is the gastric pH at high rate?

A

~1

48
Q

Why is lots of energy expended in the stomach?

A

Creating this massive difference in pH expends a lot of energy
o Parietal cells therefore expend a lot of energy

49
Q

What are Oxyntic glands?

A

Simple tubes, two or more of which open into a single duct.
o Oxynticmeans acid-secreting
o Secretehydrochloric acid(HCl) andintrinsic factor

50
Q

Where are oxyntic glands found?

A

in the fundus and body of the stomach

51
Q

How is bicarbonate produced?

A

H 2 O =>OH- + H+

OH - + CO 2 => HCO3- (catalysed by carbonic anhydrase (CA))

52
Q

How are hydrogen ions moved?

A

actively “pumped” into the lumen by the H + -K + -ATPase

53
Q

What is the pH of gastric venous blood?

A

Bicarbonate enters the blood = gastric venous circulation is therefore more alkaline

54
Q

Where is gastric acid produced?

A

parietal cell

55
Q

What controls the parietal cells ability to secrete acid?

A

active transport

stimulation by several sources

56
Q

How does bicarbonate enter blood?

A

Bicarbonate is transported out of the basolateral membrane in exchange for chloride ions → chloride
shift
 This outflow of bicarbonate into blood results in a slight elevation of blood pH known as the
alkaline tide.
 As a result, blood draining away from the stomach is slightly more alkaline than normal blood
 This process serves to maintain intracellular pH in the parietal cell, preventing alkalosis.

57
Q

How is carbonic acid formed?

A

Carbon dioxide diffuses into the cell and combines with water to form carbonic acid
 This is catalyzed by carbonic anhydrase

58
Q

What happens to carbonic acid?

A

 Carbonic acid dissociates into hydrogen ions and bicarbonate ions

59
Q

How are hydrogen ions pumped out of the cell

A

Hydrogen ions are then pumped out of the cell, into the lumen, in exchange for potassium by H + -K + -
ATPase

60
Q

What is the purpose of hydrogen ions entering the lumen?

A

Accumulation of osmotically-active hydrogen ions in the lumen generates an osmotic gradient across the
membrane
 This results in outward diffusion of water→ gastric juice

61
Q

How is potassium recycled in gastric acid production?

A

Chloride anions enter the lumen of the gastric gland together with K + by facilitated diffusion
 K + is thus recycled

62
Q

What is HCL secretion stimulated by?

A

 Histamine – Produced by ECL cells (enterochromaffin like cells) near parietal cells
 Gastrin – Secreted by G cells, acts on the cholecystokinin-2 receptor
 Acetylcholine – released by parasympathetic neurons (vagus nerve), acts at muscarinic receptor

63
Q

What targets can be used to stop excess acid secretyion?

A
  • vagus nerve innervation
  • histamine
  • proton pump
64
Q

How is the vagus nerve targeted to stop excess acid secretion

A

Vagotomy
o Oldest intervention
o Strip away the vagus nerve from around the
stomach
o The vagus nerve has many other actions and therefore this surgery had many side effects

65
Q

What are the side effects of targeting the vagus nerve?

A

Vagus nerve is also responsible for peristalsis and emptying
o Therefore a side-effect is delay in emptying
o For this reason was generally performed with pyloroplasty or gastroenterostomy

66
Q

What drug is used against H2 receptors to stop excess acid secretion?

A

anti-histamines:

  • cimetidine
67
Q

What drug is used against proton pumps to stop excess acid secretion?

A

Proton pump inhibitor (PPI)

o Omeprazole, lansoprazole, esomeprazole

68
Q

What are the side effects of proton pump inhibitors?

A

Because gastric acid kills a large number of bacteria, PPIs are associated with increased risk of nosocomial
infections including Clostridium difficile

69
Q

How is gastric acid secretion inhibited?

A

Gastrin is inhibited at lower pH (<3) (after food leaves)
 The low pH also stimulates somatostatin, a broadly inhibitory hormone. Inhibits HCl secretion by:
o Inhibiting gastrin secretion by G cells
o Inhibiting histamine release by enterochromaffin cells
o Inhibiting HCl release by parietal cells
 Duodenal enterogastrones are also released:
o GIP
o Secretin
o CCK

70
Q

What are the phases of gastric secretion

A
  1. Cephalic phase (sight/smell/taste food)
  2. Gastric phase (food in stomach-duodenum)
  3. Intestinal
71
Q

Describe the cephalic phase

A

 Sight/smell/taste of food
 VAGUS activates parietal and gastrin cells
 Moderate stimulation of HCl / Pepsinogen

72
Q

Describe the gastric phase

A

 Distension of stomach + Proteins in antrum
 VAGO-VAGAL REFLEX + GASTRIN (+ histamine)
 Strong stimulation of HCl / Pepsinogen
 Some foods directly stimulate gastrin release:
o Protein/peptides
o Coffee
o Calcium rich food
o * Alcohol oddly doesn’t appear to stimulate gastrin release (although it is associated with excess
acid/gastritis)

73
Q

Describe the intestinal phase

A

 Proteins in duodenum  gastrin (excitatory)
 HCl in duodenum  secretin (inhibitory effect on peristalsis and secretion)
 Lipids in duodenum  Peptide YY (inhibitory)

74
Q

Summarise the events in the stomach during digestion

A

 Acid is produced to convert pepsinogen to pepsin
 Pepsin is produced for protein digestion
 Mucus is produced for lubrication, and to prevent acid and pepsin from contacting the mucosa
 Intrinsic factor is produced to form a complex with B12 for absorption in the terminal ileum
 Water produced

75
Q

What is the function of the small intestine?

A

 Mixing of foodstuffs and digestive secretions/enzymes
 Circulation of all intestinal contents to facilitate contact with mucosa
 Propulsion of intestinal content towards terminal ileum

76
Q

Describe the anatomy of the small intestine

A

(increase surface area):
o Kerckring’s folds – (plicae circularis) circular folds,
large valvular flaps projecting into the lumen of the
small intestine
o Villi
o Microvilli on surface of enterocytes

77
Q

What are Brunners glands?

A

glands in duodenum submucosa which secrete bicarbonate

78
Q

What are peyer’s patches?

A

lymph follicles found in the ileum

79
Q

What motility processes occur in the small intestine?

A
  1. Segmentation contractions (non-synchronised contractions) of circular smooth muscle to mix chyme
  2. Pendular contractions (back and forth) of longitudinal muscle to mix chyme
  3. Villus movements brought about by muscularis mucosae
  4. Peristaltic waves arising from duodenal bulb propelling food towards terminal ileum
80
Q

What are secreted from the crypts?

A

o NaCl / NaHCO 3 - = neutralises gastric HCl
o Amylase = aids in starch digestion
o Enteropeptidase = activates trypsinogen

81
Q

What are secreted from the villus tips?

A

brush border enzymes

82
Q

Describe the pancreas

A

can be divided into two parts:

  • endocrine pancreas
  • exocrine pancreas
83
Q

Describe the endocrine pancreas

A

Throughout parenchymal tissue, islands of
endocrine tissue – islets of Langerhans
o β cells producing insulin
o α cells producing glucagon

84
Q

Describe the exocrine pancreas

A

Aqueous / bicarbonate component

Enzymatic component

85
Q

What is secreted from the acinar cells?

A
  • pro-enzymes

- NaCL

86
Q

What is secreted from the pancreatic duct?

A

Bicarbonate

Phase 2 1. Gastroenterology (20 decks)

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