GI System Flashcards
What do bile salts do?
Emulsify fat
What is blood detoxification?
Liver takes water insoluble compounds, adds chem groups to make them water soluble, allowing the kidneys to excrete them
Microsomal enzymes/P450 system refers to
Liver enzymes
What do microsomal enzymes do?
Inactivate compounds
If a person has low levels of microsomal enzymes, what effects do drugs have on them?
Bigger effects
If a person has higher levels of microsomal enzymes, what effects do drugs have on them?
Lower effects
When does jaundice occur in adults?
If bile secretion is blocked or liver is nonfunctional
What is hepatotoxicity
Liver disease
What are the 3 phases of control
- cephalic phase
- gastric phase
- intestinal phase
Cephalic phase
Vagus n. stimulates gastric secretion before food is swallowed.
Gastric phase
Food stretches stomach activating myenteric & vagovagal reflexes.
Gastric secretion stimulated.
Histamine & gastrin also stimulate acid & enzyme secretion.
Intestinal phase
Arriving of chyme into duodenum. Gastric function stopped due to inhibitory signals being sent.
What are enterogastrones
Hormones that inhibit gastric motility
Types of enterogastrones
- GIP (gastroinhibitory peptide)
- CCK (cholecystokinin)
- Secretin
GIP
Stimulates pancreatic insulin production from islets; secreted by duodenum in response to carbs & lipids
CCK
Secreted in response to fat & protein in chyme
Stimulates gallbladder contraction & release of pancreatic juice
Secretin
In response to acidic intestinal pH
Stimulates bicarb from panreas
What does the ENS control
Neurons & glia in gut
Interconnected by outer myenteric & inner submucosal
What does the outer myenteric control
Motor activity
What does the inner submucosal control
Secretion, absorption, local blood flow
Sensory Neurons
Extrinsic afferents: travel outside of gut
Intrinsic afferents: localized
Intestinal reflexes
Gastroileal reflex: increased motility of ileum
Ileogastric reflex: distension of ileum, decreased gastric motility
Intestino-intestinal reflex: overdistension of 1 segment - relaxation of rest of intestine
What is in pancreatic juice
Bicarb- to help neutralize acid in stomach
Enzymes
CCK
Secreted in response to protein & fat in duodenum
Stimulates release of pancreatic enzymes
What does secretin get produced in response to
Acid
Digestion beings in the
Mouth
Exocrine V. Endocrine secretion
Exocrine: secrete into duct; far reaching
Endocrine: secrete into bloodstream; work locally; hormones
What does digestion do?
Breaks food down into smaller subunits
Chemical breakdown
Breaking of CHEMICAL BONDS by small intestine
Mechanical breakdown
Chewing/ churning of stomach
What is absorption?
Going from lumen of digestive tract into bloodstream or lymph
What happens after absorption?
Delivered to tissue for energy storage
Lymph absorbs..
Fats
What is the problem with digestion?
Enzymes can digest tissue of digestive tract
Which get absorbed?
Fatty acids, monosaccharides, & amino acids
Peristalsis
Moves forward
Where does peristalsis occur
The esophagus, stomach, & intestines
Digestive system function
Motility, ingestion, secretion
Mastication
Chewing
Deglutition
Swallowing
What does digestion allow
Absorption
Where is food stored & why?
In stomach to get a continuous stream of nutrients entering blood, so that you don’t need to eat continuously
Purpose of HCL
Provides a nonspecific immune defense against ingested pathogens
Peyers patches
Area of lymphoid tissue in intestinal tract; also protect against pathogens https://image.slidesharecdn.com/lymphaticsystemnotes-120330134955-phpapp01/95/lymphatic-system-notes-14-728.jpg?cb=1333115791
What protects immune function?
Tight junctions, Hcl, Peyers patches
Digestive tract refers to
Mouth –> anus
GI tract refers to
Stomach & intestines
Which layer is in contact with ingested food
Mucosa
Layers of the GI tract
Mucosa: innermost; lines lumen
Submucosa: below mucosa
Muscularis:
Serosa: outer connective
Goblet cell function
Produce mucus; helps things move along
Submucosal plexus
Regulates secretion; located in submucosa
Mucosa function
Absorption & secretion; lines lumen; simple columnar epithelium; has goblet cells
Submucosa function
Secretion; contains glands & nerve plexuses; vascular connective tissue layer
ENS function
Detects pH, detects food ingested, has sensory neurons (brain of the GI system)
How is food broken down?
Proteins –> amino acids
Fats –> fatty acids & glycerol
Carbs –> monomeric sugars
What is segmentation?
Mixing with digestive enzymes
Muscularis function & components
Segmentation & peristalsis; Inner circular & outer longitudinal layer; smooth muscle; myenteric plexus
Myenteric plexus innervation & location
Innervation: sympathetic & parasympathetic
Location: between 2 muscle layers
Myenteric plexus function
Major nerve supply to GI tract; movement contraction or relaxation of muscle layers
Esophagus connects
Pharynx –> stomach
Esophagus
Voluntary –> Involuntary; posterior to trachea; stratified squamous
Peristalsis of Bolus
Step 1: contraction of circular muscles behind food mass
Step 2: contraction of longitudinal muscles ahead of food mass
Step 3: contraction of circular muscle layer forces mass forward
Stomach empties into
Duodenum
Stomach function
Food storage & elimination, begin protein digestion, bactericidal (i.e hcl), chyme production
Purpose of layered muscles in stomach
Strength & support; for chyme production
Receptive relaxation reflex
Stomach relaxed when you swallow food allowing stomach to distend so you can eat more
What happens to chyme that doesn’t make it to duodenum?
Turned back into stomach, churned more, a bit sent to intestines
What happens if too much chyme is sent at once?
Too much acidity; buffering capacity overwhelmed; pH of intestines will be acidic; enzymes won’t work; possible ulcerations of duodenum
What if duodenum becomes overfilled?
Gastric motility inhibited
When does salivary amylase stop functioning?
When food gets to stomach b/c saliva has a neutral-basic pH & stomach has an acidic pH
T/F: The stomach does nutrient absorption
False; stomach does breakdown; mostly mechanical
What are rugae?
Inner surface folds (macroscopic)
Gastric pits
Openings of folds in gastric mucosa
Chief cells produce
Pepsinogen
Enterochromaffin cells secrete
Histamine & seratonin
G cells produce
Gastrin
D cells
Stomatostatin (inhibits digestive function)
Stem cells produce
New epithelium
Parietal cells
Hcl in stomach; intrinsic factor
Intrinsic factor
Secreted by parietal cells for B12 absorption
B12 is for
RBC production
What is pernicious anemia?
Not enough b12 for RBC production from not producing intrinsic factor
Tx: B12 injection NOT oral
What is gastric juice composed of?
Exocrine secretions, water, pepsin & hcl
How much gastric juice produced/day
2-4 L/day
What does the proton pump do?
Takes H ions –> stomach lumen in exchange for K; Bicarb –> blood; PUMPS PROTONS INTO STOMACH LUMEN
What are proton pump inhibitors?
Reduce acidity in stomach b/c H ions don’t go out = no acid produced (i.e omeprazole)
What stimulated hcl production strongly?
Histamine
What stimulates adic production?
Gastrin, histamine, neurotransmitters, exercise, caffeine
Stomach acid funciton
Denature proteins; activates pepsinogen –> pepsin; provides optimal pH for pepsin; kills microbes
Most digestion & absorption occurs in the
S. intestine
Peptic ulcers
Erosion of stomach or duodenal mucosal membranes due to hyperacidity
Gastic ulcer cause
Depletion of mucous coat
Duodenal ulcer
Hyper-acidic conditions
Zollinger Ellison Syndrome
Gastrin secreted tumor (rare); produced by duodenal ulcers
H. Pylori
Cause of most gastric & duodenal ulcers; Tx: antibiotics & proton pump inhibitor
Small Intestinal Mucosa
Plicae circularis, villi, microvilli (brush border)
Enterokinase
For trypsin activation (brush border enzyme)
Segmentation
Muscular constrictions in lumen; churning
Intestinal microbiota function
Produce vitamin K & folic acid; ferment; outcompete pathogens; anti-inflammatory actions
If the stomach pumped it’s contents all at once into the duodenum, how would this affect the activity of the enzymes within the s. intestine?
Activity would decrease; enzymes would go from neutral –> basic –> acidic; they don’t work well under acidic conditions
NSAIDS result in stomach ulcerations by…
Inhibition of posteglandin synthesis ( is what stimulates mucous coat formation)
Defecation
Sphincters relax; rectal muscles contract
Liver function
Bile production & secretion –> fat emulsification; detoxification of compounds; largest internal organ
MMCs (migratory motor complexes)
Hint: guy in commercial
occurs in between meals to prevent bacterial growth; stops when eating begins
Significance of increase S.A
For digestion & absorption to occur more effectively
Gastroesophageal junction
Where esophagus ends & stomach begins
Gastroesophageal sphincter
Thick circular muscle that prevents back flow from stomach; if doesn’t close right: acid reflux –> ulcers; not fully functional in babies hence spit up after meals; not a true sphincter
LDL
Transports cholesterol to organs & vessels –> atherosclerosis
HDL
Returns cholesterol to liver aka good cholesterol
T/F: We want high ratio of LDL
False. HDL
What happens when LDL circles around the body?
Deposits cholesterol in sub-endothelial lining of vessels –> atherosclerotic plaque formation –> coronary artery disease
The higher the HDL is thought to be
Cardio protective against pulmonary artery disease & lower your risks of plaque deposit
VLDL converted into
LDL
If the liver needs cholesterol..
It will use LDL & convert them into bile salts
If the liver does not need cholesterol..
LDL will circulate around the body (not good)
Reverse cholesterol transport
HDL picks up some of LDL brings it back to liver; protective
Myenteric plexus regulates
Motility
Submucosal plexus regulates
Secretion
Smooth muscle is under what control
Involuntary
The parasympathetic innervation of the myenteric plexus stimulates what?
Motility
Swallowing is under what control?
Voluntary
Peristalsis is under what control?
Involuntary; by smooth muscle
Esophagus is found in areas subject to what?
Abrasion
Peristalsis moves what?
Bolus
What begins the digestion & absorption phase?
Salivary & gastric enzymes
What do tight junctions do?
Keep acid & pepsin within lumen
New stomach lining every ___ days
3
Why do people with hyper-acidic conditions present with duodenal ulcers instead of stomach ulcers?
Because the stomach is really well protected by mucous coat
Chronic use of NSAIDs does what
Corrodes mucous coat
What can h. pilori lead to?
Produces mucinase which degrades mucous coat –> stomach exposed –> stomach ulcers
Mucous production is stimulated by
Prostaglandins
T/F: ASA & NSAIDS inhibit prostaglandin synthesis
True
What are peptic ulcers?
Erosions of stomach or duodenal mucous membranes
Cause of a gastric ulcer
Depletion of mucous coat
Cause of a duodenal ulcer
Hyperacidity
What happens when more gastrin is produced than should
Stomach acid increases –> duodenal ulcer
Mucinase V . Urease
Mucinase erodes mucous lining of stomach, urease neutralizes gastric acid
Why is a proton pump inhibitor used to treat h. pylori?
To heal area & stop acid production
What is gastritis?
Inflammation of stomach mucosa caused by a breakdown of protective barriers
Gastritis: What is released due to inflammation?
Histamine –> acid production
Tx : gastritis
H2 blockers (i.e zantac)
What protects the duodenum?
Bicarb
What do mucosal cells & brunner’s glands release?
Bicard
Pancreatic & bile secretions are..
Alkaline
Enterokinase is required for
Trypsin activation
Which intestine absorbs more water?
S. intestine
Causes of diarrhea
Enterotoxin & lactose intolerence
Why is enterotoxin a cause of diarrhea?
Keeps sodium & water in lumen
Causes of cirrhosis
chronic alcohol use, biliary obstruction, viral hepatitis, hepatotoxic chemicals
What gives feces its brown color & urine its amber color?
Bile pigments
What is the result of bile pigments accumulating due to a nonfunctioning liver?
Jaundice
What does the blue lamp do for babies with jaundice?
Converts bilirubin –> water soluble form
What shuts off acid production?
Negative feedback