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Stage 1 > GI Theme 2 > Flashcards

GI Theme 2 Flashcards

1
Q

what is involved in chemical digestion in the mouth

A

a-amylase
- starch digestion at pH 7
-when bolus & enzyme hit pH 2.5 gastric juices hydrolysis will cease
lingual lipase
-breakdown of triglycerides into fatty acids and glycerol

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2
Q

what is involved in mechanical digestion int eh mouth

A

breaks into pieces

mixes with saliva

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3
Q

what are the function of the stomach

A

storage
digestion
protection

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4
Q

how does the stomach have a protective fucntion

A

acids destroys bacteria and other pathogens (HCl)

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5
Q

outline mechanical digestion in the stomach

A

gentle mixing waves
more vigorous waves
intense waves near the pylorus
with each wave a small amount of chyme enters the duodenum

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6
Q

outline protein digestion in the stomach

A

HCl denatures protein molecules

HCl transforms pepsinogen into pepsin that breaks peptide bonds between certain amino acids

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7
Q

outline fat digestion in the stomach

A

gastric lipase splits the triglycerides in milk fat

most effective at pH6 to 6

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8
Q

what is the cytoplasmic pH of the parietal cells

A

7.2

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9
Q

which cells secrete mucus and bicarbonate

A

mucus cells in the neck of gastric glands

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10
Q

how does gastric mucous & bicarbonate provide protection

A

creates a barrier protecting stomach from autodigestion
mucus-physical barrier
bicarbonate- chemical barrier

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11
Q

how are GI secretions regulated

A

Long cephalic reflexes
- CNS (feeds forward & emotional reflexes)
Short reflexes
-ENS (motility & secretion: enzymes and hormones)

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12
Q

what is the enteric ns

A

subdivision of the peripheral ns controlling GI system
capable of autonomous functions
can recieve from the autonomic ns

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13
Q

how are gastric secretions and motility regulated

A

CNS & ENS

  • cephalic phase
  • gastric phase
  • intestinal phase
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14
Q

what happens in the cephalic phase

A

“stomach getting ready”

  • cerebral cortex stimulates parasympathetic ns
  • vagus n increases stomach muscle and glandular activity
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15
Q

what happens in the gastric phase

A

“stomach working”

  • nervous control keeps stomach active
  • endocrine influences over stomach activity
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16
Q

what is the function of D-cells

A

decrease stomach acid production

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17
Q

what happens in the intestinal phase

A

“stomach emptying”

  • intestinal activity increased (duodenum)
  • distension, fatty acids or sugar signal medulla
  • hormonal influences
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18
Q

what is the role of the sympathetic nervous system in the intestinal phase

A

slow stomach activity

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19
Q

what does secretin do in the intestinal phase

A

decerases stomach secretions

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20
Q

what does cholecystokinin (CCK) do in the intestinal phase

A

decreases stomach emptying

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21
Q

what does gastric inhibitory peptides(GIP) do in the intestinal phase

A

decrease stomach secretions, motility and emptying

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22
Q

what do D cells secrete, what does this do & what is its stimulus

A

somatostatin
inhibits acid
acid in stomach

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23
Q

what do G cells secrete, what does this do & what is its stimulus

A

gastrin
stimulates acid secretion
acetlycholine, peptides

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24
Q

what do chief cells secrete, what does this do & what is its stimulus

A

pepsinogen & gastric lipase
protein digestion
ActChl, secretin, acid

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25
Q

what do mucous cells secrete, what does this do & what is its stimulus

A

mucus & bicarbonate
physical barrier & chem protection
irritation & secreted with mucus

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26
Q

what do parietal cells secrete, what does this do & what is its stimulus

A

gastric acid & Intrinsic factor
activates pepsin, denatures protein, kills bacteria & vit B12 absorption (IF)
ActChl, gastrin, histamine

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27
Q

what do enterochromaffin like cells secrete, what does this do & what is its stimulus

A

histamine
stimulates acid secretion
ActChl, gastrin
stimulates acid secretion

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28
Q

what nutrients does the stomach absorb

A

water esp if cold
electrolytes
drugs (aspirin & alcohol)

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29
Q

why would the palatal and lingual tooth surfaces be at risk of erosion

A

patient suffering from reflux (gastric goes through oesophagus into oral cavity)

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30
Q

which patients may be more at risk of aspiration of stomach contents when under GA

A

hiatus hernia
non fasted
pregnant

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31
Q

which drugs can cause a dry mouth

A

chelates and complexes

protein pump inhibitors (omeprazole)

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32
Q

which drugs can cause a chalky taste

A

antacids

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33
Q

which drug can cause staining of tongue, erythema multiforme & swelling and pain of salivary gland

A

H2 receptor antagonists - ranitidine

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34
Q

what is the approx length of the SI

A

6 meters

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35
Q

what is the approx length of the duodenum and jejunum

A

2.5m

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36
Q

what is the approx length of ileum

A

3.5m

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37
Q

what is the function of the small intestine

A

mechanical digestion- weak peristalsis
chemical digestion
absorption of nutrients across intestinal enterocyte

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38
Q

how long does chyme stay in the small intestine

A

3 to 5 hrs

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39
Q

what is meant by segmentation in the SI

A

local mixing of chyme with intestinal juices

sloshing back and forth

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40
Q

what paracrine hormones are involved in the regulating the small intestine

A

secretin
GIP
GLP-1
CCK

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41
Q

what does secretin do

A

regulates water homeostasis & secretions in the stomach pancreas and liver
located in S cells of duodenum (intestinal glands

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42
Q

what is GIP produced by

A

k cells of duodenal and jejunal mucosa

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43
Q

what is GLP-1 produced by

A

intestinal enteroendodrine L-cells and some ENS and brainstem neurones

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44
Q

what does CCK do in the SI

A

stimulates release of digestive enzymes and bile from the pancreas and gall bladder
hunger suppressant
produced by enteroendocrine duodenal cells

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45
Q

how does chemical digestion occur in the small intestine

A

pancreatic juice

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46
Q

what cells produce pancreatic juice

A

acinar

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47
Q

how does pancreatic juice enter duodenum

A

pancreatic duct

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48
Q

what does pancreatic juice contain

A

proteases
lipases
amylase
sodium bicarbonate to neutralise chyme

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49
Q

which hormones regulate pancreatic juice secretion

A

CCK- enzyme rich

secretin- bicarbonate rich

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50
Q

what are incretins

A

hormones that stimulate decrease of blood glucose levels

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51
Q

when are incretins released

A

at the beginning of intestinal phase of digestion

GIP & GLP

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52
Q

how do incretins cause a decrease a blood glucose levels

A

stimulate insulin release from pancreatic b cells

inhibit glucagon release from pancreatic a-cells

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53
Q

what hormone regulates bile

A

CCK

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54
Q

which hormone stimulates goblet cells

A

VIP

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55
Q

which enzymes break down carbs in the small intestine

A

sucrase-isomaltase
- sucrose = glucose + fructose

lactase
-lactose= glucose + galactose

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56
Q

how may lactose intolerance occur

A

damage to intestinal mucosa(age, drug treatment or chemotherapy)

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57
Q

where are the enzymes that break down carbs located

A

apical membrane of SI

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58
Q

where are peptidases found

A

brush border

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59
Q

how & where are food proteins hydrolysed for peptidases to act upon

A

pepsin - stomach

pancreatic proteases- duodenum onwards

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60
Q

what do enterokinases do

A

partially hydrolyse pancreatic zygomen proteases to release the active enzyme

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61
Q

do brush border hyrolases act on lipids or nucleic acids

A

no

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62
Q

why are tight junctions important for the function of polarised cells

A

keep extracellular fluids surrounding apical and basolateral membranes separate & prevent diffusion of membrane proteins and glycolipids between fucntional domains

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63
Q

what are the consequences of tight junctions

A

prevent passage of molecules and ions between cells

must enter by active transport

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64
Q

peristaltic waves cause aid mechanical digestion in the large intestine, outline how

A

haustral churning
gastroilial reflex
gastrocolic reflex

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65
Q

what happens the the haustral churning part of mechanical digestion in the LI

A

relaxed pouches filled from below muscular contractions (elevator)

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66
Q

what happens the the gastroilial reflex part of mechanical digestion in the LI

A

when stomach full gastrin hormone relaxes ileocal sphincter so small intestine will empty and make room

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67
Q

what happens the the gastrocolic reflex part of mechanical digestion in the LI

A

when stomach fills a strong perostaltic wave moves contents if transverse colon into rectum

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68
Q

are enzymes involved in chemical digestion in theLI

A

no, only mucus is secreted

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69
Q

what do bacteria ferment in the LI during chemical digestion

A

undigested carbs into CO2 and CH4
undigested proteins into simpler substances
bilirubin into simpler substances that produce colour

70
Q

what vitamins do bacteria produce in the colon

71
Q

what are faeces

A

dead epithelial cells, undigested foods, bacteria

72
Q

what occurs during defecation in the LI

A

gastrolic reflex moves faeces into rectum
stretch receptors signal
parasympathetic nerves contract muscles of rectum and relax int anal sphincter
external sphincter is voluntarily controlled

73
Q

What is the blood supply of the liver ?

A

hepatic artery from the abdominal aorta

portal vein - nutrient rich blood from the GI tract

74
Q

How are hepatocytes arrnaged ?

A

hexagonally

75
Q

What are the hepatocytes in contact with ?

A

bile canaliculi on one side and the blood stream on the other

76
Q

What are between hepatocytes ?

A

vascular spaces called sinusoids

77
Q

What are kupffer cells ?

A

phagocytic macrophages which attach to sinusoids and play a protective roole

78
Q

What does a portal triad conssit of ?

A

hepatic artery
portal vein
bile duct

79
Q

What are the functions of the liver ?

A 
filtering of blood
protein synthesis 
carb metabolsim 
lipid metabolsim 
secretion of bile
80
Q

How can the liver remove hormones , drugs and active molecules from the blood ?

A

excretion into the bile
phagocytosis by kupfer cells
chemical alteration

81
Q

How is ammonia produced in the liver ?

A

deamiantion by amino acids

82
Q

What does the liver do with ammonia ?

A

convert it intp urea to be excreted into the urine

83
Q

How is ammonia released from glutamate ?

A

deamination of glutamate into alpha ketoglutarate produced ammonium ions
glutamate dehydrogenase

84
Q

How is ammonia turned into urea ?

A

in the urea cycle

85
Q

What is the route for the production and release of bile ?

A

bile is made in the liver
secreted into the hepatic duct
joins the cystic duct from the gall baldder
enters the duodenum through the common bile duct which goes through the pancreas

86
Q

What does bile act for fats ?

A

emulsifier

87
Q

What hormone regulates bile production ?

88
Q

Where are chylomicrons produced ?

A

in the intestinal mucosa

enoplasmic reticulum of enterocytes

89
Q

Where are chylomicrons found ?

A

in the blood and the lymph

90
Q

Where are newly formed chylomicrons secreted from ?

A

through the basolateral membrane

into lymphatic vessels to veins

91
Q

What is the role of chylomicrons ?

A

transport fat from the intestine top the liver and the adipose tissue

92
Q

What do chylomicrons consist of ?

A

95% TAG
5% cholesterol
Apo B48

93
Q

What are chylomicrons recognised by ?

A

lipoprotein lipases on the lining of blood vessels

94
Q

What happens in chylomicron breakdown ?

A

broken down into FFA- oxidiesed for energy
LDL
HDL - taken up by the liver
reminants - taken up by the liver

95
Q

What is the bile production rate in the liver ?

A

250-1500 ml a day

96
Q

What is bile pigment ?

97
Q

Where is bilirubin formed ?

A

spleen
bone marrow
liver

98
Q

What is bilirubin a derivative of ?

A

haem groups without iron

99
Q

What does bilirubin combine with ?

A

glucorinic acid - conjugated bilirubin

100
Q

What is conjugated bilirubin converted into ?

A

urobilogen

by intestinal bacteria

101
Q

What is urobilogen absorbed by ?

A

intestine into the hepatic vein

102
Q

What does bile consist of ?

A

bile acids and bile salts
detergents for fat ingestion
glucoronic acid

103
Q

95% of bile acid is reabsorbed by?

104
Q

What is the sphincter oddi ?

A

betwene the bile duct and thre duodenum

105
Q

What is the pancreas an outgrowth from ?

106
Q

What are the 2 types of glands found in the pancreas ?

A

endocrine and exocrine glands

107
Q

What is the arrangement of cells in the exocrine pancreas ?

A

arranged as raspberry like acini around a central lumen

compound acinar

108
Q

Many lumens contact each other to form what ?

A

ductules - coalesce to form the pancreatic duct

109
Q

What do acinar cells form from ?

A

invagination of embryonic endoderm

110
Q

What do the acianr cells open into ?

A

pancreatic duct

111
Q

What is the apical membrane orientated towards ?

112
Q

What is the basolateral membrane orientated towards ?

A

bloodtstream

113
Q

Which hydrolytic enzymes do acinar cells synthesisie ?

A

amylases
proteases
lipases
nucleases

114
Q

What are enxymes usually sotred as in the exocrine acinar cells and how are they released ?

A

as zymogens

as secretory vesivles in the apical membrane

115
Q

What does the basolaterla membrane contain ?

A

receptors which hormones bind to to regualte zymogen secretion from the secretory vesicles in the apical membrane

116
Q

What is the neural control of the exocrine pancreas ?

A

vagus in anticipation of a meal

117
Q

As chyme nters the duodenum what doe CCK do ?

A

circualtes to the basoalterla membrane of acinar cells and binds to a specific receptor

118
Q

What is secretin released from ?

A

enteroendocrione cells

119
Q

What is secretin reelase din repsonse to ?

A

acid in the duodenum

120
Q

What does secretin do ?

A

activates the secretion of bicarbinate from the pancreas

as pH increases bicarbonate release is stopped

121
Q

What is the secretin receptor on the basolaterla membrane of the acinar cells like n?

A

7 pass trans membrane structure

GPCR

122
Q

How are proteases sotred in the exocrone pancreas ?

A

as zymogen sin the secretory vesicles in the apical membrane of the acianr cell s

123
Q

What are tehe enzymes released from the exocrine pancreas ?

A

lipases
phospholipas A2
amylases

124
Q

Where is bicarbiante relesed from in the oancres ?

A

epithelial cells in the pancreatic duct

125
Q

What are the endocrine cells in the pancreas arranged as ?

A

isleets of langerhans

126
Q

What are the hormones released from the endocrine opancreas and where from ?

A

alpha cells - glucagon
beta cells - insuklin
delta cells - somatostain - GHIH

127
Q

What is vomiting controlled by ?

A

emetic centre in the chemoreceptor trigger zone in an area of the meduall oblangata

128
Q

What is the process of vomiting ?

A

increaseed parasymapthetic acrtivity leads to increased salivation
retroperistalsis
increase in abdominal pressure and decrease in intrathoracic pressure
propel stomach contents into the oesophagus

129
Q

What is the sympathetic resposne in vomiting ?

A

sweating and increased HR

130
Q

What are the cell to cell junctions in the apical membrane ?

A

tight junctions
claudin and occludin
adaptor proteins which link to underlying actin- Z0-1 AND Z0-2

131
Q

What are the cell0 cell junctions in the basolateral membrane ?

A

adherens junctions
E-cadherin
A AND BETA CATENIN

132
Q

What is the gut assocaited lymphoid tissue ?

A

protects agaisnt antigens entering across the intestinal mucosal barrier
aggregates of lymphoid tissue

133
Q

What are peyers patches ?

A

bumps of lymphoid tissue in mucosa of GI tract

macrophages , dendritic cells and B and T lymphocytes found within

134
Q

What are M cells ?

A

microfold cells

135
Q

What are the role of M cells ?

A

specialised epithelial cells that overly peyers patches

provide info about the contents of the gut lumen to the immune cells of the GALT

136
Q

What does the apical surface of the M cells contain ?

A

clathrin coated pits with embedded receptors

137
Q

What happens when antigens bind to the receptor ?

A

transcytosis to basolateral membrane
released to intestinal fluid macrophages and lymphocytes
trigger inflammatory response

138
Q

What do M cells transport microbes by ?

A

endocytosis
phagocytosis
transocytosis

139
Q

What do dendriticc cells do ?

A

convert T cells into T reg cells - release IL10

supresses unecessary immune response

140
Q

Damage to the intestinal epithelium leads to what ?

A

epithelial cells release signalling molecules
inhibition of IL10
D and T cells produce IL and TNF
neutrophils undergo NETosis and Apoptosis

141
Q

How does food poisoning occur with M cells ?

A

some bacteria have evolved receptors which bind to M cell receptors
bacteria transported acorss M cells
immune system react- diarrhoea and vomiting

142
Q

Good intestinal bacteria ?

A

biotin
vitamin K
intestinal flora

143
Q

Good bacteria generate which antomicrobial peptides ?

A

lysoxymes
lactoferrin
defensins

144
Q

What are the 2 types of multicellular glands ?

A

acinar and tubular

145
Q

What is the epithelium in the excretory duct ?

A

pseudostratified columnar epithelium

146
Q

Which salivary duct has pseudostratified columnar epithelium ?

147
Q

Which parts of the salivary duct has simple cuboidal epithelium ?

A

intercalated dcut

148
Q

What are serous demilunes ?

A

mixture of mucous and serous cells

149
Q

What nutrients are abosrbed by the stomach ?

A

water , drugs , electrolytes and alcohol

150
Q

What are some proteins produced in the liver ?

A

lipoproteins

plasma proteins- albumin, fibrinogen, globulin,transferrin

151
Q

In what form is pigment secreted int the bile ?

A

conjugated bilirubin

152
Q

What are the gut defence mechanisms ?

A 
taste and mouth fell 
vomiting 
gastric acid 
hydrolytic enzymes 
mucosal epithelial barrier 
GALT 
intestinal bacteria
153
Q

What controls vomiting ?

A

the enteric centre in the chemoreceptor trigger zone in the medulla oblanagata

154
Q

What initiates vomiting ?

A

chemoreceptors and the CNS

155
Q

What is the parasympathetic contribution to vomiting ?

A

increased salivation

retroperistalsis

156
Q

Describe the pressure changes in vomiting ?

A

abdominal muscles contract- increase in abdominal pressure
lowering of thoracic pressure
propels stomach contents into the oesophagus

157
Q

What is the sympathetic response in vomiting ?

A

sweating and increased heart rate

158
Q

What type of junctions are in the mucosal epithelial barrier ?

A

tight junctions

159
Q

What is the role of the mucosal epithelial barrier ?

A

keeps the ECF around the apical and basolateral memebranes separate

160
Q

what is Gut Associated Lymphoid Tissue (GALT)

A

protects against antigens entering the body across mucosal barrier

161
Q

what is a component of MALT

A

system of nodes

162
Q

where are the collection of lymph nodes of MALT

A

tonsils
appendix
payers patches

163
Q

what are microfold (M) cells

A

specialised epithelial cells that overlie peyers matches

164
Q

what do M cells do

A

provide info about lumen contents to immune cells of GALT. move particles into lymphoid vessel

165
Q

what does the apical surface of m cells contrian

A

clathrin-coated pits with embedded receptors

166
Q

what do Dendritic cells do

A

accept antigen and develops reaction on whether is harmful.
associate with basal membrane with epitherlial cells and hijack proecsses through tight junction
project processes into intestinal lumenn

167
Q

what do T lymphocytes do

A

develop into regulatroy t lymphoctes which generate iL10 important for response

168
Q

how do m cells transport microbes and food particels

A

endocytosis
phagocytosis
transcytosis

169
Q

outline the pathiophysiology of gut immune function

A
  • Damage of intestinal epithelium
  • Epithelial cells release signalling molecules
  • inhibition of IL10 production by TReg cells
  • D cells start to produce IL6, IL12 and IL23
  • T cells start to produce IL17, IFγ and TNFα
  • Neutrophils undergo NETosis
  • Neutrophil apoptosis, start of cell repair and regeneration
170
Q

what do bacteria (salmonella etc) do to cause food poisoning

A

have surfaces tha bind to m cells and are transported across epithelial barriet into body
- diarrhoea nad vomiting

171
Q

what are the Intestinal bacteria (good bacteria!)

A

biotin
vit k
intestinal flora
antomicrobal polypeptides

172
Q

what are the antomicrobal polypeptides

A
  • Lysozymes- effective against gram + species (streptococcal)
  • Lactoferrin- antiviral properties
  • Defensins- antiviral properties

Stage 1 (21 decks)

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