GI Tract Flashcards

1
Q

Functions of mouth

A

Lip and cheeks confine food between teeth so food is evenly chewed though mastication y

Salivary glads - secrete saliva - lubricate mouth soften / dissolve food. Amylase breaks down starch

Tongue - manipulate food for chewing

Lingual glands - secrete lingual lipase. Activated in the stomach to digest triglycerides to fatty acids and glycerol

Teeth - shred and crush food- easier for deglutition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Major organ functions

A

Mouth - begins carb and lipid breakdown through actions of amylase and lingual lipase

Oesophagus - propels good to stomach

Stomach - forms chyme - chemical breakdown on proteins, absorbs fat soluble substances

Small intenstine - mixes chyme with digestive enzymes absorbs products of carbs proteins lipids etc
Physical digestion

Large intestine - further breakdown of residue - absorbs vitamins and water. Propels faeces towards rectum for emilinarion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Gastric glands (4)

A

Mucous cells- secrete protective alkaline mucous

Chief cells - secrete pepsinogen

Parietal cells - secrete HCL and intrinsic factor (If needed for absorption of vit B12)

G cells - enteroendocrine cells that produce gastric histamine somatostatin and serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Mechanical digestion in stomach

A

Mixing wave- unique form of peristalsis that mixes and softens the food with gastric juice to form chyme -

Gastric emptying into duodenum - rhythmic mixing waves forcing about 3ML chyme at a time through the partially open pyloric sphincter and into duodenum

Chyme in duodenum activates receptors inhibiting gastric secretions

Prevents additional chyme from being released by stomach before the duodenum is ready to process it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Chemical digestion (early )

A

Acidity of chyme inactivated salivary amylase and actives lingual lipase
Protein digestion begins through actions of HCL and pepsin (rennin in infancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hormonal control of the stomach

A

Gastrin - pylorus - stimulated by peptides and amino acids - increases secretion by gastric glands of pepsinogen / HCL and promotes gastric emptying

Histamine - stomach mucosa - presence of food in mouth - stimulates parietal cells to produce HCL

Serotonin - stomach mucosa - presence of food in mouth - contracts smooth muscle cells

Somatostatin - pyloric antrum / duodenum - restricts all gastric secretions motility and emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Functions of small intestine

A

Joins the stomach and large intestine

Duodenum - recovers chyme bile and pancreatic juice from sphincter of oddi

Jejenum - absorbs nutrients via enterocytes and passes to liver via hepatic portal vein

Ileum - large surface area - absorbs vit B12 and remaining nutrients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cells of the small intestine (8)

A

Absorptive - epithelium - digestion and absorption of nutrients in chyme

Goblet - epithelium - secretion of mucous

Paneth - secretion of bactericidal lysozyme

G cells - secretion of gastric

I cells - secretion of cholecystokinin to stimulate pancreatic juice and bile

K cells - secretion of GIP and insulin

M cells - secretion of motilin, accelerated gastric emptying stimulates peristalsis and secretion of pepsin

S cells - secretion of secretin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What causes lactose intolerance

A

Diary products - lack of enzyme lactase - bacteria in large intestine ferment the undigested lactose producing gas

H2 breath test can diagnose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Functions of large intestine

A

Chyme residue entering the cecum via the ileocecal sphincter has very little nutrient content other than water

Mechanical digestion -
Huastral contraction - segmentation and mixing
Peristalsis slower
Mass movement - moves contenders towards rectum

Chemical digestion
Occurs via bacterial breakdown of carbs
Results in gas formation

Feasted formation - last remains water absorbed from chyme leaving a semi solid feaces - too much water absorbed - constipation too little diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Liver

A

Revived nutrients from small intestine (via hepatic portal vein) and produces bile. Bile produced from hepatocytes. Bile salts - steroid acids conjugated to amino acids

Storage centre - vit A B12 K glycogen
Produces albumin macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Gall bladder

A

Stores and concentrated bile

Gall stones due to imbalance in the bile costituents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pancreas

A

Mix of exocrine and endocrine
Acinar cells - exocrine - secrete through ducts. Secrete pancreatic juice in INACTIVE forms - trypsinogen and active forms - amylase lipase etc

Acidic chyme stimulates the release of secretin causing release of bicarbonate rich juice

Islet cells
A cells - produce glucagon
B cells - produce insulin
& cells-produce somatostatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Splanchnic circulation

A

Blood vessels that supply the GI
Hepatic portal circulation delivers most of blood to liver
Provides metabolic needs to GI tract
Absorbs/ transports nutrients after digestion
Large blood resovior
Largest regional circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Enteric nervous system

A

Communicates with sympathetic and parasympathetic divisions but can and does act independently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe enzymatic release by pancreas’s

A

Acinar cells secrete pancreatic juice
Inactive form as pancreas’s would be digested by active form
Eg trypsinogen
And also active forms eg amylase lipase nuclease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Divisions of enteric nervous system

A

Myenteric plexus
Control of smooth muscle tone (motility)

Submucosal plexus - control of secretion, blood flow chemical stretch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Neurotransmitters of enteric nervous system

A

Excitatory
Acetyl choline - contraction of smooth muscle
5HT- increase in contraction of the gut
Sub P - increase saliva production, muscle
Cholecystokinin - stimulates pancreatic enzyme secretion and gall bladder

Inhibitory
Enkephalins - modulate smooth muscle activity
VIP - inhibits gastrin release and acid secretion
Somatostatin - modulates the release of acid pepsin gastrin insulin
NO / ATP - modulates motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What 3 mechanisms regulate motility and secretion

A

Endocrine hormones
Paracrine hormones
Neural transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Endocrine regulation

A

Endocrine mediators (HORMONES) secretes directly into the circulation - action on cells DISTANT to the site of production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the five major GI peptide hormones

A

Secretin - small intestine - increases bicarbonate from pancreas and bile for liver and decreases gastric acid secretion

Gastrin - antrum of stomach - gastric acid secretion motility

Cholecystokinin - small intestine - decrease gastric acid secretion. Pancreatic juice and bile increase m

Gastric inhib peptide - increase insulin secretion

Motilin - increases emptying, secretes pepsin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Endocrine hormone production

A

GI tract is the largest endocrine organ but secretory cells are diffusely distributed. Principal endocrine cells of the GI tract are APUD - amine precursor uptake decarboxylation

Located in the Basal portion of gastric glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Give an example of an endocrine and paracrije mediator of GI tract

A

Endocrine
Gastric secretes from pylorus
Through the blood stream to parietal cells
Stimulate HCL production

Paracrine
ECL cell release histamine
Histamine stimulates parietal cells to release HCL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Paracrine mediator

A

Mediator diffuses locally with action on neighbouring cells of different type
Derived from various cell types
Vascular endothelium mast cells ECL cells and macrophages

Non peptide
Histamine
NO
Seratonin

Peptide
Bradykinin
Somatostatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Neurotransmitters

A

Mediators released from neurones to act locally
Mainly under autonomic control
Independent of CNS and voluntary control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Para / sympathetic = extrinsic

Enteric = intrinsic

A

Parasympathetic
Transmitter = acetylcholine
Receptor M1 or M2

Salivary glands - increases - watery

Stomach / intestine
Motility and secretion increases
Sphincter tone decreases

Sympathetic does the opposite
Transmitter is noradrenaline - a or b2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Mediators of the enteric nervous system elicit either excitatory or inhibitory actions on secretion and motility. Secretory / motility functions of the gut are mediated by hormonal paracrine neural mediators

A

Gut hormones are released by APUD cells in the gut and are truly endocrine
The intrinsic nervous system of the gut may be regarded as a division of the autonomic nervous hasten

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Arrangement of muscle In GI tract

A

Muscle in GI tract is mainly arrange in 2 layers
Outter longnitudinal layer
Inner circular layer

Muscle is predominantly smooth muscle there not under voluntary control
Skeletal muscle found in pharynx upper oesophagus external anal sphincter ie voluntary control swallowing and defactation

Electrical activity of smooth muscle
Slow wave activity is seen in most physical smooth muscle - Do not cause contraction action potential required

Spontaneous regular oscillations of membranene potential = nasal electrical rhythm of visceral smooth muscle

Origin of slow waves are specialised pacemaker cells - interstitial cells of cajal

Basal rate of electrical firing of cells of cajal varies from 3-20 cycles per minute

Amplitude and rate of slow wave may be modulates by neurotransmitters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Oseophageal peristalsis

A

Propulsion of food from pharynx to stomach by coordinated contraction of oesphagael muscle

Wave of contraction followed by a wave of relaxation
Contains both smooth and skeletal muscle and is controlled by autonomic nerves coordinated by swallowing centre of medulla

30
Q

Stomach movement

A

Proximal region of stomach relaxes to accommodate passage of food with minor changes in the intragastric pressure

Peristaltic contraction arising in the mid stomach move food towards the antrum band pylorus and some food back into body of stomach
Wave of peristalsis move caudad and increases in intensity - the distal antrum is intensely constricted
Chyme passes thought the pylorus with each contraction (3ML)
Most chyme is squired back into body by retropulsion

31
Q

Stomach emptying regulation

A

Stomach emptying is determined by the tone of the pyloric muscle
Stomach emptying is regulated by
Myenteric reflexes in stomach due to stretch
Gastrin increases
Duodenal distension (decrease)
Fats in duedenum via CCK release (decrease)

32
Q

Small intestine contraction

A

Mixing movement - segmentation
Sustained contraction of rings of circular muscle
Followed by contractions of adjacent segment promotes Mixing of digestive secretions with chyme
Propulsive peristalisis
Migrating peristaltic waves moving caudad
Slow and interrupted by episodes of segmentation

Migrating myoelectric complex

Between meals - powerful regular cycles of peristalisis occur
Spontaneous contractions originate in distal stomach possibly by motilin
MMC migrates down the duodenum and ileum at rate of the slow waves
MMC finished in terminal ileum and another begins
Important for preventing accumulation of debris and microbial overgrowth

33
Q

Colon functions

A

Storage
Absorption of water and electrolytes
Bacterial synthesis of vitimin K
Regulation of chyme entry (ileoceacel sphincter)

Motility generally slower than ileum with 2 major patterns

  • haustration - formation of sacs that store / propel contents
  • peristalsis movement of contents caudad and backwards
34
Q

Summary

A

Mass movements are periods of intense caudad peristalsis
Gut smooth muscle exhibits spontaneous slow wave activity
Amplitude / rate of slow waves may be modulated by neutrotransmitters / hormones
Excitation - contraction coupling in smooth muscle has similar / dissimilar features compared to skeletal muscle
Peristalsis is the principal form of gut motility it occur me in response to the presence of food and the MMC

35
Q

Saliva function

A

Primary roles - lubrication initiation of digestion salivary amylase and lingual lipase
Antiinfective - lysosomes - igA binding glycoprotein

Parotid gland roof of mouth - AMYLASE
Submandibular - back of mouth - compound - mucous
Sublingual - under tongue - mucous

36
Q

Control of salivary secretion

A

Autonomic innervation
Parasympathetic increase - general level of saliva in mouth. Drooling with food
Sympathetic - nerves dehydrated

Food stimulates taste receptors
Parasympathetic innervation via glossopharyngael and facial nerve

LITTLE TO NO REG BY HORMONES

37
Q

What are oxynitic cells

A

Located in gastric pits - HCL pepsinogen and intrinsic factor

38
Q

Gastrin secretion

A

Major controller of gastric secretion. Released into the blood in response to stimuli. Produced in G cells in pylorus of gastric antrum (OPEN APUD cells) exerts action through stimulation of CCK type B receptors in parietal cells and ECL cells

39
Q

3 phases of digestion

A

CEPHALIC - vagal stimulation causes release of gastrin / histamine
Triggered by sight smell chewing swallowing

GASTRIC - chemical stimulation or distension

G cells releases gastric which causes ECL cell to realise histamine which causes parietal cell to release H+
Both cause increase in acidity which increases pepsinogen release from chief cells - parasympathetic innervation

INTESTINAL - presence of chyme in duodenum inhibits acid secretion and motility via release of secretin / GIP / CCK

APUD cells
Fats / fattys acids = CCK or GIP inhibits parietal cells from releasing H+
Gastric acid - secretin increases - increases amount of bicarbonate and inhibits gastric acid secretion

Decreases gastric emptying

40
Q

Acid reflux

A

Block Ach - M1 antagonists - pirenzipine - ulcers

Block histamine - H2 antagonists - ranitidine

Block H+ - PPI omeprazole

41
Q

Pepsins

A

Secretes as precursor zymogens - pepsinogens
Primary proteolytic enzymes
Secretion is stimulated mainly by Ach during cephalic and gastric phases
H+ is necessary for activation

Vagal innervation

Chief cell releases pepsinogen, converted to pepsin by autocatalysis - H+

42
Q

Pancreatic juice and bile

A

Pancreas’s has both exocrine and endocrine function

Endocrine - insulin and glucagon
Exocrine - pancreatic juice

Non digestive endocrine hormones secretes by cells in the islets of langerhans
A cells - produce glucagon
B cells produce insulin
& cells produce somatostatin

Digestive exocrine enzymes and HCO3- secretes by ACINAR cells

43
Q

What is the incretin effect

A

2 major incretin peptides in intestinal secretion

GIP - glucose dependant insulinotrophic peptide
GLP-1 glucagon like peptide 1

GIP has a minor role to gastric secretion and a major role in insulin release by endocrine pancreas

T2 diabetes - incretin effect reduced

Drugs such a gliptins inhibit GIP / GLP breakdown by enzymes DPP 1V

44
Q

Pancreatic enzymes
Secreted from ACINAR CELLS by exocytosis in response to neutral / hormonal stimuli

Active enzymes / pancreatic lipase
a amylase deoxyribosenuclease

Zymogen precursors in pancreatic juice are activated enzymatically in small intestine

A

Trypsinogen ——> trypsin

Chymotrypsinogen —-> chymotrypsin

ENZYME = ENTEROKINASE

45
Q

Regulation of exocrine pancreatic secretion

A

Hormonal control - secretin

Neuronal control - parasympathetic stimulation during gastric and cephalic phase

46
Q

Bile functions

A

Secreted more or less continuously by polygonal hepatocytes of the liver

Caniculi —> hepatic ducts system —> bile duct

In the inter digestive period hepatic bile stored in the gall bladder - concentrated by water reabsorption

Primary bile acids - cholesterol derivatives synthesised in liver conjugated with a a to become water soluble

Secondary bile salts
Dehydroxylated forms via gut bacterial
enzymes

Conjugated bile salts are amphipathic which is hydrophilic n hydrophobic

47
Q

Bile function

A

Emulsification of fats and solubilisation
Transport and absorption of fat soluble vitimins
Elimination of cholesterol

48
Q

Regulation of bile secretion

A

Gall bladder contains stimulated CCK - CCK stimulated by fat in duodenum

Bile duct HCO3 secretion stimulated by secretin- secretin stimulated by presence of acid in duodenum

49
Q

Intestinal secretions

A

Contain few unimportant enzymes
Ileum - mucous HC03 water
Burners glands -

Colon - mucus

50
Q

Summarised

A

Exocrine pancreas secretion is alkaline enzyme rich stimulates by vagal tone during cephalic and gastric phases of digestion and by hormones in intestinal phase (CCK Secretin)

In pancreas CCK stimulates enzyme secretion secretin stimulates HC03-

In gall bladder CCK stimulates bile release, secretin promotors HC03- secretion by bile duct

51
Q

Digestion and absorption means

A

NUTRIENT ASSIMILATION

Physical reduction of food
Chemical reduction of food
Constituent monomoree dimers by enzymatic hydrolysis

Absorption - transport of products of digestion from gut lumen across mucous membrane into the blood

52
Q

Carbohydrate digestion

A

Common dietary sugars are disaccharides

Eg sucrose = glucose and fructose
Lactose = glucose and galactose

Cellulose - plant material indigestible fibre - helps with propulsion thought GI tract

53
Q

Glycosidic bond digestion

A

Alpha 1.4 glycosidic binds - disaccharides
Alpha 1.6 glycosidic binds - polysaccharide

A AMYLASES - cleaves 1.4 glycosidic bonds in polysaccharides

DEXTRINASE cleaves 1.6 glycosidic binds

Salivary amylase - begins luminal phase digestion of starch

Pancreastic amylase - continues luminal phase digestion of starches in small intestine

54
Q

What is a brush border enzyme

A

Membranous phase of digestion - on microvilli

Example = lactase sucrose Maltese a dextrinase

55
Q

Absorption of monosaccharides

A

Principal monosaccharide products of carbohydrate digestion are hexoses
Hexose absortption occurs by

PASSIVE DIFFUSION
NA GLUCOSE SYMPORT - glucose and galactose are transported from the lumen of the gut into epithelial enterocytes by na glucose co transporter SGLT-1

NA INDEPENDANT FACILIATED DIFFUSION - glucose transporter proteins expressed in all cell types - GLUT 1 GLUT 2 GLUT 5

GLUT 2 on basal membrane transports hexose from enerocyte cytosine to extracellular space

56
Q

Where is the brush border ?

A

On the apical membrane

57
Q

Protein digestion

A

Protease cleaves peptide linkages by hydrolysis
Three places for proteases are
Gastric pancreatic brush border

Endopeptidases - hydrolyse peptide binds IN polypeptide eg trypsin pepsin

Exopeptidase - hydrolyse peptide bonds at end of the polypeptide chain
Carboxypeptidase

58
Q

Gastric proteases (pepsin)

A

Endopeptidase
Secreted by Chris cells as pepsinogen activated by pepsin autocatalysis)
Have acidic Ph optimum and initiate luminal phase of protein hydrolysis

59
Q

Pancreatic proteases

A

Secreted from acinar cells in response to neural and hormonal stimuli
Secreted as zymogens trypsinogen activated by enterokinase in small intestine

60
Q

Brush border protease

A

Apical surface of epithelial enterocytes in duodenum jejenum ileum
ENTEROKINASE oligopeptidase aminopeptidase

61
Q

Absorption and transport

A

Products of protein digestion are amino acids dipeptides
Further hydrolysis of tripeptides occur by cytosolic peptidases within enterocytes
Absorption from lumen across brush border occurs by

PASSIVE DIFFUSION
NA AMINO ACID SYMPORT
NA INDEPENDANT FACILIATED DIFFUSION

62
Q

What two types of co transporters do monosaccharides use

A

Monosaccharide absorption utilised two types of transporters - a na+ cotransporter - SGLT-1 and GLUT 1,2,5 by FACILIATED diffusion

63
Q

Lipid digestion

A

Digestive lipase hydrolyse triglycerides to fatty acids and mono/ di glycerides and glycerol

Acidic lipase - gastric and lingual
Pancreatic lipase

64
Q

Digestive lipase - acidic

A

Gastric lipase produced by peptic cells of fundus
Lingual lipase by serous glands of tongue
Potent and rapidly acting lipases - Ph = 4-5.5
Initiate lipid hydrolysis in stomach INDEPENDANT of bile forming fatty acids and diglycerides

65
Q

Digestive lipases - PANCREATIC

A

Acts on tri/ di glycerides in duodenum - neutral ph optimum
Major hydrolysis products are fatty acids and mono glycerides
Complete hydrolysis initiates by acidic lipases

Optimal activity requires BILE ACIDS
These smiley fat into small droplets maximising the exposure of the glycerol head structure to the enzyme

Colipase - peptide cofactor prod by pancreas
Essential for optimum pancreatic lipase activity
Prevents bile acids from inhibiting lipase activity

66
Q

Lipid absorption

A

Formation of mixed Micelle
Diffusion across apical membrane of mono glycerides free fatty acids and glycerol
Binding to fatty acid binding protein in the cytosol for transport to smooth ER
Resynthesis of triglyceride
Packaging of triglyceride with cholesterol app proteins and phospholipids to fork CHYLOMICRONS
transport of chylomicrons across basal membrane into lacteals

Ie lipids are re processed within enterocytes cells unlike carbs and amino acids

67
Q

Electrolyte and fluid balance

A

Major regulation of fluid balance is via kindeys GI tract breathing and skin

Electrolytes have chemical bonds that allow dissociation into ions which carry an electrical charge
They are of critical important in fluid balance

Fluid balance can be maintained only if intake equals output

Bidirectional fluid flux in the GI tract
Water movement into lumen (secretion)
Water moment from lumen (absorption)

Bet absorption of water by passive movement respond to osmotic and hydrostatic pressure

Luminal fluid generally remains isotonic with plasma

Most solutes and water are reabsorbed in the ileum some in colon

Major mechanism is Na+ glucose transporter SGLT1

Malabsorption of solutes and water by ileum may overwhelm the colons absorptive capacity
Leads to diarrhoea and electrolyte loss

68
Q

Electrolyte transport

A

Passive - trans cellular and para cellular

In the ileum 
Coupled with water in distal ileum 
Cotransporter mechanisms 
Coupling to na/h exchange 
Cl- absorption is coupled to na+ absorption
69
Q

Mineral absorption

A

Divalent cation eg ca2+ are poorly absorbed
Osmotic laxative effect - milk of magnesia
Ca2+ absorption by enterocytes is tightly regulated to maintain total body ca2+ stores

1,2,5 dihydroxy vitimin D3 stimulates synthesis in enterocytes of ca2+ bonding which transports ca2+ accords the apical membrane

Inorganic fe2+ is complexed with transferrrin in the lumen and absorbed into enterocytes by a receptor mechanism

70
Q

Absorption of vitimins

A

Water soluble are absorbed by simple passive diffusion eg C
Some absorbed by specialist mechanisms eg vit B12 by ileal enterocyte receptors for vit B12 intrinsic factor complex

Fat soluble - ADE depend on solubilisation by bile salts for intestinal absorption
Inactive transport in the ileum - bact synthesised passively colon

71
Q

Absorption of water

A

Approx 9L of fluid enters the small intestine each day

2.3L ingested in food drink rest is GI secretions
90% of water is reabsorbed in small intestine water absorption driven by conc gradients of water as the conc of water is higher in chyme than in epithelial cells so it moves down its conc gra doesn’t from chyme into epithelial cells
Remaining absorbed in colon

72
Q

Describe the absorption of lipids in intestine

A

Triglycerides are digested to fatty acids and mono glycerides by lipase
Bile from liver emulsified fat to form fat droplets
At the apical membrane of microvilli the fatty acids and mono glycerides diffuse into cell
The triglycerides reform within the enterocyte cell and are coupled with proteins to from chylomicrons which diffuse from the Golgi to lacteals