Physiology Flashcards
What is the term used to describe when food moves in the direction of mouth to anus?
Aboral
What is the term used to describe when food moves from the anus to mouth direction?
Oral direction
Name the accessory structures of the alimentary canal
- salivary glands
- the pancreas
- the liver and gall bladder (hepatobiliary system)
Describe the basic function of mouth and oropharynx
- chops and lubricates food
- starts carbohydrate digestion
- delivers food to oesophagus
Describe the basic function of the oesophagus
Propels food to stomach
Describe the basic function of the stomach
- stores / churns food
- continues carbohydrate digestion
- initiates protein
- digestion
- regulates delivery of chyme to duodenum
Describe the basic function of the small intestine
- duodenum, jejunum, ileum
- principal site of digestion and absorption of nutrients
Describe the basic function of the large intestine
- caecum, appendix and colon
- colon reabsorbs fluids and electrolytes
- stores faecal matter before delivery to rectum
Describe the basic function of the rectum and anus
Regulated expulsion of faeces
What are sphincters?
Muscular constrictions
What is chyme?
Small particles of food
Name the four layers of the digestive tract wall
- mucosa
- submucosa
- muscularis externa
- serosa
Describe the mucosa
- mucous membrane (epithelial, exocrine gland and endocrine gland cells)
- lamina propria (capillaries, enteric neurones, gut-associated lymphoid tissues)
- muscularis mucosae
Describe the submucosa
- connective tissue
- larger blood and lymph vessels
- submucous plexus (neurone network)
Describe the muscularis externa
- circular muscle layer
- myenteric plexus (neurone network)
- longitudinal muscle layer
Describe the serosa
Connective tissue
Name the four major functions of the digestive tract
- motility
- secretion
- digestion
- absorption
Describe motility
Mechanical activity mostly involving smooth muscle (skeletal at mouth, pharynx, upper oesophagus and external anal sphincter)
Describe secretion
Into the lumen of the digestive tract occurs from itself and accessory structure in response to the presence of food, hormonal and neural signals. Required for digestion, protection and lubrication
Describe digestion
Chemical breakdown by enzymatic hydrolysis of complex foodstuffs to smaller, absorbable units
Describe absorption
Transfer of the absorbable products of digestion (with water, electrolytes and vitamins) from the digestive tract to the blood, or lymph - largely mediated by numerous transport mechanisms
What is the gastrointestinal motility mostly due to?
The activity of the smooth muscle
The activity of the smooth muscle includes which muscles?
- circular
- longitudinal
- muscularis mucosae
- skeletal muscle is important in the mouth, pharynx, upper oesophagus and external anal spinchter
Describe circular muscle contraction
Lumen becomes narrower and longer
Describe longitudinal muscle contraction
Intestine becomes shorter and fatter
Describe muscularis mucosae contraction
Change in absorptive and secretory area of mucosa (folding), mixing activity
Adjacent smooth muscle cells are coupled by what?
- gap junctions
- electrical currents flow from cell to cell
Describe a synchronous wave
- hundreds of cells are depolarised and contract at the same time a synchronous wave
- ie. single unit smooth muscle as opposed to multiunit smooth muscle
Spontaneous activity across the coupled cells is driven by what?
Specialised pacemaker cells
Spontaneous activity across the coupled cells is modulated by what?
- intrinsic (enteric) and extrinsic (autonomic) nerves
- numerous hormones
Describe slow waves
- in the stomach, small and large intestine spontaneous electrical activity occur as slow waves
- rhythmic patterns of membrane depolarisation and repolarisation that speed from cell to cell via gap junctions
Slow waves determine what?
Determines the frequency, direction and velocity of rhythmic contractions
Slow waves are driven by what cells?
- interstitial cells of cajal (ICCs)
What are interstitial cells of cajal?
Pacemaker cells located largely between the circular and longitudinal muscle layers
Describe the interstitial cells of cajal
- form gap junctions with each other and smooth muscle cells electrically coupling them
- slow waves in ICCs drive slow waves in the smooth muscle cells coupled to them
- some ICCs forma bridge between nerve endings and smooth muscle cells
How does contraction in the intestine occur?
Occurs only if the slow wave amplitude is sufficient to reach a threshold to trigger smooth muscle cell calcium action potentials (spikes)
Force is related to what?
The number of action potentials discharged (driven in turn by the duration of the slow wave that is above threshold)
What is the upstroke and the downstroke of the action potential due to?
- upstroke mediated by voltage- activated Ca2+ channels
- downstroke by voltage activated K+ channels
What is the basic electrical rhythm also known as?
Slow waves
What does whether slow wave amplitude reaches the threshold depend on?
- neuronal stimuli
- hormonal stimuli
- mechanical stimuli
Generally act to depolarise smooth muscle cells rather than influence slow waves directly, depolarisation shifts slow wave peak to threshold
Describe the parasympathetic innervation of the GI tract
Preganglionic fibres (releasing ACh) synapse with ganglion cells (in essence post-ganglionic neurones) within the enteric nervous system (ENS)
Describe the excitatory influences of the parasympathetic innervation of the GI tract
- increased gastric, pancreatic and small intestinal secretion
- blood flow
- smooth muscle contraction
Describe the inhibitory influences of the parasympathetic innervation of the GI tract
Relaxation of some sphincters, receptive relaxation of the stomach
Describe the sympathetic innervation of the GI tract
Preganglionic fibres (releasing ACh) synapse in the prevertebral ganglia. Postganglionic fibres (releasing NA) innervate mainly enteric neurones, but also other structures
Describe the excitatory influences of the sympathetic innervation of the GI tract
Increased sphincter tone
Describe the inhibitory influences of the sympathetic innervation of the GI tract
Decreased motility, secretion and blood flow
The enteric nervous system neurones are mostly located in ganglia connected by fibre tracts within what?
- myenteric (auerbachs) plexus
- submucous (meissners) plexus
Describe the main role of the myenteric plexus
Mainly regulates motility and blood vessels
Describe the main role of the submucous plexus
Mainly modulates epithelia and blood vessels
The enteric nervous system coordinates muscular, secretive and absorptive activities via what?
- sensory neurones; mechanoreceptors, chemoreceptors, thermoreceptors
- interneurons; the majority, co-ordinating reflexes and motor programmes
- effector neurones; excitatory and inhibitory motor neurones supplying both smooth muscle layers, secretory epithelium, endocrine cells and blood vessels
Motor and secretory activity are controlled by what?
Nerve reflexes
Name an example of a local reflex
Peristalsis
Name an example of a short reflex
Intestino-intestinal inhibitory reflex
What is the intestino-intrstine reflex?
Local distension activates sensory neurones exciting sympathetic pre-ganglionic fibres that cause inhibition of muscle activity in adjacent areas
Name an example of a long reflex
Gastroileal reflex (a vasovagal reflex)
Describe the gastroileal reflex
Increase in gastric activity causes increased propulsive activity in the terminal ileum
Describe peristalsis
A wave of relaxation, followed by contraction, that normally proceeds a short distance along the gut in an aboral direction, triggered by distension of the gut wall
Describe the altered activity of motorneurones in the propulsive segment of peristalsis
- circular muscle contracts (release of ACh and substance P from excitatory motoneurone)
- longitudinal muscle relaxes (release of VIP and NO from inhibitory motoneurone)
Describe the altered activity of motoneurones in the receiving segment during peristalsis
- longitudinal muscle contracts (release of ACh and substance P from excitatory motoneurone)
- circular muscle relaxes (release of VIP and NO from inhibitory motoneurone)
Describe segmentation
- mixing or churning movements
- rhythmic contractions of the circular muscle layer that mix and divide luminal contents
- occurs in the small intestine (in the fed state) and in the large intestine (where it is called haustration)
Describe colonic mass movement
Powerful sweeping contraction that forces faeces into the rectum, occurs a few times a day
Describe the migrating motor complex (MMC)
Powerful sweeping contraction from stomach to terminal ileum
Describe tonic contractions
- sustained contractions
- low pressure; organs with a major storage function (eg. stomach)
- high pressure; sphincters
How many sphincters of the GI tract are there (excluding the sphincter of oddi) ?
6
Describe sphincters
- composed of specialised circular, generally smooth muscle
- act as essentially one way valves by maintaining a positive resting pressure relative to two adjacent structures (eg. oesophagus and stomach)
- in general, stimuli (pressure) proximal and distal to a sphincter cause opening and closing respectively
Describe the upper oesophageal sphincter
- skeletal muscle
- relaxes to allow swallowing
- closes during inspiration
Describe the lower oesophageal sphincter
- relaxes to permit entry of food to the stomach
- closes to prevent reflux of gastric contents to the oesophagus
Describe the pyloric sphincter
- regulates gastric emptying
- usually prevents duodenal gastric reflux
Describe the ileocaecal valve
- regulated flow from ileum to caecum
- distension of ileum opens, distension of proximal colon closes
Describe the internal and external anal sphincters
- internal = smooth muscle
- external = skeletal muscle
- are regulated by the defaecation reflex
What is energy homeostasis?
Physiological process whereby energy intake is matched to energy expenditure over time
- promotes body fuel stability- energy primarily stored as fat
What is not a single disorder but a heterogeneous group of conditions with multiple causes?
Obesity
Name the major influencing factors of obesity
- genetics
- environment
What is the energy balance disturbance?
Difference between energy intake and expenditure
Name some consequences of obesity
- stroke (hypertension)
- respiratory disease (sleep apnoea)
- heart disease (lipids, diabetes, hypertension)
- gallbladder disease
- osteoarthritis
- dementia (alzheimers)
- NAFLD (fatty liver)
- diabetes
- cancer (uterus, breast, prostate, colon)
- hyperuricemia, gout
Why is fat needed?
- energy storage
- prevention of starvation
- energy buffer during prolonged illness
Name a survival adaptation for starvation and infection
Adipose tissue accumulation
The CNS influences energy balance and body weight by?
- behaviour; feeding and physical activity
- ANS activity; regulates energy expenditure
- neuroendocrine system; secretion of hormones
The site of integration is where?
The brain
The neural centre responsible is what?
Hypothalamus
eg. lesioning ventromedial hypothalamus causes obesity, lesioning lateral hypothalamus causes leanness
Name the three basic concepts that underlie the control of energy intake and body weight system
- satiety signalling
- adiposity negative feedback signalling
- food reward
What is satiation?
Sensation of fullness generated during a meal
What is satiety?
Period of time between termination of one meal and the initiation of the next
What is adiposity?
The state of being obese
What regulate meal initiation, termination and inter-meal frequency?
Short-term processes
When do satiation signals increase?
During meal to limit meal size
Name the five satiation signals
- cholecystokinin (CCK)
- peptide YY (PYY 3-36)
- glucagon like peptide 1 (GLP-1)
- oxyntomodulin (OXM)
- obestatin
Describe cholecystokinin (CCK)
Secreted from enteroendocrine cells in duodenum and jejunum. Released in proportion to lipids and proteins in meals. Signals via sensory nerves to hindbrain and stimulates hindbrain directly (nucleus of solitary tract (NTS))
Describe peptide YY (PYY3-36)
Secreted from endocrine mucosal L-cells of GI tract. Levels increase rapidly post-prandially. Inhibits gastric motility, slows emptying and reduces food intake (hypo)
Describe glucagon-like peptide 1 (GLP-1)
Product of pro-glucagon gene. Also released from L cells in response to food ingestion. Inhibits gastric emptying and reduces food intake (hypo, NTS)
Describe oxyntomodulin (OXM)
Also from pro-glucagon gene and released from oxyntic cells and L-cells of small intestine after meal. Acts to supress appetite - mechanism and site unclear
Describe obestatin
Peptide produced from gene that encodes ghrelin and released from cells lining stomach / small intestine. Suggested to reduce food intake - may act to antagonise the actions of ghrelin - actions unclear
What is the hunger signal?
Grehlin
Describe ghrelin
- octanoylated peptide, produced and secreted by oxyntic cells in stomach
- ghrelin levels increase before meals and decrease after meals
- levels are raised by fasting and hypoglycaemia
What does ghrelin stimulate?
Stimulates food intake, decreases energy expenditure and decreases fat utilisation - increases body weight
Overall energy balance is controlled by what?
Feedback loops which act to maintain constancy of total body energy stores
Which two hormones, produced in peripheral tissues act on hypothalamic neurons?
Adiposity signals
What is the effect of glutamate, gaba and opioids when injected into hypothalamic centres?
Increase food intake - effect modest / short lasting
Which two hormones report fat status to the brain?
Leptin and insulin
Where is leptin made and released from?
Fat cells
Where is insulin made and released from?
Pancreatic beta cells
Describe leptin
- member of the cytokine family
- made and secreted from adipocytes
- circulates in proportion to body adiposity
- specific transport system for leptin to enter brain
- high levels of leptin receptors in hypothalamus
What type of hormone is leptin?
A pleiotropic hormone
Describe the biological roles of leptin
- food intake / energy expenditure / fat deposition
- peripheral glucose homeostasis / insulin sensitivity
- maintenance of immune system
- maintenance of reproductive system
- angiogenesis
- tumourigenesis
- bone formation
What would result in leptin resistance and why?
- diet-induced obesity
- defective leptin transport into brain
- altered signal transduction following leptin binding to its receptor
What is the starting point for digestion of proteins?
The stomach by pepsin and HCL, continues carbohydrate digestion (by salivary amylase)
Describe the stomach
J shaoed bag, 50>1000ml capacity, orad region relaxes receptively (driven by vagus) to accommodate food from oesophagus
The stomach mixes food with what to produce chime?
Gastric secretions to produce semi-liquid chyme
What does the stomach secrete?
Approx. 2 litres/day of gastric juice from gastric glands in the gastric mucosa
Describe the mechanical activity of the stomach
- occurs as two types
- orad stomach (fundus and proximal body) - tonic ie. maintained
- caudad stomach (distal body and antrum) - phasic ie. intermittent
Describe the orad region of the stomach
- relaxation driven by vagus occurs during a swallow
- no slow wave activity
- tonic contractions, when they occur, are weak due to relatively thin musculature
- contents propelled intermittently to caudad region by low amplitude tonic contractions of about 1 min duration - decrease stomach size as it empties
What allows for carbohydrate partial digestion by salivary amylase in the stomach?
Minimal mixing of contents for long 1hr periods
Which hormone decreases contractions and hence rate of stomach emptying?
Gastrin
Describe the caudad region
- slow waves occur continuously but only those reaching threshold elicit contraction
- phasic peristaltic contractions driven by suprethreshold slow waves progress from midstomach to gastroduodenal junction (the antral wave or pump) propelling contents towards pylorus through which a very small volume of chime flows into the duodenum
- velocity of contraction increases towards the junction, overtaking the movement of chime that rebounds against constricted distal antrum back into the relaxed body of the stomach - this is retropulsion
What does retropulsion do?
Mixes gastric contents reducing chime (grinding function) to small particle that pass through the pylorus
What empties the stomach?
The antral pump
What determine escape of chime through the pyloric sphincter?
The strength of antral wave, or pump, determines escape
governed by; gastric factors and duodenal factors
Describe gastric factors of control of stomach emptying
- rate of emptying proportional to volume of chime in stomach -
- distension increases motility due to; stretch of smooth muscle, stimulation of intrinsic nerve plexuses, increased vagus nerve activity and gastrin release
- consistency of chime; emptying facilitated by thin liquid chyme
How does the duodenum delay emptying?
- neuronal response; the enterogastric reflex, decreases antral activity by signals from intrinsic nerve plexuses and the ANS
- hormonal response;’ release of enterogastrones (eg CCK) from duodenum inhibits stomach contraction
Name stimuli within the duodenum that drives the neuronal and hormone responses
- FAT; particularly potent, delay in gastric emptying required for digestion and absorption in small intestine
- ACID; time is required for neutralisation of gastric acid by bicarbonate secreted from the pancreas - important for optimal function of pancreatic digestive enzymes
- HYPERTONICITY; products of carbohydrate and protein digestion are osmotically active and draw water into the small intestine - danger of reduced plasma volume and circulatory disturbance (eg. dumping syndrome)
- distension
The oxyntic gland area is where?
Proximal stomach including the fundus and body