Physiology from Midterm 2 to Final Flashcards
What is digestion a combination of?
Mechanical and enzymatic processes
Where does digestion occur?
Mouth, stomach, and small intestine
What is the point of chewing food?
Exposes more surface area for enzymes
What does the emulsification of fat via bile do?
Exposes more surface area for enzymes
What is absorption?
Crossing the gut epithelium
Where does most digestion occur?
Small intestine
Where does most absorption occur?
Mostly in small intestine (some ions and water absorbed in large intestine)
Does fat enter the bloodstream?
NO, enters lymph as lacteals
What part of the GI system is directly regulated?
Motility and secretion, which are regulated by hormones, nervous system, and local mechanisms
Order of absoprtion in small intestine?
Lumen –> apical membrane –> epithelial cell (enterocyte) –> basolateral membrane –? interstitium –> capillary in hte villi or the lymph (fat)
What do goblet cells do in the small intestine?
Secrete mucous
What do crypt cells do in the SI?
secrete ions and water
What constitutes approx. 50% of our diet?
Carbs…mostly starch and sucrose (table sugar), followed by glycogen, cellulose, glucose, fructose, etc.
Membrane transporters for carbs can transport what>
MONOsaccharides
How do artificial sweeteners work?
Typically interact with “sweet” receptors, but cannot be digested to a form that can cross into enterocytes (have Cl- instead of OH- groups)
What enzyme breaks down starch to maltose?
Amylase
What breaks down disaccharides?
Disaccharidases (maltase, sucrase, and lactase) found on brush border
Glucose enters the intestinal enterocytes via what transporter and leaves via what transporter?
Enters with Na+ via SGLT and exits on GLUT2
Fructose enters SI enterocytes via what transporter and leaves on what?
Enters via GLUT5 and exits on GLUT2
Where are the Na+/K+ ATPase pumps found on intestinal cells?
Basolateral side
What are endopeptidases?
Attack peptide bonds in the interior of the AA chain and break long peptide chains into smaller segments
Examples of endopeptidases?
Pepsin (stomach) and Trypsin/chymotrypsin (pancreas)
What are exopeptidases?
Release single AA from peptides by chopping them off the ends, one at a time
Examples of exopeptidases?
Carboxypeptidase and aminopeptidase from the pancrease
Products of protein digestion?
Free AAs, di and tripeptides
How are di and tripeptides absorbed?
Cotransport with H+ on the apical and basolateral membranes
How are amino acids absorbed?
Cotransport with Na+ on apical side (like glucose) and antiport with Na+ on basolateral side
How do babies reabsorb immunoglobulins during the first few days after birth?
The small peptides are carried intact across the cell by transcytosis
Most of the fat calories in our diet come from?
Trigylcerides because it is the major lipid in both animals and plants…cholesterol, phospholipids, long chain fatty acids, fat soluble vitamins
Why is the digestion of fats complicated?
Because it isn’t soluble in water…have low surface area for digestion in stomach
What are bile salts?
Amphipathic derivatives from cholesterol that break down fats
How do bile salts work?
Bile salts coat lipids to make emulsions of large droplets. The hydrophobic side associates with lipids, and the polar side chains/hydrophilic side associates with water.
What do pancreatic lipases do?
Can act on trigylcerides, in droplets, aided by colipase from pancreas
What are micelles?
Smaller droplets of fat that contain smaller components of fat, except cholesterol.. Micelles can then move close to surface of enterocytes and lipids can diffuse across apical membrane into cells.
Steps in fat absorption?
- Bile salts coat fat droplets 2. Pancreatic lipase and colipase break down fats into monoglycerides and fatty acids stored in micelles 3. Monoglycerides and fatty acids diffuse from micelles and cross cell membranes 4. Cholesterol is actively transported into cells 5. Absorbed fats combine with cholesterol and proteins in intestinal cells to form chylomicrons 5. Chylomicrons removed by lymphatic system, and short fatty acids can travel solo, entering capillaries rather than lymph
Steps in nucleic acid digestion?
Digested into nucleotides, then bases, and monosaccharides. Bases absorbed via ACTIVE transport. Sugars absorbed via same transporters as other monosaccharides
How are fat soluble vitamins reabsorbs?
Absorbed in SI with fats
Fat soluble vitamins?
A, D, E, K
How are water soluble vitamins absorbed?
Typically absorbed in SI via membrane transporters
Water soluble vitamins?
C, most Bs
Where is Vitamin B12 absorbed?
In the ileum
What does vitamin B12 require to be absorbed in the ileum?
Requires protein secreted by gastric parietal cells called intrinsic factor
What does deficiency of intrinsic factor lead to?
Deficiency of B12 that cannot be corrected by oral B12 supplemenntation
What 2 substances are homeostatically regulated in SI?
Iron and Calcium…decreased levels –> detectors –> signal –> increased intestinal uptake
How is absorption of ions and water caused in the small and large intestine?
Ions (esp Na+) move across apical side via various transporters; main driver in basolateral side in Na/K ATPase; water follows by osmosis
In the regulation of GI function, what are long reflexes?
Reflexes integrated in the CNS; sensory from GI tract to CNS and feedforward relfexes that originate outside the GI tract
What are cephalic reflexes?
Long reflexes that occur completely outside the digestive system…feedforward responses in response to sight, smell, thought of food, effects of emotion
What limb of the autonomic nervous system is excitatory in the GI tract?
Parasympthathetic
What are short reflexes in the GI tract?
Integrated within the gut in the enteric nervous system
WHat do neurons in submucosal plexus do?
Receive signals from lumen, regulate secretion
What do neurons in the myenteric plexus do?
Regulate motility
Reflexes involving gut peptides act where, and effect what?
Can act locally (paracrine) or travel via blood (endocrine) and can effect motility (altered peristalsis, gastric emptying, etc) and effec both exocrine and endocrine secretion…some gut peptides can also act on brain or are produced there
What are the parallels between the enteric and central nervous systems?
Intrinsic neurons lie entirely within gut, similar to interneurons within gut and autonomic neurons that bring signals from CNS to gut are extrinsic neurons 2. Release more than 30 different NT and neuromodulators that are not NE/E/Ach, similar to those in CNS 3. Has glial cupport cells, similar to astrocytes in CNS 4. Diffusion barries with capillaries surrounding glanglia that are not very permeable, like blood-brain barrier 5. Acts as an integrating centre, gut function can be regulated without CNS
What did the Bayliss and Starling experiment determine?
Acidic chyme entering the small intestine caused pancreatic secretion even when all nerves to the pancreas were cut. Applied extract of duodenum to pancreas, and it caused pancreatic secretion. Therefore, the factor from the intestine that stimulated secretion was called secretin.
3 families of gut hormones?
Gastrin family, secretin family, and motilin
Gastin family gut hoemones?
Gastrin, CCK, et al.
Targets of the gastrin family hormones?
Stomach for gastrin and intestine and accessory organs for CCK
Secretin family gut hormones?
Secretin, vasoactive intentestinal peptide (VIP), gastric inhibitory peptide (GIP), glucagon like peptide (GLP-1)
Targets of secretin family?
BOth endocrine and exocrine
What is motilin and what does it do?
Family of gut hormone that acts on gut smooth muscle and regulates migrating motor complexes
Role of oral cavity and esophagus in GI function?
M: swallowing, chewing S: saliva D: carbs (salivary amylase) A: none
Role of stomach in GI function?
M: mixing and propulsion (peristalsis) S: HCl, pepsinogen and gastric lipase, mucus and HCO3-, gastrin, histamine D: proteins and fasts A: lipid soluble substances such as alcohol and aspirin
Role of SI in GI function?
M: mixing and propulsion mostly by segmentation S: enzymes, HCO3-, bile, mucus, CCK, secretin, GIP, etc. D: carbs, fats, polypeptides, nucleic acids A: peptides, AA, glucose, fructose, fats, water, ions, minerals, vitamins
Role of large intestine in GI function?
M: segmental mixing; mass movement for propulsion S: mucus D: none, except for my bacteria A: ions, water, minerals, vitamins, small organicc molecules produced by bacteria
What is the cephalic phase of GI function?
Anticipation of food/presence of food in mouth –> activation of neurons in medulla –> efferent signals to salivary glands and autonomic signals via vagus to enteric nervous system –> increase in motility and secretion in stomach, intestine, and accessory organs
When do short reflexes in the GI tract occur?
When food hits the stomach/distension
Where does digestion begin?
In the mouth
What controls the secretion of saliva?
Autonomic nervous system
What does saliva do?
Softens and lubricates food. Chemical digestion via salivary amylase and some lipase. Also, antimicorbial through lysozyme and immunoglobulins.
What is the proper name of chewing?
Mastication
What is the proper name for swallowing?
Deglutition
Steps in the swallowing reflex?
- Tngue pushes bolus against soft palate and back of mouth, triggering swallowing reflex. Soft palate elevates closing off nasopharynx. 2. Breathing inhibited as bollus passes airway. Epiglottis folds down to help keep swallowed material out of airways, and upper esophageal sphincter relaxes.
Where is the swallowing reflex integrated?
The medulla. Sensory afferents in cranial nerve IX and somatic motor neuron and autonomic neurons mediate reflex.
What is gastroesophageal reflux disease?
Heartburn. Caused by the splashing up of acid from the stomach into lower esophagus during respiration (intrathoracic pressure drops) or during churning of the stomach.
What initiates digestive activity in stomach?
Long vagal reflex of the cephalic phase. Once food enters the stomach, series of short reflexes constitute gastric phase.
3 functions of the stomach?
- Storage 2. Digestion 3. Protection
Why is the storage function of the stomach so important?
Its neurally mediated receptive relaxation of upper stomach helps to keep undigested food blasting into the SI, which causes numerous problems (dumping syndrome)
Do secretions happen before food arrives?
Yeah
How does the stomach offer protection?
Antimicrobial via acid, and self-protection through teh mucus-bicarb barrier
What cells secrete gastric acid?
Parietal cells in tummy
What does gastric acid do?
Activates pepsin, denatures proteins to make them more accessible to pepsin, and acts as an anti-microbial agent
What cells secrete pepsinogen?
Chief cells
What is pepsinogen cleaved into?
Pepsin
What does pepsinogen do?
An endopeptidase that is particulary effective on collagen (meat digestion)
What cells secrete gastric lipase?
Chief cells…co-secreted with pepsinogen
What does gastric lipase do?
MINOR contribution to fat digestion
What cells secrete histamine in the GI tract?
Enterochromaffin-like cells (ECL)
What does histamine do in the GI tract?
Binds to H2 receptors in parietal cells, which promotes acid secretion
What cells secrete somatostatin?
D cells
What does somatostatin do?
Shits down secretion of acid and pepsinogen
What cells secrete gastrin?
G cells
What triggers the release of gastrin?
Both long and short loop reflexes
Steps in the integration of cephalic and gastric phases?
- Food or cephalic reflexes initiate gastric secretion 2. Gastrin stimulates acid secretion by direct action on parietal cells or indirectly through histamine 3. Acid stimulates short reflex secretion of pepsinogen 4. Somatostatin release by H+ is negative feedback signal that modulates acid and pepsin release.
What is the mucus bicarb barrier in the stomach?
Gastric mucous cells produce mucus that lies in a layer above the cells, allowing the pH to be 7 at the cell surface vs. pH 2 in lumen of stomach
What is a peptic ulcer>
Acid and pepsin damage mucosal surface, creating holes that extend into submucosa and muscularis layers
Prevention and treatment of peptic ulcers?
- Ingestion of anti-acids that neutralize gastric acid 2. H2 receptor antagonists that block the action of histamine, so parietal cells don’t release H+ 3. Proton pump inhibitors that block the H+/K+ ATPase
Method of acid secretion in parietal cells?
H+/K+ ATPase on apical membrane exports H+ in exchange for K+. HCO3-/Cl- on basolateral side pumps in CL- in exchange for bicarb. Cl- leaves parietal cells via a open CL- channel
What begins the intestinal phase of GI function?
Controlled entry of chyme into small intestine. Sensors in duodenum feed back to stomach to control dilvery of chyme, feed forward to intestine to promote digestion, motility and nutrient utilization
What is secreted during the intenstinal phase of GI function?
Bicarb, mucus, bile, and enzymes as zymogens
Carbs in the small intestine activate what hormones?
GIP and GLP-1
What do GIP and GLP-1 stimulate?
Release of insulin from pancrease
What do fats and proteins in the SI activate?
CCK release
What does CCK secretion activate?
Pancreatic enzyme secretion
What does secretin do?
Activates pancreatic bicarb secretion
What stimulates the release of bibarb from the pancreas’ duct cells?
Neural signals and secretin
What is the function of bicarb in GI function?
Neutralize chyme
What is the stimulus of release of mucus from goblet cells?
Increase inflammation…for protection and lubrication
What stimulates the release of bile from gall bladder?
CCK, presence of fats and proteins
Purpose of bile>
Fat digestion
Where is bile reabsorbed?
In the ileum, enters circulation, and travels back to liver. Recycled several times during a meal.
Steps in activation of pancreatic zymogens?
- Pancreatic secretions including zymogens enters small intestine through the pancreatic duct 2. Enteropeptidases in brush border activate trpysinogen into trypsin 3. Trypsin activates zymogens (chymotrypsinogen/chymotrypsin, procarboxypeptidase/carboxypeptidase, procolipase/colipase, and prophospholipase/phospholipase)
Where is most fluid absorbed?
Small intestine
What causes absorption in the SI?
Transport of organic nutrients and ions create osmotic gradient
Where do most nutrients absorbed in small intestine go?
Move into capillaries in villi, then into hepatic portal vein. Fats go into lymphatic systems. Xenobiotics must first pass through the liver before reaching the systemic circulation
Where does food enter the large intestine?
Iliocecal valve
What are the incomplete muscles on the LI that create haustra called?
Tenia coli
What is the main role of the large intestine?
Removes most of remaining water and forms feces
What is the motility like in the large intestine?
Iliocecal valce relaxes each time a peristalic waves reaches it and contracts when food leaves stomach (gastroileal reflex). Segmental contractions with little forward movement except when mass movements occur (3-4 times/day). Waves of contraction send bolus forward and triggerdistension of rectum…defacation reflex
What is osmotic diarrhea?
Unabsorbed, osmotically active solutes such as undigested lactose, sorbitol, olestra, or osmotic laxatives draw water into large intestine and cause excessive defecation
Secretory diarrhea?
Bacterial toxins, such as cholera, increase Cl- secretion. Diarrhea can be adaptive but can also lead to dehydration and metabolic acidosis
To be absorbed in the SI, carbs must be broken down to ______ and moved across the apical membrane of intestinal epithelium by ______
Monosaccharide units and 2ndary active transport
Order of protein digestion
Acid denaturation, endopeptidases, exopeptidases
Bile salts are…
Amphipathic derivatives of cholesterol that are stored in and secreted by the gall bladder
What is homeostatic eating?
Eating when energy fuels are depleted and not eating when energy fuels are sufficient…metabolically driven eating
What is non-homeostatic eating?
Eating in the complete absence of hunger, and eating despite large fat reserves. Involves cognitive, reward, and emotional factors. Also, has neural parallels with addiction mechanisms. “Hedonic” eating.
What are the two control centres for homeostatic eating, and where are they located?
Hunger/feeding centre and satiety centre in the hyopthalamus
What is the glucostatic theory?
Food intake is regulated by glucose levels, monitored by centres in the hypothalamus. When plasma glucose is low, satiety centre is depressed and feeding centre is dominant.
What is the lipostatic theory?
Signal from fat stores to the brain modulates eating behaviour. Leptin, synthesized in white adipose tissue, tells the brain to stop eating.
What happens if the “ob” gene is knocked out?
There is a mutation in making leptin, which means leptin isn’t produced, so no signal to stop eating, causing extreme obesity and voracious eaters/
What happens id the db/db receptor is knocked out?
No receptor for leptin, so you don’t stop eating.
Peptides that increase food intake and their location?
Ghrelin, released from cells in an emptystomach. Neuropeptide Y, released from hypothalamus. Orexins, released from hypothalamus.
Singals from the gut that decrease appetite and their location?
Inc. stretch of stomach and acid secretion in stomach. Increased CCK and increased glucose in lumen of upper SI. Increased GLP-1 in the lower small intestine/colon.
Energy input comes from?
Diet (hunger/appetite, satiety, and social/psychological factors)
How much of the energy output comes from heat? Work?
50% for both
What is the energy output for work used for?
Transport across membranes, mechanical work (movement), Chemical work (synthesis for growth and maintenance, energy storage, such as ATP and PCr, and chemical bonds, such as glycogen and fat)
How is metabolic rate estimated?
Rate of oxygen consumption and CO2 production, and how much O2 is produced fro macronutrients other than glucose.
Equation for reaction of glucose to yield energy?
C6H1206 + O2 + ADP + Pi —> CO2 + H2O + ATP + heat
Factors affecting metabolic rate?
Age, sex, lean muscle mass (muscle has higher O2 consumption than adipose at rest), activity level, diet (heat production increases after eating, extent depends on what was eaten), hormones, gut peptides, and genetics/
3 fates of ingested biomolecules?
- Energy to do mechanical work 2. Synthesis for growth and maintenance 3. Storage as glycogen (liver, skeletal muscles) or fat
2 states of metabolism?
- Fed/absorptive state 2. Fasted/postabsorptive state
What is the fed/absorptive state?
Anabolic, products of digestion being absorbed and used or stored
What is the fasted/postabsorptive state?
Catabolic, body taps into stores to maintain blood glucose levels, even though no food is coming into the body.
What are the nutrient pools that are available for immediate use (mostly in plasma)?
Glucose pool, amino acid pool, and free fatty acid pool
In the fed-state what enzymes are active and which are deactivated?
Insulin is active, leading to net glycogen synthesis, whereas enzymes for glycogen breakdown are inhibited.
In the fasated-state metabolism, what enzymes are active, and which are inactive?
Glucagon is active, and enzymes that break down glycogen are more active. Enzymes for glycogen synthesis are inhibited.
In the fed state, how much of the absorbed glucose in the liver passes through to brain, muscles, and other tissues?
Approx. 70%
In the fed-state, how much of the absorbed glucose in the liver travels into the interstitium and then into hepatic cells via GLUT transporters?
Apprx. 30%
Glucose that moves into hepatic cells via GLUT transporters during the fed state is used for?
- ATP synthesis or 2. Stored as glycogen or fat
What is the main source of glucose in the post-absorptive state?
Glycogen
How many hours of energy does liver glycogen provide?
Apprx 4 hours
In the fed state, where do absorbed AAs travel to?
To the liver, where some pass through, used for synthesis of structural proteins, enzymes, hormones, amines, and others move into interstitium then into hepatic cells for synthesis of liver enzymes, plasma proteins, and lipoproteins.
What happens to excess proteins?
Converted to FAT
Where are chlyomicrons formed?
Enterocytes
What makes up a chylomicron?
Cholesterol, TGs, phospolipids plus lipid binding proteins (apoproteins)
What happens to chylomicrons ater they enter the circulation from lymphatic drainage?
Acted upon by lipases in capillary endothelium—FFA can be oxidized for energy (most cells), FFA plus glycerol can be re-esterfied and stores as TG (adipose), and remaining particles (HDL, chylomicron remnants) taken up by liver
What can the liver do in regards to fat?
Metabolize fat, store fat as TGs, use cholesterol to form bile salts, which are released into gut lumen, and package FFA and cholesterol as LDL particles, which are releaed into circulation as sources of cholesterol and FAs
How are LDL-C particles taken into the cell?
By receptor mediated endocytosis when apoproteins interact with receptors.
Steps in Fat Synthesis
- Glycerol can be made from glucose through glycolysis 2. Fatty acids made when 2-carbon acyl units from acetyl CoA link together 3. One glycerol plus 3 FAs —> triglyceride (happens in smooth ER) 4. Even with 0 dietary cholesterol, colesterol can and will be synthesized from Acetyl CoA (HMG Co-Reductase)
During the fasted-state, what pathways are used to maintain plasma glucose levels?
Glycogenolysis, lipolysis, amino acids, and gluconeogenesis
What is glycogenesis?
Making glycogen from glucose molecules via glycogen synthase
What is glycogenolysis?
Breaking down glycogen into glucosyl units via phosphorylase
What is glycolysis?
Forming 2, 3C pyruvates from glucose
Steps in the overview of fasted-state metabolism?
- Liver releases glucose from stored glycogen 2. TGs in adipose broken down into FFAs and glycerol 3. Glycogen used for energy in muscle. Muscles also used FAs and break down their proteins to amino acids that enter the blood in extreme cases 4. Brain can only use glucose and ketone bodies
How can muscle contribute to plasma glucose?
Only indirectly by exporting pyruvate or lactate. Cannot release glucose because it doesn’t have glucose-6-phosphatase
2 options for formation of G-6-P from glycogen?
- Splitting off glucose by addition of Pi (90% of the time) 2. Splitting off glucose then spending an ATP to phosphorylate (only 10% of the time)
Amino acids are deaminated, giving rise to intermediates that can be?
Directly sent to glycolysis or TCA cycle or be sent to the liver to be converted to glucose (gluconeogenesis)
Proteolysis occurs when?
During extended fasts. Free AA pool is normally used for ATP production during fasted state.
What causes the formation of ketone bodies?
If lipolysis occurs faster than acetyl CoA can be used in TCA cycle, ketone bodies are formed. They can enter blood and serve as energy substrates for brain during times of starvation.
What type of diet increases ketone production?
Low carb/high fat, protein diets
Why can ketogenesis become dangerous?
Certain ketone bodies (acetoaceti acid, beta-hydroxybutyric acid) are strong metabolic acids that can disrupt acid-base balance
With respect to regulation of GI function, “long reflexes” refer to…
PNS efferent info from brainstem to GI tract that stimulates GI activity and cephalic relfexes of digestion such that the sight, smell, or through of food stimulate GI activity
Gastric acid secretion is stimulated by…
Histamine from ECL cells, PNS stimulation, and gastrin from G cells
Which secreted products of the intestine inhibit gastric acis secretion?
CCK, Secretin, and GLP-1