Regulation of Gut Function Flashcards

1
Q

Describe the nervous supply of the gut

A

10-100 million nerve cells
These neurons are arranged in rich plexuses of ganglia These ganglia are interconnected by tracts of fine, unmyelinated nerve fibres.

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2
Q

What causes dysfunction of the enteric nervous system

A

Inflammation (ulcerative colitis; Crohn’s disease)
Following invasive abdominal surgery
Irritable bowel syndrome
Ageing (constipation)

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3
Q

What are the two plexuses found in the gut wall

A

Myenteric plexus

Submucosal plexus

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4
Q

Describe the myenteric plexus (Auerbach)

A

Between the circular and longitudinal smooth muscle
Efferent innervation of both
Control of the activity of muscularis externa - coordinated control of motor function, and hence, motility.

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5
Q

Describe the submucosal plexus (Meissner)

A

This plexus has both afferent and efferent functions.

Afferent: Senses the environment within lumen using mechano/chemo/osmoreceptors

Efferent: Can fine tune local blood flow, epithelial transport and secretory/paracrine/endocrine cell function.

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6
Q

What are the functions of the enteric nervous system

A

Integrates motor and sensory activities of the GI tract independent of central control

Water and electrolyte transport
Secretion 
Perfusion/ blood flow
Absorption 
Motility
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7
Q

Describe the secretory role of the enteric nervous system

A

Controlling the secretion of enzymes, paracrine signals and hormones

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8
Q

Describe the perfusion role of the enteric nervous system

A

Blood flow control to ensure high perfusion in regions of the gut that are working (VSMC, submucosal glands) and/or absorbing (enterocytes)

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9
Q

Describe the absorptive tole of the enteric nervous system

A

Absorption of nutrients, vitamins, minerals and ions by adjusting expression of luminal transport proteins

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10
Q

Describe the motility role of the enteric nervous system

A

SMCs in the circular and longitudinal muscle layers can contract and relax for transit.

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11
Q

What is the minor plexus

A

Includes the deep muscular plexus (inside circular muscle) and the ganglia supplying biliary system and pancreas

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12
Q

What is the function of the ANS in the gut

A

Regulates smooth muscle, cardiac muscle and glands

Sympathetic (inhibition) and parasympathetic (promotion)

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13
Q

Describe the structure of the sympathetic innervation of the gut

A

Cell bodies of the preganglionic neurones are in the thoracic and lumbar spinal cord
Thoracic splanchnic nerves carry innervation to the fore/midgut
Lumbar splanchnic nerves carry sympathetic innervation to the gut

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14
Q

What is the major neurotransmitter for the gut sympathetic system

A

noradrenaline/norepinephrine

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15
Q

Describe the structure of parasympathetic innervation of the gut

A

Cell bodies of preganglionic neurones in the brainstem and sacral spinal cord
Synapse on ganglia close to the wall or directly with the enteric plexus
Cell bodies of postganglionic neurones close to the target organ

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16
Q

What is the main neurotransmitter for the parasympathetic system of the gut

A

Acetyl choline

17
Q

Describe sympathetic innervation of the GI tract

A

Majority sympathetic fibres do not directly innervate structures in the GI tract- terminate on neurons in the intramural plexuses.
BUT: Vasoconstrictor sympathetic fibers do directly innervate the blood vessels of the GI tract- coeliac, superior and inferior mesenteric.

18
Q

Describe the structure of hormone releasing cells in the gut

A

Greater at the basal membrane to release hormones into the blood (not the lumen)

19
Q

What is the function of the GI endocrine system

A

Smooth muscle contraction
Chemical and enzymatic processes
Post-absorptive processes (regulating blood glucose and appetite)
Growth and development of the GI tact

20
Q

Describe the paracrine functions of the GI tract

A

Histamine is released from the stomach to stimulate HCl secretion
Somatostatin from the stomach can inhibit acid secretion

21
Q

What is gastrin

A

Gastric acid release sitmulation
Released in the gastric antrum and small intestine
Released when pH falls < 3 (+others)
Gastric secretion, motility

22
Q

What stimulates gastrin release

A

Amino acids and peptides in the lumen
Gastric distension
Vagus nerve

23
Q

What is somatostatin

A

Synthesised in endocrine D cells or the gastric and duodenal mucosa and pancreas
Released in response to a mixed meal/less vagus nerve stimulation, low pH
Decreased acid and pepsinogen in the stomach
Decreased insulin, glucagon, enzyme and bicarbonate secretion from the pancreas
Decreased bicarbonate and absorption in the intestine

24
Q

What is used to treat neuroendocrine tumours

A

Analogue somatostatin (octreotide)
Longer half life
Selective to receptors

25
Q

What is secretin

A

Secreted by S cells of the upper duodenum and jejunum
Stimulated by acid presence in the duodenum + stomach
Stimulates bicarbonate release from the pancreas
Inhibits gastrin and acid release
High conc. - gastric emptying and acid

26
Q

What is CCK

A

Secreted by cells in the SI
Stimulated by fat and peptide presence in the SI + low pH in the stomach
Stimulates pancreatic enzyme release, delays gastric emptying(-motility), stimulates gallbladder contraction -> bile secretion

27
Q

What is GIP

A

Gastric inhibitory polypeptide
Secreted by mucosal K cells
Released follow ingestion (stimulated by amino acids, glucose and fatty acids)
Stimulates insulin secretion and decreases acid secretion from the stomach

28
Q

What is PYY

A

Peptide YY
L cells in the ileum, colon and rectum
Reduces motility, gallbladder contraction and pancreatic exocrine secretion
Inhibits fluid and electrolyte secretion and food intake