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Pharmacy > Science of Medicines Week 8 > Flashcards

Science of Medicines Week 8 Flashcards

1
Q

define gastrointestinal system

A

a network of organs and specialised cells that enable you to transform food into the energy and nutrients required for life

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2
Q

Which organs is the GI tract made up of?

A

mouth, oesophagus, stomach, small intestine, large intestine, anus

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3
Q

Name the accessory organs

A

salivary glands, liver, gallbladder, pancreas

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4
Q

define accessory organ

A

an organ that plays a role in the function of the GI tract but is not part of it

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5
Q

define mesentery

A

a membranous tissue that surrounds the organs of the GI tract

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6
Q

What is the function of the mesentery?

A
  • holds intestines in place
  • has lots of blood vessels and lymphatics for absorption and immunity
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7
Q

What prevents food travelling to the lungs?

A

the pharynx and epiglottis

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8
Q

What is the function of the oesophagus?

A

to transport food bolus to the stomach

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9
Q

What are the main functions of the stomach?

A
  • mix food
  • digest protein
  • emulsify fat
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10
Q

How many layers is the stomach wall made up of?

A

4

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11
Q

Which cells is the stomach acid produced by?

A

parietal cells

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12
Q

Which 3 sections is the small intestine divided into?

A

duodenum, jejunum, ileum

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13
Q

What is the function of the small intestine?

A

primary site of absorption

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14
Q

What increases the surface area of the small intestine?

A

finger-like projections called villi that contain microvilli with epithelial cells on surface

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15
Q

Which 3 sections is the small intestine divided into?

A

ascending colon, transverse colon, descending colon

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16
Q

What is the function of the large intestine?

A
  • role in conservation of water and ions
  • storage of faecal matter
  • crypts that are involved in lysosome secretion
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17
Q

How many sets of salivary glands do humans have?

A

3

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18
Q

What is the function of saliva?

A
  • contains some digestive enzymes
  • lubricates food with mucus
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19
Q

What is the function of the liver in digestion?

A
  • produces bile and involved in excretion
  • bile is needed for emulsification of fats
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20
Q

What is the function of the gallbladder?

A
  • collects secretions from liver
  • delivers bile to duodenum
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21
Q

What is the function of the pancreas?

A
  • makes enzymes to digest proteins, fats, carbohydrates
  • produces insulin and glucagon from islets of Langerhans
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22
Q

What are the 4 functions of the GI system?

A
  1. ingestion
  2. secretion
  3. movement
  4. digestion
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23
Q

define ingestion

A

the process of taking in food or drink through the mouth

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24
Q

define secretion

A

the release of substances that contribute to digestion

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25
Q

What are the 2 main types of movement in the GI system?

A

segmentation and peristalsis

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26
Q

define segmentation

A

‘squishing’ of substances backwards and forwards to help move them

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27
Q

define peristalsis

A

coordinated movement with contraction and relaxation of intestine

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28
Q

define digestion

A

breakdown of food into smaller components that can be absorbed into the bloodstream

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29
Q

What are the 2 types of digestion?

A

mechanical and chemical

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30
Q

define absorption

A

the process through which nutrients, water and electrolytes enter the blood (through villi and microvilli)

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31
Q

define excretion

A

the process by which metabolic waste is eliminated from the body

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32
Q
A
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33
Q

define swallowing

A

the passage of a food bolus from the oral cavity to the stomach

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34
Q

What muscles does swallowing involve?

A

muscles in the oral cavity, pharynx, larynx and oesophagus

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35
Q

What are the 3 phases of swallowing?

A

oral, pharyngeal, oesophageal

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36
Q

What are the steps of swallowing?

A
  1. stimulated when a food bolus stimulates pressure receptors in the back of the throat and larynx
  2. signals to the swallowing centre in the brain
  3. swallowing centres trigger nerve impulses
  4. this stimulates skeletal muscles in the pharynx and upper oesophagus
  5. involuntary contraction in the pharyngeal muscles pushes material into the oesophagus
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37
Q

What are the 2 types of movement in the stomach?

A

churning, peristalsis

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38
Q

When food is mixed, what are the stomach contents referred to as?

A

chyme

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39
Q

What does peristalsis in the stomach cause?

A

opening of the pyloric sphincter

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40
Q

What does the rate of gastric emptying depend on?

A

viscosity of chyme

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41
Q

How does movement in the stomach affect drugs?

A

churning is involved in dissolution and gastric emptying rate influences drug absorption

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42
Q

What happens to a drug if there is delayed gastric emptying?

A

the drug stays in the stomach and affect its stability as it is in acid for longer

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43
Q

What are the two types of movement in the small intestine?

A

segmentation (causes mixing) and peristalsis

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44
Q

What is peristalsis in the small intestine coordinated by?

A

the enteric nervous system

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45
Q

define segmentation

A

when non-adjacent segments of the small intestine alternately contract and relax, moving the food forwards then backwards

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46
Q

What are the steps of peristalsis in the small intestine?

A
  1. contraction of circular muscles behind food mass
  2. contraction of longitudinal muscles ahead of food mass
  3. contraction of circular muscle again forces food mass forward
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47
Q

What does the enteric nervous system control?

A

intestinal and colonic motility

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48
Q

What are the 2 main branches of neurones in the ENS?

A

Auerbach’s (myenteric) plexus and Meissner’s (submuscosal) plexus

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49
Q

What is the ENS influenced by?

A

neurotransmitters and autonomic input

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50
Q

How does the sympathetic NS affect the ENS?

A

inhibits the ENS -> decreases peristalsis, blood flow, secretion and absorption

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51
Q

How does the parasympathetic NS affect the ENS?

A

stimulates ENS -> increases peristalsis, blood flow, secretion and absorption

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52
Q

Which hormones increase activity of the ENS?

A

gastrin, motilin, serotonin, insulin, cholecystokinin

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53
Q

Which hormones decrease the activity of the ENS?

A

secretin and glucagon

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54
Q

How does intestinal motility affect drug absorption?

A
  1. transit time -> influences absorption
  2. distribution -> contractions in GI tract increase SA of drug
  3. migrating mobility complex -> involved in regulating drug absorption
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55
Q

define migrating motility complex

A

a recurring motility pattern that is regulated by electrical activity

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56
Q

When does migrating motility complex occur?

A

between feeding

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57
Q

What is the function of the migrating motility complex?

A

used to get rid of undigested food -> cleansing mechanism

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58
Q

How can the migrating motility complex affect drug administration?

A

if people take drug with an empty stomach, then it helps it pass through the body quickly and be absorbed quicker

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59
Q

What are the 2 types of motility in the large intestine?

A

haustral shuttling and mass movement

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60
Q

How does haustral shuttling work?

A

done by localised contraction and relaxation of haustra (bands) and occurs all the time

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61
Q

What is mass movement?

A

coordinated contraction of the intestine that moves the contents of the colon towards the rectum

62
Q

Where does mass movement occur?

A

ascending and transverse colon

63
Q

What is mass movement triggered by?

A

the gastrocolic reflex that signals to your body that you need to defaecate

64
Q

What causes constipation?

A

weak mass movement, increased transit time, too much water absorbed into the body

65
Q

What causes diarrhoea?

A

hyperactive mass movement, decreased transit time, too little water absorbed into the body

66
Q

define vomiting

A

forcible expulsion of gastric contents through the mouth

67
Q

Where are signals relayed for vomiting to?

A

the vomiting centre in the brainstem

68
Q

What are the steps of vomiting?

A
  1. increase salivation to protect teeth
  2. relaxation of the lower oesophagael sphincter to allow contents to move up
  3. contraction of diaphragm and abdominal muscles to increase pressure in stomach
  4. opening of the uppoer oesophageal sphincter
69
Q

mouth and oesophagus role in motility

A

chewing, swallowing, peristalsis

70
Q

stomach role in motility

A

churning, peristalsis, gastric emptying

71
Q

small intestine role in motility

A

segmental contractions, peristalsis

72
Q

large intestine role in motility

A

haustral shuttling, mass movement, defaecation

73
Q

sphincters role in motility

A

regulation of movement

74
Q

define digestion

A

the sequence by which food is broken down and chemically converted so that it can be absorbed by the cells of an organism

75
Q

What are the 2 types of digestion?

A

mechanical and chemical

76
Q

What are the 4 sites of digestion?

A
  1. mouth
  2. stomach
  3. small intestine
  4. large intestine
77
Q

What are the secretions from the salivary glands?

A

amylase, ligual lipase, mucus

78
Q

Which type of cell secretes amylase in the salivary glands/

A

serous cells

79
Q

What happens to amylase in the stomach?

A

it is inactivated due to low pH

80
Q

Which cell is ligual lipase secreted from?

A

serous cells

81
Q

What does ligual lipase do?

A

breaks down lipids and is NOT degraded in the stomach

82
Q

Why are mucous cells in salivary glands important?

A

they secrete mucus to lubricate food and protect the mouth from stomach acid

83
Q

What are the 4 types of cells that secrete substances in the stomach?

A
  1. parietal cells
  2. chief cells
  3. mucous cells
  4. G cells
84
Q

What do parietal cells do?

A

they secrete HCl and release pepsinogen, which is cleaved to pepsin

85
Q

What do chief cells do?

A

secrete pepsinogen also, which is cleaved to pepsin to digest proteins

86
Q

What do mucous cells do?

A

secrete mucous for lubrication and protection of food from acid

87
Q

What do G cells do?

A

produce gastrin

88
Q

What is gastrin?

A

a hormone involved in regulating the release of HCl

89
Q

What are the 4 main secretions from the stomach?

A

pepsinogen, HCl, gastrin, mucus

90
Q

What is gastric acid production stimulated by?

A

histamine, gastrin, acetylcholine

91
Q

What cells does gastric acid production involve?

A

parietal cells, G cells, enterochromaffin cells

92
Q

What does the gallbladder do?

A

collects bile from the liver and concentrates it -> bile then passes through bile duct into small intestine

93
Q

What does the pancreas secrete?

A
  1. bicarbonate (neutralise stomach acid)
  2. lipase
  3. amylase
  4. RNAase and DNAase
  5. trypsinogen, chymotrypsinogen
94
Q

How is the digestive process initiated and controlled?

A
  1. stretch receptors in the stomach trigger secretion of digestive enzymes and juices
  2. the stomach releases gastrin, which causes proudction of gastric acid
  3. intestines release secretin and cholecystokinin to stimulate the secretion of pancreatic juice and bile
95
Q

How is the small intestine adapted for absorption?

A

cells have projections called villi, which contain microvilli, giving a large SA

96
Q

What is the route of absorption for sugar and amino acids?

A

absorbed directly into the bloodstream

97
Q

How is absorption of fats different?

A

they are absorbed into the lymph lacteal system

98
Q

What are the 2 main mechanisms of absorption?

A

active transport and facilitated diffusion

99
Q

Where are proteins digested and by which enzymes?

A
  1. stomach -> pepsin
  2. pancreas -> trypsin and chymotrypsin
  3. intestinal brush border -> peptidases
100
Q

How are proteins absorbed?

A

by active transport into the gut cells, then by diffusion into the bloodstream

101
Q

Where are carbohydrates digested and by which enzymes?

A
  1. mouth -> salivary amylase
  2. small intestine -> pancreatic amylase
  3. enzymes in the intestinal brush border
102
Q

Where does carbohydrate digestion stop?

A

in the stomach as the stomach acid denatures amylase

103
Q

How are carbohydrates absorbed?

A

by facilitated diffusion and active transport

104
Q

Where is fat digested and by which substances/enzymes?

A
  1. small intestine -> secretions from liver, pancreas and gallbladder to emulsify
  2. gallbladder and pancreas -> lipase and bile
105
Q

How are lipids absorbed?

A
  1. lipids are broken down into fatty acids
  2. fatty acids absorbed into epithelial cells of small intestine
  3. they are coated with cholesterol, phospholipids and protein to form chylomicron
  4. chylomicron is water soluble and can enter the lacteal system
  5. transported to bloodstream
106
Q

What does an enteric coating do?

A

prevents degradation of drugs in the stomach by protecting them from gastric acid -> allows them to be release in the small intestine

107
Q

What is an enteric coating made from?

A

a gastric resistant polymer which is insoluble at low pH

108
Q

Anatomically, how many lobes does the liver have? What are they called?

A

4 = left, right, caudate, quadrate

109
Q

define diaphragmatic surface

A

the upper surface of the liver that sits underneath the diaphragm

110
Q

define visceral surface

A

the lower surface of the liver that faces the abdominal organs and gallbladder

111
Q

How is bile removed from the liver?

A

the bile duct feeds into the gallbladder, which joins the pancreatic duct and empties into duodenum of small intestine

112
Q

What are Kupffer cells?

A

immune cells in the liver

113
Q

What are the 3 blood vessels connected to the liver?

A

hepatic artery (oxygenated blood from heart), hepatic portal vein (little oxygen from GI tract), hepatic vein

114
Q

What are the 6 main functions of the liver?

A
  1. endocrine function
  2. exocrine function
  3. clotting
  4. cholesterol metabolism
  5. organic and drug metabolism
  6. secretion of plasma proteins
115
Q

What is the exocrine function of the liver?

A

secretes bile salts and HCO3-

116
Q

What is bile made up of?

A

bile salts

117
Q

What are bile salts important for?

A

solubilising fats

118
Q

What is bilirubin?

A

byproduct of breakdown of red blood cells

119
Q

What do epithelial cells secrete?

A

bicarbonate

120
Q

What do hepatocytes secrete?

A

bile, cholesterol, phospholipids

121
Q

What happens to bile during a meal?

A

the body must prepare to digest fats, to the gallbladder contracts and releases bile into the duodenum via the sphincter of Oddi

122
Q

What is contraction of the gallbladder stimulated by?

A

cholecysotkinin which is triggered by fatty acids

123
Q

define enterohepatic circulation

A

when the liver extracts bile salts from the blood and secretes them back into the bile to prevent having to synthesise them constantly

124
Q

Where are small amounts of bile lost to?

A

faecas and urine

125
Q

What are new bile salts synthesised from?

A

cholesterol

126
Q

What happens to bile salts during a meal?

A
  1. bile salts are absorbed into the small intestine by Na+ coupled transporters
  2. most is then returned to the liver through the hepatic portal vein via enterohepatic circulation
127
Q

What does dietary fibre do to cholesterol?

A

it conceals the bile in the small intestine to prevent it returning to the liver and it is removed from the body with the cholesterol it contains

128
Q

What are the functions of cholesterol?

A
  1. membrane synthesis
  2. bile synthesis
  3. precursor for steroid hormones
129
Q

Where and how is cholesterol synthesised in the body?

A

in the liver by HMG-CoA

130
Q

How are cholesterol levels maintained in a normal range?

A

increasing dietary cholesterol or suppressing HMG-CoA

131
Q

What do saturated fatty acids do?

A

increase plasma cholesterol

132
Q

What do poly/monounsaturated fatty acids do?

A

decrease plasma cholesterol

133
Q

How does cholesterol circulate in the body?

A

in lipoprotein complexes

134
Q

What do low density lipoproteins do (LDLs)?

A

deliver cholesterol to cells

135
Q

What do high density lipoproteins (HDLs) do?

A

remove cholesterol from plasma and deliver it to the liver

136
Q

What is atherosclerotic disease caused by?

A

deposition of cholesterol in the artery walls, increasing risk of heart attack

137
Q

What increases HDL?

A

smoking

138
Q

What increases HDL?

A

weight loss, oestrogen (until menopause)

139
Q

What are gallstones caused by?

A

cholesterol crystallising out of bile salts in the gallbladder

140
Q

What do gallstones cause?

A
  1. they block the gallbladder and bile duct
  2. prevents fat digestion and causes fat build up in the gut -> diarrhoea
  3. decrease in absorption of fat-soluble vitamins, clotting issues and calcium deficiency
141
Q

What are the endocrine functions of the liver?

A
  1. synthesis of hormones and peptides
  2. synthesis of plasma proteins
  3. synthesis of clotting factors
142
Q

How is the liver important in clotting?

A
  1. bile absorbs fats, which absorb vitamin K
  2. vitamin K is needed for prothrombin production
  3. this is a precursor for thrombin
143
Q

What is hepatitis caused by?

A

viruses or excessive alcohol intake

144
Q

What is liver cirrhosis caused by?

A

drugs, alcohol, viruses

145
Q

In liver function blood tests, what do raised levels of liver enzymes indicate?

A

liver damage -> most of the enzymes should be in hepatocytes, but are detected in blood

146
Q

Which compounds are used in liver function tests?

A
  1. alanine transaminase (ALT)
  2. aspartate aminotransferase (AST)
  3. alkaline phosphatase (ALP)
  4. gamma-glutamyltransferase (GGT)
  5. bilirubin
  6. albumin
147
Q

What does any raised hepatocyte enzyme indicate?

A

liver cell damage

148
Q

What does an AST:ALT ration above 2:1 indicate?

A

alcoholic liver disease

149
Q

What do raised levels of ALP indicate?

A

bone disease

150
Q

What do raised levels of GGT indicate?

A

alcohol excess

151
Q

What do raised levels of ALP and GGT indicate?

A

obstruction of the bile duct

Pharmacy (16 decks)

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