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Gastrointestinal > Stomach > Flashcards

Stomach Flashcards

1
Q

What level does the oesophagus passes through the oesophageal hiatus

A

T10

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2
Q

What does the muscle around the oesophagus hiatus function as

A

Sphincter

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3
Q

How long is the abdominal segment of the oesophagus

A

Less than 2cm

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4
Q

What is the distal oesophagus supplied by

A

Branches of the left gastric artery

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5
Q

What is the drainage of the distal oesophagus

A

Systemic system of veins

Via oesophageal veins that drains into the azygos vein

To portal venous system

Via the left gastric veins

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6
Q

What is the distal oesophagus a site of

A

Portosystemic anastomoses

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7
Q

What does the stomach chemically and mechanically break food down to

A

Chyme

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8
Q

What are the four parts of the stomach

A

Cardia
Fundus
Body
Pylorus

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9
Q

What is the oesophagus continuous with

A

Cardia of stomach

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10
Q

What is the most superior part of the stomach

A

Fundus

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11
Q

What is the largest part of the stomach

A

Body

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12
Q

What is the most distal part of the stomach

A

Pyloric part

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13
Q

What is the area of the pyloric part

A

Pyloric antrum
Pyloric canal - contains pyloric sphincter

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14
Q

What is the role of the pyloric sphincter

A

Circular smooth muscle
Regulates the passe if chyme into the duodenum

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15
Q

What is the right border of the stomach called

A

Lesser curvature

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16
Q

What is the left border of the stomach called

A

Greater curvature

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17
Q

Where does the stomach lie

A

Left upper quadrant

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18
Q

What is the stomach covered by

A

visceral peritoneum

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19
Q

What is the anterior surface of the stomach related to

A

Anterior abdominal wall
Diaphragm
Left lobe of the liver

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20
Q

What is the posterior surface of the stomach related to

A

Forms the anterior wall of the lesser sac

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21
Q

What does the lesser omentum connect

A

Lesser curvature to the liver

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22
Q

What does the free edge of lesser omentum contain

A

Hepatic artery
Hepatic portal vein
Bile duct

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23
Q

What is posterior to the free edge entrance to

A

Lesser sac

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24
Q

What does the greater omentum hang from

A

Greater curvature

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25
Q

What is the stomach supplied by

A

Branches of the coeliac trunk

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26
Q

Where are G-cells located

A

Pyloric antra mucosa

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27
Q

What do G-cells produce

A

Gastrin

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28
Q

What are G-cells activated by

A

Vagus nerve - Ach (M3R)

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29
Q

What stimulates G-cells

A

Partially digested proteins

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30
Q

How does Gastrin travel

A

Hormone through the blood

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31
Q

Where are Parietal cells located

A

Fundus

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32
Q

What do parietal cells contain a lot of

A

Mitochondria

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33
Q

What happens with parietal cells

A

Mitochondria - respiration produces a lot of CO2

CO2 + H20 = H2CO3- = H+ + HCO3-

H+ goes into stomach lumen

HCO3- goes in to blood

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34
Q

What is the enzyme involves in the bicarbonate reaction within the parietal cells

A

Carbonic anhydrase

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35
Q

What do parietal cells produce

A

HCl

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36
Q

How is Hydrogen transported out of parietal cells

A

By H+K+ ATPase pump

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37
Q

What acts on parietal cells

A

Somatostatin -

Ach +

Histamines +

Gastrin +

PEG2 +

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38
Q

What acts on chief cells and how

A

Gastrin

increases Ca2+

Vesicle fuses with membrane

Releases pepsinogen

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39
Q

What do chief cells secrete

A

Pepsinogen

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40
Q

Where are the chief cells located

A

Fundus

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41
Q

Is pepsinogen active or inactive

A

Inactive

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42
Q

What is the active form of pepsinogen

A

Pepsin

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43
Q

How does pepsinogen become active

A

pH 1.8-3.5

44
Q

What acts on chief cells

A

Gastrin +

Histamine +

Ach +

Secretin +

45
Q

When is secretin released

A

S-cells in duodenum

To high acidic/fatty chyme

46
Q

What to antral-D cells respond to

A

High H+ concentration on outside of cell

47
Q

What do antral-D cells release

A

Somatostatin

48
Q

What is the role of somatostatin

A

Act on G-cells

Inhibit release of gastrin - to decrease pH

49
Q

What acts on Antral-D cells

A

Ach -

Gastrin -

50
Q

Where are Antral-D cells located

A

Antrum and Body

51
Q

What do enterochromaffin like cells secrete

A

Histamine

52
Q

What acts on enterochromaffin like cells

A

Ach +

Somatostatin -

Gastrin +

53
Q

What are the cells of the stomach

A

G-cells

Parietal cells

Chief cells

Antral-D cells

Enterochromaffin like cells

54
Q

Where are enterochromaffin like cells located

A

Fundus

Cardia

55
Q

What cell secretes gastrin

A

G-cells

Enteroendrocrine cells

56
Q

What cell secretes HCL (h+ and Cl-)

A

Parietal cells

57
Q

What cell secretes pepsinogen

A

Chief cell

58
Q

What cell secretes somatostatin

A

Antral-D cells

59
Q

What cell secretes histamine

A

Enterochromaffin like cells

60
Q

What does the body of the stomach secrete

A

Mucus, pepsinogen and HCl

61
Q

What does the antrum of the stomach secrete

A

Mucus, pepsinogen and gastrin

62
Q

What do mucus cells secrete

A

Mucous

63
Q

What cell secrete intrinsic factor

A

Parietal cell

64
Q

How much hydrochloric acid is secreted a day

A

Approx 2 litres

65
Q

What is gastric acid secretion dependent upon

A

Energy

66
Q

What is the concentration of HCl in gastric acid

A

> 150 mM

67
Q

Describe the cephalic phase

A

Turning it on

Parasympathetic NS

Sight, smell, taste of food and chewing

ACh released

ACh acts directly on parietal cells

ACh triggers release of gastrin and histamine

Net effect = increased acid production

68
Q

Describe the gastric phase

A

Turning it on

Gastric distension, presence of peptides and amino acids

Gastrin release

Gastrin acts directly on parietal cells

Gastrin triggers release of histamine

Histamine acts directly on parietal cells

Net effect = increased acid production

69
Q

Describe what happens with proteins in the stomach

A

Turning it on

Direct stimulus for gastrin release

Proteins in lumen act as a buffer, mopping up H+ ions, causing pH to rise
- decreased secretion of somatostatin
- more parietal cell activity (lack of inhibition)

70
Q

Describe the turning it off gastric phase

A

Low luminal pH (high H+)

Directly inhibits gastric secretion
Indirectly inhibits histamine release (via gastrin)
Stimulates somatostatin release which inhibits parietal cell activity

71
Q

Describe the intestinal phase

A

Turning it off

In duodenum
- duodenal distension
- low luminal pH
- hypertonic luminal contents
- presence of amino acids and fatty acids

Trigger release of enterogastrones
- secretin (inhibits gastrin release, promotes somatostatin release)
- CCK - cholecystokinin

Short and long neural pathways - reducing Ach release

72
Q

What is the role of secretin (interstitial phase)

A

Inhibits gastrin release

Promotes somatostatin release

73
Q

What is involved in the gastric acid secretion

A

1 PNs neurotransmitter Ach

1 hormone - gastrin

2 paracrine factors - histamine +, somatostatin -

2 key enterogastrones - secretin -, CCK -

74
Q

What are the ways in which gastric mucosa defends itself

A

Alkaline mucus

Tight junctions between epithelial cells

Replacement of damaged cells

Feedback loops

75
Q

What is the conversion of pepsinogen dependent upon

A

pH

76
Q

When is the conversion of pepsinogen to pepsin most efficient

A

pH <2

77
Q

What type of feedback loop is the conversion of pepsinogen to pepsin

A

Positive

Pepsin catalyses the reaction

78
Q

When is pepsin active

A

Only at low pH

Irreversible inactivation in small intestine by HCO3-

79
Q

Is protein digestion dependent upon pepsin

A

No

Accelerates protein digestion

80
Q

What % does the role of pepsin in protein digestion account to

A

Approx. 20%

81
Q

What does pepsin do

A

Breaks down collagen in meat - helps shred meat into small pieces with greater surface area for digestion

82
Q

Describe receptive relaxation

A

Mediated by PNS acting on enteric nervous plexus

Afferent input via Vagus nerve

Nitric oxide and serotonin released by enteric nerves mediate relaxation

83
Q

Where do peristaltic waves begin

A

Gastric body - weak contraction

84
Q

Where are peristaltic waves more powerful

A

Gastric antrum

85
Q

What happens to chyme

A

Little chyme enters duodenum

Antral contents forced back towards body (mixing)

86
Q

Describe the basic electrical rhythm for gastric motility

A

Frequency determined by pacemaker cells in muscularis propria

3/minute

Pacemaker cells undergo slow depolarisation - repolarisation cycles

Depolarisation waves transmitted through gap junctions to adjacent smooth muscle cells

Do not cause significant contraction in empty stomach

87
Q

Gastric motility what happens if there are more action potentials

A

The strength of smooth muscle tension and time will increase

88
Q

What is the strength of peristaltic contractions increased by

A

Gastrin

Gastric distension

89
Q

What respond to gastric distension

A

Mechanoreceptors

90
Q

What is the strength of peristaltic contractions decreased by

A

Duodenal distension

Increased duodenal luminal fat

Increased duodenal osmolarity

Decreased luminal pH

Increased sympathetic NS action

Decreased parasympathetic NS action

91
Q

Describe protease activation

A

Chief cell secretes pepsinogen

Parietal cell secretes HCl (+ intrinsic factor)

HCl facilitates the activation of pepsinogen to pepsin

Pepsin breaks down proteins to peptides

92
Q

Describe protease secretion

A

Chief cells produce pepsinogen

Synthesised in inactive form (zymogen)

Pepsinogen mediated by input from enteric NS (ACh)

Secretion parallels HCl secretion

Luminal activation

93
Q

What is the blood supply to the stomach

A

Coeliac trunk

94
Q

Where does the coeliac trunk leave the aorta

A

T12

95
Q

What are the three branches of the coeliac trunk

A

Left gastric artery

Common hepatic artery

Splenic artery

96
Q

Where do the left and right gastric arteries run

A

Lesser curvature of the stomach and anastomose with each other

97
Q

Where does the left gastric artery arise from

A

Coeliac trunk

98
Q

Where does the right gastric artery arise from

A

Common hepatic artery

99
Q

Where do the left and right gastro-omental (gastroepiploic) arteries run

A

Greater curvature of the stomach and anastomose with each other

100
Q

Where does the left gastro-omental artery arise from

A

Splenic artery

101
Q

Where does the right gastro-omental artery arise from

A

Gastroduodenal artery - branch of the common hepatic artery

102
Q

What provides parasympathetic fibre to stomach

A

Vagus nerve

103
Q

What does parasympathetic stimulation to the stomach promote

A

Peristalsis and gastric secretion

104
Q

What provides sympathetic fibres to the stomach

A

Greater splanchnic nerve

105
Q

Where does the greater splanchnic nerve leave the spinal cord

A

Preganglionic fibres

T5-T9

Gastrointestinal (12 decks)

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