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BMS 150 Final > Stomach Physiology and Pathology > Flashcards

Stomach Physiology and Pathology Flashcards

1
Q

What is the stomach?

A

a J-shaped enlargement of GI tract directly inferior to diaphragm in abdomen

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2
Q

what is the most distensible part of the GI tract?

A

stomach

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3
Q

what are the functions of the stomach

A
  • serves as reservoir for food before release into SI
  • mixes saliva, food, and gastric juice to form chyme
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4
Q

what are the 4 main regions of the stomach?

A
  • cardia
  • fundus
  • body
  • pyloric
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5
Q

what are the 2 sphincters of the stomach?

A
  • lower esophageal
  • pyloric
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6
Q

what are the 2 main curvatures of the stomach?

A
  • lesser
  • greater
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7
Q

the main arterial supply comes from where?

A

celiac trunk of aorta

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8
Q

what are the 4 main arterial supply to the stomach?

A
  • Hepatic artery
    – right gastric
    – right gastro-omental
  • celiac trunk
    –left gastric
  • splenic artery
    – left gastro-omental
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9
Q

which veins does the stomach drain into?

A

drain into hepatic portal vein or superior mesenteric vein

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10
Q

specifically, tell me the vein and where it drains into

A

○ Left gastric vein
§ Hepatic Portal Vein
○ Right gastric
§ Hepatic Portal Vein
○ Left gastro-omental vein
§ Superior Mesenteric Vein
○ Right gastro-omental
§ Superior Mesenteric Vein

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11
Q

in terms of innervation of the stomach, the parasympathetic supply comes from?

A

anterior and posterior vagal trunks from vagus nerve

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12
Q

in terms of innervation of the stomach, the sympathetic supply comes from?

A

from T5-T9 segments of sympathetic trunk, passes to celiac plexus via greater splanchnic nerve

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13
Q

what is part of the mucosa of the stomach

A
  • epithelium
  • lamina propria
  • muscularis mucosae
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14
Q

epithelium and lamina propria are arranged into ?

A

glands

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15
Q

glands have 3 regions:

A
  • pit
  • neck (isthmus)
  • base
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16
Q

what are the different cell types of the stomach glands?

A
  • surface mucus cells
  • parietal cells (oxyntic)
  • chief cells (zymogenic)
  • enteroendocrine cells
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17
Q

what lines the surface of the stomach and gastric pits

A

simple columnar epithelium

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18
Q

surface mucus cells have lots of what ? which are large glycoprotein

A

mucin granules

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19
Q

what are found within the neck of gastric glands/mucus neck cells

A

simple columnar epithelium

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20
Q

parietal cells are what shape?

A

rounded/pyramidal shape

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21
Q

what are the functions of these parietal cells?

A

produce HCL and IF

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22
Q

where are parietal cells mainly found

A

in upper half of gastric gland

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23
Q

where are chief cells found?

A

in lower regions of gastric glands

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24
Q

what is the function of the chief cells?

A

pepsinogen secretion

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25
Q

where are enteroendocrine cells found?

A

found deep within gastric pits

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26
Q

what are the different types of enteroendocrine cells?

A
  • enterochromaffin-like cells
  • G-cells
  • D- cells
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27
Q

what does enterochromaffin-like cells secrete?

A

histamine

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28
Q

what does G-cells secrete

A

gastrin

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29
Q

what does D-cells secrete

A

somatostatin

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30
Q

the submucosa is made up of ?

A

dense, irregular collagenous CT

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31
Q

what are the 3 layers of muscularis externa

A
  • inner oblique
  • middle circular
  • outermost longitudinal
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32
Q

what are the 4 different stages of the stomach motility

A
  1. food entry into stomach
  2. storage in fundus
  3. mixing (aka churning)
  4. emptying into small intestine
33
Q

what are the functions of the lower esophageal sphincter?

A
  • controls movement of food into the stomach
  • also prevent reflux of gastric contents into the esophagus
34
Q

what is required of the sphincter to facilitate entry of food into the stomach?

A

relaxation

35
Q

what is initiated for the relaxation of the lower esophageal sphincter?

A

initiated by a vasovagal reflex called receptive relaxation which is triggered by swallowing and esophageal distension

36
Q

where is the food stored in the stomach?

A

fundus

37
Q

what is gastric accommodation

A

the presence of food stretches the stomach walls and reduces the tone in muscular wall of body of the stomach

38
Q

what initiates mixing waves of food in the stomach?

A

gastric pacemakers

39
Q

what is it called when waves start in mid- to upper portion and move toward pyloric antrum

A

propulsion

40
Q

the contractions in pyloric antrum “grinds” the food bolus called?

A

grinding

41
Q

the pylorus opening is very small so antral contents are pushed back upstream toward body of stomach, this is called?

A

retropulsion

42
Q

what can only leave the stomach through the pyloric sphincter

A

only liquid

43
Q

gastric acids are released from ?

A

parietal cells

44
Q

what is the pH of gastric acid?

A

pH of 1-2

45
Q

gastric acid is composed of?

A
  • hydrochloric acid
  • large amounts of KCI and small amounts of NaCl
46
Q

what are the functions of gastric acid?

A
  • digestions of denaturation of protein
  • bacteriostatic
  • needed for conversion of pepsinogen to pepsin
47
Q

what is the secretion mechanism of gastric acid?

A
  • Water dissociates into H+ and OH- in cell cytoplasm
  • CO2 combines with OH- to form bicarbonate ions by enzyme: carbonic anhydrase
  • H+ is pumped into lumen of canaliculus via H+/K+ ATPase
  • H+/K+ ATPase is blocked by the class of drugs called “proton pump inhibitors”
  • Cl- transported passively from cytoplasm of parietal cell into lumen of canaliculus
  • Parietal cells can be stimulated by several sources:
    ○ Acetylcholine acting on Muscarinic receptors
    § Parasympathetic stimulation
    ○ Gastrin acting on CCK2 receptors
    ○ Histamine acting on H2 receptors
48
Q

Histamine is stored and released form ? of the stomach

A

enterochromaffin-like cells

49
Q

what are the functions of histamine

A
  • acts on H2 receptors on parietal cells
  • stimulates release of gastric acid
  • stimulates vasodilation
50
Q

gastrin is secreted by ?

A

G cells

51
Q

gastrin is secreted in response to?

A
  • stomach distension
  • vagal stimulation
  • presence of partially digestion proteins (peptides and amino acids)
52
Q

what are the functions of gastrin?

A

○ Acts on ECL cells to stimulate release of histamine
○ Directly stimulates parietal cells by binding to CCK receptor

53
Q

Parietal cells can be inhibited by?

A
  • somatostatin
  • prostaglandins
54
Q

somatostatin is also known as ?

A

growth hormone inhibiting hormone

55
Q

somatostatin is released from what?

A

D cells

56
Q

what are the functions of somatostatin?

A
  • acts on parietal cells to reduce secretion of gastric acid
  • also reduce release of gastrin, secretin, and histamine
  • suppresses released of pancreatic hormones
57
Q

somatostatin is secreted in response to?

A

luminal H+ which is negative feedback

58
Q

the phases of gastric acid secretion after meals can be divided into 3 phases which are?

A
  • cephalic
  • gastric
  • intestinal
59
Q

the cephalic phase is triggered by ?

A

smell, sight, taste, thought and swallowing food

60
Q

the cephalic phase is primarily mediated by the ?

A

vagus nerve

61
Q

the vagus nerve releases ?

A

Ach

62
Q

what does the Ach do?

A

§ Ach acts directly on parietal cells to release H+
§ Ach acts on ECL cells to release histamine
§ Ach acts on D cells, inhibiting release of somatostatin

63
Q

Vagus nerve also releases ? to induce gastrin release from G cells

A

GRP

64
Q

food enters the stomach, distending the gastric mucosa and activating what?

A

vagovagal reflex and local ENS reflex

65
Q

partially digested proteins stimulate G cells to produce ?

A

gastrin

66
Q

what stimulates D cells to secrete somatostatin, which inhibits gastrin production (think negative feedback)

A

low luminal pH

67
Q

explain the intestinal phase of gastric acid secretion

A
  • Presence of amino acids and partially digested peptides in proximal intestine
    ○ Stimulates G cells in duodenum to secrete gastrin
68
Q

what are some intrinsic factors for secretion of gastric acid

A

glycoprotein and pepsinogen

69
Q

glycoprotein is secreted by ?

A

parietal cells

70
Q

what is the function of glycoprotein

A

required for the absorption of vitamin B12 in the ileum

71
Q

pepsinogen is secreted by ?

A

chief cells

72
Q

pepsinogen is spontaneously cleaved to ? in the presence of HCI

A

active pepsin

73
Q

how is pepsinogen secretion stimulated?

A

§ Ach release from vagus nerve or ENS
□ Ach bind to M receptors on chief cells
□ *Most important stimulus
§ Presence of acid in the duodenum triggers secretin from S cells
□ Secretin also stimulates chief cells to release more pepsinogen

74
Q

the gastric diffusion barrier is maintained by:

A
  • mucus gel layer on surface epithelium
  • bicarbonate microclimate adjacent to surfacce epithelial
  • tight junctions in gastric glands
75
Q

mucus combines with phospholipids, electrolytes, and water to form a ?

A

gel layer

76
Q

the gel layer protects against:

A

acid, pepsin, bile acid, and ethanol

77
Q

what is mucin secretion induced by?

A
  • vagal stimulation
  • chemical irritation
78
Q
A

BMS 150 Final (17 decks)

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