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bioregulatory systems 🦠 > the pancreas and small bowel > Flashcards

the pancreas and small bowel Flashcards

1
Q

what do liver buds become

A

the liver lol

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2
Q

what forms when the join between the liver and foregut narrows

A

becomes the bile duct

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3
Q

what does the bile duct give rise to

A

the gallbladder and cystic duct

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4
Q

what happens by 11 weeks

A

the proximal duodenum rotates clockwise and all organs are in place

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5
Q

what happens when the ventral and pancreatic ducts and bud have rotated clockwise

A

fuses with dorsal duct

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6
Q

what does part of the dorsal and ventral duct become

A

becomes the main pancreatic duct

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7
Q

what do the bile and pancreatic ducts join to drain together at

A

at the major papilla

where pancreatic duct emerges at the major papilla - joins up with distal common bile duct to form papilla/ampulla

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8
Q

what duct emerges at the minor papilla and what is it known as

A

dorsal duct

known as accessory pancreatic duct (can degenerate or is absent as adult)

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9
Q

what kind of an organ is the pancreas

A

retroperitoneal organ - behind the posterior peritoneum of the abdomen
and doesn’t exist within abdomen

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10
Q

what is in front of the pancreas

A

transverse colon and stomach (both are anterior to pancreas)

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11
Q

where does the head of the pancreas fit

A

into duodenum (C shaped and is labelled D1/2/3/4)

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12
Q

what is the superior edge of the pancreas called

A

coeliac axis

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13
Q

are the main pancreatic duct and the ventral duct fused together

A

n o

both ducts are separated = pancreas divisum

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14
Q

why do patients get recurrent episodes of pancreatitis

A

as a large flow has to go through minor duct

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15
Q

what is angiography used for

A

used for interventional purposes
patients that are bleeding
accessing femoral artery in groin under local anaesthetic to aorta by inserting wire - dye

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16
Q

what does endocrine mean

A

secretion into the bloodstream to have an effect on distant target organ (autocrine/paracrine) - ductless glands

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17
Q

what does exocrine mean

A

secretion into a duct to have a direct local effect

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18
Q

what is insulin and what does it do

A

an anabolic hormone
promotes glucose transport into cells and storage as glycogen
decreases blood glucose
promotes protein synthesis and lipogenesis

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19
Q

what does glucagon do

A

increases gluconeogenesis and glycogenolysis

increases blood glucose

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20
Q

what does somatostatin do

A

endocrine cyanide

inhibits almost everything

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21
Q

what is endocrine % and function relative to pancreas

A

2% of a gland
islets of langerhans
secrete hormones into blood - insulin and glucagon (also somatostatin and pancreatic polypeptide)
regulation of blood glucose, metabolism and growth effects

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22
Q

what is exocrine % and functions

A

98% of a gland
secretes pancreatic juices into duodenum via MPD (main pancreatic duct)/sphincter of Oddi/ampulla
digestive function

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23
Q

what is pancreatic cell differentiation

A

formation of acini and islets from ducts in various stages of development

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24
Q

what are acini

A

attach to ducts
grape like clusters of secretory units
acinar cells secrete pro enzymes into ducts

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25
Q

what are islets

A

derived from the branching duct system
lose contact with ducts - become islets
differentiate into alpha and beta cells secreting into blood
number of islets is higher in the tail than in the head

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26
Q

what is around a duct (of pancreas)

A

pancreatic acinus

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27
Q

what does the pancreatic acinus consist of

A

consists of pancreatic acinar cells
between cells = intercellular canaliculi
draining into pancreatic ducts > intercalated duct > intralobular duct - joins main pancreatic duct

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28
Q

does the islet have connections to ducts and how many capillaries

A

many capillaries

no connection to duct

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29
Q

how much % do alpha cells form of islet tissue and what do they secrete

A

15-20%

secrete glucagon

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30
Q

how much % do beta cells form of islet tissue and what do they secrete

A

60-70%

secrete insulin

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31
Q

how much % do delta cells form of islet tissue and what do they secrete

A

5-10%

secrete stomatostatin

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32
Q

are the islets highy vascularised

A

yes

ensuring that all endocrine cells have close access to a site of secretion

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33
Q

what do exocrine pancreatic units (acini) show

A

secretory acinar cells - large with apical secretion granules
duct cells - small and pale

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34
Q

what are the 2 components of pancreatic juice

A

produced by acinar cells - low vol and viscous and enzyme rich
produced by the duct and centroacinar cells - high in volume, watery HCO3- rich

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35
Q

where is bicarbonate produced

A

produced by duct and centroacinar cells

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36
Q

what juice is high in bicarbonate

A

pancreatic juice
~120 mM (mmol/L) - (plasma ~ 25 mM)
pH 7.5-8

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37
Q

what does bicarbonate do

A

neutralises acid chyme from stomach
prevents damage to duodenal mucosa
raises pH to optimum range for pancreatic enzymes to work
washes low volume enzyme secretion out of pancreas into duodenum that is produced by acini

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38
Q

what happens when duodenal pH <5

A
  • linear increase in pancreatic HCO3- secretion up to pH3
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39
Q

what happens when duodenal pH <3

A
  • not much more increase in HCO3- secretion
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40
Q

what does bile also contain and what does it do

A

bile also contains HCO3- and helps neutralise acid chyme (liver functions)

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41
Q

what do Brunner’s glands secrete

A

alkaline fluid

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42
Q

how is pancreatic HCO3- secreted

A

CO2 enters pancreatic cell
catalysed by carbonic anhydrase
separation of H+ and HCO3-
NA+ moves down gradient via paracellular (tight) junctions
H2O follows
CL-/HCO3- exchange at lumen (anion exchanger)
NA+/H+ exchange at basolateral membrane into bloodstream (sodium-hydrogen exchanger antiporter) type 1
exchange driven by electrochemical gradients
high EC (blood) Na+ compared to IC (duct cell)
high Cl- in lumen compared to IC (duct cell)
Na+ gradient into cell from blood maintained by Na+/K+ exchange pump
uses ATP - primary active transport
K+ returns to blood via K+ channel
Cl- returns to lumen via Cl- channel (cystic fibrosis transmembrane conductance regulator)

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43
Q

what is the equation for H2O and CO2 and where does this happen

A

H2O + CO2 ←→ H2CO3 ←→ H+ + HCO3-

same reaction in gastric parietal cells (acid) and pancreatic duct cells (alkaline)

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44
Q

what happens in the stomach in terms of HCO3- and H+

A

H+ secreted into gastric juice
HCO3- secreted into blood
gastric venous blood is alkaline

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45
Q

what happens in the pancreas - in terms of HCO3- and H+

A

HCO3- secreted into pancreatic juice
H+ secreted into blood
pancreatic venous blood is acidic

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46
Q

what enzymes break down fats

A

lipases

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47
Q

what enzymes break down proteins

A

proteases

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48
Q

what enzymes break down carbohydrates

A

amylases

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49
Q

where are lipases/amylases/proteases synthesised and stored

A

in zymogen granules of acinar cells

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50
Q

what are zymogens

A

pro enzymes - inactive forms of subsequent enzymes

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51
Q

why are proteases released as inactive proenzymes

A

to protect the acini and ducts from autodigestion

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52
Q

what prevents trypsin activation in the pancreas

A

trypsin inhibitor

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53
Q

where are enzymes activated

A

duodenum

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54
Q

what might blockage of the main pancreatic duct cause

A

overload protection > auto digestion

acute pancreatitis

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55
Q

what does duodenal mucosa secrete

A

enzyme called enterokinase (enteropeptidase)

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56
Q

what does enterokinase/enteopeptidase do

A

converts trypsinogen to trypsin (active form)

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57
Q

what does trypsin do

A

converts all other proteolytic and some lipolytic enzymes
trypsinogen > trypsin
chymotrypsinogen > chymotrypsin
proelastase > elastase
procarboxypeptidase A > carboxypeptidase A
procarboxypeptidase B > carboxypeptidase B

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58
Q

how is lipase secreted and what does it require

A

it is secreted in its active form but requires colipase (ie secreted as a precursor)

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59
Q

what do lipases require for effective action

A

presence of bile salts

60
Q

what can a lack of pancreatic enzymes (+bile) cause

A

malnutrition even if dietary input is reasonable

61
Q

what does the anti obesity drug orlistat do and side effects

A

inhibits pancreatic lipases
side effects:
increased faecal fat
occurs when pancreatic lipase secretion decreased
cystic fibrosis, chronic pancreatitis, orlistat (decreases intestinal fat absorption)
steatorrhoea

62
Q

what happens in the cephalic phase (control of pancreatic juice secretion)

A

reflex response to sight/smell/taste of food
enzyme rich component only
low volume - mobilises enzymes

63
Q

what happens in the gastric phase (control of pancreatic juice secretion)

A

stimulation of pancreatic secretion originating from food arriving in the stomach
same mechanisms involved as for cephalic phase

64
Q

what happens in the intestinal phase (control of pancreatic juice secretion)

A

(70-80% of pancreatic secretion)
hormonally mediated when gastric chyme enters duodenum
both components of pancreatic juice stimulated
enzymes and HCO3- juice flows into duodenum

65
Q

what is pancreatic juice enzyme secretion controlled by in acini

A

1) vagus nerve (cholinergic and vagal stimulation of enzyme secretion - and communicates info from gut to brain) acetylcholine
2) cholecystokinin (CCK) (Ca2+/PLC)
pancreatic juice bicarbonate secretion controlled in duct and centroacinar cells by:
secretin (cAMP)

66
Q

what are some mechanisms responsible for controlling release of CCK from duodenum cells

A

protein > amino acids > CCK releasing peptide (stimulatory)
fatty acids > CCK releasing peptide (stimulatory)
ACh and gastrin releasing peptide stimulate trypsin which inhibits release of CCK
CCK in bloodstream stimulates pancreas - negative feedback

67
Q

is acinar fluid isotonic

A

yes

68
Q

how does acinar fluid resemble plasma

A

resembles plasma in its concs of Na+, K+, Cl-, HCO3-

69
Q

what is secretion of acinar fluid and the proteins inside the fluid stimulated primarily by

A

CCK (cholecystokinin)

70
Q

what does secretin do

A

secretin stimulates secretion of H2O and HCO3- from cells lining extralobular ducts
secretin stimulated secretion is richer in HCO3- cf acinar secretion because of Cl-/HCO3- exchange

71
Q

what does a decrease in pH in the duodenum do

A

stimulates S cells to release secretin

secretin stimulates pancreatic/ductal HCO3- secretion (alkaline - increases pH)

72
Q

CCK alone has no effect on HCO3- secretion but what can it do

A

can increase HCO3- secretion that has been stimulated by secretin

73
Q

what has a similar effect to CCK

A

vagus nerve

74
Q

what has no effect on enzyme secretion from acinis

A

secretin

75
Q

summarise the steps after having a meal

A

food mixed and digested in stomach pH2
chyme squirted into duodenum
H+ ions in duodenum > increases secretin > increases pancreatic juice
and bile and Brunner’s gland secretions
the two above increases pH to neutral/alkaline
peptides and fat in duodenum causes sharp increase in CCK and vagal nerve stimulation
stimulation pancreatic enzyme release
peaks by 30 mins continues until stomach is empty
CCK potentiates effects of secretin on aq component
necessary as most of duodenum not at low pH

76
Q

what is the function of the small bowel

A

absorb nutrients, salt and water

77
Q

how long is the small bowel

A

approx 6m

78
Q

what is the diameter of the small bowel

A

3.5cm

79
Q

how long is the duodenum

A

25cm

80
Q

how long is the jejunum

A

2.5m

81
Q

how long is the ileum

A

3.75m

82
Q

is there a sudden transition between the small bowel, duodenum, jejunum and ileum

A

no

they all have the same basic histological organisation

83
Q

what is the mesentery

A

its is a fold of membrane
suspends the small and large bowel from posterior abdominal wall
anchoring them in place whilst still allowing some movement
provides a conduit for blood vessels, nerves and lymphatic vessels

84
Q

where does the superior mesenteric artery come from and what does it supply

A

comes out of the inferior border of the pancreas - supplies the jejunum and the ileal via jejunal and ileal arteries

85
Q

what does the ileocolic artery supply

A

supplies the terminal ileum and the ascending colon and the caecum

86
Q

what does the right colic artery supply

A

the ascending colon

87
Q

what does the middle colic artery supply

A

supplies the hepatic flexure, transverse colon and splenic flexure
sends blood vessels down the descending colon

88
Q

what is the outer covering of the small bowel called

A

serosa

89
Q

what is underneath the serosa

A

longitudinal muscle and circular muscle - important for motility

90
Q

describe the layers of the digestive epithelium of the small bowel

A 
serosa
circular and longitudinal muscle
submucosa
mucosa
lumen
91
Q

what does the apex of the villus have

A

microvilli

at the centre = arteries, veins and lymphatic vessels

92
Q

what do crypts of Lieberkuhn contain

A

paneth cells

stem cells

93
Q

what are some properties of villi

A

they only occur in the small intestine
they are motile
rich blood supply and lymph drainage for absorption of digested nutrients
good innervation from submucosal plexus
have simple epithelium
one cell thick
dominated by enterocytes (columnar absorptive cells)

94
Q

what is the villi (mucosa) lined with

A

simple columnar epithelium consisting of
primarily enterocytes (absorptive cells)
scattered goblet cells
enteroendocrine cells

95
Q

what is the most abundant cell type in the small bowel

A

enterocytes

96
Q

what are enterocytes

A

tall columnar cells with microvilli and a basal nucleus
specialised for absorption and transport of substances
short life span 1-6 days

97
Q

what do microvilli make up

A

0.5-1.5 micrometres high

make up brush border

98
Q

what is the surface of microvilli covered with

A

glycocalyx

99
Q

what is glycocalyx

A

rich carb layer on apical membrane
protection from digestional lumen
but allows absorption
traps a layer of water and mucous = unstirred layer
regulates rate of absorption from intestinal lumen

100
Q

what are goblet cells

A

2nd most abundant epithelial cell type
mucous containing granules accumulate at apical end - goblet shape
increase abundance of goblet cells along entire length of bowel
less in duodenum and more in colon

101
Q

what is mucous

A

large glycoprotein that facilitates passage of material through bowel

102
Q

what are enteroendocrine cells

A

columnar epithelial cells
scattered among enterocytes
most often found in lower parts of crypts
hormone secreting
to influence gut motility
can be referred to as chromaffin cells - affinity for chromium/silver salts

103
Q

what are paneth cells

A

found only in bases of crypts

contain large, acidophilic granules

104
Q

what do the granules in paneth cells contain

A

antibacterial enzyme - lysozyme (protects stem cells)
glycoproteins and zinc (essential trace metal for a number of enzymes)
also engulf some bacteria and protozoa
may have a role in regulating intestinal flora

105
Q

what are stem cells

A

undifferentiated cells which remain capable of cell division to replace cells which die

106
Q

what are epithelial stem cells for and what do they do

A

essential in the GI tract to continually replenish the surface epithelium
continually divide by mitosis
migrate up to the tip of the villus - replace older cells that die by apoptosis > digested and absorbed
differentiate into various cell types (pluripotent)

107
Q

what cells have a rapid turnover rate

A

enterocytes and goblet cells

due to short lifespan

108
Q

how are enterocytes related to pathogens

A

enterocytes are first line of defence against GI pathogens and may be directly be affected by toxic substances in the diet
effects of agents which interfere with cell function, metabolic rate etc will be diminished

109
Q

describe the duodenum and its functions

A

distinguished by Brunner’s glands
submucosal coiled tubular mucous glands secreting alkaline fluid
open into the base of the crypts
alkaline secretions of Brunner’s glands
neutralise acidic chyme from stomach - protecting proximal small bowel
help optimise pH for action of pancreatic digestive enzymes

110
Q

what is more proximal

the jejunum or duodenum

A

jejunum is most proximal

duodenum > jejunum

111
Q

which is thicker
jejunum or ileum
and why

A

jejunum is wider and thicker walled than ileum due to plicae circulares - are larger and more numerous and closely set

112
Q

where is the jejunal mesentery

A
  • above and to the left of the aorta
113
Q

where is the ileum mesentery

A

right and below to the aorta

114
Q

how many arcades do the jejunal mesentery vessels form

A

form only one or two arcades - long infrequent branches to intestinal wall

115
Q

how many arcades does the ileum have

A

numerous short terminal - about ¾ arcades

116
Q

what is only found in the lower ileum

A

Peyer’s patches

117
Q

what are the functions of small bowel motility (3)

A

to mix ingested food with digestive secretions and enzymes
to facilitate contact between contents of intestine and the intestinal mucosa
to propel intestinal contents along alimentary tract

118
Q

what is the process of segmentation (mixing)

A

mixes contents of lumen
occurs by stationary contraction of circular muscles at intervals
more freq contractions in duodenum cf. ileum
allow pancreatic enzymes and bile to mix with chyme
although chyme moves in both directions, net effect is movement > colon

119
Q

what is the process of peristalsis (propelling)

A

involves sequential contraction of adjacent rings of smooth muscles
propels chyme towards colon
most waves of peristalsis only travel about 10cm
segmentation and peristalsis result in chyme being segmented, mixed and propelled > colon

120
Q

what is the process of migrating motor complex

A

cycles of smooth muscles contractions sweeping through gut
begin in stomach > small intestine > colon > next wave starts in duodenum
prevents migration of colonic bacteria back into ileum

121
Q

in what kind of environment does digestion in small bowel occur

A

alkaline

122
Q

where do pancreatic enzymes come from and go to

A

come from MPD and CBD

go to duodenum

123
Q

what does duodenal epithelium also produce

A

own digestive enzymes

124
Q

does digestion occur in lumen and in contact with the membrane

A

yes

125
Q

where does digestion begin

A

digestion begins in mouth by salivary alpha-amylase (destroyed in stomach (acid pH))

126
Q

where does most of digestion of carbohydrates occur

A

small intestine

127
Q

what are 2 examples of simple carbohydrates

A

monosaccharides - glucose and fructose

128
Q

what are 2 examples of disaccharides

A

sucrose and maltose

129
Q

what are some complex carbohydrates

A

starch, cellulose, pectins

> sugars bonded together to form a chain

130
Q

what is secreted into duodenum in response to a meal

A

pancreatic alpha-amylase

131
Q

what does pancreatic alpha-amylase do

A

continues digestion of starch and glycogen in small bowel (started by salivary amylase)

132
Q

what does pancreatic alpha amylase require

A

needs Cl- for optimum activity and neutral/slightly alkaline pH

133
Q

where does pancreatic alpha amylase work

A

acts mainly in lumen (some also absorbs to brush border)

digestion of amylase products and simple carbohydrates occurs at the brush border

134
Q

what transport does absorption of glucose and galactose happen by

A

secondary active transport

135
Q

what are the 2 carrier proteins on apical membranes

A

SGLT-1

GLUT-5

136
Q

what happens at SGLT-1

A

absorption of fructose is by facilitated diffusion

137
Q

what happens at GLUT-5

A

GLUT-2 facilitates exit at basolateral membrane

138
Q

STEPS for digestion of proteins

A

protein digestion begins in lumen of stomach by pepsin
pepsin is then inactivated in alkaline duodenum
5x pancreatic proteases secreted as precursors > lumen of small bowel (eg trypsinogen)
trypsin activated by enterokinase - an enzyme located on duodenal brush border
trypsin > activates other proteases
hydrolyse proteins > single amino acids and oligopeptides

139
Q

what do a variety of peptidases at brush borders of enterocytes do

A

progressively hydrolyse multi amino acids > single amino acids

140
Q

what do enterocytes do

A

directly absorb some of small oligopeptides via action of H+/oligopeptide cotransporter PepT1

141
Q

STEPS for digestion of lipids

A

lipids are poorly soluble in water - more complicated to digest
4 stages process in small bowel
1) secretion of bile salts and pancreatic lipases
2) emulsification (increases SA for digestion)
3) enzymatic hydrolysis of ester linkages - colipase complexes with lipase - prevents bile
salts displacing lipase from fat droplet
4) solubilization of lipolytic products in bile salt micelles

142
Q

unlike amino acids and simple sugars what happens to lipids at enterocytes

A

they are transformed as absorbed via enterocytes

143
Q

STEPS for absorption of lipids

A

1) FAs and MG (monoglycerides) leave micelles and enter enterocytes
2) FAs and MG resynthesized into TGs by 2x pathways :
- monoglyceride acylation (major)
- phosphatidic acid pathway (minor)
3) after resynthesis into chylomicrons - lipoprotein particles synthesised as an emulsion
(80-90% TGs and 8-9% phospholipids, 2% cholesterol, trace carbohydrates) in Golgi
apparatus
4) chylomicrons secreted across basement membrane by exocytosis
5) chylomicrons enter a lacteal (lymph capillary) > lymph transports them away from
bowel

144
Q

how is the ileum and colon separated

A

ileum is separated from the colon by the ileocaecal valve

145
Q

what does the illeocaecal valve do

A

relaxation and contraction controls passage of material into the colon
also prevents backflow of bacteria into ileum

bioregulatory systems 🦠 (54 decks)

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