1
Q
What are the four functions of the GI tract?
A
- Motility: inner layer of circular muscle (contracted = lumen shrinks) + outer layer of longitudinal muscle (contracted = lumen expands)
- Secretion
- Digestion: chemical breakdown of food products
- Absorption: primarily in upper part of small intestine; almost all nutrients absorbed by the time contents leave the jejunum
2
Q
What is the enteric nervous system?
A
- Local or intrinsic reflexes
- Info received from the local microenvironment, and can relay this up and down the gut
- Signal that NEVER leaves the GI tract
3
Q
Why is the barrier function so important in the GI tract?
A
- Because the inside of the GI tract is essentially “outside” the body
4
Q
What cell layer varies most in the GI tract?
A
Epithelium
5
Q
Describe the integration of the PARA and SYM nervous systems in the GI tract.
A
- PARA: Vagus N covers mouth through transverse colon + Pelvic N in the remainder of the colon
1. 75% of fibers in Vagus N are afferent: vago-vagal reflex
2. Primarily stimulatory via Ach (nicotinic in myenteric and muscarinic in submucosa) - SYM: innervates muscle, blood vessels, mucosal cells, and both the myenteric/submucosal plexuses
1. Mostly INH, i.e., constricting of blood vessels, INH gastric secretion - NOTE: enteric nervous system also critical
6
Q
What are the 3 ways in which peptides are delivered to their targets in the GI tract?
A
- Hormones: released into interstitial space, blood, liver, heart, then distributed throughout the body; specificity determined by RECEPTORS
1. EX: gastrin, secretin, CCK, GIP, motilin - Paracrine: specificity via receptors AND location
1. EX: somatostatin, histamine (NOT a peptide) - Neurocrine: ex. is Ach release into synaptic cleft in response to action potential
7
Q
What is a physiologic effect?
A
- One that occurs with a dosed hormone that does not raise blood levels more than what occurs during a meal
8
Q
How are gastrin and CCK related structurally?
A
- Gastrin: 17-AA peptide whose 4 terminal AA’s make up its active center (primary receptor: CCK-1)
1. Pyroglutamyl and NH2 on the C-terminals prevent deactivation in the liver
2. Most gastrin comes from antrum of the stomach during a meal, and is G17; in fasting, G34 is released from the duodenum - CCK: 33-AA peptide with same 5-AA C-terminus as gastrin -> must have sulfated tyrosyl at position 7 for CCK action (gastrin action if de-sulfated: CCK-1)
- Differences in activity depend on whether tyrosine is in 6th of 7th position from C-terminus + whether or not it is sulfated -> CCK-2 activity > CCK-1 only if 7th AA is a sulfated tyrosyl
9
Q
How does desulfation affect strength of contraction of the gallbladder via CCK?
A
- Desulfated CCK does NOT cause gallbladder contraction, even at 4x physiologic level
- Will only cause small contraction, even at a pharmacologic concentration (40x physiologic)
10
Q
Which peptides are related to secretin?
A
- VIP
- GIP
- Glucagon
- NOTE: secretin has NO minimal fragment activity; occurs as an alpha-helix, so all AA’s needed for tertiary, active form of the hormone
11
Q
Where are hormones released from GI endocrine cells?
A
- From the BASOLATERAL MEMBRANE: hormone-containing granules at the basal surface of the cell in the attached image
1. Released into the INTERSTITIAL SPACE, not the lumen - Note the microvilli in contact with the lumen of the gut
12
Q
How are the hormones distributed along the GI tract (image)? Why is this important?
A
- Not in discreet glands, but in cells scattered over various areas of the gut, allowing them to sample what is happening over a wide area, and respond
- Enclosed black areas: hormone there, but mostly NOT released there
1. Acid rapidly neutralized when it reaches the gut, so secretin is hardly ever released there, for example
13
Q
What are the stimuli for release of each of the 5 GI hormones (table)?
A
- Gastrin: distention (vago-vagal and enteric), nerve, protein (INH by pH<3.5)
- CCK: fat, protein
- Secretin: acid (pH<4.5)
- GIP: protein, fat, carb (primarily carbs)
- Motilin: nerve
14
Q
What are the important actions of the 5 GI hormones (image)?
A
- Gastrin: acid secretion, mucosal growth
- CCK: gallbladder contraction, panc enzyme secretion, potentiates panc bicarb release (by secretin), panc growth, INH gastric emptying
- Secretin: pancreatic and gallbladder bicarb release, panc growth, INH acid secretion
- GIP: insulin release, INH acid secretion
- Motilin: gastric + intestinal motility
15
Q
Where are the 3 GI neurocrines released? What do they do?
A
- VIP: vasodilation of blood vessels via stimulation of NO synthesis (panc effect probably pharmacologic)
- GRP: vagal mediator for release of gastrin (NOT Ach); can’t INH Vagal gastrin release w/atropine
- Enkephalins (Met- and Leu-): stimulate opioid receptors, and do opposite of VIP -> probably interact with VIP physiologically to cause peristalsis (drug forms INH diarrhea)
16
Q
What are the actions of the GI paracrines? Where and how are they released?
A
- Somatostatin: probably INH all peptide hormone release in the body
1. INH parietal secretion of acid (located close to parietal cells) and gastrin
2. May regulate interplay between insulin and glucagon (INH both) - REMEMBER: these substances are PARACRINE, so they need to be near the things they are affecting
17
Q
What 2 endocrine cell tumors are caused by the over-production of GI peptides?
A
- Gastrinoma: tumor in pancreas OR duodenum, so NO CONTROL of release of gastrin -> normally, these tumors don’t grow rapidly, and they do fine
1. Steatorrhea: fat in the stool
2. Treated pharmacologically for the most part: INH of H-K ATPase (i.e., Omeprazole, a PPI); can prevent all acid secretion - Pancreatic cholera: VIP -> pancreatic and intestinal secretion; losing bicarb in the stool
18
Q
Where is there smooth muscle in the GI tract? What are 2 unique features of this muscle?
A
- GI tract is all smooth muscle except upper 2/3rds of the esophagus and the external anal sphincter
- Very few cells actually innervated, so muscle can contract as a unit -> functionally coupled system via nexi
- Phasic contractions vs. tonic contractions: UES, and other sphincters -> myogenic property of the smooth mm themselves that they can remain contracted for long periods of time
19
Q
Describe the chewing/swallowing reflex.
A
- Food in mouth INH muscles of mastication and jaw drops
- Mixes food with saliva so it is easily passed, and INC surface area, making it available for digestive enzymes
- Have to have at least something in there to begin swallowing reflex, i.e., saliva
20
Q
Describe the resting and swallowing pressures in the esophagus. What are primary and secondary peristalsis?
A
- 2,3,4 at (-) pressure b/c they are in the thorax, which has a (-) pressure -> pressure DEC on inhalation, and INC on exhalation
- (+) pressure when you get past the diaphragm; INC in pressure when you breathe in, rather than the DEC seen above
- When bolus reaches diaphragm, the LES relaxes; LES important because it prevents acid reflux
- Primary peristalsis: initiated by a swallow
1. Secondary: if something becomes stuck in the esophagus, it will contract above and relax below, starting new peristaltic wave
21
Q
What sphincter in the GI tract is anatomically identifiable?
A
Upper esophageal sphincter (UES)
22
Q
How is the Vagal N involved in swallowing?
A
- Vagus N directly innervates skeletal muscle in the upper 1/3rd of the esophagus, but innervates NN in myenteric plexus in the lower parts of the esophagus
- Following a vagotomy, peristalsis is interrupted in the striated muscle, but it can continue in the smooth muscle
23
Q
What is GERD? Tx? Causes?
A
- Acid reflux, heartburn
1. Normal for some amt of GER to occur, but it is cleared by 2o peristalsis - Treated by INH acid secretion -> PPI’s, i.e., Omeprazole (1 pill can last 24 hours)
- Casuses: hiatal hernia, pregnancy, failure of 2o peristalsis
24
Q
What are the 2 areas of the stomach? What is unique about the muscle here? 1o function?
A
- Oxyntic (parietal cell) area and pyloric (G-cell) area
- Only part of the GI tract with an oblique layer (goes across both surfaces of the stomach); thicker muscle in pyloric gland area b/c stronger contractions here
- Primary function: storage
1. Also mixes up, contents
2. Gastric emptying is highly regulated
25
How does pressure in the stomach respond to swallowing? Why? Mediator?
- Swallow ends when orad part of stomach relaxes (accommodation) -\> RECEPTIVE RELAXATION
- Can put in about 1.5L of food and only INC pressure 10mg Hg
- Vago-vagal reflex
26
Describe gastric motility.
- Slow waves (**3-5cpm**) via Interstitial Cells of Cajal (depolarize rhythmically), but most do NOT cause a contraction
- Contractions get _stronger as you move in a caudad direction_, and occur more rapidly after e/o
- As amplitude of depolarization INC, contraction occurs (see below: orad to caudad) -\> spiking not necessary to produce contraction, but does result in stronger and longer contraction
- These are going on all the time, but will _only cause contractions w/other involvement_, i.e., Vagal activity (which will be higher with food in the stomach)
27
What feature of gastric emptying does this image highlight?
- Retro-pulse of food back into stomach -\> continued churning until the food particles are small enough to enter the duodenum
- This process can take several hours
28
How do gastric slow waves vary from the fundus to the pylorus?
- No contractions in the fundus
- _Frequency remains the same, but the amplitude changes_ from 3 (body) on
- Can never have more contractions than frequency of the slow waves
29
How does gastric emptying vary for liquids vs. solids?
- Liquids empties more rapidly than solids
- Solids plateau b/c have to be reduced in size before they can be emptied
30
What 4 things are responsible for control of contraction in the stomach?
- CONTROL:
1. Contraction/pressure in orad stomach
2. Peristalsis of stomach
3. Pylorus can contract and relax
4. _Duodenal motility_: as acid enters, it triggers intrinsic reflex to INH gastric peristalsis and emptying -\> helps prevent duodenal damage (must have a low enough acid for pancreatic enzymes and bicarb to control it)
- NOTE: hyper- and hypotonic solutions also empty more slowly than isotonic ones b/c duodenum is an _osmotic control_
31
How do high-fat meals affect gastric emptying?
- More fat = slower rate of gastric emptying
- CCK DEC contractions of the stomach
32
What are some things that can impair gastric emptying? Symptoms?
- Obstruction: ulcer, cancer
- Vagotomy
- Symptoms: fullness, loss of appetite, nausea
33
What might cause increased gastric emptying? Consequences?
- Inadequate regulation
- May lead to diarrhea, or duodenal ulcers
34
What do you see here? Why?
- **Small intestine fed motor pattern**: brief & irregular contractions + _segmentation_ -\> mixes material and exposes to wall of the GI tract
- Virtually all ABSORPTION happens in duodenum and jejunum (small intestine)
- Motility in small intestine regulated so _material is mixed and exposed to surface of gut_; moves at a relatively slow rate
- Can remove up to 60% of gut, and digestion and absorption will occur normally
35
What does this image show?
- **Peristalsis**: not the length of the gut, but partially down the gut
- Weak peristaltic response; all of the patterns occur in the fed individual
- _Law of the intestine_: a stimulus in the intestine (the presence of food) initiates a band of constriction on the proximal side and relaxation on the distal side, and results in a peristaltic wave
36
What is the migrating motor complex?
- _Fasted individual_: intense group of contractions about every 90 minutes
1. Occurs only during fasting to get rid of any remaining material in the gut, incl. bacterial overgrowth
- This is triggered by MOTILIN: released by nervous stimulation
37
How are slow waves in the intestine triggered? Frequency?
- Contractions triggered by _spiking_, rather than amplitude -\> amplitude does NOT vary; spikes are what matter
1. Frequency of spiking determined by digestive state of the individual
- Freq of slow waves varies also: _less frequency as you move distally_
1. Interstitial cells of Cajal (ICC)
38
How is peristalsis regulated in the small intestine? Does slow wave frequency vary?
- Peristalsis regulated by VIPs (DEC), enkephalins (INC), and Vagal (INC)
- Slow waves are NOT propagated -\> fewer contractions occurring in the distal gut
1. Slow waves set the maximal number of contractions
39
What is unique about the anatomy of the colon? Innervation? Functions?
- Incomplete longitudinal muscle: _teniae colli_ and _haustra_ (physiological more than anatomical) distinguish from small bowel
- External INNERVATION:
1. _Vagus N_: proximal through transverse
2. _Pelvic N_ (from sacral region): sigmoid, rectum
3. _SYM fibers_ (from hypogastric plexus): distal rectum and anal canal
4. Somatic _Pudendal N_: external anal sphincter (striated muscle)
- FUNCTIONS: to remove final amt of water (1400 in, and about 100-150 out), also a storage organ
40
Describe the regulation of the ileocecal sphincter.
- Normally tonically contracted -\> _intrinsically regulated_ phenomenon: NN entirely contained in gut itself (myogenic resting tone)
1. When ileum stretched, relaxes so material can enter colon
2. If colon is distended, contracts to prevent retrograde mvmt
- _Gastro-ileal reflex_ from stomach to iliocecal sphincter —\> CCK
41
How does mass movement happen in the colon?
- Organized segmental contraction (oral-to-aboral direction) during "mass movement" _1-2x/day_
1. Segmental movement stops; _haustrations disappear_
2. Colon undergoes contraction -\> aboral direction
2. After, haustrations and phasic contractions return
- Moves material forward through the colon
42
Describe the rectosphinteric reflex.
- IAS relaxes when rectum distended
- External sphincter tonically contracted: spinal cord
- EAS striated muscle controlled voluntarily via the Pudendal N
1. Physical INC of pressure in the abdomen (Valsalva maneuver)
2. No teniae coli in rectum, but rather more continuous longitudinal and circular muscle
- NOTE: tonic contraction state of EAS via reflex activation of dorsal roots in sacral segments; paraplegics lack tonic contraction -\> incontinence
43
Describe the contents of saliva (and their roles).
- DIGESTION: _salivary amylase_ (ptyalin) digests starch in the same way as pancreatic amylase -\> NOT essential b/c PA can do all of this on its own
1. _Lingual lipase_: hydrolyzes dietary lipids (works best in an acidic environment)
- Absorbs and concentrates _fluoride, phosphate, and Ca_ so they can be absorbed by teeth enamel
1. Protective: prevents dental carries
- PREVENTS INFECTION: _lysozyme_ kills bacteria
1. _Lactoferrin_: chelates iron and prevents bacterial growth
2. IgA binding protein for _secretory IgA_ (bactericidal)
44
What is unique about saliva from the parotid?
- PAROTID: serous (water + electrolyte) only (ear and annal of the jaw)
- OTHERS: water + electrolytes + mucous
45
What is a salivon? Function? Blood supply? Innervation?
- _Acinar cells_: elaborate the original saliva
- _Myoepithelial cells_: contractile (may also be on intercalated ducts)
- Salivary production can be as high as _1mL/min/gm_ of tissue -\> HIGH rate of secretion
- Tremendous BLOOD FLOW to these glands: 20x that to the muscle
- Innervated by _7th and 9th cranial NN_ (facial and glossopharyngeal)
- REMEMBER: copious salivary flow prior to vomit
46
How do electrolyte contents vary with the rate of saliva secretion?
- K+ always high
- Na+ and Cl- concentration INC with flow (i.e., a fast rate of secretion would result in a higher Na and Cl concentration in the saliva)
- Bicarb INC with time too, but curve very steep at the beginning, then plateaus
- HYPOTONIC at all rates of secretion, and only approaches isotonicity at very high rates of excretion
47
How are electrolytes absorbed/secreted as saliva travels through the salivon?
- Acinar cells elaborate a saliva that is essentially identical to plasma in terms of its electrolyte composition
- Na+ concentration DEC and K+ INC as you move down the ducts
1. Na+ is ACTIVELY TRANSPORTED by ducts
2. Cl- reabsorbed
3. K+ and bicarb (stimulated by flow rate) secreted (stimulated by secretagogues)
- Much more Na+ and Cl- leave than K+ and bicarb enter, so _saliva is hypotonic_ (almost impermeable to water)
48
How are the salivary glands innervated? Name 2 hormones that can affect saliva electrolyte content.
- **PARA** and **SYM** stimulate salivary flow:
1. SYM, vasoconstriction initially, but INC BF w/hyperemia toward end (dotted line curve)
- Stimulation of salivation is ENTIRELY NEURAL
- Electrolyte content of saliva can be modified via:
1. **Aldosterone**: DEC Na+ in saliva and INC K+ by inserting carriers in the membrane that reabsorb and conserve Na+
2. **ADH** can do this too -\> not a regulation, but a modification of the contents
49
What PARA nerves stimulate salivary secretion? Name some stimuli that INH or INC secretion.
- CN 9 (glossopharyngeal) and 7 (facial), NOT 10
- SYM: stimulation not as strong; elim of SYM does NOT cause salivary gland atrophy
- See attached image for (+) and (-) stimuli
50
What 5 products are secreted by the stomach? What are their functions?
- HYDROGEN ION: activated conversion of pepsinogen to pepsin (-ogen = inactive enzyme)
1. Kills bacteria: if pernicious anemia and don't secrete acid, higher incidence of infection in proximal GI tract
2. Digests protein
- PEPSINOGENS: pepsin digests protein by cleaving interior peptide bonds -\> NOT essential in digestion of protein b/c pancreatic proteases can take care of all of this
- MUCUS: lubricates food, protects stomach lining by preventing diffusion of H+ into stomach mucosa
- INTRINSIC FACTOR: necessary for absorption of Vit. B12 -\> active process of absorption in prox ileum that recognizes *only* intrinsic factor
1. By the time patient develops pernicious anemia, disease is full-blown, and no way to study its onset
2. Reason the stomach is necessary for life
51
What are the 2 secretory regions of the stomach, and their secretions?
- OXYNTIC: acid-secreting (HCl)
- PYLORIC: gastrin-secreting
52
Describe the orientation of cell types within the gastric glands.
- Neck cells: stem cells
- _Chief cells_: capable of division, but can also be derived from stem cells
- _Parietal cells_: 150-160mEq/L acid secretion -\> concentration gradient of 3-4 million fold over pH of blood (\<1 vs. blood pH of 7.4)
53
Describe the mechanism of acid secretion in the stomach.
- Bicarb exchanged for Cl- on the basolateral mem
1. APICAL: Cl- diffuses into the lumen, down its concentration gradient; H/K ATPase
2. BASOLATERAL: some Na+ leaks back in (N/H exchanger), creating more impetus for Cl- to move into the cell (Cl/bicarb exchanger)
a. Na/K ATPase
b. Mvmt of Cl − from blood to lumen against electrical and chemical gradients is the result of excess OH – in the cell after the H + has been pumped out (CA)
- H/K ATPase is the target of PPI's: concentrate in acid spaces, interact with ATPase sulfhydryl groups
54
How does parietal cell architecture change to allow secretion?
- TUBULOVESICLES contain H/K ATPase
- When secretion is stimulated, canaliculus gets much larger, taking up almost all of the inside of the cell, except the mito
- Lumen lined with MICROVILLI -\> these are the tubulovesicles
- Takes about 10 minutes for secretion to begin, and _acid never in the cytoplasm_ of the cell
55
How is the potential difference across the oxyntic gland mucosa maintained?
- Cl- accounts for most of the potential difference
1. Following stimulation of acid secretion, the potential difference decreases to −30 or −40 mV because the positively charged H+ moves in the same direction as Cl −
- H+ ion secreted *down* its electrical gradient, but *against* its concentration gradient
56
What is used as an index of gastric mucosal barrier breaking? Name 2 things that can facilitate this "breakage."
- **Potential difference**: goes towards 0 if the barrier is damaged
- Aspirin is a weak acid, so it moves into the cell, and H+ can accumulate w/in the cell
57
What 5 things allow parietal cells to excrete acid into the lumen?
1. H/K ATPase
2. Mitochondria: provide ATP for the ATPase
3. Tubulovesicles/IC canaliculus: keeps acid out of the cytoplasm
4. Mucosal barrier: prevents diffusion of H+ back into the mucosa
5. Potential difference: about -70
58
How do the ion concentrations of gastric secretion change based on flow rate?
- Always high K+
- H+ INC with INC rate of secretion (INC volume of oxyntic fluid)
- Hypokalemia and metabolic alkalosis if chronic vomiting -\> this can be particularly problematic for young kids
59
What is the electrolyte composition of the oxyntic and non-oxyntic fluids?
- When parietal cells stimulated, only oxyntic fluid excreted
60
What is the 2-component hypothesis of gastric secretion?
- Non-oxyntic secretion is produced continuously at low rates, and is overwhelmed when secretion is stimulated from the parietal cells
1. When parietal cells stimulated, only oxyntic fluid excreted
61
What mediators are responsible for stimulating gastric acid secretion?
- Note that this combo includes:
1. Hormone: gastrin
2. Paracrine: histamine
3. Neurocrine: Ach
62
How do the 3 mediators responsible for gastric acid secretion work together?
- Gastrin releases histamine from enterochromaffin-like cell (ECL cell)
- All 3 stimulants activate *different receptors* on the parietal cell
- Histamine POTENTIATES the effects of Ach + gastrin
63
How does Cimetidine work?
- Block the direct effects of histamine, and in so doing, *blocks the potentiated effects* of the 3 hormones
64
Describe basal gastric acid secretion.
- Acid diurnal variation is NOT due to changes in gastrin -\> highest during the night
65
What is the peak acid secretion rate?
- 30 mEq/hr
- Note that this secretion INC at the beginning of the meal -\> cephalic phase
66
What is the influence of sham feeding on human gastric acid secretion? Implications?
- CEPHALIC PHASE: stimuli present in the head
1. Amount of acid secretion depends on nature of the meal
2. This phase contributes 30-40% of the maximum secretion
67
Does the Vagus have a direct affect on acid secretion in the absence of gastrin?
- Yes!
- Get rid of gastrin, and stimulate Vagus, and you still get acid -\> this means Vagus directly stimulates parietal cells
- Vagus also stimulates gastrin release
68
How is stimulation of acid secretion triggered by receptors in the head? What types of stimuli?
- STIMULI: smell, taste, chewing, swallowing, hypoglycemia
- Vagus stimulates:
1. G-cell gastrin secretion via GRP, and
2. Parietal cell acid secretion via Ach
69
When is most acid released? What foods elicit the highest acid response?
- Gastric phase is when most acid release occurs
- Protein in the food releases the hormone gastrin, which stimulates histamine and acid release
70
Describe the mechanisms involved in acid secretion during the gastric phase.
- Mechs involved in stimulating acid secretion that originate from the stomach
- 2 STIMULI:
1. Protein releasing gastrin
2. Distention stimulates 2 local reflexes via vago-vagal reflex:
a. Parietal cell in fundus, and
b. Gastrin in antrum (and local reflexes via Ach)
71
How is somatostatin involved in gastrin release?
- Somatostatin released when pH of stomach \<3.0
1. INH ALL GASTRIN release, regardless of the stimulus
- _Vagus INH somatostatin_ release (via Ach) and stimulates gastrin release (via GRP)
1. Pts with _duodenal ulcers_ have defect here in regards to somatostatin release: may have pH limit of 1.5 or 2 instead of 3
72
Summarize all of the mechanisms affecting gastrin release (table).
73
What mechanisms INH acid secretion?
- _Enterogastrone_: something from small intestine that INH acid release in the stomach
- _GIP_: gastric inhibitory polypeptide
74
How do pH, volume, and gastric secretion vary over time in response to a meal (graph)?
- Vagal release of acid first, in cephalic phase
- Empty stomach pH \<2, so gastrin is not released until you begin to eat, and food enters the stomach, neutralizing the acid, and allowing gastrin to be released
- Back to where you started in about 3-4 hours
75
Regulation of pepsinogen secretion
- Acid triggers a local cholinergic reflex that stimulates the chief cells to secrete
1. Strongest stimulant of pepsinogen secretion is **Ach**
- **Acid** (H+) in pylorus stimulates secretin secretion, which then stimulates pepsinogen secretion
- GASTRIN also stimulates pepsinogen secretion (weak)
- Pepsinogen -\> pepsin conversion instantaneous at pH around 4 (denatured around pH 5-6)
76
PUD: gastric vs. duodenal ulcers
- GASTRIC ULCER: defective gastric mucosa
1. H. pylori (NH4+) or NSAIDs
2. Low rates of acid secretion
3. NH4+ can damage mucosa, causing gastrin release -\> acid diffuses back through the damaged mucosa, producing ulcer
- DUODENAL: increased acid and pepsin
1. H. pylori (NH4+); localized in antral area
2. NH4+ INC gastrin levels, INH somatostatin
3. INC parietal cell # = INC max acid secretion =\> tropic effects of gastrin
- If you get rid of H. pylori, everything else will go away, except for INC parietal cell #
77
What GI organ is most important to ensure complete digestion? What is the major regulator of its secretion?
Pancreas
Secretin
78
What is a pancreon (image)?
- Centroacinar cells: secrete water and electrolytes
- Pancreatic enzymes: low-volume secretion (from acinar cells)
79
What is the major function of the aqueous component of pancreatic secretion?
- To neutralize gastric acid secretion: about 1-2L of both of these
- Essentially able to neutralize all of the gastric acid that enters the duodenum (with the help of some bicarb from the bile and mucosa)
- Neutralization of the acid entering the small bowel is important for:
1. Enzyme activity, and
2. To prevent duodenal ulcers
80
What are these? Describe the cells and mediators.
- _Acinar cells_: highly developed reticular endothelium -\> most active protein-synthesizing cells in the body (about 100g/d)
- _Zymogen granules_: all pancreatic enzymes secreted into lumen of the gut
1. Eventually digested, like o/proteins in diet
2. Granules secreted out into the lumen; remain intact until there is a secretory stimulus
- Enzymatic component stimulated by _Ach and CCK_
81
What is the mechanism of pancreatic secretion?
- _Na/K ATPase_ is major active process: moves Na+ out of cell -\> diffuses down concentration gradient back into the cell, providing 2o transport of H+ out
1. Oubain INH this
- Cl- comes in to maintain electroneutrality (and bicarb out); _buildup of Cl- in cell_ allows luminal mvmt of Cl- via CFTR
1. Cystic fibrosis: problem w/CFTR (cylindrical)
- Na+ diffuses paracellularly, and water moves osmotically (NEVER goes against concentration gradient) transcellularly (Aquaporin 1 channels)
- REMEMBER: alkaline tide in gastric venous blood when acid released (pH INC), but opposite (of parietal cells) with pancreatic secretion
82
How does the ion concentration of pancreatic juice vary according to rate of flow?
- Na+ here equivalent to Cl- in stomach
- Cl- here equivalent to Na+ in stomach
- Bicarb here equivalent to H+ in stomach
- NOTE: all rates of pancreatic and gastric secretion essentially isotonic -\> only one that is hypotonic is salivary
83
Enzymes synthesized on RER; hydrophobic AA’s added first (leader sequence), allowing protein to cross inside RER —\> membrane-bound until they are secreted. This is a mechanism to prevent pancreatic cells from digesting themselves (never get out into the cytoplasm).
Budded off, move into Golgi, get incorporated into condensing vacuoles, where they are concentrated, and then become zymogen granules that move to apical membrane and await secretory stimulus. Step 6 is the only one that requires a secretory stimulus; the others are ongoing. 2, 3, 4 require energy; must have supply of ATP.
Amylase: starch
Lipase: fat
Protease: protein
All occur in basically the same proportions, unless there is a major dietary change that lasts for some time. This occurs at the level of mRNA.
All proteases synthesized as inactive enzymes. TRYPSIN is responsible for activation of these enzymes, and is autocatalytic. Cell also contains an anti-trypsin.
84
Secretion lasts until all contents have been digested. Enzyme secretion can last 6-7 hours (until meal is fully digested).
85
Sham feeding cephalic phase INC in enzyme release (stimulation of acinar cells alone, with very little INC in pancreatic bicarb). Vagus does this! Ach has little effect on ductule cells (that produce water and bicarb).
86
There is a basal rate of pancreatic secretion; we’re not sure if there is a regulator of this (may be an inherent property of the gland). Not INH by atropine.
87
Major phase of pancreatic secretion is the intestinal phase (70-80% of max pancreatic response; cephalic phase only 15-20%).
pH for release of secretin \<4.5. pH\<3 does not change output, but greater area of exposure will because more cells are then capable of releasing secretin.
88
FA’s must be C8 or greater (C16, 18, most common in the diet, and most common releasers of CCK). Also released by AA and peptides. Most potent releasers in man are phenylalanine, tryptophan, etc (glycine ineffective).
CCK’s act via CCK-2 receptor, activating vago-vagal receptors Ach also potentiates effects of secretin on ductal cells (very important because it allows pancreas to secrete maximally).
89
Material entering the duodenum is neutralized very rapidly; just a small area is acidified sufficiently to induce secretin secretion and bicarb release from the pancreas.
90
Potentiation allows small amounts of secretin to result in max pancreatic secretion.
91
Different second messengers and different receptors.
CCK also potentiates this action of secretin.
VIP, glucagon also have the secretin affect here, so they cannot potentiate its activity.
92
Pancreatitis
Digestive enzymes acting on pancreatic cells. Usually caused by blockage of pancreatic duct. Back-up, and trypsin activated.
90% due to gallstone blockage, or long-term, excessive intake of alcohol, which damages pancreas via the bloodstream.
About 10% hereditary. Mutations are those that do away with the fail-safe mechs we talked about: one DEC trypsin’s ability to digest itself, and the other INC its activation.
93
Kwashiorkor
Lack of protein. Secretion of water and electrolytes with no enzymes. Lipase essential, so if not secreted, then you are going to get steatorrhea (can lose up to 70% of these and be okay, but more than that, and you have problems).
Steatorrhea: diarrhea and fat in stools. Osmotic diarrhea.
94
Cystic fibrosis
Plugs things up, so you get a mucousy secretion in the pancreas, leading to plugging and pancreatitis.
CFTR in a number of tissues, incl. salivary glands (we didn’t go over this), lungs, sweat glands, and gut itself.
95
What are the 4 protective mechanisms against enzymatic damage in the pancreas?
1. Membrane-bound
2. Inactive
3. Anti-trypsin
4. Trypsin is auto-catalytic
GI
flashcards
Decks in class (25)
# Cards
-
Johnson - Physiology95
-
Gupta - Pathology148
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Sweatman - GI System Pharm23
-
Ray - Gastroparesis35
-
Jackson - Gastric Neoplasia44
-
Jackson - Colon Polyps to Cancer66
-
Cross - ID73
-
Howden - GERD27
-
Howden: PUD30
-
Howden - IBD33
-
Marino - Pathophys of Diarrhea44
-
Tombazzi - Carcinoid, GIST, Lymphoma36
-
Tombazzi - Vascular GI Disorders61
-
Bahouth - Diarrhea and Constipation28
-
Sweatman - Drugs for HCV/HBV32
-
Waters - Liver169
-
Sweatman - Tx for C. diff11
-
Bilal - Constipation/Megacolon39
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Sweatman - Salivary Flow17
-
Howden - Acid-Suppressing Drugs32
-
Ryan/Nair - Hepatitis69
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Ray - Malabsorption49
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Tombazzi - Gallbladder56
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Marino - Pancreas73
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Sweatman - GI Cancer18
