Gastrointestinal Physiology

General Concepts
What makes up all of the sphincters except two? What makes up
the two exceptions, and what are they?
Smooth muscle
Upper Esophageal and external anal are striated muscle the start
and end!
What is the key role of the parasympathetic ner"ous system in
regards to the gut?
Excitatory to the motor function and secretion of the gut#
What is the key parasympathetic ner"e inner"ating the gut? $re
these afferent or efferent ner"es?
%agus&afferent
'rue()alse
%agal efferents carry only excitatory information#
)alse, excitatory and inhi*itory
What is the primary function of the sympathetics with regards to
the gut? What are + areas that are targeted?
,nhi*itory effect on secretory and motor functinon in the gut#
'arget the *lood "ascular system, musculature of sphincters,
and the enteric ner"ous system
,s it mostly afferents or efferents? -oth ./0./
What is the function of the enteric ner"ous system? Where is it
located?
Coordinates and programs gastrointestinal function from the wall
of the gut#
What are the two di"isions of the enteric ner"ous system, what do
they do, and where are they?
1yenteric plexus *etween longitudinal and cicrcular smooth
muscle layers2 does motor acti"ity of the gut#
Su*mucosal plexus *etween the circular smooth muscle and
su*mucosa2 regulates mucosal functions#
Where are the postganglionic sites for the parasympathetic and
sympathetic ner"ous system in regards to the gut?
PS3 E4S
S4S3 pre"erte*ral ganglia
What are the two types of receptors which are mentioned as *eing
sensiti"e to acetylcholine?
1uscarinic receptors and nicotinic receptors
What is the key neurotransmitter used in the sympathetic system?
What functinon does it ha"e?
4orepinephrine is an inhi*itory 4' acting at alpha and -eta
adrenergic receptors
5ist excitatory and inhi*itory nonadrenergic(non0cholinergic 4's Excitatory3 Su*stance P, neurokinin $
,nhi*itory3 46, "asoacti"e intestinal polypeptide
What are the four le"els of neural control of the gut? 5e"el 73 Enteric ner"ous system acting independently
5e"el 83 pre"erte*ral ganglia which is influenced *y
preganglionic fi*ers in the spinal cord
5e"el +3 S4S and P4S out*flow to the gut determined *y
sensory fi*ers and their reflexes
5e"el 93 Consciousness
What + arteries supply the G, tract? Celiac, superior and inferior mesenteric
:escri*e their arrangement and its purpose# 'hey run in parallel allowing for independent regulation of *lood
flow to the indi"idual organs in the gut#
;ow is it different in the li"er? 'he "enous drainage all emptiesinto the portal "ein so that the
li"er is exposed to all a*sor*ed su*stances
Gastrointestinal Endocrinology
5ist some of the classic hormones released in the G, tract# Gastrin, Secretin, Choleocystokinin, G,P
What is the stimuli for their release? Specific luminal contents
What hormone type acts *y diffusing through the extracellular Somatostatin is a paracrine hormone#
Wouldn<t you rather *e watching some '%?
space to their target cell? Gi"e an example#
What are the two hormone families? 4ame the hormones in each Gastrin and CC=! and Secretin %,P, G,P, Glugagon!
What is the second messenger for homones in the Gastrin family? Calcium
What is the second messenger for hormones in the secretin
family?
c$1P
What makes a hormone family Same receptor and second messanger
What ner"e plexus is seen in *etween the smooth muscle layers?
-etween the mucosa and the muscle layers?
1yenteric ner"e plexus, Su*mucosal plexux
Gastric $cid Secretion
What is now thought to *e the primary regulator of acid output? Enterochromaffin cells secreting histamine
Specifically for the oxyntic gland, where are the effector parietal
cells found?
,n the fundus and corpus
What do parietal cells secrete? ;C5, intrinsic factor and water
Where are the peptic cells found? What do they secrete? ,n the deep part of the ooxyntic gland, secreting pepsinogen
What are the two cell types in"ol"ed in the paracrine regulation
of acid secretion?
'he EC5 and the somatostatin cell
What cells located in the antrum and upper small intestine also
pro"ide for hormonal control of gastric secretion?
'he gastrin >G? cells and the somatostatin >:? cells
'race the path of %itamin -78 in the gut# -78 is li*erated from food *y gastric proteases, and rapidly *inds
to @ proteins# ,n the duodenum, -78 is clea"ed from the @
protein *y trypsin and it complexes with ,), and is protected# ,n
the ileum, ,) *inds to receptors, ena*ling -78 to *e a*sor*e#
'rue()alse
'he parietal cell uses $'P to secrete ;ydrogen ions#
'rue
What does pepsin digest? Proteins
What are two intracellular factors which increase acid secretion? c$1P and calcium
What are the main stimulants for acid secretion ;istamine and $c; and gastrin
What happens to the concentration of sodium in the stomach due
to gastric secretion?
-efore gastric secretion, its le"els are high and approximate
interstitial le"els# $fter gastric secretion, they are low due to
dilution#
$t the *asolateral mem*rane, how is sodium pumped out of the
cell?
4a(= $'Pase
;ow is potassium transported at the apical mem*rane# 'ransported in "ia a ;(= pump
Passi"ely diffuses out into the lumen
;ow does chloride use to get to the lumen? Exchanges for *icar*onate at *asolateral side
$cti"e and passi"e mo"ement into lumen
What are + functions of gastrin? Stimulate acid secretion from oxyntic cells
@egulate mucosal growth
Stimulate pepsinogen secretion
What is the function of somatostatin? ,nhi*its gastrin release
What stimulates gastrin release( :istension "ia the "agus! and the presence of amino acids and
peptides in the antrum
What effect does hydrogen ion concentration in the lumen ha"e
gastrin secretion? 6n : cells?
,nhi*it G cells
Stimulate : cells to secrete somatostatin
'his results in a regulation of acid release
What is the stimulus for "agal stimulation? Sight, smell of food
What are two other mechanisms for gastrin and acetylcholine
release?
:istention results in a "ago0"agal response where*y the afferents
of the stomach in the "agus stimulate the medulla resulting in
"agal release of $c; and *om*esin
$mino acids from protein digestion stimulate G cells to secrete
gastrin
:uring the intestinal phase of digestion, what stimulates acid
release?
:ome gastrin released from cells lining the duodenum *ut most
signals are inhi*itory and acid secretion *egins *e inhi*ited "ia
hormones and ner"es! as more and more of the meal lea"es the
stomach and enters duodenum
Prolonged "omiting leads to a loss of what ions? ;ydrogen, Potassium, chloride, and water
What are three chemicals that parietal cells ha"e receptors for?
What does it do?
Gastrin, ;istamine, $cetylcholine
What effect does somatostatin ha"e on G cells? Where does
somatostatin come from? What is the stimulus for its release?
Somatostatin from : cells is an inhi*itor of Gastrin relesae from
G cells# ,t is released due to increasing ;A le"els
What are the three maBor acid releasing stages, and the stimulus
for acid release?
Cephalic3 anticipation in head stimulates the "agus
Gastric3 when food hits the stomach2 maBor portino
,ntestinal3 slowing down of release
What are 9 effects that the "agal stimulation has during the
cephalic stage
,ncrease pepsinogen release from chief cells
;A release from parietal cells
;istimine release from EC5 cells
Gastrin release from G cells
What is the name of the reflex used in distention of the stomach? %agus0%agal reflex
What contents in the lumen stimulate gastrin release? $$ and distention
:escri*e the Cystic fi*rosis transmem*rane regulator# $ c$1P0acti"ated Cl
0
conductance channel in the luminal
mem*rane that allows recirculation of Cl imported through the
Cl(;C6 exchange
What is chloride recirculation key for? 'o keep water in the mucous
What are the two key hormones in"ol"ed in pancreatic
stimulation? What is the stimulus for their release, what do they
do, and what messenger system do they use??
Secretin is secreted *y S cells in the duodenum in response to
acid# ,t works "ia a c$1P second messenger on the duct cells to
stimulate *icar* and water secretion from the duct cells
CC= is released *y the , cells in response to amino acids and fats
in the duodenum# CC= stimulate enCyme secretion from acinar
cells
What effects do %,P and gastrin ha"e on the pancreas? %,P&also increases *icar* and fluid secretion
Gastrin&increases enCyme secretion
What stimulus does the "aso"agal reflex play in the regulation of
pancreatic secretion?
,nitiated *y the entry of chyme into the intestine, it increases
enCyme secretion from the acinar cellsa nd water and *icar*
secretion from the duct cells
'rue()alse
'here is a *asal rate of secretion from the pancreas#
'rue
What is the maBor role of *icar* secretion? 'o pro"ide a functinonal intraluminal p; for the actino of
enCymes
What acti"ates the cephalic stage with regards to the pancreas?
What is stimulated? Wht happens?
'he sight of food stimulates the "agus to stimulate enCyme,
*icar*, and fluid secretion
What happens during the gastric phase? 'he entry of food into the stomach continues the "agal
stimulatino
Which is the key phase in the release of pancreatic enCymes? ,ntestinal phase accounts for the maBority of pancreatic secretory
response#
What causes the intestinal stage? 'he release of secretin from S cells in the intestine in response to
intraluminal acid
What stimulates the release of CC= CC= release from , cells is due to the presence of fatty acids and
peptides
What effect does the release of trypsin ha"e on the enCyme
release from the pancrease?
:ecreases it
What is wrong in C) patients? $ defecti"e Cl transporter leads to a reduction in pancreatic
*icar* secretion, leadin gto "iscous secretions which *lock small
ducts
;epato*iliary Secretion
What must happen to *ile salts so that they will *e solu*le in
water? ;ow does this occur, and what is formed?
ConBugation *y glycine and taurine form the primary *ile acids
synthesiCed in hepatocytes from cholesterol#
Where are secondary *ile acids formed? -acterial alteration of primary *ile acids
Where are the maBor *ile pigments, *iliru*en and *ili"erdin
fomred? )rom what?
,n the li"er from hemoglo*in taken up *y the reticulendothelial
system#
What happens to the *iliru*in formed in the li"er? @eleased into the plasma, solu*iliCed with al*umin, and circulates
to the li"er#
What happens if there is an increase in cholesterol or a decrease
in *ile salts as pertaining to *ile!
,t *ecomes supersaturated and the cholesterol precipitates into
gall stones#
What cells form *ile? 'race its formation# -ile is formed *y hepatocytes and ductal cells, secreted into the
*ile canaliculi, modified *y the intra and extrahepatic *iliary
system, stored in the gall *ladder, and deli"ered into the
duodenum through the papilla of %ater#
What is the maBor source of *ile salts? )rom uptake from the *lood
$ "ery efficient process and all *ile acids are picked up
,n contrast, what a*out *ili"erdin uptake? ,t is inefficient# 6nce picked up it is conBugated and secreted
'race the path from *iliru*in to stool for *iliru*in -iliru*in in intestine uro*ilinogen yellow! which is partially
rea*sor*ed sterco*ilin *rown!
$re most *ile pigments rea*sor*ed? 4o#
What process is necessary for hepatocyte uptake of
chylomicrons?
@eceptor0mediated endocytosis
What do we call su*stances that increase *ile flow? Choleretics
What does *ile acid dependent *ile flow refer to? 'he Duantity of *ile salts secreted *y the li"er#
'rue()alse
-ile Salts, and *ile acids are choleretics# Why?
'rue# -(C they pro"ide an osmotic force for water and solutes to
follow
,s *ile acid0dependent *ile flow under neural or hormonal
control?
4o#
,s CC= a cholorectic? Ees, *(c it increases *ile flow from the gall *ladder#
What does *ile acid0independent *ile flow refer to? 'he amount of fluid containing water and electrolytes that is
secreted daily *y the li"er
-icar* is the key chemical modified *y the duct cells# What
controls its release? What inhi*its its release?
Secretin stimulates it
Somatostatin inhi*its the secretory effect of secretin
What is the enterohepatic circulatino? 'he recirculation of *ile salts from the li"er to the small intestine
and *ack again#
What is the principal source of *ile acids in *ile? El enterohepatic circulation
Where are most *ile salts acti"ely rea*sor*ed? $t the expense of
what?
'erminal ileum
4aA dependent transport process
What determines the rate of de no"o synthesis of *ile salts? 'he rate of return to the li"er#
What happens to the *ile in the gall *ladder in terms of
concentration?
,t is more concentrated and acidified *y the rea*sorption of water
produced *y the osmotic gradient from the acti"e a*sorption of
4a, Cl, and ;C6+
;ow does the gall *ladder respond to "agal and CC= stimulation( ,t contracts
What makes up the maBority of gall stones? Cholesterol
What are two causes of Baundice? Excess production of *iliru*in due to excessi"e @-C destruction
as in hemolytic anemia
6*struction of the *ile ducts
What type of Baundice is seen in the new*orn? Physiological Baundice due to the immaturity of the *iliru*in
meta*olism process
Gastrointestinal Smooth 1uscle
'rue()alse
G, muscle is like striated muscle, in that it needs a neural input
to contract#
)alse, it can contract without it
Where is the maBority of the calcium found that is needed to kick
off contraction(
,n the interstitium
:escri*e what is meant *y the term myogenic in terms of the
*asal electrical rhythm
Circular smooth muscle has an inherant fluctuation in mem*rane
potential creating slow wa"es or the -E@
What determines contractions in these circular smooth muscle
cells?
'he net neural and mechanical input to the muscle when it is at
the top most depolariCed! of its slow wa"e
'rue()alse
Slow wa"es generate the contractions
)alse, they go"ern the rate at which they occur#
;ow do circular and longitudinal muscle differ in terms of the
num*er of nexuses?
1ore in circular muscle so that they are stimulated *y one
another and act as a syncitium
,s the primary neural input to the smooth muscle cells inhi*itory
or excitatory?
,nhi*itory "ia %,P and 46
Why is this factor important? So that e"ery slow wa"e does not acti"ate a muscle contraction#
:escri*e tonic and segmental contractions# Which has a -E@? 'onic does not ha"e a -E@# 'onic contractions *egin or end
*ased on 4' control
Segmental contractions are a property of circular smooth muscle
and the num*er is determined *y the -E@ freDuency
Gastric 1otility
:escri*e the migrating motility complex# What is it? When does
it occur? What is it dependent on to function? What does it do
when acti"e? What hormone starts this acti"ity?
'he 11C is a cyclic motor pattern occurring during fasting# ,t is
dependent on an entact enteric ner"ous system, and originates in
the antrum and goes to the terminal ileum# :uring its Phase ,,,
there is a period of regular, intense, and repetiti"e contractions
which is key to mo"e the contents along and to pre"ent *acterial
o"ergrowth# ,t is associated with an increase in motilin le"els
What does feeding do to the 11C? ,nterrupts it
;ow does the "ago0"agal reflex influence stomach "olume? Upon swallowing and with food in the stomach, the "agus causes
the stomach to relax so that it can accommodate the *olus of
food#
Which are the first contractions to affect this *olus of food when
it hits the stomach, tonic contractions or segmental contractions?
Where in the stomach does it occur?
'onic contractions not controlled *y slow wa"es
$t the top of the stomach#
Where do propagated -E@ contractions occur? :istal stomach#
What effect does gastrin ha"e on contraction strength? ,t increases it#
Which drain from the stomach faster3
5arge or small meals?
5iDuids or solids
5arge, liDuidy meals drain fastest#
;ow does a "agotomy affect gastric emptying? ,t increases gastric emptying of liDuids *(c of the impaired
recepti"e relaxation of the upper 7(+ of the stomach# 'here is a
decrease in emptying of solids *(c of reduced force of antral
contractions
$ "agotomy also gi"es you early satiety
What two areas of the *rain control "omiting? 'he medulla and the *rain stem
What parts of the stomach contract during "omiting? 'he duodenum and antrum
Small ,ntestinal 1otility
;ow long does it take for a meal to get through the small
intestine? $! 809 hours -!F0G hours c! 7 day
809 hours
Where do the slow wa"es come at a faster rate, in the stomach or
in the small intestine?
Small intestine
:o these wa"es tra"erse the entire small intestine? 4o
What happens to the rate of these wa"es as you mo"e down the
small intestine? Why is this important?
,t declines, so that the transit of food is always a*oral
Which is controlled *y a single pacemaker, the stomach or the
small intestine?
Stomach
'rue()alse
5ike the stomach, the small intestine has a Phase ,,, 11C which
ser"es a housekeeper function
'rue
Which are more prominent after a meal, peristaltic contractions or
segmentation contractions?
Segmentation contractions
:escri*e segmentation contractions in terms of the following3
Which way do the contractions proceed? Which muscle layer
does most of the work? What is key so that the segmentation
contractions can mo"e food along the small intestine?
Contractions proceed in *oth directions, dependent upon the
circular smooth muscle# =ey to the a*ility of segmentation
contractions to mo"e food along is the fact that -E@s decline
along the length of the small intestine, so that there is a higher
freDuency of segmentatinon contractions in the proximal small
intestine#
What controls the strength of the contractions? Similar to the other contractions, it is determined *y the
hormones released and ner"es acti"ated affecting the amplitude or
strength of the slow wa"e
;ow does peristalsis work in terms of the actions of the
longitudinal muscle and the circular muscle?
'he longitudinal muscle ahead of the *olus contracts to shorten
the segment# 'he circular muscle around and *ehind the *olus
works to propel it along the way#
Which ner"ous system mediates peristalsis? What is one
excitatory 4' and an inhi*itory 4'?
'he enteric ner"ous system coordinates peristalsis using
acetylcholine excitatory! and %,P inhi*!
'rue()alse
Without the peristalsis, there would *e no mo"ement of food
along the small intestine
)alse
What relaxes the ileocecal sphincter? What contracts it? :istension of the ileum relaxes the sphincter, while distension of
the colon contracts it, functioning to pre"ent reflux of colonic
contents into the ileum#
1otility of the 5arge ,ntestine
Which muscles make up the tanea coliH? 5ongitudinal muscle
What do we call the tight *ands of circular muscle which form
the haustra?
Plicae circulares
:escri*e the ner"ous control of the small intestine in terms of the
"agus and the pel"ic ner"e stimulation, along with sympathetic
and parasympathetic ner"e stimulation
%agal stimulation is for segmental contractions in the proximal
colon
Pel"ic ner"e stimulation is for contractionsin the distal colon
'he P4S is for contraction, while the S4S is for relaxation
'rue()alse
'he large intestine has an 11C
)$5SE
:escri*e difference in small and large intestine motility in terms
of the -E@ gradient, transit time, and paristalsis#
'here is no -E@ gradient in the large intestine no 11C!
'ransit time is in days, not hours
1ass Peristalsis occurs in the large intestine
What go"erns the rate of contraction of the large intestine? Slow wa"e freDuency#
:escri*e how the rate of motility in the large intestine contri*utes
to mixing#
Slow wa"e freDuency is less in the right colon, promoting a delay
in the transit of chyme and facilitating mixing and a*sorption
What is the most common mo"ement in the large intestine? 1ixing mo"ements in the right colon
What is a minor form of mo"ement of chyme? ;austral mo"ements
What contri*utes the most to the mo"ement of chyme down the
large intestine? ;ow often does it occur?
1ass mo"ements occur infreDuently
:oes the colon ha"e phase , of the 11C? 4o&there is not e"en an 11C
What does feeding do to the num*er of mass mo"ements,
haustrations, and mixing contractions?
,t increases the mass mo"ements at the expense of fewer
haustrations and mixing contractions
What do we call the reflex which gi"es us mass mo"ements after
a meal(
Gastrocolic reflex
,s the internal anal sphincter tonically contracted? ;ow? ,t is tonically contracted "ia the sympathetic system2 the P4S
uses %,P to open it
What effect does stimulation of the external anal sphincter ha"e? Excites it
What *rings a*out the urge to deficate? 1ild distension in the rectum acti"ates the rectrosphincteric
reflex, relaxing the internal anal sphincter
;ow is the external anal sphincter affected? @ecall, it reacts *y constricting
$nd if you don<t let yourself go, what does the external anal
sphincter do?
'he E$S relaxes and the ,$S contracts
So, defication occurs through "oluntary relaxatino of theI External anal sphincter
Water and ,on 'ransport
Where is the maBority of the water rea*sor*ed in the G, tract?
Where is it most efficiently a*sor*ed? Why the difference?
1aBority a*sor*ed in the proximal duodenum&BeBunum!
intestine# 1ost efficiently a*sor*ed in the distal intestine
Where is the chyme adBusted to plasma isotonicity :uodenum
So, if the chyme is isotonic *y the time it hits the BeBunum, how is
water a*sorption accomplished?
,t is coupled to solute transport
:escri*e how sodium is used to pull water into the interstitium# $ *asolateral 4a(= $'Pase pump creates a downhill gradient for
sodium to enter into the cell, pulling water with it#
:escri*e two methods that use this sodium gradient to draw water
into the cell#
Su*strate0coupled transport couples the mo"ement of organic
solutes to 4a transport "ia "ia secondary acti"e transport# 'his
creates an osmotic gradient for water
Electroneutral transport of sodium in the ileum utiliCes a 4a(;
and a Cl(;C6+ exchange
When do we particularily use the electroneutral transport way to
rea*sor* water? What can *lock this method?
We use it during fasting
,t is inhi*ited *y c$1P and increased *y Ca
4ame an ion tha tis passi"ely a*sor*ed *y sol"ent drag secondary
to water flow
Potassium
;ow is Cl a*sor*ed? ,t follows 4a
:escri*e the whole iron a*sorption mechanisms, starting with
apoferritin
,ron *inds to apoferritin to form ferritin to enter the cell# 'o lea"e
it disassociates from the ferritin, *inds to a carrier protein, and
then in the interstitium is *ound to transferrin
)luid secretion is dependent on the secretion of what ion through
what transport channel?
Cl exits the cell through the C)'@ channel
So, to summariCe, a*sorption is dri"en *y JJJJJJJJJJJ, while
secretion of water is dri"en *y JJJJJJJJJJJJ
Sodium
Chloride
What effect does a high intracellular c$1P ha"e on anion
secretion
,t increases itIthink of the C)'@ channel and chloride
Why is the intake of glucose important for cholera patients? ,t is used to increase water and electrolyte a*sorption#
Which has a lower pore siCe, the S, or the 5,? S,
Where can water *e a*sor*ed more uphill, the S, or the 5,? 5arge ,ntestine
Small and 5arge ,ntestine ;istology
What makes up the largest folds in the small intestine, the plicae
circularies?
'he mucosa and su*mucosa
Where are they the largest? KeBunum
%ili are extensions of what? 'he mucosa
What lies *etween the *ases of the "illi? 'he intestinal glands
What makes up the core of each "illus? 5amina propia
What are the two types of cells seen on the surface epithelium? Enterocytes3 columnar a*sorpti"e cells
Go*let cells
;ow do go*let cells secrete? $pical fashion
:escri*e the shape of paneth cells# Where are they found?What
do they do that is key(
$t the *ase of the intestinal crypts are pyramidal shaped, with
a*undant rE@, Panthet Cells# 'hey ha"e eosinophilic cytoplasmic
granules# 'hey ha"e anti*acterial capa*ilities
Which cells type secretes secretin, serotonic, and CC=? Enteroendocrine cells
Where are the mitotic cells of the intestine? ,n the lower half of the crypts
What are the cells which are sDuamous and o"erlie Peyer<s
patches?
1 cells
What forms the core of the "illi? 5amina Propia
What ducts are found inside of them? 5ymphatic ducts
What role does the thin muscularis mucosa play within the "illi? 'hey shorten them, helping circulation
'he presence of what type of glands in the su*mucosa
distinguishes the small intestine?
-runner<s glands
What do the -runner<s glands secrete? Urogastrone, an inhi*itor of gastric acid secretion
$lso neutraliCes chume
What do we call the lymph nodules in the su*mucosa? Peyer<s patches
Where is the 1eissner<s plexus of the E4S? Su*mucosa
What lies *etween the two layers of the muscularis externa? $uer*ach<s plexus
What co"ers the maBority of the small intestine? $ serosa
What con"erts trypsinogen to trypsin? Enterokinase trapoped in the surface glycocalyx
Where does most hydrolysis of car*s occur? $long the micro"illous *order
What is distinguishing a*out the large intestine( 4o "illi
:escri*e the glands in the large intestine# Straight tu*ular glands extending to the muscularis mucosa
:oes the 5arge intestine ha"e paneth cells? 4o
What happens to the epithelium at the recto0anal Bunction? -ecomes stratified sDuamous, and then after a while, keratiniCed
What is *undled to form the taenia coli? 1uscularis externa
:oes the large intestine ha"e a serosa? Ees
What type of glands surround the anus? Circumanal glands which are specialiCed apocrine sweat glands
What gi"es rise to internal hemmerhoids? Con"oluted su*mucosal "eins
$ccessory 6rgans
:oes the pancreas ha"e a mesothelium? 4o
-undles of exocrine secretory cells are called what? What type
of cells are they, serous or mucosal?
$cini
Serous
What do we call the first duct cell with a pale cytoplasm and large
pale nucleus?
Centroacinar cell
'race the growth of ducts from intercalated upwards# ,ntercalated intralo*ular interlo*ular ducts
:oes the pancreas ha"e striated ducts? 4o
:escri*e the cells of the main excretory duct of the pancreas# 'all columnar epithelium
What does the pancreas produce that the G, tract needs? Pancreatic enCymes
What acti"ates trypsinogen? Where( Enterokinase produced in the duodenal mucosa clea"es it to
trypsin
4ame + things which stimulate pancreatic secretion Parasympathetic control
Secretin from duodenal $PU: cells!
CC=
:iscriminate *etween the fluids secreted when induced *y
secretin "s# CC=
Secretin3 protein poor, alkaline fluid
CC=3 enCyme rich fluid
:o the ,slets of 5angerhans ha"e ducts? 4o
What type of capillary inner"ates them( )enestrated
Where in the islets are the $lpha cells found? 'he *eta cells? $lpha around the periphery2 secr# Glucagons
-eta in the middle3 secr# ,nsulin
What surrounds the li"er? 1esothelium
What do we call sheets fo hepatocytes? 1uralia
What do we call islands of C' with a hepatic artery, portal "ein,
and *ile duct?
Portal triad
What is found *etween the muralia? Sinusoids
What type of cell is occasionally found in the sinusoidal lining? =upffer
What is the space *etween the hepatocyte and the endothelium( Space of :isse
'race the *lood flow from the sinusoids forward Sinusoids central "ein hepatic "ein *ranches
What is the fluid found in the space of :isse? 'e initial form of li"er lymph
'race the enterohepatic circulation# -ile salts resor*ed in intestines and taken *ack up *y the li"er for
secretion
What is the exocrine secretion of the li"er? -ile
What part of the tight Bunction complex is not found *etween
hepatocytes? ,nstead, what do you see? What flows in them?
Lonula adherens
-ile canaliculus2 *ile
:escri*e the following concepts of a li"er lo*ule3
Classic lo*ule
Portal lo*ule
$cinar lo*ule
Classic lo*ule3 C' septa w( portal tracts at "ertices w( central
"ein in center
Portal lo*ule3 focuses on the exocrine secretory unit w( portal
tract *ile duct in center and cords of hepatocytes
$cinar lo*ule3 )ocuses on the flow of *lood from *ranches of the
hepatic artery running perpendicular to the portal tract# 'he
hepatocytes which see the *lood first are near the center of the
acinus *etween portal tracts and central "eins
What co"ers the gall *ladder? 1esothelium except where ad"entitia merges w( capsule of li"er
What is the key difference in the wall of the gall*ladder? 'hree layers
4o muscularis mucosa
What cells line the gall *ladder? Simple tall columnar epitherlium
:o they ha"e micro"illi? :a
What causes relaxation of the common *ile duct and contractinon
of the gall*ladder muscle?
%agus stimulation
CC=
@e"iew
What do we call the intrinsic a*ility of the G, tract to contract? -E@
:oes the esophagus ha"e a -E@? 4o
:oes the -E@ work to mo"e the chyme along in the small
intestine?
Ees&the -E@ gradient so that there are more contractions in the
duodenum than in the ileum
What is the neural input that the circular muscle recei"es? Why? ,nhi*itory to pre"ent contractions
What hormone is ele"ated during the 11C? 1otilin
What regulates gastric emptying? :uodenum
;ow are CC= and secretin secreted? $s hormones
What pro"ides the force for "omiting? 'o prime the stomach? 'he a*dominal muscles pro"ide the force for explusion
'he stomach muscles mo"e the food into the upper portion#
What parts of the G, tract do not ha"e a -E@? Sphincters
What do we call the upper stomach<s a*ility to relax when food is
heading its way?
@eceptor relaxation
;ow does peristalsis work? Waist gain method, with longitudinal muscles contracting in
front, and the circular muscles contracting around the chyme#
:oes the colon ha"e an 11C? SoI 4o 11C, so slow motility
:ifferentiate the functions of the right and left colon# 'he right colon is for water and electrolyte a*sorption
'he left colon forms the feces
What part of the colon has mixing mo"ements? Why is this
good?
Proximal colon2 helps w( a*sorption
Where are the haustral mo"ements found? $ll o"er the colon
Where are the mass mo"ements found? :istal colon
Which mo"ements dominate when fasting? 1ixing mo"ements
Which dominate when eating? ;austral and mass mo"ements
What do we call the reflex that starts the mass mo"ments when
eating?
6ro0gastrocolic reflex
What are the results on the external and internal anal sphincters
from the distention of the rectum due to mass mo"ments?
,t relaxes the internal sphincters and contracts the external
sphincters#
What happens if you are in the middle of your wedding, and it
Bust ain<t a good time to go?
'he internal sphincter regains its tone
What forms the *ulk of the water in the G, treact? Endogenous secretions
Where is the most water a*sor*ed? Proximal small intestine
Where is it a*sor*ed most efficiently? Colon
Why is it more efficient there? 5ess water lost through the cells
Where does the chyme *ecome isotonic to the plasma? :uodenum
What are the two key ways that sodium and therefore water! is
a*sor*ed $)'E@ E$',4G
Su*strate coupled a*sorption&secondary transport with glucose
Sol"ent drag3 it is pulled along with water
;ow do we rea*sor* sodium when fasting? 4eutral transport coupled to chloride or hydrogen trasnport
What can inhi*it neurtral transport? ;igh c$1P le"els
What do you include in the water you gi"e to cholera patients?
Why?
Glucose, *(c although the high c$1P le"els inhi*it neutral
transport of water, you still ha"e su*strate coupled a*sorption#
Why do cholera patients ha"e watery diaherrea? ,ncreased chloride secretions due to high c$1P le"els leads to
water loss
;ow is most potassium a*sor*ed? Sol"ent drag
What determines the amount of iron a*sor*ed? 4eed
Where is most calcium a*sor*ed? ,n proximal small intestine
:oes the colon a*sor* neutrients? 4o
What is the transporter that the colon has to rea*sor* sodium?
What is it therefore sensiti"e to?
4a(= $'Pase pump
$ldosterone
So, does stool ha"e high or low potassium concentrations? ;igh
What a*out *icar*? -(c *icar* is linked to chloride a*sorption, you ha"e alkaline
stool
Car*ohydrate and Protein $*sorption in the Small ,ntestine
What kicks off car*ohydrate digestion in the mouth? Sali"ary amylase
;ow much car*ohydrate digestion goes on in the stomach? Why
might this *e?
4one
-(C so acidic it would inacti"ate the car*ohydrases
What enCyme digests most car*os in the small intestine? Pancreatic amylase
What is uniDue a*out this enCyme? ,t is secreted in its acti"e form
Where is the first place that protein digestions starts? Stomach
What digests proteins? What acti"ates this enCyme? Pepsin is acti"ated from pepsinogen *y low p;
What cells release pepsin? Why do they release it? Chief cells release pepsinogen in response to "agal sitmulation
and from acid
:uring which stage does most protein digestion occur? ,ntestinal phase
What stimulates secretion of proteolytic enCymes from the
pancrease?
CC=
What stimulates CC= release? Protein digestion products in the duodenum
$re these enCymes secreted in acti"e or inacti"e form? What
happens to them then?
,nacti"e form
$re acti"ated *y enterokinase a *rush *order enCyme
What causes the release of enterokinase? -ile salts
Enterokinase also acti"ates what other enCyme, which goes on to
acti"ate other enCymes itself#D
'rypsinogent ot trypsin
'rue()alse
'he digestion products of proteins are primarily amino acids
)alse
,t is mostly peptides
Where does most digestion of car*ohydrates occur? $long the *rush *order
What is the rate limiting stem in the a*sorption of car*os from a
meal?
$*sorption into the cell
Polysaccharides or monosaccharides
Which is a*sor*ed into the cell?
6nly monosaccharides
;ow is fructose a*sor*ed? %ia facilitated diffusion
What happens to it once it is a*sor*ed? ,t is con"erted into glucose and lactic acid to maintain a low
concentration of fructose in the cell
;ow are glucose and galactose transported into the cell? %ia secondary acti"e transport with sodium
;ow do glucose and galactose exit the cell? %ia facilitated diffusion with a 4a independent carrier
1ost car*o a*sorption has occurred *y what point in the G, tract? KeBunum
What is the rate limiting step in the a*sorption of $$s? 'ransport into the cell
1ost proteins are a*sor*ed as what? :i and tri0peptides
What happens to the proteins inside of the cell( 'hey are digested into $$s which lea"e the cell "ia facilitated or
passi"e diffusion
,f you were to remo"e the terminal ileum, a*sorption of what two
things would *e impeded?
-ile salt a*sorption
-078 a*sorption
Where are most $$s and peptides a*sor*ed? KeBunum
5ipid $*sorption in the Small ,ntestine
5ipid digestion starts in the mouth with what enCyme? 5ingual lipase
What happens to the fat once it reaches the stomach ,t is emulsified *y "ile salts and lecithin
$gain, what emulsifies *ile salts? -ile salts and lecithin
What role does CC= play in lipid digestion? )at in the duodenum triggers its release resulting in the secretion
of pancreatic lipase
What are two pancreatic enCymes secreted in their acti"e forms? Pancreatic lipase
Pancreatic amylase
What are two key enCymes secreted *y the pancrease to *reak
down triglycerides? ;ow are they secreted?
Colipase3 inacti"e form
5ipase3 in acti"e form
What acti"ates colipase? 'rypsin
What key role does colipase ha"e? $llows lipase to work w(o *eing *locked *y *ile salts
What hydrolyCes phospholipids? ;ow is this enCyme secreted? Phospholipase $83 secreted in inacti"e form
:escri*e the solu*iliCation of fat, using the following terms3
critical concentration, simple micelles, and mixed micelles#
When the concentration of *ile salts reaches the critical
concentration, *ile salts form simple micelles containing only *ile
salts
1ixed miceelles are formed with the products of lipid digestion
in them
What is the rate limiting step in the a*sorption of lipids? 'he migration of micelles through the unstirred water
layer(mucous coat to the lipid mem*rane
What happens to the free )atty acids once they are a*sor*ed?
Why is this good?
'hey are re0esterfied to maintain the concentration gradient
$re short chain )$s packaged into chylomicrons? 4o
:escri*e the structure of chylomicrons? $ core of triglycerides and cholesterol surrounded *y a
phospholipid coat
What cofactor is necessary for chylomicron exocytosis? 0lipoprotein
Where does most lipid a*sorption occur? :uodenum
What are the fat solu*le "itamins( $:E=
;ow can there *e *acteria in the gut? Slow motility no 11Cs!
Why do people who are lactose intolerent ha"e watery diaherrea
and a whole lot of gas?
,ncreased osmotic load leads to diaherrea, while the *acteria
going craCy for the lactose makes the gas
;ow do you test for car*ohydrate mala*sorption? ;ydrogen *reath test
What happens to the cholesterol in the gut? 4othing