GASTRIC SECRETION

Functions of stomach

• Motor:
• reservoir of food
• mechanical mixing
• regulate slow empting
Functions cont.,

• Secretory:
Gastric juice

Pepsinogen Hcl Mucin

Intrinsic factor Gastrin

Exocrine gland cells of gastric pits
Produce alkaline
mucus that covers
mucosa layer

Synthesize and
secrete the protease
precursor known as
pepsinogen.

Synthesize and
secrete the HCl acid
responsible for the
acidic pH in the
gastric lumen.also
secrete IF
Functions cont.,
• Feeding behaviour

• mechano receptor

• chemoreceptor
Endocrine gland cells of gastric
pits

Stimulates acid secretion

Inhibits
• acid secretion
• gastrin and pepsin release
• pancreatic exocrine
secretions

Stimulates acid secretion

Gastric glands
Oxyntic glands:
Fundus & body

Peptic parietalcells mucous ECL

Pepsinogen Hcl Mucin

GASTRIC GLANDS CONT.,
• Cardiac glands
mucin
• Pyloric glands

G-cells

Gastrin
INNERVATION OF GASTRIC
• Parasympathetic
vagal nuclei
R +L vagi
secretory nerve stom.
• Sympathetic
spinal level T-5_T-10
COMPOSITION
• Volume: 2 - 2.5 L/day
• Specific gravity: 1.006 – 1.009
• pH- 0.9 - 1.5
• Contents 1% solids

99% water org. inorganic

Organic Inorganic
Pepsinogen Hcl
Gelatinase Na ,K,Ca++
Gastric rennin Mg++,Cl-
Mucin
Functions of the constituents
• Pepsinogen
Hcl
Pepsin Protein

Peptones
Convertion of pepsinogen
CONTINUE
Gelatinase Gastric rennin

Gelatin Casinogen

casin
CONTINUE
Lipase Mucin

fat • reduces gastric acidity

• lubrication of food
• form a coat over the muc.me
Continue
• Intrinsic factor
• Glycoprotein
• Mw 49000
• Secreted by parietal cell
• Necessary for the B 12 absorption
• IF binds with B12
• Absorbed at ileum through receptor
• Defect of gastric mucosa leads to aneamia
• Haptocorin:
• Glycoprotein
• Mw 65000
• Gastrointestinal cells & salivary gland
• Higer affinity than IF
• Affinity reduced by pancreatic proteinases
• All B12 absorbed
Mechanism of hcl secretion
Mechanism Hcl secretion

H2 H
0 +
H H
HCO3 O + +
H K
+
H2CO
3
CA
CO2 + H2
O
Function of Hcl
• Activation of pepsinogen into pepsin
• Provide acid medium
• Antiseptic & Bactricidal action
• Absorption of iron, calcium
• Stimulate pancreatic juice
Requlation of gastric juice
• Cephalic phase

• Gastric phase

• Intestinal phase
Cephalic phase
Occur before food enter the stomach

Unconditioned Conditioned

Presence of food sight, smell, thought

GJ GJ
Conditioned reflex
sight, smell, thought hypothalamus

vagal nucleus

stomach

gastric juice
Unconditioned reflex
Food in mouth receptor afferent
in tongue
vagal nucle

vagale efferent

gastric juice gastric glands

Gastric phase
Higher center

VF GJ HIS

VA food ECL

Local G-cells Gastrin

 Duodenal Response to
Food by CCK (Cholecystokinin)
Regulation
live
r

⇑Bile + +
gall
bladder
- ⇓HCl

K
C
C
fat & bile & -
protein enzymes FOOD
digestion
fats &
peptides
 Duodenal Response to Acidity
Regulation by Secretin
liver
+
HC
O3

3
O
C
aH
+

N
g
a
bladd
ll
er - ⇓HCl
t i n ⇓motili
r e
c ty
Se
+
NaC
H
l 2O N
aH HCl
C
O
3 + HCl
HCl + NaHCO3 NaCl + CO2 + H2O
Experimental evidence
• Cehalic phase:
• Bilateral vagotomy
• Injection atropine
• Sham feeding
• Sham feeding
Gastric phase
• Pavlov’s pouch
• Heidenhain pouch
• Ivy’s pouch
• Pavlov’s pouch
• Heidenhain pouch:
• Ivy’s pouch:
Tests of gastric secretion
• Fractional test meal
• Histamine test meal
• Augmented histamine test
• Insulin test
• Endoscopy
• X-ray
• pH-meter
Applied physiology
• Abnormal secretion

Hypochlorhydria Achlor Hyperchlorhy

Carcinoma perni
Ch.gastritis
• Gastrectomy

Reservior rapidpassage IF Ca++

Frequent dumping anaemia

Meals syndrome

osteoporosis
Peptic ulcer
• auto digestion of mucous membrane
by acid pepsin mixture.

• Cause:due to imbalance between

mucosal protective mechanism and acid
secretion
Mucosal barrier
• Secretion of mucous
• Prostoglandin
• Bicarbonate
• Bile & pancreatic juice
Types
• Gastric ulcer: primarily due to impaired
mucosal defence mechanism

• Duodenal ulcer: due to excessive acid

secretion
Causative factor
• Factor that increase acid secretion:
• Genetic
• Psychosomatic
• Diet
• Rapid gastric emptying
Factors cont.
• Impaired mucosal defence:
• Drugs (NSAID)
• Alcohol
• Smoking
• Ischemia of the stomach mucosa
• Reflux duodenal content
• Delayed gastric emptying
Treatment
Medical Surgical
drugs
# Antacid vagotomy +
# H-2 blockers gatrectomy
# H+ pump
# sucralforte
# PGE agonists
Thank you