All About GIT Physiology
All About GIT Physiology
All About GIT Physiology
Dr Sherwan R Shal
Stomach
M: Peristaltic mixing and propulsion. S: HCl (Parietal Cells); pepsinogen and gastric lipase (Chief cells); mucus and HCO-3 (Surface mucus cells); gastrin (G cells) histamine (ECL cells). D : proteins and fats. A: Lipid soluble substances such as alcohol and aspirin.
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Small Intestine
M: Mixing and Propulsion primarily by segmentation; enzymes; HCO-3 and enzymes (pancreas); bile (liver) S: Mucus (goblet cells); hormones; CCK, Secretin, GIP, and other hormones. D: Carbohydrates, fats, polypeptides and nucleic acids. A: Peptides by active transport; amino acids, glucose and fructose by secondary active transport; fats by simple diffusion; water by osmosis; ions, minerals and vitamines by active transport.
Large Intestine
M: Segmental mixing; mass movement for propulsion S: mucus by goblet cells. D: None (Except by bacteria). A: Ions, water, minerals, vitamines produced by bacteria.
Organs of GIT
The alimentary canal (also called the gastrointestinal tract) consists of the mouth, pharynx, esophagus, stomach, small intestine and large intestine. The accessory digestive organs are the teeth, tongue, salivary glands, liver, gallbladder, and pancreas.
Digestive Processes
INGESTION PROPULSION (peristalsis) MECHANICAL DIGESTION (physically preparing food for chemical digestion) CHEMICAL DIGESTION (enzymatic breakdown of food) ABSORPTION (into blood or lymph from small intestine) DEFECATION (elimination of waste)
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Questions?
What provokes mechanical and chemical activity of the GIT? What Kind of receptors do we have in GIT? What is the role of receptors?
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Digestive Activity
A range of mechanical and chemical stimuli provokes digestive activity
Various receptors located in the GI tract respond to several stimuli such as stretching of the wall by food, osmolarity and pH, and presence of substrates. When receptors are stimulated, they: Initiate reflexes that either activate or inhibit glands that secrete digestive juices and/or hormones Mix lumen contents and moves them along by stimulating smooth muscle of GI tract walls
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Questions?
What are the reflexes that control GIT functions? What is the role of hormone producing cells in these functions?
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Within the mouth, food is chewed, mixed, and moistened with saliva which contains enzymes that aid in the process of chemical digestion Up to 99.5% of SALIVA is composed of water. It is slightly acidic and its solutes include electrolytes (such as sodium and potassium), salivary amylase a digestive enzyme, mucin which hydrates the food, and wastes such as urea.
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Saliva
The average output of saliva is 1000 1500 ml per day! Saliva also contains lysozyme, defensins, and IgA antibodies for protection against microorganisms. The role of saliva is to cleanse the mouth, dissolve food so it can be tasted, moisten food and aid in propulsion of food through the digestive tract, and to begin the chemical breakdown of starchy foods.
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Control of Salivation
Salivation is controlled by the parasympathetic division (PS) of the nervous system. Humans contain receptors in their mouths which when stimulated, send signals to the pons. The PS activates cranial nerves VII (facial) and IX (glossopharyngeal) to increase saliva output. In contrast, the sympathetic division causes release of thick, mucin rich saliva. .
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Control of Salivation
When strongly stimulated, the blood vessels serving the salivary glands constrict, which ceases release of saliva and causes drymouth. Dehydration also inhibits salivation because low blood volume results in reduced filtration pressure at capillaries
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Mechanical Processes
Mastication, or chewing, is the role of the teeth. Mastication begins voluntarily, but stretch reflexes take over when receptors in the cheeks, gums, and tongue are stimulated. Deglutition or swallowing involves the coordinated activities of over 22 muscle groups. The buccal phase, the first phase in the mouth, is voluntary.
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Once food is forced into the pharynx by the voluntary elevation of the tongue, receptors in the pharynx send messages to the pons and medulla to reflexively cause: The tongue to block the mouth The soft palate to rise The epiglottis to close off the glottis Peristalsis to move the food down the esophagus Relaxation of the cardiac sphincter so that food can enter the stomach. Within the stomach, food is mechanically churned and proteins are chemically broken down by salivary amylase. Further chemical breakdown of carbohydrates and lipids does not begin until food reaches the small intestine. Very little is absorbed in the stomach.
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Questions
I.
1. 2. 3. 4.
Define:
Gastric pits Gastric glands Gastric juice Intrinsic factor
II.
1. 2. 3. 4. 5.
Chemical Processes
The lining of the stomach is dotted with millions of goblet cells that secrete mucus. The lining also has gastric pits, which lead into gastric glands throughout the stomach. These glands contain a variety of secretory cells that collectively produce gastric juice:
Mucous neck cells found in the upper regions of the glands produce a different kind of mucus than that of the goblet cells. Its function is not yet fully understood. Parietal cells are found in the middle region of the glands and secrete hydrochloric acid and intrinsic factor.
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Chemical Processes
HCl makes the stomach extremely acidic which is necessary to activate pepsin and kill any bacteria ingested. Intrinsic factor is a glycoprotein required for absorption of Vitamin B12 in the small intestine.
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Chemical Processes
Chief cells produce pepsinogen, the inactive form of the protein-digesting enzyme pepsin. They are located in the basal regions of gastric glands. When chief cells are stimulated, HCl encountered in the gland activates the first pepsinogen molecules they release. Once pepsin is present, it also catalyzed the conversion of pepsinogen to pepsin. This positive feedback process is limited only by the amount of pepsinogen present. Chief cells also secrete small amounts of lipase.
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Chemical Processes
Enteroendocrine cells secrete a variety of hormones such as gastrin, histamine, endorphins, serotonin, cholescystokinin, and somatostatin. These all influence several digestive system target organs.
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Start here,
When food is present in the stomach, histamine and Ach are released and work with gastrin to increase secretions from gastric glands to mix and churn the food.
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What do a to c means?
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These three inhibit gastric secretion and reduce gastric motility. motility Compare the functions of Gastrin with the above hormones.
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Mechanical Processes
Gastric Stretching and Emptying The initial response of the stomach to filling is to RELAX. This is due to: RELAX
Receptive relaxation :the stomach relaxes when food is in the esophagus. Adaptive relaxation Stretch receptors on the stomach wall respond, and cause the stomach to dilate. Plasticity of the stomach allows it to respond to stretch without greatly increasing its tension and contracting expulsively.
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Gastric Emptying
Only a small amount of chyme is propelled out of the stomach with each peristaltic wave. Reflexes arising from the duodenum control the actual volume that exits. Food will only enter the small intestine at the rate that it can be processed. The less acid, fat, and protein in the chyme, the faster the chyme will be allowed to enter the small intestine. A liquid meal or a meal rich in carbohydrates will pass through the stomach faster than a meal rich in fats and protein.
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The food reaching the small intestine has been altered significantly and now appears as a creamy fluid. Carbohydrates and proteins are only partially digested, and no fat digestion has occurred at this point. The rest of digestion and nutrient absorption takes place in the small intestine.
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Composition of bile
Bile is an alkaline solution containing a number of components. The important ones for digestion are bile salts, cholesterol and phospholipids. Bile salts act as a fat emulsifier they break globules of fat entering the small intestine into millions of fatty droplets. This provides a large surface area for the fat digesting enzymes to work on.
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Composition of bile
Bile salts also facilitate fat and cholesterol absorption. These salts are conserved: They reabsorbed during digestion in the ileum, returned to the liver by the hepatic portal vein and reused.
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Composition of Bile
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The Pancreas
The pancreas is an accessory organ which lies right below the stomach. It produces many of the digestive enzymes and also secretes and alkaline fluid that helps neutralize the acid in chyme.
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The Pancreas
Pancreatic proteases are secreted in an inactive form and activated in the duodenum. This prevents the pancreas from self-digestion. For example, within the duodenum, trypsiongen is activated to trypsin by enterokinase, and intestinal brush border enzyme. Trypsin, a proteolytic enzyme, then activates procarboxypeptidase and chymotrypsinogen.
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The Pancreas
Just like the secretion of bile, parasympathetic nerve stimulation leads to the release of pancreatic juice. Also, secretin leads to the release of the watery, bicarbonate rich component and the cholecystokinin leads to the release of the enzyme rich component of the pancreatic juice.
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Peristalsis
Peristalsis occurs after most nutrients have been absorbed and is regulated on the basis of which neurons are stimulated. Peristaltic waves sweep slowly along the duodenum to sweep out debris, bacteria, and meal remnants. This is called the migrating mobility complex and its function is to keep bacteria from settling into the small intestine. The enteric neurons of the GI tract coordinate the mobility patterns. Impulses sent proximally by the cholinergic neurons cause contraction and shortening of the muscle layer.
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Peristalsis
Impulses sent distally to certain interneurons cause shortening of the longitudinal muscle layer and distension of the intestine, in response to Ach releasing neurons. Other impulses sent distally by activated VIP or NO releasing enteric neurons that cause relaxation of the circular muscle. As a result, as the proximal area constricts and forces chyme along the tract, the lumen of the intestine enlarges to receive it, where it moves toward the ileocecal sphincter.
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Peristalsis
Most of the time, the ileosphincter valve is constricted and closed. Two mechanisms; one neural, the other hormonal cause it relax and allow food residues to enter the cecum. Enhanced activity in the stomach initiates the gastroileal reflex that enhances force of segmentation in the ileum. Gastrin released by the stomach increases motility of the ileum and relaxes the ileocecal sphincter. Once the chyme has passed through, it exerts backpressure that closes the valves flaps and prevents regurgitation.
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Peristalsis
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Mechanical Processes
Haustra Contractions
The longitudinal muscles of the large intestine are tonically active and pull the wall of the large intestines into pockets called haustra. The smooth muscles within the walls of individual haustra are activated by distension and they move food along to the next haustrum. This is a local reflex that moves the food residue and mixes it which aids in water absorption. Peristalsis occurs at a very slow rate.
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Defecation
When feces are forced into the rectum by mass peristalsis, stretching of the rectal wall initiates the defecation reflex. This is a spinal cord mediated parasympathetic reflex that causes the walls of the final segment of the colon and the rectum to contract and the anal sphincter to relax.
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Defecation
As feces enter the anal canal, messages reach the brain indicating that defecation is imminent. At this point voluntary control can override the reflex and stop passage of the feces temporarily. If defecation is delayed, the reflex contractions stop and the rectal walls relax until the next wave of mass peristalsis initiates the reflex again.
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Review Questions
Describe the structure and function of the enteric nervous system. Define the basic electric rhythm (BER) and the migrating motor complex (MMC), and describe the function of each in the regulation of gastrointestinal motility. List the principal gastrointestinal hormones, the sites where each is secreted, and the main physiologic function of each of these hormones.
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Review Questions
Summarize the functions of the mouth, the salivary glands, and the esophagus. Outline the functional anatomy and histology of the stomach. Describe how acid is secreted by cells in the gastric mucosa. Describe the mechanisms that regulate the secretion and motility of the stomach. Describe the relationship between cyanocobalamin and intrinsic factor.
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Review Questions
List the main components of pancreatic juice, and outline the mechanisms that regulate its secretion. Describe the functional anatomy of the liver, and discuss the formation of bile. Discuss the function of the gallbladder and the processes that regulate the passage of bile to the intestinal lumen. List the types of movement seen in the small intestine and the function of each. Describe the functional consequences of having bacteria in the gastrointestinal tract. Outline the physiologic changes that lead to defacation.
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Review Questions
General Questions 1. What factors regulate the secretion of the exocrine portion of the pancreas? 2. Discuss the abnormalities of gastrin secretion seen in disease states. 3. What abnormalities would you expect to be produced by resection of the terminal portion of the ileum with connections of the remaining portion of the small intestine to the colon? Why? 4. What is heartburn? Discuss its pathophysiology and ways it might be treated.
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Review Questions
5. What causes gallstones? How would you treat them? 6. Several surgical procedures have been recommended for the treatment of severe obesity that fails to respond to other forms of treatment. What are these procedures? How do they cause weight loss? What are their longterm complications? 7. The bacteria in the colon exist in a symbiotic relationship with the host. How does the host benefit from this relationship, and what harmful or potentially harmful effects may occur to the host?
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