Professional Documents
Culture Documents
Several
different
layers
form
the
GI
tract
structures
(from
the
internal
to
the
external
portion):
• Epithelium
• Lamina
propria
(contains
lymph
nodes)
• Muscularis
mucosae
• Submucosa
(and
his
glands)
• Circular
layer
• Longitudinal
layer
• Serosa
Electric
Features:
Resting
potential
is
-‐40
to
-‐80
mV
(usually
near
the
lower
end
of
this
range).
Electrogenic
Na/K-‐ATPase
may
contribute
more
to
resting
potential.
Slow
waves
(3
to
12
per
minute)
are
oscillations
of
resting
membrane
potential.
Action
potentials
are
slow
with
little
overshoot
(L-‐type
Ca2+
channels
involved)
Interstitial
cells
of
Cajal
generate
slow
waves.
Their
amplitude
(and
frequency)
is
influenced
by
nerves
and
hormones.
Contractions
may
occur
in
the
absence
of
action
potentials.
When
action
potentials
occur,
contraction
is
more
forceful
N°4:
Neurological
and
hormonal
control
of
the
stomach
*By
the
way
slides
may
be
a
little
confused,
take
it
step
by
step
would
be
helpful:
1. Cephalic
Phase:
stage
in
which
the
stomach
responds
to
sight,
smell,
taste
or
thought
of
food,
these
sensory
and
mental
inputs
converge
on
hypothalamus
releasing
signals
to
the
medulla
oblongata.
From
this
point
signals
are
transmitted
to
the
VAGUS
NERVE
stimulating
gastric
activity
2. Gastric
phase:
a
period
in
which
swallowed
food
and
semi-‐
digested
proteins
activate
gastric
activity,
2/3
of
gastric
secretions
occur
in
this
phase,
ingested
food
stimulates
gastric
activity
in
2
ways,
by
stretching
the
stomach
and
by
raising
the
pH
of
its
contents.
These
stretches
activate
2
reflexes,
a
short
one
by
the
myenteric
nerve
plexus
and
a
long
one
by
the
vagus
and
the
brain
stem.
*NOW
REVIEW
THE
GASTRIC
SECRECTIONS
3. Intestinal
phase:
stage
in
which
the
duodenum
responds
to
the
arriving
chime.
First
it
enhances
gastric
secretions
but
soon
inhibits
it.
MECHANICAL
DIGESTION,
PROPULSION:
1.
Pace-‐maker
cells-‐-‐interstitial
cells
of
Cajal
establish
intrinsic
control.
2.
Vagus
nerve—control
mechanical
digestion
extrinsically.
MECHANICAL
DIGESTION:
1. Gastrin-‐-‐stimulate
gastric
emptying
2. Serotonin-‐-‐contraction
of
smooth
muscle
3. Somatostatin-‐-‐inhibits
motility
and
emptying
4. Secretin-‐-‐inhibits
gastric
motility
5. Gastric
Inhibitory
Peptide-‐-‐inhibits
gastric
motility
PROPULSION:
1.
Gastrin-‐-‐stimulates
emptying
2.
Somatostatin-‐-‐inhibits
gastric
motility
and
emptying
3.
Secretin-‐-‐inhibits
gastric
motility
and
emptying
4.
Gastric
Inhibitory
Peptide—inhibits
gastric
motility
and
emptying
N°5
Physiological
events
in
the
small
intestine
(If
you
get
this
one
your
luck
is
falling
down
apart)
These
events
can
be
divided
in:
1. Mechanical
digestion:
MOTILITY
In
segmentation,
nonadjacent
segments
of
the
intestine
alternately
contract
and
relax,
moving
the
chyme
forward
and
then
backward
resulting
through
mixing.
This
results
in
the
chyme
being
well
mixed
with
the
enzymes
from
the
liver
and
the
pancreas. In
addition,
segmentation
ensures
that
the
chyme
well
move
to
the
plasma
membrane
of
the
lining
cells
of
the
small
intestine.
These
simple
columnar
epithelial
cells
have
brush
border
enzymes
within
their
plasma
membrane,
which
complete
the
chemical
digestion
of
the
chyme.
One
by
one
we
can
read
below
these
key
features:
• Contractions,
serves
to
mix
chime
with
intestinal
juice,
bile,
pancreatic
juice
and
neutralize
acid
in
order
to
digest
nutrients
more
effectively.
It
helps
to
bring
the
chime
in
contact
with
the
mucosa
for
nutrient
absorption
and
to
move
residues
toward
the
intestine.
• Segmentation
is
a
movement
in
ring-‐like
constrictions,
common
of
several
places
of
the
intestine.
• Pacemaker
cells
of
muscolaris
externa
set
the
rhythm
of
segmentations,
contracting
it
12
times
/
minute
in
duodenum
and
8-‐9
times/minute
in
ileum.
Segmentation
processes
slow
down
as
the
chime
progresses
toward
the
colon.
2. Chemical
digestion:
(Good
Luck!)
• Carbohydrate,
firstly
by
salivary
amylase,
then
by
pancreatic
amylase
and
brush
border
enzymes.
(From
starch
to
oligosaccharides,
from
this
one
to
maltose
and
finally
to
glucose
ready
to
be
absorbed)
• Proteins,
hydrolyzed
by
pepsin,
trypsin
and
chymotrypsin.
(Breaking
all
peptide’s
bonds
we
have
to
underline
the
action
of
tree
more
enzymes:
Carboxypeptidase,
Aminopeptidse,
Dipeptidase)
• Lipids,
mainly
by:
lipases
(lingual
and
pancreatic),
important
features
of
emulsification
and
reducing
droplets
into
smaller
ones
made
by
bile
components.
3. Absorption:
• Carbohydrates
are
mainly
absorbed
as
monosaccharides
(80%glucose,
20%
galactose,
20%
fructose).
Important
key-‐feature:
Sodium-‐Glucose
co
transport
membrane.
***Attention:
absorption
of
monosaccharides
take
place
close
to
the
digestion
enzymes
and
transporters
=digestion-‐absorption
coupling.
• Most
proteins,
after
digestion,
are
absorbed
through
the
luminal
membranes
in
the
form
of
dipeptides,
tripeptides
and
few
free
amino
acids.
Similar
to
the
glucose
transport
they
are
absorbed
by
the
co-‐
transport
of
the
AA
and
peptides.
• Fats
are
first
digested
to
form
monoglycerides
and
free
fatty
acids,
dissolved
in
the
central
lipid
portion
of
bile’s
micelles.
For
their
absorption
micelles
work
as
“ferryboat”
to
bring
nutrients
to
the
epithelial
cell
membrane
and,
once
empty,
they
can
run
back
to
the
chime
to
function
once
again.
4.
Propulsion:
Propulsion
is
the
result
of
peristalsis.
This
causes
adjacent
segments
to
alternately
contract
and
relax.
• Peristalsis
begins
in
duodenum,
travels
10/70
cm
and
dies
out
to
be
followed
by
another
wave,
begins
a
little
further
down
than
the
first
one
did.
N°6
Neurological
and
Hormonal
control
of
the
small
intestine
Intrinsic
pacemaker
cells
in
longitudinal
smooth
muscle
layer
initiate
segmentation.
Gastrin
stimulates
contraction
of
the
smooth
muscle
of
the
small
intestines.
This
results
in
an
increase
in
segmentation.
Perstalsis
is
stimulated
by
gastrin.
Also,
gastrin
relaxes
the
ileocecal
valve,
which
allow
chyme
into
the
large
intestines.
N°7
Regulation
of
GI
Secretions,
Generalities
(LOL!)
There
are
several
types
of
stimulation
of
the
Alimentary
tract
glands:
• The
mechanical
presence
of
food
stimulate
glands
of
that
region
to
secret
juices
• Hormonal
and
neural
stimuli
to
the
parasympathetic
nerves
rise
most
of
the
secretions
• The
sympathetic
nerves
stimulation
has
two
roles:
it
can
slightly
increase
the
secretions
when
run
alone
and
it
can
be
superimposed
to
the
parasympathetic
one
if
it
is
already
causing
copious
secretions
by
glands.
Taking
a
further
look
for
the
motility
and
secretion
regulation
it
is
quite
better
to
talk
about
the
harmony
between
ENS,
CNS
and
GI
peptides.
• Central
nervous
system
triggers
long
reflexes
to
the
GI
tract,
cooperating
with
the
ESN,
external
stimuli
by
many
sensory
structures
and
emotional
statuses
(like
“butterfly
in
the
stomach”
feeling)
*mediated
by
Vagus
and
Brain
stem
• Enteric
nervous
system
head
the
short
reflexes
(this
system
standalone
from
the
brain
and
regulate
itself)
*mediated
by
the
myentric
nerve
plexus
• For
completeness:
the
GI
peptides
are
signal
molecules
that
are
released
into
the
blood
by
the
GI
cells.
They
act
on
a
variety
of
tissues
including
the
brain,
digestive
accessory
organs,
and
the
GI
tract.
The
effects
range
from
excitatory
or
inhibitory
effects
on
motility
and
secretion
to
feelings
of
satiety
or
hunger
when
acting
on
the
brain.
N°8
Types
of
GI
hormones
and
their
role
Epithelial
cells
lining
the
lumen
of
the
stomach
and
small
intestine
secrete
the
classical
GI
hormones.
These
hormone-‐
secreting
cells
(endocrinocytes)
are
interspersed
among
a
much
larger
number
of
epithelial
cells
that
secrete
their
products
(acid,
mucus,
etc.)
into
the
lumen
or
take
up
nutrients
from
the
lumen.
GI
hormones
are
secreted
into
blood,
and
hence
circulate
systemically,
where
they
affect
function
of
other
parts
of
the
digestive
tube,
liver,
pancreas,
brain
and
a
variety
of
other
targets.
Within
the
ducts,
the
composition
of
the
secretion
is
altered.
Much
of
the
sodium
is
actively
reabsorbed,
potassium
is
secreted,
and
large
quantities
of
bicarbonate
ion
are
secreted.
Bicarbonate
secretion
is
of
tremendous
importance
to
ruminants
because
it,
along
with
phosphate,
provides
a
critical
buffer
that
neutralizes
the
massive
quantities
of
acid
produced
in
the
forestomachs.
Small
collecting
ducts
within
salivary
glands
lead
into
larger
ducts,
eventually
forming
a
single
large
duct
that
empties
into
the
oral
cavity.
N°12
Regulation
of
salivary
secretion
Secretion
of
saliva
is
under
control
of
the
autonomic
nervous
system,
which
controls
both
the
volume
and
type
of
saliva
secreted.
Potent
stimuli
for
increased
salivation
include
the
presence
of
food
or
irritating
substances
in
the
mouth,
and
thoughts
of
or
the
smell
of
food.
Knowing
that
salivation
is
controlled
by
the
brain
will
also
help
explain
why
many
psychic
stimuli
also
induce
excessive
salivation
-‐
for
example,
why
some
dogs
salivate
all
over
the
house
when
it's
thundering.
Autonomic
nervous
system
control
its
regulation:
Parasympathetic
(ACh,
VIP):
• High
and
sustained
output
• Synthesis
and
secretion
of
amylase
and
mucins
• Transport
activity
of
ductular
epithelium
• Vasodilation
and
increased
blood
flow
• Positive
feed
back
on
blood
supply
through
kallikrein-‐
kininogen
system
• Stimulation
of
glandular
metabolism
and
growth
Sympathetic:
• Transient
increase
of
secretion
• Vasoconstriction
leads
to
decrease
of
salivation
N°13
Gastric
Juice
The
stomach
is
famous
for
its
secretion
of
acid,
but
acid
is
only
one
of
four
major
secretory
products
of
the
gastric
epithelium,
all
of
which
are
important
either
to
the
digestive
process
or
to
control
of
gastric
function:
• Mucus:
The
most
abundant
epithelial
cells
are
mucous
cells,
which
cover
the
entire
lumenal
surface
and
extend
down
into
the
glands
as
"mucous
neck
cells".
These
cells
secrete
a
bicarbonate-‐rich
mucus
that
coats
and
lubricates
the
gastric
surface,
and
serves
an
important
role
in
protecting
the
epithelium
from
acid
and
other
chemical
insults.
• Acid:
Hydrochloric
acid
is
secreted
from
parietal
cells
into
the
lumen
where
it
establishes
an
extremely
acidic
environment.
This
acid
is
important
for
activation
of
pepsinogen
and
inactivation
of
ingested
microorganisms
such
as
bacteria.
• Proteases:
Pepsinogen,
an
inactive
zymogen,
is
secreted
into
gastric
juice
from
both
mucous
cells
and
chief
cells.
Once
secreted,
pepsinogen
is
activated
by
stomach
acid
into
the
active
protease
pepsin,
which
is
largely
responsible
for
the
stomach's
ability
to
initiate
digestion
of
proteins.
In
young
animals,
chief
cells
also
secrete
chymosin
(rennin),
a
protease
that
coagulates
milk
protein
allowing
it
to
be
retained
more
than
briefly
in
the
stomach.
• Hormones:
The
principal
hormone
secreted
from
the
gastric
epithelium
is
gastrin,
a
peptide
that
is
important
in
control
of
acid
secretion
and
gastric
motility.
Gastric
epithelial
cells
secrete
a
number
of
other
enzymes,
including
a
lipase
and
gelatinase.
One
secretory
product
of
considerable
importance
in
man
is
intrinsic
factor,
a
glycoprotein
secreted
by
parietal
cells
that
is
necessary
for
intestinal
absorption
of
vitamin
B12.
N°
14
Secretion
of
the
Stomach
(why?
Gastric
juice
wasn’t
enough???
DAMN)
1°
part:
Mechanism
of
Acid
Secretion
The
hydrogen
ion
concentration
in
parietal
cell
secretions
is
roughly
3
million
fold
higher
than
in
blood,
and
chloride
is
secreted
against
both
a
concentration
and
electric
gradient.
Thus,
the
ability
of
the
partietal
cell
to
secrete
acid
is
dependent
on
active
transport.
The
key
player
in
acid
secretion
is
a
H+/K+
ATPase
or
"proton
pump"
located
in
the
cannalicular
membrane.
This
ATPase
is
magnesium-‐
dependent,
and
not
inhibitable
by
ouabain.
The
current
model
for
explaining
acid
secretion
is
as
follows:
Pepsinogens
are
secreted
in
a
form
such
that
the
activation
peptide
assumes
a
compact
structure
that
occludes
the
active
site.
On
exposure
to
an
acidic
(pH
Structurally,
the
active
site
is
located
in
a
deep
cleft
within
the
molecule.
Optimal
activity
of
pepsins
is
at
pH
of
1.8
to
3.5,
depending
on
the
isoform.
They
are
reversibly
inactivated
at
about
pH
5
and
irreversibly
inactivated
at
pH
7
to
8.
In
general,
secretion
of
pepsinogens
is
coupled
to
secretion
of
acid
from
the
parietal
cell.
In
vitro
studies
have
demonstrated
that
agents
that
stimulate
either
of
two
conditions
effectively
stimulate
secretion:
Dietary
vitamin
B12
is
released
from
ingested
proteins
in
the
stomach
through
the
action
of
pepsin
and
acid.
It
is
rapidly
bound
by
one
of
two
vitamin
B12-‐binding
proteins
that
are
present
in
gastric
juice;
at
acid
pH,
these
binding
proteins
have
a
greater
affinity
for
the
vitamin
than
does
intrinsic
factor.
In
the
small
intestine,
pancreatic
proteases
digest
the
binding
proteins,
releasing
vitamin
B12,
which
then
becomes
bound
to
intrinsic
factor.
Finally,
there
are
receptors
for
intrinsic
factor
on
the
ileal
mucosa,
which
bind
the
complex,
allowing
vitamin
B12
to
be
absorbed
into
portal
blood.
4°Part:
Chymosin
(Renin)
Chymosin,
known
also
as
rennin,
is
a
proteolytic
enzyme
synthesized
by
chief
cells
in
the
stomach.
Its
role
in
digestion
is
to
curdle
or
coagulate
milk
in
the
stomach,
a
process
of
considerable
importance
in
the
very
young
animal.
If
milk
were
not
coagulated,
it
would
rapidly
flow
through
the
stomach
and
miss
the
opportunity
for
initial
digestion
of
its
proteins.
N°15
Hydrochloric
acid
secretion
(for
the
mechanism
read
above
J )
The
best-‐known
component
of
gastric
juice
is
hydrochloric
acid,
the
secretory
product
of
the
parietal,
or
oxyntic
cell.
It
is
known
that
the
capacity
of
the
stomach
to
secrete
HCl
is
almost
linearly
related
to
parietal
cell
numbers.
When
acid
secretion
is
stimulated
there
is
a
dramatic
change
in
the
morphology
of
the
membranes
of
the
parietal
cell.
Cytoplasmic
tubulovesicular
membranes,
which
are
abundant
in
the
resting
cell
virtually,
disappear
in
concert
with
a
large
increase
in
the
cannalicular
membrane.
It
appears
that
the
proton
pump
as
well
as
potassium
and
chloride
conductance
channels
initially
reside
on
intracellular
membranes
and
are
transported
to
and
fused
into
the
cannalicular
membrane
just
prior
to
acid
secretion.
The
epithelium
of
the
stomach
is
intrinsically
resistant
to
the
damaging
effects
of
gastric
acid
and
other
insults.
Nonetheless,
excessive
secretion
of
gastric
acid
is
a
major
problem
in
human
and,
to
a
lesser
extent,
animal
populations,
leading
to
gastritis,
gastric
ulcers
and
peptic
acid
disease.
As
a
consequence,
the
parietal
cell
and
the
mechanisms
it
uses
to
secrete
acid
have
been
studied
extensively,
leading
to
development
of
several
drugs
useful
for
suppressing
acid
secretion.
N°
16
Protective
mechanism
of
the
stomach
(Quite
so!)
The
gastrointestinal
mucosa
forms
a
barrier
between
the
body
and
a
luminal
environment,
which
not
only
contains
nutrients,
but
is
laden
with
potentially
hostile
microorganisms
and
toxins.
The
challenge
is
to
allow
efficient
transport
of
nutrients
across
the
epithelium
while
rigorously
excluding
passage
of
harmful
molecules
and
organisms
into
the
animal.
The
exclusionary
properties
of
the
gastric
and
intestinal
mucosa
are
referred
to
as
the
"gastrointestinal
barrier".
The
gastrointestinal
barrier
is
often
discussed
as
having
two
components:
• The
intrinsic
barrier
is
composed
of
the
epithelial
cells
lining
the
digestive
tube
and
the
tight
junctions
that
tie
them
together.
• The
extrinsic
barrier
consists
of
secretions
and
other
influences
that
are
not
physically
part
of
the
epithelium,
but
which
affect
the
epithelial
cells
and
maintain
their
barrier
function.
The
gastric
mucosal
barrier
is
the
property
of
the
stomach
that
allows
it
to
contain
acid.
If
the
barrier
is
broken,
as
by
acetylsalicylic
acid
(ASS,
aspirin)
in
acid
solution,
acid
diffuses
back
into
the
mucosa
where
it
can
cause
damage
to
the
stomach
itself.
The
barrier
consists
of
three
protective
components.
These
provide
the
additional
resistance
for
the
mucosal
surface
of
the
stomach:
• A
compact
epithelial
cell
lining,
tight
junctions
that
repel
harsh
fluids
that
may
injure
the
stomach
lining
bind
cells
in
the
epithelium
of
the
stomach.
• A
special
mucus
covering:
the
mucus
covering
is
derived
from
mucus
secreted
by
surface
epithelial
cells
and
mucosal
neck
cells.
This
insoluble
mucus
forms
a
protective
gel-‐like
coating
over
the
entire
surface
of
the
gastric
mucosa.
The
mucus
protects
the
gastric
mucosa
from
autodigestion
by
e.g.
pepsin
and
from
erosion
by
acids
and
other
caustic
materials
that
are
ingested.
• Bicarbonate
ions,
secreted
by
the
surface
epithelial
cells.
The
bicarbonate
ions
act
to
neutralize
harsh
acids.
N°17
Regulation
of
gastric
secretions
(are
we
joking???)
READ
SOME
OF
THE
ABOVEMENTIONED
POINTS!!!
(4,5,7)
N°18
Cholecystokinin
(Name!)
==>
READ
N°8
N°19
Secretin
==>
READ
N°8
N°20
I’m
too
sleepy…
let’s
review
it
on
the
second
document!!!
That’s
all
for
today
folks,
tomorrow
I
would
like
to
start
from
here
and
finish
with
the
respiratory
system
(or
at
least
I
hope
so…)
Hope
it
will
be
useful;
if
I
missed
something
or
I
wrote
hogwash
please
tell
me
so
I’d
fix
everything…
Your
Beloved
colleague,
Alessandro
Motta
“May
the
force
be
with
you”