week 10 - gastrointestinal system Flashcards

1
Q

what is metabolism

A

sum of all chemical reactions in which energy is made available and consumed in the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what does the body need energy for

A

Contraction of muscles for all movement
Accumulation of ions and other molecules against concentration gradients (nerve impulse transmission)
Biosynthesis and hence for the building of tissues
Waste disposal and hence for getting rid of the end products of bodily function
Generation of heat and hence maintenance of body temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is gibbs free energy and when is it positive and negative

A

it is usable energy or energy that is available to do work
deltaG = negative when the reaction gives out energy and is positive when the product contains more energy than the substrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

describe the structure of ATP

A

adenosine tri-phosphate is composed of adenine, ribose and three phosphate groups
ADP is only two phosphate groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how is acetyl coenzyme A produced

A

glycolysis of glucose
beta-oxidation of fatty acids
transamination and oxidative deamination of amino acids
all of these reactions produce acetyl coA
vitamins and minerals play essential roles in these reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what kind of process is the TCA cycle

A

amphibolic meaning it has anabolic and catabolic components

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

steps of the TCA cycle

A

acetyl coA enters and condenses with oxaloacetate to produce citrate
decarboxylation phase - citrate is metabolised into succinyl coA (CO2 released)
reductive phase - succinyl coA to oxaloacetate
1 GTP produced
1 acetyl coA lead to 3 NADH and 1 FADH2 being produced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

steps of the electron transport chain

A

NADH and FADH2 donate two electrons and one proton
electrons are passed along RADOX centres which have an increasing affinity for electrons - electrons moving along produces ATP
ATP used to pump protons against conc gradient from matrix through the inner mitochondrial membrane to the intermembrane space
protons return to matrix through ATP synthase as IMM is impermeable
as protons are driven through, ATP synthase rotates and ATP is produced
electrons at end of complex 4 are donated to molecular O2 with a proton to produce water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how are electrons passed between complexes in the ETC

A

As electrons reach end of RADOX centres in complex 1, they are passed via coenzyme Q to the next complex and so on… but from complex 3 to 4, cytochrome C passes electrons between complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

why is complex 2 different (in ETC)

A

it is not pump proteins

FADH2 joins at this complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

describe glycolysis

A

glucose is broken down to 2 pyruvate molecules in two phases
phase 1 - endergonic (2 ATP in) - glucose to glyceraldehyde-3-phosphate
phase 2 - exergonic - G-3-P is metabolised to pyruvate producing 4 ATP giving a net gain of 2 ATP
occurs in the cytosol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how is pyruvate converted into acetyl coA

A

Pyruvate undergoes further metabolism in the mitochondria where, on entry, the 3C pyruvate loses a carbon atom with the production of CO2 to form acetyl CoA by the action of pyruvate dehydrogenase - A molecule of NADH is also formed in this process and that can be fed into the electron transport chain
Acetyl CoA is then able to enter the TCA cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how is excess glucose stored in the body

A

in the form of glycogen mainly within the liver and also in muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are lipids

A

highly efficient energy storage molecules and are important to the body’s ability to adapt to periods of fasting
examples - fats, oils, waxes, certain vitamins (such as A, D, E and K), hormones and most of the cell membrane that is not made up of protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are triglycerides and how can they be broken down

A

Fats are stored as triglycerides - triglycerides are three fatty acids attached to a glycerol backbone, these triglycerides can be broken down into their component parts of fatty acids and glycerol by an enzyme called lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how are fatty acids transported in the blood

A

Fatty acids are released and transported in the blood as a complex with albumin and are taken up by other cells for oxidation
they are hydrophobic so are transported within albumin which protects them from water
All enzymes required for fatty acid catabolism are within matrix of mitochondria but fatty acids need to be modified by the addition of acetyl coA molecule in order to enter the mitochondria
beta-oxidation occurs once they enter they matrix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

describe fatty acid transportation into the mitochondrial matrix

A

addition of coA allows fatty acids to enter the mitochondria - forms fatty acyl coA
carnitine replaces coA to form fatty acyl carnitine - allowing it across the outer mitochondrial membrane
carnitine shuttle allows fatty acids to cross impermeable IMM into matrix
coA replaces carnitine to from fatty acyl coA and fatty acids can be degraded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

describe fatty acid degradation

A

once in the matrix, beta-oxidation can occur
this process cleaves carbon backbone between alpha and beta carbons making the fatty acid smaller and smaller
each cleavage produces acetyl coA, 1 NADH and 1 FADH2 which can be fed into ETC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

describe protein metabolism

A

transamination - removes amine group from AA and transfers it to an alpha ketoacid - when it accepts the amine group it transfers the keto group to the original AA
deamination - amine group removed from AA releasing the carbon backbone of the AA which can be regenerated into glucose, fatty acids or various TCA cycle intermediates - produces a side product of ammonium (toxic so kidneys exclude it)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

describe glucogenic and ketogenic amino acids

A

glucogenic - breakdown products ultimately form glucose by conversion to pyruvate, or intermediates of TCA cycle
ketogenic - breakdown products form fatty acids via the intermediates of acetyl coA or acetoacetyl coA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

sources of metabolic fuel in prolonged periods of starvation

A

fat - triglycerides in adipose tissue - sufficient to prolong life for 3 months
protein - provides approx. 14 days worth of energy but is spared for as long as possible to permit mobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

why is the BMI not always a good representation of an individual

A

does not take into account muscle mass or cardiovascular condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

factors influencing energy expenditure

A

menstruation, age, last three months of pregnancy and also lactation cause increase in expenditure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

components of a balanced diet and their functions

A

carbohydrate - energy source
protein - repair and growth
fat - long term energy store, insulation
vitamins - A: vision C: antioxidant D: Ca absorption
minerals - Ca: bone mineralisation Fe: oxygen transport
fibre - effective bowel function
water - hydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

structure of triglycerides

A

glycerol and three fatty acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

where is cholesterol found

A

present in plasma membrane of cells but also serves as a precursor for the synthesis of a number of other molecules such as sex hormones, oestrogen and testosterone as well as bile salts and phospholipids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

dietary sources for the components of a balanced diet

A
C - bread rice pasta potatoes
p - meat fish dairy nuts
fat - meat cheese cream fish 
v - A: sweet potato B: veg C: citrus D: oily fish
m - Ca: milk Fe: red meat K: bananas
f - plants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

essential amino acids

A

9 AAs that cannot be produced by the body and must be obtained by the diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

types of carbohydrates and examples

A

monosaccharides - glucose, fructose, galactose
disaccharides - sucrose, maltose, lactose
polysaccharides - starch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

bonds between monosaccharides in poly and disaccharides

A

glycosidic bonds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

glands secreting saliva

A

parotid, submandibular and sublingual salivary glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

function of saliva in digestion

A

starts the digestion of carbohydrates by producing an enzyme called alpha-amylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

how alpha-amylase starts to digest carbohydrates

A

cleaves the 1-4 glycosidic bonds to produce maltose, a disaccharide, maltotriose, a trisaccharide and alpha limit dextrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

digestion in the mouth

A

alpha amylase starts carb digestion
Lingual lipase which breaks down triglycerides into fatty acids and glycerol is also present in saliva but most fat digestion takes place later in the small intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

digestion in the stomach

A

start of protein digestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

secretion and activation going on in the stomach during digestion

A

chief cells secrete pepsinogen
parietal cells secrete HCl acid which denatures proteins and activates pepsin
pepsin then cleaves peptide bonds within the polypeptide chain to produce many smaller oligo peptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is a zymogen

A

some enzymes are synthesised as inactive precursors - these inactive precursors are called zymogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

exocrine function of the pancreas

A

pancreatic juice and alkali secretion

alkali secretions buffer any acid from the stomach and provide an optimal pH for. digestive enzymes in the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

endocrine function of the pancreas

A

secretion of insulin and glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

function of the pancreatic secretions into the duodenum

A

Pancreatic secretions into the duodenum include a number of proteases such as trypsin and chymotrypsin and carboxypeptidase as well as other enzymes to digest elastin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

function of liver in digestion

A

production and secretion of bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

role of bile in digestion

A

Stored in gallbladder and released into the duodenum after a meal
Important in the emulsification of fat particles so that fats are accessible for enzymes
Bile salts aid absorption of fats by forming complexes called micelles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

properties of bile that allows it to help emulsify fats

A

Cholesterol derived potion of bile acid is hydrophobic and the amino acid conjugate is hydrophilic - bile acids are amphipathic
Due to these properties, bile salts have a detergent action of particles of dietary fat causing fat globules to break down or be emulsified into tiny droplets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

why fats are emulsified

A

greatly increases the surface area of fat making it available for the digestion by lipases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what are enterocytes

A

cells of the intestinal lining

46
Q

digestive enzymes provided by the duodenum

A

first is enterokinase which activates trypsin which then goes and activates all the other proteolytic zymogens produced from pancreas
Second group of enzymes are the brush border enzymes – digest disaccharides to monosaccharides

47
Q

describe the different types of absorption

A

passive absorption - from a high to low concentration
facilitated transport - down concentration gradient - involves a membrane carrier
active transport - uses energy and a membrane carrier - low to high

48
Q

what are micelles in digestion and how are they formed

A

mix of bile acids and lipids
Products of lipid digestion are solubilised in the intestinal lumen in mixed micelles with the aid of bile salts except glycerol which is water-soluble

49
Q

describe how fatty acids are released into the bloodstream

A

Micelles diffuse to the apical brush border where the lipids are released from the micelle and diffuse down the concentration gradient into the cell
Inside the cells, if the fatty acid chains are short they will move directly into bloodstream
if larger, triglycerides are packaged into lipid structured called a chylomicron – secreted into lymphatics via lacteals – lymphatic circulation carries these chylomicrons to thoracic duct to enter the bloodstream

50
Q

absorption of monosaccharides

A

glucose and galactose absorbed by mechanisms involving sodium dependent co-transport – they move from the intestinal lumen into the cell on the sodium glucose transporter called SGLT1
Sodium is rapidly shuttled out in exchange for potassium by sodium pumps on the basolateral membrane
Fructose is transported separately across both the apical and basolateral membranes by facilitated diffusion
all three monosaccharides are transported across the basolateral membrane into the bloodstream by the GLUT2 transporter

51
Q

absorption of amino acids

A

Luminal plasma membrane of the absorptive cell has a number of sodium dependent amino acid transporters
Di- and tri- Peptides in the small intestine are absorbed by Co-transport with hydrogen ions, then further digested into amino acids once inside the cell
All the amino acids are then transported across the basolateral membrane into the blood by facilitated diffusion

52
Q

final products of protein digestion

A

amino acids, dipeptides and some tripeptides

53
Q

describe normal eating behaviour

A

normal eating is flexible
it varies in response to your hunger, your schedule, your proximity to food and your feelings
Usually having 3 meals a day
Overeating and undereating at times

54
Q

common eating disorders

A

anorexia nervosa
bulimia nervosa
binge eating disorder
avoidant/restrictive food intake disorder (ARFID)
other feeding or eating disorders that do not fit into these categories

55
Q

presentation of bulimia

A

recurrent episodes of overeating
binge eating accompanied by repeated inappropriate compensatory behaviours aimed at preventing weight gain
individual is preoccupied with body shape or weight which strongly influences self evaluation
not significantly underweight so does not meet AN criteria

56
Q

management of bulimia nervosa in adults

A

if self-help programme does not work, try CBT - involve significant others in CBT if appropriate

57
Q

management of bulimia nervosa in children and young people

A

family therapy or CBT if FT-BN does not work

58
Q

what is cognitive behavioural therapy

A

evidence based treatment for a range of mental health diagnoses
talking therapy
changes the way the patient thinks and behaves which is turn changes they way they feel

59
Q

presentation of binge eating disorder

A
Characterised by frequent recurrent episodes of binge eating (eg once a week or more over a period of several months) with compensatory behaviours 
Eating more quickly than usual 
Eating until uncomfortably full
Eating a lot when not hungry 
Eating alone because of embarrassment 
Feeling very bad or guilty after eating
60
Q

management of binge eating disorder

A

guided self help with therapy sessions

if unsuccessful or unacceptable offer group eating disorder focused CBT-ED

61
Q

presentation of anorexia nervosa

A

A significantly low body weight for the individuals height, age and developmental stage (BMI less than 18.5, BMI under 5th percentile in children and adolescents)
Low body weight is accompanied by a persistent pattern of behaviours to prevent the restoration of normal weight
Low body weight is central to the person’s self-evaluation or is inaccurately perceived to be normal or excessive

62
Q

management of anorexia nervosa in adults

A

consider CBT-ED
If CBT-ED, MANTRA or SSCM is unacceptable try one of the others or eating disorder focused focal psychodynamic therapy
Individual CBT-ED should consist of up to 40 sessions over 40 weeks

63
Q

management of anorexia nervosa in children

A

Family therapy
Give patient the option to have single and family sessions
If FT-AN is unacceptable, contraindicated or ineffective consider CBT-ED or adolescent focused psychotherapy

64
Q

presentation of ARFID

A

Characterised by abnormal eating or feeling behaviours that result in the intake of insufficient quantity or variety of food - extreme picky eating
Causes significant weight loss/failure to gain weight/nutritional deficiencies/ dependence on nutritional supplements or tube feeding/ negatively affects health/ significantly impairs functioning
The pattern of eating does not reflect concerns about body shape or weight

65
Q

role of a psychiatrist in the MDT

A

works with the MDT in the following:
Assessment and diagnosis
Supporting psychologically informed formulation and treatment – finding the reason behind the ED
Physical monitoring
Risk assessment and management
Treating comorbidities
Developing services, improving quality, facilitating teaching and learning

66
Q

complications of anorexia

A

impaired concentration, dry skin, brittle hair, hair loss, low bp, cardiomyopathy, anaemia, osteoporosis, amenorrhoea, infertility

67
Q

2 groups of organs within the digestive system

A

gastrointestinal tract

accessory organs - salivary glands, gallbladder, liver, pancreas

68
Q

function of gall bladder in the digestive system

A

helps store and concentrate bile

69
Q

components of the GI tract

A
oral cavity
pharynx
oesophagus
stomach
small intestine
large intestine
70
Q

parts of the small intestine

A

duodenum
jejunum
ileum
as you move from the duodenum to the ileum you progress from more digestion to more absorption

71
Q

large intestine components

A

Caecum, ascending, transverse and descending colon, sigmoid colon, rectum and anus

72
Q

were is mucosa or mucous membrane found

A

lining the cavities of the body and surface of the internal organs

73
Q

what is lamina propria

A

thin layer of loose connective tissue which lies beneath the epithelium - it contains inflammatory cells and provides support and nutrients to the overlying epithelium

74
Q

what is muscularis mucosae

A

next layer deep to the lamina propria and is composed of smooth muscle and is continuous all the way through the entire length of the gastrointestinal tract

75
Q

describe the submucosa

A

is deep to the muscularis mucosae - composed of dense irregular connective tissue and contains many blood vessels, nerves and also lymphatic vessels (which collects additional fluid around the body outside the vasculature)

76
Q

describe the muscularis propria - also called the muscularis externa

A

comprised of inner circular muscle and outer longitudinal muscle - this muscle is smooth muscle and is responsible for peristalsis (movement of food and products of digestion)

77
Q

describe the adventitia

A

outer layer of fibrous connective tissue surrounding an organ

78
Q

describe the histology of the GI tract from deep to superior

A
Mucosa (mucous membrane) 
epithelium
lamina propria
muscularis mucosae
submucosa 
muscularis propria (muscularis externa)
adventita
serosa
79
Q

epithelium in the GI tract

A

Oesophagus epithelium is stratified, squamous

Change of epithelium at stomach which continues for the rest of the GI tract – simple columnar

80
Q

function of brunners glands

A

secretes bicarbonate ions to neutralise acid from stomach

81
Q

what are peyers patches

A

lymphoid follicles and form part of the immune function preventing the growth of dangerous bacteria

82
Q

describe the pharynx and its three parts

A

conducts air
muscles direct food to oesophagus
made of the nasopharynx, oropharynx and laryngopharynx

83
Q

9 sections of the abdomen

A
1 = Right hypochondrium 
2 = Epigastric 
3 = Left hypochondrium 
4 = Right lumbar 
5 = Umbilical 
6 = Left lumbar 
7 = Right iliac fossa
8 = Suprapubic 
9 = Left iliac fossa
84
Q

organs in Right hypochondrium

A

liver

85
Q

organs in epigastric

A

Duodenum, liver, gall bladder, pancreas, stomach

86
Q

organs in the left hypochondrium

A

spleen and stomach

87
Q

organs in the right lumbar

A

ascending colon

kidney

88
Q

organs in the umbilical

A

Stomach, Head of pancreas, Small intestine (duodenum), transverse colon, lower aspects of right and left kidneys

89
Q

left lumbar organs

A

descending colon

left kidney

90
Q

right iliac fossa organs

A

caecum, appendix, part of ascending colon

91
Q

suprapubic organs

A

bladder, uterus, parts of small intestine

92
Q

left iliac fossa organs

A

sigmoid colon, descending colon

93
Q

where is the pyloric sphincter found and what is its function

A

in the pylorus of stomach

controls secretions to duodenum from stomach

94
Q

what is anterior/superior to stomach

A

diaphragm and liver

95
Q

posterior/inferior to stomach

A

Diaphragm, spleen, kidney (L.), adrenal gland, pancreas

96
Q

three layers of muscle in stomach wall

A

longitudinal, circular, oblique

97
Q

describe the histology of the stomach

A

Endocrine cells produce gastrin
This stimulates the parietal cells to produce hydrochloric acid
The hydrochloric acid then breaks down pepsinogen to become pepsin produced from the chief cells
Mucous and surface mucous cells protect the mucosa

98
Q

what are villi

A

These are finger like projections and are well designed to increase surface area, and therefore aid in the digestion and absorption which typically happens in the small intestine, namely the duodenum, jejunum and ileum

99
Q

role of duodenum in digestion

A

receives chyme
contains brunners glands
bile and pancreatic secretions enter
ends at duodenojejunal junction

100
Q

functions of the pancreas

A

exocrine - Primarily produces many digestive enzymes but also Bicarbonate ions - These digestive enzymes help break down carbohydrates, proteins and fats
endocrine - islets of langerhans secrete insulin, glucagon and somatostatin

101
Q

functions of the hormones secreted by endocrine portion of pancreas

A

Insulin – promotes glucose absorption from blood into liver, skeletal muscle and fat cells - enables the conversion to glycogen (storage of glucose in this form)
Glucagon – this does the opposite and results in the conversion of the stored glycogen into glucose for release into the bloodstream when levels are low
Somatostatin – this helps to reduce acid secretion and helps to slow down the digestive process - has a variety of other functions in the body

102
Q

how many lobes does the liver have

A

four

103
Q

functions of liver

A

It detoxifies and processes everything absorbed from the gastrointestinal tract (GIT), and regulates glucose in the blood
The liver synthesizes proteins including the clotting factors and platelet regulations
It inactivates hormones and drugs, as well as insulin and many waste products and is heavily involved in drug metabolism, and sometimes this can be of detriment when the product of metabolism is more toxic than the initial compound e.g. paracetamol

104
Q

describe the blood supply for the liver

A

receives a dual supply of blood – the hepatic portal vein from the gut, spleen and related organs (approximately 75%)
The hepatic arteries account for 25% of blood flow, and this artery provides the oxygenated blood for the liver

105
Q

functions of common hepatic duct and the cystic duct

A

duct that leaves gall bladder for bile secretions to pass out is called the cystic duct
Common hepatic duct comes from the left and right hepatic ducts which carry bile to the gall bladder

106
Q

function of caecum

A

acts as a reservoir for chyme when it receives from the ileum

107
Q

four parts of the colon

A

ascending, transverse, descending and sigmoid

108
Q

where are the hepatic and splenic flexures

A

when colon meets the right lobe of the liver and turns 90 degrees = hepatic
when colon turns another 90 degrees to point inferiorly = splenic flexure

109
Q

function of goblet cells

A

produce mucous as the role of the large intestine is to absorb fluid from the GI tract

110
Q

3 main vessels that all arise from the abdominal aorta and the areas they supply

A

Coeliac trunk (foregut)
Superior mesenteric artery (midgut)
Inferior mesenteric artery (hind gut)
Foregut – supplies the oesophagus (lower portion), stomach, liver, spleen and first half of the duodenum
Midgut – supplies the last half of the duodenum, jejunum, ileum, caecum, appendix, ascending colon and first half to first 2/3 of the transverse colon
Hindgut – supplies last 1/3 of the transverse colon, descending colon, sigmoid colon and rectum

111
Q

describe the venous drainage of GI tract

A

Portal venous drainage is for the unpaired abdominal organs i.e. the gut and spleen
Femoral veins drain the lower limb
Internal iliac veins drain the pelvis
Renal veins drain the kidneys
Hepatic vein is the main vein draining the liver