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Flashcards in GI Physiology Deck (41):
1

GI physiology in order

Mouth -> Pharynx (back of throat) -> Oesophagus -> Stomach -> Small intestine (split into 3 regions, duodenum, jejunum, ileum) -> Large intestine (colon) -> Rectum -> Anus

2

Accessory structures

- Salivary glands
- Secrete amylase and lipase
Produce mucin (glycoprotein) for lubrication
- 3 sets of glands = sublingual, submandibular and parotid glands (secrete amylase)

3

Nerves involved in swallowing

Trigeminal, facia, glossopharyngeal, vagus, spinal accessory, and hypoglossal nerves

4

Barrett's oesophagus

Oesophageal sphincter is unable to prevent acid reflux which damages cells and turns them into cancerous, columnar cells, so we say Barrett's disease can progress to adenocarcinoma

5

Gastric cell types

- Mucous cells = secrete mucus
- G-cells
- Chief cells
- Parietal cells

6

G-cells

- Found in the antrum in the stomach
- Enteroendocrine
- Secrete gastrin which is used in acid production

7

Chief cells

- Found in fundus in the body
- Secretes pepsinogen and lipase

8

Parietal cells

- Also known as oxyntic cells
- Found in fundus in the body
- Pump out HCl

9

Pepsinogen

- Inactive from of pepsin
- Also known as a zymogen

10

How is pepsinogen converted to pepsin?

- Acid cleaves pepsinogen to produce pepsin
- So, pepsinogen is activated by HCl

11

Pepsin

- Pepsin is a protease which means when more pepsinogen is produced, pepsin acts on it to produce more pepsin via positive feedback
- This is achieved by removing 44 amino acids to activate pepsinogen into pepsin

12

Gastric lipase

Converts short chain triglycerides into monoglycerides

13

How do we secrete acid?

1. Via the parietal (oxyntic) cells = triggers (e.g. smell) release ACh which binds to parietal cells and releases HCl
2. G-cells produce gastrin which binds to parietal cells and also releases HCl
3. When food enters the stomach, there is stretching/distension which releases histamine which triggers the release of acid

14

H2 receptor antagonists

These drugs bind to the H2 receptor so that histamine cannot bind and this releases acid secretion
- Cimetidine and Ranitidine

15

Proton pump inhibitors

- Omeprazole
- Irreversibly bind to -SH groups in proton pump
- Unable to pump out H+
- Stop acid production

16

How do we get H+?

- Enzyme carbonic anhydrase combines CO2 and H2O into carbonic acid and then splits that into bicarbonate and protons
- This reaction happens inside parietal cells

17

What prevents the stomach from digesting itself?

Protease is secreted as a zymogen (inactivated form) known as pepsinogen

18

Why does the stomach not suffer from 1st or 2nd degree burns?

1. Mucus in foveolar cells = mucus is alkaline so it neutralises HCl
2. Tight junctions = lock epithelial cells together so acid cannot penetrate
3. High cell turnover = cells are replaced from gastric pits every 2-3 days

19

What would happen if there was a breakdown in mucus barrier?

- Stomach cells are exposed to HCl = ulcers
- May progress to perforated ulcer if there is complete erosion though the GIT wall
- Allows food and bacteria to move into peritoneal cavity = may cause peritonitis or sepsis

20

What is Helicobacter pylori

Bacterium that infects the gastric mucosa and causes a breakdown in barrier efficiency, causing more ulcers

21

Treatment of Helicobacter pylori

2 antibiotics + 1 PPI
- Clarithromycin + Amoxicillin + Omeprazole
- Clarithromycin + Metronidazole + Omeprazole

22

Procedures to reduce food intake

1. Gastric sleeve = 70-80% of stomach removed
2. Gastric band = Limits food capacity + reduces calorie intake
3. Roux en Y bypass = allows food to bypass stomach and go straight to small intestine

23

How does food move along the small intestine?

- Peristalsis
- Circular muscles = contract to prevent movement backwards into small intestine
- Longitudinal muscles = contract to push food bolus along GIT

24

What is diarrhoea?

Diarrhoea is the excessive loss of fluid and ions

25

How do medicines work to prevent diarrhoea?

- Reduce function of longitudinal muscles so food is pushed along GIT very slowly and remains in small intestine for longer, so there is more opportunity for water and ions to be reabsorbed and so reduce diarrhoea.
- These drugs e.g. loperamide target the MP

26

Myenteric plexus (MP)

Layer containing nerves within intestine sandwiched between circular and longitudinal muscles

27

Bile acid synthesis

not sure

28

What are the different adaptations of the small intestine?

1. Large SA = plicae > villi > microvilli = absorption
2. Thin epithelium = 1 cell thick for easier absorption
3. Digestive enzymes than convert non-absorbable macromolecules into absorbable smaller molecules

29

Enterocytes

Cells of the small intestine

30

How is glucose transported into SI?

Via the SGLT1 transporter which is:
- Na+ dependent as Na+ absorbs glucose
- Glucose is polar and cannot penetrate lipid bilayer so a transporter is needed

31

How is fructose transported into SI?

Via the GLUT5 transporter
- No need for Na+

32

How is protein transported into SI?

Proteins are macromolecules that cannot be absorbed so they must be digested into smaller peptides and amino acids
- Peptides are transported by PepT1
- Amino acids are transported by several different systems

33

Carbohydrate digestion by sucrase

Sucrose = glucose + fructose

34

Carbohydrate digestion by lactase

Lactose = glucose + galactose

35

Carbohydrate digestion by maltase

Maltose = glucose + glucose

36

List of drugs absorbed by the PepT1 transporter

Cephalosporins; Penicillins; Enalapril; α-Methlydopa-phenylalanine; Val-acyclovir

37

Efflux transporters

These have the opposite effect pf uptake transporters, and pump out molecules back into gut lumen
- P-glycoprotein (P-gp)
- Breast cancer resistance protein (BCRP)
Efflux transporters are the reason why anti-cancer drugs are not given orally

38

List of drugs pumped out by P-gp

- HIV PI (Indinavir)
- Immunosupressants (CsA; Tacrolimus)
- Antibiotics (Erythromycin)
- Cardiotonics (Digoxin; Quinidine)
- Anti-cancer agents (Verapamil; Quinidine; Imatinib)

39

What happens when you give oral anti-caner drugs and efflux blockers at the same time?

Increases AUC but also increases toxicity

40

Examples of efflux blockers

Valspodar and VX-710

41

What drugs interact with P-gp (e.g. Digoxin) and what effect is there?

Ritonavir, Atorvastatin and Talinolol all interact with Digoxin, to increase the effects of Digoxin, but also increase side effects such as nausea and vomiting