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BMS150 Post-MT2 > Physiology and Pathology: The Stomach > Flashcards

Physiology and Pathology: The Stomach Flashcards

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1
Q

What is the most distensible part of the GI tract?

A

Stomach

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2
Q

Two general functions of the stomach?

A
  1. Reservoir for food before release into SI
  2. Mixes saliva, food, and gastric juices to form chyme
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3
Q

4 main regions of the stomach?

A
  • Cardia
  • Fundus
  • Body
  • Pyloric
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4
Q

Two sphincters of the stomach?

A
  • Lower esophageal
  • Pyloric
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5
Q

Main arterial supply of the stomach?

A

Celiac trunk

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6
Q

Main arteries that supply the stomach?

A
  • Hepatic artery
  • Celiac trunk
  • Splenic artery
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7
Q

Branches of hepatic artery supplying stomach?

A
  • Right gastric
  • Right gastro-omental
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8
Q

Branch of celiac trunk supplying stomach?

A
  • Left gastric
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9
Q

Branch of splenic artery supplying stomach?

A
  • Left-gastro-omental
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10
Q

Veins that drain the stomach?

A
  • Hepatic portal vein
  • Superior mesenteric vein
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11
Q

Veins that drain into hepatic portal vein?

A

Left gastric and right gastric veins

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12
Q

Veins that drain into superior mesenteric vein?

A

Left and right gastro-omental veins

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13
Q

Parasympathetic supply of the stomach?

A

Vagus nerve

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14
Q

Sympathetic supply of the stomach?

A
  • From T5-T9
  • Passes to celiac plexus via greater splanchnic nerve
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15
Q

Epithelium and lamina propria are arranged into ______

A

Glands

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16
Q

Glands have 3 regions:

A
  1. Pit
  2. Neck
  3. Base
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17
Q

Cell types in surface epithelium and gastric pit? (3)

A
  • Simple columnar epithelium
  • Mucin granules
  • Short microvilli
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18
Q

Cell types in neck/ismuth?

A
  • Simple columnar epithelium
  • Shorter and contain less mucin granules
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19
Q

Cell type in neck and base?

A
  • Parietal cells (Oxyntic)
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20
Q

What are parietal cells? Function?

A

Cells found mainly in upper half of gastric gland that produce HCl and IF

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21
Q

Cell type in base?

A

Chief cells (zymogenic)

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22
Q

What are chief cells? What is their function?

A

Cells found in lower regions of gastric glands with lots of RER and granules. Function of granules is to secrete pepsinogen

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23
Q

Cell types in glands (deep in gastric pits)? Subdivisions and functions?

A

Entero-endocrine cells
- Enterochromaffin-like (histamine)
- G-cells (Gastrin)
- D-cells (Somatostatin)

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24
Q

3 layers of muscularis externa?

A
  • Inner oblique
  • Middle circular
  • Outer longitudinal
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25
4 stages of motility?
1. Food entry into stomach 2. Storage in fundus 3. Mixing 4. Emptying into small intestine
26
Functions of LES? (2)
- Controls movement of food into stomach - Prevents reflux
27
Resting tone of LES is maintained via ________ properties of sphincter muscles & cholinergic regulation
Intrinsic myogenic
28
To allow food to enter the stomach, a wave of ______ moves along the esophagus, LES, and into stomach and SI initiated by ________
Relaxation; vasovagal reflex (receptive relaxation)
29
What is gastric accomodation?
Presence of food in stomach stretches wall of body of stomach (reduces muscular tone)
30
Presence of food in the stomach triggers mixing waves, initiated by what?
Gastric pacemakers
31
Waves start where and move toward what? What is this called?
Mid- to upper portion ad move toward pyloric antrum - Propulsion
32
What is retropulsion?
Pylorus opening is very small so antral contents are pushed back upstream toward body of stomach
33
Only what can leave the stomach through the pyloric sphincter?
Liquid
34
What is the rate of gastric emptying governed by?
Signals from stomach and duodenum
35
What do gastric emptying signals ensure? (2)
- pH inside duodenum doesn't become too acidic - Travel time slow enough for nutrient absorption
36
Gastric acid: - Released from _____ - pH ____ - Composed of _____ (3) - Functions _______ (3)
- G-cells - pH 1-2 - HCl (main), KCl (lots), NaCl (little) - Functions: digestion of proteins, bacteriostatic, conversion of pepsinogen to pepsin
37
Gastric acid secretion mechanism: CO2 combines with OH to form what? Using what enzyme?
Bicarbonate via carbonic anhydrase
38
What is pumped into the lumen of the canaliculus and what is passively transported there?
- Pump: H+ - Passive: Cl-
39
What ATPase is blocked by PPIs?
H+/K+ ATPase
40
What can stimulate parietal cells? (3)
- Ach on muscarinic receptors - Gastrin on CCK2 receptors - Histamine on H2 receptors
41
Functions of Histamine? (3)
- Acts on muscarinic receptors of parietal cells - Stimulates release of gastric acid - Stimulates vasodilation
42
What is gastrin secreted in response to? (3)
- Stomach distension - Vagal stimulation - Presence of partially digested proteins
43
Functions of gastrin? (2)
- Acts on ECL to stimulate Histamine release - Directly stimulates parietal cells by binding to CCK2 receptors
44
What can inhibit parietal cells? (2)
- Somatostatin - PGs
45
Somatostatin as also known as what?
Growth hormone inhibiting hormone
46
Functions of somatostatin? (3)
- Reduce secretion of gastric acid by parietal cells - Reduces secretin and histamine - Suppresses release of pancreatic hormones
47
What is somatostatin released in response to?
Luminal H+
48
When is gastric acid secretion higher? Lower?
- Higher after meal - Lower between meals
49
Phases of gastric acid secretion? (3)
- Cephalic - Gastric - Intestinal
50
What is cephalic phase triggered by?
Smell, sight, taste, thought and swallowing food
51
Cephalic phase is primarily mediated by what?
Vagus nerve
52
Vagus nerve releases?
Ach and GRP
53
- Ach acts directly on ______ cells to release H+ - Ach acts on ______ cells to release histamine - Ach acts on D cells, inhibiting release of ______
- Parietal cels - ECL cells - somatostatin
54
Vagus nerve releases GRP to induce what?
Gastrin release from G cells
55
What is the gastric phase triggered by?
Food entering stomach, distending gastric mucosa
56
Gastric phase is mediated by what?
Vagal reflex and ENS reflex
57
Partially digested proteins stimulate what?
G cell release of gastrin
58
Low luminal pH stimulates what?
D cells to secrete somatostatin = inhibit gastrin production
59
What is the intestinal phase triggered by?
Presence of amino acids and partially digested peptides in proximal intestine
60
What is intrinsic factor? What is its function?
- Glycoprotein secreted by parietal cells - Required for absorption of B12 in ileum
61
Where is pepsinogen secreted from?
Chief cells via exocytosis
62
What is required for pepsinogen => pepsin?
Spontaneous cleavage in presence of HCl
63
Pepsin function?
Digestion of protein
64
What is pepsinogen secretion stimulated by? (2)
- Ach release from vagus nerve - Presence of acid in the duodenum triggers secretin from S cells => pepsinogen from chief cells
65
What receptor does Ach bind to on chief cells?
M receptors
66
How is the stomach able to withstand the low pH and high pepsin levels?
Gastric diffusion barrier
67
How is the gastric diffusion barrier maintained? (3)
- Mucus gel layer on surface epi - Bicarb microclimate - Tight junctions in gastric glands
68
What cells secrete gastric mucin?
Simple columnar epithelium
69
How does the gel layer form?
Mucous + phospholipids + electrolytes + water
70
Functions of mucus layer? (2)
- Protect against acid, pepsin, bile acid, ethanol - Lubricates gastric mucosa to minimize abrasions
71
Mucin secretion is induced by? (2)
- Vagal stimulation - Chemical irritation
72
What does the bicarbonate microclimate do?
Neutralize most acid that diffuses through the mucosal layer and inactivate any pepsin that penetrates the mucus
73
HCO3- secretion induced by? (3)
- Vagal stimulation - PGE2 - Intraluminal pH
74
Inflammation of stomach mucosa?
Gastritis
75
Damage is limited to the gastric mucosa (ie. does not penetrate beyond the lamina propria)?
Gastric erosion
76
What is acute gastritis?
Gastric mucosal inflammation caused by an imbalance between protective factors and secretion of acid and pepsin
77
Etiology of acute gastritis? (6)
- NSAID toxicity - Alcohol - Bile - Shock/sepsis - Intracranial lesions - H. pylori (more often chronic)
78
What happens in acute gastritis when mild inflammation progresses to active inflammation?
Lots of neutrophils above basement membrane contacting epithelial cells
79
In severe cases where erosion and bleeding occur, what is acute gastritis called?
Acute erosive hemorrhagic gastritis
80
Clinical features of acute gastritis?
- Dyspepsia - Nausea, vomiting, loss of appetite, belching, bloating - Acute abdominal pain
81
Complications of acute gastritis?
- Perforation leading to peritonitis - Bleeding - Chronic gastritis
82
Most common cause of chronic gastritis?
H. pylori
83
Most common site in the stomach for H. pylori infection?
Stomach antrum
84
Types of chronic gastritis? (2)
- Non-atrophic = inflammation without loss of gastric glandular cells - Atrophic = loss of gastric glandular cells
85
What are gastric glandular cells replaced by in chronic atrophic gastritis?
Intestinal epithelium, pyloric-type glands, fibrous tissue (metaplasia)
86
Common cause of non-atrophic and atrophic chronic gastritis?
- Non-atrophic = H. pylori - Atrophic = H. pylori and autoimmunity
87
What do H. pylori bacteria seem to cause the reduction of?
Mucous and bicarb secretion
88
What may overgrowth of MALT associated with H. pylori be associated with?
Gastric lymphoma
89
Clinical features of chronic gastritis?
- Epigastric pain - Nausea, vomiting, anorexia, early satiety - Weight loss
90
Complications of chronic gastritis?
- PUD - Gastric adenocarcinoma - MALT lymphoma
91
Two main types of peptic ulcer disease?
- Duodenal - lower likelihood of perforation/malignancy - Gastric
92
Etiology of PUD?
- H. pylori infection - NSAIDs - Cigarette smoking
93
Pathogenesis of PUD?
Occurs due to imbalance between defense mechanisms and damaging factors causing chronic gastritis
94
Duodenal ulcer and gastric ulcer pathogenesis?
H. pylori colonization due to: - decreased bicarb in duodenum - increased gastric acid in antrum
95
Gastric ulcer in fundus or body pathogenesis?
Caused by mucosal atrophy
96
Peptic ulcers are round to oval shaped, sharply _______ defect
punched-out
97
What can happen to larger vessels within scarred area of ulcer?
They can become thickened and thrombosed
98
Clinical features of PUD?
- Intense pain associated with perforation, bleeding, peritonitis - Duodenal ulcers relieved by eating and awake patient at night - Gastric ulcers weight loss is common - Can also present with iron-deficiency anemia, bleeding, nausea/vomiting, bloating, and belching
99
Complications of PUD?
- Perforation leading to peritonitis - Bleeding - Gastric adenocarcinoma & MALT lymphoma

BMS150 Post-MT2 (17 decks)

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