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Selected topics Exam 1
Gi, pancr, liver. do them in order cause it will make more sense
340
Nursing
Graduate
02/07/2013

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Term
G cells make this hormone.
Definition
Gastrin
Term
CCK (cholecystokinin)
Definition
made by I cells in the Duodenum/Jejunum
Term
the 5 sphincters in the GI system?
Definition
SES
LES/Cardiac
Pyloric Sphin
Illeocecal
Rectal/Anal Sigmoid
Term
4 functions of the GI tract?
Definition
1. secretiton
2. motility
3. absorption
4. excretion
Term
Blood supply to the GI tract is controlled by what?
Definition
Nervous system: SNS and PSNS
Term
2 types of SM in the GI tract?
Definition
longitudinal (located in 3 incomplete sections in the LI, fyi)
circular (acounts for the "ring like" structure of the GI tract)
Term
What connects the tissue in the GI tract to allow for fast, uninterrupted transfer or AP's for rhythmic contractions?
Definition
gap junctions
Term
What is the term for a stimulus to a muscle that transfers in all directions from that point?
Definition
Syncytium
Term
Does the GI tract have direct innervation from the PSNS or SNS?
Definition
NO, all innervation is done "thru passing" of nervous system near the GI system
Term
SNS stimulation in GI does?
Definition
inhibitory, decreases: blood flow, motility, secretions, etc.
Term
PSNS stimuli in the GI does?
Definition
excitatory, increases: motility, secretitons, blood flow
Term
What is one of the main cranial nerves associated with much of the GI systems activity?
Definition
X Vagus
Term
What is the name of the Gi's own nervous sustem?
Definition
Enteric ENS
Term
what are the 2 plexuses within the ENS?
Definition
1. myenteric/Auerbachs
2. Submucosal/Meissners complex
Term
The myentreric/auerbachs plexus is located where? and controls what in the GI system?
Definition
1. btwn longitudinal and circular SM
2. controls GI movements, mixing, rhythmic motions, excitatory in nature
Term
myentreric/auerbachs plexus secretes what inhibitory transmitter? and what does it do?
Definition
1. vasoactive intestinal polypetide
2. inhibits the pyloric sphincter when foods needs to empty into the duodenum
Term
The Submucosal plexus/Meissners complex is located where? and what is its main funx?
Definition
1. btwn submucosa and circular SM layer
2. controls GI secretion, absorption, and local Blood flow
Term
how many estimated neurons are inthe GI system?
Definition
100mil more than SC
Term
NTMs associated with the ENS?
Definition
ACh, NE, epi, ATP, 5HT, Dop, CCK, Sub P, VIP, Somatostatin, Bombesin...
Term
_______ is the term for propulsive movement that is stimulated by distention in the GI tract.
Definition
peristalsis or peristaltic waves
Term
What plexus must be intact for peristalsis to occur?
Definition
myenteric/auerbachs plexus
Term
What does Atropine do to the GI tract?
Definition
paralyzation of the cholinergic nerve endings or the myenteric/auerbachs plexus
Term
When the GI tract relaxes downstream form a mass of food being moved forward is called?
Definition
Receptive Relaxation
Term
"Law of the Gut"
Definition
the combination of the myentric relfex and the direction of peristalsis = food moving out your ass!!
Term
_____ tough connective tissue that forms the outer layer of GI tract.
Definition
serosal
Term
Immediatly proximal to serosal layer is the _______ that is oriented up and down the GI tract. (is excitable)
Definition
longitudinal SM
Term
_____ is the 3rd layer of the GI tract and contract in a circular motion.
Definition
circular muscle
Term
______ layer just below the submucosal layer moving inward thru the layers.
Definition
mucosa
Term
The inner most layer of tissue within the GI system, these cells are active at all times.
Definition
mucosal layer
Term
BER?
Definition
basal electrical rhythm
Term
BER is only changed by?
Definition
BMR (basal metab rate)
Term
Where can these slow waves actually cause contractions?
Definition
Stomach
Term
What must occur for a contraction to happen on the BER?
Definition
spike potentials (Ca++ moving into SM)
Term
what ions accounts for the BER?
Definition
Na+ influx
Term
Normal resting membrane potential #?
Definition
-50 to -60mV
Term
Slow waves account for what?
Definition
the rythm/rate that contractions CAN occur but only if spike potentials occur.
Term
Spike potentials can be stimulated by? (3)
Definition
1. stretch
2. ACh
3. PSNS
Term
Hyperpolarization of the slow waves occurs from what NTMs?
Definition
NorEpi (SNS)
Term
What is the name of the "pacemaker cells" in the GI system?
Definition
interstitial cells of Cajal
Term
If all the nervous system is cut away from the GI tract will it still funx?
Definition
yes
Term
Spike potential threshold is what mV?
Definition
-40mV
Term
BER cycles in the stomach? (this is the MAX rate contraction can occur, and the only place that contractions occur from slow waves)
Definition
3-5/min
Term
BER cycles in the Duodenum?
(this is the MAX rate contraction CAN occur but only if spikes happen)
Definition
12/min
Term
BER cycles in the jejunum?
(this is the MAX rate contraction CAN occur but only if spikes happen)
Definition
10
Term
BER cycles in the Illeum?
(this is the MAX rate contraction CAN occur but only if spikes happen)
Definition
7-8
Term
BER cycles in the Cecum?
(this is the MAX rate contraction CAN occur but only if spikes happen)
Definition
9
Term
BER cycles in the Sigmoid?
(this is the MAX rate contraction CAN occur but only if spikes happen)
Definition
16
Term
GI response to catecholamines (SNS)?
SM?
sphincters?
BER?
Spikes APs?
Definition
inhibit
excite
no effect
inhibit
Term
GI response to 5HT, ACh, Hist (PSNS)?
SM?
sphincters?
BER?
Spikes APs?
Definition
excite
inhibit
no effect
excite
Term
Blood flow increases durring GI activity, what substances released from MUCOSA cause this? (5)
Definition
CCK, vasoactive intestinal peptide, gastrin, secretin
Term
Blood flow increases durring GI activity, what substances released from GLANDS cause this? (2)
Definition
Kallidin
Bradykinin
Term
When metab demands increase in the gut O2 levels drop and _____ increases production by 10 fold.
Definition
Adenosine
Term
Due to the design and arrangement of arterial and venous blood flow in the Villi, what can occur under stressful states like Shock?
Definition
no blood flow/exchange at the ends of the villi leading to ischemic death of tissue
Term
When SNS stimulates the GI system and constricts blood flow, ischmeic vasodilators are released and overcome the SNS constriction to return blood flow back near normal, this is called?
Definition
Auto-regulatory Escape
Term
Secretory Glands 2 general functions?
Definition
1. digestive enzymes
2. mucous (lubricant/protection)
Term
Salivary glands secrete _____, ______, _____, to help prepare food and stick it together.
Definition
mucous, ptylain, ECF
Term
What 2 digetive enzymes are secreted by the salivary glands that end up in the stomach?
Definition
1. Amylase - breaks down CHO
2. Lipase - inactive when it hits stomach
Term
Saliva in the mouth main funxs? (5)
Definition
1. help w/ speech, swallowing, taste
2. antibacterial
3. hypersalivate to noxious stimuli
4. dental health
5. secrete digestive enzymes
Term
Saliva pH?
Definition
6-7
Term
Daily saliva production?
Definition
1 - 1.5L
Term
Parotid gland saliva production.
Active?
Rest?
Definition
20%
30%
Term
Submaxillary gland saliva production.
Active?
Rest?
Definition
70%
60%
Term
Sublingual gland saliva production.
Active?
Rest?
Definition
10%
10%
Term
What ion is saliva very high in, this aids in the H+ exchange later in the stomach?
Definition
K+ (25meq/L)
Term
Organic substances in saliva? (5)
Definition
mucous
Blood Antigens (A B O)
Amylase
Lysosomes
Iodine
Term
PSNS does what to saliva production?
Definition
increase
Term
What nerve collection controls salivary gland funx? and what CNs?
Definition
Inferior & Superior Salivary Nuclei (made up from CN VII & IX)
CN: X, VII, IX
Term
Vagus (X) nerve has more efferent or afferent transmissions?
Definition
afferent
Term
Autoimmune disorder where antibodies attack salivary glands and pt has no tears and dry mouth? treatment?
Definition
Sjogrens Syndrome
Tx: Restasis (artifical tears/saliva)
Term
Formation of stones in the salivary glands? Treatment?
Definition
Sialoithiasis
Tx: Surgery
Term
Dry mouth, ulcers, caries, gum disease? Treatment?
Definition
Xerostoma
Tx: gargle w/ medications to stimulate glands
Term
Viral infection of salivary glands?
Definition
Mumps
vaccinate
Term
What CNs are excited when food hits the back of the throat?
Definition
V (trig) & IX (glosso)
Term
What is the area that CN's associated w/ swallowing send their afferent sensory msgs?
Definition
Tractus Solitarious/Swallowing Center
CN V, IX
Term
Efferent CN nerves associated w/ chewing and swallowing?
Definition
V, IX, X, XII, all of these come form the swallowing center
Term
Phase I of swallowing is voluntary or involuntary?
Definition
voluntary, we make the decision
Term
How long does phase II take in the swallowing pathway?
Definition
6 seconds, occurs btwn inspiration or experation
Term
Phase II: Pharyngeal
sensory from CN V(trig) and CN IX(gloss) is sent to _____ which initiates all the muscle actions of this phase.
Definition
Tractus Solitarius
Term
Phase II pharyngeal:
Afferent limb CNs?
Definition
V & IX
Term
Phase II pharyngeal:
Efferent limb CNs?
Definition
V, IX, X, XII
Term
______ inhibits the respiratory center of the Medulla during Phase II of swallowing?
Definition
Swallowing Center
Term
What is the fancy term for swallowing?
Definition
deglutition
Term
When _____________ occurs phase II of swallowing is over?
Definition
food is transported past vocal cords
Term
What sphincter has to relax for swallowing to occur?
Definition
SES
Term
What type of movement propels food down the esophagus?
Definition
peristaltic mvmt
Term
The _____ swings back and covers the trachea during swallowing?
Definition
epiglottis
Term
When swallowing is not occurring what sphincter is held tightly shut so that no air enters the esophagus?
Definition
SES
Term
Phase III: Esophageal Phase of swallowing moves food from the ____ to the _____.
Definition
pharynx, stomach
Term
The Esophagus has 2 types of peristalsis?
Definition
1. Primary - initiated by stretching
2. Secondary - initiated from food being in the Gi tract
Term
Damage to any of these CNs will impair swallowing?
Definition
5, 9, 10, 12
Term
______, which is gerneral muscle weakness that can progress to paralysis will impair swallowing?
Definition
MG
Term
Posion from improperly canned foods that can cause paralysis and impair swallowing?
Definition
Botulism
Term
Difficulty swallowing?
Definition
dysphagia
Term
Deep anestehsia can impair swallowing by?
Definition
paralyzing epiglottis and laryngeal reflexes, usually only an issue when pt vomits
Term
Esophagus muscle in the upper 1/3 is?
Definition
striated
Term
Muscle in the esophagus in the lower 2/3 is?
Definition
Smooth
Term
Term for inability to swallow?
Definition
Achlasia
Term
AChlasia (inability to swallow) is a result of what sphincter not opening?
Definition
LES
Term
Barretts Esophagus is?
Definition
change in normal lining of esophagus r/t reflux and usually forewarning to CA
Term
Hiatal Hernia occurs when the esophagus and sometimes the LES get stuck btwn?
Definition
Diaphragmatic opening
Term
Landmark for anatomy of the stomach located at the notch on the greater curvature side of the stomach?
Definition
Angular Notch/Incusuria Angularis
Term
Folds of the stomach that increase surface area?
Definition
Rugae
Term
Folds in the stomach that allow pathways that fluid and substances move down are called?
Definition
Magenstrasse (stomach street)
Term
Area of the stomach from the Fundus to the angular notch?
Definition
Corpus/Body
Term
Base of the Stomach?
Definition
antrum
Term
Sphincter that empties from the stomach into the SI?
Definition
pyloric
Term
Upper portion of the stomach?
Definition
Fundus
Term
SNS stimulation of the stomach only increase one thing?
Definition
mucous production
Term
What type substances are absorbed in the stomach?
Definition
very lipid soluble, EtOH, ASA
Term
Pacemaker of the stomach?
Definition
Incusuria angularis
Term
What is important to know about the "pacemaker" of the stomach when food is being processed?
Definition
it moves up the wall of the stomach above the food to allow greater full contractions of the stomach down thru the contents (mixing)
Term
What 2 ways are proteins broken down in the stomach?
Definition
1. Acid hydrolysis
2. Pepsin (once pH is above 3.0)
Term
what 2 ways are lipids broken down in the stomach?
Definition
1. ACid hydrolysis
2. Lipase
Term
What 2 ways are sugars broken down in the stomach?
Definition
1. acid
2. Amylase
Term
How long does it take the stomach to digest 1 meal?
Definition
1-2 hours
Term
What 3 things must occur for the pyloric sphincter to open and allow stomach emptying?
Definition
1. ~300 osmo
2. fluidity of paste (chyme)
3. pH 4-5
Term
Accelerated stomach emptying occurs from? (4)
Definition
hyptotonic
liguid
high sugar/starch
high food volume
Term
Intermediate stomach emptying occurs from? (3)
Definition
isotonic
high protein
semi solid foods
Term
decreased stomach emptying occurs from? (3)
Definition
hypertonic
high fats
solid foods
Term
The oxyntic gland/cells are located?
Definition
fundus & antrum of stomach
Term
There are 2 types of mucous cells in the stomach, what are they?
Definition
mucous cells - outer barrier of mucous
mucous neck cells - mucous to protect pits of the onxytic gland
Term
What type of cell in the stomach produces acid, and is part of the oxyntic gland?
Definition
oxyntic cell/parietal cell
Term
The oxyntic cell/parietal cell produces 2 things?
Definition
HCL acid
intrinsic factor
Term
The oxyntic/parietal cells in the stoamch produce intrinsic factor, what does it do?
Definition
Protein binds with Vitamin B12 to form Transcobalamin
Term
How is Vitamin B12 stored throughout the body? (what is the name of the complex)
Definition
transcobalamin
Term
Vitamin B12 is associated with the stimulation of _______ maturation.
Definition
RBCs
Term
What is Vitamin B12 deficiency called?
Definition
Pernicious Anemia
Term
What do the RBCs look like in a person with Pernicious Anemia?
Definition
hypochromic (no color)
Term
Peptic/Chief cells are located where in the stomach?
Definition

Oxyntic Gland

Fundus & Corpus

Term
Peptic/cheif cells release what in the stomach?
Definition
Pepsinogen
Term
What activates Pepsinogen in the stomach?
Definition
HCL acid
Term
Pepsiongen's optimal pH for breaking down proteins is _____? What pH does it stop working at?
Definition
1. 1.8 - 3.5 (book numbers)
2. >5.0
Term
Pepsinogen is released in response to _____ NTM associated with CN X?
Definition
ACh
Term
Pepsinogen is released in response to _____ coming in contact with ____ cells in the rugae?
Definition
1. HCL acid 2. peptic cells (oxyntic gland)
Term
When you eat food, the pH in the stomach does what?
Definition
Goes up alot
Term
Peptic/Cheif cells release 2 enzymes?
Definition
1. pepsinogen - breakdown proteins
2. lipase - breakdown lipids/fats
Term
Pyloric Gland is located where in the stomach?
Definition
antrum (bottom of stomach)
Term
Pyloric Gland has 1 type of cell in it, what is it and what enzyme does it mainly release?
Definition
1. G cells
2. Gastrin
Term
Gastrin release in the stomach is associated with what CN stimulation?
Definition
X Vagus
Term
Gastrin in the stomach has 6 main effects?
Definition
1. stimulate HCL
2. Stimulate/activate Pepsin
3. increase motility in jejunum
4. increase mixing of stomach
5. stimulates pancreatic enzymes
6. stimulate ECL cells to release histamine (this is important in HCL acid production)
Term
Gastrin stimulates the release of pancreatic enzymes (3)?
Definition
1. amylase - CHO breakdown
2. lipase - lipid/fat breakdown
3. trypsin - protein breakdown
Term
What are the 3 things that must be present in the stomach for OPTIMAL HCL- acid production?
Definition
1. Histamine (ECL cell activation)
2. ACh
3. Gastrin
Term
If the 3 components needed for HCL acid production are not present will HCL acid still be made?
Definition
yes, but very minimal
Term
The ____ pump in the parietal cell that produces the _____ ion needed for HCL acid?
Definition
1. H/K ATPase pump 2. H+ ions pumped into stomach
Term
What is the catalyst that speeds conversion of H2O and CO2 in the parietal cell?
Definition
CA (carbonic anyhydrase)
Term
What is the main ion driving the concentration gradient for H+ to move into the stomach?
Definition
K+
Term
Where does the extra K+ come from in the stomach to provide exchange w/ H+ by the H/K ATPase pump?
Definition
saliva K+[25meq]
Term
What type of barrier exists on the Parietal cell that prevents back flow of H+ into the cell?
Definition
mucous layer, if this layer is impaired then ulcers can occur
Term
Name the 3 phases of HCL acid secretion?
Definition
1. Cephalic phase
2. Gastric phase
3. Small Intestine phase
Term
Explain what the main driving force of the Cephaic phase1 of HCL acid production?
Definition
thinking about food or Blood Sugar is low, this occurs before any food is ingested
Term
Explain what the main driving force of the Gastric phase2 of HCL acid prodcution?
Definition
food enters stomach
1. vagovagal reflex stimulated
2. ENS reflex stimulated
3. Gastrin released
Term
Explain what the main driving force of the Small intestine phase3 of HCL acid prodcution?
Definition
food enters Duodenum
gastrin released @ dudenal mucosa, stimulates HCL acid secretion
Term
Phase 1, 2, & 3 produce how much in % of HCL acid in the stomach?
Definition
1. 20-30%
2. 60%
3. 10%
Term
Gastrin released during Cephalic phase1 of HCL acid production causes mixing and contraction of an empty stomach, the noises heard are called?
Definition
Borborygmi
Term
The main thing that inhibts HCL acid production? (very general)
Definition
food entering the Duodenum (SI)
Term
What are the enzymes released when food enters SI that inhibits HCL acid production? (4)
Definition
1. secretin
2. GIP
3. VIP
4. somastatin
Term
HCL acid OVER production results in?
Definition
Peptic ulcers
Term
Causes of over production of HCL acid in the stomach? (5)
Definition
1. Type A personality
2. ZES (zolinger ellisoe Syndrome
3. H pylori
4. poor blood supply
5. poor/impaired mucous production
Term
Name the 3 common places/locations in the GI system where ulcers occur?
Definition
1. Cardiac/LES
2. antrum (bottom of stomach) (most common)
3. Pyloris/duodenum SI
Term
HCL acid underproduction is associated with chronic ______?
Definition
gastritis
Term
What are common causes of chronic gastritis leading to under production of HCL acid?
Definition
1. ASA
2. EtOH
3. stomach CA
4. infection of parietal cells
Term
NO HCl- acid production/present?
Definition
achlorhydria
Term
very minimal HCL- acid present/produced?
Definition
hypochlorhydria
Term
What CNs are associated with vomiting reflex?
Definition
5, 7, 9, 10, 12
Term
What are the 3 main complications of vomiting? explain each
Definition
1. loss of H2O - dehydration
2. loss of HCL - metabolic alkalosis
3. loss of K - weakness, hypoK+
Term
Enterochromaffin Like Cells (MAST), aka ECL cells, release what?
Definition
Histamine
Term
Enterochromaffin Like Cells (MAST), aka ECL cells, are located where?
Definition
sparsely throughout the gastric mucosa
Term
What are the anatomical structures in the SI that drastically increase surface area for absorption?
Definition
1. Valvulae Conniventes (Folds of Kercring)
2. Macrovili
3. Microvili
Term
What enzymes cover the macrovilli in the SI? (4)
Definition
1. Sucrase - sugars
2. Lactase - lactose
3. Maltase - maltose
4. Enterokinase - activates trypsinogen
5.
Term
What % of fats are drained into the lymph system from the macrovilli?
Definition
90-95%
Term
What is the protein-like sturucture covering the villi in the SI that are composed of many digestive enzymes?
Definition
glycocalyx
Term
What type of movements occur in the SI?
Definition
segmentation/myogenic contraction (NOT peristalsis)
Term
What is the purpose of "chopping" up the chyme within the SI by myogenic/segmentation?
Definition
maximize absorption
Term
Peristalsis in the SI is stimulated by?
Definition
vagus nerve
GI hormones
stretch receptors
Term
Peristaltic Rush is activated by? (2)
Definition
1. irritation from toxic substances
2. overactive vagus nerve
Term
What is the characteristics of Peristaltic Rush?
Definition
longer perstaltic contractions 20-30cm long that overloads the LI and leads to EXPLOSIVE diarrhea
Term
What is the purpose of anti-perstalsis, and where does it occur in the SI?
Definition
1. allows further mixing of chyme by contracting against the pyloris
2. duodenum
Term
Where is anti-peristalsis also occurring in the LI? and why?
Definition
1. Colon
2. allows further reabsorption of water
Term
CCK is release in response to high fat meals and does what?
Definition
1.contract gall-bladder to inject extra bile into duodenum
2. decrease stomach contractions
3. increase pancreatic enzyme secretion
4. increase bile secretion from Liver
Term
Secretin is released from what part of the GI system? What causes its release?
Definition
1. S cells of Duodenum
2. stimulates pancreas to secrete HCO3 to bring pH back up so it doesn't eat up the SI
Term
GIP (gastric inhibitory peptide) main funx is to do what?
Definition
negative feedback enzyme for the GI system to stop HCL acid production
Term
Motilin is released from where in the GI system? what does it stimulate?
Definition
1. Duodenum
2. increase SI motility (secreted when food enters the duodenum)
Term
As the GI system decends the nervous system becomes less involved and ______ control dominates.
Definition
hormonal
Term
Where does the cellular activity occur in the SI tissue?
Definition
Crypts of Lieberkuhn
Term
X-section of SI tisssue would characteristically look like?
Definition
there is almost no lumen because the infoldings take up most of the lumen.
Term
What do mucous goblet cells secrete in the SI?
Definition
large amounts of mucous to protect mucosa
Term
Where is the Brunners Gland found?
Definition
first few inches of Duodenum
Term
What is the main role of the Brunners Gland?
Definition
secrete large amounts of mucous to protect the duodenum from HCL acid spilling into the SI
Term
SI reflex _______ pushes food from the SI to the colon and occurs primarily from the ENS.
Definition
Gastro-ileal reflex
Term
The _______ relfex causes peristalsis to occur in the LI and pushes feces out the rectum to allow for new food to be ingested.
Definition
Gastro-colic reflex
Term
What is the general term for malabsorption in the SI?
Definition
Sprue
Term
Celiacs disease/Non-tropical Sprue is characterized by?
Definition
gluten sensitivity, that causes irritation, inflammation, and sloughing off of the intestinal cells.
Term
Tropical Sprue is characterized by?
Definition
inflammation in the SI to viral/bacterial infection aka "montezuma's revenge"
Term
Blind Loop Syndrome is characterized by what?
Definition
stapling of area of the GI tract and this area became ischemic and died leading to sepsis and death
Term
Dumping Syndrome is characteristic of what type of surgery?
Definition
gastrectomy or surgical removal of Duodenum
Term
What causes the hypoglycemia associated with dumping syndrome?
Definition
rapid absorption of sugars elevates BS and pancreas rapidly releases insulin to drop BS
Term
What causes the hypotension/dizziness/syncope/shock-like states with dumping syndrome?
Definition
high osmo in the intestines draws large volumes of H2O into GI system as it trys to makes the contents isotonic but is unsuccessful..
Term
Cholera is caused by what bacteria?
Definition
Vibrio Cholera (gram +)
Term
Where does the cholera bacteria endotoxins illicit their effects?
Definition
Crypts of Lieberkuhn (between the villi)
Term
Cholera binds to what in the intestinal cells causing a large amount of Cl- shifting?
Definition
ATPase pump - causing Cl- to shift rapidly and Na+ follows w/ H2O too fast and this leads to unending diarrhea
Term
How is Cholera treated?
Definition
IV fluids STAT
Term
Pancreatic Cholera is similar to the bacteria form, but this type is caused by?
Definition
CA/Tumor secreting VIP (vasoactive intestinal peptide)
Term
Obstruction at the Pylorus has what kind of vomit?
Definition
highly acidic
Term
Obstruction at the duodenum or below has what kind of vomit?
Definition
neutral or basic vomit
Term
Low obstruction of the GI system causes?
Definition
constipation and much less vomiting
Term
What are the 2 ancillary organs of the GI system?
Definition
1. Liver
2. Pancreas
Term
The pancreas's exocrine properties are secreted into _______.
Definition
ductal systems then into blood (as opposed to the endocrine going straight into the blood)
Term
The exocrine portion of the Pancreas is made up of what type of cells?
Definition
pancreatic acini (island) cells
Term
The pancreatic acini cells secrete enzymes in response to what substances released from the duodenum? (2)
Definition
1. secretin - increases HCO3 release
2. CCK - increases in response to high fat meal
Term
The most common pancreatic enzymes are?(3)
Definition
1. amylase - breaks CHO 2. lipase - breaks Lipids 3. Trypsin Family (all breakdown protein - Elastase, carboxypeptidase)
Term
The enzyme Lipase, realeased by the pancreas, is associated with what actions?
Definition
1. break down triglycerides/fats/lipids
2. stimulate Liver to release Bile
Term
How much (%) of the Pancreas is exocrine and how much is endocrine?
Definition
95%
5%
Term
Most common cause of Pancreatitis?
Definition
chronic EtOH
Term
The 2nd most common cause of Pancreatitis?
Definition
gallstone
Term
Pancreatitis can be caused by gallstones that get lodged in what area?
Definition
Papilla Vater
Term
Blockage of the Pancreas's spincter of Oddi causes what to occur?
Definition
digestive enzymes back up into Pancreas, the enzymes begin to eat away at the pancreas and infection/inflammation proceeds
Term
What enzyme does the Pancreas have that attempts to inhbit the digestive enzymes from eating the pancreas?
Definition
trypsin inhibitor - easily overwhelmed when blockage occurs
Term
What are the 3 sources of CHO in our diet?
Definition
1. sucrose (sugar)
2. Lactose (milk)
3. Starches (complex CHO)
Term
Carbohydrate breakdown starts in the ______ with the activity of ______.
Definition
mouth amylase
Term
Majority of CHO breakdown occurs in what are of the GI system?
Definition
intestines
Term
Maltose + Maltase =
Definition
Glucose - taken up into SI > blood > Liver for processing
Term
Lastose + Lactase =
Definition
Galactose then absorbed into cells and converted into glucose and transported to Liver
Term
Sucrase = Sucrose =
Definition
Fructose is absorbed into intestine and into blood which goes straight to Liver
Term
Pepsin and Acid hydrolysis breaks protein down into? (3)
Definition
1. protease
2. peptones
3. polypeptides
Term
Trypsin and Chymotrypsin further break proteins down into?
Definition
smaller peptides
Term
Carboxypeptidase further breaks polypeptides down into?
Definition
Amino Acids
Term
Proteolase forms elastase that breaks down?
Definition
elastin fibers
Term
Protein breakdown pathway?
Definition
Protein > (pepsin) > Proteoses, peptones, polypeptides > (trypsin, chymotrypsin, carboxypolypeptidase, proelastase) > polypeptides + Amino Acids > (peptidases) > Amino Acids
Term
All amino acids are pumped across cell membrane via (ion)?
Definition
Na+
Term
Bile is produced in what organ?
Definition
Liver
Term
Bile is sotred in what organ?
Definition
Gallbladder
Term
Bile is injected into the _____ thru the sphincter __ _______ located in the ______ which then ends up in the _______ (part of SI).
Definition
1. Common bile duct
2. sphincter of Oddi
3. located in the Pappila Vater
4. Duodenum (SI)
Term
Bile breaksdown fats into ?
Definition
triglycerides
Term
The action of lecithin and bile sats breaking down fats into smaller parts and making them more soluble is called?
Definition
emulsification of fat
Term
Once fat is emulsified , pancreatic Lipase cleaves the triglycerides into? (2 pairs of things)
Definition
1. 2 free fatty acids
2. 2 monoglycerides
Term
Bile salts form a barrier around the FFA and 2M, this barrier allows easy movement within cells, and this is called?
Definition
micelle
Term
Once the FFA and 2M are absorbed by the villi in the SI they are re-synthesized back into?
Definition
triglycerides
Term
The newly reformed triglycerides are taken into the ER of the cells and made into?
Definition
chylomicrons
Term
The chylomicrons located in the ER are taken up by what system and carried back to the Liver?
Definition
lympahtics (that dump into Left subclavian vein and right lymphatic duct)
Term
Deficiency in bile salts ability to breakdown fats can cause stools to have a high fat content, this is called?
Definition
streattorhea (floating poo)
Term
Main function of the Colon is to?
Definition
reabsorb remaining Na+ and H2O from the stool
Term
The illeocecal valve/sphincter opens in response to? (2)
Definition
1. pressure
2. irritation
Term
The ascending Limb of the LI is located on what side of the body?
Definition
Right
Term
The descending colon is located on what side of the body?
Definition
Left
Term
How long is the LI tract?
Definition
3.5 - 4ft
Term
The incomplete longitudinal layers (3) in the LI are called? (makes up the bulges)
Definition
Taniae Coli
Term
The LI has 3 forms of movement?
Definition
1. myogenic contractions/ haustrations 2. anti-peristalsis 3. peristalsis
Term
Another name for the myogenic contractions seen in the LI that account for the bulging effect durring contraction of the LI?
Definition
haustration movements
Term
Anti peristalsis that occurs in the LI is predominantly in the ____ portion and its purpose is?
Definition
1. descending 1/3 of LI
2. reabsorb Na+ and H2O
Term
___ - ____ cc/day enter the LI and ____cc/day is actually seen in the stool.
Definition
1. 500-700cc/day enters
2. 150cc/day in stool
Term
Intestinal bacteria in the LI is called?
Definition
Normal Flora (escheria Coli)
Term
The final product of peristaltic rush occurring in the LI?
Definition
diarrhea!
Term
Total amount of fluid absorbed by the LI per day?
Definition
400-550ml
Term
Single pocket or bulge in the LI usually associated with age/poor diet/constipation?
Definition
diverticuli (inflammation of them is called Diverticultis)
Term
Chronic constipation is called?
Definition
obstipation
Term
Genetic absence of myenteric plexus leading to a lack of peristalsis and decreased moltility most commonly seen in the LI is called?
Definition
Hirschprung's Disease (megacolon)
Term
Ulcerative colitis is characterized by?
Definition
inflammation primarily in rectum and descending colon
Term
Chron's disease is characterized by?
Definition
inflammation of entire colon and some parts of the SI
Term
Defecation reflex is primarily controlled by?
Definition
PSNS (not vagus)
Term
The cortex has some control over defecation and will inhibit nerves at what level in the SC to allow some decision about when to take a crap?
Definition
sacral level
Term
Defecation can also be initiated by contraction of ____ which lowers diaphragm and presses on the LI/bowel.
Definition
abdominal muscles
Term
What % of feces is water and solids?
Definition
25% solid
75% water
Term
Of the Solid % of stool what makes up this portion? (4)
Definition
30-35% bacteria
30-35 undigested material (cellulose)
20% fat
10-20@ inorganic material
Term
What is the largest organ in the body not counting the SKM system?
Definition
Liver
Term
The Liver receives what % of CO?
Definition
25-30% (1500ml/min)
Term
Of the 1500ml of blood received into the Liver per min, what is the breakdown in mL to each vessel?
Definition
1. 400mL/min from hepatic artery
2. 1100mL/min from portal vein
Term
The liver gets the 1st crack at all the absorbed materials from the GI system expect _____ which eventually ends up in the liver from lymphatic system?
Definition
fats
Term
Name the 4 cells of the Liver?
Definition
1. epithelial -leaky
2. parenchymal "hepatic" cells - filters
3. kuppfer cells - macrophages
4. mast cells - heparin is made
Term
The endothelial cells line the _____ of the liver and are characteristically ____.
Definition
1. sinusoids
2. very leaky (allow proteins thru)
Term
The parenchymal "hepatic" cells of the Liver do what?
Definition
filter
(filter glucose, AA, lipids, vitamins, iron....)
Term
The Kuppfer cells in the Liver do what?
Definition
phagocytic in nature, blood entering the liver has alot of bacteria and these cells clean the blood of all this bacteria
Term
Kuppfer cells use ____ to bind the bacteria and remove it from the blood.
Definition
opsitones
Term
Blood flows from the _____ vein into the liver lubule and ends up in the ______ vein.
Definition
portal vein
hepatic central vein
Term
What is the pressure at the portal vein end in the Liver?
Definition
8-9mmHg
Term
What is the pressure at the hepatic central vein?
Definition
almost 0mmHg
Term
What is the structure in the Liver that arterial and venous blood flow along?
Definition
Lobule
Term
what is the path/tributary that blood flows along inside the Liver lobule slowly in order to alows cells here to clean the blood?
Definition
sinousoids
Term
Bile made in the lubule is carried out thru closed end vessels called?
Definition
Bile Cannalliculus
Term
what other cells located in the liver can produce bile?
Definition
parenchymal "hepatic" cells (filters)
Term
Bile flows in what direction compared to blood flow?
Definition
Bile flows in OPPOSITE direction to blood flow
Term
What is the total fluid volume entering LI?
Definition
500-700
Term
How much fluid is absorbed by the colon?
Definition
400-500
Term
Total fluid in feces?
Definition
100-150ml
Term
One side of the parenchemal "hepatic" cell works to _______ the blood, while the back side of it secretes substances that make up ______.
Definition
1. filter
2. bile
Term
Bile flows in the opposite direction within the lobule and this closed end structure is called?
Definition
bile canalliculus
Term
How much lymph flows into circulation per min? of this amount how much is from the Liver?
Definition
120ml/min
60ml/min (50%)
Term
Area of lymph drainage that surrounds the liver cell plate within the lobule is called?
Definition
Space of Disses
Term
List the cells that make up the Liver cell plate? (2)
Definition
endothelial - leaky
parenchymal - filter
Term
Functions of the Liver as it pertains to glucose? (3)
Definition
1. synthesis
2. storage
3. breakdown
Term
Normal serum glucose?
Definition
90-100
Term
List the multiple funx of the Liver? (9)
Definition
1. metabolism of food stuffs
2. glucose synthesis, storage, breakdown
3. blood filtration
4. Vitamin storage
5. Blood resevior
6. makes clotting factors
7. storage of iron
8. synthesis of proteins
9. creates bile salts
Term
Iron in its storage form is called?
Definition
Apoferritin
Term
Iron in its broken down form that can travel to bone marrow for RBC production?
Definition
transferrin
Term
Fructose can be transformed into ______ another tpye of sugar that is used in ____.
Definition
ribose
RNA
Term
How much of stored glycogen in weight can the Liver store? muscle?
Definition
8%
1%
Term
What is significant about the glycogen that is sent to the muscle?
Definition
only the muscle can use it as energy, cannot be sent to anywhere else
Term
Excess glucose is transformed into ____ and sent to the tissues.
Definition
fats
Term
Glycogen structure is a bunch of bound _____ held together by _____.
Definition
glucose molecules
PO4
Term
_________ enzyme breaksdown glycogen into glucose int the Liver (only place this enzyme is present).
Definition
glucose phosphatase
Term
Gluconeogenesis is?
Definition
production of glucose from non-essential AA
Term
What 4 main structures/organs in the body need glucose to survive?
Definition
1. brain
2. retina
3. renal medulla
4. germ cells (reproductive)
Term
What % of food intake is fat/lipids?
Definition
45-50%
Term
Beta-oxidation is the process of?
Definition
Liver breaks 2 C off of a FA and attaches it to coenzyme-A
Term
ACetyl CoA is _______ in water and can be further metabolized into _____ which is a much more ______ form.
Definition
insoluble
acetoacetic acid
soluble
Term
Acetoacetic acid is commonly used in what cycle?
Definition
Kreb
Term
The combination of 2 Acetyl-CoA molecules forms acetoacetic acid and this can be further broken down into ______ and _____.
Definition
1. acetone
2. b-hydroxybutyric acid
Term
Ketosis is the conversion of _____ into energy?
Definition
fat/lipid
Term
What % of glucose in diet is converted to fat?
Definition
roughly 30%
Term
We cannot live without ______ metabolism.
Definition
protein
Term
Deamination of AA is done by the removal of _____ to create _____.
Definition
1. NH2
2. amonia
Term
2 ammonia + CO2 can be combined to form ____ & _____.
Definition
urea & H2O, which is excreted in the urine
Term
Transamination is the conversion of _____ into other _____ by the aid of an enzyme called ______.
Definition
AA AA transaminase enzyme
Term
What main plasma protein is made in the Liver?
Definition
Albumin
Term
What Vitamins are stored in the Liver?
Definition
A
D
B12
Term
Enough Vit A and D is stored in the Liver to last _____ days, and enough B12 for _____months.
Definition
60-90days
3-6months
Term
Vitamin K is needed for what process?
Definition
clotting cascade
Term
Where in the SI is bile salts absorbed?
Definition
Ileum
Term
Name 2 common bile salts.
Definition
1. cholic acid
2. chenodeoxycholic acid
Term
What is the primary pigment in bile come from?
Definition
bilirubin
Term
name the simple pathway of RBC destruction and its pathway to excretion.
Definition
Hgb > heme > biliverdin > bilirubin (unconjegated) > conjugate bilirubin aka bilirubin diglucuronide > urobilinogen > ...urine or feces
Term
Conjugated bilirubin is the _____ form.
Definition
soluble
Term
what gives poop its brown color?
Definition
stercobilin
Term
what give urine its yellow color?
Definition
urobilin
Term
The 4 F's of choleolithiasis.
Definition
fair, fat, female, 40
Term
Common gall stones are made of ____ or ____.
Definition
Ca++
Cholesterol
Term
What are the 4 types of jaundice?
Definition
hemolytic
hemolytic of newborn
erythroblastosis fetalis
obstructive
Term
What ratio is looked at to diagnose Liver disease? and how does this comparison show liver disease?
Definition
Alb/Globulin ratio
Albumin is only made in liver and globulin is made by immune/lymph system. so if the ratio of alb drops off but globulin is normal than liver disease is evident.
Term
Hep A is not lethal and its incubation period is? and is commonly acquired through?
Definition
15-45days
eating contaminated food/needles also
Term
Hep B/C is very lethal and its incubation period is? this is commonly transferred thru?
Definition
4-26 weeks
dirty needles/drugs...
Term
Phase 2 of swallowing the first step is the apposition of ________ and approximation of _______ that closes off the nares, so that food doesnt come out the nose.
Definition
1. pharyngeal wall
2. uvula & soft pallet
Term
Phase 2 of swallowing most important step (according to the book) is the tight approximation of _____ & ______.
Definition
1. vocal cords
2. trachea
Term
Pepsinogen release is strongly influenced by ______ in the stomach.
Definition
HCL acid
Term
Pepsinogen converts to _______ by ______ coming in contact with it.
Definition
1. pepsin
2. HCL acid
Term
The part of the Oxynitc/Parietal cell that secretes HCL acid is?
Definition
Canaliculli
Term
HCL acid has a pH around?
Definition
0.8 - 1
Term
THe pyloric gland located at the ______ in the stomach, has 2 types of cells ______ & ______. The ______ cell secretes ______ that comes back into the circulation and acts on another gland in the stomach called _______.
Definition
1. Antrum
2. mucous & G-cells
3. G cells
4. Gastrin
5. Onxyntic Gland (to produce HCL acid)
Term
Saliva is made from ______ which is isotonic and when its released the saliva is ________.
Definition
ECF
HYPOtonic
Term
The ATPase pump located in parietal/oxyntic cells takes how much of our caloric expenditure to funx?
Definition
1/4
Term
Input from the ______ can activate Chemo-R from motions, driving in a car, flying in a plane, anesthesia.
Definition
vestibular apparatus
Term
What drugs can initiate the Chemo-R Trigger Zone in the Medulla.
Definition
Digg & Morphine
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