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419 Cards in this Set

  • Front
  • Back
What is the order food travels through the body?
Mouth to Pharynx to Esophagus to Stomach to Small Intestine to Large Intestine to Rectum to Anus
What are the accessory organs to digestion?
Liver
Gall Bladder
Pancreas
The chopper is analogous to what organ?
Mouth
The blender, acid sterilizer, and reservoir is analogous to what organ?
Stomach
The enzyme supplier & neutralizer is analogous to what organ?
Pancreas
The detergent supplier is analogous to what organ?
Liver
The catalytic and absorptive surface is analogous to what organ?
Small Intestine
The residue combuster, dessicator, and pelleter is analogous to what organ?
Large Intestine
The emission control device is analogous to what organ?
Anus
What is the word for the covering of the internal and external organs of the body and the lining of the vessels, body cavity, glands, and organs?
Epithelium
Epithelial cells are usually:
A. Squamous
B. Cuboidal
C. Pseudostratified
D. Columnar
D. Columnar
In the ________ you will find stratified squamous cells instead of the usual columnar cells for the epithelium.
Esophagus
True or False: There are small amounts of stem cells present in the epithelium.
False!! There are large amounts because theres a constant turnover of cells.
Which type of cells represent the barrier that prevent the entry of food into the blood supply?
Columnar epithelial cells
What 3 layers make up the mucosa?
- Epithelium basement membrane
- Lamina propria
- Muscularis mucosa
What 3 layers make up the muscularis propria?
- Circular muscle
- Myenteric plexus
- Longitudinal muscle
What are the 4 main layers of the wall of the intestine?
- Mucosa
- Submucosa
- Muscularis propria
- Mesothelium (Serosa)
What allows for the communication of muscle fibers?
Gap junctions
Which ion is needed by smooth muscle cells to activate the action potential?
Calcium!!!
True or False: The smooth muscle of the GI tract is excited by continual, slow, intrinsic electrical activity along the membrane of the muscle fibers.
Trueeeee. She said that word for word. lol
True or False: The more the wave potential increases, the lower the spike potential.
False!!!

The higher the spike potential
How many sphincters are present in the GI tract?
7
Name the sphincters in the GI tract
- Upper esophageal sphincter
- Lower esophageal sphincter
- Pylorus
- Sphincter of Oddi
- Ileocecal valve
- Internal anal sphincter
- External anal sphincter
What is the term for muscle fibers that constrict a passage or close natural openings?
Sphincters
Which sphincter is under our own control?
External anal sphincter
What part of the stomach is known for secretion and being a reservoir?
Fundus/Body
What part of the stomach is known for mixing and grinding of the food?
Antrum
What part of the stomach controls its emptying into the small intestine?
Pylorus

It also pushes food back for more grinding
What are the 3 parts of the small intestine?
- Duodenum
- Jejunum
- Ileum
Which part of the small intestine is immediately distal to the pylorus?
Duodenum
What is the term for the duodenum + pancreas + bilary system?
Duodenal cluster unit
Where in the small intestine specifically do the secretions from the exocrine pancreas and liver/gallbladder drain into?
Duodenum
Where does the majority of nutrient absorption in the small intestine occur?
Jejunum
What causes the increased surface area in the jejunum?
- Surface folds aka folds of Kerckring
- Crypts
- Villi
What are crypts?
They are folds in the intestine designed to increase surface area.

(Like waiting lines at a ride at a theme park)
What compensates for a nonfunctional jejunum?
The ileum
What parts of the large intestine are geared for absorbing fluids that were previously not absorbed and also dietary by-products?
Ascending colon and transverse colon
What part of the large intestine serves primarily as storage of fecal wastes?
Descending colon
True or False: The liver gets only arterial blood.
False!

It gets both arterial and venous blood
The aorta branches out into what 3 arteries which give blood supply to the GI tract?
- Celiac artery
- Superior mesenteric artery
- Inferior mesenteric artery
True or False: The villi have countercurrent blood flow.
True
What are the 3 main modes of communication in the GI tract?
- Endocrine
- Paracrine
- Neurocrine
True or False: The enteric nervous system is in control of all parts of the GI tract.
False! It is NOT in control of the oral cavity (mouth)
What are 3 substances that regulate GI function through paracrine communication?
- Histamine
- Prostaglandins
- Somatostatin
What is the term for organs with specialized cells that secrete substances not related to their ordinary metabolism?
Glands
Name the different types of glands
- Single cell mucous glands
- Pits/crypts
- Tubular glands
- Complex glands
What is the function of single cell mucous glands?
To protect and lubricate the epithelium
Tubular glands are found mostly in which organ?
The stomach
Complex glands are found where?
- Liver
- Pancreas
- Parotid gland
- Submandibular gland
- Sublingual gland
What do all complex glands have?
Exocrine secretory acini
True or False: The major salivary glands produce 600 ml to 1 L of saliva a day.
True
What are the major salivary glands?
- Parotid gland
- Submandibular gland
- Sublingual gland
Which salivary gland(s) lack mucins?
Parotid gland
Which salivary gland(s) secrete watery substances?
Parotid gland
Which salivary gland(s) produce viscous saliva that contains mucins?
Sublingual
Submandibular
True or False: The parotid, submandibular, and sublingual glands all contain serous and mucous cells.
Falseeeeee!

The parotid gland does NOT contain mucous cells
What are the components of saliva?
- Water
- Electrolytes
- Enzymes
- Growth factors
- Secretory immunoglobulins
What are the main functions of the saliva?
- Digestion
- Protection
- Oral hygiene
What substance lubricates and moistens food in the oral cavity to make swallowing easier?
Saliva
What helps with the initiation of carbohydrate digestion?
Saliva
True or False: The saliva contains secretory immunoglobulins.
True!!

They help with protection
How does the saliva help with protection and oral hygiene?
- Cleans the mouth
- Has enyzmes with antimicrobial properties
- Has secretory immunoglobulins
Name 3 protective salivary proteins? (aka these enzymes help with protection)
- Lactoperoxidase
- Lysozymes
- Cytokines
Which salivary enzyme is found in milk and inhibits microorganisms?
Lactoperoxidase
Which salivary enzyme hydrolyzes the outer membrane of bacteria?
Lysozymes
Which salivary protein/enzyme amplifies immune activity?
Cytokines
Name 2 salivary enzmes involved in digestion.
- alpha amylase
- Lingual lipase
True or False: Alpha amylase carries out the major digestive functio of the saliva.
Trueeeee!

It breaks down starch to oligosaccharide molecules
What does alpha amylase do?
It breaks down starch to oligosaccharide molecules.
What is he optimum pH for alpha amylase to work? Between what pH can it function?
Optimum pH of 7

Function between 4 - 11
What is the salivary enyzme produced by the tongue that catalyzes the break down of lipids?
Lingual lipase
Which salivary enzyme is more active in children than adults?
Lingual lipase
True or False: Mucus is resistant to digestion by GI enzymes.
Trueeee. Duhhhhh otherwise we would have no mucus in our bodies.
What are some properties of mucus?
It is a glycoprotein

It is resistant to digestion by GI enzymes

It is a lubricant

It has low resistance to slippage
True or False: Stimulation of the parasympathetic NS results in litle saliva production.
Falseeee. It results in a lot!!!
Where does the parasypathetic stimulation of salivary glands stem from?
The superior and inferior salivary nuclei in the brain stem
Where does the sympathetic stimulation of salivary glands stem from?
The superior cervical ganglia
Which nervous system is excited by taste and tactile stimuli from the tongue and responds to smell?
Parasympathetic nervous system
True or False: Your blood supply decreases with parasymphathetic stimulation of the salivary glands.
Falseeeee. PNS stimulates saliva production which means you are eating which means you need more blood for increased absorption of food. DUHHH.
True or False: Saliva is a filtrate of plasma.
Trueeeee
What 3 molecules stimulate the release of alpha amylase from granule cells?
Acetylcholine
Histamine
Norepinephrine
Alpha amylase is producd n which type of cells?
Acinar cells
Describe the process by which alpha amylase is released.
- Alpha amylase is stored in zymogen granules
- When stimulated, zymogen granules fuse with the apical plasma memrane
- Salivary amylase is released by exocytosis
- Release from the granule cells is stimulaed by acetylcholine, histamine, and norepinephrine.
High amounts of which ion cause saliva to be more alkaline?
Bicarbonate
True or False: At rest, K+ is higher in the saliva than it is in the plasma.
Trueeee.
What is saliva mainly made up of?
Water!
Which transporter (aquaporin) is present in parotid gland and submandibular gland?
AQP5
What are aquaporins stored in?
Lipid rafts
What are lipid rafts?
They are cholesterol and glycolipid-enriched domains in cells that store aquaporins
What happens when aquaporins are stimulated?
The aquaporins are translocated from the cytoplasmic lipid rafts to the apical plasma membrane of he cells
Describe cholinergic regulation of water secretion in saliva.
Upon stimulation of food, ACH binds to the M3 receptor. This allows for Gq to be activated which allows PIP to convert to IP3 and DAG though the enzyme PLCBeta. IP3 binds to its receptor which is called IP3R. This allows Calcium to be released from vesicle stores from the endoplasmic reticulum into the cell and you have an increase in intracellular calcium. Calcium allows for aquaporins to be translocated o plasma membrane so water is released.
How is NO involved in water secretion in the saliva?
When calcium is released (because of acetylcholine) it activates NO synthetase which activates NO. NO uses cGMP to activate AQP5.
How can NTV activate water secretion in saliva?
NTVs activate NO which activates AQP5.
What type of people are more susceptible to getting Xerostomia?
People who are aged or diabetic
What is xerostomia?
It is dry mouth which makes it hard to perform oral functions
What is the pathogenesis of xerostomia in aged patients? aka what causes the dry mouth?
You have decreased responsiveness of AQP5 to cholinergic stimulation
What is the pathogenesis of xerostomia in diabetic patients? aka what causes the dry mouth?
Translocation of AQP5 from lipid rafts to the apical membrane is decreased in diabetes. There also might be a decrease in M3 receptors or decreased release in calcium
How can adrenergic effects cause amylase secretion in salivary glands?
If you activate the beta adrenergic receptor, it will activate adenyl cyclase which will activate cAMP, PKA and evenually cause the release of amylase.
How can cholinergic effects cause amylase secretion in salivary glands?
Once the M3 receptor is activated, through several steps, calcium is released and this release of calcium causes the release of amylase.
True or False: Cells in the salivary glands need a lot of energy.
Trueeeee, therefore they have a lot of mitochondria
What provides the energy gradient for cholinergic amylase secretion?
Na-K ATPase
How does NO affect amylase secretion?
It causes amylase secretion through that process of NO to cGMP to PKG to Amylase.
True or False: NTVS only affect aquaporin secretion in salivary glands.
Falseeeeee. They can cause amylase secretion through stimulation of NO in the pancreas too!!
What important side effect do antimuscarinics cause?
Dry mouth!
How do antimuscarinics cause dry mouth?
They bind to M3 receptors which prevents water secretion, amylase secretion, and even NO release.
Which glands may be affected by antimuscarinics?
Submandibular, parotid, and sublingual glands
What are 2 antimuscarinic drugs that were talked about in class?
- Ditropan XL (oxybutynin chloride)

- Detrusitol, Detrol LA (tolterodine)
What is the only substance invovled in digestion the esophagus secretes?
Mucus
What is excoriation?
An injury caused by trauma, scratchng, abrasion, or chemical or thermal burn
What do the mucus secretions of the esophagus protect it from?
Excoriation
True or False: The oxyntic glandular region is 80% of the of the stomach and is also the proximal region and is aka the fundus.
True!!!
True or False: The pyloric glanduar region is 20% of the stomach and is also the distal region and is aka the antrum.
Trueeeeee
Which organ is responsible for being a reservoir for ingestion of large meal, dealing with motor activity for mixing secretions with ingested food, and coordinating motor activity to regulte emptying of chyme ito duodenum.
The stomachhh
What types of cells are included in the oxynotic (fundus) gland of the stomach.
- Enterochromaffin-like cells
- Chief cells/peptic cells
- Parietal cells
- Mucus cells
What types of cells are found in the pyloric glandular region (antrum) of the stomach?
- Chief cells
- Mucus cells
- G cells
What do enterochromaffin-like cells do?
Storage and release of histamine
What do chief cells/peptic cells do?
Secrete pepsinogen
What do parietal cells do?
Secrete HCl and gastric intrinsic factor
What do mucus cells do?
Secrete mucus!!!

Oh em gee.
What do G cells do?
Secrete gastrin.

G for gastrin DUHHHH
What is the function of intrinsic factor?
It is required for the absorption of vitamin B12 and it binds to it.

It is a glycoprotein secreted by the parietal cells of the stomach
What is the name for the active digestive enzyme that is secreted by the chief cells and digests proteins.
Pepsin!
Name a proenzyme secreted by chief cells in the stomach.
Pepsinogen
What cleaves pepsinogen to pepsin at a low pH?
HCl!!!
True or False: Pepsinogens need a low pH to become activated
True!!!
How is pepsinogen released?
They are stored in zymogen granules in chief cells and released when stimulated by acetycholine

They can be stimulated by gastrin too!!
What 2 substances stimulate the release of pepsinogen?
Acetylcholine
Gastrin
What is the purpose of tubulovesicular structures on a parietal cell?
TVs pump protons into the tubular lumen against the concentration gradient
What happens to the H, K ATPase in resting states?
Its restricted to the tubulovesicular elements (TVEs)
What does H, K ATPase cause in stimulated states?
A transient rise in the intracellular levels of second messengers like:
- Calcium
- cAMP
- PKA
Which protein complex mediates the translocation process of H,K ATPase?
SNARE
Which ions do you find a lot of in gastric juice? Less of?
- A lot of H+ and Cl-

- Less of Na+ and K+
True or False: The rate of gastric secretion does not vary much throughout the day.
Falseeeee! If its unstimulated its 1-5 mEq/hr and if its stimulated its 6-40 mEq/hr
The number of which cells vary among individuals?
A. Chief
B. Parietal
C. Mucus
D. G Cells
B. Parietal
At high flow rates gastric juice contains predominantly which ions?
H+ and Cl-
What 3 things stimulate HCl?
- Acetylcholine
- Histamine
- Gastrin
Which receptor does gastrin bind to to cause the release of HCl?
CCK-B
Which receptor does acetylcholine bind to to cause the release of HCl?
M3
Whats the mechanism by which HCl is released by stimulation of acetylcholine or gastrin?
The binding of gastrin to CCK-B or acetylcholine to M3 receptors causes Gq to turn PIP2 into IP3 and DAG. IP3 causes the release of calcium from the endoplasmic reticulum. The release of calcium causes chlorine channels to open releasing chlorine, and also activates the H, K ATPase.
What is made from the amino acid histidine, through the enyzme histidine carboxylase and stored/released from ECL cells?
Histamineeeee
How is histamine released from ECL cells?
Gastrin binds to CCK receptors on ECL cells which causes the release of histamine
Which molecule is responsible for the release of histamine from the ECL cells?
Gastrin
How does histamine affect the relase of HCl?
It binds to H2 receptor, activates adenylate cyclase which increases cAMP which activates PKA which causes the release of HCl.
What main ion is not needed in the release of HCl by histamine stimulation?
Calcium!!!!

In all other pathways so far, calcium was released intracellularly and this caused the release of something. This is the only one that works by a different mechanism.
Explain how the bicarbonate ion fits into transporting HCl out of the cell into the lumen?
H+ is pumped out of the cell by the H,K+ ATPase. The pumping of H+ leaves an excess of HCO3-. HCO3- flows down its electrochemical gradient across the basolateral membrane. The Cl-, HCO3-counter-transporter transports Cl- in the cell. Cl- moves against its electrochemical gradient into the cell. Cl- exits the cell into the lumen of the gland via an electrogenic anion channel.
True or False: HCl is secreted at a basal level which is 10% of the maximal rate, but after a meal the stomach promptly increases the rate of acid secretion.
Trueeeee!
Name the 3 phases of increased acid secretion.
Cephalic phase
Gastric phase
Intestinal phase
When is the cephalic phase of increased acid secretion?
Elicited before food reaches the stomach
When is the gastric phase of increased acid secretion?
Elicited by the presence of food in the stomach
When is the intestinal phase of increased acid secretion?
Elicited by the mechanism that originates in the duodenum and upper jejunum
What conditions inside the duodenum stimulate secretin cells to secrete secretin?
Acidic conditions
What does secretin do?
It inhibits gastrin release from G cells. This decreases the response of parietal cells.
What does somatostatin do?
Its secreted by D cells in gastric antrum in response to the prescence of HCl. It binds to the G cell receptor and inhibits the release of gastrin.
What 2 things inhibit gastric secretions?
- Secretin
- Somatostatin
What protects the luminal surface of the stomach from degradation by HCl and pepsin?
The gastric mucosal barrier
What two substances form the gastric mucosal barrier?
- Mucus
- Bicarbonate
What molecule stimulates the release of mucus and bicarbonate?
Acetylcholine
Which organ quickly neutralizes acid?
Pancreas
True or False: If you have an insufficient pancreas, but you are consuming high quality foods, you are fine.
Falseeeeee. If you have an insufficient pancreas it can lead to starvation even if you are consuming high amounts of high quality food.
What do acini cells in the pancreas secrete?
Pancreatic juice
What to do the Islets of Langerhans secrete?
- Insulin
- Glucagon
- Somatostatin
- Pancreatic polypeptide
True or False: The substances produced by the acini are drained into ducts that go into the duodenum. These ducts are lined with cuboidal epithelial cells that produce the fluid component of the pancreatic juice.
Falseeeeeee.

Lol the whole thing is true except there are columnar epithelial cells that line the ducts not cuboidal. :)
What secretes the aqueous component of exocrine pancreatic juice?
Columnar epithelial cells
Whats the role of the enzyme components of pancreatic juice?
They help to digest carbohydrates, proteins, and fats secreted by acinar cells.
What 3 things control pancreatic secretions?
- Cholinergic stimulation
- Secretin
- CCK-cholecystokinin
True or False: When food enters the small intestine, the pancreatic secretion rises. First the secretion is more watery and then turns more enzyme rich.
Falseeeeee. The secretion is first enzyme rich and then turns more watery (because those enzymes are being used up)
Cholinergic stimulation, secretin, and CCK-cholecystokinin all are triggered by something to secrete pancreatic secretions. What is this trigger?
The presence of acid and digestion products in the duodenum triggers them to trigger the pancreas to secrete its fluids.
What 2 things trigger the release of CCK?
- CCK releasing factor
- Monitor peptide

They are released in response to neural signals!!
Where is CCK-releasing factor secreted?
The small intestine
What makes up the enzyme component of pancreatic secretions?
Secretions of the acinar cells and cells of the intercalated ducts
Name 3 proteases found in zymogen form from the pancreas.
- Trypsinogen
- Chymotrypsinogen
- Procarboxypeptidase

All are secreted in pancreas but activated in the intestine
____________ converts trypsinogen to trypsin in the intestine.
Enterokinase
__________ converts chymotrypsin to trypsin in the intestine.
Trypsin
__________ converts procarboxypeptidase to carboxypeptidase in the intestine.
Trypsin
What are 2 proteolytic digestive enzymes that catalyze the break down of dietary proteins to peptones, peptides, and amino acids?
- Trypsin

- Chymotrypsin
Which enzyme cleaves peptides from the C-terminal?
Carboxypeptidase
What are 3 lipases secreted in pancreatic secretions?
- Triacylglycerol hydrolase
- Cholesterol ester hydrolase
- Phospholipase A2
Which enzyme found in pancreatic secretions cleave starch molecules into oligosaccharides?
Alpha amylase
What thing allows you to bypass IP3 receptors and increases calcium intracellularly to allow for enzymatic secretion?
Ionomycin
How does CCK-cholecystokinin allow for the release of enzymatic secretion in the pancreas? aka tell me the mechanism
It binds to CCK beta receptors which activates Gq. This activates PIP2 and converts IP3 to DAG. IP3 binds to IP3 receptors and causes the increase of calcium intracellularly. This activates the release of enzymatic secretion from the pancreas
True or False: There are compensatory mechanisms if 1 IP3 receptor is gone but if both are gone then you can't do anything and will eventually die.
Trueeee :(
What is the function of the bicarbonate-rich aqueous component of pancreatic juice?
Its produced to neutralize the acidic pH of the exocytic enzymes from the acinar cells
The secretion of which ion is high in pancreatic juice? Which ion is low in pancreatic juice?
Bicarbonate is high

Cl- is low
What is the only difference between aqueous secretion in the pancreas as opposed to aqueous secretion by the salivary glands?
The transporters!!!

Salivary glands have AQP5

Pancreas has AQP8
Which substance allows for an aqueous and bicarbonate rich pancreatic secretion?
Secretin.

It binds to a receptor, which causes a change in cAMP. Which activates PKA. Which allows for the production of bicarbonate in the aqueous component.
What are the 3 phases of pancreatic juice release?
- Cephalic phase
- Gastric phase
- Intestinal phase
What do Kupffers cells do and where are they found?
They are specialized cells that have a phagocytic role

They are found in the liver!
The cystic duct and hepatic duct form a tube which forms another duct. What is the name of this duct?
The common bile duct
What regulates what goes into the duodenum from the pancreas, gallbladder, and liver?
Sphincter of Oddi
The cystic, hepatic, and pancreatic duct all come together to form what structure?
Ampulla of Vater
True or False: People who have gone through surgery to to remove their gallbladder have no way of breaking down their bile.
Falseeeeee. The bile made in the liver can still go into the duodenum.
What do Kupffer's cell and where are they found?
They are specialized cells that have a phagocytic role

They are found in the liver!
The cystic duct and hepatic duct form a tube which forms another duct. What is the name of this duct?
The common bile duct
What regulates what goes into the duodenum from the pancreas, gallbladder, and liver?
Sphincter of Oddi
The cystic, hepatic, and pancreatic duct all come together to form what structure?
Ampulla of Vater
True or False: People who have gone through surgery to to remove their gallbladder have no way of breaking down their bile.
Falseeeeee. The bile made in the liver can still go into the duodenum.
What makes up the bulk of bile?
Bile acids makes up 65% of the dry weight of bile
True or False: The first phase of bile secretion is mainly aqueous whereas the second phase of bile secretion is mainly solid.
Falseeee. Its switched!!
True or False: AQP8 is found in hepatocytes as well as pancreatic secretions.
Trueeeee. :)
The secretory activity of bile secretion is stimulated by what?
Secretin!!
True or False: Bicarbonate concentrations in bile are greater than that of plasma.
Trueeeee
How does the gallbladder epithelium concentrate the bile contents?
It extracts salts and water from the stored bile
True or False: Relaxation of the gallbladder force bile through the sphincter of Oddi.
False. Contraction of the gallbladder force bile through the sphincter of Oddi.
What stimulates the emptying of the gallbladder?
ACH and CCK
What relaxes the Sphincter of Oddi?
NO and VIP
What is the mechanism of action that bile acids break emulsify fats?
They emulsify them so decrease their surface tension which increase the surface area by which digestive enzymes can work
What is the function of lecithin?
It helps emulsify fats
What is an important characteristic of bile acids?
Amphipathic
True or False: Cholesterol is made from bile salts.
False. Hahhhahahaha sorry that was too easy. Its the other way around.
Synthesis of bile acids from cholesterol accounts for what percent of cholesterol elimination from the body?
50%
The majority of bile acids are conjugated with what?!
- Glycine
- Taurine
What is the enterohepatic circulation?
It is when the bile is recycled to or more times in response to a typical meal
What are substances that enhance bile acid secretion?
Choleretics
What does the gallbladder absorb from the bile to concentrate it?
- Na+
- Cl-
- HCO3-
- Water


So no Potassium!! She could easily ask a question like this and just remember that potassium is not absorbed by the gallbladder

Also when you absorb these ions you are increasing the bile acid concentration.
What are bile acids made from?
Cholesterol

When you make bile acids, you are converting cholesterol to a water-soluble and readily excreted molecule.
Bile acids are absorbed in what part of the small intestine?
The ileum
Bacteria in the ileum and colon deconjugate bile acids and ________ them to produce secondary bile acids.
Dehydroxylate
Where are bile acids reconjugated and rehydroxylated?
In the liver
The ________ effect is the stimulation of secretion of bile acids.
Cholerectic
True or False: Bile acid lost into the feces are the only significant source of cholesterol excretion.
Trueee. Word for word.
How do statins work?
They work in the liver to prevent the formation of cholesterol
How do resins work?
They bind to bile so it can't be used during digestion.

They also work in the intestines by promoting increased disposal of cholesterol
Whats are HMG CoA reductase inhibitors commonly known as?
Statins
What are bile acid sequestrants or bile acid binding drugs commonly known as?
Resins
What can excess cholesterol in the bile lead to?
Cholesterol gallstones
Cholesterol crystals in the bile leads to the formation of cholesterol gallstones in _________ or in ___________.
In the duct system of the liver

In the gallbladder
What is the condition where you have accumulation of bile salts in the blood and deficiency of bile salts in the intestinal lumen?
Cholestasis

You also have decreased bile flow through the canaliculi
Bilirubin is removed from the blood by _______ and conjugates with __________ to form __________.
Bilirubin is removed from the blood by hepatocyes and conjugates with glucuronic acid to form bilirubin glucuronides
What are the 2 types of gallstones?
- Bile pigment gallstones
- Cholesterol gallstones
Why is it that in liver disease, bile may contain elevated levels of unconjugated bilirubin?
Because hepatocytes are deficient in forming the bilirubin glucuronides.
Does bile pigment gallstones have calcium salts of conjugated or unconjugated bilirubin?
It has salts of unconjugated bilirubin.

The conjugated bilirubin conjugates with glucoronic acid to form bilirubin glucuronides which is soluble!
True or False: Duodenal secretion consists of mucus and an aqueous component.
Trueeeee
Where are 2 places goblet cells are found?
- Small intestine
- Colon
True or False: The duodenum, small intestine (in general), and colon all secrete mucus for protection of the lining of the mucosa.
Trueeeee
True or False: The duodenum, the small intestine (in general), and the colon all produce an aqueous component to their secretions.
Trueeeee
True or False: Fluid absorption by the small intestine is slower than the rate of aqueous secretion by the small intestine.
Falseeee. Absorption is faster than secretion
Which ions are rich in the aqueous component of the colon?
K and HCO3-
The first hepatic uptake of Pravastatin is by which transporter?
OATP1B1
What is the term for a rhythmic contraction of smooth muscle that forces food through the GI tract and also bile through the bile duct?
Peristalsis
True or False: Serotonin is produced in the ECL cells in the GI.
Trueeeeee
True or False: The rate of peristalsis is generally the same for all people.
Falseee. It varries in everyone.
At what point in the electric wave graph are there contractions?
At the spike potential
True or False: You can have a contraction at the slow waves or when the wave is depolarized.
Falseee you cannot
In what direction does peristalsis generally move?
From oral to caudal (anal)
In what direction does gastric segmenting/mixing generally move?
It moves from oral to anal and anal to oral.
What regulates gastric segmentation and mixing?
The enteric system
True or False: The enteric system can solely regulate gastric segmentation and mixing.
Trueeeee!
The migrating motor complex is initiated by substance?
Motilin
In __________ __________ _________ you basically want to clear the GI tract of all remnants and prepare for the next meal.
Migrating motor complex
True or False: Migrating motor complex occurs while you are eating and ends once the meal is over.
False! It occurs during periods of fasting and ends when the meal is ingested.
Fancy term for chewing?
Mastication
What is the term for food mixed with mucus and salivary secretions?
Bolus
What is the term for food mixed with hydrochloric acid?
Chyme
Whats the name for the mechanism by which the stomach relaxes? (aka by which the gastric smooth layer in the proximal part of the stomach is relaxed)
Receptive relaxation
Whats the fancy term for swallowing?
Deglutition
True or False: A glucose solution takes less time to digest in the stomach than a protein solution which takes less time to digest in the stomach than a solid meal.
True!
Along with segmentation and peristalsis, what else causes food to move in the small intestine?
Tonic contractions
Whats the term for long prolonged contractions involved in pushing food in the small intestine which gives the meal time to be in absorbed?
Tonic contractions
How long does it take the first batch of food to reach the cecum?
About 4 hours and then 9 hours for all of the food to reach
About how long does it take all of the food to reach the anus?
24 to 72 hours
Along with segmentation and the peristalic wave, what else helps move the food along in the colon?
Mass action contraction
Whats the term for simultaneous contractions of smooth muscle over large areas in the colon?
Mass action contraction
Which valve links the ileum to the colon?
The ileocecal valve
Whats the term for the relaxation of the cecum to allow the passage of food through the ileocecal valve.
Gastroileal reflex
True or False: In humans, the sympathetic nerve supply to the internal anal sphincter is inhibitory, whereas the parasympathetic is excitatory.
False. The SNS is excitatory and PNS is inhibitory
True or False: Pressure builds up in the colon and once this pressure builds up too much, the external anal sphincter relaxes causing defecation.
True
What is the gastrocolonic reflex?
When a meal enters the stomach it signals the lower part of the body to clear itself to allow a new meal to come in
In your starches amylose are your branched chain polymers while amylopectin are your straight chain polymers.
Falseeee. Its switched.
True or False: Humans cannot digrest dietary fiber at all.
True!
True or False: Dietary fiber makes up the bulk of feces.
True. Ewwww
What is hydrolysis? (Please tell me you know this)
Its when you add water to break a substance down
Alpha amylase hydrolyzes starch into what what sugars?
Either maltose or glucose
30-40% of starch is hydrolyzed to what sugar?
Maltose
True or False: Salivary amylase is inactivated at low pH.
Trueeee
What are enterocytes?
They are specialized cells that allow for absorption and allow for further break down of sugars
What are 4 intestinal epithelial enzymes that further break down sugars?
Lactase
Sucrase
Maltase
alpha-dextrinase
Which intestinal epithelial enzyme is found more in babies than adults and could lead to lactose intolerance?
Lactase
Glut 5 transports what?
Fructose
Glut 2 transports what?
All sugars except fructose
Glucose transport into the cell is dependent on what ion?
Sodium!
Pepsin digests what percentage of dietary protein?
10 to 20%
What does elastase do?
Digests elastin fibers that holds meat together
True or False: Larger polypeptides can be absorbed because there are transporters for them, whereas carbohydrates have to be small.
Trueeee.
What is the name of the main protein transporter?
PepT1
What do bile salts form to accelerate fat digestion?
Micelles
True or False: Emulsification of fats begins in the stomach but can begin in the mouth.
True!
Where does most of the emulsification of fat occur?
In the duodenum
What are the 3 different types of pancreatic lipases?
Pancreatic Lipase
Cholesterol Esterase hydrolase
phospholipase A2
What does pancreatic lipase hydrolyze?
triglycerides. It breaks it down into free fatty acidds and 2 monoglycerides
What does cholesterol esterase hydrolase hydrolyze?
Cholesterol esters into free fatty acids
What does phospholipase A2 hydrolyze?
phospholipids into free fatty acids
What are the 3 different types of pancreatic lipases?
Pancreatic Lipase
Cholesterol Esterase hydrolase
phospholipase A2
How much water enters the GI and how much is excreted in the feces?
About 9200 ml enter the GI
Only 50-100 mls are lost in feces (so about 9L is absorbed in the body)
What does pancreatic lipase hydrolyze?
triglycerides. It breaks it down into free fatty acidds and 2 monoglycerides
What does cholesterol esterase hydrolase hydrolyze?
Cholesterol esters into free fatty acids
What are the 3 different types of pancreatic lipases?
Pancreatic Lipase
Cholesterol Esterase hydrolase
phospholipase A2
What does phospholipase A2 hydrolyze?
phospholipids into free fatty acids
What does pancreatic lipase hydrolyze?
triglycerides. It breaks it down into free fatty acidds and 2 monoglycerides
How much water enters the GI and how much is excreted in the feces?
About 9200 ml enter the GI
Only 50-100 mls are lost in feces (so about 9L is absorbed in the body)
What does cholesterol esterase hydrolase hydrolyze?
Cholesterol esters into free fatty acids
What does phospholipase A2 hydrolyze?
phospholipids into free fatty acids
How much water enters the GI and how much is excreted in the feces?
About 9200 ml enter the GI
Only 50-100 mls are lost in feces (so about 9L is absorbed in the body)
True or false
Bile acids form micelles to remove digested fats from pool of digested foods
True.
How is lipid absorption different from protein and carbohydrate absorption?
-Lipids are initially hydrolzed into free fatty acids
-absorbed and are re-esterified in the Smooth ER
-They are coated with Apolipoproteins and form "chylomicrons"
-Chylomicrons are excreted from the basolateral pore into the lymphatic system (NOT blood)

Note: Carbs are only absorbed as monosacchrides
Proteins are absorbed at amino acids or small peptide chains but are ALWAYS released as single amino acids
How many ways are there to absorb sodium and choride? What are they?
Three ways:
- active transport of sodium
-sodium absorption coupled with absorption of organic solutes (ie: glucose)
-Neutral sodium chloride transport

Note: Last one is used when no meal is present or by the large intestine
Where in the GI is bicarb absorbed?
duodenum and jejunum (it is indirect, not direct)
Which GI parts within the body secrete bicarb and which are absorbed?
-Salivary glands
-Pancreatic glands
-Gastic mucosal barrier

Those secreted by saliva and pancreas are absorbed b/c they work to neutralize acid production. Those produced by mucosal barrier are present for protection - hence it's not absorbed.
Where in the GI is calcium absorbed? What is the channel called?
it's absorbed pretty much everywhere in teh GI and it uses the TRPV6 channel (transient receptor potential vanilloid type 6)
Why calcium have to be heavily regulated?
Calcium is involved in specific cell fxns like contractions etc, so it has to regulated, it cannot be free.
Which substtance keeps calcium sequestered within the cells?
Calbindin
Which vitamin is necessary for calcium absorption via the intestine?
Vitamin D (1, 25 Dihydroxyxcalciferol)

(after absorbed from intestin it's bound by calbindin)
_________ is the iron source from meats, while ________is the iron source from other sources like vegetables etc
Heme
Ferric (Fe+3 --> Fe+2)
Describe iron absorption process
- Heme is absorped through HCP1 or HT transporter
- Fe+3 -->Fe+2 and is absorbed through the DMT transporter
- once inside the cell, the ferrous state (fe+2) exits the cell via the Hephaestin transporter and enters the blood
-In the blood Fe+2 is converted back to Fe+3 and is bound by transferin in blood.
Which transporter is used to tranport heme into the cell?
HCP 1 or HT
Which transporter is used to tranport Fe+2 into the cell?
DMT 1
What must happen to Fe+3, the ferric form of iron, before it can be absored by the cell?
It must be reduced to its ferrous state (Fe+2) in order to be absorbed into cell
Once inside the cell, which form of iron is bound is used?
Ferrous state (Fe+2)
Which transporter is used to allow iron to exit the cell and enter the blood system?
Haphaestin (Fe+2 form is needed)
Which protein binds to iron once in blood?
Transferin (binds ferric state - Fe+3, not ferrous)
About how many mls of fluid is excreted into feces?
100 mls (majority of it is reabsorbed)
Which colon (proximal/distal) does abosorption of fluid take place? Storage of feces?
-Proximal colon
-Distal colon
Which cells produce the intinisic factor?
Parietal cells
Before absorption, Vit B12 is bound by what protein?
R protein (vit b12-R protein complex)
In order for Vit B12 to be absorbed, what must it be bound to?
Intrinsic factor


No intrinsic factor = no vit B12 absorption
True or false:
High pH allows for lack of intrinsic factor binding to Vit B12
False! Low pH causes intrinsic factor to not bind Vit B12
Another name for Vit B12
Cobelamin
what are the fat soluble vitamins?
A D E K
What do fat soluble vitamins require to be absorbed?
Bile
What are the water soluble vitamins?
thiamine, riboflavin, niacin, pyridoxin, pantothenate, biotin and ascorbic acid
Water soluble vitamins need what transport/carrier to be absorbed?
They need Na+ co transporters
Bile is used to transport _____vit and ________ is used to transport ________ vitamins
-fat soluble
-water soluble
Feces get their brown color from what substance?
Bilirubin (stercobilin and urobilin)
3/4 of fecal composition is made up of what?
Water
True or False
Protein makes up a major portion of fecal material
False: Only about 2-3%

Major: Water, dead bacteria - 30%, undigester roughage -30%
Another name for dry mouth
Xerostomia
Which classes of medications can lead to xerstomia?
Anti-depressants
Anti hypertensives
Psychotropics
Anti muscarinics
True or False:
Xerstomia can be a result of autoimmune disease or genetic disease
True:

The genetic disease is called Siogren's Syndrome
Siogren's Syndrom is associated with which disease state/complication
Xerstomia
Dysphagia can be result from several things..name at least 3
- Elderly are at higher risk
-structural abonormalties
-tongue abnormalties
-Neurological disorders (stroke, parkinson's)
-esphogeal muscle disorders
-Lack of saliva (Xerostomia)
What is dysphagia?
Diffficulty in swallowing
___________ is a common result of dysphagia
malnutrition
__________ is considered a disease state when chronic
GERD
GERD stands for?
Gastroesphageal reflux disease
Common name for GERD
heart burn
Why do we usually not get GERD
B/c of the presence of secondary peristalsis, which quicklies bring down any food that may have entered the esophagus
In ________ the esophagus has prolonged exposure to acid
GERD
One reason why GERD may occur is due to ____________ (too much/too little) relaxation of the lower esophageal sphincter.
Too much relaxation (aka under stimulation of Ach)
A class of drugs used to treat GERD
PPI's
____________ is a very common GI disease
peptic ulcer disease
What causes ulcerations to occur in peptic ulcer disease?
there is a breakdown of the gastic mucosal barrier
Some factors which can induce Peptic ulcer disease
Helicobacter pylori
Aspirin
NSAIDS
Excess acid secretion (Zollinger Ellison Syndrome)
Overstimulation of _________ neurotransmitter causes the lower esophageal sphincter to stay contracted causing ____________ disorders of the esophagus.
Ach
Motor disorders of esophagus
(LES does not relax, food accumulates in esophagus and causes distension)
Lower esophageal sphincter incompetence is similar to what disease?
GERD
True or False
Pyloric stenois is a congenital disease and more common in girls
False; more common in boys
What happens in pyloric stenosis?
The pylorus does not relax completely, causing the stomach to remain full.
true or False:
People suffering from pyloric stenosis suffer from bilious vominting
False, Non-bilious vomiting (without bile)
True or False:
Gastroparesis is a symptom of pyloric stenosis
True ( aka there's delayed gastric emptying)
What is the condition where the release of feces occurs against one's wishes?
Fecal Incontinence
Why does fecal incontinence occur?
You have an inability of the external anal sphincter to maintain appropriate tone of the anal canal.
What is the genetic condition where infants have abnormal colonic motility causing them to defecate as infrequently as once every 3 weeks?
Hirschsprung Disease

It can be corrected by surgery!
What is the genetic disorder where peristalsis causes feces to pass the aganglionic region with difficulty?
Hirschspring Disease
Whats the name for a permanent dietary disorder caused by an immunologic response to gluten?
Celiac Disease
True or False:

There is no evidence of physical obstruction in those suffering from gastroparesis
True
__________ disease accounts for most of the surgeries seen in children 6 months or younger
Pyloric stenosis (treated surgically)
List 3 causes of gastroparesis
-Diabetes Mellitus
-Surgical or medical injuries
-Medications - anti-cholinergics and/or opiates
One method to treat gastroparesis
Diet alterations
True or False:

Vomiting involves a neuronal, hormonal and muscular response
True
Which disease is reversible if you stop eating foods with gluten?
Celiac Disease
Which disease is associated with Inflammatory Bowel Disease and can lead to mal digestion, fat mal-absorption, and diarrhea?
Crohn's disease
What is inflammation of the colon known as?
Colitis (Ulcerative colitis)
True or False: The large intestine has more normal bacteria in it than the small intestine.
True!
Whats the disorder where there is a larger amount of bacteria than normal present in the small intestine?
Small Bowel Bacteria Overgrowth
the 3 main muscles types involved in the vomit repsonse
Thoracic
Abdominal
diaphragm
What are the brain centers involved in the vomit response?
Area postrema (chemoreceptor trigger zone)
Nucleus tractus solitrarius
Area postrema and nucleus tractus solitarius are both innervated by what nerve?
Vagus nervce
Cerebellum receives input regarding vomit from what body part
Ear (labyrinth)
What is suspended during the onset of a vomit response?
BER (basic electrical rhythm)
What types of contractions are initiated during a vomit response?
Retrograde peristalsis contractile complex or retrograde giant contraction
What is diarrhea?
passage of abnormally liquid or unformed stools at increased frequency
Major cause of diarrhea? Lease common cause of diarrhea?
90% of cases - infectious agents like E.Coli or Salmonella

10% - medications, toxic agents, ischemia,
What are the three classification of diarrhea?
Acute - less than 2 weeks
persistant - 2-4 wks
chronic - over 4 weeks
What causes traveler's diarrhea?
E.Coli
A "stagnant loop system" is associated with which gastrointestinal disease?
Small Bowel Bacterial Overgrowth
In which disease is there competition for Vitamin B12 leading to anemia, in the presence of carbohydrates there is fermentation, and there is deconjugation of bile acids?
Small Bowel Bacterial Overgrowth

The excess bacteria causes all of this
Which disorder is a "systemic disease but has profound effects on the GI?"
Cystic Fibrosis (CF)
Cystic fibrosis has inadequate regulation of which main ion?
Cl- ion

Because the Cl- ion is coupled with many other ions like bicarbonate and Na, it can lead to inadequate regulation of other ions too.
Exocrine pancreatic dysfunction and intestinal dysfunction are characteristic of which disease? (This is kinda vague but its straight from her notes. Sorrry)
Cystic Fibrosis (CF)
E.Coli produces a toxin which ressembles what substance?
Gaunyln; toxin performs molecular mimcry, increase cGMP and causes disregulation of secretion
True or False:

Excessive alcohol consumption can lead to diarrhea
True (affects enterocytes)
Lack of this enzyme causes lactose intolerance
Lactase (high during infacny, decreases with age)
Infecting agent causing cholera?
vibrio cholerae
Which type of G protein does Vibrio cholorae activate
Gs (irreversibly)
Whats a fancy term for gallstones?
Cholelithiasis
What is a main complication of chronic liver disease that causes an alteration in mental status and cognitive function?
Hepatic Encephalopathy
Why can liver failure lead to encephalopathy?
The liver detoxifies toxins. If you have liver failure that means your liver cells aren't working properly and can't detoxify toxins properly. Therefore, these toxins can go into the blood stream and eventually to the brain causing problems.
Whats the name of the disease in which hepatic inflammation lasts for at least 6 months?
Hepatitis
Chronic alcohol use can cause which liver disorders? (Theres a lot)
- Hepatitis
- Cirrhosis
- Fibrosis
- Diarrhea
- Hemochromatosis (but if you have that gene mutation)
You can treat cholera with normal saline and gluose because...
because the bacteria does not impair the Na+/glucose transport.
True or False:
Constipation occurences increases with age
True
_______ is the term for iron deficiency, while __________ is the term used to describe iron overload
Anemia
Hemosiderin
True or False:

Iron uptake disorders can only be genetic in origin
false: they can be acquired as well (like anemia)
The genetic form of hemochromotosis is common in which ethnic group?
Caucasians
In which disease do you have deposition of excess collagen in the liver?
- Fibrosis
- Cirrhosis
What role do Kupffer cells have in Fibrosis/Cirrhosis?
Kupffer cells produce excess cytokines which triggers stellate cells to produce collagen
True or False: Cirrhosis can be reversed but if not reversed it can lead to Fibrosis.
False. Its the other way around. Fibrosis can be reversed but if not reversed it can lead to Cirrhosis.
Hyperbilirubinemia can cause which disease?
Jaundice
Which color is associated with Jaundice?
Yellow

Aren't you happy I ask some easy questions? :)
True or False:

Excess alcohol consumption can trigger hemochromotosis
True, espeically if the defective gene is present
Which gene mutation can cause hemochromotosis?
HFE - mutations here cause excess absorption of iron
Name a 3 complications taht can occur because of an iron overlaod?
- skin pigmentation
-liver cirrhosis
-pancreatic damage in diabetics
True or False:
Large amounts of hemosiderins can cause tissue damage.
True
constipation is defined as
a pathological decrease in bowwl movements
True or False:

Iron can accept and donate electrons easily
True
In Jaundice, what gets yellow?
- Skin
- Sclera (eyes)
- Mucous membrane
Unconjugated or conjugated bilirubin accumulating in the blood can cause which disease?
Hyperbilrubinemia and then of course Jaundice
Whats another name for Jaundice?
Icterus

Not hyperbilirubinemia. Hyperbilirubinemia is a cause of Jaundice
Whats the term for the impairment of bile production or the obstruction of bile flow?
Cholestasis
Why can Cholestasis lead to atrophy of the liver?
Because you have a build-up of bile and a build-up of anything can lead to toxicity.
True or False: If you have blockage in your cystic duct, it will block bile flow.
Falseeee!

The cystic duct is what leads to the gallbladder. If you have blockage here its okay because the liver can still produce bile and secrete it in the duodenum without storing it in the gallbladder