Gastrointestinal Physiology
description
Transcript of Gastrointestinal Physiology
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Gastrointestinal Physiology
Xia Qiang, PhDDepartment of Physiology
Zhejiang University School of MedicineEmail: [email protected]
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Introduction
Basic processes of digestion and absorption
Propulsion and mixing of food in the alimentary
tract
Secretory functions of the alimentary tract
Digestion and absorption in the gastrointestinal
tract
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The four processes carried out by the GI tract: digestion, secretion,absorption, and motility.
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Many functions in the gut are found in specific locations along its length. Most of the absorption of nutrients occurs in the small intestine, so most of digestion is accomplished there or upstream.
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Functions of the digestive system Movement: propels food through the digestive system
Secretion: release of digestive juices in response to a
specific stimulus
Digestion: breakdown of food into molecular components
small enough to cross the plasma membrane
Absorption: passage of the molecules into the body's
interior and their passage throughout the body
Elimination: removal of undigested food and wastes
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Anatomy:
Components of the
digestive system
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Structure of the alimentary canal
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General properties of gastrointestinal smooth muscle
Low excitability
High distensibility
Tonic contraction
Autorhythmicity
High sensitivity to temperature, stretch and
chemical stimulation
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Electrophysiological properties of gastrointestinal smooth muscle
Resting membrane potential-40~-80 mV
Ionic basisEm (selective membrane permeability to K+, Na+, Cl-
and Ca2+)
Electrogenic Na+-K+ pump
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Slow wave (basic electrical rhythm)
The spontaneous rhythmic, subthreshold
depolarizations of the cell membrane (slow
wave) of the gastrointestinal tract that
characterizes the underlying electrical activity of
the bowel
Initiated in the interstitial cells of Cajal (ICC)
(pacemaker cell)
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Santiago Ramon Y Cajal
He and Camillo Golgi received the Nobel Prize in 1906 for introduction of the silver-chromate stain
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Calcium imaging in ICC-MY from the guinea-pig antrum. A colocalization procedure was used to identify the Rhod-2 signal from ACK2-Alexa 488 labelled ICC-MY. Panel A shows a stack of 30 sequential optical sections made in the Z optical axis of the ACK2-Alexa 488 signal and the Rhod-2 signal; panels B and C show each signal independently. Panel D shows the stack after the colocalization algorithm was used on each confocal slice, showing that most ICC-MY were well labelled with Rhod-2. It was evident from this experiment that some, but not all, ICC-MY were well-labelled with Rhod-2 (see text for more details). The scale bar in panel D is 40 um and it applies to all images
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Intracellularly recorded electrical activity from a guinea-pig antral ICC-MY identified with ACK2-Alexa 488. Panel A shows a network of ICC-MY labelled with ACK2-Alexa 488 visualized using fluorescence microscopy, and a single ICC-MY impaled with a LY-filled microelectrode. Panel B shows changes in membrane potential recorded intracellularly from an ICC-MY. One slow wave, marked with the horizontal line in Panel B, is shown in Panel C at an expanded time scale. The scale bar is 15 um.
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Cyclic changes in intracellular calcium in ICC-MY in the murine jejunum. Panel A shows a single confocal image with ACK2-Alexa 488 immunore-activity (green) and Rhod-2 labelling (red) taken from a time series. ICC-MY were distinctly labelled with Rhod-2 as shown in panel B. The average fluorescence intensity delineated by the white circled region was measured from images recorded every second, shown in panel C
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Slow wave (basic electrical rhythm)
Intensity: 10~15 mV
Frequency: 3~12 cpm
Ionic mechanism
spontaneous rhythmic changes in Na+-K+ pump
activity
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Normal BER frequencies in the
gastrointestinal system
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Spike potential (Action potential)
Duration: 10~20 ms
Ionic mechanism:
Depolarization: Ca2+ influx
Repolarization: K+ efflux
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Neural control of gastrointestinal function
Enteric nervous system (intrinsic)
Autonomic nervous system (extrinsic)
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Enteric (Intrinsic) nervous system
Myenteric plexus (Auerbach’s plexus)
Submucosal plexus (Meissner’s plexus)
Neurotransmitters secreted by enteric neurons
Ach, NE, ATP, serotonin, dopamine, cholecystokinin,
substance P, vasoactive intestinal polypeptide,
somatostatin, leu-enkephalin, met-enkephalin,
bombesin, etc.
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Sympathetic nerve• NE• Inhibitory (-)
• Autonomic nervous systemParasympathetic nerve
• Mainly ACh• Stimulatory (+)
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Afferent sensory nerve fiber from the gutSensory fibers with their cell bodies in the ENS
terminate in the ENSSensory fibers with their cell bodies in the ENS
send axons upward through the ANS to terminate in the prevertebral sympathetic ganglia
Sensory fibers with their cell bodies in the dorsal root ganglia or in the cranial nerve ganglia send axons to multiple area of the spinal cord or brain stem
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Gastrointestinal reflexes
Three types
Reflexes that are integrated entirely within the enteric
nervous system
Reflexes from the gut to the prevertebral sympathetic
ganglia and then back to the gastrointestinal tract
Reflexes from the gut to the spinal cord or brain stem
and then back to the gastrointestinal tract
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Gastrointestinal hormones
The hormones synthesized by a large number of
endocrine cells within the gastrointestinal tract
Physiological functions
Control of the digestive function
Control of the release of other hormones
Trophic action
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Gastrointestinal hormones
Four main types
Gastrin
Secretin
Cholecystokinin (CCK)
Gastric inhibitory peptide (GIP)
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Splanchnic circulation
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Microvasculature of the intestinal villus
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Digestion in the stomach
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The swallowing reflex is coordinated by the medulla oblongata, which stimulates the appropriate sequence of contraction and relaxation in the participating skeletal muscle, sphincters, and smooth muscle groups.
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The coordinated sequence of contraction and relaxation in the upper esophageal sphincter, the esophagus, and the lower esophageal sphincter is necessary to deliver swallowed food to the stomach.
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The abundant smooth muscle in the stomach is responsible for gastric motility.
Specialized cells in the stomachsynthesize andsecrete mucous fluid, enzyme precursors,hydrochloric acid,and hormones.
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Gastric juice
PropertiespH 0.9~1.51.5~2.5 L/day
Major componentsHydrochloric acid PepsinogenMucusIntrinsic factor
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Hydrochloric acid
Secreted by the parietal cells
Output
Basal: 0~5 mmol/h
Maximal: 20~25 mmol/h
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Mechanism of HCl secretionActive transportHuge H+ gradient (3
million)
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Acid production by the parietal cells in the stomach depends on the generation of carbonic acid; subsequent movement of hydrogen ions into the gastric lumen results from primary active transport.
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One inhibitory andthree stimulatory signals that alteracid secretion byparietal cellsin the stomach.
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Role of HCl
Acid sterilization
Activation of pepsinogen
Promotion of secretin secretion
Assisted effect of iron and calcium absorption
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Pepsinogen
MW: 42,500 Secreted by the chief cells as an inactive
precursor of pepsin Activated in the stomach, initially by H+ ions
and then by active pepsin, autocatalytic activation
Active pepsin (MW: 35,000)
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The acidity in the gastric lumen converts the protease precursor pepsinogen to pepsin; subsequent conversions occur quickly as a result of pepsin’s protease activity.
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Effect of pepsinPepsin is an endopeptidase, which attacks peptide bonds in the interior of large protein molecules
ProteinsProteosesPeptonesPolypeptides
Pepsin
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Mucus
Secreted by the epithelial cells all over the mucosa and by the neck mucus cells in the upper portion of the gastric glands and pyloric glands
RoleLubrication of the mucosal surfaceProtection of the tissue from mechanical
damage by food particles
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Mucus-HCO3- barrier
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Intrinsic factor
A high molecular weight glycoprotein,
synthesized and secreted by the parietal
cells
The intrinsic factor binds to Vit B12 and
facilitates its absorption
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Secretion of other enzymes
Gastric lipase
Gastric amylase
Gelatinase
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Regulation of gastric secretion
Basic factors that stimulate gastric secretion
Acetylcholine (+ all secretory cells)
Gastrin (+ parietal cells)
Histamine (+ parietal cells)
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Regulation of gastric secretion
Nervous regulation
‘Short’ reflex pathways
‘Short’ excitatory reflexes: mediated by cholinergic
neurons in the plexuses
‘Short’ inhibitory reflexes: mediated by non-
adrenergic non-cholinergic (NANC) neurons
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Regulation of gastric secretion
Nervous regulation
‘Long’ autonomic pathways
‘Long’ excitatory reflexes: parasympathetic
‘Long’ inhibitory pathways: sympathetic
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Regulation of gastric secretion
Humoral regulation
Excitatory
ACh
Histamine
Gastrin
Inhibitory
Somatostatin
Secretin
5-hydroxytryptamine (5-HT)
Prostaglandin
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Phases of gastric secretion
Cephalic phase
Gastric phase
Intestinal phase
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Inhibition of gastric secretion
The functional purpose of the inhibition of
gastric secretion by intestinal factors is
presumably to slow the release of chyme from
the stomach when the small intestine is
already filled or overactive
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Inhibition of gastric secretion
Reverse enterogastric reflex: initiated by the
presence of food in the small intestine
Secretin secretion: stimulated by the
presence of acid, fat, protein breakdown
products, hyperosmotic or hypo-osmotic
fluids, or any irritating factors in the upper
small intestine
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Delivery of acid and nutrients into the small intestine initiates signaling that slows gastric motility and secretion which allows adequate time for digestion and absorption in the duodenum.
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Motor function of the stomach
Proximal stomach
cardia
fundus
corpus (body)
Distal stomach
antrum
pylorus
pyloric sphincter
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Waves of smooth muscle contraction mix and propel theingested contents of the gastric lumen, but only a small amount of the material enters the small intestine (duodenum) as a result of each wave cycle.
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Motor function of the stomach
Receptive relaxation
Storage function (1.0~1.5 L)
Vago-vagal reflex
Peristalsis
BER in the stomach
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Contractions in the empty stomach
Migrating Motor Complex (MMC)
Periodic waves of contraction, which move along the
gastrointestinal tract from stomach to colon
Purpose of this activity: to ‘sweep’ debris out of the
digestive tract during the interdigestive period
MMCs can lead to hunger contractions, which are
associated with discomfort, referred to as ‘hunger pains’
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Emptying of the stomach
Emptying rate
Fluid > viscous
Small particle > large particle
Isosmotic > hyper- & hypo-osmotic
Carbohydrates > Protein > Fat
Regular meal 4 ~ 6 hrs
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Regulation of stomach emptyingGastric factors that promote emptying
Gastric food volume
Gastrin
Duodenal factors that inhibit stomach emptyingEnterogastric nervous reflexes
Fat
Cholecystokinin
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Vomiting
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End.