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Author: John Williams, M.D., Ph.D., 2009License: Unless otherwise noted, this material is made available under the terms o...
Citation Key                      for more information see: http://open.umich.edu/wiki/CitationPolicyUse + Share + Adapt  ...
M1 - GI Sequence  Nerves and Hormones        John Williams, M.D., Ph.D.Winter, 2009
OVERVIEW OF GASTROINTESTINAL TRACT                 ingested nutrients                                      skeletal muscle...
BASIC PROCESSES OF THE GI TRACT                             food & water                secretion                         ...
BASIC PROCESSES OF THE GI TRACT                food & water                                                             Mo...
Overall Fluid Balance of the GI Tract                                  Ingestion                                 2 liters/...
Phases of GI Regulation                                                                         Origin of Stimuli         ...
SPLANCHNIC CIRCULATIONGranger, D, et al. Clinical Gastrointestinal Physiology. W.B. Saunders, Philadelphia, PA; 1985: 28.
ENTERIC NERVOUS SYSTEM                          Myenteric    Interganglionic                          Ganglion     Fiber T...
Short Reflex Pathways                 (within ENS)                                                                        ...
NEUROTRANSMITTERS INVOLVED     IN GI REGULATION NON-PEPTIDES        PEPTIDES Acetylcholine       Substance P Norepinephrin...
Fig. 2 Johnson, L. Physiology of the Gastrointestinal Tract, Vol. 1, 2nd ed. Raven Press, New York, NY; 1987: 4.
Fig. 9 Johnson, L. Physiology of the Gastrointestinal Tract, Vol. 1, 2nd ed. Raven Press, New York, NY; 1987: 21.
Source Undetermined
Extrinsic parasympathetic and sympathetic innervation of the digestive tract                                 system       ...
BLOCK DIAGRAM FOR NEURAL CONTROL OF THE GI TRACT                                       CNS                  Autonomic nerv...
Source Undetermined
GENERAL PROCESSES AFFECTED BY     GI REGULATORY MOLECULES1. GI Secretion (stomach, pancreas, intestine)2. GI Motility (sto...
NeuralJohn Williams
H+                         Amino acids                         Fatty acids                NeuralJohn Williams
Source Undetermined
Source Undetermined
GASTRIN-CCK FAMILY1.  Gastrin2.  Cholecystokinin (CCK)
GASTRINMajor Physiological Effects:1. Gastric Acid Secretion2. Gastric Mucosal GrowthChemistryG-4 minimal active fragment ...
CHOLECYSTOKININ (CCK)                       Major Physiological Effects:                      1. Gallbladder Contraction  ...
Secretin-GIP-VIP-Glucagon Family  1. SECRETIN  2. GASTRIC INHIBITORY PEPTIDE (GIP)  3. GLUCAGON  4.   VASOACTIVE INTESTINA...
Secretin-GIP-VIP-Glucagon Family  SECRETIN  Major Physiological Effects:  1. Stimulation of Bile and Pancreatic HCO3 Secre...
GASTRIC INHIBITORY PEPTIDE (GIP)     Major Physiological Effects:     1. Stimulation of Insulin Secretion     2. Inhibitio...
GLUCAGON      Found in both pancreas and gut but processed      in islets to glucagon and in gut to GLP-1 and      GLP-2VA...
Other GI Regulatory MoleculesHistamine – paracrine regulator; major stimulant of gastric acid secretionBombesin or GRP (Ga...
Fig. 1-2 Granger, D, et al. Clinical Gastrointestinal Physiology. W.B. Saunders, Philadelphia, PA; 1985: 7.
Additional Source Information                      for more information see: http://open.umich.edu/wiki/CitationPolicySlid...
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01.06.09: Nerves and Hormones

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01.06.09: Nerves and Hormones

  1. 1. Author: John Williams, M.D., Ph.D., 2009License: Unless otherwise noted, this material is made available under the terms ofthe Creative Commons Attribution–Non-commercial–Share Alike 3.0 License:http://creativecommons.org/licenses/by-nc-sa/3.0/We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, andadapt it. The citation key on the following slide provides information about how you may share and adapt this material.Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, orclarification regarding the use of content.For more information about how to cite these materials visit http://open.umich.edu/education/about/terms-of-use.Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement formedical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questionsabout your medical condition.Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
  2. 2. Citation Key for more information see: http://open.umich.edu/wiki/CitationPolicyUse + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (USC 17 § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation LicenseMake Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (USC 17 § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (USC 17 § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
  3. 3. M1 - GI Sequence Nerves and Hormones John Williams, M.D., Ph.D.Winter, 2009
  4. 4. OVERVIEW OF GASTROINTESTINAL TRACT ingested nutrients skeletal muscle smooth muscle feces mucosa exocrine glands Gastrointestinal System 1. Salivary glands 6. Rectum 2. Esophagus 7. Pancreas 3. Stomach 8. Liver 4. Small Intestine 9. GallbladderJohn Williams 5. Colon
  5. 5. BASIC PROCESSES OF THE GI TRACT food & water secretion digestion motility absorption fecesJohn Williams
  6. 6. BASIC PROCESSES OF THE GI TRACT food & water Motility secretion 1.  Segmental Contractions 2.  Propulsive Movements digestion 3.  Reservoir Function motility absorption Digestion The chemical breakdown of food into molecules able to be absorbed fecesJohn Williams
  7. 7. Overall Fluid Balance of the GI Tract Ingestion 2 liters/day Absorption Secretion Saliva 8.8 liters/day 7 liters/day Gastric Juice Bile Pancreatic Juice Intestinal Feces 0.2 liter/dayJohn Williams
  8. 8. Phases of GI Regulation Origin of Stimuli cephalic HEAD phase gastric phase STOMACH intestinal INTESTINE phaseCephalic Stimuli Gastric and Intestinal Luminal Stimuli taste, smell, sight, emotions mechanoreceptors - volume, pressure chemoreceptors - amino acids, fatty acids, pH osmoreceptors - osmolarity John Williams modified from Guyton, AC. Textbook of Medical Physiology, 6th ed. W.B. Saunders Philadelphia, PA; 1981: 784.
  9. 9. SPLANCHNIC CIRCULATIONGranger, D, et al. Clinical Gastrointestinal Physiology. W.B. Saunders, Philadelphia, PA; 1985: 28.
  10. 10. ENTERIC NERVOUS SYSTEM Myenteric Interganglionic Ganglion Fiber Tract Circular Muscle Submucus Ganglion MucosaSource Undetermined
  11. 11. Short Reflex Pathways (within ENS) Source: Undetermined Long Reflex Pathways (involve CNS)Granger, D, et al. Clinical Gastrointestinal Physiology. W.B. Saunders, Philadelphia, PA; 1985.
  12. 12. NEUROTRANSMITTERS INVOLVED IN GI REGULATION NON-PEPTIDES PEPTIDES Acetylcholine Substance P Norepinephrine CCK Serotonin Somatostatin Nitric Oxide VIP Dopamine Enkephalin Purinergic (adenosine, ATP)
  13. 13. Fig. 2 Johnson, L. Physiology of the Gastrointestinal Tract, Vol. 1, 2nd ed. Raven Press, New York, NY; 1987: 4.
  14. 14. Fig. 9 Johnson, L. Physiology of the Gastrointestinal Tract, Vol. 1, 2nd ed. Raven Press, New York, NY; 1987: 21.
  15. 15. Source Undetermined
  16. 16. Extrinsic parasympathetic and sympathetic innervation of the digestive tract system sublingual chorda tympani gland submaxillary otic gang. Cranial gland parotid Solid lines represent preganglionic and broken lines represent Cervical postganglionic fibers. pancreas liver gall bladder celiac gang. stomach Thoracic small bowel proximal colon splanchnic nerve distal colon superior mesen. rectum gang. Lumbar inferior mesen. gang. pelvic nerve Sacral Fig. 1-6 Granger, D, et al. Clinical Gastrointestinal Physiology. W.B. Saunders, Philadelphia, PA; 1985: 12.
  17. 17. BLOCK DIAGRAM FOR NEURAL CONTROL OF THE GI TRACT CNS Autonomic nerves Afferent fibers (command fibers) Enteric Nervous System myenteric plexus submucus plexus Effectors Receptors smooth muscles glands (endo & exo) epithelium John Williams
  18. 18. Source Undetermined
  19. 19. GENERAL PROCESSES AFFECTED BY GI REGULATORY MOLECULES1. GI Secretion (stomach, pancreas, intestine)2. GI Motility (stomach, intestine, gallbladder)3. Endocrine Secretion (pancreatic islets) (Incretin)4. Growth of GI Organs5. Food Intake
  20. 20. NeuralJohn Williams
  21. 21. H+ Amino acids Fatty acids NeuralJohn Williams
  22. 22. Source Undetermined
  23. 23. Source Undetermined
  24. 24. GASTRIN-CCK FAMILY1.  Gastrin2.  Cholecystokinin (CCK)
  25. 25. GASTRINMajor Physiological Effects:1. Gastric Acid Secretion2. Gastric Mucosal GrowthChemistryG-4 minimal active fragment shared with CCKG-5 Pentagastrin (synthetic)G-17 “little” gastrin Exist as both non-sulfatedG-34 “big” gastrin and sulfated formsSecretion1.  Synthesized by G cells in gastric antrum2.  Released in response to food in stomach
  26. 26. CHOLECYSTOKININ (CCK) Major Physiological Effects: 1. Gallbladder Contraction 2. Pancreatic Enzyme Secretion 3. Inhibition of Gastric Emptying Chemistry: CCK-8 CCK-33 All contain sulfated tyrosine CCK-58Secretion:1. Synthesized by I cells in duodenal and upper jejunal mucosa2. Released in response to peptides and fatty acids in lumen of small intestine
  27. 27. Secretin-GIP-VIP-Glucagon Family 1. SECRETIN 2. GASTRIC INHIBITORY PEPTIDE (GIP) 3. GLUCAGON 4. VASOACTIVE INTESTINAL PEPTIDE (VIP)
  28. 28. Secretin-GIP-VIP-Glucagon Family SECRETIN Major Physiological Effects: 1. Stimulation of Bile and Pancreatic HCO3 Secretion 2. Inhibition of Gastric Acid Secretion Chemistry: 27 aa peptide Secretion: Secretin is synthesized by S cells in the duodenal mucosa and released in response to acid (pH <4.5) in the duodenal lumen
  29. 29. GASTRIC INHIBITORY PEPTIDE (GIP) Major Physiological Effects: 1. Stimulation of Insulin Secretion 2. Inhibition of Gastric Acid Secretion Secretion Synthesized and released from a distinct type of duodenal endocrine cell in response to luminal nutrients
  30. 30. GLUCAGON Found in both pancreas and gut but processed in islets to glucagon and in gut to GLP-1 and GLP-2VASOACTIVE INTESTINAL PEPTIDE (VIP) Widely distributed neuropeptide most often inhibitory to muscle but stimulates glandular secretion. Tumors (VIPomas) result in secretory diarrhea
  31. 31. Other GI Regulatory MoleculesHistamine – paracrine regulator; major stimulant of gastric acid secretionBombesin or GRP (Gastrin Releasing Peptide) – neuropeptide; stimulates gastrinreleaseMotilin - intestinal GI hormone; regulates intestinal motility (MMC)Enkephalins - neurocrine regulators of motility and secretionSubstance P – neuropeptide; usually excitatorySomatostatin - universal inhibitory paracrine or endocrine regulatory peptideGLP-1 (glucagon-like peptide 1) - formed by postranslational processing ofproglucagon in intestine. An important regulator of insulin secretion and appetiteGLP-2 (glucagon-like peptide 2) - stimulates growth of intestinal mucosaInflammatory Mediators - Serotonin, cytokines, chemokinesGrowth and Trophic Factors - Insulin, TGF α, IGFGhrelin – oriexigenic peptide present in the gastric mucosa
  32. 32. Fig. 1-2 Granger, D, et al. Clinical Gastrointestinal Physiology. W.B. Saunders, Philadelphia, PA; 1985: 7.
  33. 33. Additional Source Information for more information see: http://open.umich.edu/wiki/CitationPolicySlide 4 – John WilliamsSlide 5 – John WilliamsSlide 6 – John WilliamsSlide 7 – John WilliamsSlide 8 – John Williams modified from Guyton, AC. Textbook of Medical Physiology, 6th ed. W.B. Saunders Philadelphia, PA; 1981: 784.Slide 9 – Granger, D, et al. Clinical Gastrointestinal Physiology. W.B. Saunders, Philadelphia, PA; 1985: 28.Slide 10 – Source UndeterminedSlide 11 – Granger, D, et al. Clinical Gastrointestinal Physiology. W.B. Saunders, Philadelphia, PA; 1985.Slide 13 – Fig. 2 Johnson, L. Physiology of the Gastrointestinal Tract, Vol. 1, 2nd ed. Raven Press, New York, NY; 1987: 4.Slide 14 – Fig. 9 Johnson, L. Physiology of the Gastrointestinal Tract, Vol. 1, 2nd ed. Raven Press, New York, NY; 1987: 21.Slide15 – Source UndeterminedSlide 16 – Fig. 1-6 Granger, D, et al. Clinical Gastrointestinal Physiology. W.B. Saunders, Philadelphia, PA; 1985: 12.Slide 17 – John WilliamsSlide 18 – Source UndeterminedSlide 20 – John WilliamsSlide 21 – John WilliamsSlide 22 – Source UndeterminedSlide 23 – Source UndeterminedSlide 32 – Fig. 1-2 Granger, D, et al. Clinical Gastrointestinal Physiology. W.B. Saunders, Philadelphia, PA; 1985: 7.

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