The classical GI hormones are secreted by epithelial cells lining the lumen of the stomach and small intestine. These hormone-secreting cells - endocrinocytes - are interspersed among a much larger number of epithelial cells that secrete their products (acid, mucus, etc.) into the lumen or take up nutrients from the lumen. GI hormones are secreted into blood, and hence circulate systemically, where they affect function of other parts of the digestive tube, liver, pancreas, brain and a variety of other targets.
The classical GI hormones are secreted by epithelial cells lining the lumen of the stomach and small intestine. These hormone-secreting cells - endocrinocytes - are interspersed among a much larger number of epithelial cells that secrete their products (acid, mucus, etc.) into the lumen or take up nutrients from the lumen. GI hormones are secreted into blood, and hence circulate systemically, where they affect function of other parts of the digestive tube, liver, pancreas, brain and a variety of other targets.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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4. To understand the physiology of Stomach
and Gastric Juice secretions
Functions of gastric juice
Mechanism of HCl secretion
Regulation of HCl secretion
Peptic ulcer disease
5.
6.
7.
8. Food is stored in the stomach
Mixed with acid mucus and pepsin
Stomach also add significant amount of digestive
juices to meal
As cephalic phase of gastric secretion start earlier
This food is released in steady in to the duodenum
9. It is a colorless, watery, acidic, digestive fluid produced
in the stomach
Pale yellow in colour , pH is 1-3 ,
Per day secretion is 2-3 L .
Chemical composition;
it contains inorganic salts ,and organic components
that include ,mucin, digestive enzymes , hormones,
intrinsic factors
10.
11. • They secret HCl into the stomach
◦ This acid is important for activation of pepsinogen,
inactivation of microorganisms , It also secrets the
intrinsic factor, necessary for intestinal absorption of
vitamin B12.
12. ◦ It secrets pepsinogen(zymogen). Once secreted,
pepsinogen is activated by stomach acid into the
active protease pepsin,
◦ Gastric Lipase is also secreted by chief cells,
responsible for the initiation of fat digestion
13. G cells secretes gastrin hormone which in turn
stimulate chief, parital and ECL cells
G cells are activated by GRP and inhibited by
somatstatin
14. ECL cells secretes Histamin ses HCl sec.
D cells secretes somatostatin by the influence of HCl
Somatostatin inhibit G cell
15. Gastric acid sec. can be divided into three phases:
Cephalic phase mediated by the CNS and
triggered by smelling, chewing or even the thought of food.
Mediated by the vagus and acounts for 10- 30% of the acid
secreted).
Gastric phase triggered by the presence of food in the
stomach Accounts for 70-90% of the acid secretion
Intestinal phase. Presence of chyme, most
probably amino acids, in the intestine triggers
approximately 5% of the gastric acid secretion.
16. Stimulation of acid secretion – cephalic phase
blocked by
vagotomy
sham feeding
hypoglycemia
role of GRP
(bombesin)
18. Presence of chyme, most
probably amino acids, in the intestine triggers
approximately 5% of the gastric acid secretion.
19.
20.
21. HCl converts pepsinogen to pepsin for chemical
digestion
provides optimal pH environment for pepsin
destroys some bacteria
stimulates the small intestinal mucosa to release
Secretin and CCK
promotes the absorption of Ca2+ and Fe2+ in small
intestine
22. 2. Pepsinogen (precursor of pepsin)
digestion of proteins
3. Mucus
forms a protective barrier: Mucus-bicarbonate barrier
4. Intrinsic factor
combines with vitamin B12 to make it absorbable
23. Neurocrine (denoting an endocrine influence on or by the
nerves).
Endocrine (gastrin)
Paracrine (histamine) in contrast to true endocrines these
hormones are not released into the bloodstream but into the
surrounding tissues and act in the immediate vicinity, e.g.
intestinal mucosal hormones.
24.
25.
26. Peptic ulcers:
◦ Erosions of the mucous membranes of the stomach or duodenum
produced by action of HCl. Disruption of mucus barrier
Zollinger-Ellison syndrome:
◦ Ulcers of the duodenum are produced by excessive gastric acid
secretions. Due to gastrinomas
Helicobacter pylori:
◦ Bacterium that resides in GI tract that may produce ulcers.
Acute gastritis:
◦ Histamine released by tissue damage and inflammation stimulate
further acid secretion.
27. Proton pump inhibitors (omeprazole),
Antibiotics assist in eradicating H. pylori bacteria.
Histamine 2 (H2) receptor antagonists (Ranitidine)
Local antacids
Life Style Changes
28. Lippincott’s Illustrated Reviews: Physiology (2013)
Medical Physiology, UPDATED SECOND EDITION
(Walter F. Boron, MD, PhD)
BERNE & LEVY, PHYSIOLOGY, SIXTH EDITION,
UPDATED EDITION
Ganong’s Review of Medical Physiology, T W E N T Y -F O U R T H
E D I T I O N
29.
30. (A)When the stomach is distended by meal.
(B) )When the PH of the gastric content is Decreased below 2.
(C)If the fundic mucosa is anaesthesized.
(D) If the vagi are Stimulate.
31. (A)It is Secreted at the pyloric antrum and reaches the fundus
tohrough the gastric lumen.
(B) It Promotes the secretion of pepsin, but not HCL.
(C)Its Secretion Stimulated by secretin and GIP.
(D) It is structurally similar to CCK .
(E)It has +ve feedback relation with gastric acidity.
32. (A)Is a function of peptic cells.
(B)Require no energy.
(C)Occurs by passive diffusion of both H+and CL- in the gastric
human.
(D) Require presence of carbonic anhydrase enzyme.
35. a. Depends on presence of intrinsic factor.
b. D epends on passive diffusion.
c. Occurs in the jujenum.
d. Occurs in the stomach.
36. a. Parietal cells of the stomach.
b. Chief cells of the stomach.
c. Upper duodenum.
d. Beta cells of pancreas.
37. a. Occurs secondary to active transport of H⁺ by the parietal
cells into the lumen of the stomach
b. Requires the presence of the carbonic anhydrase enzyme.
c. Is increased by administration of histamine.
d. All of the above.
38. a. Occurs when food reach the stomch.
b. Isnot accompanied by release of GRP.
c. Is controlled by the vagi nerves.
d. Isnot blocked by injection of atropine.
39. A 45 years old man is found to have a condition in which the
parietal cells of his stomach have been destroyed by an
autoimmune mechanism. This condition is often associated
with which of the following?:
a.Prenicious anaemia.
b.Gastric ulcerarion
c.Steatorrhea.
d.Protein deficiency.
40. Which of the following statements is correct?:
a. The gastric juice contains pepsins, lipase and α-amylase enzymes.
b. The only essential constituent of the gastric juice is the intrinsic factor.
c. The hunger contractions disappear after bilateral vagotomy
d. HCL is essential for both carbohydrate and fat digestion.
41. A 42years old salesman presents with the chief complaint of
intermittent midepigastric pain that is relieved by antacids or eating.
Gatric analysis reveals that basal and maximal acid output exceed
normal values. The gastric hypersecretion can be explained by an
increase in the plasma concentration of which of the following?:
a.Somatostatin
b.Histamine
c.Gastrin
d.Secretin
e.Enterogastrone
42. About the cephalic phase of gastric secretion, all
the following are true except:
a.It occurs before food enters the stomach
b.It’s inhibited by bilateral vagotomy
c.It involves some release of gastrin
d.It begins only when food is tasted and accounts for
most of the gastric secretion
43. The gastric mucosal barrier is maintained by all the
following
except:
a.The nature of the surface membrane of the gastric mucosal cells and
the tight junctions between these cells.
b.Certain prostaglandins and the alkaline mucous secretion of the
stomach
c.The mucus gel-like membrane that coats the gastric mucous membrane
d.Administration of H₂ receptor blocking drugs (e.g. cimetidine)
e.Excessive amounts of bile salts,asprin or ethanol
