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Gastrointestinal Physiology

Gastrointestinal Physiology

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Published by Reynaldo Rivera

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Published by: Reynaldo Rivera on Aug 04, 2011
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What are the five (5) phases of digestion?
1.Cephalic2.Oral3.Pharyngeal4.Esophageal5.Upper GI6.Lower GI
What nerve regulates the cephalic phaseof digestion?
The CEPHALIC PHASE Is regulatedentirely by Cranial Nerve X. This includesAll senses, touch, sound, smell, feel, andtaste all feed into the corticobulbar tract andcranial nerve X.
What effect would a vagotomy have ondigestion?
A vagatomy (removal of the vagus) wouldcause loss of all senses to the cephalic phase.
What part of the brain is responsible forall urges? What other system canoverride it?
The Limbic System is Responsible for ALL urges. This is the oldest part of the human brain.
The Cerebrum is part of the neocortex.It is able to override the LimbicSystem.
What two part of the Hypothalamusfunction in eating? Where in thehypothalamus does each reside? Whatdoes each regulate? What results fromlesions to each?
The hunger & satiety centers
The hunger center resides in the LateralHypothalamus. Stimulation of itcauses the feeling of hunger. Lesion of the hunger center causes death byANOREXIA because the urge to eat isgone.
The Satiety Center resides in theMedial Hypothalamus (Middle gets big). Stimulation causes the feeling of fullness. Lesion causes death byHYPERPHAGIA (Overeating)
How do you calculate the IDEAL BODYEIGHT for Men? Women? How isobesity defined?
Men - 106lbs for the first 5' + 5lbs for each inch after 5' + 15lbs for frame (15for medium frame, 30 for large frame)
Women - 100lbs for the first 5' + 5lbsfor each inch after 5' + 15lbs for frame(15 for medium frame, 30 for largeframe)
Obesity is a person more than 20%over their ideal weight.
What is the psychology is behindAnorexia and Bulimia, respectively?
Body Dysmorphism.
Anorexics think they are overweightdespite being normal of below idealweight.
Bulimics are ashamed of their eatinghabbits.
What is the body type of anorexia andBulimia? What social factors aretypically seen in each? How does eachachieve their respective goals?
ANOREXics are typically slim,underweight girls trying to please their mothers. They starve themselves.
BULEMics are typical chubby girlstrying to please their boyfriends. They binge and purge (Eats and then causethemselves to vomit or defecate)
What is the pathology behind PRADER-WILLI?
Prader-Willi One of the two gnomicimprinting diseases. It is Inherited paternally and Presents with Obesity,Hypotonia, and Mental retardation. It isessentially a Lesion of the Satiety Center.
What neuro transmitters affect theSatiety and hunger centers? Do theseneuro-transmitters sitmulate of inhibitthe centers?
Both Hunger and Satiety centers areaffected by Norepinephrine (NE) andSerotonin (5-HT). 5-HT is morespecific.
These catecholamines are 80%stimulatory to the Satiety center and20% stimulatory to the Hunger center.
What drug classes are a good choice foruse in weight loss? What is the generalprinciple behind using these drugclasses? How does each class work specifically?
Amphetamines and SSRI's are a goodchoice for use in weight los.
Both set of drugs work by increasingthe amount of catecholamines in thesystem. This has the effect of stimulating the satiety center leading toa feeling of fullness.
Amphetamines cause the release of  preformed catecholamines.
SSRI's inhibit the re-uptake of 5-HT atthe presynaptic terminal.
What is the main stimulant for thehunger and satiety centers? What othersubstance also stimulates hunger?
The main stimulus for the Hunger andthe Satiety center is Glucose.Decreased Glucose stimulates theHunger Center. Increased Glucose andGastric distention stimulates the SatietyCenter.
Progesterone also stimulates appetite.This is the reason women are morehungery during menses and why pregnant women want to eat.
Why should you eat small frequentmeals?
To keep blood glucose levels even. This is because if the levels are low, the hunger center fires and you eat a lot. If the glucoselevel is high, insulin kicks in and causes theglucose levels to drop and you end upeating.
What are the two phases of the stressresponse?
Phase I - is the Parasympathetic Phase.You get Increased sympathetic outflowcausing: Deification, urination,sweating, etc...
Phase II - is the Sympathetic phase.You get Increased sympathetic outflowcauses: tachycardia, HTN, mydriasis,etc...
What is the pathology of a STRESSULCER 
Parasympathetic outflow causes increasedmotility of GI tract and then sympatheticoutflow cause decreased blood flow. Thiscauses the gut to produce more acid, butthen blood is shunted away from the gutand the papillae sloughs off.
What is the pathology of IRRITABLEBOWEL SYNDROME?
During stress parasympathetic causediarrhea followed by the sympatheticoutflow which causes constipation.
In what patient population do you seeCURLING ULCERS?
Stress ulcers caused in burn patients
In what patient population do you seeCUSHING ULCERS
Increased Intra cranial Pressure (ICP)
What is the Cushing Triad?
Increased ICPBardycardiaHTN
Gastrointestinal Physiology 1 of 6
 
What gland is responsible for telling timein the body and regulates the Hunger andSatiety center?
The PINEAL GLAND affects the hunger and satiety centers.
How does the Pineal gland tell time?How does it perform this function?What will result from lesion of thisgland?
The Pineal gland senses time of day(Circadian Rhythm) using withMelatonin
Increased Melatonin à nighttime andthe body is shut down
Decreased Melatonin à daytime and the body is turned on.
Lesion of the Pineal Gland causesPrecocious Puberty
List all the salivary glands (4)?
ParotidLingualSublingualSubmandibular 
Which is the largest salivary gland?
The Parotid gland is 90% of all salivaryglands by weight.
Which salivary glands are mucinus?Which are are serous? What nerveinnervates each?
Parotid and lingual are serous (Lingualis most serous). Sublingual andSubmandibular are mucinous(Sublingual is the most serous)
The Parotid is controlled by CN IX andthe Lingual, Sublingual, andSubmandible are controlled by CN VII
What is the tonicity of saliva?
Saliva is hypotonic because you want thesaliva to be able to diffuse into food youeat.
What bacteria and virus causes infectionof the salivary glands?
Acute infection - Staph. Aureusinduced by intubation
Mumps virus
What are several complications of mumps infection?
Parotitis
Pancreatitis
Orchitis
Oopheritis
What is the most common tumor andcancer of the salivary glands?
Most common tumor is a PleaomrphicADENOMA
Most common Cancer is aMucoepidermoidADENOCARCINOMA
How does the parasympathetic systemaffect the amount and tonicity of saliva?
Saliva production is increased by parasympathetic simulation. This causesincrease in the amount of saliva produced.However, since there is greater flow, lesstime is given for reabsorption of solutes (Naand HCO3). This results in the saliva produced having an increased tonicity(NEVER BECOMES HYPERTONIC).
How does the Sympathetic system affectthe amount and tonicity of saliva?
Sympathetic stimulation causes decreased production of saliva. The amount of saliva produced is lower. Since sympathetic alsocause vasoconstriction, there is decreased blood flow near the lumen of the glandresulting in decreased reabsorption of solutes. This gives rise to a saliva that alsohas increased tonicity (like parasympathetic).
What is the structural defect in cysticfibrosis? What is the inheritancepattern? What gene is defective?
Structural defect is of the Na-K ATPase
Inherited - Autosomal Recessive
Defect on Chr 7 (CFTR gene)
What is the most common cause of malabsorption in children?
Cystic Fibrosis
What is the most common presentationof cystic fibrosis in the newborn? Towhat other complications does it usuallyprograss?
The most common presentation of cystic fibrosis in the newborn ismiconium Ileus
It the progresses toMALABSORPTION, LUNGPROBLEMS, and finally STERILITY.
What level of sweat sodium is diagnosticfor CF? What sweat sodium suggests CFin the heterozygote? What is normal?
 Normal sweat sodium is less than 20
Greater than 60 is diagnostic for CF
Heterozygotes sweat sodium is 30-60
What drug is used for the Cystic Fibrosissweat test?
Pilocarpine
From what structure do the muscles of mastication arise? What nerve innervatesthem?
The muscles of mastication arise from thefirst Brachial pouch and are innervated by(CN V).
List each of the muscles of masticationand their function?
L - Lateral Pterygoid - Lowers Jaw (Opensmouth)T - Temporalis - Moves Jaw Forwards andBackwardsM - Medial PterygoidM – Masseter 
Give the sequence of events that takesplace during swallowing?
Tip of tongue rises up and sides comeup an medially to form a gutter 
Tip of tongue rises to hard palate anduses gravity to start food bolus rolling.
The bolus rolls until it comes near theglottis and the epiglottis closes totrachea.
The bolus rolls over the close epiglottisand touches the pharynx.
Once the bolus touches the pharynx,the levator villi palatine raises the soft palate.
The posterior pharynx comes down andmedially to complete the gutter.
Food rolls into the esophagus.
What nerver innervates the upperpharynx? The lower pharynx?
Upper Pharynx is innervated by CN IX
Lower Pharynx is innervated by CN X
What are the sources of acid in themouth?
Food and Drinks - Main source
Fermentation by bacteria - StrepMutans.
Reflux – Normal
Why do we salivate?
We salivate to produce Bicarb to neutralizethe refluxed acid.
What is GERD?
When reflux becomes symptomatic
What is Esophagitis?
Inflamed Esophagus on visualization
Gastrointestinal Physiology 2 of 6
 
What is Barrett's Esophagus?
Squamous metaplasia (Squamous tocolumnar) of the lower esophagus
What is a Malloy Weiss Tear?
Superficial tear in esophagus due toforcefull vomiting
What is Boorhaave's?
Perforation of esophagus
In what populations do you typically seeBoorhaave's? What are the commonpresenting signs and symptoms?
Alcoholics and Bullemics
Signs and symptoms are Chest pain,Pneumothorax, and Pleural effusion.
What is HAMMAN'S SIGN?
Subcutaneous Emphysema can be seen withany pheumothorax. Crunches below skinare called HAMMAN'S SIGN.
Is the Upper esophageal Sphinctervoluntary or involuntary?
Voluntary
What muscles make up the UES?
Upper, Middle, & Lower pharyngealconstrictors, and the Stylopharyngeus.
What innervates the UES?
Upper, Middle, and Lower pharyngealconstrictors are innervated by CN X.Stylopharyngeus innervated by CN IX. Theganglia is the nucleus ambiguous.
For what neurological exam finding isthe UES responsible?
It is Responsible for the GAG reflex.
Into how many parts is the esophagusdivided?
Esophagus is divided into thirds
Give the histology of each part of theEsophagus.
1st third is made up of Skeletal muscleand squamous cells
2nd third is made up of skeletal andsmooth muscle with mixed squamousand columnar cells
Final third has smooth muscle andmostly short columnar cells.
What is the most common cancer of theesophagus?
Since the esophagus is mostly squamouscells the most common cancer is squamouscell carcinoma.
What is the most common presentingsymptom of esophageal cancer?
Most common presentation is painfulswallowing (Odynophagia)
What sign does the patient use to indicatethe problem?
Patient will use one finger to point tolocation of pain (one-finger sign).
When does peristalsis start in theesophagus?
Primary Peristalsis Starts with bolus of foodentering the esophagus
What nerves are responsible for theconstriction phase of peristalsis and therelaxation phase? Where does secondaryperistalsis start? What is its function?
The Vagus (CN X) causes constrictionand The Aurabach plexus via VIPcauses relaxation.
Secondary Peristalsis begins when foodgets stuck in esophagus and it wherethe food is stuck and carries that pieceof food down the esophagus.
What is Achalasia?
Achalasia is Lack of Aurabach's plexus inthe esophagus. Therefor you cannot relaxduring peristalsis.
Clues for Achalasia?
 Narrowed distal esophagus & dilated proximal portion
Show 4 months of age because this iswhen most children are switched tosolids.
Bird's beak sign, upside down ace of spades are seen on barium swallow
How is Achalasia diagnosed? What is thetreatment?
Diagnose with Barium swallow andconfirm with biopsy
Treat with surgery - Partial vagotomyand myotomy
When the Lower Esophageal SphincterRelaxes to allow bolus of food to dropinto the stomach, this is called:
This is called Receptive Relaxation
What types of cells are below the LES?
Cells below LES are tall columnar.
Given the pathology, name the disease:
1.Pouch above UES where food getsstuck and can reflux.2.Pouches below UES and above LES3.Most Common congenital esophagealGI problem4.Vomit with first feeding.5.Large gastric bubble on Xray6.Blue on feeding and ping on crying7.Failure of separation of nostril and posterior pharynx8.Cough and choke while feeding9.Extra pieces of mucosa that exist in theesophagus10.Extra pieces of mucosa in theesophagus along with Iron deficiencyanemia. it is called Plummer Vinson1.Zenkers Diverticulum2.Traction diverticulum3.Esophageal atresia with distal trachealfistula4.Esophageal atresia with distal trachealfistula5.Esophageal atresia with distal trachealfistula6.Cloacal Atresia7.Cloacal Atresia8.H-type tracheoesophageal fistula9.Esophageal webs10.Plummer Vinson
Clues for Carcinoid Syndrome?
Flushing
Wheezing
Diarrhea
In what layer of the GI tract do sugarenzymes reside?
In the mucosa in contact with food.
In what layer of the intestinal tract doAV anastamoses exist? What is theirfunction?
They exist in the Lamina Propria. They arenormally closes. During stress they shunt blood across the AV anastamoses. Thiscauses the mucosa to slough off.
What tissues of the body have the mostAV anastamoses?
Fingers and toes
Toes
Lips
Ear lobes
What is the name for icles formed in theintestitium when cold?
Chilbain
What is primary and secondaryperistalsis called in the Esophagus, smIntestine, and Colon:
Esophagus/Stomach: Primary andSecondary peristalsis
Small Intestine: Primary -Segmentation, Secondary - MMC
Gastrointestinal Physiology 3 of 6

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