Ho '. 'm'" "0'" ···n· .. -··a···· r"e' ····9··.··' ula ..

It-tIIO···-····n··_··· 0'" ····f:- G········ ····1

I' -". .' "-'1 . 1'1 .' .... . ...• -.. ..' . i" . . . ..... . ...•... - 1'1" .... 1'1- - .'

.... ".. .' .... , '" "."' __ " ,",' ',.", .. ~: . "' .. '~ .. -~'. / " >. " .. : ", .' .. _ ", ',.", .. ~: . ",' '" "."' __ . '" '" ."'_ - .. ," ", ,'... . ... ,,'

- - - - I., __ <,' - - -

'M····:· uh a·:····ln·' ad saad abd elwahab

. ..'

, .: . ", ... " < " < ." ." ," . < , . < ,". . - ", ","".. ..... ' .. _., . ,: . . : '.' .~ I •• ' .~ I ':". ,"

Kassala Ulni/faculty of medicine Dep. Of physiology

0' ,:. .. f' 't'hl, , G':' 'I t ict

'. I .... ,", ,. ,". . I .. t',·,

" ,:rgarls 0 _ Il,e ',', rae!

'T'o!ngue ,,- ----~ -~_u..

'--"F--____,------ 0-,.,11 re'llv'it,

Palrotid Iglalnldl ====~~ ............ ~~

SIUlb~iin,gIIUII~ !gllnd ,----~::..:... [Phary':~M:

'-----"""II!;.

:SlUIbm,andibuhI1i1,glla " ~;""'_~----J

Salliivary 'gl,snds

Accessory diqcsttve orqans

,A's,celndiinlgl pcn1~on ,of [,alrg'&1' ~nlte,5;I,i'ne'

P~dDlrbJ: sphinel,s'r

~..;.;...._--+-- :S!ma,I~[ i:n:tes,tiilnll

\

DUlodelnlum 01

,s,msllll itnles]ne

,A,ppendb,;' ,

1- -

,

~-'\---la e i'nte.9,liine:

t-'a-

", ",

-' ,

I ',' I

_",_, "

01 50
'y' III II III w- II II II,

111 IDOl Y'

III

III

III

III

''11581 ''W''

II CIfti1iI

·As we know the alimentary Canal is about • 30 feet

-

1: .. lor

I[iJ' [0 ,....,.

·!~.b. :1.01. J Ie,

Nlame

s

. ",.-, - I .

, QIUlrC'e

S,eClret'i'ln

C hoi ety' ,"",', stokl [nl iii Inl

, ,

IE nte r egastr on e .0 r 'G a str lc ~ n hi bit,ory' Pe' ptid e (: G'II P]I

Partiallv-

a lgested 'fosd

Fats or c ombi,nat:ilol~ of acids anal fats

Target Organ

Pancreas and liver

Palncreas and. gallbladder

(Sphincter of' Oddi]

D UI 0" '. ,...Ji e' n, ','Ii m"" '

,", ··.·u .... UIII

Secretion of pj rict: in HCO 3'and bile production

Secretion of PJ,. bilejrom qatlbtaddet. opening of 50

SEN; retioo of in testin all j ui ee

Hormone released from the stomach

•

Gastrin hormone

S- - .. -t-_· . -to -t---'- I. . _. _.... _.

orna -0·······'5····' .a mn ······o····-···r-m·' .. none

, ". • .•. _.. .... . • ' . .'. '. I

- .~., ,,-, .••. _ .• '" ~ ...• - .:__", ',_, I • ,"_'. • '~ .• , I ." ... J

G- h I !II Lire In

•

•

'. Scurces: -D,~IIS/····t'--·a·· ·11 Stern a tc h-'" IG· •• ·I -cefs

'.'::__:'., ._.' '., •.•. ._". . ••.•• • ..• ~ •..••.. _.' •. __ . __ -. --_ .. 1 •. _..... '.,'

• Main <ole: Stimulates proxlmal stomach secretion

G-':' .... -r' '0- - ·-th· - 'IR" ole - Lo -n- g" - Jt-'e" rm"'" g' -.- -ro- -. -. -Jt'h-' h' 0- -. -r'-m" o· . ne'

'.. .1 '. - ·-·-w·····.r ." · - •.... ' _..~II .' '_.' .. " ....• I-_:_;--' •· •• ···-w·······-··.·· - .', .. ,' '.' ".- .. ' - ' .. __;

'- '.' . ' .. ' ''-.' ,.' ..... .... . -.... "- . - '. -- .. ' ,.... ..-- .. .. . ..... .. ' .. ' ' ..

- - .". . . ri... . - -

. . .

for lntenstlnal mucosa

• Functional IRolles:

...... St.ilmllU lates parietal cells to secrete acid

S- to' I. II t h I. f~ III~ t t Iii

~. _,lllmI1U·la .. es, C·lllle·1 ceu·s.o, sle·c·re.e pepsmoqen

- Augments 'gastric mucosal flow by vascular dilatlion

• Gastrin Secretion from G,-Cells:

• Stiimulated by:

- Antral Amino Acids + oUgopeptides '_I Antral Calcium or Alchohols

- Antral pH >, 3

_, 'V'', ",,::,',:': a", '.' g"' •• ru -S"'·',', N"'·,'""", erve

. '. "_" .. > . . '. '_". ..' -' .' .'. . .. ' .

• Inhibited by: Antral pH< 1 ~5

S t t til

. omatostatir

• p ··d·: ced I iii iii ·····11······ '.'-". ',.'- --.' t· b···· '-:'S ·->t··,·· nach

-- - ro uce·. In sma amounsy ··.·;omac •

and in larger amounts by Pancreatic D cells

. - .

,". I: .

- .', ," /1 '."'_",

• 'Main Role: Globailly iinhiibits Gil functiion

Keep" - s' th e "actr ~a" '. tion' by- G"'-"'> ut

• .- -., _". . (... - - " c·. __ '" .. -. _.' . '., " - -_. _ .- .. _ .'

. . .>Ii-' u '_ '.· ... ·.IV Ie .,> ....1 .....

hormones under control

S t t til

. omatostatir

• Growth hormone inhibitory hormone (G,HIH)

.' First found iin hypothalamus

• Secre .. ted by D-·····: c·····_,e····.-,II ln stomach d uod enum

'.' '.' "-'-'-/' ~ .. -.<., '~'. .•... - '.' '_., _/ ~~. '.'~'..-.~. , ~ .. - <~- '- _ ,

till II I t

pa •. mcrea ·IC····,' IS._·I e"'-,--

'.~ "., .. '_:'" ._... ~".. I.·_:. ~ .. '~ .. , .. _. ," ", ~,

• Secreted in larger amount into gastriic

I ~ II t-

umen >1 crrcu anon

• Released in response to acid in stomach

Actio .. of sornatostatl

• Inhibit secretion of qastrln, VIP, GIP, secretin, motlln, GH, insuUn, glucagon

• T fluid absorption and! secretion from Intestine

• ~ endocrine and exocrine pancreatic secretion

I b ~lle flo __ a nd g-alill bladder con traction

• _., :,_I_·~ - _'_W '_~ .. '_" ,.: __ '~. ~ - •.. _\,.' __ '_;"_',_'-,' '_"_. 1-" ,, __ -, I J'_ .

• ~ gastric acid secretion and motmty

• ~ absorption of glucose, amino acid, trlgllyceride

S t t til

. omatostatir

CIIiI ill I U IT II d t·- t~1

• mica uses: I urrnnq c own qut secretion

and controlllnq gut bleeding (reduces

blood flo ).

'_' .... -.' .. -._ ,- .-·.-.-.···WI

• Disease (too much): Inabiility to secrete well

le>··-··a·'· .. ,- d s- .. r, -t-·o·-··· 'S·· ·"-t-e····- ·'·-·8'·' itorrh -··e-···- -····a·'· ,. g·':·-a~'· uls rto ···-·n-"- e·,:'s·' -w-~e--- ···-;g·:-h·-,··-t·-=

-' ,-:_-__-. ----. ,-,'---' ,-"- ,'-'. -,_:_-~. ,., '>'_/, '-'-' ~I._:_-,

10· -·8·S

... ",' I. ", 1 I' ",

•.. ..' .:.. ••........ :--_. Iii

,._,-------".: ..... _ .... ---

- •. V,iI.'g'U'S nerve

.' I 'If I,

G'3:stlriic: Lumen

55 .= somatcstatt In

Illntegrati on of Gastri e Se,cretiiQ'n

Fadl '---liJi;;

"BUllY Inalu ro'D

I~~~~~:" nS'UtD'n

I nteg ration of the gastric controle

~, ~

o

An'ti!"iiYim ,OiLgnst dl ~O,10 1T'!i!" mi .0, ac:id~

r-.

Lumu::rn ,o'f IOCrpVS,

~ma'tosit 'me !pto

SlOrn8rtosll;

,", '""Ij

~""!i-- A:ni~1'1!J rn ,~

..

........--""0011<0 '('OO~I~1l1I

, I ,t,acep'ki t.)

,=

'1 .~IJ.··

.' .o:"'" ............... """""' .......................... ~--

........ AI~n,

• Source: produced in proximal stomach

M·~ ·R····II·~ [!:I- ~t,!!I···1111 ~d·-·Jt~f·~··d·· ..... G········~- .- th

., am ·\0 e: uu ta y I" enJ tee as 8>_1 rowtr

hormone releasing hormone

• Integrates proximal stomach state ~-n- Jt-o total bod- - - -m· etabollc ph enot --p. e

~ .. (- 1-'-(: •...•.... - .•..•....•.. y.' . '- -'< •....... - 11'- '-, .. ·-ry· .. ····.···-.···· .. ~

. "-- ..... _. ._/ . -~ I· "- .. '- ._.' .. ' '.' ~ :_:... '- .. -., J .... > •

• Not much is known - it's the "new' guy

• D·'lu· o.,..··· t. d e·······n· 8········1 Hermon e'" Secretion ·

_.' -_-,' '.~ ,"'. I '.-~'-' , ' '.' - e- , '_::/ ·,I·_ Ii

- Secretiin

Ch I t kill iI C"C"K

-I· 0 . ecysto .'1 ru n : .

- Motilin

G- a' stric lnh lb itory .- P-'e' ptid e'

- I. . . I··. •••••. ... • I ..• · •.• 1 .• ....> .....11'- .•....•..

Secretin

• M:·······: alor role .. • lncreases secretion fr 0"''':' m····· '. p.····a·······n··-··c'r·"e·········-:a-·s·····_

., '._ . _ .•.. __ .-. '._' __ _ _ _ '.~. '._ .. , :~ .. _. "._'. _'.,"'_." '.'_', .. _ _.:

. _

(particularly bicarbonate)

• Minor' roles:

i~1 I ncrease bile flow

---, Decrease stomach acid by' decreasing 'Qla.strinl release

- Inhibit gastlrlic emptying

Secretin

S- t· !III S-·:···· t· !III

• . .....................• ".--- --'. ' .......................•.... --- ..... -- . iii

.. ecre.-I n-eCreJIOn iii

-. S' '.:- .. \. t· - ~I -m'" ". -U I a' . t· e'" d I b '-. -

• _ .. :'. -I" . .:',,.. .y .

.... ~ " '. ~ .' ~~_, . < . ." _." ~. I _< .~' ", ",. . .'

- Acid

- Fats and Lipids

,- B· ilia sallts

lnh lb lted b . h" ~Ig' h p H ln t-he D····· -0

• ..... I~lc.~ Y . I:~ .. _ -. I' -. '_IU-_

D. Duodenal Integration & Control: 1. Response to Acidity .egulation by Secretin

gall bladder

UHIC,I

I11I mo' ., . 0- .-. 't'"l: IIOII"t-y'-

v 111:._ u , ",','

H_, . .C •.. ·,:'l- - '+- N .. ','_- -.:.'._ a _.R. ,'. 'C "0.',-., .- '3,:" ,----4 _. -N'" -;- C'- '-'I C" .- 0" " H- , 0"--'"

- - - - ,a::_ +, .",". ''-'? ,+, " :',)/

Cho t kill III

-. . . . -. . - . ,. . -.

·····0 ecystoxi un

'. Source: l-cells of the duodenum and proximal jejunum

• Main Role: Aids in fat processing by Increasing

b ~I II'" --. Jt,!!i. -. - . -

_ I e sacre -Ion

• Growth IRale: Trophic factor for Pancreas and

GaUlblladder -

• . 'arqets: Gallbladder, Pancreas, Sphincter of Oddil

C· t kill

- . . . -. . - . ,

.... 0 ecys. ,0'1/1

• Functions:

- Squeeze Gallbladder

- Relax S •. sp •• ihincte .. ·:·.r··o.:'f·: Od d· •• · "

....... A ... ,I .,1.... I ....

- [I n" c···,~e·····a··s: e,":' p·a,·~ In'" c···r···e· •. atic ". S'·· e······c,· .. retio n"

I I I", .".11: . ,. ',' j '". . ".' ",' .• I _ . , '. ',' I IL, ," .. ", ," .' .. ". '". I ,",",'

[ ncrease intestine motility d ecrease g' astric e' rn p't-'y',ng

- ,:. ,'.",:' .11..·· t,1 : •..•. ~ ..: I." . :.~. ....~. ,"":" ," ",~" .•..•.. ':, 1'1. I,:'.

- Trophic factor on pancreas and ga,I,I,bla,dder mucosa

• Secretion stimulated by:

- Duodenal Fat (lonq chain FA and micelles)

- Duodenal Amino Acids (tryptophan +phenylalanine)

• Secretion iinhibited by trypsin, chymotrypsin

Regulat.ion by CCK ,(Cholecysokinin) .

gall Ib I~ aid d '8 r .--._____.---

fat &

protein .... ~

d:iige,sti'on ...

FOOD

. .. .

.,.,.' ...•...••.• m; ..

cc······ .' K// d S- -.' ' '.-- '.~' f -

........ /. a ..•... ,ec eJ

C- d c-

o • • •

• '.' ." - .....-.. ; ..... ...• . ". . . .; .. ': . ". •. -t . / .... .', - - '.' '._ . . ..•.. - - iii

'.. ampare an.. ··.ontrast.

Bot-h cai rse bile and' pancreatic ~I tlce

• •...••...• .' ..•.......••..•...... U' .11 ,'- ...• ' , .•.... ..'., . , .••..•.•..........••..•.•......• ," J ••...• ~ JI U I' ••.........••

t-!!!I secre ron

cc K···· !I ILIII p"

.'-_~'" Increases liver >1 -ancreas

• Secretin increases Pancreas >, Liver

• S··-O/·······I rce: C" ':"e/"'lls"" th ro .. ··, 1 g:' h' 0"""" 1 t··- g",:' - rt hiqh est in

" '> '::.,,' .:. ',' U, .,.' ,,'J' iii ','i ",'-'-' ',' • u ".' , ',' . U,' "U,,' .1, •• ', ""'~" II ,

duodenum and proximal jejunum

,., .. , ,>- '.' .... '" ",' ,'> .' '" "·"'1 '," ""'.,, " " ',_1,->-

• Main Role: lnitiates js Ig- atiing motoi complexes (MIMe) and

increases interdigestive gut motility

• Transitions from postprandiial to fasting

• Motlliin secretion stimullated by: iliiiiiiiiiiiiiJ D,IU':O· r- aden -a·:·'I~ acid .. ·:, a··:' n··· d',,:, foe id

" "·1 I~. .,..... . .... . .. : I.,.~..- ,

I hlblt d b

• nr ·1·· •• · .•. Ley:

'~i Somatostatln

i~1 Secretin l CCK

-- Pancreatic polypeptide ~ Duodenal fat.

G til I hibit as--lc . ·-1 ~ 10 -y

eptide GI

• Source: K-cellis of Duodenal glands

• Targets: Pancreatic islets, Proximal Stomach

• Main Rolle: Inhibits Gastric Secretion

'. S',,·,'e':""'c"""Q"':'n":"d."-' a ry' ~"","~ R:_:OI19-:S'-:-'·

,___:/, :' ... "" > ',- " r ' ~"" •

i~i Enhances insulin effects,

---- Trophic Factor for Bet.a Cells

G- tri I hibit P tid t·!III.1

• astnc nrnmtory+eptn e SeCreJIOn IS

stim ",U~ ilated by Iii

I, 'I'., ::. ,- '.' '_':",' ~

-Duodenal Presence of: ,- Amino Acids

-,IGllucose

- "_,._ ..... "_'

- Long chain Fatty Acids

II

iii,

.. .. ..

..

,.

... '

L,

... .,

.'

.' ' .

• . '

,.

.'

..

tnhibition

~/

..........,/e··-· .. ·· ptid e'-"" 'YV.,., .. ' r ,> ....•...

..... '> ,"'...... '" < ...... '>

• Source: Ceilis In distal ileum, colon, rectum

• Main Rolle: Ilea II Brake (For 'Gastric Emptying)

'. Eff·~=e' .• rcts:

I, '" _ . '. '. ". .'.

~ Inhibits gastric emptying

i~ lnhlblts qastrin stimulated acid secretion

- Inhibits cck-stlmulated pancreatic secretion

• Stlm u Ilated by intrallu min all fat

'. Source: Nl'Cellls in distal smalill lntestlne & lleal

m'-'" ". -u c'." "0' ·:·S·' a'" .'

. '. __ ' ,,_. ~ .. ,: '. ., .. -~.-':., .. " - .'.

• Main Role: lIIeall Brake (for Absorption)

Eff'" t

• - ~ re,c,-l-'S·· ·, II

I , , . _. '_', •

- I nhibits gastrin mediated gastric acid secretion

S- t I. ~ t t'lII t'·

____ I _ 1,lllmlU rates pancreanc S,Bc,relOln

,----, lnhlblts intestinsl motility

T ,. t I. d"·11 t"·

~j Irlglglers, ImeS,9Inl,9'lrIIC vaS,'O,lha"IIO'inl

·Stlmullated by lornlnal fat

GI ik 'p tid 1- (. G'" 'po 1-)' ucagon- Je/ep 1 .. · ••• e .. • •.•.•..•..•• ' .'. .r> ··1

• 3~·O:· ,", a··:m'···· .. uno-a .···c' id '.' p'" 0' ·.'Iy,:···:'··,:'p·. ·"e..-··p. " tid e""-"',

"..... .._. "~' '.~', "1·"- "'" . .., ",'. ")_,", " '.~,'

In' "C" '-r'e" tin h O '-r'm····o· " n"e- ", _ ln ite "st'-~I'n' ral h O '-r'm····o· " n"e'- ",

• "',_ ,/_:. - J'" r- . .,- ." " "',1, : II' __'" ' __ II' ,~_. r- . .,- ." " "',1,

secreted in response to nutrient iingestion __ h~IC' h potentiate 9"1- reese ind - reed lns: -I!II·n· W • II . 'I_i' ,]-_ .__ Uc'· :/-1 ,'_ U_:'. 11_ U I .

re,,··1 e' """8:- .'" 5····" e..-··

.... ~ ,I " •......... ',.". ~'./

• Produced by L cell in ileum and colon, pancreatic alpha cell, neurons in hypothalamus, pituitary gland

Actio - of GL~-

Sb) ae CI;S:i[!I~'~C· 1111Pbi19

Cardio,ro.tec _~:J - .. . ICardilc Olllp,ull

fm&ulh, secr11100nl

'""""lIIM!I;;I"lI1 ,r,m-II'"--m - .. "'A

~ ~,~I!Iiiii!I_~_

--rul1.

I, '

om ,aAd

1 '1:\¥.

r'm·:

, ·iil"ii,,- 1_·~Uj·

'] I

Enteric factors increasing insulin

re'" ····1 e···· a···· ',' S·,. " e,:,' '.:"

". . .. '" ", ",. '...."... /

• CCK, G P, GLP-1, Glucaqon

• GIP is also called glucose-dependent ln sullnotrop ~IC polyp' eptid e by this a' ction

I . .._ I. I . _ .l •.•••• •.••• I: I···.. 1- .•••...•••.... i ...._ : .l ie t •...••. -.'. .I'_,,_ ..•..• , J •..•.

• GLP'-1 is more potent than GIP (limited study)

• GIP, GLP-1 act via protein kinase A

, . ' I

pathway (increased cAMP' and cytosollc

calciium)