CHAPTER 28- GASTROINTESTINAL

HORMONES
1. Gastrin:
o 1) produced by G-cells in antrum
o 2) Secretion stimulated by:
o 1- amino acids
o 2- vagal input (ACh)
o 3- calcium
o 4- EtOH
o 5- antral distention
o 6- pH >3
o 3) Secretion inhibited by:
o 1- pH <3
o 2- somatostatin
o 3- secretin
o 4- CCK
o 5- vasoactive intestinal peptide
o 6- gastric inhibitory peptide
o 4) Target cells-
o 1- parietal cells
o 2- chief cells
o 5) Response-
o 1- increased HCl
o 2- increased intrinsic factor
o 3- increased pepsinogen
2. Omeprazole

blocks H/K ATPase of parietal cell (final pathway for H+ release)

3. Somatostatin:
o 1) produced by D (somatostatin) cells in antrum
o 2) secretion stimulated by acid in duodenum
o 3) Target cells- many; is the great inhibitor
o 4) Response:
o Inhibits release of:
o 1-HCl
o 2- insulin
o 3- glucagons
o 4- secretin
 o 5- GIP
o 6- motilin
o 7- neurotensin
o 8- enteroglucagon
o 9- decreased pancreatic and biliary output
4.
5. Octreotide:
o (somatostatin analogue)
o - can be used to decrease pancreatic fistula output
6. Gastric inhibitory peptide
o 1) produced by K cells in duodenum
o 2) secretion stimulated by:
o 1- amino acids
o 2- glucose
o 3- long-chain fatty acids
o 4- decreased pH
o 3) Target cells:
o 1- parietal cells of stomach
o 2- beta cells of pancreas
o 4) Response;
o 1- decreased HCl secretion and pepsin
o 2- increased insulin release
7. CCK:
o 1) produced by I cells of duodenum and jejunum
o 2) Secretion stimulated by:
o 1- amino acids
o 2- fatty acid chains
o 3) Response:
o 1- gallbladder contraction
o 2- relaxation of spincter of Oddi
o 3- increased pancreatic enzyme secretion
o 4- some increase in intestinal motility
8. Secretin
o 1) produced by S cells of duodenum
o 2) secretion stimulated by:
o 1- fat
o 2- bile
o 3- pH <4
o 3) secretion inhibited by:
o 1- pH>4
o 2- gastrin
 o 4) Response:
o 1- increases pancreatic HCO3- release
o 2- increases bile flow
o 3- inhibits gastrin release (this is reversed in patients with gastrinoma)
o 4- inhibits HCl release
o 5)
o High pancreatic duct output- high HCO3, low Cl-
o Slow pancreatic duct output- high Cl-, low HCO3 (carbonic anhydrase in
duct exchanges HCO3- for Cl-)
o
9. Vasoactive intestinal peptide:
o 1) produced by cells in gut and pancreas
o 2) Secretion stimulated by:
o 1- fat
o 2- acetylcholine
o 3) Response:
o 1- increased intestinal secretion (water and electrolytes
o 2- increased motility
o 3) inhibits gastrin release
10. Insulin
o 1) released by beta cells of the pancreas
o 2) secretion stimulated by:
o 1- glucose
o 2- glucagons
o 3- CCK
o 3) Secretion inhibited by:
o 1- somatostatin
o 2- pancreatostatin
o 4) Response-
o 1- cellular glucose uptake
o 2- promotes protein synthesis
11. Glucagon
o 1) released by alpha cells of the pancreas (also from alpha cells in the
stomach, intestine)
o 2) Secretion stimulated by:
o 1- decreased glucose
o 2- increased amino acids
o 3- increase acetylcholine
o 4- increased gastrin-releasing peptide
o 3) Secretion inhibited by:
o 1- increased glucose
 o 2- increased insulin
o 3- somatostatin
o 4) Response:
o 1- glycogenolysis
o 2- gluconeogenesis
o 3- lipolysis
o 4- ketogenesis
o 5- decreased gastric acid secretion
o 6- decreased pancreatic secretion
o 7- decreased intestinal motility
o 8- decreased stomach motility
o 9- increased LES pressure
o 10- decreased MMCs
12. Pancreatic polypeptide:
o 1) secreted by islet cells in pancreas
o 2) Secretion stimulated by:
o 1- food
o 2- vagal stimulation
o 3- other GI hormones
o 3) Response- decreased pancreatic and gallbladder secretion
13. Motilin
o 1) released by intestinal cells of gut
o 2) Secretion stimulated by:
o 1- duodenal acid
o 2- food
o 3- vagus input
o 4- gastrin-releasing peptide
o 3) Secretion inhibited by:
o 1- somatostatin
o 2- secretin
o 3- pancreatic polypeptide
o 4- duodenal fat
o 4) Response:
o 1- increased intestinal (small bowel) motility--> erythromycin acts on
this receptor
14. Bombesin (gastrin-releasing peptide):
o 1) increased intestinal motor activity
o 2) increased pancreatic enzyme secretion
o 3) increased gastric acid secretion
15. Peptide YY-
 1) released from terminal ileum following a fatty meal--> inhibits acid
secretion and stomach contraction; inhibits gallbladder contraction and
pancreatic secretion

16. Anorexia

mediated by hypothalamus

17. Bowel recovery

o 1) small bowel: 24hrs
o 2) stomach: 48 hours
o 3) large bowel: 3-5 days