Digestive Physiology
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Mouth Esophagus Stomach Rectum and Anus Large Intestine Small
1 Liver The liver produces bile, which aids in digestion of fats through a dissolving process known as emulsification. In this process, bile secreted into the small intestine 4 combines with large drops of liquid fat to form Healthy tiny molecular-sized spheres. Within these spheres (micelles), pancreatic enzymes can break down fat (triglycerides) into free fatty acids. Pancreas Digestion The pancreas not only regulates blood glucose 2 levels through production of insulin, but it also manufactures enzymes necessary to break complex The digestive system consists of a long tube (alimen- 5 carbohydrates down into simple sugars (sucrases), tary canal) that varies in shape and purpose as it winds proteins into individual amino acids (proteases), and its way through the body from the mouth to the anus fats into free fatty acids (lipase). These enzymes are (see diagram). The size and shape of the digestive tract secreted into the small intestine. varies in each individual (e.g., age, size, gender, and disease state). The upper part of the GI tract includes the mouth, throat (pharynx), esophagus, and stomach. The lower Gallbladder part includes the small intestine, large intestine, The gallbladder stores bile produced in the liver appendix, and rectum. While not part of the alimentary 6 and releases it into the duodenum in varying canal, the liver, pancreas, and gallbladder are all organs concentrations. that are vital to healthy digestion. 3 Small Intestine Mouth Within the small intestine, millions of tiny finger-like When food enters the mouth, chewing breaks it 4 protrusions called villi, which are covered in hair-like down and mixes it with saliva, thus beginning the first 5 protrusions called microvilli, aid in absorption of of many steps in the digestive process. -
Common Bile-Duct Mucosa in Choledochoduodenostomy Patients--- Histological and Histochemical Study
HPB Surgery 1988, Vol. 1, pp. 15-20 (C) 1988 Harwood Academic Publishers GmbH Reprints available directly from the publisher Printed in Great Britain Photocopying permitted by license only COMMON BILE-DUCT MUCOSA IN CHOLEDOCHODUODENOSTOMY PATIENTS--- HISTOLOGICAL AND HISTOCHEMICAL STUDY E. ELEFTHERIADIS*, V. TZIOUFA 1, K. KOTZAMPASSI and H. ALETRAS Departments of Surgery and Pathology1, University of Thessaloniki, Greece We describe the histological and histochemical changes of the common bile-duct mucosa in specimens obtained by means of peroral cholangioscopy, 1-12 years after choledochoduodenal anastomosis. Our findings- hyperplasia of the superficial epithelium, metaplastic goblet cells containing predominantly acid sialomucins, and pyloric-like gland formation containing neutral mucins- express a morphological and functional differentiation of the common bile-duct mucosa that probably facilitates its survival in a different environment. We consider that these adaptive changes may explain the uneventful long-term postoperative period of choledochoduodenostomized patients. KEY WORDS" Common bile duct, choledochoduodenal anastomosis, adaptation, peroral cholangio- scopy. INTRODUCTION After choledochoduodenal anastomosis (CDA), the common bile-duct mucosa (CBDM) is exposed to a different environment, no longer being protected by the sphincter of Oddi. Although, theoretically, this new environment i.e. gastric acid and food flowing through the anastomosis- should affect it, both clinical practice and experimental data have shown no evidence -
Are You Ready for ICD-10-PCS? Expert Tips, Tools, and Guidance to Make the Transition Simple
Are You Ready for ICD-10-PCS? Expert Tips, Tools, and Guidance to Make the Transition Simple By Amy Crenshaw Pritchett February 19, 2014 1 Agenda In this webinar: Expand your understanding of ICD-10-PCS with can’t miss ICD-10-PCS coding conventions & guidelines. Understand the basic differences between ICD-9-CM Volume 3 and ICD-10-PCS. Learn code structure, organization, & characters: Step 1 to coding section “0” ICD-10-PCS? Pinpoint the body system. To build your ICD-10-PCS code, you must identify the root operation. Study 7 options when assigning your PCS code’s 5th character. Master how to determine the device value for your PCS code’s character. Raise your awareness of unique ICD-10-PCS challenges pertaining to documentation and specificity: Prepare physicians now for more detailed transfusion notes under ICD- 10-PCS. Discover why writing “Right Carotid Endarterectomy” won’t be enough. Know where to find ICD-10-PCS tools, techniques, and best practices. 2 Understanding ICD-10-PCS ICD-10-PCS is a major departure from ICD-9-CM procedure coding, requiring you to know which root word applies. Effective October 1, 2014, this procedure coding system will be used to collect data, determine payment, and support the electronic health record for all inpatient procedures performed in the US. 3 Gear Up for ICD-10-PCS This procedure coding system is starkly different from ICD-9-CM procedure coding: Every ICD-10-PCS code has seven characters, each character defining one aspect of the procedure performed. For instance, not correctly identifying your physician’s approach – the fifth character – and not being able to distinguish between similar root operations can throw off your claims accuracy! 4 Converting to ICD-10-PCS Have your inpatient coders and clinical documentation specialists begun preparing for ICD-10-PCS yet? That’s why we’re here today … to ease your transition from ICD-9-CM procedure coding to ICD-10-PCS. -
Ost , Is Essential for Intestinal Bile Acid Transport and Homeostasis
The organic solute transporter ␣-, Ost␣-Ost, is essential for intestinal bile acid transport and homeostasis Anuradha Rao*, Jamie Haywood*, Ann L. Craddock*, Martin G. Belinsky†, Gary D. Kruh‡, and Paul A. Dawson*§ *Department of Internal Medicine, Section on Gastroenterology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston–Salem, NC 27157; †Medical Science Division, Fox Chase Cancer Center, Philadelphia, PA 19111; and ‡Department of Medicine, Section of Hematology/Oncology, University of Illinois, Chicago, IL 60612 Communicated by David W. Russell, University of Texas Southwestern Medical Center, Dallas, TX, December 28, 2007 (received for review November 28, 2007) The apical sodium-dependent bile acid transporter (Asbt) is respon- Ost␣-Ost efficiently transports the major species of bile acids sible for transport across the intestinal brush border membrane; when expressed in transfected cells (3, 4); and (iv) expression of however, the carrier(s) responsible for basolateral bile acid export Ost␣ and Ost mRNA is positively regulated via the bile into the portal circulation remains to be determined. Although the acid-activated nuclear receptor farnesoid X receptor (FXR) heteromeric organic solute transporter Ost␣-Ost exhibits many (6–9), thereby providing a mechanism to ensure efficient export properties predicted for a candidate intestinal basolateral bile acid of bile acids and protection against their cytotoxic accumulation. transporter, the in vivo functions of Ost␣-Ost have not been Although these data are consistent with a role in bile acid investigated. To determine the role of Ost␣-Ost in intestinal bile transport, the in vivo functions of Ost␣-Ost have not been acid absorption, the Ost␣ gene was disrupted by homologous investigated. -
Overview of Gastrointestinal Function
Overview of Gastrointestinal Function George N. DeMartino, Ph.D. Department of Physiology University of Texas Southwestern Medical Center Dallas, TX 75390 The gastrointestinal system Functions of the gastrointestinal system • Digestion • Absorption • Secretion • Motility • Immune surveillance and tolerance GI-OP-13 Histology of the GI tract Blood or Lumenal Serosal Side or Mucosal Side Structure of a villus Villus Lamina propria Movement of substances across the epithelial layer Tight junctions X Lumen Blood Apical membrane Basolateral membrane X X transcellular X X paracellular GI-OP-19 Histology of the GI tract Blood or Lumenal Serosal Side or Mucosal Side Motility in the gastrointestinal system Propulsion net movement by peristalsis Mixing for digestion and absorption Separation sphincters Storage decreased pressure GI-OP-42 Intercellular signaling in the gastrointestinal system • Neural • Hormonal • Paracrine GI-OP-10 Neural control of the GI system • Extrinsic nervous system autonomic central nervous system • Intrinsic (enteric) nervous system entirely with the GI system GI-OP-14 The extrinsic nervous system The intrinsic nervous system forms complete functional circuits Sensory neurons Interneurons Motor neurons (excitatory and inhibitory) Parasympathetic nerves regulate functions of the intrinsic nervous system Y Reflex control of gastrointestinal functions Vago-vagal Afferent reflex Salivary Glands Composition of Saliva O Proteins α−amylase lactoferrin lipase RNase lysozyme et al mucus O Electrolyte solution water Na+ , K + - HCO3 -
Does Your Patient Have Bile Acid Malabsorption?
NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #198 NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #198 Carol Rees Parrish, MS, RDN, Series Editor Does Your Patient Have Bile Acid Malabsorption? John K. DiBaise Bile acid malabsorption is a common but underrecognized cause of chronic watery diarrhea, resulting in an incorrect diagnosis in many patients and interfering and delaying proper treatment. In this review, the synthesis, enterohepatic circulation, and function of bile acids are briefly reviewed followed by a discussion of bile acid malabsorption. Diagnostic and treatment options are also provided. INTRODUCTION n 1967, diarrhea caused by bile acids was We will first describe bile acid synthesis and first recognized and described as cholerhetic enterohepatic circulation, followed by a discussion (‘promoting bile secretion by the liver’) of disorders causing bile acid malabsorption I 1 enteropathy. Despite more than 50 years since (BAM) including their diagnosis and treatment. the initial report, bile acid diarrhea remains an underrecognized and underappreciated cause of Bile Acid Synthesis chronic diarrhea. One report found that only 6% Bile acids are produced in the liver as end products of of British gastroenterologists investigate for bile cholesterol metabolism. Bile acid synthesis occurs acid malabsorption (BAM) as part of the first-line by two pathways: the classical (neutral) pathway testing in patients with chronic diarrhea, while 61% via microsomal cholesterol 7α-hydroxylase consider the diagnosis only in selected patients (CYP7A1), or the alternative (acidic) pathway via or not at all.2 As a consequence, many patients mitochondrial sterol 27-hydroxylase (CYP27A1). are diagnosed with other causes of diarrhea or The classical pathway, which is responsible for are considered to have irritable bowel syndrome 90-95% of bile acid synthesis in humans, begins (IBS) or functional diarrhea by exclusion, thereby with 7α-hydroxylation of cholesterol catalyzed interfering with and delaying proper treatment. -
Sporadic (Nonhereditary) Colorectal Cancer: Introduction
Sporadic (Nonhereditary) Colorectal Cancer: Introduction Colorectal cancer affects about 5% of the population, with up to 150,000 new cases per year in the United States alone. Cancer of the large intestine accounts for 21% of all cancers in the US, ranking second only to lung cancer in mortality in both males and females. It is, however, one of the most potentially curable of gastrointestinal cancers. Colorectal cancer is detected through screening procedures or when the patient presents with symptoms. Screening is vital to prevention and should be a part of routine care for adults over the age of 50 who are at average risk. High-risk individuals (those with previous colon cancer , family history of colon cancer , inflammatory bowel disease, or history of colorectal polyps) require careful follow-up. There is great variability in the worldwide incidence and mortality rates. Industrialized nations appear to have the greatest risk while most developing nations have lower rates. Unfortunately, this incidence is on the increase. North America, Western Europe, Australia and New Zealand have high rates for colorectal neoplasms (Figure 2). Figure 1. Location of the colon in the body. Figure 2. Geographic distribution of sporadic colon cancer . Symptoms Colorectal cancer does not usually produce symptoms early in the disease process. Symptoms are dependent upon the site of the primary tumor. Cancers of the proximal colon tend to grow larger than those of the left colon and rectum before they produce symptoms. Abnormal vasculature and trauma from the fecal stream may result in bleeding as the tumor expands in the intestinal lumen. -
Bile Physiology
BILE PHYSIOLOGY DIPENDRA PARAJULI University of Louisville BILE COMPLEX LIPID-RICH MICELLAR SOLUTION ISO-OSMOTIC WITH PLASMA VOLUME OF HEPATIC BILE = 500 – 600 CC/DAY University of Louisville COMPOSITION University of Louisville FUNCTION OF BILE INDUCE BILE FLOW AND PHOSPHOLIPID AND CHOLESTEROL SECRETION ESSENTIAL FOR INTESTINAL ABSORPTION OF DIETARY CHOLESTEROL , FATS AND VITAMINS BIND CALCIUM AND HELP TO PREVENT Ca GALLSTONES AND OXALATE KIDNEY STONE FORMATION EXCRETION OF LIPID SOLUBLE XENOBIOTICS, DRUGS AND HEAVY UniversityMETALS of Louisville BILE FORMATION AND CIRCULATION University of Louisville University of Louisville BILE ACID SYNTHESIS TWO PATHWAYS 1) CLASSICAL / NEUTRAL - RESULTS IN THE SYNTHESIS OF APPROXIMATELY 1:1 RATIO OF CHOLIC AND CHENODEOXYCHOLIC ACIDS 2)ALTERNATE / ACIDIC - YIELDS PREDOMINANTLY UniversityCHENODEOXYCHOLIC of LouisvilleACID BILE ACID SYNTHESIS CLASSICAL / NEUTRAL PATHWAY - PREDOMINANT PATHWAY IN HEALTH - POSTCHOLECYSTECTOMY PATIENTS WITH BILE FISTULA - INFUSED WITH RADIOLABELLED PRECURSORS * [3H]7αOH CHOLESTEROL University* [3H]27-OH CHOLESTEROL of Louisville [3H]7αOH CHOLESTEROL 70-95% CONVERTED TO BILE ACIDS [3H]27-OH CHOLESTEROL <20% CONVERTED TO BIL ACIDS University of Louisville BILE ACID SYNTHESIS ALTERNATE / ACIDIC PATHWAY - MORE IMPORTANT IN CHRONIC LIVER DISEASE -CIRRHOTICS - LOW RATE OF BILE ACID SYNTHESIS - ALMOST EXCLUSIVELY UniversityCHENODEOXYCHOLIC of Louisville BILE ACID SYNTHESIS FINAL STEP = - CONJUGATION OF CHOLIC AND CHENODEOXYCHOLIC ACIDS WITH GLYCINE AND TAURINE - CONJUGATION -
GLOSSARY of MEDICAL and ANATOMICAL TERMS
GLOSSARY of MEDICAL and ANATOMICAL TERMS Abbreviations: • A. Arabic • abb. = abbreviation • c. circa = about • F. French • adj. adjective • G. Greek • Ge. German • cf. compare • L. Latin • dim. = diminutive • OF. Old French • ( ) plural form in brackets A-band abb. of anisotropic band G. anisos = unequal + tropos = turning; meaning having not equal properties in every direction; transverse bands in living skeletal muscle which rotate the plane of polarised light, cf. I-band. Abbé, Ernst. 1840-1905. German physicist; mathematical analysis of optics as a basis for constructing better microscopes; devised oil immersion lens; Abbé condenser. absorption L. absorbere = to suck up. acervulus L. = sand, gritty; brain sand (cf. psammoma body). acetylcholine an ester of choline found in many tissue, synapses & neuromuscular junctions, where it is a neural transmitter. acetylcholinesterase enzyme at motor end-plate responsible for rapid destruction of acetylcholine, a neurotransmitter. acidophilic adj. L. acidus = sour + G. philein = to love; affinity for an acidic dye, such as eosin staining cytoplasmic proteins. acinus (-i) L. = a juicy berry, a grape; applied to small, rounded terminal secretory units of compound exocrine glands that have a small lumen (adj. acinar). acrosome G. akron = extremity + soma = body; head of spermatozoon. actin polymer protein filament found in the intracellular cytoskeleton, particularly in the thin (I-) bands of striated muscle. adenohypophysis G. ade = an acorn + hypophyses = an undergrowth; anterior lobe of hypophysis (cf. pituitary). adenoid G. " + -oeides = in form of; in the form of a gland, glandular; the pharyngeal tonsil. adipocyte L. adeps = fat (of an animal) + G. kytos = a container; cells responsible for storage and metabolism of lipids, found in white fat and brown fat. -
Lumen Retiree and Inactive Health Care Plan* Standard Consumer
Lumen Retiree and Inactive Health Care Plan * Standard Consumer Driven Health Plan (CDHP) (Administered by UnitedHealthcare) Summary Plan Description (SPD) For Retired and Inactive Former Employees CenturyLink, Embarq, Qwest Post-1990 Management, Qwest Post-1990 Occupational Retirees (including Inactive and COBRA Participants) Effective January 1, 2021 This SPD must be read in conjunction with the Retiree General Information SPD , which explains many details of your coverage and provides a listing of the other Benet options under the Plan. * The Lumen brand was launched on September 14, 2020. As a result, Lumen, Inc. is referred to as Lumen Technologies, or simply Lumen. The legal name Lumen, Inc. is expected to be formally changed to Lumen Technologies, Inc. upon the completion of all applicable requirements. Issued Jan. 1, 2021 Table of Contents INTRODUCTION 1 The Patient Protection and Affordable Care Act Known as the “Affordable Care Act” ....................................... 1 The Required Forum for Legal Disputes .......................................................................................................... 2 How to Use This Document ............................................................................................................................... 2 Exempt Retiree Medical Plan Status Notice ...................................................................................................... 2 Lumen’s right to use your Social Security number for administration of benets ............................................. -
Glucose-Dependent Insulinotropic Polypeptide (GIP): from Prohormone to Actions in Endocrine Pancreas and Adipose Tissue
PHD THESIS DANISH MEDICAL BULLETIN Glucose-dependent Insulinotropic Polypeptide (GIP): From prohormone to actions in endocrine pancreas and adipose tissue Randi Ugleholdt The two incretins, glucagon-like peptide 1 (GLP-1) and glu- This review has been accepted as a thesis with two original papers by University of cose dependent insulinotropic polypeptide (gastric inhibitory Copenhagen 14th of December 2009 and defended on 28th of January 2010 peptide, GIP) have long been recognized as important gut hor- mones, essential for normal glucose homeostasis. Plasma levels Tutor: Jens Juul Holst of GLP-1 and GIP rise within minutes of food intake and stimulate Official opponents: Jens Frederik Rehfeld, Baptist Gallwitz & Thure Krarup pancreatic β-cells to release insulin in a glucose-dependent man- ner. This entero-insular interaction is called the incretin effect and Correspondence: Department of Biomedical Sciences, Cellular and Metabolic Re- search Section, University of Copenhagen, Faculty of Health Sciences, Blegdamsvej accounts for up to 70% of the meal induced insulin release in man 3B build. 12.2, 2200 Copenhagen N, Denmark and via this incretin effect, the gut hormones facilitate the uptake of glucose in muscle, liver and adipose tissue (2). Although the E-mail: [email protected] pancreatic effects of these two gut hormones have been the target of extensive investigation both hormones also have nu- merous extrapancreatic effects. Thus, GLP-1 decreases gastric Dan Med Bull 2011;58:(12)B4368 emptying and acid secretion and affects appetite by increasing fullness and satiety thereby decreasing food intake and, if main- THE TWO ORIGINAL PAPERS ARE tained at supraphysiologic levels, eventually body weight (3). -
(CCK); B. When Small Intestine Fills with Fatty Chyme
5. Regulation of bile release: a. Hormone = CHOLECYSTOKININ (CCK); b. When small intestine fills with fatty chyme, -cholecystokinin is released; -sphincter in common bile duct opens; -bile is released into duodenum to emulsify fat. Digestive dissection of F. domesticus Esophagus: -Macroscopically -measure length -measure diameter -external structures -internal structures - Microscopically -external serosa -internal mucosa -cross section of all 4 layers Stomach -Macroscopically -measure length -measure diameter -external structures -internal structures - Microscopically -external serosa -internal mucosa -cross section of all 4 layers Small intestine -Macroscopically -measure length -measure diameter -external structures -internal structures - Microscopically -external serosa -internal mucosa -cross section of all 4 layers Large Intestine -Macroscopically -measure length -measure diameter -external structures -internal structures - Microscopically -external serosa -internal mucosa -cross section of all 4 layers III. Digestive Organs (continued) G. Small Intestine 1. Parts of Small Intestine: a. duodenum - nearest stomach, b. jejunum - mid-region, c. ileum - near large intestine. The distal end of the ilium narrows to form the ileocecal valve (sphincter muscle between small & large intestine). 2. Mucosal Structure a. intestinal villi project into lu men (increasing SA); b. each villus is composed of simple columnar epithelium (with microvilli) and connective tissue with many blood & lymph vessel s (lacteals ); c. absorbed nutrients are carried away by blood & lacteals; d. intestinal glands are located between villi. 3. Secretions of Small Intestine a. mucus, b. digestive enzymes: peptidases * peptides-----> amino acids; sucrase, maltase, lactase * disaccharides-->monosaccharides; lipases * TG-----> 2 fatty acids + monoglyceride. G. Small Intestine 4. Absorption in Small Intestine (90% of total) a. Intestinal villi (and microvilli) increas e absorptive surface area; b.