Outline 9 1. Introduction A. Splincter Prevent 2. Splanchnic Circulation A. Directly sympathetic 3. Innervation of the Gastrointestinal Tract (GIT) A.

. Sympathetic Nervous System i. Start SCSI ii. Termination of MESSS B. Parasympathetic Nervous System i. Start Pelvic/Vagus ii. Termination of SubOaaE C. Enteric Nervous System i. Start Submucosal/Myenteric ii. Termination of Smoothmm,sphincter,cap,enterotyle,endocrine, other 4. Neural reflexes in the GIT A. Short and long 5. Hormonal regulation of the GIT A. Hormones 4 McGasS (Global) B. Paracrine 2 SoHis C. Neurocrine 2P (local) Outline 10 and11 1. Visceral smooth muscle a. Deglutition OPE b. Swallowing Reflex i. Vagal excitatory ii. Vagal inhibitory c. Peristalasis 2. Esophageal motility a. UES (vagus,ACh), body, LES (myenteric,NO) b. Fig4 and 5 3. Slow waves and motility a. ICC, Ach, NoE 4. Gastric motility a. Gastric emptying: PERMS i. Sieving/retropulsion b. Gastric control i. Para= + ii. Gastric distension = + iii. Sym, secretin (acidic), CCK (LCFFA) = 1. Feedback inhibition = 2. F-HAD 5. Small Intestinal Motility a. Fed i. MEN ii. Enteric neuron control frequency of phasic contraction iii. Segmentation and peristalsis iv. GAINS

v. DOESN'T 1. Imodium = opiod receptor agonist treats diarrhea b. Fasting MMC i. Housekeeper ii. Only in small intestine iii. 3 phase = motilin iv. erythromycin = motliin receptor agonist diarrhea for gastropersis 6. Colonic Motility a. Parasym vagus nerve CAT RPP b. Pelvic nerve DSR RS c. Sympatheic nerve colon RM d. Enteric neuron myenteric (smooth mm) and submucosal (mucosa) e. Pudenal nerve external anal sphincter f. Haustral: SPMRM g. Gastrocolonic reflex i. Rapid long enteric motor neuron ii. Slow gastrin smooth mm cell h. Control of sphincters i. Distention relaxes IAS; EAS relaxes with defecation is appropriate i. Storage of feces j. Defection i. Short, long, pudendal 7. VomitingVESTED Outline 12 1. Salivary secretion A. Function B. Secretory mechanism i. Rate = neural control via para (Ach) and sym (NoE) ii. Muscarinic receptor antag: decrease/agonist: increase iii. Low rates: reabsort ( low NaCl, nigh K and HCO3-) iv. Aldosterone modifies electrolyte []; not rate C. Regulation of secretion D. Effect of flow rate 2. Gastric acid secretion A. Function B. Secretory mechanism i. HCl PIG, HisGaS, BM ii. HCl = HAG/ProstgSS (PPI/H2 receptor antagonist) C. Regulation of secretion 1. Gastrin a. Increase:PsGAGrp/D:S 2. Histamine a. GPS3. Somatostatin a. Inhibit! D. Inter-regulation of acid secretion

Outline 13 1. Gastric Secretions a. Pepsinogen i. HAG ii. Active in low pH iii. H pepsin iv. digest protien b. Gastric lipase i. ACh c. Intrinsic factor i. B12 d. Gastric mucosal barrier i. Mucus 1. GAPros ii. Bicarbonate 1. APros 2. Pancreatic Secretions a. Enzyme i. Zymogen (inactive) 1. Alpha amylase and lipase =active 2. Activate by trypsin; trypsinogen activated by enterokinase 3. Trypsin inhibitor and procolipase = not enzymes b. Bicarbonate i. CCK(increase Ca++), Secretin (increase CAMP) c. Regulation of secretion i. Para Ach = slight increase ii. Sym NoE= reduce (bf reduced to pancreas) 3. Small Intestinal Enterocyte Secretion a. Cl- increase CAMP when VIP activated b. High Cl- = diarrhea (Cholera toxin) Outline 14 1. Formation of hepatic bile by hepatocytes a. 7 components b. conjugated 1 bile salt water soluble (AA) c. unconjugated 2 bile salt lipid soluble (bacteria ) d. increase [] bile salt in portal vein = bile salt syn down and secretion up (MEAL) e. unconjugated bilirubin i. hemolytic anemia excessive breakdown of RBC ii. neaonatal jaundice lower UGT1A1 transportor activity, shorter RBC life span f. conjugated bilirubin i. liver disease defect in transport ii. bile duct obstruction defect in excretion of bile g. bile acid-dependent- osmotic gradient, solvent drag h. bile acid-independent biocarb/cl secreation increased by SECRETIN 2. Storage and concentration of bile in gallbladder a. Balance between resistence to filling gallbaladder and entering duodenal b. Fasting sphincter Oddi = always tonically constricted i. gallbladder smooth mm = low resting tone

1. Na = with cl/hco3 = electrically neutral 2. Water absorption = passive 3. [bile salt] increases makes micelles 3. Expulsion and transport of bile from the gallbladder into the lumen of the duodenum a. Small bile salt secreted during fasting b. Parasym vagus nerve i. Contract gallbladder smooth mm ii. Relax Oddi iii. Increast blie flow to lumen Outline 15 and 16 1. Carbohydrate a. General a. 3 oligo (MadM) b. brush borer enxyme = glycosidases (LMSI) i. gluclose, fructose, galactose b. Digestion a. L G&G b. M G c. S G&F d. I G c. Absorption a. G&G (Glut- 2; SGLT-1 Na-dependent) b. F (Glut-5)) 2. Protein i. Digestion to oligopeptides 1. Pepsin 2. Endopeptidases (trypsin)and Exopeptidases 3. Aminopeptidases (brush) 4. Cytoplasmic peptidase (completes hydrolysis) 3. Fat 1. Class a. TAG b. SCFFA c. LCFFA 2. Digestion a. Emulsification b. Gastric lapase (TAG DG and FFA) c. Binding to colipase (typsin) d. Pancreatic lipase e. Micelles 3. Absorption a. Micelle content b. SM-FFA c. chylomicrons 4. Vitamin B12 1. Diagram Rprotien 5. Calcium 1. Vitamin D

6. Sodium 1. Cotransport AA = small intestine 2. Exchange H+ = small and large intestine 3. Passive Na channel = colon a. Aldosterone increase: #ENac, insertions 7. Iron 1. DMT1 only Fe2 enters 2. Heme transporter 3. Stored as ferritin 8. Water 1. 98% efficient 2. osmotic and hydrostatic pressure Outline 17 1. Gastrointestinal Hormones that Regulate Food Intake a. Orexigenic Hormones: increase food intake i. Ghrelin b. Anorexigenic Hormones: decrease food intake i. CCK ii. PYY iii. GIP iv. GLP-1 2. Interdigestive period (fasting) a. Max somostatin and bile acid synthesis 3. Digestive period a. Cephalic phase (start) i. Stomach: somatostaitin = low; gastrin = increase ii. Pancreatic: Secretin, CCK = low iii. Gallbladder: weak and relaxed Oddi b. Gastric phase (eating) i. Salivary flow = MAX ii. Stomach: somatostaitin = decrease; gastrin = MAX; Gastric Acid = MAX iii. Pancreatic: Secretin, CCK = low iv. Gallbladder: weak and relaxed Oddi c. Early intestinal phase (stopped eating) i. Stomach: somatostaitin = increase; gastrin = decrease ii. Pancreatic: Secretin= MAX; CCK = MAX iii. Gallbladder: weak and relaxed Oddi iv. Hapatic ductal and pancreatic ductal = MAX d. Late intestinal phase i. Pancreatic: Secretin= low; CCK = low ii. Ileum: Bile salt= MAX; hepatic bile = MAX iii. Water and electrolyte absorption = MAX