physiology-16.消化与吸收2.ppt

第三节 胃内消化 一、胃液及其分泌（一）胃液的性质、成分与分泌细胞 Colorless，pH 0.9～1.5; 1.5～2.5 L/day Mucus（粘液/黏液）: surface and neck mucous cells Intrinsic factor（内因子）: parietal cells（壁细胞） HCl: parietal cells Pepsinogen: chief cells（主细胞）. Protective Mechanisms of Stomach and Stomach Pathophysiology Protective mechanisms include: Impermeability of parietal chief cells to HCl A layer of alkaline mucus containing HC03- Tight junctions between adjacent epithelial cells Rapid rate of cell division (entire epithelium replaced in 3 days) Prostaglandins (PGs) inhibit gastric secretions Which is why PG blockers such as NSAIDs can cause ulcers Gastric and Duodenal Ulcers Peptic- hydrochloric acid/pepsin present Stress-induced ulcers (reduced Bicarbonate) 80% of gastric, 90% of duodenal ulcers are due to H. pylori infection(40% of general population) weakens mucus barrier causes acid production (decreased Bicarb) NSAIDs can also contribute (COX-1 inhibitors) Gastrin Carcinomas (Zollinger-Ellison syndrome )- secrete gastrin cause excessive acid secretion Treatment triple therapy (2 antibiotics, one antacid or bismuth) vagotomy Dumping Syndrome Uncontrolled gastric emptying due to lack of feedback inhibition by duodenum post-surgical neurological deficit Un-digested food makes it to the colon Patient barely makes it to the bathroom Pyloric Stenosis Projectile vomiting Pediatric disease failure to thrive projectile vomiting after breast feeding (Wall’s sign) caused by atresia, improper formation of duodenum 第四节 小肠内消化和吸收 Structure of SI Chemical digestion in SI 胰液、小肠液和胆汁 Mechanical digestion in SI 分节运动、蠕动 Digestion and Absorption of major food types in SI 1. Structure of Small Intestine (SI) Surface area increased by foldings projections (plicae circulares, villi microvilli) Attached to microvilli are brush border enzymes: Disaccharidase: sucrase, maltase, lactase; Peptidase: aminopeptidase enterokinase; Phosphatase: needed for absorption of dietary calcium, etc Inorganic co