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Trudy is a 67 year old patient with stomach cancer who recently had a tube…

- - - - loss of appetite
      - Change in bowel habits
      - Anemia caused by persistent gastrointestinal bleeding that is not visible to patient
      - Discomfort and pian
      - Vomiting
      - Unexplained weight loss
    - - Diet
        
        Low intake of fruits and vegetables
        
        Use of tobacco and alcohol
        
        Heavy salted and preserved foods
      - Genetics
        
        Gender
        
        Blood Type A
        
        Pernicious anemia (Inability to absorb Vitamin B12)
      - Exercise
  - - - Limit fat intake
- - - - Carbohydrates
        
        Salivary amalyse
        
        Enzyme is on the saliva that starts chemical beak down of a carbohydrate
        
        Salivary amylase helps start break down, when bolus reaches the stomach the enzyme is inactivated by the low PH of the stomach
        
        Pancreatic amylase
        
        synthesized in pancreas then ejected into duodenum
        
        for example- lactase digests lactose to glucose and galactose and sucrase digest sucrose to glucose and fructose
        
        Organization of Carbohydrates
        
        polysaccharides
        
        starch & cellulose
        
        Enzyme main goal is to break down into subunit
        
        monosacccharides
        
        glucose,fructose and galactose
        
        Smallest, the building blocks
        
        disaccharides
        
        sucrose, maltose,and lactose
        
        Enzyme wants to break bonds to smallest subunit
      - Nucleic Acids
        
        Enzyme- nuclease
        
        Nucleases, deoxyribonuclese and ribonuclease
        
        phosphatase
        
        breaks the bond holding phosphate to the rest of the nucleotide
        
        nucleosidase
        
        breaks bond sugar and nitrogen base
      - Proteins
        
        Protease
        
        Location of chemical breakdown
        
        Digestion initiates at the stomach by the HCL acid and it terminates at the duodenum in the small intestine
        
        The gastric phase - initiated by presence of food in stomach
        
        Its a pancreatic enzyme or pancreatic juice that breaks down protein
        
        Parietal cells
        
        HCL is not formed within the cell but it forms from the H+ and the CL- Secreted from the parietal cells
        
        HCL converts the inactive enzyme pepsinogen into active pepsin
        
        1 more item...
        
        Chief cells
        
        Inactive pepsinogen
        
        Hydrochloric acid activates pepsinogen into pepsin
        
        1 more item...
      - Lipids
        
        Peyer's patches
        
        They are lymphatic tissue found in the ilium of the small intestine
        
        they form an important part of the immune system by monitoring intestinal bacteria populations and preventing growth of pathogenic bacteria
        
        Main functions
        
        it helps prevent ingested microbes from crossing the GI tract wall and entering the body
        
        To monitor intestinal bacteria and to prevent pathogenic bacteria growth
        
        Lacteals
        
        A lacteal is a lymphatic capillary that absorbs dietary fats in the villi of the small intestine
        
        Bile salts released from the liver and gallbladder emulsify lipid droplets to form micelles
        
        pancreatic lipase functions within micelles to digest each triglyceride into a monoglyceride and three free fatty acids
        
        Monoglycerides and free fatty acids enter an epithelial cell , while bile salts remain in the intestinal lumen to be reabsorbed and recycled
        
        Portal venous system
        
        Is responsible for directing blood from parts of the GI tract to the liver
        
        Substances absorbed in the small intestine travel first to the liver for processing before continuing to the heart
        
        The liver detoxifies any toxin material that we ingest.
  - - - motilin
        
        participates in controlling the pattern of smooth muscle contractions in the upper gastrointestinal tract. This also triggers the secretion of gastrin which elicits the release of (HCL) acid.
      - glucose dependent insulinotropic peptide
        
        this induces insulin secretion which is stimulated by a hyperosmolarity of glucose in thee duodenum
      - cholecystokinin
        
        it stimulates the delivery of enzymes from the pancreas and bile from the liver and gall bladder
      - somatostatin
        
        this regulates a wide variety of physiological functions and inhibits the secretion of other hormones
      - histamine
        
        plays a role in gastric secretion by helping to induce the production of acid in the stomach
      - secretin
        
        inhibits the secretion of gastrin
      - gastrin
        
        it's a peptide hormone that stimulates secretion of gastric acid (HCL) by the parietal cells in the stomach and acids in stomach motility
    - - cephalic phase
        
        initiated by thought, smell, sight , or taste of food
        
        even sounds of food preparation
      - intestinal phase
        
        initiated by presence of acidic chyme in duodenum
        
        CCK decreases the force of contraction in the stomach and the presence of acidic chyme causes release of secretin
      - gastric phase
        
        initiated by the presence of food in the stomach
        
        baroreceptors and chemoreceptors detect and start secreting gastrin
    - - Reflexes that mediate motility, secretions, and hormone release
    - - reflex goes from gut mechano and chemical receptors along the vagus nerve to the Brain
  - - - Serosa
        
        Function
        
        Covers portions of the GI tract within peritoneal cavity
        
        Tissue type
        
        Areolar Connective tissue
      - Muscularis Externa
        
        Function
        
        Inner layer is the circular muscle and the outer layer is the longitudinal both are for peristalsis
        
        Tissue Type
        
        Two layers of smooth muscle, *circular and longitudinal
      - Submucosa
        
        Function & features
        
        Fine branches of nerves that extend into the mucosa, these nerves innervate the tunic layers
        
        Tissue Type
        
        Areolar and dense irregular connective tissue
      - Mucosa
        
        3 sublayers
        
        Epithelium
        
        Tissue Type-Simple Coumnar Epithelium
        
        Function is for protection can withstand abrasion in esophagus
        
        Muscularis Mucosa
        
        Tissue type- is smooth muscle
        
        Function is for movement within mucosa* very minor
        
        Lamina Propria
        
        Tissue type-Areolar connective tissue
        
        Contain small blood vessels and nerves
    - - Large intestine (N2.4)
        
        Colon
        
        Ascending colon, transverse colon, and descending colon, absorbs water and electrolytes, turns leftovers into a solid form
        
        Rectum
        
        Muscular tube that expands to store accumulated fecal prior to deification
        
        Cecum
        
        Fist part,appendix is attached,chyme enters the cecum from the ileum
      - Accessory Digestive Organs (N3.1,2,3)
        
        Gallbladder
        
        Stores bile
        
        Pancreas
        
        produces pancreatic juice to assist with digestion, amylase, lipase, proteases, and nucleases
        
        Liver
        
        Detoxifies, Liver secretes bile, bile salts and lecithin function in a chemical digestion of lipids, allowing more efficient chemical digestion of triglycerides.,
        
        Teeth
        
        For mastication
        
        Tongue
        
        Bolus of food is pushed by tongue against the hard palate
        
        Salivary Glands
        
        Sublingual
        
        secrete serous and mucus secretions
        
        Submandibular
        
        secrete serous and mucus secretions
        
        Parotid
        
        largest gland, secretes only serous secretions
      - Anal Canal
        
        Makes up the terminal few centimeters of the large intestine
      - Small intestine (N2.4)
        
        Jejunum
        
        Middle region of small intestine, chemical digestion of nutrients
        
        Duodenum
        
        first part of the Small intestine,its arched into the pancreas. also attached to the liver by lesser omentum
        
        Ileum
        
        Last part of the small intestine absorption and digestion still occurs
      - Stomach
        
        Makes bolus into chyme, a liquid substance
      - Esophagus
        
        Peristaltic contractions of esophageal muscle push bolus toward stomach
      - Pharynx
        
        Provides lubrication for swallowing
      - Oral Cavity ( N2.2)
        
        Lingual Frenulum
        
        Tongue movement
        
        Uvula
        
        elevate and close off the nasopharynx
        
        Soft Plates
        
        help elevate to close nasopharynx
        
        Hard plate
        
        help move the bolus back to the oropharynx
        
        Lips
        
        hold food and drinks inside
        
        Labial Frenulum
        
        Provide stability of upper and lower lip
  - - - Pancreatitis
        
        inflammation of pancreas, pancreatic enzymes digest the pancreatic tissue and duct (caused from activation of pancreatic enzymes in duct)
      - Gallstones
        
        bile stored in gall bladder for too long or too much water is removed, cholesterol it contains crystallizes and forms gallstones
    - - PH Balance
        
        saliva in the mouth is the primary digestion of carbohydrates
        "salivary amylase"
        
        this is slightly acidic because it can't be to strong or it will harm the oral cavity structures
        
        To balance things out it is important that the small intestine has a high pH, because most of the enzymes used in digestion can’t function properly in an acidic environment
      - Helpful Bacteria
        
        Microflora
        
        These resident bacteria help keep transient bacteria from invading the body
        
        Microflora species have such a positive effect on their host, help produce vitamins, help formulate excrement and guard against harmful bacteria.
    - - Returned to the liver via the hepatic portal blood
      - Resecreted into newly formed bile
      - Bile salts are reabsorbed in to the blood by ileum
  - - - The introduction of solid or liquid nutrients into the oral cavity
        
        Uses structures of the oral cavity to start breaking food apart to turn it into a bolus
        
        If its a carbohydrate - salivary amylase then bonds start breaking
    - - Voluntary and involuntary muscular contractions for mixing and moving materials trough the gastrointestinal tract
        
        Peristalsis and Mixing the constriction and altering of the circular and longitudinal for propelling, also the blending of ingested material with secretions in the GI tract.
    - - Producing and releasing digestive enzymes, acid and bile
        
        From the start of Cephalic phase srcretory activity initiate by preparing the body to start chemical breakdown
    - - Is the expulsion of indigestible components that are not absorbed
    - - Involves membrane transport of digested molecules, into the blood or lymph
        
        Once pancreatic enzymes chemically digest the bolus and the chyme substance then nutrients are absorbed
    - - Mechanical digestion
        
        Only mastication without breaking bonds
      - Chemical digestion
        
        Breaking bonds
        
        Gall bladder realeses bile, Parietal cells secreting hydrochloric acid
  - - - Oral cavity
        
        Salivary glands release salivary amylase to partially breakdown starch
      - Stomach : No enzymes added
      - Small intestines
        
        Pancreatic amylase that is produced by the pancreas is secreted to continue the partial digestion of starch
        
        Brush border enzymes ( micro villi ) complete the break down of starch
        
        Maltose
        
        Maltase
        
        Glucose
        
        Lactose
        
        Lactase
        
        Glucose, Galactose
        
        Sucrose
        
        Sucrase
        
        Glucose, Fructose
    - - Oral Cavity : No protein digestion
      - Stomach
        
        Hydrochloric acid is released from parietal cells to activate pepsinogen to pepsin
        
        Polypeptide and peptide fragments
      - Small intestines
        
        inactive enzymes reactivated by
        
        Enteropeptidase activates
        
        Chymotrypsinogen
        
        Chymotrypsin : Polypeptide and peptide fragments
        
        Procarboxypeptidase
        
        Carboxypeptidase : Amino acids on carboxyl end
        
        Trypsinogen
        
        Trypsin : Polypeptide and peptide fragments
        
        Brush border enzyme
        
        Dipeptidase : Amino acids
        
        Aminopeptidase: amino acids from amino ends of peptides
    - - Oral cavity
        
        Lingual lipase produced by salivary glands are activated at a low PH in the stomach
      - Stomach
        
        Lingual lipase and gastric lipase
        
        Breaks down of some of triglycerides to diglyceride and fatty acid
      - Small intestine: absorption and digestion
        
        Pancreatic lipase functions within micelles to digest each triglyceride into monoglyceride and free fatty acids
        
        Bile salts are released into the liver and gallbladder to emulsify lipid droplets to form micelles
        
        Monoglyceride and free fatty acids enter the epithelial cell. Bile salts remain in the interstitial lumen to be reabsorbed and recycled
        
        Triglyceride molecules are reassembled within epithelial cells . Chylomicron are released from the epithelial cells by exocytosis then are absorbed by the lacteals
    - - Oral cavity : No nucleic acid
      - Stomach : No nucleic acid
      - Small intestines
        
        DNA to Deoxyribonuclease
        
        Deoxyribonucleotides
        
        RNA to Ribonuclease
        
        Ribonucleotides
        
        Brush border enzymes
        
        Nucleotides
        
        Phosphatase : nucleosides and phosphate
        
        Nucleotides : nitrogenous base and sugar
  - - - Peristaltic waves move food bolus to stomach. Thus, accomplishing involuntary phase of swallowing
    - - Digestion of proteins begun by pepsin
      - Absorbs a few fat soluble substances
        
        Aspirin
        
        Alcohol
        
        Some drugs
      - Peristaltic waves mix foods with gastric juice and propel into duodenum
    - - Segmentation by smooth muscle of small intestines continuously mixes contents with digestive juices and moves food along tract and through ileocecal valve at a slow rate allowing time for digestion and absorption.
      - Digestive enzymes in pancreas and brush border enzymes attached to microvilli membranes complete digestion of all classes of food.
      - Absorbed by active and passive mechanisms
        
        Proteins
        
        Fats
        
        Carbohydrates
        
        Nucleic acid digestion
        
        Vitamins
        
        Electrolytes
        
        Water
    - - Some remaining food residues are digested by intrinsic bacteria (Vitamin K)
      - Absorbs most remaining
        
        Water
        
        Electrolytes
        
        NaCl
        
        Vitamins produced by bacteria
      - Propels feces towards rectum by peristalsis, churning, and mass movements
      - Reflex triggered by rectal dissension (eliminates feces from body)
    - - Buccal phase of swallowing initiated by tongue will propel food into the pharynx
      - Chewing by teeth and mixing food by tongue
      - Food is voluntarily placed into oral cavity
      - Chemical breakdown of starch is begun by salivary amylase, produced by salivary glands
- - - - Bypassing mouth: No physical breakdown of food (chewing), chemical breakdown of carbohydrates (enzymes), or swallowing
        
        Absence of taste
      - Bypassing pharynx and esophagus :
        
        Absence of swallowing. No movement of food to stomach.
      - Stomach
        
        No breakdown of proteins via gastric juices and pepsin. No movement of food into duodenum.
      - Bypassing the duodenum
        
        Materials that need to be broken down through bypass and will be absorbed in the small intestines
        
        Proteins
        
        Fats
        
        Carbohydrates
        
        Nucleic acid digestion
        
        Vitamins
        
        Electrolytes
        
        Water
        
        all classes of food can not be digested and absorbed.
      - Large Intestines
        
        Some remaining food residues are digested by intrinsic bacteria (Vitamin K)
        
        Absorbs most remaining
        
        Water
        
        Electrolytes
        
        NaCl
        
        Vitamins produced by bacteria
        
        Propels feces towards rectum by peristalsis, churning, and mass movements
        
        Reflex triggered by rectal dissension (eliminates feces from body)