The Stomach

 Volume can be from 50 ml to 4 L

 Muscularis externa is composed of 3 layers
_______________________________________________________________
 _______________________ epithelium line stomach
 Smooth lining dotted with millions of deep gastric pits
which lead to gastric glands
Gastric glands
 Mucous neck glands-found at upper region of gland
produce and secrete a type of mucus
 _____________: middle of gland secret __________
 ___________________________: lower part of
gland produces _____________________
 __________________ cells: dispersed at bottom of
gland release hormones directly into lamina propria
including gastrin from _____, histamine from
___________________, and somatostatin from
________.
Gastric glands according to region:
Gastric motility
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  3 motor functions stomach is responsible for
o Storage of large quantities of food until food can
be processed
o Mixing of food with gastric juice until chyme is
formed
o Emptying of chyme into duodenum at a rate that is
suitable for proper digestion
 As food stretches the esophagus the vago-vagal
reflex causes _______ stomach to relax so that the
food can enter________________________
 ______________________-occurs when food
entering the stomach stretches the walls
 The stomach has weak peristaltic contractions
(constrictor waves) when food inside stomach
 This activity is set by the pacemaker cells (interstitial
cells of Cajal) located at the margins of the
longitudinal muscle
 __________________-intense antral contractions
that cause retropulsion which serves to mix contents
and grind solids.

Regulation of motility
 Gastrin causes a mild to moderate
_________________ on motor function
 3 Duodenal factors which regulate motility by
_____________ the pyloric pump contractions and
increase tone of pyloric sphincter
o Reflexes from duodenum to stomach via enteric
n.s.
o Thru extrinsic n. via prevertebral sympathetic
ganglia then back sympathetic n
o Thru vagus n.
 Hormones also ________ stomach action
 Hormones from the duodenum.
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 o ____________________-released by mucosa of
duodenum and jejunum in response to fat and
proteins
o _________-released from duodenal mucosa in
response to acid
o ______________________-released from upper
small intestine in response to fat and/or
carbohydrates

Phases of Gastric Secretion

 There are 3 phases of gastric secretion

STIMULATION
1)Cephalic Phase
 Occurs before food enters stomach
 Results from sight, smell, thought, or taste of food
 Gets stomach ready for work that is coming
 Inputs from the olfactory and gustation receptors
relay to hypothalamus which in turn stimulates the
vagal nuclei sending signals via the vagus to the
enteric ganglia

2) Gastric phase (responsible for 2/3)

 Bolus entering stomach causes distension activating
stretch receptors which activate local myenteric
reflexes and vago-vagal system
__________________________
 Partially digested proteins, caffeine, and rising pH,
cause G cells to release ________________
 ______________ released by ECL cells

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3) Intestinal phase
 Chyme begins to fill the intestine, which then
stimulate the intestinal mucosal cells to release a
hormone __________ which acts like gastrin

Three major stimulators of the parietal cells are:

_________________________. The receptors for gastrin
and ACh on the basolateral membrane of parietal cells once
stimulated cause an increase of ________________, and
the histamine receptor cause an increase of intracellular
____. The net effect of these secondary messengers are
transport and morphological changes to the parietal cell.

INHIBITION
1) Cephalic phase
 If you are depressed or some other emotional factor
causes you to lose appetite

2) Gastric phase
 Too much acidity in stomach will cause G cells to
reduce gastrin
 Emotional upset, fear, fight or flight, will cause
sympathetic response which decreases G cell

3) Intestinal phase
 (Reverse) Enterogastric reflex transmitted through
the a) myenteric n.s., b) extrinsic sympathetic n.s., c)
less by vagus n. from the duodenum to the stomach
in the presence of acid, protein breakdown products
(peptides), or by irritation of mucosa in duodenum
 Presence of those products in duodenum can also
release hormones _________________________
___________________________________ which have
slight to moderate effects of inhibiting gastric secretion

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 Mechanism of HCl secretion
 Cl- ion travels to lumen from parietal cell through
channels_____________________________.
 H+ actively pumped into lumen in exchange for K+
by the ____________________. H+ comes from
carbonic acid_____________________________.
 HCO3- is exchanged for Cl- from blood. This is
called the alkaline tide

RECAP
 Chief cells secret pepsinogen
 No digestive activity until it comes in contact with
HCl, at which point it converts to pepsin (proteolytic
enzyme)
 Intrinsic factor secreted by parietal cells which is
essential for absorption of vitamin B12 in the ileum

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Digestion
 Carbohydrates
– When chewing food, __________________ is
mixed with the food and starts digesting carbs
– ___________ will continue digesting for several
hours until the enzyme is broken down.
– In that time _________ starches will be digested
before leaving the stomach
 Protein
– Pepsin a peptic enzyme is most active in an acidic
environment, that is why the parietal cells secrete
HCl
– Collagen is digested by pepsin, which would then
allow further digestion of proteins
– Pepsin provides _________ of protein digestion,
will allow the pancreatic secretions to digest
remainder more easily
 Fats
– Up to ____ of triglycerides are digested in by
lingual lipase from the saliva
 Absorption
– Very little absorption takes place at the stomach
– Only things that are absorbed are alcohol, and
some drugs (aspirin), and only at small quantities

Pathologies
Gastritis
 Acute-mucosal inflammation with hemorrhaging, and
in more severe cases erosion.
 Associated with
o _________________________

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 o _________________________
o heavy smoking
o chemo drugs
o bacterial/viral infections
o stress
 S/S
_________________________________________
__________________________________________
Chronic atrophic gastritis-chronic inflammatory leading
to mucosal atrophy and intestinal metaplasia
 Associated with:
o Chronic infection by H-pylori
o Autoimmune associated with pernicious anemia
o Toxic exposures alcohol smoke
o Postsurgical
o Motor and mechanical, including obstructions
o Miscellaneous
 Consequences of chronic gastritis
 _________________-lack of HCl secretion by
parietal cells which leads to:
o Poor absorption of ______ iron def anemia
o Poor absorption of ______, osteoporosis
o _________________________________
o _________________________________
 Pernicious anemia-lack of intrinsic factor. Cannot
absorb B12 causing macrocytic anemia

Peptic ulcers
 Defined as a _______________________________
___________________________________________________________
 Can occur anywhere in alimentary tract but are more
prevalent in _______________________________

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  ______________________________________, and
associated to areas with aggressive action of
acid/peptic juices
 Not a cause of hyperacidity, rather caused by
breakdown of defense system. Ie mucosal blood flow
drops, gastric emptying is delayed, or epithelial
restitution is impaired
 H. pylori is a major factor
 S/S
__________________________________________
__________________________________________

Zollinger-Ellison Syndrome
 ______________-gastrin producing tumors
 Hypergastrinemia from duodenal tumors stimulate
extreme gastric acid secretion, which causes multiple
peptic ulcerations
 These ulcers are unresponsive to treatments of
normal peptic ulcers
 S/S- diarrhea ______________________________
 Treatment-H+/K+ATPase inhibitors and excision of
tumor

Peutz-Jeghers hamartomatous polyps

 _________ involving the mucosal epithelium, lamina
propria, and muscularis mucosa of the alimentary
tract
 ________________________________________________________
 Can be singular or multiple (Peutz-jeghers
syndrome)
 ________________________________________________

Gastric carcinoma
 Very common tumor in the world
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  In 1930 was the most common cause of cancer
death in US
 Symptoms do not develop until later in the disease,
and when they do it resembles
__________________________________________
__________________________________________
 Major factors associated with increased incidence:
o Infection of H. pylori
o Diet high in nitrites derived from nitrates
(preserved food)
o Smoked or salted food, pickled veggies, chili
peppers
o Lack of fresh fruit and veggies
o Low socioeconomic status
o Cigarette smoking
o Chronic gastritis
o Partial gastrectomy
o Gastric adenomas
o Barretts esophagus
o Slight increase risk with blood group A
o Family history

Nitrosamines
 Proteins are acted upon bacteria to form amines
 Some foods contain nitrates
 Nitrates + bacterial action=nitrites
 Nitrites + amines at high temp cooking form
nitrosamines which are highly carcinogenic
 Avoid bacterially altered food (smelly fish)
 Cook at lower temp and longer time is OK
 Reduce consumption of foods with nitrates and
nitrites (smoked)

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