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Methodical Instructions to Lesson 10 for Students

June 9, 2024

5 Cycle Physiology of digestion system and kidneys

Methodical Instructions to Lesson for Students

Lesson № 1 (practical – 6 hours)

Theme:

1. Digestion in the STOMACH. Digestion in INTESTINES (2 hours).

2. ABSORPTION in the dIgestive tract(2 hours).

3. MOTOR FUNCTION OF GASTRO-INTESTINAL TRACT (2 hours).

Aim: To know the mechanisms of regulation of stomach digestion, role of stomach juice components in digestive processes. To know the mechanisms of regulation of intestines, pancreatic juiсes and bile secretion, role of intestines in digestive processes. To know the mechanisms of absorption in digestive tract. To know the mechanisms of motor activity of digestive tract, role of motor functions in vital activity of organism.

Professional Motivation: The knowledge of mechanisms of secretion of stomach juice, their regulation are necessary for future physicians to value the mechanisms of development of secretion dysfunctions and correct them. The knowledge of mechanisms of secretion of intestine juice, pancreas juice, bile secretion and their regulation are necessary for future physicians to value the mechanisms of development of digestion disfunctions and correct them. The knowledge of mechanisms of absorption and its regulation are necessary for future physicians to value the mechanisms of medicines absorption and development of digestion dysfunctions and correct them. The knowledge of mechanisms of motility and their regulation are necessary for future physicians to value the mechanisms of development of digestion dysfunctions and correct them.

Basic Level:

1. Structure of stomach (Anatomy Course)

2. Anatomy of stomach nerves (Anatomy Course)

3. Structure of stomach glands (Histology Course)

4. The types of secretion cells (Histology Course)

5. Mechanisms of enzymes transport through the membrane (Chemestry Course)

6. Structure of liver, pancreas, small and large intestine (Anatomy Course)

7. Nerves and vessels which are innervate and vascularisate liver, pancreas, small and large intestine (Anatomy Course)

8. Structure of hepatocytes, pancreatocytes and enterocytes (Histology Course)

9. The types of pancreas’s secretor cells (Histology Course)

10. Mechanisms of substances transport through the membrane (Chemistry Course)

11. Structure of oral cavity, stomach, liver, pancreas, small and large intestine (Anatomy Course)

12. Innervation and vascularisation of oral cavity, stomach, liver, pancreas, small and large intestine (Anatomy Course)

13. Structure of livers’, pancreas’ and intestines’ cells (Histology Course)

14. Mechanisms of substances transport through the membrane (Chemistry Course)

15. Structure of oral cavity, esophagus, stomach, liver, pancreas, small and large intestine (Anatomy Course)

16. Innervation of oral cavity, esophagus, stomach, liver, pancreas, small and large intestine (Anatomy Course)

Students’ Practical Activities:

Practical work 9.00 – 12.00

1. The influence of gastric juice on the protein

Pour in each of three test-tubes 3 mL of gastric juice. Then overdo the contents of the second test-tube, and add sodium carbonate in the third test-tube. Measure pH in test-tube and add 1 drop of protein in each. Put test-tubes on 15-20 minutes in water-bath at temperature 37-38 ºC.

The course of the work and received results give in a look of table.

NN of tests

Before activity of temperature 37-38 ºC

After activity of temperature 37-38 ºC

The quality of stomach juice

pH of stomach juice

Protein

Valuing of results

In conclusion indicate about activity of pepsin on the protein, necessary conditions for it and about influence of hydrochloric acid on it.

2. Determination of debit of hydrochloric acid of the stomach juice

On reason of facts about quantity of the stomach juice and about its acidity determinate at nomogram debit of hydrochloric acid in each portion. To do it if it is necessary to connect by ruler located on opposite branches of nomogram figures and read the result in the place of her crossing with the medium line. Add received quantities for each portion of basal and stimulated secretion. Give results in a look of table.

Indicators of stomach juice

Kinds of secretion

On an empty stomach

Basal

Stimulated

Debit of general HCl, mmol/hour

Debit of free HCl, mmol/hour

In a conclusion indicate if received results are within the limits of norm.

3. Influence of bile on lipids

On a predmet glass put a drop of water and a drop of bile with a pipette. Add a small amount of oil to each drop, mix it well and watch the content of the drops under the microscope. Draw the results of the experiment.

In the conclusion explain the reason and the mechanism of observed changes.

4. Action of pancreatic juice

Pour 1 ml of pancreatic juice into two tubes. Add 3 ml of HCl to the first tube and 3 ml of Na₂CO₃ to the second one and determine their pH. Add 2-3 drops of protein and 1-2 drops of toluol into both tubes. Put them on water heat bath with a temperature of 40 ⁰C for 20-25 minutes.

Obtained the table:

Content of a test-tube

1 test-tube

2 test-tube

Pancreatic juice, 1 mL

HCl, 3 mL

Na₂CO₃, 3 mL

Protein, 2-3 drops

Toluol, 1-2 drops

Results

In the conclusion explain the mechanism of the observed changes.

5. Auscultation of intestines

Auscultation should be held in a place of projection of small intestine and ceacum. Compare the frequency and intensity of intestinal murmurs in these places. Confront them with the time of eating.

In conclusion explain the mechanism of appearing of sound phenomena in intestines.

Students’ Independent Study Program

I. Objectives for Students’ Independent Studies

You should prepare for the practical class using the existing textbooks and lectures. Special attention should be paid to the following:

1. Common characteristic of the stomach digestion

a) Functions of stomach (1. Digestive (mechanical treatment, absorption, evacuation, secretion, depo); 2. Excretor; 3. Incretor.)

b) Experimental method of studying of stomach secretion (Method of Basov – during the operation on dogs put the fistula in stomach.

c) Clinical method of stomach investigation (Gastroscopy, stomach sound, ultrasonic investigation, electrogastrography, pH-metry, determine helycobacter pylory.)

2. Secretor activity of stomach

a) Composition of stomach juice and their properties

b) Role of the hydrochloric acid in the digestion

3. Phases of stomach secretion

a) Cephalic phase (

b) Stomach phase

c) Intestine phase

1. Digestion in the small intestine

a) Role of duodenum in the digestive system

b) External secretor function of pancreas

c) Composition and property of pancreas juice

d) Regulation of pancreas secretion

e) Bile production and bile secrete

f) Composition of bile, their role in digestive processes

g) Composition and properties of intestine juice

h) Cavity and membrane hydrolyses of substances

2. Digestion in the big intestine

a) Composition of intestine juice and their properties

b) Role of the micro flora of big intestine

1. Common characteristic of absorption process

a) Determine of notion “absorption”

b) Main types of transport of nutritive substances in internal surroundings of organism

c) Absorption in the mouth cavity and stomach

d) Absorption in intestines

e) Methods of absorptions’ investigation (

f) Regulation of absorption (

2. Peculiarities of absorption of organic and inorganic substances

a) Water and mineral salts

b) Products of proteins hydrolyses

c) Products of carbohydrates hydrolyses

d) Products of fats hydrolyses

Basic Mechanisms of Amino Acid Transport..

Amino acid transport (.

Absorption of Fats

METHODS OF ABSORPTION INVESTIGATION OF GASTROINTESTINAL TRACT

1. Angiostoma

2. X-ray investigation

3. Biochemical method of investigation

4. Radioisotopic investigation (clinical method

1. Characteristic of swallowing act

a) Phases of swallowing act of digestive lump

b) Regulation of swallowing act

c) Peculiarities swallowing of liquid

2. Motor function of stomach

a) Role of motor function of stomach in digestive processes

b) Types of peristaltic waves

c) Regulation of motor function

3. Passage of food from stomach to

a) Role of sphincters in evacuation of food from stomach to duodenum

b) Regulation of evacuations speed of food from stomach to duodenum (

4. Motor function of small intestine

a) Meaning of motor function of small intestine in digestion process

b) Characteristic of shortenings types of small intestine

c) Regulation of motor function of small intestine

5. Motor function of big intestine

a) Role of motor function of big intestine in digestion process

b) Regulation of motor function of big intestine

Key words and phrases: digestion, stomach, depositive, secretory, chemical treatment, mechanical treatment, absorbtive, evacuatory, excretory, incretory, delay, amount, plasticity, gastric juice, parietal cell, chief (principal) cell, hydrogen iones, pump, lumen, exocytosis, pore, gastric fistula, imaginary, feeding, starvate, hungry, fractional investigation of gastric secretion by means of thin probe, on an empty stomach, valuation, total acidity, hydrochloric acid, acid production per hour, fibrogastroscopy, mucus, alkaline, organic and unorganic components of gastric juice, denaturation, bactericidal action, complex-reflectory phase, conditioned reflex, unconditioned reflex, stimulate, irritate, peptide, disotiation, potassium, inherent in, discharge.: Digestion, proteolitic enzymes, tripsinogen, chemotripsinogen, enterokinase, secretory, chemical treatment, mechanical treatment, absorbtive, evacuatory, excretory, incretory, pump, lumen, hydrochloric acid, mucus, conditioned reflex, unconditioned reflex, stimulate, irritate, disotiation, potassium, pancreatic juice, glikogen, oligo-, di- and monosaccharides, chephalic, stomach, intestine. Absorption, villus, digestion, stomach, absorbtive, evacuatory, excretory, incretory, pinocitic bulb, amino acids, monosaccharids, validol, nitroglycerin, vitamins C, B₆, B₂, pepper, mustard, adrenocorticotropin, insulin, thyroxin, osmotic gradient, basolateral membrane of entherocyte, galactose, mannose, fructose, glucose. And phrases: digestion, stomach, evacuatory, rythmical segmentation, pendular and peristaltic, back-forward, mixing, enterogastral reflex, antrofundal reflex, receptive relaxation, fundoantral reflex, ileocecogastral reflex, katecholamines, serotonine, histamine, bradikinine

II. Tests and Assignments for Self-assessment

Multiple Choice.

Choose the correct answer/statement:

1. What is the optimum pH of gastrecsin activity?

a) 1,5-2,0; b) 2,1-3,0; c) 3,2-3,5; d) 3,5-4,5; e) 4,5-7,2

2. What is pH on an empty stomach in the morning?

a) 1,5-2,0; b) to 3,0; c) 3,2-3,5; d) to 3,5; e) to 4,5

3. What is the basal pH in stomach?

a) 1,5-2,0; b) 2,1-3,0; c) 3,2-3,5; d) 3,5-4,5; e) 4,5-7,2

4. What is the stimulated pH in stomach?

a) 1,3-1,4; b) 1,5-2,0; c) 3,2-3,5; d) 3,5-4,5; e) 4,5-7,2

5. What is the maximal stimulated pH in stomach?

a) 1,0-1,2; b) 1,3-1,3; c) 1,5-2,0; d) 2,1-3,0; e) 3,2-3,5

6. In which test-tube present liver portion of bile?

a) color – gold-yellow; density – 1,010 g/sm³; pH=8,2;

b) color – light yellow; density – 1,030 g/sm³; pH=6,8;

c) color – dark-brown; density – 1,010 g/sm³; pH=7,3;

d) color – gold-yellow; density – 1,030 g/sm³; pH=6,8;

e) color – light yellow; density – 1,010 g/sm³; pH=7,3.

7. In which test-tube present bile portion of bile?

a) color – gold-yellow; density – 1,010 g/sm³; pH=8,2;

b) color – dark-brown; density – 1,030 g/sm³; pH=6,8;

c) color – dark-brown; density – 1,010 g/sm³; pH=7,3;

d) color – light yellow; density – 1,010 g/sm³; pH=7,3;

e) color – gold-yellow; density – 1,030 g/sm³; pH=6,8.

8. In which test-tube present duodenal portion of bile?

a) color – gold-yellow; density – 1,010 g/sm³; pH=8,2;

b) color – dark-brown; density – 1,030 g/sm³; pH=6,8;

c) color – light yellow; density – 1,010 g/sm³; pH=7,3;

d) color – gold-yellow; density – 1,030 g/sm³; pH=6,8;

e) color – light yellow; density – 1,010 g/sm³; pH=7,3.

9. Which substances absorbed only in small intestines?

a) glucose, water, lipids, proteins; b) amino acids, fat acids, glucose; c) lipids, proteins, carbohydrates; d) proteins, fat acids, glucose; e) carbohydrates, amino acids, fat acids

10. In which part of digestive tract absorbed mineral salts?

a) oral cavity; b) esophagus; c) stomach; d) small intestines; e) big intestines

11. Which hormone increases absorption of sodium and water?

a) somatostatin; b) insulin; c) aldosteron; d) thyroxin; e) glucagon

12. Which hormones increase absorption of glucose?

a) Thyroxin, insulin, glucocorticoids, serotonin

b) Growth hormone, insulin, glucagon, histamine

c) Somatostatin, insulin, glucocorticoids, serotonin

d) Thyroxin, glucagon, glucocorticoids, histamine

e) Thyroxin, insulin, glucocorticoids, hystamine

13. Which hormones increase absorption of fats?

a) Secretine, insulin, glucocorticoids, serotonin, aldosterone

b) Thyroxin, glucagon, glucocorticoids, histamine, insulin

c) Cholecystokinine-pancreasimine, thyroxin, somatostatine

d) Cholecystokinine-pancreasimine, thyroxin, insulin

e) Secretine, cholecystokinine-pancreasimine, thyroxin, somatostatine

14. Which reflexes are inhibits motor function of stomach?

a) antrofundal, fundoantral

b) fundoantral, enterogastral

c) enterogastral, antrofundal

d) receptive relaxation

e) enterogastral, antrofundal, receptive relaxation

15. Which reflex is activates motility of stomach?

a) enterogastral

b) ileocecogastral

c) antrofundal

d) fundoantral

e) receptive relaxation

Real-life situations to be solved:

1. Your see big lemon. What is the phase of stomach secretion begin in these time?

2. What kind of stomach secretion we have in analyses when the volume of secrete – 0,03 mL; common acids – 25 mmol/L; free acid – 13 mmol/L; pH – 3,6; debit of HCl production – 1,2 mmol/hour; debit of free HCl – 0,6 mmol/hour?

3. What kind of stomach secretion we have in analyses of patient R. when we know that the volume of secrete – 0,07 mL; common acids – 42 mmol/L; free acid – 21 mmol/L; pH – 1,7; debit of HCl production – 3,1 mmol/hour; debit of free HCl – 2,6 mmol/hour?

4. What kind of stomach secretion we have in analyses when the volume of secrete – 0,13 mL; common acids – 82 mmol/L; free acid – 73 mmol/L; pH – 1,36; debit of HCl production – 9,2 mmol/hour; debit of free HCl – 6,5 mmol/hour?

5. Patient R. has some problem with bile secretion. What can You used him?

6. You have three portion of bile. What can You say if in the first portion the bile is light yellow; density – 1,010 g/sm³; pH=7,3; bilirubin – 0,7 mmol/L; bile acids – 4,3 g/L; in the second portion the bile is dark-brown; density – 1,029 g/sm³; pH=7,3; bilirubin – 2,3 mmol/L; bile acids – 21,1 g/L; in the third portion the bile is gold-yellow; density – 1,010 g/sm³; pH=7,3; bilirubin – 0,9 mmol/L; bile acids – 4,1 g/L?

Real-life situations to be solved:

7. Patient F. eat 300 grams of meat, 45 grams of butter, 300 grams of bread, 230 grams of potation, 150 grams of tomato, 250 grams of cabbage, drink 2,5 liters of water per day. What quantity of protein, carbohydrates, lipids, mineral substances and water may absorbed in his intestines, when we know that he has not problem with digestive tract?

8. Patient K. has 0.56 mmol/L bile acids, 52 mmol/L Na⁺ in stomach content. What do you can to say about his condition?

Visual Aids and Material Tools: Charts No

49.1. Innervation of stomach

49.2. Method of investigation of secretory function of stomach

49.3. Schema of operation of isolated digestive ventriculus

49.4. Regulation of stomach secretion

49.5. Secretory function of stomach

49.6. Experiment of imegion feed

50.1. Composition of bile

50.2. Role of bile

50.3. Schem of intestine digestion

51.1. Structure of intestine wall

51.2. Schema of proteins digestion and absorption

51.3. Schema of fats digestion and absorption

51.4. Schema of carbohydrates digestion and absorption

52.1. Schema of swallowing

52.2. Movements of small intestine

Visual Aids

Water-bath, test-tubes, gastric juice, natrium carbonate, ribbon for pH-metry, protein, water thermometer, milk, nomogram, acidity and quantity of gastric juice, ruler

Water-bath, test-tubes, gastric juice, sodium carbonate, ribbon for pH-metry, protein, water thermometer, microscope, bile, glass, oil, pipettes, water, toluol

Water, stetoscope, second-clock, electrogastrograph, white bread, sugar, tea

Water-bath, test-tubes, tablets of nitroglycerin, tablet of neoepinephrine (isadryn), apparatus for blood pressure determine, second clock, rat, 1% solution of pentobarbital sodium, water thermometer, physiological salt solution, appliance for investigation of absorption

Students must know:

1. Functions of stomach

2. Method of stomach investigation

3. Composition of stomach juice

4. Properties of stomach juice

5. Mechanisms of each phase of stomach secretion

6. Role of pancreas in digestion

7. Role of bile in digestion

8. Role of intestine juice in digestion

9. Origin of excitement and stimulate of excitability

10. Regulation of secretion

11. Main type of nutrients transport

12. Absorption in the mouth cavity and stomach

13. Absorption in intestines

14. Peculiarities of absorption of different substances

15 Motor activity of all part of digestive system

Students should be able to:

1. To determine debit of hydrochloric acid of the stomach juice

2. To estimate the activity of gastric juice

3. To value enzymes activity of pancreatic juice

4. To value activity of bile juice

5. To analyze absorptive processes

6. To value the absorption processes in digestive system

7. To estimate bioelectrical phenomenon in stomach

8. To master the techniques of auscultation of intestines

III. Answers for the Self-Control

1. c; 2. d; 3. a; 4. a; 5. a

2. a; 2. b; 3. c

3. b; 2. d; 3. c; 4. a; 5. e

4. e; 2. d

1 real-life situation – The first phase – cephalic phase, because it may caused by vision of food. 2 real-life situation – We have secret on an empty stomach in the morning, because the volume of secrete in these case – 0,01-0,05 mL; common acids – 10-35 mmol/L; free acid – 0-20 mmol/L; pH – to 3,5; debit of HCl production – to 1,5 mmol/hour; debit of free HCl production – to 1,0 mmol/hour. 3 real-life situation – We have basal secret, because the volume of secrete in these case – 0,05-0,1 mL; common acids – 40-60 mmol/L; free acid – 20-40 mmol/L; pH – 1,5-2,0; debit of HCl production – 1,5-5,5 mmol/hour; debit of free HCl production – 1,0-4,0 mmol/hour. 4 real-life situation – We have submaximum stimulated secret, because the volume of secrete in these case – 0,1-0,14 mL; common acids – 80-100 mmol/L; free acid – 65-85 mmol/L; pH – 1,3-1,4; debit of HCl production – 8-14 mmol/hour; debit of free HCl production – 6,5-12 mmol/hour.

2 real-life situation – I say to eat eggs and fats. 2 real-life situation – It is the bile of healthy person, because iorm in the first (duodenal) portion the bile is light yellow; density – 1,008-1,012 g/sm³; pH=7,0-7,5; bilirubin – 0,5-1,0 mmol/L; bile acids – 4-5 g/L; in the second (bile) portion the bile is dark-brown; density – 1,028-1,032 g/sm³; pH=6,5-7,5; bilirubin – 1,7-3,4 mmol/L; bile acids – 18-22 g/L; in the third (liver) portion the bile is gold-yellow; density – 1,008-1,012 g/sm³; pH=7,5-8,5; bilirubin – 0,5-1,0 mmol/L; bile acids – 4-5 g/L.

3. real-life situation – 1. In intestines of patient F. may absorbed only 1/3 part of protein (50-100 grams of protein may absorbed per day iorm), all fats (near 100 grams of fat may absorbed per day iorm), 400-500 grams of carbohydrates (a few hundred carbohydrates may absorbed per day iorm), all electrolytes (to 100 grams of mineral salts may absorbed per day iorm), all water (7-8 L of water may absorbed per day iorm.)

4. real-life situation – He has doudenogastral reflux (the contents of duodenum return to stomach when the pyloric sphincter opened). At norm quantity of bile acids must be less than 0,53 mmol/L; sodium – less than 45 mmol/L.

References:

1. Review of Medical Physiology // W.F.Ganong. – 24th edition, 2012.

2. Textbook of Medical Physiology // A.C.Guyton, J.E.Hall. – Eleventh edition, 2005.

3. University Web – site > Intranet > Students facilities > Practical classes materials > Department of normal physiology > Dentistry faculty > Cycle 5. Physiology of digestion, energy exchange and excretion > Lesson № 1. Digestion in oral cavity.Digestion in stomach, intestine and colon. Absorption and motor function in the gastrointestinal tract.

4. University Web – site > Intranet > Students facilities > Lecture presentations> Department of normal physiology > Dentistry faculty> Cycle 5. Physiology of digestion, energy exchange and excretion > Digestion, its types and functions.