Chapter 2 Steroids are a kind of lipid Types of steroids: Testosterone/estrogen (a lot of hormone are steroids), cortisol, cholesterol, bile

salts, Vitamin D y Bile is something secreted by the gallbladder and it helps break down fats and absorb them into your system. Known to have a lot of cholesterol based compound in it. Liver produces in Bile. Stored in gallbladder. Gallbladder would contract and secrete bile to the intestine All of the lists of steroids except cholesterol are actually derived from the cholesterol molecule. Basically all related to one another.

Protein is a chain of amino acids. Typical adult has a composition of 12-18 % Protein mass in body. Mainly include muscle tissue. Chapter 24 Digestive System 6 basic function of digestive system: 1. Ingestion a fancy word for eating 2. Secretion, bile is secreted from the gallbladder to the intestine. Mucus isn t just for the respiratory system it is used in the digestive system too it helps allows food to move along smoothly so we don t get too constipated. Insulin. Digestive enzymes find them in saliva which has chemicals that help break down food. Start chemical digestive process in the mouth. 3. Mixing and propulsion moves it along or pushes it along. Mix the food with all the enzymes, bile, saliva, and etc. And it gets pushed along the digestive system. 4. Digestion; mechanical digestion physically breaking it down. Chemical digestion where pieces get broken down into even smaller pieces. 5. Absorption 6. Defecation

Layers of GI tract: 1. Mucosa- epithelial tissue (Its generally going to columnar for secretion and absorption) there are cells that secrete mucus called the goblet cells. Mucus gets secreted along the intestine so that when food flows it will help move things smoothly not just the intestine also etc. Also simple columnar is important for secretion, absorption and is a little more protective than simple squamous epithelium because it s thicker. It helps protects us from bacteria and viruses. There are a lot of bacteria in the gastrointestinal tract. Columnar cells keep a barrier from foreign objects coming in. Lamina propria (CT) underlying connective tissue. Muscularis mucosa muscle within the mucosa smooth muscle. Along the GI tract smooth muscle tissue and some

areas could be skeletal muscle tissue but it tends to me more in sphincter are. Example esophagus and stomach in between is a sphincter which has skeletal muscle tissue. 2. Submucosa mainly connective tissue 3. Muscularis which contains smooth muscle and sometimes skeletal muscle tissue 4. Serosa it anchors everything and keeps it in place (Connective tissue). Serous membrane secrete a lubricating fluid, the purpose for it is to prevent damage between other organs so there isn t any friction. Serous membrane which we are referring to is the visercal (peritoneum) covers almost all of the organs within the abdominal pelvic region. Peritoneum is a layer of simple squamous epithelium that secretes a lubricating fluid so that when organs rub against there isn t any friction. Organs of the digestive system: Mouth, pharynx, Esophagus, Stomach, Small intestine, Large intestine (In terms in the major part of the GI tract) also pancreas, liver/gallbladder Peritoneum covers most organs. There are organs are said to be behind the peritoneum and others the peritoneum covers a lot of the organs. Peritoneum is a serous membrane which secretes lubricating fluid. It covers a large majority of the abdominal pelvic cavity. Some of the organs are considered to be behind the peritoneum, we would consider them to be retroperitoneal organs= organs that are behind the peritoneum; kidneys, parts of the colon, part of the small intestine and pancreas. Along the GI Tract: Mouth Area in the mouth called Palate is a wall that separates the mouth from another area nasal cavity. Palate a wall that separates the oral cavity from the nasal cavity. (Roof of the mouth) The front part is hard as you go back it becomes soft. When you swallow especially the soft palate and hanging ball called the uvula (muscle) actually lifts the soft palate against the nasal cavity so that when you swallow you don t get food up your nose. The hard palate has some bone in there. Soft palate does not have any bone in it; hanging from soft palate is the uvula. y y y y y y y During swallowing the soft palate and uvula are pulled superiorly to prevent food from entering the nasal cavity What do we have in the trachea that prevents food from entering? Epiglottis. Tonsils are also referred to as palatine tonsils. Tongue has a structure. It prevents you from you swallowing your tongue. It is referred as the lingual frenulum which prevents you from swallowing the tongue. We have deciduous teeth means teeth fall out( baby teeth) than we have permanent teeth We use our teeth to break down and then we use our tongue to mush it around and try to break it down as much as possible before we swallow the food (mechanical digestion) What is secreted in the mouth? Saliva

Saliva contains two main enzymes. Enzymes are protein that speeds up some sort of chemical process. Break down of certain molecules. o Salivary amylase starts to break down carbohydrates such as disaccharides and polysaccharides (referring to starch. Ex potato, rice, pasta, bread, etc.) Is secreted by your (saliva)salivary gland o Lingual lipase breaks down lipids. Secreted by lingual glands. It gets secreted in the mouth but there are enzymes that need to be activated before it could do its job. It gets activated in the stomach hydrochloric acid (HCl). Needs to get activated in stomach from stomach acids. o Do you break down fat in the mouth? No Pharynx

Pharynx is the throat. When you swallow the soft palate and uvula contracts and go up so that stuff doesn t go up your nose. The epiglottis covers the opening of the trachea so that nothing goes down respiratory tract. Pharynx helps push food along the esophagus. Esophagus Which is more anterior the trachea or esophagus? Trachea. The esophagus is posterior to the trachea. Layer of esophagus: Mucosa stratified squamous epithelium, lamina propria, and muscularis mucosa What time of epithelium is going to be in esophagus? Stratified squamous epithelium Submucosa is going to be connective tissue Muscularis has a lot of muscle. Smooth muscle. At the proximal and distal end of the esophagus the muscularis is thickened. This thickening forms the sphincters at the top and both of the esophagus. Thickening of the muscularis at proximal (upper esophageal sphincter) are made up of skeletal muscle and distal end (lower esophageal sphincter) are made up of smooth muscle. Skeletal muscle often voluntary. You can often control skeletal muscle contraction. Esophagus does not have serous because it is not in the abdominal pelvic cavity area. The esophagus has an Adventitia which is an outer most layer connect tissue which holds esophagus in place. None of that lubricating membrane serosa. Does esophagus produce any kind of enzymes? No Technical term of swallowing is known as deglutition. There are 3 stages of swallowing: 1. Voluntary stage in this stage the tongue pushes food back towards the pharynx. 2. Pharyngeal stage food gets into the pharynx. We have two structures preventing food into going the wrong places (soft palate and uvula prevent food from going into the nasal cavity)

(epiglottis prevents food from entering into the trachea).The proximal upper esophageal sphincter (UES) relaxes so that food can get into the esophagus. 3. Esophageal stage peristalsis pushes food along (contraction) a. Circular muscle that are going to contract to prevent backflow. Are ring like structures around esophagus that contract so that when food goes down it doesn t go back up b. Longitudinal muscles that go along the length of the esophagus. When it contracts it shorten the esophagus and it actually helps push the food further along. The area distal to food is relaxed so that as the circular muscle is contracted the length is shortens, the food goes to the area where there is a lot of room. What is the contraction of the GI tract as it pushes food along? Waves like contraction? Peristalsis What does Hydrochloric acid (HCl) do? Strong acid that dissolves stuff but it s not that great at dissolving stuff. It s very low on pH scale and super acidic. It kills microbes also starts to unfold protein. Protein gets broken down by protease enzyme and pepsin and etc. The HCl acid helps unfolds the protein so it s easier for the enzymes to get to break down the proteins. It triggers the secretion of hormones that are than going triggers the secretion of bile from gallbladder and also pancreatic juice. Which cells do pepsingoen get secreted from? Chief cells Chief cells 1. Secrete pepsin. Pepsin first secreted as pepsinogen (inactive) in order for pepsinogen to be active it has to first come in contact with HCl. Hydrochloric acid (HCl) activate the pepsinogen turn it to pepsin(active) and pepsin digest the protein. y Pepsinogen (inactive) + Hydrochloric acid (HCl) pepsin (active) What the difference between enzymes in stomach breaking down raw steak vs. organs in the body? There is no difference. What we have in the stomach, we have a thick layer of mucous that protects the stomach from getting eaten up. 2. Gastric lipase breaks down fats. And it s different from pepsin. It needs a basic environment to be activated. Gastric lipase doesn t start working in the stomach it works till later on in the intestine. Once the pH in the intestine gets higher. Needs pH of 5-6 (basic) in order to work properly. What major organ does potassium affect? The Heart it affects the contraction. When people have imbalance of blood potassium levels they can end up with arrhythmias. Pancreas Stomach contents get released in first part of the small intestine but communication with other organs actually may dump their contents to the intestine. Liver produce bile stores it in gallbladder.

Pancreatic duct the main duct of the pancreas 2 ducts that empty into small intestine (specific the duodenum): 1. Hepatopancreatic amuplla bile duct joins with this duct so that bile and pancreatic juice are secreted from here (ampulla of vater). 2. Accesory duct more minor duct. The majority of the cells in the pancreas are made up of acinar cells. Those cells produce the pancreatic juice. Pancreas is made of many acini contains glandular epithelial cells (99%). That secrete fluid and enzymes pancreatic juice (exocrine) 1 % (endocrine part)

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Pancreatic enzymes are very talented. They can break down carbohydrates, proteins and fats. o Pancreatic amylase breaks down carbohydrates (starch) o Trypsin breaks down protein o Chymotrypsin breaks down protein o Carboxypeptidase breaks down protein o Elastase breaks down protein o Pancreatic lipase breaks down triglyceride (fats) o Deoxyribonuclease (DNA) breaks down DNA nucleic acids o Ribonuclease(RNA) breaks down RNA nucleic acids the enzymes that break down proteins are all first secreted in an inactive form than they get converted in an active form to break down protein o Pepsinogen pepsin o trypsinogen trypsin o chymotrypsinogen chymotrypsin o procarboxypeptidase carboxypeptidase o proelastase elastase In order for these four enzymes to not eat the pancreas. These enzymes are in their inactive form inorder to prevent the enzymes from digesting the pancreas. It gets dumped in the small intestine in the inactive form and then gets activated. Chymotrypsinogen, procarboxypeptidase, and proelastase are all activated by trypsin There is an enzyme that is specifically within the intestine that activates trypsinogen. Enterokinase ( in the intestine produced in small intestine) activates trypsinogen trypsin activates other 3 proteases Trypsin inhibitor is produced by pancreas to inactive any trypsin that accidentally produced in pancreas (instead of trypsinogen)

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What happens when the enzyme starts digesting the pancreas? Inflammation of the pancreas: pancreatitis Pancreatitis inflammation of pancreas y y y Alcoholism is most common cause. You end up producing trypsin. Pancreas cells increase trypsin, not enough trypsin inhibitor digests the pancreas Pancreatitis feels like a dull pain around the body like a belt.

Pancreatic cancer is very deadly because it is usually not detected until it metasize (painless jaundice). Once people are diagnosed it s a likely chance you won t survive because the symptoms are hardly there. When symptoms show that s when it s already on the second stage. High mortality rate. Liver Hepatocytes are the major functional cells of the liver and perform a wide array of metabolic, secretory and endocrine functions. Hepatocytes produce bile and it gets collected in the end of bile duct. Than we have another thing going on the branch of hepatic portal vein, what flows in the vein? Blood. Blood flowing through the opposite side direction from hepatic portal vein through hepatic sinusoids and it gets collected. The liver detoxifies stuff such as alcohol and drugs. Example: Drinking alcohol: What the liver does is it takes alcohol molecule and breaks it down. So it s no longer toxic; buzz wears off. All the alcohol is flowing through hepatic portal vein and eventually moves along through hepatic sinusoids. Hepatocytes from the liver along the sinusoids soaks up the alcohol and actually breaks the alcohol and detoxifies your blood from the alcohol. Two main function of liver are 1. Detoxification of the blood that s what s happening as the blood through the veins 2. Liver cells produce bile and that gets collected in bile ducts. Bile canaliculi where bile is collected and eventually dumped into the bile duct. y Bile comes from the Hepatocytes of the liver. Hepatocytes produce bile which is sent into the gallbladder. Gallbladder stores bile until it is needed. Bile job is to break down fats (emulsifies fats).

Summary of liver functions: 1. Produces bile needed to absorb dietary fats 2. Carbohydrate metabolism: liver stores carbohydrates in a form of glycogen. Glycogen is a really long chain of carbohydrate of glucose molecules that are stored in the liver. When blood sugar level is low your liver breaks off glucose molecule from glycogen. So that it can release glucose molecule into blood than blood sugar level won t be too low. Glucose is used to make ATP. i. Breaks down glycogen ii. Amino acids and lactic acids are converted into glucose iii. Converts other sugars into glucose y When blood glucose is low iv. Converts glucose into glycogen

When blood glucose is high

3. Lipid metabolism a. Stores fat b. Breaks down fatty acids to make ATP c. Synthesizes cholesterol to make bile salts Ingredient of bile have? Cholesterol , fatty that helps break down the fat on what we eat. 4. Protein metabolism  Uses amino acid as a source of ATP  The amino group (ammonia) from amino acids (toxic) gets converted into urea and is secreted via the urinary system  Hepatocytes synthesize most plasma proteins y Example: albumin, globulin, prothrombin, fibrogen Prothromin and fibrogen process involved in? Involved in blood clotting If you have liver failure, its not be able to produce as much as plasma proteins as it should. The tonicity of plasma would be hypotonic. There isn t going to be enough stuff in the blood would be water down. Water would enter the cell. 5. Detoxifies drug and alcohol Part of a way that the liver gets rid of drugs is it incorporates drug into bile so that when your gallbladder release bile into intestine. Some of the bile stays in the intestines and the drugs that are in intestines are released as feces. 6. Other -stores: glycogen, fat soluble vitamins A, D, E, K, not a fat soluble vitaminB12 and Iron - activates vitamin D Small Intestine Three regions of small intestine: duodenum, jejunum and ileum Wall of Small intestine: Mucosa simple columnar, lamina propria,and muscularis mucosa Submucosa Muscularis 2 layers of muscle 1. inner circular 2. outer longitudinal Serosa has peritoneum. It doesn t cover the whole entire intestine In the mucosa we have a few different types of cells:

Goblet cells mucus secreting cells Absorptive cells meaning cells that actually absorb a lot of those nutrients and helps digest the stuff that we eat. Paneth cells secretes lyzosome to kill bacteria; can do phagocytes enteroendocrine cells release hormones

Enteroendocrine cells secrete hormones secrete secretin glucose-dependent insulinotropic peptide (GIP) cholecytokinin (CCK) All involved in digestion

Lamina propria contains a lymphatic tissue which is referred as mucosa-associated lymphoid tissue (MALT). We want extra protection in the small intestine. MALT very similar role in lymph nodes but not the specific structure found in small intestine. Within ileum we have some more lymphatic tissue called lymphatic nodules and Peyer s patches (basically cluster of lymphatic tissue) Muscularis mucosa will have smooth muscle Submucosa of small intestine specifically in the duodenum has special glands called Bruner s gland. That secretes alkaline mucus to neutralize the acidic chyme (food moved with gastric juice, etc ) from the stomach. y Chyme is basically a fancy word of food that we have eaten that is mixed with digestive enzymes.

The point of the intestines not only to mix chyme but also to absorb as much of nutrients as possible. A lot of mixing and a lot of absorption. So we want to increase the length of the intestine to be a long as possible. The length of small intestine is 13 ft. few ways that intestine is design in order to increase surface area: Circular folds (visible to the naked eyed), villi (microscopic folds) where the epithelium has a hilly shape to it. Microvilli (microscope fold along apical surface of the epithelial cells)create a brush-border Some digestive enzymes are embedded within the plasma membrane of the individual cells. Mechanical digestion in small intestine: 2 types 1. Segmentation chyme is sectioned off and the middle and ends of the section contract intermittently. Example: tube of toothpaste 2. Migrating motility a peristalsis-like movement that pushes chyme along the length of the intestines. Example: worm motion y This process is done really slowly to allow nutrients to be absorbed. Chyme spends about 3-5 hours in the small intestine.

Chemical digestion in Small intestine: Carbohydrates Pancreatic amylase breaks down larger polysaccharides into smaller polysaccharides, dissacharides [+ monosaccharides] Brush border enzymes example: lactase. Breaks down all carbohydrates into monosaccharides Protein Proteins that come from pancreas and enzymes that come from the brush border. y y Proteins from pancreas: trypsin, chymotrypsin, elastase, carboxypeptidase ( breaks down proteins into peptides) Enzymes that break down proteins that are secreted by brush border: breaks down peptides into individual amino acids. Lipids I. Bile salts take large lipids globules are breakdown into smaller lipid globules -> emulsification II. Pancreatic lipase is responsible for majority of triglyceride breakdown. y Bile salts are amphipathic (hydrophobic and hydrophilic region) that helps emulsify lipids.

Absorption in Small intestine: Carbohydrates: monosacccharides are absorbed into capillaries Proteins: absorbed as amino acids. Half of proteins we absorbed are from what we eat. The other half is cells from the GI system that sluggish off and the enzymes are that are being recycled. y Carbohydrates and proteins use facilitated and active transport. The go through the circulatory system and the first stop is the liver. The liver will help direct where these carbs and proteins will go.

What kind of carbohydrate is stored in the liver? Glycogen Lipids short chain fatty acids by simple diffusion. Long chain fatty acids are monoglycerides bile salts surrounds these to form Micelles. These lipids are absorbed and the micelles stay behind. Micelles cells also help absorb vitamins A,D,E,K and cholesterol. Long chain fatty acids and monoglycerides recombine and are absorbed into the lymphatic system as protein coated globules called chylomicrons Vitamins most are absorbed in a simple diffusion. Vitamin A,D,E,K require aid of Micelles. Vitamin B12 requires intrinsic factor. Large intestine

4 major region of large intestine: 1. Cecum first part of large intestine. Attached to the cecum is the appendix 2. Colon a. Ascending up b. Transverse across c. Descending d. Sigmoid s shape 3. Rectum very end part. The Last portion of the rectum is called anal canal 4. Anus last part. Sphincter If food gets stuck in the appendix and doesn t leave and cause an infection called? Appendicitis . Removal of appendix by surgery. The connection between the ileum and cecum is the ileocecal value Ileocecal valve regulates the passage of chyme from small intestine to large intestine. Appendix is attached to the cecum In small intestine we absorb all the nutrients from the food we eat such as carbs, proteins and fats. SI absorbs vitamins and fluids. Villi is only specific to small intestine Walls of large intestine: I. Mucosa contains simple columnar which absorb excess water and secrete mucus, no villi.

Example: Large intestine absorbs the remaining water. When you have diarrhea you might have had a lot of fluid absorbed in the small intestine but it passes through the large intestine. Large intestine is there to properly absorb the right amount of water from feces so that it s not too hard not to soft just right.  Lamina propria, muscularis mucosa Submucosa Muscularis we have same two layers of muscle tissue: longitudinal and circular smooth muscle. Internal circular smooth muscle and external longitudinal smooth muscle. External longitudinal muscle thickened areas formed teniae coli. They are separated by areas in wall that have few muscle fibers haustra (pockets) Serosa Chemical digestion in Large intestine: Majority of chemical digestion happens in the small intestine but there is slight chemical digestion that happens in the large intestine. What is going to do the chemical digestion in Large intestine? By product is gas. Bacteria.

II. III.

IV.

Bacterial digestion digest remaining carbohydrates and release gas digest remaining proteins digest bilirubin (bile) some bacterial biproducts include vitamin B6, vitamin K they get absorbed y Good bacteria play an important role in digestion and that s why when someone is on antibiotics. The doctor recommends eating yogurt with pills because when you take the pills it will kill all the good and bad bacteria. The yogurt brings back good back bacteria.

Appendicitis inflammation of the appendix Diverticulosis saclike out pouching in wall of colon (areas of weakened muscularis) when food get stuck and it inflames called diverticulitis happens in order people. Example: Flax seed. Some of them don t get completely digested but what can happen is someone who has diverticuli , the seed could actually get stuck in the pouch. If the seed does not leave it can develop into an infection. When some has these diverticuli than we say the person has diverticulosis and when someone gets food stuck in those diverticuli than we call it diverticulitis. Colon cancer a condition you can get in the large intestine. It is the second most common cause of cancer in men, third in women. Genetics plays a role. After a certain age screening must be done whether or not there is colon cancer in the family. The most common caused that is coming out most recent is when a lot of people eat grill/bbq food. It s more of the charring of the meat. Inflammatory bowel disease has two conditions that falls into the category y Crohn s disease inflammation anywhere along GI that can extend through all 4 layers of wall. Usually genetic. Sometimes people with CD has to gets parts of the GI removed because of the inflammation. By the time they reached middle aged a large percentage of their intestine are taken out. Ulcerative colitis inflammation of mucosa in the colon and rectum. o Immune system related

Irritable bowel syndrome abdominal cramping, diarrhea, constipation. Related to stress. Chapter 26 Renal hilum which is the area where ureter leaves and blood vessels, lymphatic vessels and nerves enter and exit. Walls of kidney: surface of kidney, renal capsule, area of fat tissue adipose capsule, tougher CT renal fascia, renal cortex, renal medulla and within the renal medulla are renal pyramid.

Parenchyma the functional tissue of kidney; stroma is the non-functional tissue of kidney What is the basic function unit of kidney? Nephron y When your kidney produce urine. The urine will flow from the renal papilla. Each of the pyramids have the renal papilla which to collect the urine. It s going from the papilla to the minor calyx, from the major calyx their going to the renal pelvis Renal papilla minor calyx major calyx renal pelvis Nephrons don t only exits in the pyramids it also goes in the cortex.

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Nephron is made up of renal corpuscle which is comprised of glomerulus and glomerular (bowman s) capsule. y y y Glomerulus is a cluster of winding tubes Bowman s capsule is what surrounds the glomerulus Yellow tubes going up and down are renal tubule

The kidney takes blood and filters out the stuff that you want to get rid of. It takes out a large percentage of the fluid, ions, electrolytes and etc from your blood. Spills it into the Bowman s capsule and all the fluid will travel into all the tubules. Some gets reabsorbed, not reabsorbed and ends up in the urine. 1. Proximal convoluted tubule 2. Loop of Henle 3. Distal convoluted tubule How does the nephron filter out blood? y y y y y Afferent arteriole brings blood to the glomerulus Efferent arteriole take blood away We are actually taking the blood and doing stuff to the blood. The kidney is filtering out the blood Still oxygenated blood when it leaves 25% of blood goes to your kidney. A lot of blood flow in the kidney. Blood is going to enter in the glomerulus. The glomerulus has a lot of pores in it. When blood flows into it a lot of stuff is going to seeps through the walls in the glomerulus and end up in the capsule. The capsule collecting all the stuff the seeps out of the glomerulus. About 20% of the fluid from your blood ends up in the capsule. Referred to that material as filtrate. Filtrate eventually become urine. Filtrate has water, ions, small proteins and amino acids. What we don t get in filtrate is RBC, WBC, larger things, platelets, large proteins. What gets included in filtrate and what doesn t?

It continues in the proximal convoluted tubule. Certain molecules that are going to be reabsorbed which is glucose, sodium, water, amino acids. When someone has diabetes and have high blood glucose level. Find glucose in their urine. Glucose is reabsorbed by active transport. If you have super high glucose the kidney can t keep up with that transport.