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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2937_Библиотеки_им_академика_М_И_Перельмана.pdf
roughage – non- digestible dietary fibre, important to
promote gut motility.
ruga – a fold of mucosa in the stomach.
satiety – cessation of the feeling of hunger.
scintigraphy – a clinical procedure consisting of the
administration of a radiolabelled agent with a specific
affinity for an organ or tissue of interest, followed by
determination, with a detector, of the distribution of the
radiolabelled compound.
sclerosis – hardening of a tissue, especially by the
overgrowth of fibrous tissue.
sclerotherapy – a technique using sclerosing solutions to
cause obliteration of pathological blood vessels (as in the
treatment of haemorrhoids).
secretagogue – a substance that regulates the release of
a secretion.
sigmoidoscope – a rigid tubular instrument used for
direct visualization of the rectal and sigmoid colonic
mucosa.
somatic – pertaining to one of two major divisions of
the peripheral nervous system, consisting of sensory
neurones concerned with sensation from the skin and
body surface and motor neurones to the skeletal muscles,
the other division being the autonomic nervous system.
splenomegaly – enlargement of the spleen.
steatorrhoea – a condition where the faeces have a high
fat content.
stenosis – a narrowing or constriction of a tube (e.g.,
bowel) or aperture (e.g., ampulla of Vater).
stent – a short plastic tube.
submodality – subclass of a stimulus which evokes a
sensory response.
submucosal – beneath the mucosa.
tetany – a maintained contraction.
thrombocytosis – an abnormal increase in the number of
thrombocytes (blood platelets).
tonic – undergoing continuous muscular activity.
vagotomy – division of the vagus nerves.
varices – dilated veins, usually of the oesophagus, owing
to raised portal vein pressure.
vasoconstriction – constriction of blood vessels.
vasodilator – a substance which causes dilatation of
arterioles.
viscera – body organs (e.g., liver, pancreas).
xenobiotic – an organic substance which is foreign to the
body (e.g., a drug or an organic poison).
xerophthalmia – a disturbance of epithelial tissues
xerostomia – dry mouth.
GLOSSARY
157THE DIGESTIVE SYSTEM
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Index
Note: Page number followed by ‘f’ indicate figure, ‘t’ indicate table and ‘b’ indicate boxes.
A
Absorbents, diarrhoea treatment, 93
Absorption, 85–86, 98
barriers to, 85–86
bile acids, 114
into blood, 87–88
carbohydrates, 98–99
disaccharides, 100f
glucose, 118
chloride, 89
drugs, 86–87
affecting factors, 87
lipid soluble drugs, 86
strong electrolyte drugs, 87
weak electrolyte drugs, 86, 87f
folate, 109
ions, calcium, 106–107
lipids, defects, 113–114
into lymph, 88
minerals, 106–109
monosaccharides, 102–103
potential difference effects, 86
proteins, 103–106
amino acids. See Amino acids
digestion, 103–104, 103f–104f
sites of, 98f
small intestine adaptations, 85, 86f
sodium, 88–89, 89f
trace elements, 106–109
vitamin B12, 109–110
water, 88
water- soluble vitamins, 109–110
Absorptive cells, small intestine wall, 83
Absorptive state, 118
amino acids, 119
carbohydrates, 118
energy metabolism, 118, 118f
insulin. See Insulin
triacylglycerols, 119
Acetylcholine
colon motility, 138
colon secretion control, 136
gastric secretion, 29, 29f
Acetylcysteine, paracetamol overdose
treatment, 68b–69b
Achalasia, 19b–20b, 22–23, 22b
causes, 22
diagnosis, 22, 23f
management, 22–23
symptoms, 22
Acid–base balance
cholera, 91b–92b
starvation, 130b
Acid reduction therapy, 32
antacids, 32
H2 receptor antagonists, 32
muscarinic receptor antagonists, 32
proton- pump inhibitors (PPIs), 32
Acinus, pancreas, 47–48
Actinobacteria, 146
Active transport
bile acid absorption, 114
calcium absorption, 106
Acute pancreatitis, 54–56, 54f
functions, 56
pancreatic and digestive diseases,
diabetes mellitus, 56
Acute pancreatitis (Continued)
physiological consequences, 56
treatment and management, 56
Adenocarcinoma, pancreas. See Pancreas
Adrenal disease, lipid digestion/absorption
defects, 114
Adrenaline, post- absorptive state
regulation, 128
Adrenocorticotropic hormone (ACTH),
post- absorptive state regulation, 126
Alcohol
cirrhosis, 63
dehydrogenase, 67
Alcoholic liver disease, 64b
Alkalosis, metabolic, 90b
American trypanosomiasis. See Chagas
disease
Amino acids
absorption, 104–105, 105t
insulin, 118–119
malabsorption diseases, 105–106
5- Aminosalicylate, ulcerative colitis
treatment, 142b–143b
AMP. See Antimicrobial peptides (AMP)
Ampulla of Vater, 80
pancreas, 46
α- Amylases
carbohydrate digestion, 99–100, 99f
saliva, 99
Amylopectin, 99
degradation, 99f
structure, 99, 99f
Amylose, 99
degradation, 99f
INDEX
Anaemia, Crohn’s disease, 115b–116b
Anal canal, 132, 133f, 135–136
Anions
bile preferential excretion, 69
biotransformation, UDP- glucuronyl
transferase, 69, 70f
conjugation
hepatocyte biotransformation, 70f
hepatocytes, 70f
transporters, 67–68
Antacids, 32
Antibiotic- associated diarrhoea, 148
Antibiotics
diarrhoea treatment, 92–93
intestinal microbiome, 148
Antiemetic drugs, 96
Antimicrobial peptides (AMP), 149
Antimotility drugs, diarrhoea treatment,
93
Appendicitis, 136
Appendix, 135–136
Ascending colon, 137
Ascorbate (vitamin C), absorption, 109
ATP- dependent active transport, organic
ion transport, 69–70
Autoimmune disease, cirrhosis, 63
B
Bacteroides enterotype, 148–149
Bacteroidetes, 146
Barrett’s metaplasia, 18–19, 19b–20b, 22b
diagnosis, 18, 18f
Helicobacter pylori, 21
obesity, 21
risk factors, 18
surveillance, 19
symptoms, 18
tobacco smoking, 21
treatment, 18–19
Bicarbonate (HCO3- )
chloride ion absorption, 89
pancreatic secretion, 48
Bifidobacterium, 152–153
Biguanides, non- insulin- dependent
diabetes mellitus (NIDDM)
treatment, 124
Bile, 60, 63–65
anion preferential excretion, 69
biliary lipids, 65–66, 65f–66f
composition, 63, 64f
functions, 63, 64f
gallbladder, 72–74
organic ion transport, 69–70
proteins, 72
secretion sites, 64f
duct cell secretion, 63–65
hepatocyte secretion, 65
Bile acids, 65, 114
absorption, 114
composition, 65f
conjugated, 114
Crohn’s disease, 115b–116b
Bile acids (Continued)
electrical polarity, 67f
enterohepatic circulation, 77–78, 77f
formation, 66
gallstone treatment, 74b–76b
micelles, 66
small intestine, modification in, 114
uptake/secretion, 66f
Bile pigments, 114
in gastrointestinal tract, 71
metabolism, 71f
Bile salts
calcium absorption, 107
intestinal microbiome, 148
micelle formation, 112
Bilirubin
bile, 63–64
metabolism, 70–71, 71f
Biliverdin, structure, 70
Biotin, 109
Blood, absorption into, 87–88
Blood supply, liver, 61
Branching enzyme, defects, 119
Brunner, glands of, 80
Brush border enzymes, carbohydrate
digestion, 100
Brush- border diseases, 100–101
Bulk- forming agents, constipation
treatment, 96
C
Caecum, 132, 132f
Calcium (Ca2+)
absorption, 106–107
requirements, 106
rickets and osteomalacia, 107
Campylobacter enteritis, 149b
Campylobacter jejuni, 149b
Canalicular multiorganic anion transporter
(cMOAT), 70
Canaliculi, 62
anion transporters, 67–68
liver, 61
Cancer, 19b–20b, 22b
Capsule of Glisson, 61
Carbohydrates
absorption, 98–99
absorption diseases
digestion, 99–100
structures, 98, 99f
Carboxypeptidase A, 104
Carboxypeptidases, 50
CCK. See Cholecystokinin (CCK)
CDI. See Clostridioides difficile infection (CDI)
Cellulose, structure, 99
Cephalic phase
gastric function control, 40–41, 41f
hepatobiliary system regulation, 78
pancreatic secretion regulation, 53
CFTR. See Cystic fibrosis transmembrane
conductance regulator (CFTR)
Chagas disease, nervous control, 139
Chenodeoxycholic acid
bile acids, 65
structure, 65f
Chewing. See Mastication (chewing),
xerostomia
Chief cell secretions, 27, 34–35
drug therapy, 34–35
pepsinogen secretion control, 34, 35f
surgery, 35
triple therapy, 35
Chloride ions (Cl- )
absorption, 89
colon, 136–137
3-
HCO
exchange, 89
cystic fibrosis transmembrane
conductance regulator (CFTR), 48f
intestinal secretions, 84–85
osmotic gradient effects, 137
Chloridorrhoea, congenital. See Congenital
chloridorrhoea
Chlorpromazine, hepatocyte
biotransformation, 70f
Cholecystokinin (CCK)
hepatobiliary system regulation, 60
insulin secretion control, 121
intestinal digestion, 81
pancreatic secretion regulation, 52
reflex control, 139
sphincter of Oddi, 77
Cholera, 91b–92b
Cholesterol
absorption, 98
esterase, 111
gallstones, 74b–76b
hepatocytes, 65–66
micelle formation, 112
structure, 65f
Cholic acid
bile acids, 74b–76b
structure, 65f
Cholinergic parasympathetic nerves, colon,
133
Chronic pancreatitis, 55b
Chylomicrons, 112–113
Chymotrypsin, 104
pancreatic secretion, 100
Chymotrypsinogen, activation
Cirrhosis, 63
Clostridioides difficile infection (CDI), 148, 151
antibiotic refractory, 153b
dysbiosis, 151
cMOAT (canalicular multiorganic anion
transporter), 70
Cobalamins, vitamin B12 absorption,
109–110
Coeliac disease, 101b–102b
Colipase, 112
Colon, 131–144
absorption, drugs, 137
anal canal, 136
anatomy, 132–133, 132f–133f
appendix, 135–136
ascending, 132
bacterial- derived nutrients, 137
160
Colon (Continued)
cancer, 143–144. See also Colorectal cancer
hereditary non- polyposis colorectal
cancer, 144
familial adenomatous polyposis (FAP),
144
risk factors, 143–144
surgical resection, 144
chronic constipation, 141b
defecation, 139–141, 140f
control, 139–141, 140f
descending, 132
digestion, 136–137
distension, 134b–135b
food effect and fibre, 138
functions, 136–141
Hirschsprung’s disease, 134b–135b
histology, 133–135, 136f
ions and water, 136–137
innervation, 133, 133f
intestinal gas, 138
laxatives, 138
motility, 137–138
control, 138, 139f
giant migrating contractions (GMCs),
137–138
nervous control, 139, 139f
reflex control, 139
rhythmic phasic contractions (RPCs), 137
muscle layer, 132
secretion, 136
sigmoid, 132
submucosa, 133
transverse, 132
ulcerative colitis, 142, 142b–143b
wall structure, 136f
Colonic bacteria, osmotic diarrhoea, 92
Colorectal cancer, 144b
Columnar epithelial cells, 83
Computed tomography (CT), 54, 54f
Congenital chloridorrhoea, 90b
Conjugated bile acids, lipid emulsification,
111
Constipation
dietary fibre, 138
treatment, 96
Crigler–Najjar disease, 72
Crohn’s disease, 115b–116b, 150
Cystic fibrosis, 46, 49, 49b–50b, 52b
Cystic fibrosis transmembrane conductance
regulator (CFTR), 49, 84
Cystinuria, 106
D
D cells, 27
Debranching enzyme, defects, 119
Defecation, 139–141, 140f
control of, 139–141, 140f
Hirschsprung’s disease, 134b–135b
Deoxycholic acid, structure, 74b–76b
Descending colon, 132
Detoxification, liver, 60
Diarrhoea, 90–92
coeliac disease, 101b–102b
congenital chloridorrhoea, 90b
Crohn’s disease, 101b–102b
intestinal hypermobility, 92
invasive, 92
osmotic, 92
secretory, 90–91
treatment, 92–93
Dietary fibre, 138
Diet, intestinal microbiome, 147
Digestion
carbohydrates, 99–100
lipids, 111
defects, 113–114
protein, 103–104
Disaccharides, 103–104
absorption, 104f
digestion, 104
Diseases/disorders, drug absorption
effects, 87
DMT1, iron absorption, 107–108
Domperidone, 96
Drugs
conjugation, 66–68
oxidation, 67
Duct cells, pancreas, 47f, 48
Duodenum
anatomy, 80
glands of Brunner, 80
intestinal glands (crypts of Lieberkühn), 80
intestinal juice, 80
lipid absorption, 112
plicae circularis, 80
Dysbiosis, 150
Clostridioides difficile infection, 151
in disease, 150–151, 150f
extra- intestinal diseases, 151
inflammatory bowel disease (IBD), 151
obesity, 151
E
ECL cells. See Enterochromaffin- like (ECL)
cells
Elastase, 104
pancreatic secretion, 54
Electrolytes
cholera, 91b–92b
gastric function control, 44
Emollients, constipation treatment, 96
Emulsification, lipids, 111–112
Endopeptidases, 103–104
Energy provision, starvation, 130b
Enterochromaffin- like (ECL) cells, 27
Enterocytes
GLUT5, 103
intestinal microbiome, 148–149
Enteroglucagon, small intestine motility, 95
Epithelial cells, columnar. See Columnar
epithelial cells
Eosinophilic oesophagus, 23b–24b
Escherichia coli, 152
Excretion, preferential liver, 69
Exopeptidases, 103–104
Extrahepatic ducts, 63
F
Faecal microbiota transplantation (FMT),
153
in disease, 153–154
preparation, 153, 154f
Familial iminoglycinuria, 106
Fats. See Lipids (fats)
Fat- soluble vitamins, 110
Fatty acids, post- absorptive state, 125
Fermentable Oligo- , Di- , Monosaccharides
And Polyols (FODMAP) diet, 147
Fibre. See Dietary fibre
Firmicutes, 146
FMT. See Faecal microbiota transplantation
(FMT)
Folate, absorption, 109
Fructose
absorption, 98
GLUT5 transport, 101
G
Galactose
absorption, 98
malabsorption, 101
Gallbladder, 60, 74b–76b
anatomy, 60f, 72
contraction, 60, 73–74
functions, 72–73, 73f
histology, 72
ion transport, 70f
neck, 72
wall, 72
Gallstones, 60
cholesterol, 73
composition, 74b–76b
detection, 74b–76b
formation, 63–64
occurrence, 74b–76b
pain, 74b–76b
pigment stones, 74b–76b
treatment, 74b–76b
Gastric cancer, 36–37
surgical resection, 36–37
Gastric function control, by food, 40–44
acid–base status, 43–44
cephalic phase, 40–41, 41f
electrolytes, 44
gastric phase, 41–42, 41f
intestinal phase, 42, 42f
vomiting, 42–43, 43b
Gastric inhibitory peptide (GIP), 121
Gastric juice, 27
Gastric phase
gastric function control, 41–42, 41f
hepatobiliary system regulation, 78
pancreatic secretion regulation, 53
INDEX
161
INDEX
Gastric secretion, 29
acetylcholine, 29, 29f
gastrin- releasing peptide (GRP), 29,
29f
Gastric ulcer, 35b, 37b–39b
Gastrin, 28
pancreatic secretion regulation, 52–53
receptors, 28
secretion, G cells, 28
small intestine motility, 81
Gastrin- releasing peptide (GRP), 29, 29f
Gastro- ileal reflex, small intestine motility,
95
Gastrinomas, 31b
Gastrointestinal peptides, 30, 30t
Gastro- oesophageal reflux disease (GORD),
16, 19b–20b, 22b
diagnosis, 17
Helicobacter pylori, 21
obesity, 21
risk factors, 16–17
tobacco smoking, 21
treatment, 17
Gastroparesis, 44
G cells, 27
GH (growth hormone), post- absorptive
state regulation, 129
Gilbert’s syndrome, jaundice, 72
GIP. See Gastric inhibitory peptide (GIP)
Glands of Brunner, 80
Glisson, capsule of, 61
GLP-1 (glucagon- like peptide 1), insulin
secretion control, 121
Glucagon
insulin secretion control, 121
post- absorptive state regulation, 126
secretion, 56
Glucagon- like peptide 1 (GLP-1), insulin
secretion control, 121
Gluconeogenesis, post- absorptive state,
124
Glucose
absorption, 98, 118
glycogen, conversion to, 118
insulin effects, 122–123
malabsorption, 101
plasma. See Plasma glucose
skeletal muscle, 118
sparing reactions, post- absorptive state.
See Post- absorptive state
structure, 99f
supplying reactions, post- absorptive
state. See Post- absorptive state
Glucose 6- phosphatase defects (von
Gierke’s disease), 119
Glucose tolerance test, 121, 125–126
Glucuronide production, 69
GLUT1, 102–103
insulin, effects of, 122–123
structure, 103f
GLUT2, 103
glucose transport, 120
GLUT4, 102–103
insulin, effects of, 122–123
GLUT5, 103
fructose absorption, 101
Glycogen
periportal cells, 62
skeletal muscle, 118
storage disorders, 118–119
structure, 99
Glycogenolysis
insulin effects, 123
post- absorptive state, 124
Glycogen storage disorders, 118–119
Glycolysis, insulin, 123
α-1,6 Glycosidase, carbohydrate digestion,
100
Goblet cells, 83
anal canal, 136
colon, 133–135
GORD. See Gastro- oesophageal reflux
disease (GORD)
G protein- coupled receptors, 149
Granular cells. See Paneth cells
Growth hormone (GH), post- absorptive
state regulation, 129
H
H2 receptor antagonists, 32
Haemochromatosis, hereditary, 108–109
Haemolytic jaundice, 71
Haemorrhoids, 136
dietary fibre, 138
Haem oxygenase (HO-1), 107–108
Hartnup’s disease, 106
Haustration, colon, 138
Helicobacter pylori, 33
Barrett’s metaplasia, 21
gastro- oesophageal reflux disease
(GORD), 21
Hepatic artery, 61
Hepatitis, chronic, 63
Hepatobiliary system, 60. See also
Gallbladder; Liver
anatomy, 60f
regulation during a meal, 78
Hepatocellular jaundice, 71–72
Hepatocytes, 61
anion conjugation, 67f
cholesterol, 66
drug conjugation, 74b–76b
functions, 62f
metabolite conjugation, 66–68
organic ion transport, 69–71
phospholipids, 74b–76b
Hereditary haemochromatosis, 108–109
Hexose transporters, 102–103
monosaccharide absorption, 102–103
specificity, 102t
structure, 103f
Hirschsprung’s disease, 134b–135b
Hormonal control, 28
gastrin, 28
gastrin receptors, 28
G cells and gastrin secretion, 28
Hormones
pancreatic secretion regulation, 52
post- absorptive state, 128–130, 129f, 129t
small intestine motility, 85
Hygiene hypothesis, 150
Hyperbilirubinaemia, 70
Hyperglycaemia, diabetes mellitus, 126
Hypersecretion, cholera, 91b–92b
Hypovolaemia, cholera, 91b–92b
I
IBD. See Inflammatory bowel disease (IBD)
IBS. See Irritable bowel syndrome (IBS)
IDDM. See Insulin- dependent diabetes
mellitus (IDDM)
Ileocaecal sphincter, 95
Ileum
anatomy, 80–81
lipid absorption, 104–105
segmentation, 94
water absorption, 88
Infective diarrhoea, 149b
Inflammatory bowel disease (IBD), 151
Inherited diseases, cirrhosis, 63
Insulin, 119–124
absorptive state, 121–123
glucogenesis inhibition, 123
glucose entry to cells, 122–123
glycogenolysis inhibition, 123
glycogen synthesis, 123
glycolysis, 123, 123f
insulin receptor, 122, 122f
lipolysis inhibition, 123
triacylglycerol synthesis, 123
actions, 121–123
amino acid transport, 123
blood glucose vs., 120–121, 120f
energy metabolism control, 121–122,
121f
protein synthesis, 123
proteolytic processing, 120f
secretion control, 120–121
amino acids, 121
glucose, 120–121, 120f
hormones, 121
nervous control, 121
secretion of, 56
sensitivity, 123–124
Insulin- dependent diabetes mellitus
(IDDM), 124–125
diabetic ketoacidosis, 126–127
metabolic state, 125, 125f
post- absorptive state vs., 126
type 1 diabetes, 124–125
See also Non- insulin- dependent diabetes
mellitus (NIDDM)
Insulin receptor, 122
Insulin receptor substrate (IRS) proteins,
122
Insulin sensitivity, 123–124
Intestinal glands (crypts of Lieberkühn), 80
duodenum, 80
162
Intestinal microbiome
16S ribosomal RNA (rRNA) gene, 151–152
antibiotic refractory Clostrioides difficile
infection, 153b
beta diversity, 151
composition, 146–149
age, 148
antibiotics, 148
Bacteroidetes, 146
bile salts, 148
diet, 147
early development, 146
enterotypes, 148–149
factors, 146–148, 147f
Firmicutes, 146
dysbiosis, 150
Clostridioides difficile infection, 151
in disease, 150–151, 150f
extra- intestinal diseases, 151
inflammatory bowel disease (IBD), 151
obesity, 151
functions
colonisation resistance, 149
digestive, 149
host defence, 149
host immune development, 149–150
human genome, 146
immune system, 146
infective diarrhoea, 149b
metagenomics, 152
modulation, 146
second genome, 151
sequencing methods, 151
therapeutic target, 152–154
in disease, 153–154
faecal microbiota transplantation
(FMT), 153
plasticity, 152
prebiotics, 152–153
preparation, 153, 154f
probiotics, 152, 152f
super donor phenomenon, 153–154
Intestinal phase
gastric function control, 42, 42f
hepatobiliary system regulation, 78
pancreatic secretion regulation, 53–54
Intrahepatic jaundice, 71–72
Intralobular ducts, pancreas, 47
Intravenous rehydration, cholera, 91b–92b
Intrinsic factor, vitamin B12 absorption,
109–110
Intrinsic nerves, colon motility, 138
Ions, absorption, colon, 136–137
Ion transport
gallbladder, 70f
organic ions. See Organic ion transport
Iron
regulation, 108
transport, 107–108, 108f
stomach, nutrient absorption, 34
Iron- deficiency anaemia, 108
stomach, nutrient absorption, 34
Irritable bowel syndrome (IBS), 147
Islets of Langerhans, 53
J
Jaundice, 63
Crigler–Najjar disease, 72
Gilbert’s syndrome, 72
haemolytic, 74b–76b
hepatocellular, 71–72
intrahepatic, 71–72
obstructive, 72
post- hepatic, 72
prehepatic, 71
Jejunum
anatomy, 80–81
lipid absorption, 112
segmentation, 94
water absorption, 88
K
Ketoacids, 119
Ketone bodies
insulin- dependent diabetes mellitus, 125,
125f
post- absorptive state, 125
Kupffer cells, 61–62
L
Lactase, carbohydrate digestion, 100, 100f
Lactase deficiency, 98
brush- border diseases, 100
osmotic diarrhoea, 96
Lactic acid- producing bacteria, 146
Lactose, digestion, 100
Laxatives, 96
colonic mobility, 138
osmotic, 96
secretory, 96
Lecithin. See Phosphatidylcholine
Lieberkühn, crypts of. See Intestinal glands
(crypts of Lieberkühn)
Linoleic acid, 110
α- Linolenic acid, 110
Lipases, lipid digestion, 111
Lipids (fats), 110–114
absorption, 110
dietary, 110
digestion, 111, 111f
defects, 113–114
emulsification, 111–112
epithelial cell, 112–113, 113f
essential fatty acids, 110
fat- soluble vitamins, 110
malabsorption, 74b–76b
diarrhoea, 92
micelle formation, 112
solubility, 110–111
unstirred layer, 112
Lipid- soluble drugs, absorption, 86
Lipolysis, insulin effects, 123, 126
β- Lipoproteinaemia, lipid digestion/
absorption defects, 114
Lithocholic acid, structure, 65f
INDEX
Lithotripsy, gallstone treatment, 74b–76b
Liver
anatomy, 60–63
capsule of Glisson, 61
lobes, 61
lobules, 61
blood supply, 61
canaliculi, 61
cancer, 77
functions, 60
detoxification, 60
excretion, 60
glycogen storage diseases, 119
histology, 61–62, 61f
morphology, 60–63
secretory system, 61
sinusoids, 61
surgery, 77
See also under hepatic
Lobes, liver, 61
Lobules, liver, 61
Longitudinal muscles, small intestine
motility, 93
Lymphatic system, lipid digestion/
absorption defects, 114
Lysosomal acid α- glucosidase defects, 119
M
MACs. See Microbiome- accessible
carbohydrates (MACs)
Malabsorption, coeliac disease, 101b–102b
Maltase, 100, 100f
Maltose, digestion, 100, 100f
Mastication (chewing), xerostomia, 7–9
bite regulation, 7–8
control, 7, 8f
movements generation, 7
tongue movements, 8–9
Maternal- derived microbes, 146
McArdle’s disease, 119
Mechanoreceptors, pancreatic secretion
regulation, 53
Meglitinides, non- insulin- dependent
diabetes mellitus treatment, 124
Metabolic alkalosis, congenital
chloridorrhoea, 90b
Metabolism, starvation, 130b
Metabolite conjugation, hepatocytes, 66–68
Metagenomics, 152
Micelles
bile acids, 66
formation, 66, 112
mixed, 66
phospholipid, 66
primary, 66
structure, 67f
Microbiome- accessible carbohydrates
(MACs), 147
Microvilli, 83
canaliculi, 62
Migrating motor complex (MMC), 93–94, 93f
163
INDEX
Minerals, absorption, 106–109
Mixed micelles, 66
MMC (migrating motor complex), 93–94, 93f
2- Monoacylglycerols, micelle formation, 112
Monosaccharides
absorption. See Absorption
See specific monosaccharides
Motilin, small intestine motility, 95
Motility
Chagas disease, 139
colon. See Colon
Hirschsprung’s disease, 134b–135b
See also Smooth muscle
Mouth
absorption, 11
anatomical features, 2, 2f
causes
Sjögren’s syndrome, 4–5, 5f
xerostomia, 4
oral mucosa, 2–3
innervation, 2–3, 3f
Mucosa, anal canal, 136
Mucosal barrier, stomach, 30–32
corrosive gastric juice, 30
secretions, 31–32
Mucous cells. See Goblet cells
Mucus- secreting cells, 27
Muscarinic receptor antagonists, 32
Muscle
glycogen storage diseases, 119
smooth. See Smooth muscle
Muscularis externa
colon, 135
intestinal wall structure, 83
Muscularis mucosae
intestinal wall structure, 83
small intestine motility, 94
N
Nerves, intrinsic. See Intrinsic nerves
Nervous system
small intestine motility, 95
See also specific nervous systems
Neurotransmitters, small intestine motility, 85
Non- insulin- dependent diabetes mellitus
(NIDDM), 124
defects, 124
treatment, 124
See also Insulin- dependent diabetes
mellitus (IDDM).
Non- steroidal anti- inflammatory drug
(NSAID), 56
Noradrenaline, small intestine secretion
control, 85
Nuclei, hepatocytes, 62
O
Obesity
Barrett’s metaplasia, 21
dysbiosis, 151
gastro- oesophageal reflux disease (GORD), 21
insulin sensitivity, 124
Obstructive jaundice, 72
Oddi, sphincter of, 53–54, 77, 80
Oesophageal cancer, 19–22
management, 21
risk factors, 21
alcohol overconsumption, 21
socioeconomic status, 21
tobacco smoking, 21
surgical resection, 21–22
symptoms, 20
Oesophagus
anatomical arrangements, 14
eosinophilic, 23b–24b
swallowing (deglutition), 14–16
control, 16
events, 14, 15f
motility, 16, 16f
oesophageal phase, 15–16
pharyngeal phase, 15, 15f
voluntary phase, 14–15
varices, 14
Omeprazole, 32
Opioids, absorption control, 95
Oral rehydration therapy, 91b–92b
Organic ion transport, 69–71
bile, 69–70
hepatocytes, 69
Osmotic diarrhoea, 92
Osmotic gradients, water absorption, 88
Osmotic laxatives, 96
Osteomalacia, 107
P
Pancreas, 46, 47f
alkaline secretion, 48–49
cellular mechanism, 48–49
composition, 48
functions, 48
variation, 48f, 49
anatomy, 46–48
cystic fibrosis, 49b–50b, 52b
enzymes, 50
precursor activation, 51–52, 51t
secretion mechanisms, 50–52, 51f
See also specific enzymes
exocrine tissue, 46–47, 47f
histology, 47–48, 47f
morphology, 46–48
pancreatic juice, 48–49
secretion regulation, 52–53
bicarbonate secretion, 52–53, 53f
cephalic phase, 53
gastric phase, 53
hormonal, 52–53
intestinal phase, 53–54
during meals, 53–54
nervous control, 53
Pancreatic cancer, 55b, 57
Pancreatic juice, 48–49
Pancreaticoduodenal artery, 57b
Pancreatic polypeptide (PP), 74
Pancreatitis
acute. See Acute pancreatitis
chronic. See Chronic pancreatitis
Paneth cells, 83
Paracellular sieving, bile in protein, 72
Paracetamol overdose, 68b–69b
Parasympathetic nerves
cholinergic, colon, 133
defecation, 140
insulin secretion control, 121
small intestine secretion control, 85
Parathyroid hormone (PTH), calcium
absorption, 107
Parietal cell acid secretion, 27f, 28–29
duodenal hormone secretin, 30
feedback control, acid concentration, 29
gastrointestinal peptides, 30, 30t
inhibitory control, 29–30
somatostatin, 29–30, 29f
Parietal cells, 27–28, 27f. See Oxyntic
(parietal) cells
Passive diffusion, ion absorption, 98
Passive mechanisms, calcium absorption,
114
PCR. See Polymerase chain reaction (PCR)
Pepsin, 104
Pepsinogen secretion control, 34, 35f
Peptic ulcer disease, 35–36, 36f
Periportal cells, glycogen, 62
Perisinusoidal spaces, liver, 61–62
Peristalsis
colon, 135
small intestine motility, 94, 94f
Pernicious anaemia, 110
stomach, nutrient absorption, 34
Peyer’s patches, 80–81
Phenacetin, hepatocyte biotransformation, 69
Phosphate ions, requirements, 106
Phosphatidylcholine
in bile, 66
structure, 65f
Phosphofructokinase, defects, 119
Phospholipase A2, 111
Phospholipids
hepatocytes, 66
micelles, 66
Phosphorylase defects, 119
Phosphorylase, defects (McArdle’s disease),
119
Phosphorylase kinase defects, 119
Pigment gallstones, 74b–76b
Piles. See Haemorrhoids
Plasma glucose
post- absorptive state, 124
starvation, 130b
Plasma membrane, hepatocytes, 62
Plicae circularis, duodenum, 80
Polymerase chain reaction (PCR), 151–152
Post- absorptive state, 124–128
control of, 128–130, 129f
diabetic ketoacidosis, 126–127
glucose sparing reactions, 127–128, 128f
hormones, 129–130, 130t
glucose supplying reactions, 127, 127f
hormones, 129–130, 130t
glucose tolerance test, 125–126, 126f
hormones, 128, 129t
insulin- dependent diabetes mellitus
(IDDM), 124–125
164
Post- absorptive state (Continued)
metabolic state, 125, 125f
non- insulin- dependent diabetes mellitus
(NIDDM), 124
plasma glucose, starvation, 130b
Post- hepatic jaundice, 72
Potential difference, absorption, 86
P P. See Pancreatic polypeptide (PP)
Prehepatic jaundice, 71
Primary micelles, 66
Prebiotics, intestinal microbiome, 152–153
Prevotella enterotype, 148–149
Procarboxypeptidase, activation, 51
Proelastase, activation, 51
Prophospholipase A, activation, 51
Proteins, 103–106
digestion, 103–104, 104f
small intestine, 104
stomach, 104
structure, 103f
Proteobacteria, 146
Proton- pump inhibitors (PPIs), 32
Pyloric sphincter control, 40
Pyridoxine (vitamin B6), absorption, 109
R
Reactive hypoglycaemia, 121, 125
Rectum, 132
Reflex control, small intestine motility, 95
Rehydration therapy
cholera, 91b–92b
oral therapy. See Oral rehydration
therapy
Riboflavin, bacterial- derived nutrients, 137
16S Ribosomal RNA (rRNA) gene, 151–152
Rickets, 107
S
Sacral control centre, defecation, 140–141
Saliva
composition, 9–10
α- amylases, 99
functions, 10–11
digestion, 10
lubrication, 10
protective functions, 10–11
taste, 10
water intake control, 11
Salivary glands, structure and histology,
9f, 10
SCFAs. See Short- chain fatty acids (SCFAs)
Secretin
intestinal digestion, 81
pancreatic secretion regulation, 52
Secretion
blood flow, 13–14
control, 12–14
cellular mechanisms, 13
by food, 14, 15f
mechanisms, 11–12, 12f, 13t
Secretomotor neurones, small intestine
secretion control, 85
Secretory diarrhoea, 90–91
Secretory laxatives, 96
Segmentation
colon motility, 138
ileum, 94
jejunum, 94
small intestine motility, 94, 94f
SGLT1, 101, 103
Shigella infection, 152
Short- chain fatty acids (SCFAs), 147,
149
Shotgun metagenomics, 152
Sigmoid colon, 132
Sinusoidal spaces, liver, 61–62
Sjögren’s syndrome, 4–5, 5f
Skeletal muscle
glucose, 118
glycogen, 118
Somatostatin, 29–30, 29f
Small intestine, 77
absorption, 85–86
anatomy, 80–81, 80f–81f, 81t
blood supply, 81–82, 82f
ischaemia, 81–82
villi circulation, 82, 82f
digestion, 80
protein digestion, 104
secretions, 84–85
control, 85
electrolyte secretion, 84–85
luminal osmotic pressure, 84
surface area, 85
surgical resection, 82–83
wall structure, 80–81, 83
brush border/unstirred layer, 83
columnar absorptive cells/enterocytes,
83
endocrine cells, 83–84
goblet cells, 83
histology, 83–84, 84f
M cells, 84
oligomucous cells, 84
paneth cells, 83
stem cells, 84
tuft cells, 84
villus and crypts, 83
Small intestine motility, 93–94
control, 94–95
drugs, 96
gastro- ileal reflex, 95
hormonal control, 95
ileocaecal sphincter, 95
migrating motor complex (MMC), 93–94,
93f
mixing and propulsion, 94
muscularis mucosae contraction, 94
nervous control, 95
peristalsis, 94
reflex control, 95
segmentation, 94, 94f
spontaneous contractions, 93
types, 93–94
Small peptides, absorption, 104
Sodium (Na+) ions
absorption, 88–89
colon, 136–137
intestinal secretions, 85
Na+ dependent co- porters, amino acid
absorption, 105
Na+ dependent/glucose transporter
(SGLT1), 89
Somatostatin, 53
Sphincter of Oddi, 46, 77, 80
Spontaneous contractions, small intestine
motility, 93
Starch, structure, 98–99
Starvation, 130b
Stomach
acid reduction therapy, 32
antacids, 32
H2 receptor antagonists, 32
muscarinic receptor antagonists, 32
proton- pump inhibitors (PPIs), 32
anatomy and morphology, 26, 26f
cell types, 27
chief cell secretions, 34–35
drug therapy, 34–35
pepsinogen secretion control, 34, 35f
surgery, 35
triple therapy, 35
epigastric discomfort, 33b
function, 26
gastric cancer, 36–37
surgical resection, 36–37
gastric function control, by food, 40–44
acid–base status, 43–44
cephalic phase, 40–41, 41f
electrolytes, 44
gastric phase, 41–42, 41f
intestinal phase, 42, 42f
vomiting, 42–43, 43b
gastric juice, 27
gastroparesis, 44
Helicobacter pylori, 33
hormonal control, 28
gastrin, 28
gastrin receptors, 28
G cells and gastrin secretion, 28
motility, 37–39
control, 39–40
mixing and emptying, 37–39
mucosal barrier, 30–32
corrosive gastric juice, 30
secretions, 31–32
neural control, gastric secretion, 29
acetylcholine, 29, 29f
gastrin- releasing peptide (GRP), 29, 29f
nutrient absorption, 33–34
iron, 34
iron- deficiency anaemia, 34
pernicious anaemia, 34
vitamin B12, 33–34
parietal cell acid secretion, 27f, 28–29
duodenal hormone secretin, 30
feedback control, acid concentration, 29
gastrointestinal peptides, 30, 30t
inhibitory control, 29–30
somatostatin, 29–30, 29f
INDEX
165
INDEX
Stomach (Continued)
parietal cells, 27–28, 27f
peptic ulcer disease, 35–36, 36f
protein digestion, 104
pyloric sphincter control, 40
structure, gastric mucosa, 26, 26f
Straight tubular glands, colon, 133–135
Stroke–loss, swallowing function, 7b
Strong electrolyte drugs, absorption, 87
Substance P, colon motility, 139
Sucrase, 100
Sucrase- isomerase deficiency, 101
Sucrose, digestion, 100
Sulphonylureas, non- insulin- dependent
diabetes mellitus treatment, 124
Superior mesenteric artery, 81
Superior rectal artery, 136
Surgery, ulcerative colitis, 142b–143b
Swallowing (deglutition), oesophagus,
14–16
control, 16
events, 14, 15f
motility, 16, 16f
oesophageal phase, 15–16
pharyngeal phase, 15, 15f
voluntary phase, 14–15
Sympathetic nerves
post- absorptive state regulation, 128
small intestine, 81
T
Taeniae coli, 132
Taste
buds, 3–4, 3f
sensation, 4, 4f
Tetrapeptide absorption, 104
Thiamine, bacterial- derived nutrients, 137
Thiazolidinediones, non- insulin-
dependent diabetes mellitus
treatment, 124
Tobacco smoking
Barrett’s metaplasia, 21
gastro- oesophageal reflux disease
(GORD), 21
oesophageal cancer, 21
Tongue
anatomy and histology, 3–4
taste buds, 3–4, 3f
taste sensation, 4, 4f
Trace elements, absorption, 106–109
Transcellular route, sodium ion absorption, 89
Transcobalamin II, vitamin B12 absorption,
109–110
Transverse colon, 132
Triacylglycerol synthesis, insulin, 122
Tripeptides, absorption, 104
Trypanosomiasis, American. See Chagas
disease
Trypsin, 104
acute pancreatitis, 54
enzyme activation, 51
pancreatic secretion, 50
Trypsinogen, trypsin, conversion to, 100
Tubuloacinar lands, pancreas, 46–47
U
UDP- glucuronyl transferase, anion
biotransformation, 67
Ulcerative colitis, 142, 142b–143b
Ultrasound
acute pancreatitis, 54f
gallstones, 74b–76b
Ursodeoxycholic acid, gallstone treatment,
74b–76b
V
Vagus nerve
pancreas innervation, 53
small intestine, 83
Vasoactive intestinal peptide (VIP)
colon secretion control, 136
gallbladder control, 74
intestinal secretion control, 85
pancreatic secretion regulation, 52–53
Villi, 80
Vitamin(s)
fat soluble. See Fat- soluble vitamins
water- soluble, absorption, 109–110
Vitamin A deficiency, 110
Vitamin B
Vitamin B complex
Vitamin C (ascorbate), absorption, 98
Vitamin D, 110
Vitamin E, 110
Vitamin K
Von Gierke’s disease, 119
12
absorption, 98, 109–110
deficiency, 110
stomach, nutrient absorption, 33–34
absorption, 109–110
bacterial- derived nutrients, 137
calcium absorption, 106
deficiency, 106
bacterial- derived nutrients, 137
deficiency, 110
W
Water absorption, 88
colon, 136–137
Water- soluble vitamins, absorption,
109–110
Weak electrolyte drugs, absorption, 86,
87f
X
Xerostomia, 4, 5b
diagnosis, 6
mastication (chewing), 7–9
bite regulation, 7–8
control, 7, 8f
movements generation, 7
tongue movements, 8–9
smell, 6
symptomatic, 5
teeth, 6–7, 6f
treatment and side- effects, 6
Z
Zollinger–Ellison syndrome, 31b
166