Ministry of Public Health of Ukraine M. Gorky Donetsk National Medical University icon

Ministry of Public Health of Ukraine M. Gorky Donetsk National Medical University




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Ministry of Public Health of Ukraine

M. Gorky Donetsk National Medical University


The digestion in the small and large intestine. The mechanisms of absorption. The physiological role of liver and pancreas. Regulation of bile and pancreatic secretion.


Methodical instructions for students


Donetsk


2009


The digestion in the small and large intestine. The mechanisms of absorption. The physiological role of liver and pancreas. Regulation of bile and pancreatic secretion.


Actuality of subject: Studying of this topic is very important for understanding of functions and regulative mechanisms gastrointestinal tract. The knowledge of these mechanisms is necessary for the therapeutist and surgeon in assessment of the patient’s state and for their treatment.

Common purpose: To be able to interpret mechanisms of digestion regulation in the intestines for understanding its role in forming the integrate activity and metabolism of the organism and further use of the knowledge in clinic of surgical and internal diseases.

^ Specific purposes Purposes of initial level of knowledge

To be able to:



1. Explain role of pancreas juice enzymes for digestion of different food components, nervous and humoral mechanisms of pancreas secretion.

1. Recognize anatomic and histological peculiarities of structure, blood supply and innervations of the liver, the pancreas and intestine.(Anatomy and Histology Departments)

2. Value of the bile role in digestion processes, liver functions and mechanisms of bile production and releasing.

2. Analyze composition of the pancreas juice, secretions of intestine and liver. (Biochemistry Department)

3. Prove importance of the intestine juice components for digestion.


3. Value some properties of smooth muscles. (Biophysics Department)

4. Value of type digestion in the intestine for decomposition of chyme and absorption .





You must decide some tasks in order to reveal your initial level of knowledge-skill:

^

Tasks for control of initial level of knowledge



Task # 1. The activity of the submucous nervous plexus of the small intestine was blocked. Which process is mostly disturbed?

  1. Secretion of intestinal juice

  2. Parietal digestion.

  3. Rhythmical segmentation.

  4. Anti-peristalsis.

  5. Propulsive peristalsis.


Task#2.

Vomiting and dyspepsia appeared at infant after feeding by milk. During drinking of glucose solution these phenomena ended. Insufficient activity of which enzyme led to such disorder ?

  1. Lactase.

  2. Amylase.

  3. Maltose.

  4. Saccharase.

  5. Isomaltose.


Task # 3.

During the experiment it was determined that the smooth muscles of human stomach after stretching keep long time length. Which property of the smooth muscles provides this effect?

  1. Elasticity.

  2. Automatia.

  3. Plasticity.

  4. Refractory.

  5. Excitability.

If you decide previous tasks then you must decide following tasks independently.

Task#4.

A 15 sm long the segment of small intestine was isolated by Tyri-Well’s method in an experimental animal. Which function helped to determine the oral and anal part of the intestinal segment?

  1. Defense.

  2. Absorptive.

  3. Motor.

  4. Secretory.

  5. Detoxicative.


Task # 5.

A coprologic examination was carried out in a 48 year old patient. It was determined that feces was colorless, contained drops of neutral fat. The doctor wrote his conclusion about the disturbance of a certain digestion process. Which process was impaired?

1. Secretion of gastric juice.

2. Absorption in the intestines.

3. Secretion of saliva.

4. Release of bile in the intestines.

5. Secretion of intestinal juice.


Task # 6.

A segment of the small intestine was placed in a warming oxigenative physiologic solution. The smooth muscles of this segment contracted spontaneously. Which property of the intestine did this experiment demonstrate?

  1. Strain.

  2. Elasticity.

  3. Automatia.

  4. Excitability.

  5. Plasticity.

Basic theoretical questions.

  1. The composition and digestive action of some components on pancreatic juice; the methods of its receiving. Phases of pancreatic juice secretion.

  2. The composition and role of bile in digestion. The regulation of bile secretion. The functions of the biliary tree.

  3. The secretions in the small and large intestine. The regulation of secretion of the small and large intestines.

  4. Types of digestion in the intestine for decomposition of chyme and absorption. Enzymes and microflora of the intestine that take part in digestion.

  5. The role of different sections of the gastrointestinal tract in absorption. Absorption of proteins, fats and carbohydrates, water and mineral salts.


LITERATURE


  1. 1. Arthur C. Guyton, John E. Hall Textbook of medical physiology.-2000.-Vol.2.-P.720-726, 732-737, 749- 753, 758-763, 768-769.

  2. Lectures.
^

The educational tasks



Task#1 At 47 year old patient the part of the pancreas was extracted by medical deposition. What products could he use after this operation?

  1. Sour-milk products

  2. Boiled meat.

  3. Bread, fat meat.

  4. Vegetables.

  5. Fruits.


Task # 2. A 45 year old patient had the liver dysfunction and complained of his body weight loss, hemorrhage of parodont, an edema. Which function of liver was impaired?

  1. Defensive function.

  2. Synthesis of glycogen.

  3. Synthesis of proteins.

  4. Synthesis of pigments.

  5. Synthesis of vitamins.


Task # 3. A decrease in concentration of enterokinase was revealed in a woman, who had a disturbance of digestion. What was the role of this enzyme in digestion?

  1. Intensified motility of intestine.

  2. Stimulated a release of bile.

  3. Inhibited of trypsinogen.

  4. Activated of trypsinogen.

  5. Stimulated of enzymes excretion.


Task # 4. A 57 year old patient was treated for a long time with antibiotics and after this he complained on disturbance of intestine digestion. What caused this situation?

  1. Increase in motility of intestine.

  2. Intestine secretion impairment.

  3. Absorption impairment.

  4. Suppression of microflora.

  5. Bile secretion disorder.


If you decide previous tasks then you must decide following tasks independently.


Task#5. A 53 year old patient had acute pancreatitis. The doctor prescribed complete three day starvation .What products did he use after abolition of starvation?

  1. Concentrative broth.

  2. Fatty milk.

  3. Boiled meat.

  4. Vegetable puree.

  5. Grapes juice.


Task # 6. A 57 year old patient had a gallstone in common bile duct. It caused the bile not release to the intestine. Which process of digestion changed in this situation?

  1. Digestion of carbohydrates.

  2. Digestion of proteins.

  3. Digestion of fats.

  4. Absorption of proteins.

  5. Absorption of carbohydrates


Task # 7. Synthesis and secretion of pancreatic juice decreased in a 78 year old woman. The level of trypsine also decreased. Which substances didn’t split?

  1. Proteins.

  2. Polysaccharides.

  3. Phosphatides.

  4. Vitamins.

  5. Fats.


Task#8. At 7 year child with Girshprung’s disease atonic and dilated segments were in large intestine, that caused functional obstruction. Which mechanisms were damaged in this case?

  1. Central reflex.

  2. Humoral.

  3. Local reflex.

  4. Endocrine.

  5. Conditioned reflex.


Approximate basic of work.


Laboratory work # 1. Examination of pancreatic juice influence on proteins, fats and carbohydrates.

Fill 1ml of casein solution in test-tubes № 1-3, 1ml of tributyrin solution in test-tubes № 4-6; 1ml of starch solution in test-tubes № 7-9. In all three groups of test-tubes to add 1ml of pancreas juice in dilution of 1:200; 1:400; 1:600. The test-tubes input to the thermostat for 20 minutes. Then to add 7 drops of 5% solution of acetic acid in test-tubes № 1-3, add 1 drops of water in test-tubes № 4-6; add 1 drop of 0.5% solution of iodine in test-tubes № 7-9. Note the intensity of color change.


Laboratory work # 2. Study of emulsificative properties of bile.

  1. For study of emulsificative properties take 2 test-tubes with the watering-can, put filters in, which are impregnated: 1-st - by bile; 2-nd-by water. To add some sunflower-oil in each filters. Note that through filter, which impregnated by water, fat is not filtered.

  2. In two test-tubes fill: 1-st - 3ml of bile, 1ml of water and 0.5ml of sunflower-oil; 2-nd- 4ml of water and 0.5ml of sunflower-oil. The contents of the test-tubes shake up then put them in the support. Note in what state is contents of the test-tubes?

Make conclusion about the importance of bile.


The task for the control of final level of knowledge


Task . An animal died in result of the liver damage by toxic agent. What function of this organ was damaged?

  1. Detoxication.

  2. Defensive.

  3. Glycogen synthesize.

  4. Protein synthesize.

  5. Secretory.


^ SHORT METHODICAL INSTRUCTIONS.

After organization part, in the beginning of study, after actualization of topic pay attention to importance of the bile and pancreas juice in digestion and hormones of small intestine which influence on motor action of the intestine tract.

After this the teacher checking of initial level of knowledge-skill.

After decision of teaching tasks students independently interpret physiologic properties of digestion in the stomach. Pay attention to physiological importance of digestion mechanisms in intestine. During this students use table-train, graf of topic logical structure (addition 1) .

After this students decide teaching tasks, which they receive during classes.

Students with teacher modulate situation tasks on these topics. Teacher corrects students’ mistake.

Students carry out laboratory works independently. For consolidate of the topic students see education film .

After this students decide control tasks. Sum up of study and announcement marks.

^ TECHNOLOGICAL MAP OF THE STUDY




Stage

Time

Teaching aids

Place

Note







Min

Means of training

Equipment

of study




1.

Organization part. Actuality of subject. Purpose of study. Control initial level of knowledge-skill with the help of tasks.

15

Tasks




Classroom




2.

Independent work of students with recommend models and scheme. Independent work of students with recommend teaching tasks. Model situation tasks and correct mistake action of students.

50

Graf logical structure of topic. Table-train Tasks Graf logical structure of topic.




-//-




3.

Independent carry out laboratory works. Draw up minutes. .

40

Instruction for laboratory works Tasks

Test-tubes, bile, water, sunflower oil, filters, pancreatic juice, iodine solution, casein, tributyrin, Lemmings’ reagent. TVset

Videoroom




4

The task for the control of final level of knowledge. Sum up of study. Announcement of marks

15

Tasks

Computer

Computeroom Classroom





Addition 1.

Graf logical structure of topic
Mechanisms of digestion regulation at intestine.
^

Neuro- reflector

Humoral

“Peculiarities of digestion in the intestine. Mechanisms of absorption in the GIT.”
^
Large intestine кишечник
Small intestine
Liver
Pancreas gland

Cerebral

Gastric
Intestinal
Proteolytic
Lipolytic
Amylolytic

Secretion phases
Ferments of gland
^
Digestive functions
Emulsion of fats
Activation of ferments
Absorption of fats
Activation of motility
Stimulation of bile secretion
Stimulation of membranous digestion
Nondigestive functions
Digestive functions
^
Nondigestive functions
Cavitary hydrolysis
Membranous hydrolysis

Telemetric


Methods of examination

Fistulous


X-ray

Intubation


Interpret of organism physiological state for further use this knowledge in clinic


Biochemical



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