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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 stomach. Composition and properties of the gastric juice. The adaptive changes of stomach secretion.


Methodical instructions for students


Donetsk


2009


The digestion in the stomach. Composition and properties of the gastric juice. The adaptive changes of stomach secretion.


Actuality of subject: Importance of topic studying “The digestion in the stomach. Composition and properties of the gastric juice. The adaptive changes of stomach secretion” is determined by role of stomach in organism that does not limit only digestive functions. Diseases, which connect with dysfunction of stomach, occupied one of the main places in the common structure of incidence of illness. Knowledge of digestion mechanism in stomach is necessary for therapeutist, surgeon and stomatologist.

^ Common purpose: To be able to interpret mechanisms of digestion in stomach for understanding its role in integrate activity of the organism and further use of the knowledge in therapeutical, gastroenterological and surgical clinic.

Specific purposes Purposes of initial level of knowledge

To be able to:


  1. Base physiological role of different components of the gastric juice.

  2. Explain neurohumoral regulator mechanisms of stomach regulation and principles of some phases of the gastric secretion.

  3. Characterize mechanisms of some regulation phases of stomach secretion, mechanisms of self-regulation and inhibition of the gastric secretion.

  1. Characterize anatomical and histological peculiarities of structure, blood supply and innervations of different stomach sections (Anatomy Department).

  2. Interpret principle of action of the gastric juice enzymes (Biochemistry Department).

  3. Value рН as measure of acidity and alkalinity (Chemistry Department).



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 action of gastrin and histamine on secretion of the stomach has studied at experimental animal, which has deinnervated stomach. How did injection of these substances influence on stomach secretion?

  1. Secretion increased.

  2. Secretion stopped.

  3. Secretion didn’t change.

  4. Secretion fell.

  5. It decreased and then increased.


Task # 2. Patient has atony of the stomach. In consequence of this retention of chyme evacuation was observed. Lack of which hormone, that stimulate motor function of the stomach, leads to atony?

  1. Gastrin.

  2. Secretin.

  3. Glucagon.

  4. Neurotensin.

  5. Pancreatic peptide.


Task # 3. The activity of proteases, which produced in the fundal part of the stomach, was studied at the experimental animal. Which pH was optimum for better activity of these enzymes?

  1. pH – 1.5-2.0.

  2. pH – 4.0-4.5.

  3. pH – 6.0-6.5.

  4. pH – 5.0-5.5.

  5. pH – 3.7-4.2.



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


Task # 4. Maintenance of gastricsins was decreased in gastric juice of 58 year old man after operation on the stomach. Where did this substance is produced?

  1. In body of stomach.

  2. In cardial section.

  3. In pyloric section.

  4. In fundus of stomach.

  5. In antral section.


Task # 5. Great part of the stomach was extracted at the 60 year man. What occur with digestion of proteins after this operation?

  1. Proteins were decomposed by bile.

  2. Only vegetable proteins were hydrolyzed.

  3. Only animal proteins hydrolyzed.

  4. Proteins were decomposed by the pancreatic juice.

  5. Hydrolysis of proteins stopped.


Task # 6. The analysis of the biopsy material of stomach mucous of patient, which has gastritis, determined significance decrease in number of parietal cells. How did this influence on intesivity of gastric secretion?

  1. Volume of gastric juice increased.

  2. Volume of gastric juice decreased.

  3. Acidity decreased.

  4. Production of mucus decreased.

  5. Acidity increased.


Basic theoretical questions.

  1. The methods of examination of stomach function.

  2. Function of the stomach (digestive and non-digestive). Motor functions of the stomach.

  3. Composition and digestive action of the gastric juice. Common acidity, free and connected hydrochloric acid.

  4. Stimulation of the gastric acid secretion. Substance which inhibit gastric secretion. Peculiarities of the secretion in response on various nutritional substances.

  5. Neurohumoral mechanisms of the gastric secretion phases. Role of НС1 in self-regulation of the gastric secretion.

LITERATURE





        1. Guyton, Arthur C. Textbook of medical physiology / Arthur C. Guyton, John E. Hall.-10th ed.-in two vol.-2000.-Vol.2.-P.730-733; 742-746; 764-766, 755.

        2. Lectures



^

The educational tasks



Task # 1. During the experiment on the dogs the stomach isolation was carried out by Geidengain’s method. It was determined, that latent period of gastric juice secretion in small isolative stomach after operation was differed from secretion of basic stomach. What led to this?

  1. Disorder of humoral regulation.

  2. Disorder of influence gastrointerstitial hormones.

  3. Disorder of blood supply.

  4. Disorder of nervous regulation.

  5. Stop of humoral and nervous regulation.


Task # 2.

At laboratory experiment the composition and properties of the adult man gastric juice were studied. It was determined, that one of component parts of juice was hydrochloric acid. What was pH of pure gastric juice?

  1. 0.8.

  2. 2.5.

  3. 1.5.

  4. 0.2.

  5. 3.2.


Task # 3. The 150 ml of meat broth was brought into gastric cavity to experimental animal through tube. Which hormone will release in the blood in response to food intake in stomach?

  1. Insulin.

  2. Somatostatin.

  3. Gastrin.

  4. Glucagon.

  5. Neurotensin.

Task # 4. Inhabitants of hot climatic zones traditionally use piquant seasoning. What function of the stomach increases in consequence of these substances using?

  1. Regulative.

  2. Absorptive.

  3. Protective.

  4. Secretory.

  5. Evacuatory.


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


Task # 5. A 54 year old man was investigated in gastroenterological department. Doctor prescribed histaminic test to him. With what purpose was histamine injection?

  1. For study of nitrogenous state.

  2. For proteolysis activation.

  3. For examination of stomach secretory function.

  4. For activation of intestine ferments.

  5. Lipoids digestion for stimulation.


Task # 6. A 45 year old man had peptic ulcer. During examination of the gastric juice it was determined, that number of basal secretion was 100 ml/h and acidity was 60 mmol/l. What substance lead to this changes?

  1. Amylase.

  2. Gastrin.

  3. Glucagon.

  4. Cholecystokinine.

  5. Somatostatin.


Task # 7. A 75 year old man, who lost teeth, feeds by the cutting small and humidified food. During this he complains on heavy feeling in region of stomach, delay of food digestion. What phase of gastric secretion has changed?

  1. Cerebral phase of secretion.

  2. Gastric phase of secretion.

  3. Secretion of bile.

  4. Secretion of pancreatic juice.

  5. Intestinal phase of secretion.


Task # 8. At 75 year old man the initial part of the small intestine was extracted. What changes occurred with stomach?

  1. Increase in secretion.

  2. Stop of secretion.

  3. Decrease in secretion.

  4. Depositive dysfunction.

  5. Increase in gastric juice pH.


Approximate basic of work.

Laboratory work # 1.The function of gastric juice digestion and role hydrochloride acid.

For work necessary. Fibrin, Gastric juice, 0.5% solution of HCl, Sodium bicarbonate in powder, Lighter, test-tubes in racks, pipettes, thermostat, litmus paper.

Purpose of the work: to reveal role of the hydrochloric acid in digestion of proteins, and also role of pepsin in digestion of non-soluble fibrin in solution of albulose and peptone.

Speed of work.

Take 4 number test-tubes, and in three of them fill 2ml gastric juice, and in fourth – 2ml of HCl. Determine presence of free hydrochloric acid in the gastric juice by litmus paper. Fill sodium to total neutralization in second test-tube with gastric juice. Maintenance of third slowly bring to boiling, in consequence of this pepsin destroys. Put down the same small pieces of fibrin in each of four test-tubes and place in thermostat by temperature near 38C. In 15 minutes take out and value result. Fibrin reformed only in the first test-tube, in second and third test-tubes changes didn’t arise, in fourth test-tube (with HCl) piece of fibrin increase in size, took place swelling.

Laboratory work # 2. Determination of gastric juice proteolytic activity on Mett’s method.

Raw white of the egg coagulates in glass tubes with diameter of 1-2mm. These tubes have 2-3cm long// Put down tubes with raw white in middle in test-tubes with the gastric juice, and test-tubes place in thermostat on one hour. Under influence of pepsin the white digests. Size of proteins that digested is 3mm at an empty stomach, size of proteins that digested is 7mm with maximal stomach secretion.


^ The task for the control of final level of knowledge


Task.

A 53 year old man with disease of stomach was admitted in gastroenterological department. What type of stimulation of gastric secretion were used for examination?

А. Exploratory breakfast.

В. Introduction of secretion stimulation in intestine.

С. Introduction of secretion stimulation in the colon.

D. Conditioned-reflector food stimulation.

Е. Weak electrical stimulation of the tongue.


^ SHORT METHODICAL INSTRUCTIONS RELATIVELY CARRY OUT OF STUDY.

After organization part, in the beginning of study, after actualization of topic pay attention to necessity to be able to interpret peculiarities of gastric secretion.

After this the teacher checking initial level of knowledge-skill which you received before.

After decision of teaching tasks students independent interpret physiologic properties of stomach, you must pay attention to damage of stomach activity which lead to different diseases and influence on common organism state. You must pay attention to practical importance of physiologic properties of stomach. During this students use table-train and grafological structure of topic (addition 1) .

After this students decide teaching tasks which they receive during this. Students with teacher modulate situation tasks on these topics. Teacher corrects mistake students’ actions.

Students carry out laboratory works independent. For consolidate 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.

40

Graf logical structure of topic. Table-train Tasks




-//-




3.

Independent carry out laboratory works. Draw up minutes.

40

Instruction for laboratory works

Test-tubes, fibrin, sodium carbonate, hydrochloric acid solution, litmus paper, gastric juice, egg’s protein’s.

Classroom




4.

Seeing of educational videofilm

10

Tasks

TV set

Videoroom




5.

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 “ Digestion in the stomach.^

Stomach digestion


Methods of examination


Stomach functions

Fistulous


Esophagotomy

Isolated stomach

Intubation

Telemetric

X-ray

Digestive

Digestive depot




Secretory

Motor


Absorptive

Excretory

Take part in water-salt exchange

Hemopoietic

Glands of stomach mucous membrane

Chief cells

Ferments pepsin

Parietal cells

Mucosal cells

Mucoid secretion

Cerebral

Stimulation of mouth chemo and mechanoreceptors, visual and olfactory receptors

Gastric

Stimulation of stomach chemo and mechanoreceptors

Intestinal


Stimulation of duodenum chemo and mechanoreceptors


Acute

Chronic




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



























Secretion phases

Nondigestive

Protective

HCl





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