口腔、食道、胃功能課件

GastrointestinalPhysiology

(Part2)GastrointestinalPhysiology(P1OutlinesPregastricdigestionMasticationSwallowingSecretionofsalivarySaliva：secretion，compositionandfunctionsNervousregulationofsalivarysecretionGastricdigestionGastricsecretionGastricjuice：source，compositionandfunctionsHClsecretion：cellularmechanismandregulationControlofgastricsecretionduringdigestiveperiodGastricmotilityReceptiverelaxation，toniccontractionandPeristalticcontractionGastricemptying：mechanismandcontrolOutlinesPregastricdigestion2胃前消化咀嚼Mastication(chewing)將大顆粒塊狀食物研磨成小塊，增加唾液淀粉酶作用面積與唾液混合，形成食團(tuán)刺激口腔內(nèi)感受器，參與胃、小腸消化功能調(diào)節(jié)

胃前消化咀嚼Mastication(chewing)3PregastricdigestionPregastricdigestion4Pregastricdigestion吞咽Deglutition分期及特點(diǎn)UPregastricdigestion吞咽Deglutit5Pregastricdigestion蠕動(dòng)Peristalsis蠕動(dòng)的機(jī)械消化功能蠕動(dòng)過(guò)程中平滑肌的收縮特征介導(dǎo)蠕動(dòng)的主要是內(nèi)在神經(jīng)系統(tǒng)Pregastricdigestion蠕動(dòng)Peristal6Pregastricdigestion食管下括約肌loweresophagealsphincter(LES)的功能未進(jìn)食期間…吞咽時(shí)…Pregastricdigestion食管下括約肌low7Pregastricdigestion吞咽時(shí)介導(dǎo)LES張力下降的物質(zhì)：NO和VIP（由迷走神經(jīng)末梢釋放）其它體液因素/NOAchPregastricdigestion吞咽時(shí)介導(dǎo)LES張8返流性食管炎Inhumans,commondisordersinvolvingtheesophagusincludeheartburnandgastroesophagealrefluxdisease(GERD).Inbothcases,thelowersphincterdoesnotcloseproperly,allowingacidfromthestomachtorefluxbackintotheesophagus,causesaburningsensationinthechestorthroat(heartburn)oradditionalsignssuchascoughingorasensationofchoking.返流性食管炎Inhumans,commondisord9Pregastricdigestion唾液腺腮腺下頜下腺舌下腺Pregastricdigestion唾液腺10Pregastricdigestion唾液來(lái)源：Secretedfromserousandmucouscellsofsalivaryglands理化特性：A97-99.5%water,低滲hypo-osmotic,pH6-7，containing電解質(zhì)–Na+,K+,Cl–,PO42–,HCO3–唾液淀粉酶蛋白質(zhì)–mucin,lysozyme,defensins,andIgA代謝產(chǎn)物–ureaanduricacidPregastricdigestion唾液11Pregastricdigestion導(dǎo)管上皮細(xì)胞：主動(dòng)吸收Na+，被動(dòng)吸收Cl-，主動(dòng)分泌K+和HCO3-

分泌速率改變對(duì)唾液滲透壓的影響分泌速率改變對(duì)唾液pH值的影響Pregastricdigestion導(dǎo)管上皮細(xì)胞：主動(dòng)吸12Pregastricdigestion唾液的功能形成可以吞咽的食團(tuán)開(kāi)始對(duì)淀粉的化學(xué)性消化（唾液淀粉酶）殺菌和參與機(jī)體防御作用對(duì)牙齒的保護(hù)作用Pregastricdigestion唾液的功能13Pregastricdigestion唾液分泌的神經(jīng)調(diào)節(jié)

主要由副交感神經(jīng)調(diào)節(jié)交感神經(jīng)興奮時(shí)也能引起唾液分泌增加刺激和抑制唾液分泌的因素

Pregastricdigestion唾液分泌的神經(jīng)調(diào)節(jié)14胃內(nèi)消化胃的主要消化功能:接納和暫時(shí)貯存胃內(nèi)的機(jī)械性和化學(xué)性消化將食糜送入小腸（排空）分泌內(nèi)因子，幫助vitaminB12在小腸吸收胃內(nèi)消化胃的主要消化功能:15Gastricdigestion胃液的來(lái)源賁門(mén)腺：mucous幽門(mén)腺：mucous泌酸腺SurfaceEpithelium-insolublemucousNeckCells-solublemucousParietal(oroxyntic)Cells-HCl&IntrinsicFactorChiefCells-pepsinogen

Gastricdigestion胃液的來(lái)源賁門(mén)腺：mu16Gastricdigestion胃液的成分Salt,water,HCl,pepsin,intrinsicfactor,andmucus.（pH1.0-3.5,1.5-2.5L/Day）胃液中HCl有哪些生理功能?

分泌速率改變對(duì)胃液成分的影響pHK+--嘔吐引起的低血鉀癥Gastricdigestion胃液的成分17TEMofrestingparietalcellfrompigletstomach,showingcanaliculus(C)surroundedbynumeroustubulovesicles(TV)andmitochondria.

Bar=1μmTEMofmaximallystimulatedparietalcell(piglet),showinggreatlyenlargedcanaliculiwithelongatedmicrovilli.

Remainingspacehasdenselypackedmitochondriaandveryfewtubulovesicles.

Bar=1μmTEMofrestingparietalcellf18口腔、食道、胃功能課件19壁細(xì)胞分泌鹽酸的機(jī)制細(xì)胞內(nèi)H2O分解為H+和OH-，OH-與CO2反應(yīng)生成HCO3-;碳酸酐酶（CA）催化這一過(guò)程HCO3-在基底膜與Cl-交換.HCO3-隨后進(jìn)入毛細(xì)血管，導(dǎo)致血液pH輕微升高(餐后堿潮，postprandialalkalinetide）Cl-和K+從管腔膜上的特異通道進(jìn)入胃腔管腔膜上的質(zhì)子泵（protonpump，H+-K+ATPase)主動(dòng)將H+泵出細(xì)胞，同時(shí)交換一個(gè)K+進(jìn)入細(xì)胞管腔內(nèi)，H+與Cl-生成HCl壁細(xì)胞分泌鹽酸的機(jī)制細(xì)胞內(nèi)H2O分解為H+和OH-，O20Gastricdigestion質(zhì)子泵抑制劑Protonpumpinhibitors,PPIs抑酸機(jī)制Drugshavebeendevelopedthatnon-competivelybindandinactivatetheATPase,resultinginstronginhibitionofacidsecretion.Omeprazole奧美拉唑isanacid-activatedprodrugthatbindscovalentlytotwocysteinesontheATPase,resultinginitsirreversibleinactivation..Otherinhibitors,includinglansoprazole蘭索拉唑,esomeprazole艾美拉唑,rabeprazole雷貝拉唑andpantoprazole泮托拉唑havesimilarmodesofaction.PPIsGastricdigestion質(zhì)子泵抑制劑Proton21鹽酸分泌的調(diào)節(jié)內(nèi)源性刺激物：Ach，組織胺和胃泌素通過(guò)壁細(xì)胞上的各自受體（M3-R，H2-R和G/CCK-B-R）刺激HCl分泌迷走神經(jīng)末梢：AchG細(xì)胞：胃泌素（血液循環(huán)途徑）ECL細(xì)胞：組織胺（旁分泌途徑）ECL細(xì)胞是重要調(diào)節(jié)細(xì)胞，其上分布Ach和胃泌素受體G細(xì)胞釋放胃泌素的調(diào)節(jié)因素對(duì)胃竇的機(jī)械牽張刺激和化學(xué)刺激促進(jìn)G細(xì)胞分泌迷走神經(jīng)興奮末梢釋放GRP激活GRP受體促進(jìn)G細(xì)胞分泌來(lái)源于D細(xì)胞的生長(zhǎng)抑素激活生長(zhǎng)抑素受體抑制G細(xì)胞分泌迷走神經(jīng)末梢釋放Ach作用于D細(xì)胞上的受體抑制其分泌生長(zhǎng)抑素，間接促進(jìn)了G細(xì)胞分泌D細(xì)胞介導(dǎo)壁細(xì)胞HCl分泌的負(fù)反饋調(diào)節(jié)機(jī)制胃竇內(nèi)H+濃度升高，刺激D細(xì)胞分泌生長(zhǎng)抑素鹽酸分泌的調(diào)節(jié)內(nèi)源性刺激物：Ach，組織胺和胃泌素通過(guò)壁細(xì)胞22阿托品Atropine的抑酸機(jī)制：阻斷M受體西米替丁cimetidine的抑酸機(jī)制：阻斷H2受體SomeotherH2ReceptorAntagonists：ranitidine,famotidineandnizatidine

阿托品Atropine的抑酸機(jī)制：阻斷M受體Someoth23口腔、食道、胃功能課件24Gastricdigestion胃蛋白酶原和胃蛋白酶

胃蛋白酶原的激活HCl胃蛋白酶自身激活pHoptima1.8-3.5AchandHCl刺激主細(xì)胞分泌胃蛋白酶原內(nèi)因子IntrinsicFactor結(jié)合VitaminB12，防止其被消化和破壞與VB12生成的復(fù)合物IF-VitB12是回腸吸收VB12的形式缺乏：惡性貧血perniciousanemia(PA)Gastricdigestion胃蛋白酶原和胃蛋白酶25Gastricdigestion粘液-碳酸氫鹽屏障Mucus-bicarbonatebarrier物理屏障：厚(500μ)，凝膠狀化學(xué)屏障：碳酸氫鹽-pH梯度Gastricdigestion粘液-碳酸氫鹽屏障Muc26GastricdigestionReviewquestionHowdoesthestomachprotectitselffromthegastricHCl?GastricbarrierTightjunctionsbetweentheepithelialcellsControlofHClsecretionTrophiceffectsbyGIhormonesGastricdigestionReviewquest27AcutegastritisGastriculcerAcutegastritisGastriculcer28Gastricdigestion消化期胃液分泌的調(diào)節(jié)Gastricdigestion消化期胃液分泌的調(diào)節(jié)29Gastricdigestion頭期（神經(jīng)調(diào)節(jié)）頭部刺激因素：感覺(jué)器官刺激，高級(jí)中樞參與的調(diào)節(jié)反射支配壁細(xì)胞的迷走神經(jīng)興奮(ACh)支配G細(xì)胞的迷走神經(jīng)興奮（GRP）支配ECL的迷走細(xì)胞興奮（GRP）支配D細(xì)胞的迷走神經(jīng)興奮（Ach）Gastricdigestion頭期（神經(jīng)調(diào)節(jié)）30Gastricdigestion胃期GastricPhase胃內(nèi)的機(jī)械和化學(xué)刺激經(jīng)短反射和長(zhǎng)反射（迷走-迷走反射）作用于Parietalcells(ACh)Gcells(releasegastrin)ECLcells(releasehistamine)胃酸分泌的正反饋機(jī)制Gastricdigestion胃期GastricPh31Gastricdigestion腸期(pHabove3)

蛋白質(zhì)消化產(chǎn)物（多肽）在十二指腸刺激G細(xì)胞食糜進(jìn)入十二指腸機(jī)械刺激G細(xì)胞腸泌酸素enterooxyntin的作用Gastricdigestion腸期(pHabove32Gastricdigestion抑制胃酸分泌的因素：胃內(nèi)：GastricpH<2--->gastricDcellsreleasesomatostatinwhichinhibitsgastrinrelease十二指腸：Acidinduodenum--->secretin&CCK--->inhibitsgastricsecretionandmotilityAcid,fats,hyper-osmoticsolutionsintheduodenum--->releaseofenterogastrones--->inhibitgastricmotilityandsecretionGastricInhibitoryPeptide(GIP)fromduodenum--->inhibitsparietalcellfunction

Distensionandchemicalstimulation

--->腸胃反射Entero-gastricreflex

Gastricdigestion抑制胃酸分泌的因素：33Gastricdigestion胃的運(yùn)動(dòng)胃的生理功能分區(qū)

EmptyingGastricdigestion胃的運(yùn)動(dòng)Emptying34Gastricdigestion緊張性收縮頭端胃（近端胃）的容受性舒張神經(jīng)反射，NO和VIP介導(dǎo)VagusNO,VIP[Entericnervoussystem]Gastricdigestion緊張性收縮VagusNO35口腔、食道、胃功能課件36Gastricdigestion遠(yuǎn)端胃的蠕動(dòng)Peristalticcontraction起源于胃中部（3次/min）向幽門(mén)方向推進(jìn)，一波未平一波又起，蠕動(dòng)波得以疊加、增強(qiáng)幽門(mén)附件蠕動(dòng)波最強(qiáng)食糜數(shù)毫升被擠入十二指腸大部分返回胃竇進(jìn)一步研磨和混合

Gastricdigestion遠(yuǎn)端胃的蠕動(dòng)Perist37Gastricdigestion胃排空的概念促進(jìn)胃排空的因素（反之，抑制）IntenseperistalticcontractionsDecreasedpylorictoneRelativelydecreasedduodenalmotility胃排空的速率由胃內(nèi)因素和十二指腸內(nèi)因素共同調(diào)節(jié)GastricfactorspromoteemptyingDuodenalfactorsinhibitstomachemptyingGastricdigestion胃排空的概念38Gastricdigestion神經(jīng)和體液因素均參與胃排空速率的調(diào)節(jié)維持合適的胃排空速率的生理意義？？Gastricdigestion神經(jīng)和體液因素均參與胃排39GastricdigestionMigratingmotorcomplexes(MMC)移行性復(fù)合運(yùn)動(dòng)arewavesofactivitywhichsweepthroughtheintestinesinaregularcycleduringfastingstate(originatesinthestomachroughlyevery75-120minutes).GastricdigestionMigratingmo40GastricdigestionThesemotorcomplexeshelptriggerperistalticwaveswhichfacilitatetransportationofindigestiblesubstancessuchasbone,fiberandforeignbodiesfromthestomach,throughthesmallintestinepasttheileocecalsphincterintothecolon.Italsoservestotransportbacteriafromthesmallintestinetothelarge,andtoinhibitthemigrationofcolonicbacteriaintotheterminalileum.Anincreaseingastric,biliaryandpancreaticsecretionisalsoseeninconjunctionwiththemotoractivityTheMMCisthoughttobepartiallyregulatedbymotilinwhichisinitiatedinthestomachasaresponsetovagalstimulation,anddoesnotdependonextrinsicnervesdirectly.GastricdigestionThesemotor41GastricdigestionVomitingVomitingistheforcefulexpulsionofcontentsofthestomachandoften,theproximalsmallintestine.Itisareflexcontrolledbyacenterinthemedulla（Apomorphine）GastricdigestionVomiting（Apo42GastrointestinalPhysiology

(Part2)GastrointestinalPhysiology(P43OutlinesPregastricdigestionMasticationSwallowingSecretionofsalivarySaliva：secretion，compositionandfunctionsNervousregulationofsalivarysecretionGastricdigestionGastricsecretionGastricjuice：source，compositionandfunctionsHClsecretion：cellularmechanismandregulationControlofgastricsecretionduringdigestiveperiodGastricmotilityReceptiverelaxation，toniccontractionandPeristalticcontractionGastricemptying：mechanismandcontrolOutlinesPregastricdigestion44胃前消化咀嚼Mastication(chewing)將大顆粒塊狀食物研磨成小塊，增加唾液淀粉酶作用面積與唾液混合，形成食團(tuán)刺激口腔內(nèi)感受器，參與胃、小腸消化功能調(diào)節(jié)

胃前消化咀嚼Mastication(chewing)45PregastricdigestionPregastricdigestion46Pregastricdigestion吞咽Deglutition分期及特點(diǎn)UPregastricdigestion吞咽Deglutit47Pregastricdigestion蠕動(dòng)Peristalsis蠕動(dòng)的機(jī)械消化功能蠕動(dòng)過(guò)程中平滑肌的收縮特征介導(dǎo)蠕動(dòng)的主要是內(nèi)在神經(jīng)系統(tǒng)Pregastricdigestion蠕動(dòng)Peristal48Pregastricdigestion食管下括約肌loweresophagealsphincter(LES)的功能未進(jìn)食期間…吞咽時(shí)…Pregastricdigestion食管下括約肌low49Pregastricdigestion吞咽時(shí)介導(dǎo)LES張力下降的物質(zhì)：NO和VIP（由迷走神經(jīng)末梢釋放）其它體液因素/NOAchPregastricdigestion吞咽時(shí)介導(dǎo)LES張50返流性食管炎Inhumans,commondisordersinvolvingtheesophagusincludeheartburnandgastroesophagealrefluxdisease(GERD).Inbothcases,thelowersphincterdoesnotcloseproperly,allowingacidfromthestomachtorefluxbackintotheesophagus,causesaburningsensationinthechestorthroat(heartburn)oradditionalsignssuchascoughingorasensationofchoking.返流性食管炎Inhumans,commondisord51Pregastricdigestion唾液腺腮腺下頜下腺舌下腺Pregastricdigestion唾液腺52Pregastricdigestion唾液來(lái)源：Secretedfromserousandmucouscellsofsalivaryglands理化特性：A97-99.5%water,低滲hypo-osmotic,pH6-7，containing電解質(zhì)–Na+,K+,Cl–,PO42–,HCO3–唾液淀粉酶蛋白質(zhì)–mucin,lysozyme,defensins,andIgA代謝產(chǎn)物–ureaanduricacidPregastricdigestion唾液53Pregastricdigestion導(dǎo)管上皮細(xì)胞：主動(dòng)吸收Na+，被動(dòng)吸收Cl-，主動(dòng)分泌K+和HCO3-

分泌速率改變對(duì)唾液滲透壓的影響分泌速率改變對(duì)唾液pH值的影響Pregastricdigestion導(dǎo)管上皮細(xì)胞：主動(dòng)吸54Pregastricdigestion唾液的功能形成可以吞咽的食團(tuán)開(kāi)始對(duì)淀粉的化學(xué)性消化（唾液淀粉酶）殺菌和參與機(jī)體防御作用對(duì)牙齒的保護(hù)作用Pregastricdigestion唾液的功能55Pregastricdigestion唾液分泌的神經(jīng)調(diào)節(jié)

主要由副交感神經(jīng)調(diào)節(jié)交感神經(jīng)興奮時(shí)也能引起唾液分泌增加刺激和抑制唾液分泌的因素

Pregastricdigestion唾液分泌的神經(jīng)調(diào)節(jié)56胃內(nèi)消化胃的主要消化功能:接納和暫時(shí)貯存胃內(nèi)的機(jī)械性和化學(xué)性消化將食糜送入小腸（排空）分泌內(nèi)因子，幫助vitaminB12在小腸吸收胃內(nèi)消化胃的主要消化功能:57Gastricdigestion胃液的來(lái)源賁門(mén)腺：mucous幽門(mén)腺：mucous泌酸腺SurfaceEpithelium-insolublemucousNeckCells-solublemucousParietal(oroxyntic)Cells-HCl&IntrinsicFactorChiefCells-pepsinogen

Gastricdigestion胃液的來(lái)源賁門(mén)腺：mu58Gastricdigestion胃液的成分Salt,water,HCl,pepsin,intrinsicfactor,andmucus.（pH1.0-3.5,1.5-2.5L/Day）胃液中HCl有哪些生理功能?

分泌速率改變對(duì)胃液成分的影響pHK+--嘔吐引起的低血鉀癥Gastricdigestion胃液的成分59TEMofrestingparietalcellfrompigletstomach,showingcanaliculus(C)surroundedbynumeroustubulovesicles(TV)andmitochondria.

Bar=1μmTEMofmaximallystimulatedparietalcell(piglet),showinggreatlyenlargedcanaliculiwithelongatedmicrovilli.

Remainingspacehasdenselypackedmitochondriaandveryfewtubulovesicles.

Bar=1μmTEMofrestingparietalcellf60口腔、食道、胃功能課件61壁細(xì)胞分泌鹽酸的機(jī)制細(xì)胞內(nèi)H2O分解為H+和OH-，OH-與CO2反應(yīng)生成HCO3-;碳酸酐酶（CA）催化這一過(guò)程HCO3-在基底膜與Cl-交換.HCO3-隨后進(jìn)入毛細(xì)血管，導(dǎo)致血液pH輕微升高(餐后堿潮，postprandialalkalinetide）Cl-和K+從管腔膜上的特異通道進(jìn)入胃腔管腔膜上的質(zhì)子泵（protonpump，H+-K+ATPase)主動(dòng)將H+泵出細(xì)胞，同時(shí)交換一個(gè)K+進(jìn)入細(xì)胞管腔內(nèi)，H+與Cl-生成HCl壁細(xì)胞分泌鹽酸的機(jī)制細(xì)胞內(nèi)H2O分解為H+和OH-，O62Gastricdigestion質(zhì)子泵抑制劑Protonpumpinhibitors,PPIs抑酸機(jī)制Drugshavebeendevelopedthatnon-competivelybindandinactivatetheATPase,resultinginstronginhibitionofacidsecretion.Omeprazole奧美拉唑isanacid-activatedprodrugthatbindscovalentlytotwocysteinesontheATPase,resultinginitsirreversibleinactivation..Otherinhibitors,includinglansoprazole蘭索拉唑,esomeprazole艾美拉唑,rabeprazole雷貝拉唑andpantoprazole泮托拉唑havesimilarmodesofaction.PPIsGastricdigestion質(zhì)子泵抑制劑Proton63鹽酸分泌的調(diào)節(jié)內(nèi)源性刺激物：Ach，組織胺和胃泌素通過(guò)壁細(xì)胞上的各自受體（M3-R，H2-R和G/CCK-B-R）刺激HCl分泌迷走神經(jīng)末梢：AchG細(xì)胞：胃泌素（血液循環(huán)途徑）ECL細(xì)胞：組織胺（旁分泌途徑）ECL細(xì)胞是重要調(diào)節(jié)細(xì)胞，其上分布Ach和胃泌素受體G細(xì)胞釋放胃泌素的調(diào)節(jié)因素對(duì)胃竇的機(jī)械牽張刺激和化學(xué)刺激促進(jìn)G細(xì)胞分泌迷走神經(jīng)興奮末梢釋放GRP激活GRP受體促進(jìn)G細(xì)胞分泌來(lái)源于D細(xì)胞的生長(zhǎng)抑素激活生長(zhǎng)抑素受體抑制G細(xì)胞分泌迷走神經(jīng)末梢釋放Ach作用于D細(xì)胞上的受體抑制其分泌生長(zhǎng)抑素，間接促進(jìn)了G細(xì)胞分泌D細(xì)胞介導(dǎo)壁細(xì)胞HCl分泌的負(fù)反饋調(diào)節(jié)機(jī)制胃竇內(nèi)H+濃度升高，刺激D細(xì)胞分泌生長(zhǎng)抑素鹽酸分泌的調(diào)節(jié)內(nèi)源性刺激物：Ach，組織胺和胃泌素通過(guò)壁細(xì)胞64阿托品Atropine的抑酸機(jī)制：阻斷M受體西米替丁cimetidine的抑酸機(jī)制：阻斷H2受體SomeotherH2ReceptorAntagonists：ranitidine,famotidineandnizatidine

阿托品Atropine的抑酸機(jī)制：阻斷M受體Someoth65口腔、食道、胃功能課件66Gastricdigestion胃蛋白酶原和胃蛋白酶

胃蛋白酶原的激活HCl胃蛋白酶自身激活pHoptima1.8-3.5AchandHCl刺激主細(xì)胞分泌胃蛋白酶原內(nèi)因子IntrinsicFactor結(jié)合VitaminB12，防止其被消化和破壞與VB12生成的復(fù)合物IF-VitB12是回腸吸收VB12的形式缺乏：惡性貧血perniciousanemia(PA)Gastricdigestion胃蛋白酶原和胃蛋白酶67Gastricdigestion粘液-碳酸氫鹽屏障Mucus-bicarbonatebarrier物理屏障：厚(500μ)，凝膠狀化學(xué)屏障：碳酸氫鹽-pH梯度Gastricdigestion粘液-碳酸氫鹽屏障Muc68GastricdigestionReviewquestionHowdoesthestomachprotectitselffromthegastricHCl?GastricbarrierTightjunctionsbetweentheepithelialcellsControlofHClsecretionTrophiceffectsbyGIhormonesGastricdigestionReviewquest69AcutegastritisGastriculcerAcutegastritisGastriculcer70Gastricdigestion消化期胃液分泌的調(diào)節(jié)Gastricdigestion消化期胃液分泌的調(diào)節(jié)71Gastricdigestion頭期（神經(jīng)調(diào)節(jié)）頭部刺激因素：感覺(jué)器官刺激，高級(jí)中樞參與的調(diào)節(jié)反射支配壁細(xì)胞的迷走神經(jīng)興奮(ACh)支配G細(xì)胞的迷走神經(jīng)興奮（GRP）支配ECL的迷走細(xì)胞興奮（GRP）支配D細(xì)胞的迷走神經(jīng)興奮（Ach）Gastricdigestion頭期（神經(jīng)調(diào)節(jié)）72Gastricdigestion胃期GastricPhase胃內(nèi)的機(jī)械和化學(xué)刺激經(jīng)短反射和長(zhǎng)反射（迷走-迷走反射）作用于Parietalcells(ACh)Gcells(releasegastrin)ECLcells(releasehistamine)胃酸分泌的正反饋機(jī)制Gastricdigestion胃期GastricPh73Gastricdigestion腸期(pHabove3)

蛋白質(zhì)消化產(chǎn)物（多肽）在十二指腸刺激G細(xì)胞食糜進(jìn)入十二指腸機(jī)械刺激G細(xì)胞腸泌酸素enterooxyntin的作用Gastricdigestion腸期(pHabove74Gastricdigestion抑制胃酸分泌的因素：胃內(nèi)：GastricpH<2--->gastricDcellsreleasesomatostatinwhichinhibitsgastrinrelease十二指腸：Acidinduodenum--->secretin&CCK--->inhibitsgastricsecretionandmotilityAcid,fats,hyper-osmoticsolutionsintheduodenum--->releaseofenterogastrones--->inhibitgastricmotilityandsecretionGastricInhibitoryPeptide(GIP)fromduodenum--->inhibitsparietalcellfunction

Distensionandchemicalstimulation

--->腸胃反射Entero-gastricreflex

Gastricdigestion抑制胃酸分泌的因素：75Gastricdigestion胃的運(yùn)動(dòng)胃的生理功能分區(qū)

EmptyingGastricdigestion胃的運(yùn)動(dòng)Emptying76Gastricdigestion緊張性收縮頭端胃（近端胃）的容受性舒張神經(jīng)反射，NO和VIP介導(dǎo)VagusNO,VIP[Entericnervoussystem]Gastricdigestion緊張性收縮VagusNO77口腔、食道、胃功能課件78Gastricdigestion遠(yuǎn)端胃的蠕動(dòng)Peristalticcontraction起源于胃中部（3次/min）向幽門(mén)方向推進(jìn)，一波未平一波又起，蠕動(dòng)波得以疊加、增強(qiáng)幽門(mén)附件蠕動(dòng)波最強(qiáng)