EXCITING INPUTS AND NEUROTRANSMITTER ROLE IN EMESIS OR REGULATION OF EMESIS

 EXCITING INPUTS AND NEUROTRANSMITTER ROLE IN EMESIS OR REGULATION OF EMESIS

Proper pharmacological management of vomiting requires understanding of neuro transmitter  involvement in emesis.

1. The major afferent inputs to vomiting centre are routed through chemoreceptor trigger zone (CTZ; or areal prostema) which is located at the end of IV ventricle. Since CTZ lies outside of the BBB, it can feely monitor for toxic and emetogenic stimuli circulating in blood or CSF and can relay  this information to VC to trigger nausea and vomiting. The CTZ is rich in dopamine (D2), serotonin (5-HT3), muscarinic (M3), histamine (H1), opioid and NK1, receptors which could be the targets for existing and newer antiemetic drugs.

2. The vestibular apparatus generates impulses during motion sickness which reach VC mainly via cerebellum. Vestibular apparatus is rich in muscarinic (M1) and histaminic (H1) receptors.

 3.Vagal and splanchnic afferents in the GIT mucosa are rich in 5-HT3 receptor. Irritation of  GIT mucosa by irritants, chemotherapeutic agents, radiation therapy, endogenous toxin and poisons lead to a release of mucosal serotonin from enterochromaffin-like cells (ECL cells) which activate these 5-HT3 receptors. This propagates vagal afferent inputs to nucleus tractus solitarius (NTS) for onward transmission to VC. NTS is rich in histamine (H1), cholinergic (M1) and serotonin (5-HT3) receptors. 

4. Transmitter mediators in the cerebral cortex (higher centers) are poorly understood. However, cortical cannabinoid (CB1) receptors have been implicated. Muscarinic (M1) , histaminic (H1), serotonin (5-HT3) and Neurokinin-1 (NK1) receptors has a permissive role to play, as an excitatory neurotransmitter, in all sorts of emesis 

Neurotransmitter  role in emesis or regulation of emesis

what is lipid metabolism and how does it work?

 what is lipid metabolism and how does it work? -SEY PHARMA

The dietary lipids of metabolic significance include triacylglycerol (neutral fat/triglycerides), phospholipids and cholesterol-cholesterol esters.

Digestion and Absorption of Lipid

Some hydrolysis of neutral fat takes place during cooking. A fat splitting enzyme-gastric lipase is present in gastric juice. The activity of this enzyme is restricted as it is sensitive to free acid. Fat hydrolysis in stomach may take place in cases of achylia gastrica and in young suckling ones ingesting large quantities of milk. A small amount of short chain triacylglycerol of milk is digested in the stomach by gastric lipase. However the amount is so slight that it is unimportant.

The pancreatic juice consists of three fat splitting enzymes - pancreatic lipase acting on triacylglycerol, phospholipase A2 which brings about limited hydrolysis of phospholipids at 2 position to form lysophospholipid and cholesterol esterase which causes hydrolysis of cholesterol esters.

The most important enzyme for the digestion of triacylglycerol is pancreatic lipase in pancreatic juice which hydrolyses triacylglycerol in stages. Itactson oil water interface of finely emulsified lipid droplets formed by mechanical agitation in the presence of products of gastric lipase, bile salts, colipase (a protein present in pancreatic juice), phospholipids and phospholipase A2.


The digestion and absorption of lipids occurs in three phases:

Lumen phase : 

Pancreatic lipase acts on emulsified fat at position 1 and 3 to form 2-monoacylglycerol (72%) the major end product of triacylglycerol digestion and free fatty acids. By the action of isomerase remaining 2-monoacylglycerol is converted to 1-monoacylglycerol. About 22% of 1-monoacylglycerol is completely hydrolysed to free fatty acids and glycerol.

Absorption of Triacylglycerol-intracellular phase


Short chain fatty acids and glycerol directly pass in portal circulation.


 Penetration phase :  

The 2-monoacylglycerol, fatty acids (long chain) and small amount of 1-monoacylglycerol leave the oil phase of lipid emulsion and alongwith bile salts, partly hydrolysed phospholipids and free cholesterol form fine droplets-micelles of diameter less than 0.5 u and absorbed into the intestinal epithelium.


  Intracellular phase : 

  Within the intestinal wall 1-monoacylglycerol is further hydrolysed to produce free glycerol and fatty acids by intestinal lipase. Glycerol is reutilised for triacylglycerol synthesis after activation to glycerol 3-phosphate by ATP.

In the intestinal wall 2 monoacylglycerol is reconverted to triacylglycerol via monoacylglycerol pathway. The fatty acids required for resynthesis are first activated.

Lysophospholipids are reacylated with acyl-CoA and cholesterol is esterified. Triacylglycerol, phospholipids and cholesterol esters are packed and generate lipid droplets - chylomicrons, forming a milky fluid chyle that is collected by lymphatics and passed to systemic circulation via thoracic ducts.

Absorption of fat is reduced in pancreatitis, pancreatic insufficiency, malabsorption syndrome and biliary duct obstruction. Steatorrhea is common in these conditions.


Oxidation of fatty acid :

         It takes place in three ways:


(a) α-Oxidation

removal of 1-C atom at a time from the carboxyl end. It is detected in brain tissue.

The enzymes catalysing a-oxidation are located in the endoplasmic reticulum. It does not require CoA intermediates and does not generate high energy phosphates. There is direct hydroxylation of long chain fatty acid at the a-carbon atom to generate a-hydroxy fatty acid which is oxidatively decarboxylated to eliminate one carbon atom from the carboxyl end of the molecule.

α-Oxidation of Fatty acid

Alpha oxidation helps in the oxidation of fatty acids that have a methyl group on β-carbon which blocks β-oxidation. Phytanic acid, derived from phytols, is present in plant foods, contains a methyl group at β-carbon which blocks β-oxidation.

Lipid metabolism disorder

Refsum's disease :

 It is a disorder due to genetic defect in the oxidation. The biochemical defect is the lack of a-hydroxylase (phytanic acid oxidase), consequently phytanic acid accumulates in the blood and tissues, resulting into neurological and skeletal abnormalities.

(b) ω-oxidation :

 a very minor pathway catalysed by the enzyme monooxygenase (hydroxylase involving cytochrome P450) resulting into the formation of dicarboxylic acid followed by β-oxidation to form adipic and suberic acid which are excreted in urine.


ω-oxidation of fatty acid
ω-oxidation of fatty acid

(c) Knoop's β-oxidation

 Two carbon atoms are cleaved at a time from acyl-coA starting from carboxyl end. It is the major pathway for the oxidation of fatty acids occurring in mitochondria. Initial step is activation of fatty acid to form acyl-CoA. In this reaction 2 high energy phosphate bonds are expanded. The long chain activated fatty acid requires entry into mitochondria for oxidation, which is facilitated by a special transporter, carnitine (β-hydroxy-γ-trimethylammonium butyrate). Short chain acyl-CoA enters into mitochondria freely.

Role of carnitine in the transport of long chain fatty acid
Role of carnitine in the transport of long chain fatty acid


After the penetration of acyl moiety through mitochondrial membrane via the carnitine transporter system and reformation of acyl-CoA, there follows the removal of 2 hydrogen atoms, catalysed by acyl-CoA dehydrogenase forming Δ²-trans-enoyl-CoA. The coenzyme required is FAD. Water is added to form 3 hydroxyacyl-CoA, Catalysed by the enzyme Δ²-enoyl-CoA hydratase, which undergoes further dehydrogenation on carbon 3 to form corresponding ketoacyl-CoA. NAD is involved as coenzyme. Finally ketoacyl-CoA is split at the 2, 3 position by thiolase involving another molecule of CoA. The products are acetylCoA and acyl-CoA derivative with 2 carbons less than the original acyl-CoA.

β-oxidation of fatty acid


Energetics of Lipid metabolism:

 Transport in respiratory chain of electrons from reduced FAD and NAD will form 5 ATP for each of first 7 acetyl-CoA formed by ?-oxidation of palmitate (7 x 5 = 35 ATP). A total of 8 mol of acetyl-CoA is formed and each will give rise to 12 ATP on oxidation in citric acid cycle making 8 mol 12 = 96 ATP. Thus total 131 ATP are formed. Two high energy phosphate bonds are utilised in initial activation of fatty acid. The net production of ATP is 131 - 2 = 129 yielding a net gain of energy (129 x 30.5) 3935 kj/mol of palmitic acid.

Oxidation of unsaturated fatty acid
Oxidation of unsaturated fatty acid



Anatomy and Function of Salivary Glands - SEY PHARMA

 Anatomy and Function of Salivary Glands - SEY PHARMA

       Salivary glands release their secretions into ducts that lead to the mouth. There are three main pairs: the parotid glands, the submandibular glands and the sublingual glands. There are also numerous smaller salivary glands scattered around the mouth.

Parotid glands

These are situated one on each side of the face just below the external acoustic meatus. Each gland has a parotid duct opening into the mouth at the level of the second upper molar tooth. 

Submandibular glands

These lie one on each side of the face under the angle of the jaw. The two submandibular ducts open on the floor of the mouth, one on each side of the frenulum of the tongue.

Sublingual glands

These glands lie under the mucous membrane of the floor of the mouth in front of the submandibular glands. They have numerous small ducts that open into the floor of the mouth.

Three Salivary Glands
fig: Three Salivary Glands


Structure of the salivary glands

The glands are all surrounded by a fibrous capsule. They consist of a number of lobules made up of small acini lined with secretory cells. The secretions are poured into ductules that join up to form larger ducts leading into the mouth. Arterial supply is by various branches from the external carotid arteries and venous drainage is into the external jugular veins.

Composition of saliva:

Saliva is the combined secretions from the salivary glands and the small mucus-secreting glands of the oral mucosa. About 1.5 litres of saliva is produced daily and it consists of : water, mineral salts, salivary amylase; a digestive enzyme, mucus, antimicrobial substances; immunoglobulins and the enzyme lysozyme.

Functions of saliva :

  1. Saliva keeps the mouth moist and facilitates speech.
  2. Saliva helps in mastication of food and forms the bolus.
  3. Saliva dilutes, hot and pungent substances and prevents injury to the mouth. It also acts as solvent.
  4. Saliva removes food particles and thus prevents the growth of microbes. It also acts as an antiseptic to the mouth.
  5. Maltose changes maltose to glucose to some extent. So, if one chews food well he enjoys a sweet taste of glucose.
  6. Saliva helps in excretion of heavy metals, urea and certain other drug.
  7. Saliva helps in maintenance of water balance and is secreted through the nervous system mechanism.
  8. Saliva cts as buffer by maintaining the level of bicarbonate and phosphate in the blood.





Digestive System and it's five functions - SEY PHARMA

What is Digestive System?  and it's five functions

 The digestive system comprises of the gastrointestinal tract with various glands attached to it and also known as alimentary canal. It begins at the mouth, passes through the thorax, abdomen and pelvis and ends at the anus. It has a basic structure which is modified at different levels to provide for the processes occurring at each level. The digestive processes gradually break down the foods eaten until they are in a form suitable for absorption.

Five function of Digestive system :

Ingestion :

This is the taking of food into the alimentary tract, i.e. eating and drinking.

Propulsion : 

This mixes and moves the contents along the alimentary tract.

Digestion : 

This consists of :

     • mechanical breakdown of food by, e.g. mastication (chewing).

     • chemical digestion of food into small molecules by enzymes present in secretions produced by glands and accessory organs of the digestive system.

Absorption : 

This is the process by which digested food substances pass through the walls of some organs of the alimentary canal into the blood and lymph capillaries for circulation and use by body cells.

Elimination : 

Food substances that have been eaten but cannot be digested and absorbed are excreted from the alimentary canal as faeces by the process of defaecation.

Digestive system with different organ
Fig: Digestive system with different organ



Regulation of Acid Production through Parasympathetic Nervous System - SEY PHARMA

How does acid production regulate through Parasympathetic Nervous System?

  Gastric. acid production is regulated by both autonomous nervous system and hormones. The parasympathetic nervous system via vagus nerve and the hormone gastrin stimulates parietal cells to produce acid secretion. The production of gastric acid in the stomach involves four types of cells in this process : parietal cells, G cells, D cells and enterochromaffine like cells.

  There are three phases in the secretion of gastric acid which increase the secretion rate in order to digest a meal.

Regulation of secretion of gastric juice

       There are three phases of secretion of gastric juice

1.Cephalic phase

This flow of juice occurs before food reaches the stomach and is ? due to reflex stimulation of the vagus (parasympathetic) nerves initiated by the sight, smell or taste of food. When the vagus nerves have been cut, this phase of gastric secretion stops. Sympathetic stimulation, e.g. during emotional states, also inhibits gastric activity.

2.Gastric phase

When stimulated by the presence of food the enteroendocrine cells in the pylorus and duodenum secrete the hormone gastrin, which passes directly into the circulating blood. Gastrin, circulating in the blood which supplies the stomach, stimulates the gastric glands to produce more gastric juice. In this way secretion of digestive juice is continued after completion of a meal and the end of the cephalic phase. Gastrin secretion is suppressed when the pH in the pylorus falls to about 1.5. 

3.Intestinal phase

When the partially digested contents of the stomach reach the small intestine, two hormones, secretin and cholecystokinin, are produced by endocrine cells in the intestinal mucosa. They slow down the secretion of gastric juice and reduce gastric motility.

By slowing the emptying rate of the stomach, the chime in the duodenum becomes more thoroughly mixed with bile and pancreatic juice. This phase of gastric secretion is most marked following a meal with a high fat content. The rate at which the stomach empties depends largely on the type of food eaten. A carbohydrate meal leaves the stomach in 2 - 3 hours, a protein meal remains longer and a fatty meal remains in the stomach longest.

The three phases of secretion of gastric juice
Fig: The three phases of secretion of gastric juice


How acid is produce in Stomach? - SEY PHARMA

 How acid is produce in Stomach?

     Gastric acid or gastric juice is a digestive fluid formed in the stomach and is composed of hydrochloric acid, potassium chloride and sodium chloride. Gastric acid is produced by the cells in the lining of the stomach, which are coupled in feedback systems to increase acid production when needed. These cells also produce mucus, which form a viscous physical barrier to prevent gastric acid damaging the stomach. The main constituent of gastric acid is hydrochloric acid which is produced by parietal cells in the gastric glands of the stomach. Parietal cells contains an extensive secretory network from which hydrochloric acid is secreted into the lumen of stomach. In the human lumen stomach, the acidity being maintained by the proton pump H+/K+ ATPase. Chloride and sodium ions are actively secreted from cytoplasm of parietal cells into the lumen of canaliculus.

CO2, and Cl- diffuse form the blood into the stomach cell. Within the cell, CO2, combines with H,O, in presence of CA enzyme to form H2CO3. H2CO, dissociates into HCO3(-), and H+. HCO3(-), is absorbed to blood in exchange of Cl- which subsequently diffuse to gastrioc lumen and combines with H+ to form HCl.

Acid regulation in stomach
Fig: acid production in Stomach


What is the role of pepsin in Digestive System? - SEY PHARMA

Pepsin Role in Digestive System:

The highly acidic environment in the stomach lumen causes proteins from food to lose their characteristics folded structure. This exposes the proteins peptide bonds. The gastric chief cells of the stomach secrete enzymes for protein breakdown i.e inactive pepsinogen. Hydrochloric acid activates pepsinogen into enzyme pepsin, which then helps digestion by breaking the bonds linking amino acids, a process known as proteolysis.
Protein Digestion mechanism
Fig: Mechanism of Protein Digestion


What is the Function of Gastric Juice - SEY PHARMA

Functions of gastric juice :

    1. Hydrochloric acid carries out hydrolysis of food stuff and act as antiseptic.
    2. Renin acts as milk protein caseinogens and converts it into casein which is then digested by pepsin.
    3. The enzyme pepsin, with hydrochloric acid, digests protein into peptone and proteoses.
    4. Gastric juice excretes toxins, heavy metals and certain drugs.

Structure And Function of Stomach - SEY PHARMA

Anatomy or structure of Stomach : 

It is 'J' shaped hallow organ lying in the abdomen under the diaphragm. Its major part is to the left of midline. Its capacity is 1-2 litres. It stores food and partially digest it by gastric juice The stomach is continuous with the oesophagus at the cardiac sphincter and with then duodenum at the pyloric sphincter. It has two curvatures. The lesser curvature is short, lies on the posterior surface of the stomach and is the downward continuation of the posterior wall of the oesophagus.

Different parts of stomach
Fig: Different Parts of Stomach

 The stomach is divided into three regions: the fundus, the body and the pylorus. At the distal end of the pylorus is the pyloric sphincter, guarding the opening between the stomach and the duodenum. When the stomach is inactive the pyloric sphincter is relaxed and open, and when the stomach contains food the sphincter is closed.

Walls of stomach
Fig: Walls of Stomach


Walls of the stomach

     The four layers of tissue that comprise the basic structure of the alimentary canal are found in the stomach butwith some modifications.

Muscle layer

   This consists of three layers of smooth muscle fibres: an outer layer of longitudinal fibres, a middle layer of circular fibres and an inner layer of oblique fibres. The stomach is different from other regions of the alimentary tract as it has three layers of muscle instead of two. This arrangement allows for the churning motion characteristic of gastric activity, as well as peristaltic movement.Circular muscle is strongest between the pylorus and the pyloric sphincter.

Mucosa : 

When the stomach is empty the mucous membrane lining is thrown into longitudinal folds or rugae, and when full the rugae are 'ironed out' giving the surface a smooth, velvety appearance. Numerous gastric glands are situated below the surface in the mucous membrane and open on to it. They consist of specialised cells that secrete gastric juice into the stomach.

Arterial supply to the stomach is by the left gastric artery, a branch of the coeliac artery, the right gastric artery and the gastroepiploic arteries. Venous drainage is through veins of corresponding names into the portal vein.

Functions of stomach :

     1. Mechanical functions : 

It act as a reservoir of food. It helps in mixing of food with digestive juices. It liquefies and propels the food further into duodenum.

      2. Secretion :

 It secretes gastric juice which converts food into chime and helps in digestion.

      3. Antiseptic : 

Hydrochloric acid of gastric juice destroys microbes and prevents infection.

     4. Digestion : 

Gastric juice partly digest proteins and fats

     5. Absorption :

 Water, glucose, alcohol and certain drug are absorbed from wall of stomach.

     6. Excretion : 

It helps in excretion of some toxins and drugs.






Structure And Function of Mouth - SEY PHARMA

Anatomy of Mouth 

  This is the first enlarged part of alimentary tract. It opens externally through upper and lower lips. The cavity has dome shaped roof is called the palate. The hard palate is in front and soft palate is behind. This forms an arch, with uvula hanging behind in the centre. Pharyngeal tonsils which form the lymph glands, are on either side and work like gate keepers, protecting against the infection of the adjacent area.

Functions of mouth :

1. In oral cavity food is teared and grinded with the help of teeth.

2. It also mixed food thoroughly with saliva


Structure And Function of Mouth
Fig: Different Parts of Mouth


Structure And Function of Tongue - SEY PHARMA

 Anatomy of Tongue

The tongue is composed of voluntary muscle. It is attached by its base to the hyoid bone and by a fold of its mucous membrane covering, called the frenulum, to the floor of the mouth. The superior surface consists of stratified squamous epithelium, with numerous papillae. Many of these contain sensory receptors for the sense of taste in the taste buds. The main arterial blood supply to the tongue is by the lingual branch of the external carotid artery. Venous drainage is by the lingual vein, which joins the internal jugular vein. The nerve supply involved are: the hypoglossal nerves, the lingual branch of the mandibular nerves, facial and glossopharyngeal nerves.

Functions of the tongue

   1. Chewing (mastication) 

   2. Swallowing (deglutition)

   3. Speech

   4. Taste.

Structure And Function of Tongue
Fig: Different Parts of Tongue