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Applied Physiology Of

Gastro-Intestinal
Hormones
By Sreya Mazumder,
1st Year,
KPC Medical College & Hospital, Kolkata

Endocrine Disorders
Endocrine disorders can be broadly classified into three groups:
o

Endocrine gland hyposecretion (leading to hormone deficiency).

Endocrine gland hypersecretion (leading to hormone excess).

Tumors (benign or malignant) of endocrine glands.

Endocrine disorders are often quite complex, involving a mixed picture of


hyposecretion and hypersecretion because of the feedback mechanisms involved
in the endocrine system. Moreover, the changes in the quantity of secretion
cause further diseases/syndromes.

GASTRITIS
Inflammation Of The Lining Of The Stomach

Symptoms: Upper Central Abdominal Pain, Nausea,


Vomiting, Belching, Bloating, Loss Of Appetite
Causes:
Acute Gastric Mucosal Erosion Caused By Damage to
Mucosal Defences
Chronic Wide Range of Gastric Tissue Problems
Metaplasia Mucous Gland Metaplasia
Heliobacter Pylori
Treatment: Antacids can treat mild gastritis. For
acute & chronic infections, drugs like Omeprazole,
Rabeprazole, Prantoprazole(which acts as proton
pump inhibitors to shut down the acid-secreting
stomach cells) are prescribed.

Peptic Ulcer
Ulcer Of An Area Of The Gastro-Intestinal Tract Caused By Digestive
Action Of Gastric Juice
Symptoms: Severe Pain In Epigastric Region, Nausea,
Vomiting, Hematemesis, Heartburn, Anorexia, Weight Loss.
Causes:
1. Excessive Secretion of Pepsin in Gastric Juice
2. Hyperacidity of Gastric Juice
3. Reduced Alkalinity of Duodenal Content
4. Stress
5. Long-term use of NSAIDs
6. Chronic Inflammation Due To Heliobacter Pylori
Treatment:
1. Antacids
2. Combination of 2 Antibiotics & 1 Proton Pump Inhibitor

Zollinger-Ellison Syndrome
A Non-Beta Islet Cell, Gastrin-Secreting Tumor Of The Pancreas That Stimulates Parietal Cells Of
Stomach To Maximal Activity, With Consequent Gastro-Intestinal Mucosal Ulceration.

Gastrinomas may occur as single tumors or as


multiple, small tumors. About one-half to twothirds of single gastrinomas are malignant tumors
that most commonly spread to the liver and lymph
nodes near the pancreas and small bowel.
Symptoms: Chronic diarrhea, oesophageal pain,
nausea, wheezing, vomiting blood, loss of
appetite, malnourishment.
Diagnosis: Secretin stimulation test, fasting
gastrin levels, endoscopy.
Treatment: Proton pump inhibitors (such as
omeprazole and lansoprazole) and histamine H2receptor antagonists (such as famotidine and
ranitidine); Surgical removal of tumor. Octreotide
is the best drug for pharmacologic management.

Gastric Dumping Syndrome


Rapid Gastric Emptying Of Undigested Food From Stomach
Into Small Intestine

Gastric Dumping may begin immediately after taking meals(early


dumping) or about few hours after taking meals(late dumping).
Causes:
Partial Gastrectomy
Gastroenterostomy
Zollinger-Ellison Syndrome

Symptoms: Diarrhoea, Nausea & Vomiting,


Sweating & Weakness, Dizziness, Hypoglycemia

Treatment: Diet low on carbohydrates,


Medication, Surgery.

Gastroparesis
(Delayed Gastric Dumping)
Gastroparesis is a medical condition consisting of partial paralysis of the
stomach, resulting in the food remaining in the stomach for a longer
time than normal. The stomach contractions are usually controlled by
the vagus nerve. A high content of secretin in blood plasma also
contributes to gastroparesis as it inhibits post-prandial gastic emptying.
Causes:
Transient Gastroparesis - Automatic Neuropathy; Damage to
Vagus Nerve, Scleroderma, Ehlers-Danlos Syndrome,
Parkinsons.
Chronic Gastroparesis Abdominal Surgery, Heavy Smoking.
Idiopathic Gastroparesis Stomach Flue, Mononucleosis.

Diagnosis: X-Rays,
Manometry, Gastric Emptying
Scans.

Complications:
Fluctuations In Blood Glucose
General Malnutrition
Severe Fatigue & Weight Loss
Intestinal Obstruction
Bacterial Infection.

Symptoms: Chronic Nausea,


Chronic Diarrhea, Vomitting,
Erratic Blood Glucose Levels,
Heartburn, Palpitations,
Abdomina Pain, Spasms Of
Stomach Wall.

Treatment: Dietary Changes


Oral Medications such as
Metaclopramide.

Coeliac Disease/Gluten-Sensitive Enteropathy/NonTropical Sprue

It is an auto-immune disorder characterized by damage of mucosa & atrophy


of villi in small intestine, resulting in impaired digestion & absorption.

Symptoms: Diarrhea, Steatorrhea, Abdominal Pain, Weight Loss, Irritability,


Depression.

Causes: Coeliac disease is caused by a reaction to gliadin, a prolamin(gluten


protein) found in wheat, oats, rye, barley etc.

Post-Prandial Gut Hormone Profile In Coeliac Disease


1200
1000
800
600
400
200
0

Series 3

Treatment: Gluten-free Diet.

Anorexia Nervosa
Eating Disorder Characterized By Immoderate Food Restriction & Irrational
Fear Of Gaining Weight, As Well AsSymptoms:
A Distorted Body Self-Perception
Causes:
Obstetric
Complicat
ions,
Epigenetic
Mechanis
ms,
Serotonin
Dysregualt
ion, BDNF,
Leptin &
Ghrelin
Dysregulat
Epidemiol
ion.
ogy:
Prevalenc
e of 0.31% in
women &
0.1% in
men. 75%
of
anorexic
people
are
female.

Hypokalae
mia,
Hypotherm
ia, Rapid
Weight
Loss,
Dieting,
Depression
, Rapid
People suffering
from anorexia
Mood
have extremely
high levels of
Swings
ghrelin (the hunger hormone
that signals a physiological need
for food) in their blood. The high
levels of ghrelin suggests that
their bodies are desperately
trying to make them hungry;
however, that hunger call is
being suppressed, ignored, or
overridden. Nevertheless, one
small single-blind study found
that intravenous administration
of ghrelin Treatment:
to anorexia nervosa
patients increased
Dietaryfood intake by
1236% over
the trial period.
Supplemen
ts of Zinc,
Calories,
EFAs.
Medication
Olanzapine
Cognitive
Behavioura
l Therapy.

Complicatio
ns: Growth
Retardtatio
n, Pubertal
Arrest, Peak
Bone Mass
Reduction,
Hepatic
Steatosis,
Cardiac &
Neurologica
l Disorders,
Death.

Diagnosis:
A
Cumulati
on of
Medical
Illness
Tests &
Psycholog
ical Tests.

Diabetes Mellitus
A Group Of Metabolic Diseases In Which A Person Has High
Blood Sugar
A person suffering
from diabetes
mellitus has high
blood sugar either
because the
pancreas does not
produce enough
insulin, or because
cells do not respond
to the insulin that is
produced.
Universal Blue Symbol For Diabetes

Classification
Diabetes Mellitus is broadly classified into three groups:

Type I Diabetes Mellitus: It is characterized by loss of the insulin-producing


beta cells of the islets of Langerhans in the pancreas, leading to insulin
deficiency. Hence, it is called insulin-dependent diabetes mellitus(IDDM).
Causes: Degeneration of -cells in pancreas; Destruction of -cells in viral
infections or auto-immune disorders; Congenital disorders of -cells.
Other Forms: Latent Autoimmune Diabetes in Adults(LADA) & Maturity Onset
Diabetes in Young Individuals.

Type II Diabetes Mellitus: It is characterized by insulin resistance, which may


be combined with relatively reduced insulin secretion. Since it can be
controlled by oral hypoglycemic drugs in most cases, it is known as Non
Insulin-Dependent Diabetes Mellitus(NIDDM).
Causes: Genetic Disorders; Lifestyle Changes; Stress.
Other Forms: Pre-Diabetes.

Features

Type I (IDDM)

Type II (NIDDM)

Age of Onset

Usually Before 40 Years

Usually After 40 Years

Major Cause

Lack Of Insulin

Lack Of Insulin Receptor

Insulin Deficiency

Yes

Partial Deficiency

Immune Destruction of cells

Yes

No

Hereditary Cause

Yes

May or May Not Be

Need For Insulin

Always

Not Initially, May Require In


Later Stages

Insulin Resistance

No

Yes

Control By Oral
Hypoglycemic Agents

No

Yes

Appearance of Symptoms

Rapidly

Slowly

Body Weight

Usually Thin

Usually Overweight

Stress-Induced Obesity

No

Yes

Ketosis

Common

Rare

Prevalence

~10%

~90%

Gestational Diabetes Mellitus: It resembles type 2


diabetes in several respects, involving a combination
of relatively inadequate insulin secretion and
responsiveness. It occurs in about 25% of all
pregnancies and may improve or disappear after
delivery. Gestational diabetes is fully treatable, but
requires careful medical supervision throughout the
pregnancy. About 2050% of affected women develop
type 2 diabetes later in life.

Signs & Symptoms

Complications
1.
2.
3.
4.

Cardiovascular Complications: Hypertension, Myocardial Infarction


Diabetic Retinopathy
Diabetic Nephropathy
Diabetic Neuropathy

Treatment
Type I DM: Exogenous Insulin.
Type II DM: Oral Hypoglycemic Drugs(Insulin Secretagogues, Insulin Sensitizers,
Alpha Glucosidase Inhibitors).

Glucagonoma
Rare Tumor Of The Alpha Cells Of Pancreas, Resulting In Overproduction Of
Glucagon.
Symptoms: Necrolytic Migratory Erythema(Spread
of erythematous blisters and swelling across
areas subject to greater friction and pressure,
including the lower abdomen, buttocks,
perineum, and groin); Weight Loss, Abdominal
Pain, Diabetes Mellitus, Anemia, Neuropsychiatric
symptoms.
Diagnosis: Presence Of Significantly Elevated
Level Of Plasma Glucagon In Association With A
Pancreatic Mass.
Treatment: Administration of Octreotide, A
Somatostatin Analogue; Surgical Resection For Removal
Of Tumor; Chemotherapeutic Agents In Case Of Relapse.

Somatostatinoma
A Tumor Of The Delta Cells Of Endocrine Pancreas That Produces Somatostatin.

Most clinical symptoms observed in the originally described somatostatinoma syndrome


reflect the inhibitory properties of somatostatin on most digestive organs.

Somatostatin suppresses the release of gastro-intestinal hormones, lowers the rate of


gastric emptying, reduces smooth muscle contractions and blood flow within the
intestine and also suppresses the exocrine & endocrine secretory action of the
pancreas.

Abnormally elevated somatostatin can cause diabetes mellitus, by inhibiting insulin


secretion, steatorrhoea by inhibiting cholecystokinin and secretin, gall stones by
inhibiting cholecystokinin which normally induce gallbladder myocytes contraction, and
hypochlorhydria caused by inhibiting gastrin, which normally stimulate acid secretion.

Somatostatinomas are associated with calcium deposits called psammoma bodies.

Diagnosis: Presence of markedly elevated levels of plasma somatostatin. CT scan and


both conventional and endoscopic ultrasonography.

Treatment: Surgical resection in patients with localized diseases & chemotherapeutic


agents in patients with recurrent disease.

Verner-Morrison Syndrome
Endocrine Tumor Originating From Non- Islet Cells Of The Pancreas That
Produce Vasoactive Intestinal Peptide (VIP).
Clinical
Manifestatio
-ns

Severe Watery Diarrhea,


Hypokalaemia,
Dehydration, Metabolic
Acidosis, Hypotension.
Achlorhydria, Glucose
Intolerance, Abdominal
Cramps

Diagnosis

Increased Circulating
Levels Of Peptide
Histidine Methionine,
PP, NT & Prostaglandins.
Ultrasonography, CT
Scan, SRS imaging,
exploratory laparotomy.

Treatment

Aggressive Fluid &


Electrolyte
Replacement,
Somatostatin Analogue
Administration.
Surgical Resection Of
Tumor.

Summary
A large number of peptides are
synthesized in and secreted by endocrine
cells of the pancreas and gastrointestinal
tract. Many of these peptides circulate
as hormones, but they also function as
paracrine modulators or
neurotransmitters not only in the gut but
in the central and peripheral nervous
systems. Although some biologic actions
for many of these peptides have been
delineated, it seems likely that new
peptides, receptors, and novel biologic
functions will continue to be discovered,
which may provide new opportunities for
understanding the pathophysiology,
diagnosis, and treatment of endocrine
disease.

Thank You!