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Hepatobiliary and pancreatic emergencies
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
The gallbladder is a hollow organ that sits in the gallbladder fossa on the inferior surface of the right lobe of the liver. It has a fundus, body and neck, which is continuous with the cystic duct. At the junction between the neck and the cystic duct there is an out-pouching, known as Hartmann's pouch, which is a common site of impaction for gallstones. Its function is to store bile for release when a fatty meal is eaten. When fat enters the duodenum it stimulates the release of cholecystokinin, which in turn stimulates the gallbladder to contract (see Chapter 13).
Transmitter/Peptide Interactions in NTS Neuronal Circuits
Published in I. Robin A. Barraco, Nucleus of the Solitary Tract, 2019
Cholecystokinin produces satiety, decreases food intake, and slows down gastric motility, partly by its action in the brainstem, pons, and hypothalamus.33 The prolonged postsynaptic CCKB excitation of preganglionic neurons16 is therefore unlikely to mediate an inhibition of gastric motility. In contrast, the CCKA-induced inhibition16 is in keeping with the relaxation of the digestive tract that occurs after the administration of CCK8.
The digestive system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
Most pancreatic secretion takes place during the intestinal phase. The intestinal hormone, secretin, stimulates the release of a large volume of pancreatic juice with a high concentration of bicarbonate ions. Secretin, “nature’s antacid,” is released in response to acidic chyme in the duodenum (maximal release at pH < 3.0). The intestinal hormone, cholecystokinin, is released in response to the presence of the products of protein and lipid digestion. Cholecystokinin then stimulates the release of digestive enzymes from the pancreas.
Pancreatic exocrine insufficiency in diabetes is associated with autonomic dysfunction
Published in Scandinavian Journal of Gastroenterology, 2021
Dag André Sangnes, Elisabeth Sandvik Bergmann, Rose Marie Moss, Trond Engjom, Eirik Søfteland
As the first study finding an association between autonomic dysfunction and PEI in diabetes using state-of-the-art technology, our results are both novel and biologically plausible [1]. Secretion of pancreatic digestive enzymes is mainly mediated by cholecystokinin, which is released upon duodenal exposure to peptides, amino acids and fatty acids [7]. The presence and physiological importance of cholecystokinin A-receptors in human pancreatic acinar cells have been debated, with completely disparate findings [8,24,25]. Instead, cholecystokinin is thought to mediate most of its stimulatory effect indirectly through vagal neurons [7]. Since the vagus nerve plays such a central role in the regulation of digestive enzyme secretion, it is likely to make the pancreas susceptible to autonomic neuropathy. If vagal signalling is impaired, there might be insufficient stimulation of acinar cells, contributing to decreased enzyme secretion and the reduced faecal elastase levels seen in our case group [8,9].
Acupoint Massage Can Effectively Promote the Recovery of Gastrointestinal Function after Gynecologic Laparoscopy
Published in Journal of Investigative Surgery, 2021
Di Ruan, Jingjing Li, Junchang Liu, Dandan Li, Ning Ji, Cheng Wang, Yujiang Qu, Yongtao Li
The vagus nerve of the autonomic nervous system regulates gastrointestinal motility by stimulating the release of different gastrointestinal hormones [14]. Motilin is among the one that promotes the motility of gut intestine during digestion [15], and indeed, motilin is one of the indicators that have been clinically used to evaluate postoperative gastrointestinal function [16]. In past few years, the functional relationship between the meridian and autonomic nervous systems has been extensively studied. Acupoint massage was shown to modulate both heart rate variability and meridian electrical conductance [17]. Enhanced qi circulation is believed to promote the stimulating effect of the vagus nerve on gut motility. In accordance to this hypothesis, our data showed that the qi-promoting massage could profoundly elevate not only motilin but also cholecystokinin. Cholecystokinin mediates digestion in the small intestine, and stimulates digestive enzyme releases from the pancreas [18]. Somatostatin suppresses the release of gastrointestinal hormones including motilin and cholecystokinin [19]. Here, we showed that the acupoint massage could reduce somatostatin level in patients, resulting in the up-regulation of digestion-promoting hormones.
Is transcranial direct current stimulation an effective modality in reducing food craving? A systematic review and meta-analysis
Published in Nutritional Neuroscience, 2020
Seyed-Ali Mostafavi, Ali Khaleghi, Mohammad Reza Mohammadi, Shahin Akhondzadeh
The inability to resist food craving is related to dysfunction of neuronal circuits associated with cognitive control, reward sensitivity, and conditioning resulting in resistance to homoeostatic signals.6,38–40 Accordingly, as shown in neuroimaging studies, defects in dopaminergic neurotransmission system, which modulates neuronal systems involved in reward sensitivity and control, may contribute to food addiction and obesity.6,8,41 Acute stimulation of the prefrontal cortex using tDCS may regulate the dopaminergic pathways and improve resistance to food craving by enhancement of the reward system.9,33 Furthermore, serotonin system anomalies and low levels of the brain-derived neurotropic factor (BDNF) may interfere with the pathogenesis of eating disorders.42,43 Knowing that electrical stimulation of the brain enhances the activity of pre-synaptic serotonin and increases the level of BDNF, it can be guessed that brain electrical stimulation may improve eating disorder.44,45 Also, cholecystokinin can inhibit human food intake and its level may be increased by electrical stimulation of the brain.46 In addition, eating behavior and food craving are highly affected by mood, impulsivity, and chronic stress.8 Several studies have shown that tDCS can be a proper treatment modality to regulate mood,47,48 and thus, it may regulate the eating behavior in this way.