Main directions of secretory disorders
The secretory function of the stomach can be impaired along several key vectors affecting both the volume of fluid secreted and its qualitative composition. According to the pathogenesis scheme, standard disorders are classified as follows:
- Change in the total amount of gastric juice. Glands may function excessively, leading to an increased volume of secretion (hypersecretion). In other cases, gland depression is observed with a reduced volume (hyposecretion) or complete cessation of gastric juice secretion (achylia).
- Disorder of mucus production. Protective mucus is essential for the normal functioning of the organ. In pathology, its content may pathologically increase, decrease, or completely cease.
- Disorders of the acid-forming function. Associated with changes in the synthesis of hydrochloric acid (HCl). Three states are distinguished:
- Hyperchlorhydria — increased HCl content.
- Hypochlorhydria — decreased acid content.
- Achlorhydria — complete absence of HCl.
- Disorders of the enzyme-forming function. Concern the production and release of pepsin. Its secretion may increase, decrease, or stop completely (the state of apepsia).
Disorders of secretion dynamics: 5 main types
The pathogenetic essence of dynamic disorders lies in the dyssynchrony of glandular activity. The latent period (time from food stimulation to the onset of juice secretion), intensity (rate of growth), duration of the process, and final volume of secretion are evaluated. 5 main types are distinguished:
- Excitable type. Characterized by glandular hyperactivity. The latent period is shortened. Intensive and rapid increase in secretion is observed, the process itself lasts longer than usual, and the final volume of secretion increases.
- Inhibitory type. Differs by the suppression of the secretory process. The latent period is increased (long pause between stimulation and response). The rate of secretion increase is reduced, the juice secretion period is shortened, and the total volume of secretion is decreased. The extreme degree is achylia.
- Inert type. Manifests as "sluggishness" of excitation and inhibition processes. The latent period is prolonged. The rates of secretion increase and cessation are slowed down. The total volume of contents is increased due to the prolonged period of gland shutdown.
- Asthenic type. The main feature is rapid functional exhaustion. The glands produce a rapid reaction (shortened latent period) and an intensive start of juice secretion, but this activity is replaced by a rapid decrease in secretion. The final volume of contents is small.
- Chaotic type. Characterized by a complete absence of patterns in dynamics and volumes. Periods of activation and inhibition alternate unsystematically for a long time (months and years). The volume of juice is usually increased.
Place of secretory disorders in digestive pathology
Secretory disorders rarely occur in isolation. The most frequent etiological cause is partial and combined functional disorders of the stomach.
In addition to secretory, other basic functions in the stomach can also be impaired:
- Motor.
- Absorptive.
- Barrier.
- Protective.
It is the combined impairment of these five functions that forms the full picture of digestive disorders in the stomach.
Briefly: answers to topical questions
What etiological factors lead to gastric hypersecretion?
Causes of gastric hypersecretion include:
- Increase in the mass of gastric secretory cells — most often genetically determined.
- Activation of vagus nerve effects — in neurotic states, constitutional vagotonia, as well as in brain injuries that stimulate n. vagus tone.
- Increased synthesis and/or effects of gastrin; the most pronounced hypersecretion is observed in gastrinoma.
- Hypertrophy and/or hyperplasia of enterochromaffin (enteroendocrine) cells.
- Overdistension of the gastric antrum.
- State after small bowel resection — due to the loss of inhibitory intestinal factors.
- Hypercalcemia of any origin.
- Pancreatitis or pancreatic duct obstruction.
- Effects of certain medications — for example, acetylsalicylic acid or glucocorticoids.
To easily remember the 5 types of secretory dynamics disorders, use the mnemonic "VTIKHarya": Vozbudimy (Excitable), Tormoznoy (Inhibitory), Inertny (Inert), Khaotichesky (Chaotic), Asthenichesky (Asthenic).
Class and exam questions
What is achylia, and for which type of secretion is it characteristic?
Achylia is the complete absence of gastric juice. It represents the extreme degree of glandular function suppression and is characteristic of the inhibitory type of secretory dynamics.
What is the difference between the asthenic and inhibitory types?
In the inhibitory type, the glands react with a delay (latent period is prolonged), whereas in the asthenic type, they react quickly (latent period is shortened). However, in both cases, the final volume of juice is reduced: in the inhibitory type due to low activity, and in the asthenic type due to rapid functional exhaustion.
How does acid-forming function change in pathology?
Disorders of hydrochloric acid (HCl) synthesis manifest as hyperchlorhydria (increased content), hypochlorhydria (decreased content), or achlorhydria (complete absence of acid in gastric juice).
Why is the juice volume increased in the inert type if the processes are slowed?
In the inert type, not only the onset of secretion is slowed, but also the process of its inhibition. Because of this prolonged shutdown period of the glands, the final volume of gastric contents turns out to be increased.
What else to study on this topic
- Etiology of partial and combined disorders of gastric functions
- Pathogenesis of motor and absorptive function disorders
- Mechanisms of barrier and protective functions of the mucous membrane
- The role of altered mucus production in the development of gastric pathologies
- Consequences of achylia and apepsia for subsequent stages of digestion
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