GIT MOTILITY

1. 2.

The GIT motility refers to the movements for :Mechanical breakdown of food Mixing & circulating the GI contents

3.

Propel food along the length of the tract from the

mouth to the anus

1. 2. 3.

GIT motility is determined by : Properties of smooth muscle Neural input Endocrine & paracrine factors

Electrical Activity of Gastrointestinal Smooth Muscle

- Oscillating RMP : -65 to -45 mv ( Na pump activity) -Comprise of : Slow waves (BER from 3-12/min) & Spikes (Ca-Na
channels & K channels) - Interstitial cells of Cajal act as electrical pacemakers - Acts as syncytium due to presence of gap junctions - Determines the rhythm of most GI contractions

4. Hormones

FUNCTIONAL TYPES OF MOVEMENTS IN GIT

(1)

2 types:
Propulsive movements : They cause food to move forward along the tract at an appropriate rate to accommodate digestion and absorption.

Peristalsis relaxation

contraction ring along with receptive

Stimuli : distention of the gut , chemical/ physical irritation Myenteric plexus is necessary for peristalsis. The myenteric reflex or the peristaltic reflex plus the anal direction of movement of the peristalsis is called the "law of the gut."

Propulsive movements : Peristalsis

(2)

Mixing movements :
They keep the intestinal contents thoroughly mixed at all times.

Peristaltic contraction : against closed sphincter results in churning.

Local intermittent constrictive contractions occur every few

centimeters in the gut wall.

last only 5 to 30 seconds; then new constrictions occur at other points in the gut. Thus "chopping" and "shearing" the contents . Like segmentation

Segmentation movements of the small intestine

PHYSIOLOGY OF MASTICATION
AND

SWALLOWING

INGESTION OF FOOD

The amount of food that a person ingests is determined

principally by intrinsic desire for food called hunger.

The type of food that a person preferentially seeks is determined by appetite.

1. 2. 3. 4.

Ingestion involves :Placement of food in mouth Mastication Lubrication Swallowing

MASTICATION/CHEWING

Refers to process by which the food placed in mouth is

cut and grounded into smaller pieces.

It involves :-

1.

Action of teeth
Movement of jaws Co-ordinated movements of tongue

2.

3.

MUSCLES OF MASTICATION
1.

Masseter Temporalis Medial Pterygoid Lateral Pterygoid Buccinator Muscles of tongue(extrinsic & intrinsic)

2.

3.

4.

5.

6.

CHEWING REFLEX

Mastication voluntary act coordinated by chewing reflex opening & closing of jaw.

Opening of mouth for food stretch reflex closure. Food particles buccal receptors reflex inhibition of muscle of mastication & reflex contraction of digastric with lateral pterygoid opening.

Tongue moves the food between the upper & lower jaw

FUNCTIONS OF MASTICATION
1.

Breaking of food into smaller pieces increases the total surface area.

2.

Undigestive cellulose membrane present around the nutrition portion of most fruits and raw vegetables is broken, making it easier for them to be digested.

3. 4.

Lubricates food by mixing it with salivary mucus Mixing of food with saliva initiates the process of starch and lipid digestion

5. 6.

Swallowing becomes easy Eating becomes pleasurable.

DEGLUTITION (SWALLOWING)

It refers to passage of food from the oral cavity into stomach. It is facilitated by the secretion of saliva and mucus and involves the mouth, pharynx, and esophagus.

1.

Swallowing occurs in three stages: the voluntary stage,(Buccal phase) in which the bolus is passed into the oropharynx;

2.

the pharyngeal phase, the involuntary passage of the bolus

through the pharynx into the esophagus;

3.

the esophageal stage, the involuntary passage of the bolus through the esophagus into the stomach

BUCCAL /ORAL PHASE

It is voluntary phase. First the tip of the tongue , and later the more posterior portion of the tongue press against the hard palate.

The action of tongue moves the bolus upward and then backward into the mouth.

The bolus is forced into oropharynx , where it stimulates

the touch receptors that initiates swallowing reflex

1. BUCCAL PHASE

Hard palate Food bolus Pharynx Tongue

PHARYNGEAL STAGE (1-2 S)

It is an involuntary stage. Swallowing reflex :The bolus stimulates receptors in the oropharynx, which send impulses (Afferent via V ,IX ,X CN) to the deglutition center (NTS ,N. Ambiguus ,Dorsal motor nucleus) in the medulla oblongata and lower pons of the

brain stem.

Efferent via V,VII,IX,X,XII CN and C1-3 goes to soft palate ,uvula,pharyngeal musculature and the tongue

1. 2.

Approximation of post. pillars of fauces

Soft palate & uvula is pulled upward and the palatopharyngeal fold move medially.

3.

The vocal cords are pulled together (deglutition

apnoea)

4. 5. 6. 7. 8.

The larynx is moved forward and upward Epiglottis swings over laryngeal opening, closing it. The upper esophageal sphincter relaxes.

A peristaltic wave is initiated

Respiration is reflexly inhibited.

2. PHARYNGEAL PHASE
Soft palate closes entry to nasopharynx Food bolus

Epiglottis - closes over airways Larynx

Trachea

OESOPHAGEAL PHASE

The food bolus is propelled from the upper part of the esophagus to stomach by the esophageal peristalsis and aided by gravity.

Esophageal peristalsis Primary (initiated by swallowing) Secondary ( stretching of mechanical receptors) LES relaxes as peristalsis wave approaches . ( Receptive relaxation )

1.

2.

3. OESOPHAGEAL PHASE

Epiglottis - open

Food bolus Oesophagus

PERISTALSIS IN THE OESOPHAGUS

Muscle contraction Stomach Food bolus

Gastroesophageal sphincter relaxes

LOWER ESOPHAGEAL SPHINCTER

LES is tonically active but relaxes on swallowing. The tonic activity prevents reflux of gastric contents into the

esophagus.
1.

LES is made up of 3 components : The esophageal smooth muscle is more prominent at the junction with the stomach (intrinsic sphincter).

2.

Fibers of the crural portion of the diaphragm, a skeletal muscle, surround the esophagus at this point (extrinsic sphincter) and exert a pinchcock-like action on the esophagus.

3.

The oblique or sling fibers of the stomach wall create a flap valve that helps close off the esophagogastric junction and prevent regurgitation when intragastric pressure rises.

APPLIED
1.

Abolition of swallowing reflex Aerophagia

2.

3.

Achalasia Cardia
Gastroesophageal Reflex Disease (GRD) Dysphagia

4.

5.

PHYSIOLOGY OF GASTRIC MOTILITY

 Major function of Gastric motility

Allow stomach to serve as reservoir for large

1.

volume of food .

2. Break food into smaller particle & mix food with

gastric secretions to form chyme

3.

To empty gastric contents into duodenum at

controlled rate

Physiologic anatomy of the stomach

TYPES OF GASTRIC MOTILTY

Related to meal

1.

Receptive Relaxation

Distention of esophagus during swallowing evokes relaxation

of stomach via vagovagal reflex

Oral region relaxes to accommodate ingested food without increase in intraluminal pressure.

Stretch Receptors produces further relaxation Vagovagal reflex with NO,VIP & CCK of plays imp. Role for Receptive relaxation

2. Mixing persistaltic waves

Food in stomach week peristaltic constrictor waves or mixing waves begin mid portion & move towards antrum (3-4/Min.) Initiated by BER & consists of electrical slow waves As constrictor waves progress from body into antrum become intense & provide powerful peristaltic constrictor rings Force antral contents under high pressure towards pylorus Constrictor rings also play important role in mixing most of antral contents squirted backward through peristaltic ring towards body of stomach Retropulsion moving peristaltic constrictor rings combined with squirting action at this point partly digested food is semisolid mass called chyme

3.

Gastric Emptying
Food in the stomach is normally emptied into the duodenum within 4 hours of ingestion.

Chyme is propelled towards the pyloric sphincter by vigorous

peristalsis.
1. 2.

Intense Antral Peristaltic Contractions Pyloric Pump

Role of the Pylorus in Controlling Stomach Emptying + Antral

Systole

With each wave about 2-5ml of chime is released into the

duodenum before the sphincter closes again.

The rest of the chyme tumbles back and is propelled forward again with the next wave of peristalsis.

GASTRIC EMPTYING

Pyloric sphincter closed Duodenum

Chyme

1st peristaltic wave

GASTRIC EMPTYING

Pyloric sphincter opens

2nd peristaltic wave Chyme enters duodenum

Antral systole

REGULATION OF GASTRIC EMPTYING

1.

It depends on the : Type of food ingested :

Food rich in carbohydrate leaves the stomach in a few hours.

Protein-rich food leaves more slowly, and emptying is slowest after a meal containing fat

2.

Osmotic pressure of the material entering the

duodenum.

Hyperosmolality of the duodenal contents is sensed by "duodenal osmoreceptors" that initiate a decrease in gastric emptying which is probably neural in origin.

The rate at which the stomach empties is regulated

by neural and hormonal signals from both the

stomach and the duodenum.

Gastric Factors That Promote Emptying

1.

Fluidity of the chyme

Effect of Gastric Food Volume on Rate of Emptying

2.

3.

Effect of the Hormone Gastrin on Stomach Emptying

POWERFUL DUODENAL FACTORS THAT INHIBIT STOMACH EMPTYING

Inhibitory Effect of Enterogastric Nervous Reflexes from the Duodenum ( ENS, Symp. , Vagus)

1. 2. 3. 4. 5.

Factors affecting are :

Degree of distention of the duodenum The presence of any degree of irritation of the duodenal mucosa degree of acidity of the duodenal chyme degree of osmolality of the chyme The presence of breakdown products of fats > Carbohydrate > proteins

Hormonal Feedback from the Duodenum Inhibits Gastric Emptying : CCK , Secretin ,GIP

Applied : Dumping syndrome

# Related to Empty stomach 1. Migrating motor complexes

Soon after stomach emptied between meals mild peristaltic contractions begin by migrating motor complexes [MMC] in body of stomach gradually over periods of hours to ileum MMCs are initiated by motilin, migrate aborally at a rate of about 5 cm/min, and occur at intervals of approximately 90 min

Serve to clear the stomach and small intestine of luminal contents in

preparation for the next meal

2. Hunger contractions

When the stomach has been empty for several hours They are rhythmical peristaltic contractions in the body of the

stomach.

When the successive contractions become extremely strong , often fuse together to cause a continuing tetanic contraction

last for 2-3 min

The person sometimes experiences mild pain in the pit of the stomach, called hunger pangs. Hunger contractions more intense in young & healthy with high degree of gastrointestinal tonus

by low level of blood sugar

VOMITING (EMESIS)

It is the forcible expulsion of the contents of the upper GI tract (stomach and sometimes duodenum) through the mouth.

It is preceded by a

- nausea, salivation - rapid or irregular heartbeat / breathing - dizziness, sweating

- pallor, and dilation of the pupils

- reverse peristalsis/antiperistalsis - retching

Neural pathways leading to the initiation of vomiting in response to various stimuli

Motor impulses to UGIT

V,VII,IX,X,X II, spinal nerves

Symp

PROGRAMMED VOMITING RESPONSE

Ejection Phase
Involves several preprogrammed coordinated smooth and striated muscle responses. Abolition of intestinal slow-wave activity Start of retrograde contractions Vomiting Act

(1) a deep breath, (2) raising of the hyoid bone and larynx to pull the upper esophageal sphincter open,

(3) closing of the glottis to prevent vomitus flow into the lungs, and
(4) lifting of the soft palate to close the posterior nares.

5.

Contraction of abdominal and inspiratory muscles against a closed glottis.

6.

in intra-abdominal pressure & in intrathoracic pressure

7.

Relaxation of the diaphragmatic crural muscle and LES

Expulsion of the gastric contents into the esophagus and hence through the mouth

8.

DISORDERS OF THE STOMACH

1. 2.

Gastritis-Inflammation of the Gastric Mucosa Peptic ulcer :

It is an excoriated area of stomach or intestinal mucosa caused principally by the digestive action of gastric juice or upper small intestinal secretions.

MOVEMENTS OF SMALL INTESTINE

I.

During interdigestive period

Migrating Motor Complexes (MMC)
Between meals mild peristaltic contractions begin in body of stomach gradually over periods of hours ended in ileum

MMCs are initiated by motilin, migrate aborally at a rate of about 5 cm/min, and occur at intervals of approximately 90 min.

1.

Function as housekeeper Serve to clear the stomach and small intestine of luminal contents in preparation for the next meal.

2. 3.

Keep upper gut free of bacetria Help in circulation , GI secretion

II.
1.

During digestive period

Mixing movements : - Segmentation contractions ( rhythmic / irregular)

Ring like contractions appear a regular interval along gut involving a localized segment of 1-2cm & then relaxes Have the appearance of a chain of sausages

sequence of segmental contraction

By these movements food is divided [segmented] & mixed together with digestive juices thoroughly [again & again] slows transit time contact time with absorptive area.

No net movement in a particular direction

 2 types Eccentric[A]

&

Concentric[B] contractions

Control of Rhythmic segmental contractions

Initiated by pacemaker cells located in 2nd part of duodenum near entry of common bile duct a BER of slow wave can be demonstrated is conducted caudally by longitudinal muscle layer & coordination is via myenteric plexus

Frequency is directly related to frequency of slow waves initiated by

pacemaker cells & less influenced by neural or circulating hormones Strength of contraction = frequency of spike generated by slow waves. Strength by : Gastrin ,Motilin, CCK, Insulin ,serotonin by : secretin , glucagon

2.

Propulsive movements

Peristalsis : refers to wave of contraction followed by wave of

relaxation
- Stretching or distention of intestinal wall chyme Circular constriction forms above due to contraction of circular

muscle layer while the lumen below is dilated due to contraction of

longitudinal muscle layer (receptive contents move towards dilated part .
- Worm like vermicular or peristaltic movements
- Control : neural & hormonal

relaxation)

so

intestinal

Peristalsis Rush :

-Refers to powerful peristaltic contractions which occurs when

intestinal mucosa is irritated.

3. Movements of villi :
-

Lashing ,or pumping movements i.e shortening, elongating, and shortening again-"milk" the villi

Villikinin & local neural reflexes in +nce of chyme Motility reflexes Gastroenteric reflex Gastroileal reflex Intestointestinal reflex

III.

1.

2.

3.

Function of peristalsis propel intestinal content towards ileo-cecal valve. duration of wave 1-2cm/sec Stimulus for peristalsis local stretch release serotonin & this activates sensory neurons stimulate Myenteric plexus & response knows as Myenteric Reflex Ach & substance P released circular constriction NO ,VIP & ATP below the point of stimulus relaxation strong emotions via vagal can muscular contraction & tone of SI anger ,fear & pain via splanchnic nerves muscular contraction & tone of SI Adynamic ileus or Paralytic ileus .Mechanical obstruction of SI localized mechanical obstruction of SI severe cramping pain intestinal colic

Peristaltic movements

Segmental movements

Function of the Ileocecal Valve

LARGE INTESTINE

FUNCTIONS OF THE LARGE INTESTINE

1. Haustral churning, peristalsis, and mass peristalsis drive

contents of colon into rectum.

2. Bacteria in large intestine convert proteins to amino acids, break down amino acids, and produce some B vitamins and vitamin K. 3. Absorbing some water, ions, and vitamins. 4. Forming feces. 5. Defecating (emptying rectum)

Movements of large Intestine .Most of contractions of cecum & proximal part of large intestine are segmental & are effective at mixing & circulating colonic contents than propelling .mixing action facilitates absorption of salts & water by mucosal epithelium .localized segmental contractions divide colon into ovoid segments called haustra & segmentation in colon haustration Prominent haustral pattern
HAUSTRAL CONTRACTIONS

Food residue Haustra

.In proximal colon antipropulsive pattern predominant . Reverse peristalsis & segmental propulsion toward cecum both take place & so chyme retained in proximal colon & this retention facilitate absorption of salt & water Mass movements .simultaneous contraction of smooth muscle occurring at same time over a large portion of colon & occur in descending & sigmoid colon ,lasts 3-4 min with pressure rising steeply to peak up to 100 cm saline & decline slowly Gastrocolic reflex

Control of colonic Motility As in other segments of GIT intramural plexus directly control contractile behavior of colon Extrinsic innervations modulate .Enteric stimulatory motor neurons use Ach & substance P as neurotransmitter .Enteric inhibitory neurons release VIP & NO onto colonic smooth muscle .Extrinsic autonomic nerves to colon modulate control of colonic motility by enteric nervous system .Reflex control of colonic motility gastrocolic reflex

The Defecation Reflex

Removes undigested faeces from the body. Stretch receptors in GIT wall detect distension of rectum. Parasympathetic reflex causes contractions of the sigmoid colon & rectum + relaxation of internal anal sphincter. External anal sphincter (under voluntary control) consciously relaxed if appropriate.

Certain Physiological events,as arising [orthocolic reflex ] & ingestion of food [gastrocolic & gastroileal reflexes] ,may initiate a mass peristalsis propelling fecal bolus into rectum
.

Gastroileal reflex may be mediated via vagus or via intrinsic nerves or both

Gastrocolic reflex may be mediated via pelvic splanchnic nerves or via intrinsic nerves as continuation of gastroileal reflex, or both

Stimulation of rectal stretch receptors sends afferent impulses to spinal cord[for local reflexes] & thence to brain[ for awareness of urge] Local autonomic reflexes [via pelvic splanchnic nerves] cause contraction of rectal musculature & relaxation of internal sphincter in effort to expel feces

Awareness of urge,correlated with visual & auditory stimuli,plus memory & habit ,cause individual to seek out toilet & make other appropriate preparations & simultaneously Voluntary contraction of external cause sphincter & levator ani muscles [via pudendal & levator ani nerves] to retain feces until suitable conditions prevail