Fifth part

Movement of
large intestine

==
concerned -> concerned with the
with absorptions storage and elimination

↑-

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⑪

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O peeter
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 first of all we should know:
-
in the large
intestine the proximal
half of it is concerned with the
absorption (mainly absorb water and electrolytel

-> and the distal half of large intestine is

concerned with the S
torage of the fecal
matter and elimination of fecal matter

-
when the chyme enters into the cecum
very slowly it goes through the large
intestine to sigmoid colon
it convert from semisolid material to the
fecal
-

matter
-

- it will take 1-2 days for the material to reach from

the secur up to the last part of large intestine

- MMC is not the feature of large intestine

Ieo cecal Value :

-Ieocecal Value is a Small part

of the Hleum with its mucosa
protruding into the cecum

-proximal of Ileocecal value there is thicken ring a

of Smooth muscle which act as Ileocecal functional

S phincter
- Heocecal value
normally remain lightly
closed and they only work one way
f rom ileum to the cecum bez cecum
is
highly populated with bacteria but in
the ileum it is sterile or bacteria population is Very
low
So one the major function of ileo cecal
of
value is to prevent the
highly bacterial
population from the cecum to the Small gut

- Ileocecal Sphincter is
very properly
regulated
for example , when content in the cecum become more

Bleocecal value Should become light

bcz if pressure in the secur is
increasing
there is a
dangerous of spilling of fecal in

large intestinal gut into ileum

we can say this is a type of seco -
Ileal reflex
which is maintained by
myenteric
local and

sympathetic prevertebral ganglion .

but remember gastro-ileal reflex is opening

the Hleocecal value So that contents of small

gut going into large gat -> So

gut can
small

acommodate the in
coming chyme from stomach ,
 large gut;
of large intestine movement
-B -
Mixing Seg mental MaSS
movement
↓ propulsion

I
Haustration - While haustrations > are
very strong
a

are produced there constriction ring

-
are the appearance of can be very weak appear in a part of

content the colon and then

contraction at intervals propulsion ,
about 20 distal
spill from
cm
one
in the large gut may to that area haustration
make the naustra to the next
·
they lumen
disappear and all that
narrow
haustra
contract
.
area as one

- in between the two unit and push the

contractions wall of content as one mass

the colon bulges out distally .

like a
bag
- two process occur :I
- and if multiple
① Smooth muscle contract mass movement come
and make circular
a
and lot of content
constriction

② Tineae coli also contract pushed into rectur then

and shorten the
large desire for defecation will

gut be there

in this they bring

-

normally rectur is
way
different areas of Semisolid
almost empty ,
bcz.
① there is weak functional
of large gut
a

content to
of
thickening Smooth muscle at

exposure to the mucosa So recto

sigmoidal junction
that water and electrolyte ② there is an
angulation
can be absorbed , gradually this
Semifluid content of large gut > occurs in different
fecal matter
convert into semisolid .

people with different

frequency per day 1
* mass movements once they start usually they ,

persist for 10-30 minutes (they keep on reminding

that you need defecation

movement be initiated by
A mass can
gastrocolic
reflex (many people when they
get heavy a real within
short time they need to
go to washroom for defecation)
and also it can be initiated by duodenocolic
reflex

Defecation reflex
How the dribbling of fecal matter
is prevented ?

·
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/

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-

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-

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④

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dena--
· Si
A
-

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-

A- O
⑤
To
· EI-↓
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N- S

↑
Internal anal Sphincter -> involuntary

· external and Sphincter -> voluntary

⑥ before the desire for defecation starts
multiple mass movements occur -> if there are

enough fecal contents over there - then this

fecal content will be pushed through the
descending
colon and
sigmoid colon into return

② when rectur receive these contents -> there

will b rectal stretching and irritation to
rectal mucosa
- local reflex of myenteric reflex is stimulated
the local system Stimulate the
sensory
ascending pathway and this ascending
myenteric system stimulates all the way up
and this stimulation creates more mass movement

at the same time local sensory system inhibit

the descending pathway and internal and sphincter
becomes inhibited

- this reflexion is weaks and it is

called intrinsic myenteric defecation reflex

0
3 When more material come this weak
reflex can be intensified by parasympathetic
reflex
Some of the Sensory fibers from rectal
Stretch area of mucosa , they go to the
lower part of Spinal cord (S2-Sy) and from
there parasympathetic fibers come and they
are further inhibit internal and sphincter and
further stimulate my enteric intrinsic reflex .
④ If you don't want
go to washroom , you
keep your external and sphincter consciously
lightened -> if you remain like this
sensory system
will think that you are not responding then rectal

sensory fibers get will to used this high pressure ,

So for a while this reflex will die out

but after sometime again the call will come
and that time you want to defecate

⑤ conscious decision to make defecation is

done at the
higher center -> from higher centers
fibers will come down and they will control the
outflow (external and sphincter) by pudendal
nerve -> this nerve make the external anal

Sphincter relaxes

* Sometimes when
you are
going to
defecate ,
the
desire is there but the pathway of nerves is reduced
so you can ampilify it by conscious effort you -

take a deep breath , close your glottis and then

you contract your abdominal muscles and diaphragm
and relax the pelvic floor downward abdominal

by
diaphragm ,

-> muscle inward

on are raising the intraabdominal pressure (you

the whole colon to material there
are
squeezing push more ,

So the pathway is again stimulated and parasympathetic

is also stimulated) ·

6
this mechanism is called ValSalva Maneuver
 Disorders of GIT motility =

&
⑤
ralyticusag
· occurs when the whole myenteric plexus in
SIT becomes paralysed

-
this situation is seen after general anasthesia
or it is seen in abdominal surgery and you

manually handle the 61T or when there is

Severe electrolyte imbalance or there is
Septicemia or peritonitis

)
⑰
⑳
chs diseas
-this disease is usually congenital disease

- one
segment in the large intestine doesn't
have
ganglion and neuronal cell bodies
- Sometimes neural crest cells don't migrate
properly and in Some
Segment of the
large
intestine ganglia will not be there (there is

aganglionic Segment (
this is congenital cause of megacolon but this
ganglion can be destroyed by a parasite called
trypanosoma cruizi
 failureo meaxalie ene

⑱ ->
-unfortunately if baby is born with this
abnormality , there will b delay of meconeum
and bcz contents of GIT retain so nausea +

vomiting may occur .

-
what is
meconeum ?
Treatment ⑧
· surgical resection first fecal
-

of aganglionic Segment excretion of

a
newborn

.
&
⑳ ..
.
~@
ritablelgromeg
- in this syndrome the patient suffer with abdominal
pain and with that they repeatidly suffer with
dysfunction of GIT motility (sometimes develop diarrhea
sometimes develop constipation)

- this IBS is thought

now to be due to increased
visceral hypersensitivity (in CIT Sensory neurons which
are
supposed to move the myenteric plexus they are over sensitive
⑤
&
& ...
ea inSinen
- neurons which are controlling the external
and sphincter are
disrupted or
high
control to the Sacral area is interrupted
Le for example , if you have a lesion in spinal
cord above cons medullaris ,
so

the defecation reflex will be

inhibited

- the defecation is no more controlled by

the descending pathways of cons medullaris
So the defecation become Semi automatic
then if intrinsic and parasympathetic reflex
become very strong ,
whenever fecal matter
reaches return it will be automatically
evaculate but if external pudendal nerve
is very strong then it may lead to retention