Gastric Secretion & Motility
Dr. Nisreen M. Abo-elmaaty
Introduction
Regulation of GIT Functions
I- Nervous
Autonomic NS; PSN & SNS
II- Hormonal
Gastrin Family G+ CCK
Secretin Family Sec +GIP+ VIP Others Motilin, Serotonin
Enteric NS
I- Nervous Regulation; a). Autonomic NS
Origin Parasymp.SN - Vagus: oesophagus till proximal half of colon -Pelvic n (S2,3,4):distal half of colon, rectum & anal canal Terminate entirely on local nerve plexuses (+) secretory & motor activities (-) to sphincters Symp.NS Greater & lesser splanchnic nerves: from T8-L2 Many terminate on local nerve plexuses (-) to secretory & motor activities (+) to sphincters
Effect
I- Nervous Regulation of GIT; b). Enteric NS
Submucosal Meissners plexus; - Mainly controls secretory function Myenteric Auerbachs plexus; - between longitudinal & circular muscle layers - Mainly controls motor function Activity of ENS is largely independent of autonomic innervation but modified by it.
II- Hormonal Regulation
By GI hormones Polypeptides secreted by special enteroendocrine mucosal cells Released by local axon reflex
Gastric Secretion & Motility
Functional Anatomy of Stomach
Gastric Secretion
2L/day pH:1-2 Gastric glands have 3 types of exocrine cells; 1) Mucous neck cells mucous 2) Parietal oxynetic cells HCl & IF 3) chief cells Pepsin
Gastric Secretion
Gastric glands contain enteroendocrine secreting cells: ECL (enterochromaffin like)-cells histamine G-cells gastrin D-cells somatostatin
Gastric Secretion
Gastric Secretion; 1- Digestive enzymes
Pepsin:
Main gastric enzyme Active in acidic pH (2) Action: partial digestion of ptn.
Gastric Secretion; 1- Digestive enzymes:
Other enzymes; very minor role Gastric amylase (starch digestion) Gastric Lipase Gelatinase liquefaction of gelatine
Gastric Secretion; 2- HCl:
Secreted by Parietal cells by an active mechanism There is about 1 billion parietal cells in human stomach Parietal cells membrane have receptors for Gastrin, histamine & Ach; the potent direct stimulators for HCL release
Gastric Secretion: 2- HCl; Mechanism of secretion
Gastric Secretion: 2- HCl;
Stimulants of HCl secertion
Gastric Secretion: 2- HCl;
Inhibitors of HCl secertion
Gastric Secretion
3- Mucous 1- Thin soluble of mucous neck cells lubricating & mixing chyme 2- Thick insoluble alkaline of mucosal gastric epithelial cells (with HCO3); forming mucosal barrier protecting gastric mucosa from HCl & mechanical erosion by food
Gastric secretions;
4- Intrinsic Factor
By parietal cells with HCl Essential for absorption of vit B12 in terminal ileum May be the only essential gastric secretory element
Regulation of Gastric Secretion Nervous & Hormonal 3 Phases;
Cephalic
Before food reaching stomach - Accounts for 20% of gastric sec Mediated by nervous reflexes only: conditioned & unconditioned
Gastric
food entering stomach - 70% of secretions Nervous: short & long reflexes Hormonal: gastrin
Intestinal
Chyme in duodenum - Mainly inhibitory to gastric sec. Nervous: enterogastric reflex Hormonal: secretin, CCK, GIP)
Regulation of Gastric Secretion 3 Phases;
Gastrin Hormone
Is a polypeptide hormone produced by enteroendocrine cells called G cells in the antral portion of the gastric mucosa Exist in 3 forms; G 34, G 17, and G 14 gastrins (denoting number of a.a) G 17 is the principal form with respect to gastric acid secretion Gastrins are inactivated primarily in the kidney and small intestine
Stimuli affecting gastrin secretion
Stimuli that increase gastrin secretion Peptides and amino acids Distension Neural; Increased vagal discharge via GRP Calcium, epinephrine Stimuli that inhibit gastrin secretion Acid; pH<3 (negative feed back inhibition) Somatostatin Secretin, GIP, VIP, glucagon, calcitonin
Gastrin Hormone
its principal physiologic actions are: stimulation of gastric acid and pepsin secretion Stimulation of gastric motility stimulation of the growth of the mucosa of the stomach and small and large intestines
Gastric Mucosal Barrier
Protective mechanisms against irritation & auto-digestion of gastric & duodenal mucosa by gastric HCl & pepsin Made by: Thick insoluble alkaline (HCO3) Mucous PG inhibiting acid sec, stimulating mucous Alkaline duodenal juice Tight junctions between cells (impermeable to acid) Rapid Regenerative capacity of gastric mucosa (replaced every 3 days)
Gastric Secretion During the Interdigestive Period.
The stomach secretes a few millilitres of gastric juice each hour during the interdigestive period The secretion is composed mainly of mucus but little pepsin and almost no acid. Emotional stimuli frequently increase interdigestive gastric secretion (highly peptic and acidic) to 50 millilitres or more per hour, one of causative factors of peptic ulcer.
Gastric Motility
3 components of gastric motility: Relaxation of proximal part to receive food bolus from esophagus Contractions of distal stomach to reduce size of bolus, mix it starting digestion Gastric emptying to propel food into small intestine
Gastric Motility
Functionally, Stomach is divided into: Proximal motor unit Distal motor unit
Gastric Motility
Proximal Motor unit: - fundus + 2/3 of body - Thin wall - Storage of food - receptive relaxation; is a vagovagal reflex relaxation of stomach in response to gastric distension with food, making stomach accommodates up to 1.5 L without marked increase in intragastric pressure
Gastric Motility
Distal Motor unit: last 1/3 of body + antrum Thick wall Shows strong peristalsis so its function is mixing (mechanical digestion) + emptying of food - Has pacemaker cells in midpoint of greater curvature (cells of Cajal) generating slow wave (35/min), which when reaching firing level spike potentials contractions (propulsion & retropulsion)
Gastric Emptying
Takes about 3 hours
Factors affecting gastric Emptying
I- Food Factors: - Solid food particles should be reduced to the size of 1 mm3 to pass to duodenum - Consistency of food - Type of food; Ptn + fat slower rate of emptying
Factors affecting Gastric Emptying
II- Gastric Factors: rate of emptying - Nervous; Gastric distension long vagovagal reflex + short enteric reflex - Hormonal; gastric distension + decreased acidity + digestion products stimulates Gastrin H secretion from G antral cells rate of emptying
Factors affecting Gastric Emptying
III- Intestinal Factors: rate of gastric emptying - Nervous (enterogastric reflex); - the most important factor - Hormonal (enterogastrone); CCK, Secretin, GIP, VIP & motilin
During interdigestive periods (fasting)
There are periodic gastric contractions (migrating myoelectric complex) Mediated by motilin Occurs at 90 min interval Serve to clear the stomach from any residuals from previous meal
Hunger Contractions
Intense gastric rhythmic peristaltic contractions Usually starts 24 hours of starvation, reaching peak in 3-4 days Mechanism: blood glucose level stimulation of hypothalamic feeding (hunger) centre sending impulses to cerebral cortex vagal nucleus in medulla long nervous reflex (+) of peristalsis (hunger contractions)
Summary in Figures
Regulation of Gastric Secretion
Which Phase?
Regulation of Gastric secretion Which Phase?
Regulation of Gastric Secretion Which Phase?
Regulation of Gastric Emptying
Good Luck
