Gastrointestinal (GI)

system
Objectives
• To discuss on peristalsis and motility of gut.

• To discuss on deglutition.

• To discuss on defecation.
Introduction- Cross-section of
Mesentery
• The Gastrointestinal wall from outer to inner surface consists of:
1. Serosa
2. Longitudinal smooth muscle layer
3. Circular smooth muscle layer
4. Submucosa
5. Mucosa
Motility
• Initiated by slow, intrinsic activity inside GI smooth muscle.

• Electrical pacemaker for smooth muscle cells: Interstitial cells of Cajal.

• Motility depend on interaction between smooth muscles and cells of Cajal.

• Change in voltage of Resting membrane potential.

• Entry of calcium ions causes contraction of smooth muscles.

Figure: Membrane potentials in intestinal smooth muscle
GI hormonal action with stimuli and
site of secretion
Nervous system of gut wall
1. Myenteric and Submucosal plexuses
(black fibers).

2. Extrinsic control of above plexuses by

sympathetic and parasympathetic
(autonomic) nervous system (red fibers).

3. Sensory fibers passing from the luminal

epithelium and gut wall to the enteric
plexuses, then to the prevertebral
ganglia of the spinal cord and directly to
the spinal cord and brain stem (green
fibers).
Figure: Neural control of gut wall
Enteric Nervous System
Myenteric (Auerbach’s plexus) Submucosal (Meissner’s plexus)
Lies in between outer longitudinal Lies in submucosal layer of gut wall.
and inner circular muscle layers. Involved more in local conditions like
Helps increasing tone of gut as well as local secretion, absorption and local
velocity and intensity of motility. muscle movements.
Syncytial tissues and
Pacemaker tissues
1. Syncytial tissues
• Numerous gap junctions present in GI smooth muscle cells.
• Easy transmission of electrical impulse from cell to cell.
• So, this accounts for syncytial nature of GI smooth muscle cells.

2. Pacemaker tissues
• There are also pacemaker tissues in GI tract.
• These generate and spread electrical impulse.
Functional types of movement
1. Propulsive movement
• Also called peristalsis.

• Numerous gap junctions make smooth muscle a syncytium.

• Appearance of contractile ring around gut and moving forward.

• Ring spreads along the gut tube.

• Can be elicited after stimulation at any point of gut.

• Usual stimulation being distention.

Stimuli for peristalsis
I. Distention stretching of gut wall stimulation of enteric
nervous system contraction of gut wall 2 to 3 centimeters (cms)
behind that point.

Then contractile ring appears initiating peristaltic movement.

II. Chemical or physical irritation of epithelial lining also initiates peristalsis.

III. Strong parasympathetic nervous signals to gut elicits strong peristalsis.

Law of the gut
• Movement of peristaltic waves towards anus with downstream causes receptive
relaxation.

• Peristaltic wave can occur either towards mouth (orad) or towards anus (caudad).

• Waves towards mouth usually die out rapidly but continues for considerable distance
towards anus.

• Probably due to polarization of myenteric plexus in anal direction.

• Stimulation Peristalsis contractile ring at orad side of distended segment  pushing

intestinal contents in aboral or anal direction for 5 to 10 cms and dies out.
2. Mixing or segmental contractions

• Differs in different parts of alimentary tract.

• Peristaltic contractions cause most of mixing.

• Local intermittent constrictive contractions, occurring every few centimeters in

the gut wall causes mixing.

• These constrictions lasting only for 5 to 30 seconds followed by new constriction

occurring at other points in gut helps ‘chopping’ and ‘shearing’.

• These peristaltic and constrictive movements are modified in different parts of GI

tract for proper propulsion and mixing.
Mixing and propulsion of food in
stomach
• As long as food is in stomach, weak peristaltic constrictor waves (mixing wave)
occur.
• Begins in mid to upper portions of stomach wall and move toward the antrum
once every 15 to 20 seconds.
• These waves are initiated by gut wall basic electrical rhythm consisting ‘slow
wave’ that occur spontaneously in the stomach wall.
• Becomes more intense as constrictor waves progress from body to antrum of
stomach.
• Some become extremely intense providing powerful peristaltic action potential-
driven constrictor rings.
• This forces antral contents under higher and higher pressure toward the pylorus.
 Swallowing or deglutition

• Swallowing can be divided into 3 stages:

1. Voluntary stage
Initiates swallowing process.

Food squeezed or rolled posteriorly into

pharynx by pressure of tongue upwards
and backwards against the palate.

Then swallowing process almost entirely

automatic.

Then cannot be stopped ordinarily.

Figure: Swallowing mechanism
Continued…
2. Pharyngeal stage
A bolus of food enters the posterior mouth and pharynx.

Stimulation of “epithelial swallowing receptor areas” located around

pharynx, mainly in the tonsillar pillars.

Impulses travel to brainstem from these areas.

Initiation of a series of automatic pharyngeal muscle contractions.

Continued…
Series of automatic pharyngeal muscle contractions occurs as follows:

i. Soft palate pulled upwards.

ii. Palatopharyngeal folds on each side of pharynx pulled medially to approximate each
other.
iii. Vocal cords strongly approximated, and larynx is pulled upwards and anteriorly by the
neck muscles.
iv. Upward movement of the larynx also pulls up and enlarges opening to esophagus.
v. Once larynx is raised and pharyngo-esophageal sphincter relaxes, entire muscular wall
of pharynx contracts, then food is propelled into esophagus by peristalsis.
vi. Between swallows, sphincter remains strongly constricted to prevent air going into
esophagus during respiration.
Nervous initiation of pharyngeal
stage of swallowing
• Impulses arise from around pharyngeal opening.

• Transmitted by sensory portion of 5th and 9th cranial nerves into the medulla oblangata.

• The successive stages of swallowing is initiated automatically in orderly sequence by

neuronal areas of reticular substance of medulla and lower pons.

• These are collectively called swallowing or deglutition center in medulla and lower
pons.

• The motor impulse from swallowing center to pharynx and upper esophagus are
successively transmitted by 5th, 9th, 10th and 12th cranial nerves.
Swallowing contd….
3. Esophageal stage
• For passage of food from mouth to stomach.
• Peristalsis occur which can be primary or secondary.

i. Primary peristalsis
• Occurs as continuation of peristalsis in pharynx.
• Spreads into esophagus during pharyngeal stage of swallowing.

ii. Secondary peristalsis

• Occur when food retained in esophagus distends esophagus.
• Continue until all contents are emptied into stomach.
Receptive relaxation of stomach
during swallowing
• Esophageal peristaltic waves when approaches stomach, wave of relaxation occur.

• Is transmitted through myenteric inhibitory neurons.

• This relaxation is called receptive relaxation and it precedes peristalsis.

• Entire stomach, and to a lesser extent, even duodenum become relaxed as wave
reaches lower end of esophagus.

• This way stomach and duodenum receive food propelled into esophagus during
swallowing act.
Role of constrictor rings during
mixing
• Peristaltic wave passes down the antral • Most antral contents squeezed upstream
wall towards pylorus. through peristaltic rings towards body of
stomach backwards.

• Digs deeply into food contents in the

antrum. • Moving constrictive rings combined with
upstream squeezing action is called
retropulsion.
• With each peristalsis, the pyloric muscle
often contracts impeding stomach • Retropulsion thus is exceedingly important
emptying. for components mixing in stomach.

• Only few milliliters of food passed into • After mixing thoroughly with gastric
duodenum due to small opening of secretions, resulting component passing
pylorus. down gut is called “chyme”.
 Stomach emptying
• Passage of chyme opposed by varying degrees of resistance at pylorus.

• Thus, peristaltic waves, beginning in midstomach and spreading through caudad stomach in
addition to mixing also provide pumping action called “pyloric pump”.

• Pyloric circular muscle tonically constricted result in pyloric sphincter.

• When pyloric tone normal, each peristaltic wave forces several millilitres of chyme into
duodenum.

• This constriction helps in well mixing with chyme before passing to duodenum.

• Degree of constriction increased or decreased under influence of nervous and hormonal

signals from stomach and duodenum.
Stomach emptying
• Antrum, pylorus and upper duodenum function as a unit.
• Antral contraction followed by sequential contraction of pyloric region and
duodenum.
• Partial contraction ahead of advancing gastric contents prevents solid masses
from entering duodenum.
• Are mixed and crushed instead.
• Normally, no regurgitation from duodenum as contraction of pyloric segment
persist a bit longer than that of duodenum.
• Action of cholecystokinin (CCK) and secretin on pyloric sphincter also prevent
regurgitation.
Regulation of gastric motility
and emptying
• Rate of emptying depends upon type of food ingested.

• Food rich in carbohydrate leaves stomach slowly, rich in proteins more slowly and
emptying is slowest for food containing fats.

• Also depend upon osmotic pressure of material entering duodenum due to

presence of duodenal osmoreceptors.

• Hyperosmolar contents initiate decreased emptying  neural regulation.

• Fats, carbohydrates and acid in duodenum inhibit gastric acid and pepsin
secretion and gastric motility via neural and hormonal mechanism.
Small intestine motility
• Intestinal contents mixed with mucosal cell secretions and with pancreatic juice
and bile.

• Peristalsis and contractions controlled by basic electrical rhythm (BER).

• Average of 12 BER per minute in the proximal jejunum declining to 8 per minute
in distal ileum.

• Peristalsis, segmentation contraction and tonic contractions occur.

• Peristalsis propels chyme towards large intestine.

Continued…
• Segmentation contraction moves chyme to and fro enhancing more mixing as
well as increasing exposure for absorption of nutrients.

• Contraction initiated by focal increase in calcium influx with waves of increased

calcium concentration spreading from each focus.

• Tonic contractions relatively prolonged that in effect isolate one segment of

intestine from another.

• Segmentation and tonic contractions longer in duration due to slow transit time.
Functions and movement in
colon
• Principal functions of colon are:

1. Absorption of water and

electrolytes from chyme.

2. Storage of fecal matter until

expelled.

• Movements can be divided once

again into mixing movements and
propulsive movements.
Figure: A human colon
Mixing movements
• Large circular constrictions occur.

• About 2.5 centimeters of circular muscle contract, sometime occluding the

lumen.

• Longitudinal muscle of the colon, aggregated into 3 longitudinal strips called

teniae coli, contracts.

• This combined contraction of circular and longitudinal strips of muscle cause

unstimulated portion to bulge outwards into bag like sacs called
“haustrations”.
Propulsive movements-Mass
movements
• Results from slow but persistent haustral contractions.
• Requires 8 to 15 hours to move chyme from ileocecal valve through
the colon.
• Mass movement from cecum to sigmoid take over propulsive role.
• For about 15 minutes during the first hour of breakfast.
• Series of mass movements usually persists for about 10 to 30
minutes.
• Then cease but returns perhaps half a day later.
• Desire for defecation felt when mass of feces forced into rectum.
Initiation of mass movements
by gastrocolic and duodenocolic
reflexes
• These reflexes result from stomach and duodenum distention.

• The reflexes almost certainly transmitted by way of the autonomic

nervous system.

• Irritation in colon also can initiate intense mass movements. For

example in ulcerative colitis, it persists all the time.
Defecation
• Most of time rectum is empty of feces.

• Partly because of weak functional sphincter existing about 20 centimeters from

anus at junction between sigmoid colon and rectum.

• And partly because of sharp angulation that provide resistance to rectal filling.

• Desire for defecation occurs when mass movements forces feces into rectum.

• This includes reflex contraction of rectum and relaxation of anal sphincter.

• Movement is coordinated by the basic
electrical rhythm of colon.

• Frequency of wave increases along

colon from about 2 per minute at
ileocecal valve to 6 per minute at
sigmoid.

Figure: A human colon

Continued…
• Continue dribble of fecal matter prevented by tonic constriction of:
1. Internal anal sphincter
2. External anal sphincter

• External sphincter is controlled by pudendal nerve fiber, part of

somatic nervous system and therefore is under voluntary, conscious
or at least subconscious control.
Defecation reflex
• Defecation ordinarily initiated by
defecation reflexes.
• As previously, passage of feces into
rectum distends it initiates afferent
signals of myenteric plexus  initiates
peristalsis.
• As peristalsis approaches anus,
internal anal sphincter relaxed by
inhibitory signals of myenteric plexus.
• If the external anal sphincter is also
consciously, voluntarily relaxed at the Figure: Afferent and efferent pathways of the
parasympathetic mechanism for enhancing the defecation
same time, defecation occurs. reflex.
Continued…
• Normally when the intrinsic myenteric defecation reflex is functioning by itself, it is
relatively weak.

• To be effective in causing defecation, it usually must be fortified by another type of

defecation reflex called a parasympathetic defecation reflex.

• It involves the sacral segments of the spinal cord.

• When the nerve endings in the rectum are stimulated, signals are transmitted first into the
spinal cord.

• And then reflexly back to the descending colon, sigmoid, rectum, and anus by way of
parasympathetic nerve fibers in the pelvic nerves.
Thank you.