[THE GASTROINTESTINAL SYSTEM] Dr.

Sanchez
GI tract - An open system/ hollow tube extending from the mouth to the anus - Includes accessory glands that assist in food digestion - Moves food along its tract Functions of the GI tract 1. Motility: moves food along its tract 2. Secretion: of digestive juices 3. Digestion: occurs mainly in the small intestine; minimal in the stomach and large intestine 4. Absorption : of water, electrolytes and digestive products 5. Circulation of blood through the gastrointestinal organs to carry away the absorbed substances Organs 1. Alimentary tract hollow tube where food passes from the mouth going down to the anus. 2. Accessory organs organs that assists in digestion and mechanically such as pancreas, liver. Anatomy of the GI wall: 4 layers 1. Mucosa innermost mucous membrane lines the lumen made up of simple columnar epithelium with mucous-secreting goblet cells consists of lamina propia, muscularis mucosa, and mucous membrane Lamina propia - underlying loose connective tissue that contains blood vessels, lymph vessels, sensory nerve endings, and scattered lymphatic tissues a. Muscularis mucosa - layer of smooth muscle mainly for peristalsis Functions of the Mucosa 1. Protects underlying tissue 2. Absorbs digested material 3. Secretes digestive juices 4. Increases surface area for absorption Presence of folds in the mucosa Presence of villi in the small intestine 2. Submucosa loose connective tissue contains blood vessels and lymphatics nerves from the ANS o Forms the submucosal plexus o o component of the intrinsic nervous system of the GI tract regulates glandular secretions

3. Muscularis externa - with an inner circular and outer longitudinal layers a. Inner circular layer Contraction: decreased lumen size Forms sphincter muscle that is tonically contracted to prevent backflow of material b. Outer longitudinal layer Contraction: peristalsis (propulsion of food) and mixing of food 4. Serosa outermost layer of the GI wall a. inner sublayer: fibrous connective tissue; for structural support b. outer sublayer: mesothelium; secretes lubricating fluid allowing organs to slide past one another *Meissners nerve plexus - located in between submucosa and muscularis externa which affects secretory function *Myenteric nerve plexus - located in between the inner circular and the outer longitudinal layers of the muscularis externa which affects motility function Peritoneal cavity - space between visceral peritoneum (covers organs) and parietal peritoneum -both visceral and parietal peritoneum secretes serous fluid into the peritoneal cavity

Hormonal control of GI functions Types of secretion 1. Endocrine

[THE GASTROINTESTINAL SYSTEM] Dr. Sanchez

Hormones are produced by endocrine cells and released into circulation to exert effect on remote target organs - eg. Gastrin- secreted by G cells of the stomach antrum with primary actions of (1) stimulation of gastric acid secretion (2) stimulation of growth of the gastric mucosa 2. Paracrine - secreted by cells into the extracellular uid and affect neighboring cells of a different type. 3. Neurocrine - are secreted by neurons into the circulating blood and inuence the function of cells at another location in the body. Functions of GI Hormones 1. Regulate secretion and motility of the GI tract eg.gastrin- regulates HCl secretion and gastric emptying 2. Trophic action- action on the surface eg. Gastrin acts on the stomach and duodenum mucosa 3. Regulate release of other hormones eg. Gastrin Inhibitory Peptide (GIP) regulates release of insulin SS- regulates release of GH and gastrin Nervous Control of GI Function Two types of nervous system control in the GI tract 1. Intrinsic control - largely a function of local enteric reflexes, making use of the meissners and myenteric plexuses 2. Extrinsic control- uses higher control a. Parasympathetic- generally stimulates GI function b. Sympathetic- generally inhibits GI function Innervations of the GI tract Autonomic control a. Vagus nerve: innervates most of the GI tract including esophagus, stomach, pancreas, small intestine, and the proximal half of the large intestine b. Pelvic/Sacral nerve: innervates the distal half of the large intestine and all the way to the anus *parasympathetic stimulation: increased motility, increased glandular secretion (except gut sphincters) - acetylcholine as neurotransmitter; preganglionic *sympathetic stimulation: decreased motility, decreased glandular secretion - noreadrenaline as neurotransmitter; postganglionic Enteric/ Intrinsic nervous System

Control: o Myenteric/ Auerbachs plexus- motility stimulation: increased tonic contraction, or tone of the gut wall, intensity of rhythmical contractions, slightly rate of rhythmical contraction, velocity of conduction of excitatory wavesrapid movt of peristaltic waves o Submucosal/ Meissners plexus- secretion and local blood flow Sensory nerve endings originating from the epithelium send afferent fibers to both plexuses as well as to the prevertebral ganglia, spinal cord, and brain stem

[THE GASTROINTESTINAL SYSTEM] Dr. Sanchez

Gastrointestinal Reflexes - enteric nervous system and its connections with the sympathetic and parasympathetic systems support three types of gastrointestinal reexes 1. Reexes that are integrated entirely within the gut wall enteric nervous system 2. Reexes from the gut to the prevertebral sympathetic ganglia and then back to the gastrointestinal tract 3. Reexes from the gut to the spinal cord or brain stem and then back to the gastrointestinal tract General Functional Characteristics 1. Lower excitability, slower contraction and relaxation 2. Higher extensibility 3. Tonic contraction 4. Autorhythmicity 5. More sensitive to stretch, chemicals, cold and warm stimulation, but not to electrical stimulation Electrical Activity of the GI Smooth Muscle body temperature and metabolic activity o extrinsic and intrinsic nerves o hormones 2. Spike potentials - true action potentials - occurs when RMP becomes more positive than -40 mV (RMP: -50 - -60 mV) - generated due to entry mainly of calcium and smaller numbers of sodium - factors causing depolarization: a. stretching of the muscle b. stimulation by acetylcholine c. stimulation by parasympathetic nerves d. stimulation by GI hormones - hyperpolarization is stimulated by norepinephrine and sympathetic; makes smooth muscle less excitable fewer or absent contraction Musculature of the GI Tract all smooth muscles except: o upper third of esophagus (striated) o middle third of esophagus (mixed) o external anal sphincter (striated) *areas of striated muscles are areas under conscious control Structure Function Interstitial cells of Cajal Production of slow waves Smooth muscle cells Depolarization and opening of Ca2+ channels leading to production of an action potential Autonomic axon Neural input to ICC and smooth muscles Gastrointestinal Blood Flow Splanchnic circulation o

Types of electrical waves: slow waves, spikes 1. Slow waves - Basic electrical rhythm, changes in resting membrane potential - 3-12 cpm depending on the area of the GI tract: 3/min in the stomach;12/min in the small intestine - Produced by the interstitial cells of Cajal (electrical pacemakers) - Always present but do not always cause contraction - Frequency of contraction is dictated by the frequency of slow waves - Slow wave frequency and height are modulated by:

[THE GASTROINTESTINAL SYSTEM] Dr. Sanchez

dual: it includes the blood flow through the gut itself plus blood flows through the spleen, pancreas, and liver - all blood from the gut, spleen and pancreas flows into the liver via the portal vein GI Motility Patterns - function of the contraction of the muscularis externa - 2 methods: a. Peristalsis- forward propelling motion produced by alternating slow waves of contraction and relaxation of muscularis externa layer - occurs due to contraction of one part of the GI wall with simultaneous relaxation of the wall ahead -propels food along the tube o o Lips and cheeks- keep food in the mouth Palate- forms roof of the mouth Hard palate- forms a hard surface against which food is pushed during chewing Soft palate- closes nasopharynx during swallowing Salivary glands Parotid gland: largest; anterior to ears Submandibular gland: inferior to the jaw Sublingual gland: beneath the tongue

- Stimuli: distention of the gut, chemical or physical irritation, strong parasympathetic nervous signals Segmentation- food within lumen gets mixed up -occurs due to rhythmic, local contraction of the smooth muscles of muscularis externa -mechanically grinds food in the stomach and intestine mixing it with digestive juices Propulsion and Mixing of Food in the Alimentary Tract INGESTION - Begins in the mouth - Includes mechanical fragmentation and .. Organs and associated structures: o Tongue mixes food with saliva during chewing Initiates swallowing Contains taste buds o Teeth tear and grind food Designed for chewing (mastication) b.

PROPULSION Swallowing- reflex response where food is moved from pharynx to esophagus - Swallowing reflex is triggered by food movement into the pharynx - Governed mainly by nervous control o Nerves: CN IX,X,XI o Brainstem: medulla oblongata, pons o Disorder: dysphagia (difficulty in swallowing) aphagia (inability to swallow)

Components of the swallowing reflex 1. Soft palate rises 2. Epiglottis covers opening of larynx

[THE GASTROINTESTINAL SYSTEM] Dr. Sanchez

3. Peristaltic contraction along the pharyngeal and esophageal wall propels food to the GI 4. Relaxation of lower esophageal sphincter to allow food to enter stomach ESOPHAGUS Usually collapsed 3 Constrictions: aortic arch, primary bronchus, diaphragm Surrounded by: SNS plexus, blood vessels Fxn: secretes mucous, transports food No digestion nor absorption occurs; mainly secretion and motility Sphincters: upper sphincter, lower sphincter (both are not anatomical sphincters) Abnormality: o Achalasia (enlarged esophagus, mega esophagus) o Atresia o Hernia o Barrets esophagus o Esophageal varices STOMACH Major digestive organ Main fxn: o Storage: can distend to accommodate food; able to hold 1-1.5 L o Preparation of chyme: food mixes with gastric secretions forming a semifluid chyme o Stomach emptying Empty stomach- walls collapse forming folds (rugae; rugae are present more on the greater curvature) Full stomach- rugae smooth out Modifications are based on: o Greater churning/ mixing ability o Mechanical breakdown of food Layers: o Circular layer o Longitudinal layer o Oblique layer- additional innermost layer

Parts of the stomach o Fundus o Body o Antrum o Pylorus Reservoir part: fundus + upper third of the body Antral pump: plays major role in gastric emptying

Receptive relaxation- triggered by swallowing reflex Adaptive relaxation- triggered by stretch receptors along stomach wall (vaso-vagal reflex) - Lost in vagotomy - Threshold of fullness and pain Feedback relaxation- triggered by chyme in the intestine