Gastrointestinal Physiology PDF

Gastrointestinal Physiology Enas Sabah MSc. Human Physiology  General Principles of Gastrointestinal Function The alimentary tract provides the body with a continual supply of water, electrolytes, vitamins, and nutrients. achieving this requires : 1. movement of...

Gastrointestinal Physiology Enas Sabah MSc. Human Physiology  General Principles of Gastrointestinal Function The alimentary tract provides the body with a continual supply of water, electrolytes, vitamins, and nutrients. achieving this requires : 1. movement of food through the GIT 2. secretion of digestive juices and digestion of the food 3. absorption of water, various electrolytes, vitamins, and digestive products 4. circulation of blood through the GI organs to carry away the absorbed substances 5. control of all these functions by local, nervous, and hormonal systems. Physiologic Anatomy of the GI Wall Submucosal plexus  Characteristics of GIT wall: layers from outside towards the lumen: 1. Serosa. 2. Longitudinal muscle layer. 3. Circular muscle layer. 4. Submucosa. 5. Mucosa  Electrical Activity of Gastrointestinal Smooth Muscle Slow Waves They are slow, undulating changes in the resting membrane potential. Their intensity usually varies between 5 and 15 millivolts  Spike Potentials: They are true action potentials. occur automatically when the resting membrane potential of the GI smooth muscle becomes more positive than about −40 millivolts. The normal resting membrane potential in the smooth muscle fibers of the gut is between −50 and −60 millivolts).  Factors that depolarize the membrane”make it more excitable”: 1. stretching of the muscle 2. stimulation by acetylcholine 3. stimulation by several GI hormones. Factors that make the membrane potential more negative ”hyperpolarize the membrane” make the muscle fibers less excitable: 1. the effect of NE or EP on the fiber membrane 2. stimulation of the sympathetic nerves that secrete mainly NE at their endings.  The slow waves do not cause calcium ions to enter the smooth muscle fiber (only sodium ions). Therefore, the slow waves by themselves usually cause no muscle contraction. Instead, it is during the spike potentials, generated at the peaks of the slow waves, that significant quantities of calcium ions do enter the fibers and cause most of the contraction.  Neural Control of Gastrointestinal Function—Enteric Nervous System The GI has its own nervous system called the enteric nervous system. It lies entirely in the wall of the gut, beginning in the esophagus and extending all the way to the anus. It's composed of 2 plexuses: 1. myenteric plexus an outer plexus lying between the longitudinal and circular muscle layers. 2. submucosal plexus an inner plexus, that lies in the submucosa.  The myenteric plexus controls mainly the GI movements submucosal plexus controls mainly GI secretion and local blood flow. Although the ENS can function independently, stimulation by the parasympathetic and sympathetic systems can greatly enhance or inhibit GI functions.  The myenteric plexus is not entirely excitatory because some of its neurons are inhibitory their fiber endings secrete an inhibitory transmitter, like vasoactive intestinal polypeptide (VIP) or other inhibitory peptide. The resulting inhibitory signals are useful for inhibiting some of the intestinal sphincter muscles that impede movement of food along segments of the GI tract, such as the pyloric sphincter, which controls emptying of the stomach into the duodenum.  The submucosal plexus, is mainly concerned with controlling function within the inner wall many sensory signals originate from the GI epithelium and are then integrated in the submucosal plexus to help control local intestinal secretion, local absorption.  Autonomic Control of the Gastrointestinal Tract The parasympathetic supply to the gut is divided into cranial and sacral divisions. The cranial parasympathetics provide extensive innervation to the esophagus, stomach, and pancreas and somewhat less to the intestines down through the first half of the large intestine. The sacral parasympathetics originate in the 2nd , 3rd , and 4th sacral segments of the spinal cord and pass through the pelvic nerves to the distal half of the large intestine and all the way to the anus.  Stimulation of parasympathetic nerves causes general increase in activity of the entire ENS. This in turn enhances activity of most GI functions.  The sympathetic fibers to the GIT originate in the spinal cord between segments T5 and L2. The sympathetics innervate essentially all of the GIT, rather than being more extensive nearest the oral cavity and anus, as the parasympathetics. The sympathetic nerve endings secrete mainly NE & small amounts of EP. stimulation of the sympathetic NS inhibits activity of the GIT, causing effects opposite to those of the parasympathetic system. Strong stimulation of the sympathetic system can inhibit motor movements of the gut so greatly that this can block movement of food through the GIT. Afferent Sensory Nerve Fibers from the Gut Many afferent sensory nerve fibers innervate the gut. Some of them have their cell bodies in the ENS itself and some in the spinal cord. These sensory nerves can be stimulated by (1) irritation of the gut mucosa. (2) excessive distention of the gut. (3) presence of specific chemical substances in the gut. Hormonal Control of Gastrointestinal Motility  GIT blood flow: splanchnic circulation include the blood supply to the GIT, Spleen, liver & pancreas. The blood passes to the liver to remove the bacteria & the other harmful substances to prevent its passage to the general systemic circulation.  Propulsion and Mixing of Food in the Alimentary Tract Mastication (Chewing) The teeth are designed for chewing. The anterior teeth (incisors) provide a strong cutting action and the posterior teeth (molars) a grinding action. Most of the muscles of chewing are innervated by the motor branch of the 5th cranial nerve (trigeminal), and the chewing process is controlled by nuclei in the brain stem.  Swallowing (Deglutition) swallowing can be divided into 1. a voluntary stage, which initiates the swallowing process (food is squeezed into the pharynx by pressure of the tongue upward and backward). 2. pharyngeal stage, which is involuntary and constitutes passage of food through the pharynx into the esophagus. 3. esophageal stage, also involuntary phase that transports food from the pharynx to the stomach.  Function of the stomach 1. motor function 2. secretory function  Motor Functions of the Stomach 1. storage of large quantities of food until the food can be processed. Gastric distention cause relaxation of the stomach to ↑capacity to 1- 1.5 L. 2. mixing of this food with gastric secretions until it forms a semifluid mixture called chyme 3.slow emptying of the chyme into the small intestine at a rate suitable for proper digestion and absorption by the small intestine.  Stomach or gastric Emptying promoted by intense peristaltic contractions in the stomach antrum. Most of the time, the rhythmical stomach contractions are weak and function mainly for mixing of food and gastric secretions. Then the contractions become intense, beginning in midstomach and spreading through the distal part of the stomach; these contractions are strong peristaltic,very tight ringlike constrictions that can cause stomach emptying.  Regulation of Stomach Emptying Gastric Factors that Promote Emptying: Increased food volume in the stomach Gastrin hormon has mild to moderate stimulatory effects on motor functions in the body of the stomach. Powerful Factors That Inhibit Stomach Emptying (Duodenal factors) When food enters the duodenum, multiple nervous reflexes are initiated that strongly inhibit the “pyloric pump” propulsive contractions, and ↑ tone of the pyloric sphincter. The factors that can initiate enterogastric inhibitory reflexes include the following: 1. The degree of distention of the duodenum 2. The presence of any degree of irritation of the duodenal mucosa  3. The degree of acidity of the chyme 4. The degree of osmolality of the chyme 5. The presence of certain breakdown products in the chyme, especially breakdown products of proteins and to a lesser extent, of fats  Small intestine Function Digestion : Enzymes are intracellular (Disaccharidases and aminopeptidases). Absorption: completed in s. intestine, large surface area (as large as a tennis court area). (Site where most digestion and absorption take place). Secretion Motility Secretion of digestive enzymes by the brush border of the villi The enterocytes of the mucosa, especially those that cover the villi, contain digestive enzymes that digest specific food substances while they are being absorbed through the epithelium. These include: a- Several peptidases for the splitting of small polypeptides into AA. b- Disaccharidases which breaks disaccharides into monosaccharides. c- Small amounts of lipases for the digestion of fat.  Defecation Reflexes There are 2 types of defecation reflexes 1. The intrinsic reflex mediated by the local enteric nervous system in the rectal wall. distention of the rectal wall initiates afferent signals through the myenteric plexus Initiate peristaltic waves in the descending colon, sigmoid, and rectum, forcing feces toward the anus. internal anal sphincter is relaxed by inhibitory signals from the myenteric plexus external anal sphincter is also consciously, voluntarily relaxed at the same time defecation occurs 2. The parasympathetic reflex that involve the sacral segments of the spinal cord Nerve endings in the rectum are stimulated Signals are transmitted into the spinal cord Then reflexl back to descending colon, sigmoid & rectum (by pelvic parasympathetic Nerve fibers) Intensify the peristaltic waves &relax internal anal sphincter external anal sphincter is also consciously, voluntarily relaxed defecation occurs  Secretory Functions of the GIT Secretory glands have two primary functions: 1. secrete digestive enzymes are secreted in most areas of the GIT 2. provide mucus for lubrication and protection of all parts of GIT.  Basic Mechanisms of Stimulation of the GIT Glands contact of Food with the Epithelium Stimulates Secretion(direct contact stimulation of the surface glandular cells by the food). Parasympathetic Stimulation GIT Glandular Secretion Rate. Sympathetic Stimulation Has a Dual Effect (sympathetic stim. alone secretion parasympathetic stim. the secretion  Esophageal secretions They are entirely mucous and provide lubrication for swallowing. The main body of the esophagus is lined with many simple mucous glands.  Homework 1. Gastric Secretions? secretions of oxyntic glands and pyloric glands? Relationship with Pernicious anemia? Phases of Gastric Secretion?(3 phases) Anatomical Types of Glands (oxyntic) (Peptic)  Pancreatic Secretion The pancreatic digestive enzymes are secreted by pancreatic acini & large volumes of sodium bicarbonate solution are secreted by the small ductules and larger ducts leading from the acini. The combined product (enzymes +sodium bicarbonate) flows through a long pancreatic duct that joins the common bile duct.  The pancreatic enzymes for digesting proteins are trypsin, chymotrypsin & carboxypolypeptidase. Trypsin and chymotrypsin split whole and partially digested proteins into peptides of various sizes but do not cause release of individual amino acids. Carboxypolypeptidase splits some peptides into individual amino acids, thus completing digestion of some proteins all the way to the amino acid state.  For digesting carbohydrates there is pancreatic amylase, which hydrolyzes starches, glycogen, and most other carbohydrates to form disaccharides and a few trisaccharides. The main enzymes for fat digestion are 1. pancreatic lipase, which is capable of hydrolyzing neutral fat into fatty acids and monoglycerides 2. cholesterol esterase, which causes hydrolysis of cholesterol esters 3. phospholipase, which splits fatty acids from phospholipids.  Secretion of Bile by the Liver One of the many functions of the liver is to secrete bile, Bile serves two important functions A- bile plays an important role in fat digestion and absorption, because bile acids in the bile do two things: 1. They help to emulsify the large fat particles of the food into many minute particles, which can then be attacked by lipase enzymes secreted in pancreatic juice 2. aid in absorption of the digested fat end products through the intestinal mucosal membrane. B- bile serves as a means for excretion of several important waste products from the blood. These include especially bilirubin, an end product of hemoglobin destruction, and excesses of cholesterol. Reference: Gyton and Hall text book of medical physiology.