Gastrointestinal tract
Physiology
Dr. Suaad M. Ghazi
MBChB, MSc, PhD
Objectives of lecture 1
1. Describe the gross and
microscopic anatomy and the
basic functions of the digestive
system.
2. Explain enteric nervous
system that control most GI
functions.
3. Explain types of GIT
movements.
The primary function of
the alimentary tract is to
break down food and to
provide the body with a
continual supply of
water, electrolytes and
nutrients. To achieve this
function, the GIT must
performs the following
processes: ingestion,
movement, digestion,
absorption, secretion
and defecation.
GIT is a tube running
through the body from
mouth to anus.
Digestive
Secretion and
Absorption of
Water
Figure 24.27
The Components of the Digestive
System
Figure 24.1
Anatomical features:
the structures that make up the wall of the (GIT) from the posterior
pharynx to the anus generally are from the outer surface inward:
1. Serosa which continues on to the mesentery, which contains the nerves,
lymphatics, and blood vessels supplying the tract.
2. Longitudinal muscle.
3. Myenteric (Auerbach’s) p1exus which controls mainly the GIT movement.
4. Circular muscle which causes a decrease in the diameter of the lumen of
the GIT when it contracts.
5. Submucous (Meissner’s) plexus which is important in controlling
secretion and blood flow and also subserves many sensory functions,
receiving signals from chemoreceptors in the gut epithelium and from
stretch receptors in the gut wall.
6. Mucosa which consists of epithelium and subepithelial connective tissue
and are specialized for secretion and absorption.
The structure of the esophagus is similar except that it has no mesentery.
Histological cross section of the
digestive tract
The GIT activity is controlled by:
1. Interinsic nervous system
Which can be modified by:
2. Extrinsic nervous system
The enteric nervous system :
The GIT has an intrinsic nervous system of its own
called the enteric nervous system which controls
most GI functions, especially GIT movements and
secretion. ENS is composed of two layers of neurons
and connecting fibers, the outer layer is called the
myenteric (Auerbach’s) plexus, the inner layer is
called the submucous (Meissner’s) plexus.
The degree of activity of this ENS can strongly be
altered by extrinsic (autonomic) nervous system,
parasympathetic and sympathetic nervous systems.
PNS & SNS send signals to GIT from the brain and
spinal cord to modulate the activity of the enteric
nervous system.
1. Intrinsic nervous system
[Enteric Nervous
System]
Submucosal plexus
Controls secretion through:
excitatory neurotransmitter [Ach]
Myenteric plexus
controls motility through:
Excitarory neurotransmitters [Ach
and substance P]
Inhibitory neurotramsmitter[ VIP,
nitric oxide]
Stimulation of the parasympathetic nerves fibers releases
Ach and causes a general increase in activity of the entire
ENS which in turn enhances the activity of most GIT
functions, but causing sphincters to relax (except the lower
esophageal sphincter, which they stimulate), however,
some of enteric neurons are inhibitory and, therefore
inhibit certain functions.
The parasympathetic supply to the gut is divided into :
Cranial division : Is mediated almost entirely through
the vagus (X CN). Innervate esophagus, stomach,
pancreas, gallbladder and first half of the large intestine,
and little innervations to the small intestine
Sacral division : originates in S2, 3, 4 sacral
segments of the spinal cord, and pass through the pelvic
nerves to the distal half of the large intestine. These fibers
function especially in the defecation reflex.
The sympathetic nerve endings secrete NE.
In general, stimulation of the SNS inhibits activity in
the GIT, while causing sphincters to contract causing
effects essentially opposite to those of the PNS.
The sympathetic nerve fibers to the GIT originate in the
spinal cord between the segments T - 8 and L - 2.
The preganglionic fibers after leaving the cord, pass
through the sympathetic chains to outlying ganglia,
such as the celiac, hypogastric, and mesenteric
ganglia. Here, the postganglionic neuron bodies are
located, and postganglionic fibers spread from them
along with the blood vessels to all parts of the gut,
terminating principally on neurons of the enteric
nervous system.
Therefore, reflexes of GIT are either occur
entirely within the enteric nervous system
(short reflex arc)
Or
the reflex arc is originated from the gut
and to the CNS (spinal cord or brain stem)
and then back to the gut (long
reflex arc)
Signals transmitted through these reflexes
can cause reflex excitation or inhibition of
intestinal movements or secretion.
Long reflex arc
Short reflex arc
GIT Motility
1. Phasic Contractions
Peristalsis
Segmentation
[Muscles contract and relax in seconds]
2. Tonic Contractions
Sphincters
[Contractions maintain over minutes or hours]
Types of GIT smooth muscle contractions
The smooth muscle of GIT is almost exclusively unitary
smooth muscle while that of pharynx, upper one third
of the esophagus, and external anal sphincter are
striated muscles. There are two main types of smooth
muscle contractions:
Phasic (rhythmical) contractions that occur in the
esophagus, stomach, and intestine. They include
peristaltic , migrating Motor Complex (MMC),
segmentation and haustration contractions.
Tonic contractions that occur in the lower esophageal
sphincter, pyloric sphincter, ileocecal sphincter, and
internal anal sphincter. Tonic contraction is
continuous, occasionally increases or decreases in
intensity.
In peristalsis, contraction of a small section of
proximal muscle relaxation of the muscle just
distal to it wavelike motion moves food
along the GIT.
Peristaltic wave could be of two types:
Primary peristaltic wave which is a continuation
of the peristaltic wave that begins proximally and
mediated by vagovagal reflexes, long reflex arc.
Secondary peristaltic wave which is generated
by the enteric nervous system (short reflex
pathway), initiated from the distension of the
viscus by the retained food.
MMC is a distinct pattern of electromechanical activity
observed in gastrointestinal smooth muscle during the
periods between meals, and it is interrupted by feeding.
Serve a "housekeeping" role and sweep residual
undigested material through the digestive tube.
Recurs every 1.5 to 2 hours.
Facilitate transportation of indigestible substances
such as bone, fiber, and foreign bodies.
The MMC is thought to be partially regulated by
motilin.
It is initiated in the stomach as a response to vagal
stimulation. Vagotomy abolishes the motor activity in
the stomach, but leaves the periodic activity in the
small bowel intact.
In segmentation contraction, nonadjacent
segments of alimentary tract organs,
especially small intestine, contract and relax
moving food forward then backward food
mixing.
It is primary motility pattern as irregular and
uncoordinated contraction of the circular
muscle layer.
It develops in response to intestinal wall
distention.
It is determined by activation of
preprogrammed neural circuits within the
myenteric plexus.
The combined contractions of
the circular and longitudinal
smooth muscle cause the
unstimulated portion in large
intestine to bulge outward into
baglike sacs called haustration
fecal material in the large
intestine is squeezed, moving
back and forth along the colon.
Peristalsis: Waves that move a
bolus forward
Motility
Segmentation
n
Figure 14.3B
Segmentation contractions in the small intestine
Paralytic ileus
is a temporary cessation of gut motility
that is most commonly caused by
abdominal surgery.
Other common causes
appendicitis, hypokalemia, and
narcotics.
Signs and symptoms of paralytic ileus
include nausea and vomiting,
abdominal distension, and absent bowel
sounds.
