Lecture 3&4

Stomach and small intestine

Dr Lakmali Amarasiri
Department of Physiology
Objectives: at the end of this lecture, you should be
able to
• List the functions of the stomach
• Describe gastric motility and emptying
• State the composition of gastric juice
• Describe the process of gastric acid secretion and how it is regulated
at parietal level
• Explain the cephalic, gastric and intestinal regulation of gastric acid
secretion
• Describe the gastric mucosal barrier
The stomach LATIN :stomachos, gaster
Endoscopic view of stomach
Functional anatomy of the stomach…..GROSS
• Anatomically 4 parts: PROXIMAL

• fundus
• corpus
DISTAL
• antrum
• pylorus

• Functionally divided as proximal stomach and distal stomach

• Same basic structure of GIT wall

• Muscle layer has 3 layers:
• inner circular
• middle oblique
• outer longitudinal
Gastric glands

Mucous cells

Parietal cells
– acid, intrinsic factor

ECL cells – histamine

Chief cells – pepsinogen

Functions of the stomach
1. Motor function
• stores food
• secretes and mixes food with acid, mucous and pepsin
• participates in digestion (mechanical & chemical)
• releases food at a controlled, steady rate into the duodenum

2. Secretory function
• Pepsinogen,lipase: digestion
• acid: digestion & protective function
• intrinsic factor: vitamin B12 absorption
• gastrin: endocrine function

3. Protective function: gastric mucosal barrier, HCl

4. Absorption : water, ethanol
 Storage function – motility of proximal stomach

• Proximal stomach (fundus & upper body) has a high compliance

• Can accommodate a high volume with small increase in pressure –

• Called ACCOMODATION/ RECEPTIVE RELAXATION

• Mediated by vagal fibres releasing VIP to inhibitory neurons of the

myenteric plexus

• As a result food remains unmixed for upto an hour

 In the fed state…..
• after about an hour (period of receptive relaxation)

• peristaltic contractions start

• contractions increase in velocity and force towards pylorus

• frequency of contractions  3-4 per minute

• Peristaltic contractions
• mix food with secretions
• break down food
• propel food towards duodenum

• Ground food is ejected backwards into the body of the stomach

(retropulsion) and helps to further break down any large particles

• Solids are broken down into to particles less than 2 mm (CHYME)

 Mechanical activity is preceded by gastric myoelectrical activity

•Gastric smooth muscles have a resting membrane potential (-50 to -60mV);

not stable – slow waves

•Gastric slow waves starts from the ‘gastric pacemaker’

– a region of rapid spontaneous depolarization
– along the greater curvature of the stomach
– interstitial cells of CAJAL

•Determines the rate of gastric contractions

 Measuring gastric myoelectrical activity in our unit

Cutaneous electrogastrography
cEGG

Normal activity

Disordered activity – note irregularity

Gastric emptying
• Process of release of chyme into duodenum

• Regulated by antro-pyloro-duodenal coordination

• antrum, pylorus & duodenum function as a unit

• Gastric emptying rate (GER) depends on

• force and frequency of antral contractions
• chemical and physical properties of chyme
• Higher the acidity or osmolality: slower the rate
Effect of type of food on gastric emptying
Regulation of stomach activity
• Parasympathetic activity
• increases force of contraction
• relaxes pyloric sphincter

• Sympathetic activity
• decreases force of contraction
• contracts pyloric sphincter

• Gastrin
• increases peristalsis
 Factors operating in duodenum
• Duodenal receptors detect presence of chyme
• chemoreceptors (acid, concentrations of fat, CHO, proteins)
• osmoreceptors (osmolality)
• stretch receptors (volume)

• Neural and hormonal reflexes

• Low pH : secretin
• Fat : CCK and GIP
• Peptides and amino acids : gastrin, CCK, GIP
• Hypertonic chyme : enterogastrone

• Effect is inhibition of antral contractions and contraction of pyloric

sphincter
Measuring gastric emptying Real time- Ultrasonography

Start of meal

End of meal
 Gastric secretions ‘gastric juice’
About 2.5 L / day
SECRETION CELL LOCATION OF CELL

Hydrochloric acid (HCl)

Pepsinogen
Intrinsic factor
Mucous
Gastrin

Cations
Anions
HCl
• Function
• Kills pathogens
• Activates pepsinogen; starts protein digestion
• Stimulates flow of bile

• pH of gastric juice is very low; 3

• Low pH created by active secretion of H+ into gastric

lumen

• Iry active transport by H+-K+ -ATPase (proton pump)

located in luminal membrane of parietal cells
HCl secretion in parietal cells
HCl formation and secretion in the parietal cell

Primary active
transport
Regulation of HCl secretion in the stomach

NSAIDS

H2
M3 G
CEPHALIC PHASE GASTRIC PHASE INTESTINAL PHASE
 Mucous secretion by the stomach
• Secretion stimulated
by prostaglandins
• Function – “Gastric
Mucosal Barrier”
• Mucins form a gel
coating mucosa
• Traps HCO3- :
creates alkaline
environment
Resistance of gastric mucosa to auto digestion
• Gastric mucosal barrier
• Adequate blood flow
• Trefoil peptides
• Cellular renewal
• Prostaglandins: decrease acid secretion
Gastric mucosal barrier is disrupted by
• Acid
• Ethanol
• Vinegar
• Bile salts
• NSAIDS eg. Aspirin, Indomethacin
• Helicobacter pylori infections
Disorders
• Gastritis

• Gastric atrophy -> pernicious anaemia

• Gastric & duodenal ulcers (peptic ulcers)

• Gastric – reduced defence mechanism
• Duodenal – increased gastric acid
• Role of H Pylori
• Aspirin & other NSAIDs

• Gastrinoma
• Tumor leading to prolonged secretion of acid
 Methods of reducing HCl secretion

• Acid suppression
• H2 receptor blockers
• Proton-pump inhibitors
• Neutralization by antacids M3 H2 G

• H pylori eradication
• Antibiotics

• Surgery
• Gastrectomy
• Vagotomy
Summary
• Gastric secretions
• Functions of gastric secretions
• Regulation of gastric secretion : 3 phases
• HCl secretion and regulation
• Disorders in gastric secretion
• Treatment
Refer
• Pepsinogen
• Intrinsic factor
• Histamine
• Pernicious Anemia
• Helicobacter Pylori
Small Intestine
Objectives: by the end of this lecture, you should be able to

• List the functions of the small intestine

• Explain the digestive functions of small intestinal enzymes
• Outline the digestion of carbohydrates, proteins and lipids
• Discuss the structural adaptations of the small intestine for digestion
and absorption
• Briefly describe the absorption of digestive products in the small
intestine
• State the composition of small intestinal secretions
• Outline the function of small intestinal mucous and how its secretion
is regulated
• Outline the special features of small intestinal motility
 Functions of the Small Intestine

1. Digestion
2. Absorption
3. Motility
4. Endocrine function
5. Immunological function
 Small intestinal enzymes

Enzyme Substrate
• Enteropeptidase • Trypsin
• Amino/ carboxy/ di peptidases • Peptides
• Maltose/ Lactose/ Sucrose • Disaccharides
• Others
• -dextrinase • -dextrins
• Trehalase • Trehalose
• Nucleases
• Nucleic acids
Chemical digestion of food

Protein CHO Fats

Proteins Polysaccharides Fat

 pepsin  salivary amylase  bile salts
phospholipids
Small -limit dextrins Emulsified fats
polypeptides Disaccharides
 Trypsin
 lipase
chymotrypsin  disachcharidases Fatty acids,
Small peptides Monosaccharides monoacylglycerol
 peptidases (Glucose, Fructose, and
Amino acids Galactose) monoglycerides
ENTEROHEPATIC CIRCULATION
Fat malabsorption
• Causes pale, bulky oily, foul smelling stool that is and
difficult to flush

• STEATORRHOEA
Absorption in the small intestine
 water (7500ml/day)
REFER MECHANISMS
 electrolytes
 amino acids
 monosachcharides (glucose,galactose, fructose)
 monoglycerides, glycerol, fatty acids & cholesterol
 minerals (Ca2+, Fe2+, Mg2+ )
 vitamins ( water soluble & insoluble)
 bile salts
Important
• Active transport of Na2+ is associated with absorption of glucose,
some amino acids and other substances
• Presence of glucose facilitates reabsorption of Na2+ ; basis of
treatment of Na2+ and water loss in diarrhoea by administering
‘JEEWANI’ (Oral Rehydration Solution)

• REFER – cholera (Na2+ - glucose transporter unaffected) and

treatment
 UNSTIRRED LAYER
Luminal side of the small
intestine is adapted to
increase surface area for
absorption

• Circular mucosal folds

 retard the speed of
chyme transport

• Villi

• Microvilli
 Form the brush
border
Make a table of where different substances
are absorbed in the gut
Substance Part of gut Mechanism
 Intestinal secretions
• Isotonic fluid ( about 3L/day)
• pH 7.8-8.0

• Water and mineral salts, digestive enzymes, mucous

• Stimulated by intestinal distension and release of VIP

Refer - mucous secretion by the intestines
and its regulation
 Movements of the intestine

Fasting
Migrating motor complexes ( MMCs)- occur during fasting

Fed
Segmentation

Peristalsis

Tonic contractions
Segmentation

Purpose : Permits longer contact of the chyme with the enterocytes

Peristalsis
Tonic contractions
- relatively prolonged contractions
- isolate one segment of the intestine from the other
 Muscular contractions of the small intestine are

Stimulated by
CCK
bombesin
opioid peptides
substance P
acetyl choline

Inhibited by
sympathetic discharge
NO
VIP
glucagon
Summary
• Functions of the small intestine
• Digestive functions of small intestinal enzymes
• Digestion of carbohydrates, proteins and lipids
• Structural adaptations of the small intestine for digestion and
absorption
• Absorption of digestive products in the small intestine
• Composition of small intestinal secretions
• Function of small intestinal mucous and how its secretion is regulated
• Small intestinal motility patterns