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Gastrointestinal Motility

Digestive System
GI Wall

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Motor fxns of the gut performed by the different layers of smooth ms Individual smooth ms fibers arranged in bundles of parallel fibers

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Digestive System

Ms fibers electrically connected with one another thru large numbers of gap junctions (more rapid along length of bundle) Each ms layer fxns as a syncytium N resting membrane potential: -50 - -60 mV Has 2 types of electrical waves

(ave: -56 mV)

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Slow waves

Spikes (peaks of slow waves) Rhythmic *Tonic (continuous Not action potentials (AP) repetitive spikes) True AP Intensity:5-15 mV Has longer duration of AP Freq: 3-12/min (large number of Ca ions) Cause: interstitial cells of Cajal (electrical pacemakers Occur with resting for smooth ms cells); Na membrane potential more ions only so (-) ms cx positive than -40 mV Not cause ms cx except in stomach (precx for spikes)

Digestive System

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Gastric Motor Function Fed Motor Pattern After a meal, peristaltic waves move toward the antrum to the pyloric sphincter, propelling the mixture of food and gastric acid into the duodenum. Peristalsis is controlled by a wave of partial depolarization known as the electrical rhythm (BER) or

A. 1.

slowly a.

basic

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(2)

For example, when vagal fibers are activated by distention of the stomach, muscle fibers are depolarized enough to bring them to so that they have action potentials and contraction occurs. Contractions of circular muscle occur in step with the BER-induced depolarization wave moving over the antrum.

circular

threshold (3)

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2.

The three major gastric motor activities of the fed stomach include relaxation, mixing, and emptying. With each swallow, the proximal stomach stretches to receive food from esophagus, which involves only a small rise in intragastric pressure (receptive relaxation).

Receptive a.

the

5/16/12 The distal stomach grinds and mixes food to reduce bolus size so that it can be moved to the small intestine through the pyloric sphincter. d. Muscle contractions of the antrum control the amount of food that leaves the stomach so as not to overload the digestive ability of the small intestine.

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e.

The amount of chyme (semifluid material produced by gastric digestion food) emptied depends on the strength of the peristaltic wave and the gradient between the antrum and duodenum. The pylorus limits the size of particles emptied and acts to prevent reflux duodenal contents into the

of

pressure f.

of

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B. 1.

Fasting Motor Pattern: Migrating Motor Complex (MMC) The MMC is the pattern of a fasting or interdigestive state that is divided three phases (Figure 53). The MMC moves stomach contents through the intestine to the ileocecal valve during overnight fasting. The MMC performs a housekeeping function by

into 2.

3.

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The distal stomach contracts rhythmically in a phase called antral systole, when food is mixed with gastric juice to reduce the particle size. Food is broken down by retropulsion, when food is forcefully reflected back from the pyloric sphincter into the stomach.

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The meal then becomes a suspension of partially dissolved particles called chyme. Peristaltic waves occur at a rate of 34 per minute in the distal stomach during antral systole. Each peristaltic wave pushes about 1 mL of chyme through the pyloric sphincter, which, at this stage of digestion, only allows small particles (about 0.52 mm) to pass through.

 C. 1.

Control of Gastric Emptying

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Volume: Emptying of isotonic, noncaloric fluids is proportional to the volume or distention of the stomach. Osmolality: Hypertonic and hypotonic fluid empty more slowly than isotonic fluids, probably because of neural and hormonal factors.

2.

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. Control of Gastric Emptying

8.

Duodenal pressure: Increased duodenal pressure slows emptying and vice versa. Negative feedback: Control of emptying is mediated by neural and humoral factors activated by nutrients.

9.

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 GASTRIC

MOTOR DYSFUNCTION

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The most common dysfunction is gastroparesis, which is delayed gastric emptying in the absence of obstruction. long history of diabetes associated with peripheral neuropathy can cause diabetic gastroparesis. failure to generate enough force to empty the stomach can be

mechanical A

The

 Disorders

associated with rapid gastric emptying are often related to surgical procedures such as vagotomy or pyloric resection. of the pyloric sphincter allows too rapid emptying of hypertonic material into the small intestine, resulting in dumping syndrome. results in a loss of gastric compliance and an increased rate of emptying liquids.

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Incompetence

Vagotomy

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Motility of the Small Intestine

Digestion

and absorption of food depend on normal contractile behavior of small intestine. Intestinal slow waves determine the frequency and patterns of contractions The frequency of slow waves is highest in the proximal small intestine (12/min).

the 1.

2.

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Peristalsis A ring of muscle contraction appears on the oral side moves toward the anus, propelling the contents of the lumen in that direction; as the ring moves, the muscle on the other side of the distended area relaxes, facilitating smooth passage of the bolus.

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SegmentationContractions Segmentation contractions are a common type of mixing motility seen especially in the small intestine - segmental rings of contraction chop and mix the ingesta. Alternating contraction and relaxation of the longitudinal muscle in the wall of the gut also provides effective 5/16/12 mixing of its contents.

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Segmentation movements of the small intestine

3636

peristalsi s 1.Occur in any part of the small intestine 2. Move analward at a slow velocity 3. Are weak and die out after traveling only 3 to 5 centimeters 4. The net movement of chyme in the small intestine is very slow
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Peristalsis

3838

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peristalsi s

the entry of chyme into the duodenum

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Distention of the stomach elicit peristalsis of small intestine through myenteric plexus, which is called

INTESTINAL MOTOR DYSFUNCTION

Symptoms

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such as nausea, vomiting, abdominal distension, colic, diarrhea, and constipation result from abnormalities in moving luminal contents through the small intestine. Vomiting is a complex, coordinated set of motor discharges programmed in the medullary vomiting

may

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The

stomach and esophagus are relaxed. contents are then moved up to and out of the mouth by forceful contraction of abdominal (retching) and the diaphragm. chemicals, such as apomorphine, stimulate vomiting through the chemoreceptor trigger

Gastric

muscles

Blood-borne

zone.

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Peristaltic

rush is abnormal in humans but common in animals that consume feces. is characterized by strong peristaltic waves moving chyme large distances. results in maldigestion, malabsorption, and diarrhea in humans.

It

It

Peristaltic rush Powerful and rapid peristalsis Is produced by intense irritation of the intestinal mucosa, infectious diarrhea Travel long distances to sweep the contents of the intestine into the colon and thereby relieve the small intestine irritative chyme 5/16/12 and excessive distention

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Motility of the Colon and Rectum

Hirschsprung disease (aganglionosis, or megacolon) is a congenital absence of the enteric in the distal colon. no inhibitory neurons present, colonic tone is increased, resulting in prolonged constipation. area above the contracted segment becomes grossly dilated, causing megacolon.

plexus With

The

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