Gastric Motility Flashcards
Gastic pacemaker cells
Interesitial cells
Initiate basal electrical rhythm
Sensitive to stretch-> stretch increases excitability-> BER over threshold->muscle contractions
Myenteric plexus-> Ach upstream-> contraction
VIP downstream-> relaxation
Modification by extrinsic nerves, oesophagus
Sympathetic-> NA-> inhibitory -> directly by beta adrenoceptors, indirectly by Ach release
Parasympathetic->Ach-> stimulatory
Oesophageal peristalsis
Mechanorecptors in pharynx detect food bolus
Initiate peristaltic wave
Controlled by vagus
5cm/sec every 7-10 seconds
Gravity assisted
Second wave initiated if food not projected in to stomach by vago-vagal
Empty oesophagus
Salivary swallowing
Awake 70/h
Asleep 7/h
Small peristaltic waves
Gastric motility
Primed by pacemaker cells-> BER-> 3-5 mins-> only associated with peristaltic wave when smooth muscle is excitable enough Acts as a storage organ Controlled by: Myogenic Intrinsic nerves Extrinsic nerves Hormones
Empty stomach
Feeble contractions as underlying smooth muscle not excited
Full stomach
1st hour peristaltic waves are weak Pyloric sphincter remains closed Later waves more powerfull Higher pressure in stomach than duodenum Food pushed in to duodenum Also help mix food
Control of gastric motility
Neural: Vagus-> VIP-> relaxatory in fundus-> stimulated by oesophageal and gastric distension Vagus-> Ach-> stimulate motility Sympathetic-> NA-> inhibits motility Hormones Stimulatory: Gastrin (Antrum) Motility Inhibitory: Gastrin (proximal stomach) Secretin CCK
Rate at which food appears in duodenum depends on:
Meal composition:
Protein-> slow-> gastrin and CCK release
Carbs-> fast
Fat-> really slow
Increase meal volume, increase speed of emptying
Fragments have to be smaller than 1mm
Osmolality above or bellow 200mosm, decrease emptying speed
Excess acid decreases emptying speed
Small intestinal motility
Segmenting contraction smooth circular muscle moves chyme to and fro Increase exposure to mucosal surface BER 12/min duodenum BER 9/min ileum
Peristaltic contractions Longitudinal muscle Short distance After meal Occasional migrating motility complex-> shift remaining food in to colon
Control of small intestinal motility:
Myogenic Myenteric plexus Stimulatory-> Ach, gastrin, CCK Inhibitory-> VIP, opioids, NO Extrinsic nerves, mainly sympathetic Local chemicals
Large intestinal motility
12 hours
Ileal-caecal sphincter, ZEP, prevents retrograde movement of bacteria
Water reabsorption and storage of faeces
Movement mostly slow and non propulsive
Haulstral contraction every 2h
3-4 times per day powerful contractions moving food to distal colon
Defeacation
Rectum usually empty
Arrival of faeces induces desire to poo via sensory nerves, peristaltic wave in colon
Internal anal sphincter relaxes
Voluntary relaxation of external sphincter
Parasympathetic reflex and voluntary effort
Layers of gastrointestinal tract
Longitudinal muscle Myenteric plexus Circular muscle Submucosal plexus Submucosal Mucosa