swallowing and peristaltic wave Flashcards
UES
- neurogenic
- skeletal muscle
- constriction
- primary peristaltic wave (swallowing)
- anatomic sphincter that is anatomically controlled
LES
- myogenic
- smooth muscle
- relaxation by VIP
- not anatomically controlled
- functional
LES
- is sensitive to
- nicotine
- alcohol
- chocolate
- caffeine
case:
joey chestnut
68 hotdogs in 10 minutes
- LES
- receptive relaxation (inhibited by atropine)
- vagally mediated response (vagus nerve)
case of hotdog eating contest
- neostigmine
- physostigmine
- edrophonium (tensilon and elon)
ALL INCREASES ACH, GI MOTILITY (receptive relaxation)
swallowing
- is a reflex controlled from the brain stem
case:
stroke patient damage to CN IX and X
- aspiration pneumonia from loss of gag reflex
- difficulty swallowing
basic electrical rhythm 3/min (BER)
- pacemaker
- force increases not the frequency
PARASYMPATHETIC (vagal stimulation)
major force
- ACh increase
- GRP (gastrin releasing peptide) increase
- causing distension/stretch
case of DM for 15 years
presented with bloating abdominal distention
- diabetic gastroparesis
- low ACh mechanism
- parasympathetic
- won’t feel the gastric distension/stretch due to neuropathy
duodenum
- fat (CCK) GIP
- acid (Secretin)
- distension
- osmolarity (hyper)
ALL CAUSE INHIBITS GASTRIC MOTILITY
stretch of duodenum
- inhibits motility
leaves the stomach fastest
- normal saline ( no fats, CHO, CHON, acid)
- same osmolality as blood
- normal osmolality
- it won’t stretch the duodenum much
pills with gatorade gastric emptying time
- 20 mins
gatorade vs water
- water replacement can cause hypokalemic and hyponatremic
- leaves the stomach longer and take much energy to the athlete
gatorade
- has water with normal pH
- with salt, K, Na, sugar
- osmolality is closer to physiologic
- leaves the stomach fast
- rapidly absorbed
- does not distend the stomach
gastric motility stimulation
- PARASYMPATHETIC
- via ACh and gastrin release
- local distension
- DIABETIC GASTRICPARESIS INHIBITS THIS PROCESS
- treatment METROCLOPROMIDE (reglan) increases GI motility and ERYTHROMYCIN side effect vomiting diarrhea too much motility increases GI motility
gastric motility inhibition
- low pH of the stomach inhibits release of gastrin
- feedback from duodenal overload (neuronal and hormonal)
stomach emptying
- normal saline > liquids > CHO > Protein > Fat (has a lot of calories)
stretch of the cecum
- closes the ileocecal valve
stretch of the duodenum
- closes the pyloric sphincter
stretch of the ileum
- opes the ileocecal valve
half the volume of stool is (migrating myoelectric complex)
increase activity
- GI epithelial cells
- cleans every 5 days
- irritable bowel syndrome (IBS)
diabetic gastroparesis
- too little activity of the migrating myoelectric activity
case:
patient develops diarrhea abdominal pain constipation
- IBS
- hyperactivity of motilin
- increase activity of migrating myoelectric activity
- 90 - 120 mins
- stopped by meal, interrupted by meals
