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MSS - GI Exam 2 > Swallowing, Gastric Emptying, Intestinal Motility > Flashcards

Swallowing, Gastric Emptying, Intestinal Motility Flashcards

1
Q

three phases of swallowing

A

oral
pharyngeal
esophageal

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2
Q

deglutition

A

swallowing

initiated voluntarily

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3
Q

swallowing center

A

medulla oblongota (lower pons)

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4
Q

innervation of pharynx and upper esophagus

A

cranial nerves

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5
Q

innervation of lower esophagus

A

vagus nerve

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6
Q

receptors of swallowing

A

touch receptors at opening of pharynx

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7
Q

oral phase

A

voluntary

bolus from tongue to pharynx

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8
Q

pharyngeal phase

A

involuntary

  • initiated by pressure receptors in pharynx
  • relaxes upper esophageal sphincter
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9
Q

esophageal phase

A

involuntary

-bolus from UES through peristalsis to LES to stomach

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10
Q

respiration and swallowing?

A

during pharyngeal phase - inhibited
-pharyngeal mm. push bolus into pharynx and UES relaxes

peristalsis wave moves bolus through UES

respiration is reflexively inhibited

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11
Q

UES constriction

A

reflex constriction after bolus passes

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12
Q

uvula

A

prevents food to nasal cavity

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13
Q

epiglottis

A

prevents food to trachea

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14
Q

respiration during swallowing

A

swallowing center inhibits respiratory center

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15
Q

esophageal phase

A

after UES closes, LES begins to relax

primary peristaltic waves begin below UES
secondary peristalsis - due to ditension of esophagus if first wave not enough

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16
Q

esophageal sensory fibers to CNS and ENS

A

modulate both primary and secondary peristalsis

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17
Q

secondary peristalsis

A

esophagus distension due to food

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18
Q

sphincter of esophagus?

A

never both open

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19
Q

swallowing and stomach?

A

it relaxes

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20
Q

sphincters

A

muscular barriers

  • proximal - relax
  • distal - contract

facilitate unidirectional movement

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21
Q

upper esophageal sphincter

A

striated

  • highest resting P of GI sphincters
  • cranial nerves
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22
Q

esophagus

A

top striated
middle smooth and striated
bottom smooth muscle

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23
Q

LES tone maintained by?

A

smooth muscle

-vagus nerve - Ach and substance P

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24
Q

LES relaxation by?

A

VIP and NO (local regulators)

relaxation occurs after UES returns to resting pressure

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25
Q

relaxation of LES?

A

VIP and NO

decreased vagal innervation

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26
Q

dysphagia

A

difficulty swallowing

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27
Q

hiatal hernia

A

stomach portion protrudes above diaphragm

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28
Q

neuro defects affecting swallowing

A

PD, myasthenia gravis, muscular layer effect

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29
Q

treatment of dysphagia

A

surgery cut tight m.
remove tumors
increase salivary function

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30
Q

achalasia

A

special form of dysphagia

  • absence of relaxation of LES
  • megaesophagis - dilated above LES
  • peristalsis impaired smooth m. esophagus

peristalsis functional in striated m. esophagus

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31
Q

treatment of achalasia

A

focus on symptomatic relief

-balloon to force LES open (temporary)

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32
Q

GERD

A

LES pressure prevents reflux
-reduction in pressure - gastric juice to esophagus

esophagitis and erosion of esophagus mucosa

could be caused by lots of things

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33
Q

treatment for GERD

A

control gastric acid secretion
decrease resistance of esophageal mucous
decrease bicarb from saliva

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34
Q

accomodation

A

receptor relaxation of stomach

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35
Q

orad region

A

fundus and proximal body of stomach

receives and stores food

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36
Q

caudad region

A

distal body and antrum

mixing and propelling of food

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37
Q

division of stomach secretion

A

LES and cardiac - mucus/HCO3

fundus and body - H, IF, mucus/HCO3, pepsinogen, lipase

antrum and pylorus - mucus/HCO3

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38
Q

antrum of stomach?

A

increased pressure due to thicker muscle wall

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39
Q

receptive relaxation of stomach

A

initiated by swallowing

  • LES and stomach relax
  • VIP - vasovagal reflex
  • pressure in stomach does not increase despite increase volume

is an anticipated relaxation
vagus mediated response

disruption of vagus nerve - rapid pressure increase

40
Q

gastric accomodation

A

relaxation in response to filling of stomach

vagus nerve reflex

41
Q

vagotomy

A

results in decreased accommodation in stomach

ENS involved in reflex relaxation

42
Q

gastric mixing

A

in antrum

-increased contractility

43
Q

ACh and substance P

A

increase gastric mixing

44
Q

gastrin

A

excitatory - increase contractility

released from G cells

45
Q

gastric emptying

A

duodenum contents - full of food
-inhibits gastric emptying

in duodenum - FAs, monoglycerides, low pH, distension, hypertonicity, AAs, peptides

46
Q

CCK, secretin, GIP

A

inhibit gastric emptying**

released from duodenal area

47
Q

factors affecting gastric motility within stomach

A

volume of chyme

degree of fluidity

48
Q

emotion

A

increased sympathetic activity

-inhibits motility and emptying of stomach

49
Q

pacemaker of zone

A

body of stomach
-slow wave potentials

remember cells of cajal

50
Q

increase contractility

A

ACh
gastrin

depolarize membrane

increase amplitude and duration

51
Q

decrease contractility

A

norepinephrine

hyperpolarize membrane

52
Q

gastric emptying

A

peristalsis in upper fundus to pyloric sphincter

strong antral contraction propels chyme forward

chyme to duodenum

53
Q

gastric mixing

A

when peristalsis contraction reaches pyloric sphincter - sphincter tightly closed and no further emptying

chyme propelled to close sphincter shoots back and is mixed up

54
Q

gastric mixing

A

propulsion
griding
retropulsion

trituration

55
Q

trituration

A

reduction of solid particle size

> 2mm does not leave stomach

56
Q

strongest stomach contraction

A

antrum

57
Q

leaves stomach first?

A

liquid > carb > protein > fat

isotonic > hypertonic or hypotonic

58
Q

to rehydrate faster?

A

drink isotonic solution

not water **

59
Q

CKK and GIP

A

relax gastric smooth m

increase constriction of pylorus

60
Q

gastrin

A

increase contractility antrum

increase constriction of pylorus

61
Q

pyloric sphincter increased constriction

A

CCK
GIP
secretin
gastrin

62
Q

constriction of pyloric sphincter

A

Ach - vagus

also sympathetic causes of constriction

don’t want food to be coming during fight/flight

63
Q

relaxation of pyloric sphincter

A

VIP

64
Q

parasympathetic of stomach

A

increased activity

65
Q

MMC

A

migrating myoelectric complex

occurs during fast state

cleans tract (stomach to ileum)

strong antral contraction and relaxes pylorus

removes undigested particles

66
Q

emesis

A

vomiting

67
Q

vomiting center

A

in medulla

68
Q

stimulation of vomiting

A 
gastric/duodenal distension
dizziness, inner ear, pregnancy
drugs
GU injury
emetics - chemicals cause vomiting
69
Q

ipecac

A

gastric duodenal receptor

stimulates vomiting

70
Q

chemoreceptor zone for vomiting?

A

brain 4th ventricle

71
Q

vomiting response

A 
reverse peristalsis
-pylorus sphincter relax and stomach relax
-abdominal m contract
pylorus/antrum contract
LES relax
UES relax

gastric contents to esophagus

72
Q

retching

A

UES remains closed

73
Q

small intestine motility

A

segmentation - mixing chyme
peristalsis - propulsion
MMC - sweeping undigested contents

74
Q

segmentation

A

in fed state after eating
-alternating contraction of circular smooth m

slow process of propulsion and retropulsion

mixes chyme with digestive secretion
maximize contact with mucosal layer

75
Q

peristalsis

A

in fed state after eating

  • relaxation in front of bolus (VIP and NO)
  • contraction behind bolus (ACh substance P)
76
Q

MMC

A

during fasting**

stomach and small intestine to colon
-new wave in stomach when previous passes distal ileum

77
Q

motilin

A

high levels during MMC

78
Q

3 phases of MMC

A

quiescence
small disorganized contractions
strong propagation contractions

79
Q

slow waves in intestine

A

highest rate duodenum

slow toward ileum

80
Q

strength of contraction

A

burst of APs on top of slow waves

81
Q

intestinointestinal reflex

A

distension one segment, relaxation rest of small intestine

82
Q

time for chyme?

A

2-4 hours move through small intestine

83
Q

ileocecal sphincter

A

normally contracted

ileum distension - relaxation
ascending colon distension - constriction

prevents bacterial reflux -colon lots of bacteria

84
Q

gastroileal reflex

A

increased gastric activity

-increased ileal motility and relaxation of sphincter

85
Q

colonic motility

A

haustrations
long duration contraction
mass movements

86
Q

haustration

A

short duration contractions
circular muscle**
slow alternated for water and salt absorption

87
Q

long-duration contraction

A

longitudinal muscle**

-longer duration

88
Q

mass movements

A

high amplitude contractions

-cecum to rectum

89
Q

internal anal sphincter

A

smooth m.

90
Q

external anal sphincter

A

skeletal m.

91
Q

parasympathetic to colon

A

vagus and pelvic nn.

vagus - proximal
pelvic - distal

92
Q

sympathetics in colon

A

inhibit motility

abdominal postganglionic sympathetic ganglia

93
Q

defecation reflex

A

voluntary and involuntary events

94
Q

hirschprungs disease

A

congenital megacolon

  • failure of enternic plexus formation
  • impair motility-function

contracted segment
-commonly just above internal anal sphincter

Tx: surgical excision of diseased segment

95
Q

irritable bowel syndrome

A

inflammatory of colon and SI

visceral hypersensitivity

  • due to sensitization of afferent neural pathways
  • abnormal response to stimulus
96
Q

types of IBS?

A

crohns** and ulcerative colitis

97
Q

Dx of IBS?

A

assessment of inflammatory marker in stool followed with colon and Bx pathological lesions

MSS - GI Exam 2 (11 decks)

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