Upper GI Physiology/Gut Motility Flashcards
what areas of the GI tract are under voluntary control?
upper oesophageal sphincer - swallowing
external anal sphincter - defacation
what are the 2 main components of the enteric nervous system?
submucosal (meissners) plexus
myenteric (auerbachs) plexus - inbetween CM and LM
what do the CM and LM do?
CM - allows squeezing/increased pressure allowing contents to be moved around
LM - squeezes to shorten diameter to allow forward movement
what are the interstitial cells of cajal?
pacemaker function
lies in myenteric plexus
produce basic electrical rhythm (BER) determining how often a gut area can contract
higher BER in proximal than distal
what is the function of the enteric nervous system?
mediates reflex activity in absense of CNS input (interprandial period)
what is the enteric nervous system influenced by?
extrinsic factors:
vagal control - excitatory to non-sphincteric muscle
sympathetic control - inhibitory to non-sphincteric muscle (excitatory to sphincter muscle)
neurohormonal influences (opioid receptors, motilin)
describe the measurement of motility function
pressure (circular muscle function)
transit (radiolabelled isotopes, breath tests, scintigraphy, dynamic contrast radiology)
what is the innervation of the oesophagus?
sympathetic - sympathetic trunk
parasympathetic - vagus nerve
describe the muscular structure of the oesophagus?
prox 2/3 - striated voluntary muscle
dist 1/3 - smooth muscle
what is a hiatus hernia?
weakness of diaphragmatic hiatus allowing stomach to partially move into the chest resulting in increased reflux
what diseases can be diagnosed by manometry in the oesophagus?
achalasia - lower oesophageal sphincter less responsive, lower peristaltic function
oesophagus in scleroderma - weak LOS, absent peristalysis, severe oesophagitis
jackhammer oesophagus - pain on swallowing (still functional)
what is the interprandial period controlled by?
migrating motor complex
what is the interprandial period?
cleansing of gut in preparation for next meal
cyclic contraction sequence occuring every 90 minutes
regulated by motilin
what are the 4 phases of the interprandial period?
- prolongued quiescence
- increased frequency of contractility
- a few minutes of peak electrical/mechanical activity
- declining activity merging to next phase 1
what is motilin?
polypeptide hormone produced by M cells in small intestine
secreted in 90 minute intervals
cleanses gut
stimulates contraction of gastric fundus and enhances gastric emptying