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Physiology of GIT

Chapter No=62

By
Dr. Mudassar Ali Roomi (MBBS, M.Phil.)
Assistant Professor Physiology
GIT
Function: The GI tract provides a continuous
supply of water, nutrients and electrolytes to the
body.
To achieve this target we need:
1. Movement (Motility)
2. Secretion of glands
3. Absorption of nutrients
4. Circulation of blood (splanchnic circulation)
5. Control of all these functions (nervous and
hormonal)
Two Types of Digetsive Systems
Incomplete digestive
system
One-way, saclike
digestive cavity
Complete digestive
system
A tube with an
opening at each end
Major Components of GIT
Mouth (oral cavity)
Pharynx (throat)
Esophagus (food pipe)
Gut
Stomach
Small intestine
Duodenum
jejunum
ileum
Large intestine
Cecum
appendix
colon
Rectum
Anus
Accessory Organs
Salivary glands (sublingual, submandibular and parotid
glands)
Secrete saliva.
Pancreas:
Secretes digestive enzymes.
Liver:
Secretes bile.
Gallbladder:
Stores and concentrates the bile.

Typical cross section of intestine
A typical cross section
shows:
1. Mucosa.
2. Submucosa.
3. Muscularis externa:
Circular muscle layer.
Longitudinal muscle
layer.
4. Serosa.
Mucosa: First Layer (innermost layer)
Mucosa= epithelium and
lamina propria
Small amount of smooth
muscle (muscularis
mucosae) is also present
Lumen: passageway.
Epithelium may have
mucus secreting glands
(also secrete digestive
enzymes)
Secretes and absorbs.
Second Layer: Submucosa
Contains loose
Connective Tissue.
Contains Glands, blood
vessels, lymphatics and
nerves.
Carries away absorbed
materials.
Third Layer: Muscularis externa
Provides the tube
movements (peristalsis)
Has two coats of
smooth muscle tissue:
Inner Circular fibers
(increase and decrease
tube diameter)
Outer Longitudinal fibers
(lengthen and shorten
the tube)
Fourth Layer: Serosa (serous layer)
Outer covering of the
tube.
Visceral peritoneum.
Secretes serous fluid to
keep the outside of the
organs lubricated and
moist, thus performs a
protective function.
Neural Control of the GI Function
Neural Controls:
Extrinsic (3)
Parasympathetic.
Sympathetic.
Somatic.
Intrinsic (2)
Myenteric plexus.
Submucosal plexus.

SANS and PANS
modulate the enteric
nervous system as
opposed to directly
controlling the smooth
muscle of the bowel.

Extrinsic control
Autonomic Neural Pathways:
Parasympathetics


Upper/Cranial via Vagus nerve:
Innervates the upper segments of GI tract to Splenic flexure
along with the pancreas.
Lower/Sacral via Pelvic Splanchnic nerves (nervi erigentes)
S2-S4 to the descending colon, rectum and anus.
Post Ganglionic Neurons:
Located mainly in the Myenteric and Submucosal plexuses.
Neurotransmitter:
Acetylcholine.
Function:
Stimulates GI secretion, motor activity.
Relaxes sphincters

Extrinsic control
Autonomic Neural Pathways:
Sympathetics


Fibers originate in the spinal cord between segments T-5 and L-2.
Preganglionic fibers enter the Sympathetic chains, then pass on to
Coeliac and Mesenteric ganglia (PREVERTEBRAL ganglia)
Post Ganglionic Fibers:
They originate in these ganglia and pass on to all parts of the GIT
through sympathetic nerves.
Neurotransmitter:
Norepinephrine.
Some amounts of Epinephrine.
Function:
Inhibition of GI secretion, motor activity.
Contraction of GI sphincters and blood vessels.

Extrinsic control
Neural pathways:
Somatic fibers

Along Pudendal Nerve:
S2-S4.
External anal sphincter and the pelvic floor.

Intrinsic/ Enteric Nervous System:

Submucosal (Meissners)
plexus.
Myenteric (Auerbachs)
plexus.
Regulate segment-to-
segment movement of
the gastrointestinal
tract.
May be considered a 3
rd

part of the ANS.
Enteric Nervous System
Myenteric plexus (Auerbachs plexus):

Located between the
longitudinal and circular
layers of muscle in the wall
of the GIT.
Controls tonic and
rhythmic contractions.
Exerts control primarily
over digestive tract
motility.
Principal effects:
Increased tone.
Increased intensity of
contractions.
Increased rate of
contractions.
Increased velocity of
conduction.
Myenteric plexus (Auerbachs plexus):
It is not totally excitatory in nature.
Some of the neurons of the myenteric nervous
system secrete VIP. This is an inhibitory peptide.
These inhibitory signals are useful for controlling
the intestinal sphincters e.g. pyloric sphinter
Partially controlled by autonomic nervous
system.

Enteric Nervous System
Submucosal plexus (Meissners plexus)

Buried in the Submucosa.
Senses the environment
within the lumen.
Regulates GI blood flow.
Controls epithelial cell
function (local intestinal
secretion and absorption).
May be sparse or missing
in some parts of GI tract.
Partially controlled by
autonomic nervous
system.
Enteric Nervous System
Types of Neurons in the Enteric System:
1. Sensory neurons:
Chemoreceptors sensitive to acid, glucose and amino acids have
been demonstrated which, in essence, allow "tasting" of luminal
contents. Sensory receptors in muscle respond to stretch and
tension.
2. Motor neurons:
Control GI motility and secretion, and possibly
absorption.
3. Interneurons:
Largely responsible for integrating information from
sensory neurons and providing it to motor neurons.
Types of Enteric Neurotransmitters in enteric
neurons

Acetylcholine:
Excitatory
Stimulates smooth muscle contraction.
Increases intestinal secretions.
Releases enteric hormones.
Dilates the blood vessels.
Norepinephrine:
Derived from extrinsic sympathetic neurons.
Inhibits the GI activity.
Causes vasoconstriction
Others (some are excitatory some are inhibitory)
Adenosine tri phosphate (ATP), Serotonin, Dopamine,
Cholecystokinin, VIP, Somatostatin, Substance P,
Leu-enkephalin, Met-encephalin and Bombesin.
Electrical activity in the Smooth Muscle of GIT
Smooth muscle in the GIT is excitable.
Slow, intrinsic electrical activity takes place
along the membranes of this smooth muscle.
The GI smooth muscle acts as a functional syncytium.
Due to presence of Gap junctions.
Therefore, whenever an action potential is generated
within the muscle mass, it travels in all directions.

Electrical activity in GIT
The RMP is -50 to -55
mV. This can be
changed to different
levels to control the
motor activity of the
gut.
There are two types of
electrical waves:
Slow waves-
Spike potentials.

Slow Waves/ Basic Electrical Rhythm of the gut.
These are spontaneous,
rhythmic fluctuations in
the RMP between -55 to -
40 mV.
These are not true action
potentials, but are
localized/graded potential
They do not cause muscle
contraction in the GIT.
Frequency of slow waves
in different parts of gut:
3/ min in the body of the
stomach.
12/ min in the duodenum.
8-9/ min in the terminal
ileum.
Cause of Slow Waves
Pacemaker
cells/Interstitial cells of
Cajal:
These pacemaker cells
undergo cyclic changes
in the membrane
potential due to unique
Na ion channels which
periodically open and
produce inward,
pacemaker currants
which in turn generate
slow waves.
Slow Waves
Function:
They lead the RMP to
threshold value so that the
spike potential can take place.
Stimulated by (which causes
hypopolarization):
Stretch.
Acetylcholine.
Parasympathetic nervous
system (vagus)
Parasympathomimetic drugs
e.g. Pilocarpine
Slow wave activity is greatly
reduced by Vagotomy,
Norepinephrine and
sympathetics (which causes
hyperpolarization)
Spike Potentials
These are true action potentials.
They occur whenever the RMP of the smooth muscle
becomes more positive than -40 mV (threshold)
Higher the slow wave potential, greater is the frequency of
the spike potentials
Each spike lasts for up to 10- 20 m sec which is 10- 40 times
longer than the action potential in the nerves fibers.
Ionic basis of action potentials/spike potential:
In GIT, the ion channels involved are slow Calcium- Sodium
channels.
The slowness accounts for the long duration of the action
potential in the GI smooth muscle.

Three types of Gastrointestinal Reflexes
1. Reflexes that are integrated entirely within the enteric nervous
system. These are the reflexes which control:
Secretion.
Peristalsis.
Contractions etc.
2. Reflexes from the gut to the prevertebral sympathetic ganglia and
then back to the GI tract.
Gastrocolic reflex.
Enterogastric reflex.
Colonoileal reflex.
3. Reflexes from the gut to the spinal cord or brain stem and then
back to the GI tract.
Reflexes from stomach and duodenum to the brain stem and back via
the vagus nerve.
Pain reflexes.
Defecation reflexes.


Hormonal Control of the GI Motility
Following hormones affect the motility of the
gut in addition to their digestive functions:
1. Gastrin.
2. Cholecystokinin (CCK)
3. Secretin.
4. Gastric Inhibitory Peptide (GIP)
5. Motilin.
1. GASTRIN:

Secretion: By G cells in gastric pits of the mucosa.
Stimulus: Stomach distention , the products of
proteins and Gastrin releasing peptide, which is
released by the nerves of the gastric mucosa as a
result of Vagal stimulation.
Actions:
1. Increases HCl production in stomach.
2. Increases gastric motility.
3. Stimulates growth of gastric mucosa.
4. Contracts lower esophageal sphincter.
5. Relaxes pyloric sphincter.
2. CHOLECYSTOKININ (CCK):

Secretion: By I cells in the mucosa of the duodenum
and jejunum.
Stimulus: Chyme rich in digestive products of
triglycerides and fatty acids and monoglycerides and
amino acids.
Actions:
Contracts the gallbladder.
Opens the Sphincter of Oddi.
Increases secretion of pancreatic juice rich in digestive
enzymes.
Inhibits gastric secretion and motility.
May reduce hunger.


3. SECRETIN

Secretion: By S cells in the mucosa of the
duodenum.
Stimulus: Acid chyme (H+), fatty acids in the small
intestine causes secretion of Secretin.
Actions:
Stimulates the watery secretion of pancreatic juice and
bile that is rich in bicarbonate ions. MCQ
Inhibit production of HCl in stomach.
Promotes growth and maintenance of the pancreas.
Enhances the effects of Cholecystokinin (CCK)



4. Gastric Inhibitory Peptide (GIP)/Glucose
dependent insulinotropic peptide

Secretion: By mucosa of the upper small
intestine.
Stimulus: Chyme rich in fatty acids and
amino acids, glucose
Actions:
Inhibits gastric secretion and motility.
Stimulates release of Insulin by beta cells.

5. Motilin

Secretion: By the cells of the upper
duodenum.
Stimulus: It is released during fasting.
Actions:
Increases the gastrointestinal motility.
Causes formation of Interdigestive myoelectric
complexes/Migratory motor complexes (MMC) in a
fasting person.
House keeping function
Functional Types of Movements in the GIT
1. Propulsive movements/peristalsis
2. Mixing movements.
Both are brought about by the Enteric nervous system, but
are influenced by the Extrinsic nervous system, especially the
Parasympathetic nervous system.
Propulsive movements/peristalsis

It is an inherent property of many syncitial smooth
muscle tubes.
Occurs in the gut, bile ducts, glandular ducts and
ureters.
Stimulus:
Distension of the gut, physical or chemical irritation of the
surface epithelium and stimulation by the Parasympathetic
nervous system.
Controlled by:
Actual peristalsis is brought about by the Myenteric
nervous system.
But it is influenced by the Parasympathetic nervous
system.
Propulsive movements/peristalsis

Mechanism of myenteric
reflex or the peristaltic
reflex:
Distension of the gut-
Stimulation of the enteric
nervous system.
The gut wall contracts 2-3 cm
behind the point of stimulus-
formation of a contractile
ring.
Initiation of a wave of
contraction- travels in the
anal direction.
Relaxation of the gut wall
distal to the point of
stimulation- receptive
relaxation.
Function of the Myenteric plexus in
peristalsis:
Weak or no peristalsis in areas of the gut where
the Myenteric plexus is absent ( e.g. congenital
megacolon/Hirschprungs disease)
If the Cholinergic nerve endings of the Myenteric
plexus are blocked by Atropine- No peristalsis.
Therefore, effectual peristalsis requires an intact
functional Myenteric plexus.
Properties of peristalsis:

1. Directional movement:
Theoretically, it can occur in both the orad and anal directions.
But the wave of peristalsis dies out if it travels in the orad direction.
Exact reason is not known.
Probably because of the fact that the Myenteric plexus is itself polarized.
2. Receptive Relaxation:
Part of the gut immediately after the peristaltic ring relaxes to allow the
easy movement of food.
Is a function of the Myenteric plexus.
This relaxation takes place only the anal direction, ahead of the contractile
ring.
Therefore, peristalsis moves towards the anus.
3. The anal ward moving complex in association with the Myenteric
plexus is called the Myenteric/ peristaltic reflex.
The peristaltic reflex Plus the anal direction of the movement is called the
Law of the Gut.


Mixing Movements
Differ in most parts of the gut.
Segmentations- in small
intestine
Haustrations- in large intestine
In many cases, most of the
mixing is provided by
peristalsis itself, especially
when it pushes the food
against a closed sphincter.
Local , intermittent,
constrictive contractions
occur at some places in the
gut. They are present after
every few cms.
They last for 5 to 10 secs.
Then new contractions
appear at new places.
This pattern is called
chopping and shearing of
food.