Physiology 4.

Lower Gastrointestinal Tract

OUTLINE
I. Small Intestine
II. Small Intestinal Motility
III. Migrating Myoelectrical Complex
IV. Intestinal Reflexes
V. Large Intestine
VI. Large Intestinal Motility
VII. Defecation/Rectosphincter Reflex

I. SMALL INTESTINE

November 11, 2011

Dr. Alcon
Effect of stimuli that result in a set of changes that represent the
small intestinal phase of a meal:
o Increased pancreatic secretion
o Increased gallbladder contraction
o Relaxation of the sphincter of Oddi: A constriction at the end of
the common bile duct, which regulates the flow of bile into the
duodenum
o Regulation of gastric emptying
o Inhibition of gastric acid secretion
o interruption of the migrating motor complex (MMC)
Has 3 parts/segments:
o Duodenum
Smooth walled, thicker mucus
Glands neutralizes acid
o Jejunum
o Ileum
Sphincter between ileum and colon contains the most
bacteria
Additional information about the small intestine c/o Dr. Alcon:
o The small intestine is very clean and is close to being bacteriafree. It is the colon thats filthy. The colon is a house of filth.
o Papaitan (stew made from goat innards flavored with bile that
gives it a bitter or mapait taste) and isaw (Pinoy street food;
chicken or pig small intestines that are barbecued or fried) are
made of small intestines; this is how clean the small intestine is.
o The small intestine is also very fatty (in the serosa) and has lots
of mesentery.

II. SMALL INTESTINAL MOTILITY

Figure 1. Anatomy of Lower Gastrointestinal Tract

*Lower GIT is the area below the ligament of Treitz (connects the
duodenum to the diaphragm)
Critical portion for assimilation of nutrients: area of greatest
absorption.
Area where food is mixed with variety of secretions that permit
digestion and absorption, and motility functions serve to ensure
adequate mixing and exposure of intestinal contents (chyme) to
the absorptive surface.
The main specialization of this area serves to increase surface
area of the small intestines for efficient digestion and absorption,
its primary function.
The small intestine is essentially a long tube that is coiled inside
the abdominal cavity.
o The mucosa has finger-like projections called villi.
o Each epithelial cell has microvilli on its apical surface.
The main characteristic of the small intestinal phase of the
response to a meal is controlled by the delivery of chyme from
the stomach to match the digestive and absorptive capacity of
the intestine.
o There is further stimulation of pancreatic and biliary secretions
into the SI which is highly regulated by feedback mechanisms
that involve hormonal, paracrine, and neural pathways.
The stimuli that regulate these processes are both mechanical
(distension of the intestinal wall) and chemical (presence of
protons, high osmolarity and nutrients in the lumen)

Carrasco, Castillo M., Castillo F., Catolico, Cauyan, Chavez, Chiu

Main goal is to mix the chyme with the digestive juice and bile to
facilitate digestion and absorption.
o No mechanical action, only chemical: enzymatic digestion and
absorption.
o Small intestine has very good vascular layer for absorption.
Propels the chyme from the duodenum to the colon in an aboral
direction (opposite the mouth).
Transit time: 2-4 hours from one end of the small intestine to
another
Ileocecal junction:
o Close link between terminal ileum and cecum by ileocecal
ligament
o functional valve: prevents backflow of cecal contents
o Keeps small intestinal bacterial concentrations at usual low
levels
Immediately after a meal:
o Similar to stomach activity
o Segmentation: churning, mixing
o Peristalsis: propulsive
In between meals:
o Migrating Myoelectric Complex (MMC)
o Interdigestive motor cycle
o cycles occur every 60-90 min
o has 3 to 4 phases

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 3 Phases:
o Phase 1 Quiescent phase
o Phase 2 Increasing action potential frequency / Increasing
activity phase
Sweeping motions (gastric, pancreatic, intestinal)
o Phase 3 Peak electrical and mechanical activity
Associated with increased GI secretions (pancreas, billary
tree, etc)
Rinsing motions: washing of all residues in gastric,
pancreatic, and intestinal regions
A constant sweeping and washing motion is present in the
small intestines to ensure its cleanliness.
Figure 2. Mixing Movements of the Small Intestine

Mixing movements
o The movements of the small intestine, can be divided into
mixing/segmentation contractions and propulsive contractions.
This separation is artificial because essentially all movements of
the small intestine cause both mixing and propulsion
The segmentation pattern of motility is characteristic of the
digestive state: When a portion of the small intestine
becomes distended with chyme
Propulsive segments separated by receiving segments occur
randomly at many sites along the small intestine
Mixing of the luminal contents occurs in the receiving
segments
Receiving segments convert to propulsive segments, while
propulsive segments become receiving segments

III. MIGRATING MYOELECTRICAL COMPLEX (MMC)

Small intestine motility in between meals: migrating myoelectric
complex cycles (MMC) or interdigestive motor cycles occur every
60-90 mins.
Motility in interdigestive period (fasting) or after a successful meal
when everything has been processed (because it takes 2-4 hours
anyway)
During the MMC, a constant sweeping and cleansing motion takes
place from top to down: stomach, duodenum, jejunum, ileum
(and repeat); sweeping cleansing motion
Phases 2 and 3 are the activity fronts of the MMC when the
sweeping and cleansing motions occur
Motilin hormone that determines MMC pattern; in the past,
was believed to be important for the whole cycle. It has been
proven that it is only important in Phase 3

IV. INTESTINAL REFLEXES

Peristaltic reflex (Law of the Intestine)
o Bayliss and Starling formulated the "Law of the Intestine" to
provide an explanation for peristalsis
o They found that the response of the small intestine to a local
stimulus consisted of:
Contraction of muscularis externa immediately above, and
Relaxation immediately below the point of stimulation.
o initiated when the gut wall is stretched by the contents of the
lumen, and it occurs in all parts of the gastrointestinal tract
from the esophagus to the rectum
o shows polarity of the GIT (proximal pole and distal pole)
Intestinointestinal reflex
o If there is any slight obstruction in the GIT, there will be
resulting reflex contractions to clear that area.
o But there are some cases when the obstruction is immovable
(e.g., presence of a tumor).
o Because further contractions may cause more damage,
inhibition of intestinal motility occurs.
The following reflexes also show the polarity of the GIT :
o Gastroileal reflex a full stomach stimulates the ileum to
increase motility
o Ileogastric reflex a full ileum inhibits gastric motility
o Anointestinal reflex a full anus inhibits intestinal motility
o Generally, the idea is:
If a proximal portion of the GIT is distended, a portion distal
to it will contract more (If top is full, bottom moves).
If a distal portion of the GIT is distended, the portion
proximal to it will decrease contractions (If bottom is full, top
stops).

V. LARGE INTESTINE

Figure 4. Anatomy of Large Intestine

Figure 3. Three Phases of MMC

Carrasco, Castillo M., Castillo F., Catolico, Cauyan, Chavez, Chiu

Most distal portion of gastrointestinal tract

Consists of the cecum, ascending, transverse, descending, sigmoid
colon, rectum and anus

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o Descending colon: Wider diameter, 3 muscle layers oriented

transversely, sigmoid shape
Left side: Splenic flexure
Right side: Hepatic flexure
Vagus nerve and ENS: Contraction of proximal colon
Pelvic nerve: Remainder of colon and control internal anal
sphincter

Orthocolic reflex promotes morning urge to defecate

Peptide YY decreases gastric emptying and intestinal propulsive
motility
Ileal break is released when fats are not absorbed by the time
food reaches ileum
Note: MMC is for the stomach and small intestines only.
Movements
o Display nocturnal suppression and can be stimulated by a meal
Non propulsive segmentation, haustrations, 2-4
cycles/min
Mass peristalsis (HAPCs) 20-50 cm, 1-3x/day, includes
weak retrograde patterns
Rectal motor complex sigmoid colon and rectum, more
during sleep; break to keep sigmoid and rectum distended at
sleep

VII. DEFECATION/RECTOSPHINCTER REFLEX

Figure 5. Absorptive and Storage Functions of the Large Intestine

Primary function: Digest and absorb meal components, water

reabsorption and storage of waste products (feces)
Commensal bacteria
o Metabolize meal components not digested by enzymes through
the process of fermentation
o Detoxify xenobiotics
Gastrocolic reflex: Stomach distention increases colonic motility
and mass movement of fecal material

Mass peristalsis

distension of rectum

Parasympathetic & Enteric Nervous Systems

peristaltic waves
Internal anal sphincter: Reflex relaxation
External anal sphincter: Voluntary
Valsalvas maneuver
Fecal evacuation

VI. LARGE INTESTINAL MOTILITY

Figure 7. Afferent and Efferent Pathways of Defecation Reflex

Figure 6. Colonic Transit Revealed by Radioscintigraphy

Regulated primarily by neural pathways (ENS) by filling the

lumen (stretch receptors)
Enhances the efficiency of water and electrolyte absorption
Promotes excretion of fecal material
No distinction between fed and fasting state
Large intestines dont move during sleep but is stimulated by food

Carrasco, Castillo M., Castillo F., Catolico, Cauyan, Chavez, Chiu

Rectosphincter reflex initiates defecation

Mass peristalsis distends the rectum, initiating afferent signals to
the myenteric plexusinitiate peristaltic waves in the descending
colon, sigmoid and rectumfeces are forced into the anus
As the peristaltic wave approaches the anus, the internal anal
sphincter is relaxed by inhibitory signals from the myenteric
plexus
The external anal sphincter voluntarily controls its relaxation
Relaxation of both sphincters fecal evacuation

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Figure 8. Structural Relationship of the Anorectum and Puborectalis Muscle

On one end of puborectalis inserts on left pubic tubercle, the

other end inserts on right pubic tubercle forming a loop on the
junction of rectum and anal canal
Contraction forms the anorectal angle maintenance of fecal
continence (anus and rectum are not in the same line)
Note: Puborectalis muscle relaxes during defecation

Carrasco, Castillo M., Castillo F., Catolico, Cauyan, Chavez, Chiu

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