Gastrointestinal Physiology

Defecation Reflex Maj Umbreen Ahmed

Functional Anatomy of Rectum

Rectum ( means straight) Curved No sacculations, appendices epiploicae, taeniae coli Upper parts diameter is same as sigmoid colon Lower part dilated to form rectal ampulla 3 lateral curves 3 valves produced by circular muscle fibers May be concerned with separation of flatus from fecal material Nerve supply Sympathetic----hypogastric plexus Parasympathetic----S2 & S3 or S3 & S4 by pelvic splanchnic nerves Both convey pain sensations

Functional Anatomy of Anal Canal

Tube like Internal anal sphincter circular smooth muscle fibers continuation of circular muscle of rectum lie immediately inside the anus External anal sphincter skeletal muscle fibers striated voluntary muscle Surrounds the internal sphincter and extends distal to it

Internal Anal Sphincter

Supplied by autonomic nervous system Parasympathetic Inhibitory to internal sphincter Sympathetic Motor to internal sphincter

External Anal Sphincter

Nerve supply Inferior rectal branch of pudendal nerve Somatic nervous system---voluntary control the external sphincter is usually kept continuously constricted unless conscious signals inhibit the constriction. Slow twitch muscle fibers are abundant in external sphincter which show constant electromyographic activity

Anal Continence
Contraction of puborectalis
maintenance of angle between rectum and anal canal

Abdominal pressure falttening ant rectal wall over the upper end of canal Presence of mucosal cushions in anal canal Tonic contraction of external sphincter
Voluntary control

Tonic contraction of internal sphincter

can only maintain continence of there is no distension Involuntary control

Defecation
Defecation is a reflex by which feces are expelled from the large intestine through anus Defecation is the temporary reflex interruption of the anal continence by which the feces are expelled from the large intestine through anus

Defecation
Rectum is mostly empty Weak functional sphincter---juncture b/w sigmoid colon and rectum Sharp angulation -----additional resistance

Defecation
Urge starts--- rectal pressure increases to 18 mm Hg Intrinsic reflex In response to entry of feces in the rectum Mediated by myenteric plexus Weak reflex Extrinsic reflex Parasympathetic defecation reflex Strong reflex Reinforce intrinsic reflex

Defecation reflexes Intrinsic reflex

Intrinsic reflex mediated by the local enteric nervous system Weak Integrated in myenteric plexus Stimulus-------stretch of the rectal wall presence of feces in the rectum Receptors---nerve endings Afferent signals---- spread through the myenteric plexus Response--- initiate peristaltic waves in the descending colon, sigmoid, and rectum, forcing feces toward the anus. As the peristaltic wave approaches the anus
the internal anal sphincter is relaxed by inhibitory signals from the myenteric plexus if the external anal sphincter is also voluntarily relaxed at the same time, defecation occurs.

Defecation reflexes Extrinsic reflex

a parasympathetic defecation reflex Receptors--- nerve endings in the rectum Afferents---parasympathetics Center--- sacral segments of the spinal cord Efferents--parasympathetics (pelvic nerves) Effectors---smooth muscle of the descending colon, sigmoid, rectum, and anus Response---- greatly intensify the peristaltic waves as well as relax the internal anal sphincter

Defecation reflexes Extrinsic reflex

other effects taking a deep breath closure of the glottis contraction of the abdominal wall muscles to force the fecal contents of the colon downward pelvic floor to relax downward and pull outward on the anal ring to evaginate the feces

Constipation
slow movement of feces through the large intestine dry, hard feces in the descending colon --- over- absorption of fluid Causes intestinal obstruction tumors adhesions that constrict the intestines ulcers

Constipation
Causes functional cause irregular bowel habits (inhibition of the normal defecation reflexes) spasm of a small segment of the sigmoid colon motility even normally is weak in the large intestine cause serious constipation

Diarrhea
rapid movement of fecal matter through the large intestine Causes of diarrhea Enteritis. Cholera
cholera toxin directly stimulates excessive secretion of electrolytes and fluid from the crypts of Lieberkhn in the distal ileum and colon. 10 to 12 liters per day loss of fluid and electrolytes can be debilitating

Diarrhea
Psychogenic Diarrhea. periods of nervous tension emotional diarrhea caused by excessive stimulation of the parasympathetic nervous system motility excess secretion of mucus in the distal colon

Diarrhea
Ulcerative Colitis. extensive areas of the walls of the large intestine become inflamed and ulcerated. mass movements occur much of the day rather than for the usual 10 to 30 minutes. colons secretions are greatly increased repeated diarrheal bowel movements.

Megacolon Hirschsprungs disease

Severe constipation bowel movements occur only once every several days/once a week. Tremendous quantities of fecal matter accumulate in the colon colon sometimes distend to a diameter of 3 to 4 inches.

Megacolon Hirschsprungs disease

Cause of megacolon lack of or deficiency of ganglion cells in the myenteric plexus in a segment of the sigmoid colon. Defecation reflexes or strong peristaltic motility cannot occur in this area of the large intestine sigmoid colon becomes small and almost spastic feces accumulate proximal to this area causing megacolon in the ascending, transverse, and descending colons