Year II GI/Liver System

Introduction to Gastrointestinal Motility

Dr. Austin Mircheff
Friday, February 28, 2014 8:00 8:50 AM

Introduction to Gastrointestinal Motility

Student Learning Objectives
1) What is the basic architecture of the gastrointestinal musculature and innervation?
a) How does the enteric nervous system mediate autonomic input to, and sensory output from,
the gut?
b) What happens when circular muscle contracts? When longitudinal muscle contracts?
2) Why does swallowing require coordination of several muscular tissues?
a) The tongue, soft palate, pharyngeal muscles, epiglottis, larynx, vocal cords, and upper
esophageal sphincter?
b) How are they coordinated?
c) Why does the esophagus need an upper- and a lower sphincter?
3) What are the motor activities of the stomach?
a) Why is the reservoir function of the orad stomach an active function?
b) How does the stomach transform solid food to liquid chime?
c) Why is it helpful to have a pyloric sphincter?
4) What are the motor activities of the small intestine?
a) How does it mix chyme? Why must it mix chyme?
b) How does it propel chyme?
c) What is Peristaltic Reflex?
d) What is the Intestino-Intestinal Reflex?
e) What is the interdigestive myoelectric complex, aka the migrating myoelectric complex?
f) How does the ileocecal sphincter function as a one-way valve?
5) What is the difference between retching and vomiting?
6) What are the motor activities of the large intestine?
a) What is accomplished by haustral shuttling, multihaustral propulsion, multihaustral
retropulsion?
b) What is a (physiological) mass movement?
7) What is the rectosphincteric reflex?
a) How are the internal- and external anal sphincters controlled?
8) What is the slow wave, aka the basic electrical rhythm?
a) What role does it play in regulating gastrointestinal smooth muscle contraction?
b) What are spike bursts and how do they determine smooth muscle tension?
9) Why is the dominant motor signal from the enteric plexuses inhibitory?
a) How do the enteric plexuses propagate peristaltic waves?

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Introduction to Gastrointestinal Motility

1) What is the basic architecture of the gastrointestinal musculature and innervation?

Smooth muscle muscularis mucosae
Submucosal plexus
Smooth muscle inner layer circular
Myenteric plexus
Smooth muscle outer layer longitudinal
a) How does the enteric nervous system mediate autonomic input to, and sensory output from,
the gut?

Sympathetic input: Postganglionic

- most synapse with enteric plexuses
- some synapse with effectors, i.e., smooth muscle cells or epithelial cells
Parasympathetic input: Postganglionic
- all synapse with enteric plexuses
Sensory output
- mechano-, chemo-, osmo-, pH-, and amino acid receptors
- signal to splanchnic plexuses, spine, higher centers through the enteric plexuses
b) What happens when circular muscle contracts? When longitudinal muscle contracts?

Circular: narrows lumen, increases length

Longitudinal: shortens, widens lumen

2) Why does swallowing require coordination of several muscular tissues?

a) The mouth communicates with the respiratory system (nasal pharynx, larynx, trachea) as well as
with the GI system (esophagus)
b) Tongue isolates bolus, forces it into oral pharynx
Soft palate and posterior wall of oral pharynx appose
Vocal cords appose, larynx moves forward, epiglottis lowers
Upper esophageal sphincter relaxes
Peristalsis and if needed secondary peristalsis propel bolus through esophagus
c) Pressure in thoracic cavity is negative with respect to stomach and abdominal cavity
Upper sphincter prevents it from inflating with air
Lower sphincter prevents it from filling with gastric acid
Normal positioning below diaphragm reinforces closure
Displaced into thoracic cavity in hiatal hernia and, often, in pregnancy
3) What are the motor activities of the stomach?
a) Lower esophageal sphincter relaxes; smooth muscle of orad stomach relaxes to accommodate
larger volume with no increase in tension
b) Peristaltic waves propagate from mid stomach to pyloric sphincter; they narrow but do not
occlude lumen; most chyme retropulsed back to body of stomach.
Stomach also produces 2 L of 140 mM (0.14 N) HCl.
c) Pyloric sphincter isolates duodenal mucosa from gastric acid

Isolates gastric mucosa from bile salts.

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Introduction to Gastrointestinal Motility

4) What are the motor activities of the small intestine?

a) Diffusion is slow; thorough mixing assures

b)
c)
d)
e)
f)

g)

optimal access of digestive enzymes to starch, protein, and triglycerides

optimal access of nutrient molecules to the absorptive surface
Segmenting contractions are small intestines only mixing activity
Small intestine propels chyme with short peristaltic sequences
More than normal distension initiates a peristaltic wave that propagates to the ileocecal
sphincter- the Peristaltic Reflex
Excessive distension triggers shut-down of intestinal motility - the Intestino-Intestinal Reflex
During sleep and wakefulness during fasting, peristaltic waves arise to propel sloughed cells,
secretion, microbes to the ileocecal sphincter - the interdigestive myoelectric complex, aka the
migrating myoelectric complex.
Tonic contraction and structure isolate the relatively sterile ileum from the decidedly non-sterile
ascending colon.

Activation of mechanoreceptors in terminal ileum trigger relaxation of the sphincter

Activation of mechanoreceptors in the ascending colon trigger increase of sphincter tension

5) What is the difference between retching and vomiting?

a) Retching:

Abdominal muscles contract.

Region of the lower esophageal sphincter displaced above diaphragm

Antrum contracts but corpus, fundus, lower esophageal sphincter, and esophagus are flaccid
- Upper esophageal sphincter remains closed
- Chyme flows back into stomach.
b) Vomiting:

Retching, except:
- upper esophageal sphincter relaxes
- increase of intra-thoracic pressure expels chyme from esophagus

6) What are the motor activities of the large intestine?

a) Mixing:

Haustral shuttling: individual haustra contract independently; resembles segmentation

Multihaustral propulsion and multihaustral retropulsion; adjacent haustra contract

sequentially
- Occur with equal frequency, propagated over similar distances: No net propulsion
b) Propulsion, accomplished by mass movements:

Circular muscle of several aboral haustra relax

Circular muscle of several more haustra contract

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Introduction to Gastrointestinal Motility

7) What is the rectosphincteric reflex?

a) Activation of mechanoreceptors in rectum triggers reflex relaxation of the internal anal
sphincter (smooth muscle)
Also signals urge to defecate
b) External anal sphincter is striated muscle.

Urge to defecate integrated with other signals, leading to voluntary increase of external anal
sphincter tension. Or not.

Signals from mechanoreceptors accommodate; attenuation of signal to brain:

- Stops relaxation of internal sphincter
- Stops urge to defecate

8) What is the slow wave, aka the basic electrical rhythm?

A spontaneous activity of certain smooth muscle cells; propagated electrotonically to

neighboring cells.
a) What role does it play in gastrointestinal smooth muscle contraction?

Frequency determines frequency at which the muscle may contract

Resetting in hyperpolarizing direction prevents action potentials

- forced relaxation

Resetting in depolarizing direction can allow peak of the slow wave to cross the electrical
threshold, permitting action potentials
- resetting entire slow wave above threshold causes tonic contraction.
b) What are spike bursts and how do they determine smooth muscle tension?

Sequences of action potentials at the plateau of a slow wave that has crossed threshold

Comprised of inward Ca2+ currents; Ca2+ activates contractile apparatus

9) Why is the dominant motor signal from the enteric plexuses inhibitory?

Isolated from neural inputs, the entire slow wave passes electrical threshold
- Aganglionic segment of (Hirschprungs disease) tonically contracted
b) How do the enteric plexuses propagate peristaltic waves?

Distension by a bolus of chyme activates mechanoreceptors

Mechanoreceptor signals
- Attenuate inhibitory output to nearby circular smooth muscle
- Elicit stimulatory output to nearby circular smooth muscle
- Enhance inhibitory output to adjacent, distal circular smooth muscle
- Elicit stimulatory output to adjacent, distal longitudinal smooth muscle

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