Gastrointestinal System Lectures

PHPY 303.3
Lecture #2

Instructor: Dr. Francisco Cayabyab

Department of Surgery

Office: Rm. GD30.5 D-Wing,

Health Science Building

Tel: 966-8191

Email: frank.cayabyab@usask.ca
Objectives:

Know the general structural and

regulatory features of the GI tract

Know the cellular and electrical basis for

GI motility

Know the contributions of the oral cavity

and esophagus to digestion and motility
Accessory organs

Structures and
functions of the
digestive system

6 Functions:
Secretion
Digestion
Absorption
Motility
Excretion
Host defense
 Review: Basic Functions of GI Tract
Nutrients, water, electrolytes support other body organ systems
Maintenance of energy balance

Excretion

Host defense/immune surveillance

Focus on Motility Function today

 Voluntary and Involuntary Control of GI Motility

Sk. muscles (vol.)

Continuous tube
Same general structure
Local variation

Sphincter of Oddi
Smooth
Muscles
(invol.)

Sk. muscles (vol.)

(external)
Four layers/tunics
-serosa
-muscularis externa
-submucosa
-mucosa

Features enhancing
absorption/secretion
in small intestine

-plicae circularis
-villi, crypts
-microvilli
->600-fold increase
in surface area
 Mucosa
Luminal surface
Inner epithelial layer (protective function)
Exocrine cells (secretion of digestive juices)
Endocrine cells (Secretion of GI hormones)
Epithelial cells (Absorbing nutrients)
Submucosa
Layer of connective tissues distensibility and elasticity
Blood and lymph vessels
Submucous plexus (network of nerves)
Muscularis externa
Two muscle layers (inner circular and outer longitudinal)
Myenteric plexus (network of nerves)
Serosa
Outer connective tissue covering the digestive tract
Secretes a watery fluid for lubrication.
 Regulation of gastrointestinal functions
Autonomous smooth muscle function
Muscle-like but not contractile cells (Interstitial cells of Cajal)
Rhythmic variations in membrane potentials (Basic Electrical
Rhythm, also called slow wave potential)
Pacesetter cells
Intrinsic nerve plexuses (enteric nervous system)
Interconnecting network of nerve cells
Two major networks (myenteric and submucous)
Run the entire length of GI tract
Influence all facets of digestive tract activity
Extrinsic innervation
Sympathetic and parasympathetic activity
Gastrointestinal hormones
Released in response to local changes in luminal content into
blood
Also immune and paracrine factors
 Anatomy
Epithelium

Submucosal Plexus Neurons

Nerve fibers
Deep Muscular Plexus
ICCs

Circular Muscle

Neurons
Myenteric Plexus
ICCs

Longitudinal Muscle
 Muscle
Generally smooth muscle
Exceptions: upper esophagus, anus
Muscle is a syncytium
Bundles of cells form functional unit
Coupling via gap junctions
circular muscle to circular muscle
Longitudinal muscle to longitudinal muscle
ICC to circular muscle, also ICC to ICC
ICC to longitudinal muscle (controversial)
Muscle has inherent rhythmicity (due to ICC)
Frequency gradient in each organ
Pacemaker sites have highest frequency
Coupling between pacemaker cells modulates frequency
Lowest frequency in stomach (3 cpm), and colon (5 cpm)
Highest frequency in duodenum (12 cpm)
ICCs are essential for motility function
3 waves / min in stomach to 12 / min in duodenum
Originates from Interstitial cells of Cajal

Force/duration of muscle contraction proportional frequency of

action potentials
Basal membrane potential can be increased or decreased

3) Nitric oxide
***

Note: freq. of slow waves unaltered by transmitters! *** Will be on exam

 Gastrointestinal Motility
1. Motor functions performed by
different layers of smooth
muscles.
2. GI smooth muscles are
electrically coupled by gap jns.
3. Rhythm of contractions
depend upon frequency of
slow waves in smooth muscle
membrane potential
4. Spike potentials are true action
potentials causing
contractions
Motility Patterns
Peristalsis 5. Resting membrane potential
Segmentation dependent upon stretch, neural
Mass movement and hormonal influences
MMC
Receptive relax. 6. Different motility patterns
Different Motility Patterns in Stomach and Small Intestine
MOUTH and PHARYNX
Motility:
Chewing
Swallowing
Secretion:
1500mL saliva/day
Facilitate swallowing
Keeps mouth moist
Solvent (taste buds)
Aids speech
Antibacterial action parotid
Keeps mouth/teeth clean gland
Contains sublingual
99.5% water/0.5% gland
submandibular
electrolytes and proteins gland
Lingual lipase
Acinar Amylase
Digestion:
Ductular mucins Carbohydrates (start)
IgA Absorption:
Lysozyme
No food
Lactoferrin
Bicarbonate Some drugs
 Regulation of Salivary Secretion
Salivary center in medulla of
parotid brainstem
gland Parasympathetic nerves
sublingual (stronger)
gland Sympathetic nerves (weaker)
submandibular
gland Conditioned reflex, taste, smell,
pressure on glands, and nausea
Sleep, fatigue, dehydration, fear

NOT antagonistic
Para- abundant flow
Symp- much less, rich in mucus
Damage to para-> atrophy!!!

Acetylcholine (parasym) and

norepinephrine/epinephrine
(symp.) are major secretagogues

Xerostomia-damage to salivary glands

 Salivary Pathophysiology ***

Xerostomia (dry mouth)

Impaired salivary secretions
Sjgrens syndrome-autoimmune attack of salivary
glands
Drug side effects (e.g., antidepressants,
antihypertensives, psychotropics)
Head/neck radiation to tumours

Patients present with: tooth decay, esophageal

erosions (decreased pH in saliva), difficulty in
lubricating/swallowing food, opportunistic infections
(impaired host defense)

*** Know for exam

ESOPHAGUS
Tube with sphincters at both ends

striated
muscle

smooth
muscle
Innervation of Esophagus
Sensory inputs from pharynx
activates an area in medulla
{DVC in brainstem} (swallowing center)
Pharynx and striated muscle
areas of esophagus
activated by center via
nucleus ambiguus (somatic
motor type)
Areas of smooth muscle
activated via dorsal motor
nucleus (visceral motor type)
Peristalsis- sequential
activation of muscles by
sequential neural impulses
from the center
 Primary Esophageal Peristalsis
UES: Prevents air from entering
esophagus during breathing

After bolus passes UES, reflex

action causes sphincter to
constrict
Followed by peristaltic wave
(primary peristalsis) just
below UES, controlled by
swallowing center
At rest Inhibitory nerves (NO)
LES: Prevents reflux of
gastric content relax LES during swallow
Secondary Esophageal Peristalsis
If primary peristalsis
insufficient to clear
food, distension of
esophagus activates a
secondary peristalsis
Begins above site of
distension and moves in
aborad direction (away
from mouth)
Purpose?
Primary and Secondary Peristalsis
Regulation by Nerves http://www.nature.com/gimo/contents
/pt1/images/gimo13-v1.mov

Control of peristalsis by
vago-vagal reflexes in the
lower esophagus

Input from esophageal sensory fibers to CNS and enteric nervous system
modulates both primary and secondary peristalsis.
 Control of Peristalsis by ENS

***Know for exam

Peristalsis triggered when sensory nerves detect distension

or luminal acidity
Interneurons convey signal to excitatory and inhibitory
nerves above and below site of stimulation, resp.
 Acid reflux / heartburn

Gastroesophageal reflux disease (GERD)

Esophagitis (erosions of mucosa and ulcers)
Lumen stricture
Columnar cells replace squamous epithelium
Adenocarcinoma
GERD Treatments:
Treated with proton pump inhibitors
Also H2 histamine receptor antagonists
ESOPHAGUS
Secretion:
Protective
Entirely mucus
Lubrication
Protect from acid and enzymes
if gastric reflux should occur
Digestion: None
Absorption: None