GI motility

MouthEsophagusStomachSmall intestine (duo, jej, ill)Large

intestineAnus

Layers of GI

Extrinsic system
Parasympathetic innervation via vagus and pelvic nerve and inneract with plexus
layers

Sympathetic innervation from fibers that run b/w spinal cord. Postganglionic fibers
act on plexus or directly on muscle, secretory, or endocrine cells

Both systems contain afferents and efferents so feedback loops exist

Intrinsic System
GI can control itself with the para and sym for modulation

Motility
1) Chewing
a. Breaks food down
b. Mixes with saliva for lubrication
c. Starts carbs digestion by amylase
2) Swallowing
a. Integrated activity of oral cavity, pharynx, esophagus (voluntary and
involuntary)
b. Phases
i. Oral-Tongue propels food back and activates
mechanoreceptors on pharynx to send reflex to brainstem to
initiate swallowing reflex
ii. Pharyngeal phase
1. Soft pallet pulled up
2. Epiglottis covers larynx
3. Upper esophageal sphincter relaxes
4. Peristaltic wave initiated
 iii. Esophageal phase controlled by both swallowing reflex and
enteric system
1. Food bolus passes thru upper esophageal sphincter
2. Sphincter closes to prevent reflux
3. Swallowing initiates peristaltic wave
4. If primary wave doesn’t propel food to stomach, enteric
initiates second wave
iv. Bolus passes thru lower sphuincter and orad region of stomach
relaxes, modulated by vagal input
-Relaxation of orad region referred to as receptive relaxation
-Contractions to mix food with gastric secretions to start digestion retropulsion
-Gastric emptyin that propels bolus, now referred to as chime into duodenum
Facts about contractions
-Contractions referred to as slow waves
-Rate of 3-5/min
-Frequency controlled by intrinsic NS but intensity modulated by extrinsic NS.
Parasym increases, symp decreases (via secretin and GIP)
-During fasting, contractions still occur but slower (90 min intervals) and referred
to as migrating myoelectric complexes(mediated by motilin)

Gastric emptying
Constraints
-Rate slow to keep acid in duodenum neutral
-Keep slow to allow chime to adequately churn
Regulation: pH in duodenum and fat

Motility in small intestine

-Para increases, symp decreases

Large intestinal motility

-Material elaves ileum to cecum
-Ileocecalsphincter closes
-Segmental contractions occur and produce mixing
-Mass movements occur to move material
Retrosphincteric reflex-Reflexive contraction of smooth muscle in rectum and
relaxation of internal anal sphincter to prep for defecation
Valsalva maneuver-Forced expiration to produce movement thru constricted
passage, used to drive defecation, clear sinuses, pop ears, give birth etc (who
thought popping your ears and defecating were related? It’s gna be weird seeing
people on an airplane and hoping they’ve got the right reflex triggered)
Gastrocolic reflex-Reflex whereby distention of stomach triggers mass movements
in large intestine to clear way for more food