gastrointestinal regulation and motility
TRANSCRIPT
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Chapter 31
Gastrointestinal Regulation and Motility
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We require:
carbohydrates (mainly glucose)
proteins (essential amino acids)
fats (but Western diet fats too high)
vitamins
minerals
Nutrition
Carbohydrate 50%
Fat 35%
Protein 15%
Intake (normally 3000-6000kcal per day & depends on
Geography
Occupation
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Gastrointestinal system
consists of
Gastrointestinal (GI) tract
Accessory glandular organs
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Anatomy and functions of the GI tract
GI tract mouth, pharynx, esophagus, stomach, small intestine, large intestine, anus
Accessory Glandular Organs
salivary glands, liver, gallbladder, pancreas
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Histology/organization of the Gut Wall
From esophagus to anus, GI tract has the same basic arrangement of tissues.
There are 4 layers that can be distinguished
• Mucosa
• Submucosa
• Muscularis
• Serosa
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Layers of Alimentary Canal
Serosa
Submucosa
Mucosa
Circular muscle layerLongitudinal muscle layer
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MucosaSerosa
SubmucosaLongitudinalmuscle
Circular muscle
Layers of Alimentary CanalMyentericplexus
Submucosalplexus
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1.Digestion of food and absorption of nutrients are accomplished in a long tube connected to the external world at both ends
2.Secretion and motility of “the tube” are major themes in understanding the gut.
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1. Ingestion : process of eating
2. Propulsion : passing of food down the GI tract
• swallowing : voluntary
• peristalsis : reflex, involuntary, involves alternating contractions of muscles in body walls of
GI organs
3. Mechanical digestion
• prepares food for chemical digestion
• includes chewing, mixing with saliva by tongue action, churning in stomach...
Processing of food by the DS
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4. Chemical digestion
• catabolic steps in which food is broken down to
basic building blocks
• accomplished by enzymes in digestive juices
5. Absorption : passage of food particles into the blood-
lymph
6. Defecation: elimination of indigestible food
substances
Processing of food by the DS
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Gastrointestinal Motility: Movements that mix and circulate the gastrointestinal contents and propel them along the length of the tract
Secretion: Process by which the glands associated with the gastrointestinal tract release water and substance into the tract
Digestion: Process by which food and large molecules are chemically degraded to produce smaller molecules that can be absorbed across the wall of the gastrointestinal tract.
Absorption: Process by which nutrient molecules are absorbed by cell that lin the gastrointestinal tract and enter the bloodstream
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I REGULATION OF GASTROINTESTINAL TRACT FUNCTIONS
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Cell Hormone Site
G Gastrin (G) autrumn, duodenum
I Cholecystokinin (CCK) duodenum 、 jejunum
S Secretin duodenum 、 jejunum
D Somatostatin (SS) Stamoch, duodenum, pancreas, colon
L Enteroglucagon Small intestine, colon
PP Pancreatic polrpeptide (PP) pancreas
EC1 Substance P (SP) Stamoch, intestine
D1 VIP Stamoch, intestine, pancreas
P bombesin Antrum, duodenum
N neurotensin ileum
B insulin pancreas
A glucagon pancreas
K Gastric inhibitory polypeptide(GIP)
duodenum 、 jejunum
Mo motilin Stamoch, intestine
Endocrine Cell and gut hormoneEndocrine Cell and gut hormone
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Types of secretionTypes of secretion
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Function of GI hormones
1. Regulate the secretion and motility of GI tract
Gastrin HCl secretion, gastric empty
2. Trophic action
Gastrin stomach and duodenum mucosa
3. Regulate the release of other hormones
GIP insulin
SS GH, gastrin
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Innervation of the GI tract1. Central nervous system
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CNS to gut connections
SPINAL CORDdorsal root
ganglion
Spinal afferent
Vagalafferent
Vagal efferent
nodose ganglion
BRAIN STEM
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The autonomic nervous system Sympathetic system:
Noradrenaline
Gut secretions (+)
Sp
inal co
rd
Pons/medulla
Midbrain
Gut sphincters (-)
Pancreas (+)
ACTION
Rectum (+)defaecation
ACTION
Gut wall (+)
adrenaline
EFFECTSEFFECTS
Salivary glands (+)
X IX
VII
Cranial nerves
Parasympathetic system: Acetylcholine (Ach)
(+) salivary glands
(+) gut blood 2 (-) vessels
1/2 (-) gut wall, (+) sphincters
(+) secretion
Adrenal medulla
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Innervation of the GI tract
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Innervation of the GI tract2. Intrinsic (enteric) nerve plexuses
Located
in the submucosa (submucosal or Meissner’s plexus) and between circular and longitudinal muscle layers (myenteric or Auerbach’s plexus)
Control
Motility - Myenteric plexus
Secretion - Submucosal plexus
through release of neurotransmitters
Excitatory - Acetylcholine, Substance P
Inhibitory - VIP, nitric oxide
Excitatory - Acetylcholine
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The enteric nervous system
Deep muscular plexus
Submucosal
artery
Muscularis mucosa
Submucosalplexus
MUCOSA
Myenteric plexus
Longitudinal muscle
Circular muscle
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The enteric nervous system coordinates
digestion,
secretion
motility
to optimize nutrient absorption.
Its activity is modified by information
from the CNS
from local chemical and mechanical sensors.
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Myenteric plexus
Submucosal plexus
Enteric nervous system
CNS
Sympathetic ganglia
Vagal nuclei
Sacral spinal cord
Preganglionic fibres
Postganglionic fibres
Preganglionic fibres
Parasympathetic n.s Sympathetic n.s.
Smooth muscle
Secretory cells
Blood vessels
Endocrine cells
Innervation of the GI tract
Postganglionic fibres
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Gastrointestinal reflex
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II GASTROINTESTINAL SMOOTH
MUSCLE
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Musculature of the GI tract
All smooth muscle except:
Upper third oesophagus – striated
Middle third of oesophagus – mixed
External anal sphincter – striated
Areas of striated muscle are areas that are under conscious control
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Form hollow tubes not contracting against skeleton
Form a syncitium - electrically coupled, joined by gap
junctions contractions synchronous
Actin:myosin ratio 15:1 (skeletal muscle 2:1)
Contractile elements not arranged in sarcomeres
not striated
Anatomical Properties of GI smooth muscle
5-10m
200m
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General Functional characteristicsGeneral Functional characteristics
1. Lower excitability, slower contraction and relaxation
2. Higher extensibility
3. Tonic contraction
4. Autorhythmicity
5. More sensitive to stretch, chemicals, cold and warm stimulation but not to electric stimulation
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Electrical activity of GI smooth muscleElectrical activity of GI smooth muscle
1. Resting potential
2. Slow wave or basic electric rhythmThe smooth muscle membrane slowly depolarizes and repolarizes in a cyclic fashion
3. Action potential
4. Relationship to contraction
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0
-60Mem
bra
ne
po
ten
tial
(m
V)
Tension
0
-60
Tension
Mem
bra
ne
po
ten
tial
(m
V)
Acetylcholine
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Slow waves are changes in resting membrane potential 3-12 cycles per minute depending on area of GI tract -
3/min in stomach, 12/min small intestine Always present but do not always cause contractions Frequency of contractions dictated by frequency of
slow waves Slow wave frequency and height modulated by –
• body temp & metabolic activity, • intrinsic & extrinsic nerves• circulating hormones
Slow waves in GI smooth muscle
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Relationship to contraction
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gNa,Cavoltage
delayed gK
+ gK(Ca)resting pot:
gNa + gK + Na pump
-60 mV
Membrane potential
Contractile force
Thresholdfor contraction
2 sec
Plateau:Na + Ca influx =K efflux
In interstitialpacemaker cells:slow closing
of delayed gK
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.
electricalthreshold
action potentials
slow waves
Force of contraction determined by additional neural andhormonal input.
Frequency of contractions-determined by basic electricalrhythm of interstitial pacemaker cells.
con
trac
tio
ns
elec
tric
al a
ctiv
ity
Slow Waves & Visceral Smooth Muscle Contractions
Excitatory(contracts smooth muscle)
Inhibitory(relaxes smooth muscle)
AChSubstance P
VIPNO
Contractionthreshold
AP threshold
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Contraction of GI smooth muscle
Out
In Ca2+
(Ca2+)4. calmodulin
Inactive myosin light chain kinase
Active myosin light chain kinase
MUSCLE CONTRACTION
Myosin -(PO4)2
Calcium activates contraction
Depends on influx of calcium from extracellular space through calcium channels
Calcium- calmodulin complex activates myosin light chain kinase
Contraction explained by sliding filament theory
Out
In Ca2+
(Ca2+)4. calmodulin
Inactive myosin light chain kinase
Active myosin light chain kinase
MUSCLE CONTRACTION
Myosin -(PO4)2
Out
In Ca2+
(Ca2+)4. calmodulin
Inactive myosin light chain kinase
Active myosin light chain kinase
MUSCLE CONTRACTION
Myosin -(PO4)2
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AP in GI smooth muscle
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4. Noradrenaline release
5. Sympathetic stimulation
more hyperpolarised smooth muscle, Less excitable and fewer contractions
Stimulus Effect on muscle
Electrical activity and muscle contraction
1. Stretch of GI tract wall
2. Acetylcholine release
3. Parasympathetic stimulation
more depolarised smooth muscle, more excitable.
Leads to action potential generation and smooth muscle contraction
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GI motility
There are many types of contractions in different areas of the GI tract.
Some muscles contract and relax in seconds – Phasic Contractions
-Peristalsis and Segmentation
Some maintain contractions over minutes or hours – Tonic Contractions
-Sphincter