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GI Dysmotility III

GI Dysmotility III

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Published by Diana Hylton
gi DYSMOTILITY
gi DYSMOTILITY

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Published by: Diana Hylton on May 01, 2013
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GI Motility III
Week 2
Wednesday, February 09,
 
Major Functions of the SI & motilityrequirements
o
 
Digest macromolecular nutrients (requiressignificant agitation
& ↓
size
& ↑
solubility)
o
 
 Absorb
digestion products (stirring to mixcontents w/ digestive enzymes/secretions &maximizes contact b/twn nutrient molecules& epithelial cell membranes)
o
 
 Absorption
of fluid and electrolytes
o
 
Retain nutrients in small bowel untilmaximal digestion & absorption (requiresslow distal movement of chyme)
o
 
Move chyme from duodenum to point of emptying at ileo-colonic sphincter
 
Structure & Innervation
o
 
Circular (thicker) & longitudinal SM
o
 
Duodenum-20 cm
o
 
Jejunum- 3 meters
o
 
Ileum-4 m long
o
 
Functions: Duod. & Jej.- digest & absorb
o
 
Innervation:
 
Extrinsic: vagus nerve & sympatheticfibers from celiac & sup. mesentericganglia
o
 
Intrinsic:
 
 
distension, mechanoreceptors sendsignals both aboral and toward anus
 
Oral- contraction to push bous
 
Circular muscle layer
 
Signals sent in the myenteric plexus-which is between the circular andlongitudinal /outter muscle layer
o
 
↑ MOTILITY 
 
 
Acetylcholine (parasymp. & myenteric)
 
Serotonin (5-HT)
 
Gastrin
 
CCK (small intestine)
 
Enkephalin
 
Motilin
o
 
↓ motility 
 
 
Norepinephrine (sympathetic)
 
Adenosine
 
Somatostatin
 
Nitric oxide (NO)
 
Secretin
 
VIP
 
CCK (stomach)
 
GIP
 
Enteroglucagon
Peristaltic Reflex (intrinsic)
 
Intrinsic:
Bolus causes distension.Felt by chemoreceptors. Send signals in aboraldirection
inhibitory neurotransmitters (VIP & NO)released that cause relaxation.Oral direction
contraction of smooth muscle
Multiple Ganglia of the Submucous & MyentericplexusesExtrinsic from the CNS-
Bolus
stimulates receptorSends signal along vagus to the CNSSignals in front of bolus (aboral) causingrelaxation
Nitric OxideThose behind
cause contractionACh
 
Interneurons
Interneuron
(Oral) (Aboral)(Stretch)
myenteric plexus
Circular muscle contracts
Longitudinal muscle relaxesCircular muscle relaxes
Longitudinal muscle contracts
 
 
 
 
Coordinated Muscle layerContraction/Relaxation during peristalsis
o
 
Circular muscle -
 
 
contracts tube diameter
 
lengthens tube
 
decreases volume
 
displaces contents
o
 
Longitudinal muscle -RELAXATION
 
 
relaxes when circular muscle contracts inperistalsis
 
formation of segmentation
o
 
Sites:
esophagus, stomach, SI, briefly in LI
o
 
Functions:
propulsive transport or non-propulsive mixing
 
3 Main patterns of Small Intestine Motility
o
 
Major pre-programmed motility patterns
o
 
Digestive patterns (after meal; frequent contractions, net mvt 1 cm/min or total of 3-5hr from pylorus to ileocecal sphincter
o
 
Aboral peristalsis
o
 
Mixing pattern
o
 
Post-digestive patterns (fasting
;
strongcontractions every ~90 min)
o
 
Migrating motility complex
o
 
Protective response pattern
o
 
Power propulsion
 
Mixing Pattern Motility: SEGMENTATION
o
 
Contraction of circular layer(both sides)
o
 
Alternating contraction & relaxation
o
 
Results in MIXING of food
 
↑ digestive juices
 
 
Facilitates exposure of luminial contents tomucosal surface
 
↑ breakdown of particle sizexs
 
Contractile patterns of SI
o
 
Propagating Contractions
o
 
Clustered Contractions
 
Move down intestine; slowly
o
 
Segmentation
mixing
o
 
Multiple are going on at same time
 
Clustered, isolated, propagating
 
Interdigestive Motility: 3 Phases
o
 
Migrating Motor complex generated in
stomach
 
 
Mechanism to clear out stomach of largeresidual particles
o
 
Moves down to duodenum
Jejunum
Ileum
o
 
Contraction in Phase III
Phase I
Phase II
Coordinated Muscle layer Contraction/Relaxationduring peristalsisSmall Intestine MotilitySEGMENTATIONInterdigestive Motility Consists of 3 Phases:
 
 
 
 
Migrating Motor Complex
o
 
Starts 2-3 hr after meal digestion
o
 
Triggered by hormone -
motilin
 
o
 
Aborally clears undigested debris from SI
 
Three motility phases
o
 
Phase III
, regular contractions (lengthens asregion migrates to ileum)
o
 
Starts at 3-6 cm/min
 
slowing to 1-2 cm/min at termination
o
 
Phase I,
quiescent (shortens as regionmigrates to ileum)
o
 
Phase II,
irregular contractions(intermediate)lengthens as region migrates
 
to ileum)
o
 
MMC reaches ileum, new begins at antrum
o
 
Time between cycles is longer during day
o
 
Terminates when food enters SI
o
 
I.V. nutrition alone will not terminate MMC
o
 
Gastrin & cholecystokinin terminate MMCexcept in ileum
 
Meal ingestion suppresses interdigestive &initiates digestive motor pattern
 
o
 
Meal stimulates motility in duodenum *antrum
o
 
Breaks quiescent period of phase I
 
Sleep fating pattern
 
o
 
Reduced phase II
o
 
Lengthened Phase I
o
 
Waking up in the morning
takes you out of relaxed Phase I
 
Retroperistalsis (Reverse Peristalsis)
o
 
protective response to rapidly clear tract of irritants or move obstructions
o
 
Large & small intestine
o
 
Triggered by:
 
mechanoreceptors
in throat 
 
mechano & chemoreceptors
instomach & gut 
 
labyrinthine receptors in inner ear
o
 
Speed of movement may not be tied to slowwaves - in such cases, extrinsic neural inputsare involved
o
 
Emesis program excellent example
 
Role of Retroperistalsis:
o
 
Helps dislodge material that may get stuck 
o
 
Important in vomiting reflux
o
 
Can occur in both small & large intestine
 Migrating Motiltiy ComplexSleep Fasting Pattern

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