STORAGE FUNCTION OF THE GASTRIC EMPTYING BY FACTORS THAT INITIATE

STOMACH PYLORIC PUMP ENTEROGASTRIC INHIBITORY

REFLEXES TO GASTRIC
Food enters the stomach Strong peristaltic, very tight EMPTYING & SECRETION
 ring-like constrictions
Concentric circles of the food  1. Distention of the duodenum
(closest to the esophageal opening) Stomach emptying mid and caudad 2. Any duodenal mucosa irritation
 stomach 3. Acidity of the duodenal chyme
Older food (lie nearer the outer wall  4. Osmolality of the chyme
of the stomach) Addition of food 5. Certain breakdown products in the
 to the chyme in the antrum chyme, especially of proteins and,
Food stretches the stomach  mildly, of fats
 Constrictions begin farther up the
Vagovagal reflex body of the stomach INHIBITORY HORMONES TO
  GASTRIC EMPTYING
Tone reduction in the muscular wall Gradual addition food in the body
of the body of the stomach to the chyme in the antrum Fatty substances enters the
  duodenum
Wall bulges progressively outward Stomach emptying 
 (+) CCK
Accommodation of 
greater quantities of food EFFECT OF GASTRIC FOOD Hormones are carried by
VOLUME ON RATE OF blood to the stomach
EMPTYING 
MIXING AND PROPULSION OF (-) Gastrin
FOOD IN THE STOMACH Stretching of the stomach wall 
 (-) Motor functions in the body of the
Food in the stomach (+) local myenteric reflexes in the wall stomach
  
Slow waves (+) Activity of the pyloric pump (-) Activity of the pyloric pump
 
Mixing waves (-) Pyloric contraction
(weak peristaltic constrictor waves Acidic substances enters the
every 15 to 20 seconds) duodenum
 EFFECT OF GASTRIN ON 
Starts in mid to upper EMPTYING (+) Secretin
portions of stomach 
 Gastrin Hormones are carried by
Become more intense  blood to the stomach
toward the antrum (+) Moderate, motor functions in the 
 body of the stomach. (-) Gastrointestinal motility
Peristaltic action potential 
 (+) Moderate, activity of the pyloric
Antral contents are forced pump Fatty, carbohydrate-rich (mildly)
toward pylorus substances enters the duodenum
 
Antral contents are expelled into the INHIBITORY REFLEXES TO (+) GIP
duodenum GASTRIC EMPTYING 
(only a few milliliters or less) Hormones are carried by
Food enters the duodenum blood to the stomach
 
RETROPULSION Multiple nervous reflexes from (-) Gastrointestinal motility
duodenal wall (+) Insulin secretion by pancreas
Peristaltic wave approaches the 
pylorus 1. Enterogastric Nervous Reflexes
 2. Extrinsic Nervous Reflexes SEGMENTATION
Pyloric muscle contracts that go to the prevertebral CONTRACTIONS
 sympathetic ganglia and then
Impedes emptying through pylorus back through inhibitory Chyme enters SI
 sympathetic nerve fibers to the 
Antral contents are squeezed stomach SI becomes distended
upstream toward body of the 3. Extrinsic Nervous Reflexes 
stomach through the vagus nerves all the (+) Localized concentric contractions
 way to the brain stem, spaced at intervals along the intestine
Moving peristaltic constrictive where they inhibit the normal 
ring combines with this upstream excitatory signals transmitted Relaxation
squeezing action to the stomach through the vagi 
  New set of contractions begins,
Retropulsion (-) Strong, “pyloric pump” propulsive mainly at new points between the
contractions previous contractions
(+) Tone of the pyloric sphincter
 PERISTALSIS IN THE SMALL FEEDBACK CONTROL OF THE INTRINSIC DEFECATION
INTESTINE ILEOCECAL SPHINCTER REFLEX

Meal Distention of the cecum; Feces enter the rectum

 Irritant in the cecum 
Bolus enters the stomach;  Distention of the rectal wall
Chyme enters the duodenum Myenteric plexus; 
 Extrinsic autonomic nerves (+) Afferent signals that spread
Distention of the stomach;  through the myenteric plexus
Distention of the duodenal wall (+) Contraction of ileocecal sphincter 
 (-) Ileal peristalsis (+) Peristaltic waves in the descending
Gastroenteric reflex  colon, sigmoid, and rectum
 Delayed emptying of additional 
(+) Peristaltic activity of the SI chyme into the cecum from the ileum Forcing of feces toward the anus
 
Spread out of chyme along the Internal anal sphincter is relaxed by
intestinal mucosa; MASS MOVEMENTS inhibitory signals from the myenteric
Progression of chyme toward the plexus
ileocecal valve Meal 
  If external anal sphincter is also
Chyme reaches the ileocecal valve Distended stomach and/or duodenum consciously, voluntarily relaxed
  
Chyme is sometimes blocked for Extrinsic nervous reflexes Defecation
several hours (Gastrocolic and duodenocolic reflex)
 
Meal Mass movement PARASYMPATHETIC
 DEFECATION REFLEX
Gastroileal reflex intensifies
peristalsis in the ileum Distended or irritated point in the Nerve endings in the rectum are
 colon stimulated
Remaining chyme is forced through  
the ileocecal valve into the cecum of Constrictive ring occurs Signals are transmitted into the spinal
the large intestine  cord
20 or more centimeters of colon distal  
to the constrictive ring lose their Signals are transmitted
PERISTALTIC RUSH haustrations reflexly back to the descending 
 colon, sigmoid, rectum, and anus
Severe cases of infectious diarrhea Contraction as a unit  
  Intensified peristaltic waves;
Intense irritation of the intestinal Fecal material is propelled in this Relaxed internal anal sphincter 
mucosa segment en masse further down the
 colon 
Nervous reflexes  (+) Taking a deep breath
 Contraction develops progressively (+) Closure of the glottis
Peristaltic rush more force for about 30 seconds (+) Contraction of the abdominal wall
(powerful and rapid peristalsis)  muscles
 Relaxation occurs during the next 2 to (+) Relaxation of the pelvic floor
Content are swept into the colon 3 minutes downward and pull outward on the
  anal ring to evaginate the feces
Relief of small intestine from irritative Another mass movement occurs
chyme and excessive distention perhaps farther along the colon
 PERITONEOINTESTINAL
Mass movements persists for 10 to REFLEX
MOVEMENTS CAUSED BY 30 minutes
MUSCLE FIBERS OF THE VILLI  Irritation of the peritoneum
Movements cease 
Chyme in the small intestine  (-) Excitatory enteric nerves
 Movements return perhaps a half day 
Nervous reflexes in the submucosal later Intestinal paralysis
nerve plexus 
 Mass of feces is forced into the
Mucosal and villous contractions rectum RENOINTESTINAL,
  VESICOINTESTINAL REFLEXES
“Milking” of the villi Desire for defecation is felt
  Irritation of the kidney or bladder
Lymph flows freely from the central Reflex contraction of the rectum; 
lacteals of the villi into the lymphatic Relaxation of the anal sphincters (-) Intestinal activity
system
 ENTERIC NERVOUS  FAT DIGESTION
STIMULATION OF SECRETION Starch (30-40%)  maltose
 Food enters the mouth
1. Tactile stimulation Bolus becomes mixed with the 
2. Chemical irritation stomach secretions Lingual lipase secretion
3. Distention of the gut wall  by lingual glands
 Ptyalin is then blocked by acid 
Enteric nervous reflexes (pH<4.0) Swallowed with the saliva
  
(+) mucous cells on the gut epithelial Chyme enters SI Partial digestion of fats (10%) in the
surface  stomach
(+) deep glands in the gut wall Amylase, by pancreas 
  Emulsification of fat in the stomach by
Increased secretion Starch (50-80%)  maltose + dextrins agitation
 
Disaccharides come into contact with Chyme enters SI
brush border 
PRINCIPLES OF SECRETION  Emulsification of fat in the SI by bile
Maltase, Lactase, Sucrase (with bile salts & lecithin)
Nutrient material diffuse or actively in microvilli surface 
transported into the base of the cell  Fat (TAGs) globules with increased
 Disaccharides  glucose (80%), surface area
Mitochondria forms ATP fructose (10%), galactose (10%) 
  Pancreatic lipase (important)
ATP + substrates are used to To portal blood Enteric lipase (usually not needed)
synthesize the organic secretory 
substances TAGs  FFAs + 2-MAGs
 PROTEIN DIGESTION 
Secretory materials are transported Bile salts form micelles
through the tubules of the Bolus enters the stomach 
endoplasmic reticulum to golgi  Micelles transport MAGs and FFAs to
complex Chief cells secrete pepsinogen enterocytes
  
Materials are modified, added to, Parietal cell secrete HCl MAGs, FFAs
concentrated, and discharged into the   
cytoplasm in the form of secretory Pepsinogen  Pepsin Re-esterification (condensation)
vesicles   
 Proteins (10-20%)  Proteoses, Reformation of TAGs
Secretory vesicles are stored in the peptones, polypeptides  
apical ends of the secretory cells  Chylomicron formation
 Chyme enters the SI  
Nervous or hormonal control signals  To blood To lacteal
 Trypsin, chymotrypsin,
Hormone binds to its receptor carboxypeptidase, elastase
 by pancreas CHOLESTEROL ESTERS AND
Increased cell membrane  PHOSPHOLIPIDS
permeability to calcium ions Protein  Polypeptides
 Polypeptides  AAs (from C-terminal) Chyme enters the SI
Calcium enters the cell Elastin  Polypeptides 
  Cholesterol ester hydrolase;
Vesicles fuse with the apical cell Polypeptides, Dipeptides, Tripeptides, Phospholipase A2
membrane AA 
  Cholesterol, MAGs, Phospholipid by-
Apical cell membrane breaks open Remaining polypeptides comes into products
 contact w/ brush border 
Exocytosis  Bile salts form micelles
Aminopolypeptidases, Dipeptidases, 
other Peptidases Micelles transport cholesterol, MAGs,
CARBOHYDRATE DIGESTION in microvilli surface Phospholipid by-products to
 enterocytes
Food enters the mouth Dipeptides, Tripeptides, AAs 
  Re-esterification
Ptyalin, mainly by parotid glands Transport into interior of the 
 enterocyte Reformation of cholesterol esters and
Starch (5%)  Maltose + Dextrins  phospholipids
 Cytosolic peptidases 
Starch digestion continues in the body  Chylomicron formation
and fundus of the stomach for as long AAs (w/ TAGs)
as 1 hour  
 To blood To lacteal