GASTROINTESTINAL PHYSIOLOGY: 200 LEVEL MBBS (PHS 202)

COURSE OUTLINE:
 Gastrointestinal Tract – (i) Functional of GIT(ii) Innervations and
Visceral Sensations (iii) GIT Motility (Movements) (iv) GIT
Secretions and Control (v) GIT Blood circulation. (1)
 (i) GIT hormones (ii) GIT Biliary System: Secretions and Control,
(iii) Composition of Bile, adaptability of biliary secretions to
digestion and absorption of food. (2)
 Digestion and Absorption of different classes of food i.e.
Carbohydrate, Protein Nucleic acids, Fat, Water etc. in the GIT. (3)
 The Liver – (i) Functional Anatomy (ii) Liver Function Tests. (4)
 Clinical Tests of (i) Gastric (ii) Small intestinal functions and
Control (5)
 Clinical and Applied Physiology of Gastro intestinal Tract. (6)

(1) GENERAL PRINCIPLES OF GASTROINTESTINAL SYSTEM

At the end of the Lectures on this section, students shall be able to
discuss and appreciate:
(i) Physiological and Functional Anatomy of GIT; (ii) Innervations,
Nervous control and sensations of GIT;
(iii) Motility or Mechanical activities of GIT;
(iv) GIT blood Flow ( Splanchnic Circulation).
THE PHYSIOLOGICAL AND ANATOMICAL FUNCTIONS OF THE
GASTROINTESTINAL TRACT.
 Gastrointestinal System is the (i) GIT and (ii) Associated Glandular
and other organs i.e.(a)Teeth (b) Tongue (c) Salivary glands (d)
Liver (e) Gall bladder and (f) Exocrine part of Pancreas
  The GIT consists of a hollow tube that starts from the mouth and
ends up in the anus with a length of about 30 ft. It opens into the
external environment on both ends. The GIT can be divided from
above downwards into (i)Mouth (ii) Pharynx (iii) Oesophagus (iv)
Stomach (v) Duodenum (vi) Jejenum/ileum (vii) Colon (viii)
Rectum and (ix) Anus. (i) –(ix) are Primary digestive organs while
(a) –(f) as listed above are accessory digestive organs.
 The main functions of the GI systems are:
1. Ingestion or Consumption of food substances;
2. Breaking these foods into small particles;
3. Transportation of these small food particles to different
areas of the digestive tract;
4. Secretion of necessary enzymes and other substances for
digestions;
5. Digestion of food particles;
6. Absorption of the digested products (Nutrients);
7. Removal of unwanted substances from the body.
In order to perform these functions, the GI system carries out the
under-listed activities broadly grouped into five main headings:
(1) Motility
(2) Secretion
(3) Digestion
(4) Absorption and
(5) Excretion of unwanted materials.
MOTILITY: This is movement of GIT, which help to mix and grind the
contents of the GIT and propel same along the length of the tract and in
an oro-caudal direction i.e. from mouth to anus.
SECRETION: This is the process by which the glands that are associated
with the GI system pour H2O and other substances (enzymes, mucus,
electrolytes e.t.c into the GIT.
DIGESTION: This is the process by which ingested large food molecules
are chemically broken down into much smaller molecules that can pass
across the wall of the GIT into the blood steam. Digestion consists of:
(i) Mechanical brake down of food by Mastication (Chewing) and (ii)
Chemical digestion of food into small molecules by enzymes present in
secretions produced by glands and accessory organs of the digestive
system.
ABSORPTION: This is the process by which nutrients molecules (the end
products of digestion) are transported from the gut lumen into the
blood steam.
ELIMINATION/EXCRETION: This refers to the passage of faeces out of
the body through the anus in form of faeces. Faecal material includes
undigested and unabsorbed dietary food products, colonic bacteria and
their metabolic products such as heavy metals like Fe+, Cu+ and several
organic anions or cations and drugs.
 Accessory organs: Various secretions are poured into the
alimentary canal, some by glands in the lining membranes of the
organs, e.g. gastric juice secreted by glands in the lining of the
stomach, and some by glands situated outside the tract. The latter
are the accessory organs of digestion and their secretion pass
through ducts to enter the ducts. They consist of:
 three pairs of Salivary glands;
 the Pancreas;
 the liver and biliary tract.
The organs and glands are linked physiologically as well as anatomically
in that digestion and absorption occur in stages, each stage being
dependent upon the previous stage or stages.
FUNCTIONAL ANATOMY OF THE GASTROINTESTINAL OF THE GIT
STYSTEM: Basic structure of the GIT.
LEARNING OUTCOMES. By the end of the this section, student should
be able to:
 Describe structure and layers of the walls of the GIT:
 Explain the function of smooth muscles in the walls of the GIT
 Discuss the structures of the alimentary mucosa.
 Outline the Nerve supply of the alimentary canal.
 Describe the Peritoneum after 1st & 2nd contacts.
The layers of the walls of the GIT canal follow a consistent pattern from
the Oesophagus onwards. This basic structure does NOT apply to the
mouth and pharynx. From the oesophagus onwards, modifications to
structures are found which are associated with specific functions.
WALLS OF THE GIT: The GIT is formed by four (4) layers which are from
inside out, (i) Mucus layer (ii) Submucus layer (iii) Muscular layer (iv)
Serous or Fibrous layer.
1. MUCUS LAYER: This is the innermost layer of the GIT. It faces the
hollow cavity of the GIT. It has three (3) layers- (i) Epithelial Lining
(ii) Lamina Propia (iii) Muscularis mucosa.
 (i) Epithelial Lining: (i) It is in contact with the contents of the GIT
with different types of cells in different parts of the GIT; (ii)
Stratified Squamous cells are present in the inner surface of (a)
Mouth (b) Tongue (c) Pharynx and (d) Oesophagus. (iii) The Mucus
membrane of (a) Stomach (b) Small intestine and (c) Large
intestine are lined by Columnar epithelial cells line.
(ii) Lamina Propia: This layer is formed by connective tissue, which
contains fibroblasts, macrophages, lymphocytes and eosinophils.
 (iii) Muscularis mucosa: This layer contains a thin layer of smooth
muscle fibres. It is absent in the mouth and pharynx BUT present
from oesophagus onwards.
2. SUBMUCUS LAYER: This layer is present in ALL parts of GIT except
the mouth and the pharynx. It contains (a) (i) Loose collagen fibres
(ii) elastic fibres (iii) reticular fibres and (iv) few cells of connective
tissues (b) Blood vessels, lymphatic vessels and nerve plexuses are
also present in this layers.
3. MUSCULARIS LAYER: Muscularis layer are present in (i) lips and
(ii) cheek while smooth muscle fibres form the stomach and the
intestines.
In the Stomach, smooth muscle fibres are arranged in three (3)
layers: (i) Inner oblique layer;
(ii) Middle circular layer and
(iii) Outer longitudinal layer.
In the Intestine, Smooth muscle fibres are arranged two (2) layers:
i. Inner circular layer.
ii. Outer longitudinal layer.
Auerbach’s Nerve plexus is present in between the Circular and
Longitudinal fibres. The smooth muscle fibres are present in the inner
circular layer of anal canal constituting the internal anal sphincter.
Skeletal muscle fibres form the external anal sphincter.
4. SEROUS OR FIBROUS LAYER. This is the outermost layer of the
GIT and it either serous or fibrous in nature.
(i) The serous layer is also called serosa or serous membrane and
it is formed by connective and mesoepithelial cells. It covers
the (i) Stomach (ii) Small intestine and (iii) Large intestine.
(ii) The fibrous layer is also called fibrosa is formed by connective
tissue to cover the pharynx and oesophagus.
NERVE SUPPLY & SENSATION TO THE GIT. GIT has two (2) types of
nerve supply: (i) Intrinsic and (ii) Extrinsic nerve supply.
INTRINSIC NERVE SUPPLY called Enteric Nervous System that (i)
Controls ALL the (a) Secretions and (b) Movements of GIT;
(ii) It is present within the wall of GIT from Oesophagus to the
Anus;
(iii) The Nerve fibres are interconnected to form two (2) major
networks called 1. Auebach’s Plexus. 2. Meissner’s Plexus.
 These nerve plexus contain (i) Nerve cell bodies.
(ii) Processes of nerve cells.
(iii) Receptors i.e. Stretch receptors and Chemoreceptors.
(i) Auerbach’s Nerve Plexus: is also known as myenteric nerve
plexus present between the inner circular muscle layer and
outer longitudinal muscle layer.
1. The major function of the auerbach’s plexus is to regulate the
movements of the GIT.
2. Some fibres of the auerbach’s plexus accelerate the movements
of the GIT by secreting the excitatory neurotransmitter substances
like (i) Ach, (ii) serotonin and (iii) substance P.
3. Other fibres slows down the GIT motility by secreting inhibiting
substances like (i) Vasoactive Intestinal Polypeptides (VIP) (ii)
Neurotensin and (iii) encephalin.

(ii) Meissner’s Nerve Plexus: This is also known as Submucus

nerve plexus situated in between the muscular layer and
submucus layer of the GIT
 The major function of the meissner’s plexus is (i) the regulation of
secretory function of the GIT and (ii) Constriction of blood vessels
of GIT.
**The illustrations/Diagrams on GI wall with intrinsic nerve plexus is
compulsorily mandatory and important**
EXTRINSIC NERVE SUPPLY: Extrinsic nerves that control the enteric
(intrinsic) nervous system of GIT are from the Autonomic Nervous
System (ANS). Both sympathetic and parasympathetic divisions of the
ANS supply the GIT.
**Enteric nervous system is controlled by extrinsic nerves supply from
the ANS**.
Sympathetic Nerve Fibres: Thoraco-Lumbar outflow
 The preganglionic Sympathetic nerve fibres to GIT arise from
the lateral horns of spinal cord between 5th thoracic and 2nd
lumbar segments (T5-L2).
 From T5-L2, the fibres leave the spinal cord, pass through
the ganglia of spinal cord and that of sympathetic chain
without having any synapse and then terminate in the celiac
and mesentery ganglia – both superior and inferior.
 The postganglionic fibres from these ganglia are then
distributed throughout the GIT.
 Sympathetic autonomic nerve fibres (i) inhibit the GIT
movements (ii) decrease the secretion and (iii) causes the
constrictions of the sphincters by secreting neurotransmitter
Noradrelanine (Nadr)
Parasympathetic Nerve Fibres. – Cranio-Sacral outflow.
 Parasympathetic nerve fibres to GIT pass through some of the
cranial nerves and sacral nerves.
 The preganglionic and postganglionic parasympathetic autonomic
nerve fibres to mouth and salivary glands pass through facial
(CN7), glossopharyngeal nerves (CN9) and Vagus (CN10).
  Preganglionic parasympathetic nerve fibres to (i) oesophagus,
stomach (iii) small intestine and (iv) upper part of large intestine
pass through the vagus nerve.
 Preganglionic nerve fibres supplying lower parts of the of large
intestine arise from 2nd, 3rd, 4th sacral segments (S2, S3, and S4) of
spinal cord and pass through pelvic nerve.
 All these preganglionic parasympathetic nerve fibres synapse with
the postganglionic nerves in the myenteric and submucus
plexuses of the GIT.
 Parasympathetic nerve fibres accelerate the movements and
increase the secretions of GIT by secreting the neurotransmitter
Acetycholine (Ach).
 The GI system therefore contains both afferent and efferent nerve
fibres that serve both local and central reflex arcs

The illustration/Diagram of the Extrinsic nerve supply to the GIT is

compulsorily mandatory and important.
Actions of sympathetic & parasympathetic divisions of ANS on GIT:
(Extrinsic Nerve Supply & Sensations of GIT)
S/N Effector organ Sympathetic Parasympathetic
1 Salivary Glands Decrease in Increase in
Secretion and Secretion and
Vasoconstriction Vasodilatation
Motility Inhibition Acceleration
GIT Secretion Decrease Increase
2 Sphincters Constriction Relaxation
Smooth Relaxation Constriction
muscles
 3 Gall bladder Relaxation Contraction
4 Neurotransmitter(s) Nadr Ach
Thoraco-lumbar Cranio-sacral
5. Cranial Outflow (T5-L2) (Nuclei of CN7,
CN 9 & 10); & (S2
&S3).

THE PERITONEUM
 The peritoneum is a continuous membrane that lines the
abdominal cavity and covers the abdominal organs (abdominal
viscera).
 It acts to support the viscera, and provides pathways for blood
vessel and lymph to travel to and from the viscera.
 It is the largest serous membrane in the body. Peritoneal fluid
lubricates the surface of the abdominal cavity.
Layers: The peritoneum contains of two (2) layers (i) the superficial
parietal layer and (ii) the deep visceral layer.
 The peritoneal cavity contains the (i) omentum (both greater and
lesser) (ii) ligaments and (iii) mesentery – double layer of
peritoneum attaches the vasculatures and nerves to the
intraperitoneal organs.;
 Intraperitoneal organs are (i) stomach (ii) spleen (iii) liver (iv) 1 st &
4th parts of the duodenum, jejenum, ileum, transverse colon and
sigmoid colon.
 The peritoneal cavity is not closed in the females to allow
the uterine tube to open into the peritoneal cavity,
providing a potential pathway between the female genital
tract and the abdominal cavity.
  Retroperitoneal organs lie behind the posterior sheath and
include the (i) aorta, (ii) esophagus (iii) 2nd & 3rd part of duodenum
(iv) ascending and descending colon (v) pancreas (vi) kidneys (vii)
ureters, and adrenal glands.

GASTROINTESTINAL MOTILITY: These are the mechanical activities of

the GIT.
Course outlines: At the end of this topic, students should be able to:
1. List the major forms of motility in the GIT and their roles in digestion
and secretion; distinguish between peristalsis and segmentation.
2.Explain the electrical basis of GI contractions and roles of electrical
activities in governing motility patterns.
3. Describe how GI motility changes during fasting.
4. Understand how food is swallowed and transferred to the stomach.
5.Define the factors that govern gastric emptying and the abnormal
response of vomiting.
6. Define how motility patterns of the colon subserve its function to
desiccate and evacuate the stool.
GIT MOTILITY:
 The digestive and absorptive functions of the GI system depend
on a variety of mechanisms that (i) soften the food (ii) propel
same through the length of the GIT and (iii) mix same with bile
from the gallbladder and digestive enzymes of salivary glands and
pancreas.
 So many of these mechanisms depend on intrinsic properties of
the GI smooth muscle and other involve the operations of (i)
reflexes involving the neurons intrinsic to the GIT, (ii) reflexes
 involving the CNS, (iii) paracrine effect of messengers and (iv) GIT
hormones.
 These mechanical activities (GIT motility) occur in different
regions of the GIT. They include:
(1)Chewing (mastication) in the mouth;
(2)Swallowing (deglutition) in the mouth and esophagus;
(3)Gastric motility & emptying
(4)Motility of the small intestine;
(5)Motility of the Colon;
(6)Defeacation (passage) of faeces.
The GIT movements are facilitated/controlled by the GIT (i) intrinsic (ii)
extrinsic nervous systems (iii) GIT hormonal secretions and gated or
timed the GIT sphincters. GIT sphincters are seven (7) oro-caudally. The
sphincters are:
1. Upper oesophageal;
2. Lower oesophageal;
3. Pyloric;
4. Ileo-caecal valve (regulates entrance from the intestine to the
ileocaecal part);
5. Houston’s valves (the semilunar transverse folds of rectal wall
that protrude into the rectum);
6. Internal sphincter of anus;
7. External sphincter of anus.
 Two types of movement occur in the GIT (1) Propulsive
movement which cause food to move forward along the GIT to
move forward along the tract at an appropriate rate to
accommodate digestion and absorption i.e Peristalsis and (2)
Mixing movements which keeps the intestinal contents
thoroughly mixed at all times i.e. Churning & Local intermittent
constrictive contraction.
PERISTALSIS:
 Peristalsis is a reflex response that is initiated when the gut
wall is stretched by the content of the lumen, and it occurs
in ALL parts of GIT from the esophagus to the rectum. It is a
wave of contraction followed by wave of relaxation of
muscles of GIT which travel in aboral direction.
 The stretch initiates a circular contraction behind the
stimulus and an area of relaxation in front.
 The wave of contraction then moves in an oro-caudal
direction, propelling the contents of the lumen forward at
the rate of 2-25cm/s.
 Peristaltic movement can be increased or decreased by
autonomic input to the gut BUT its occurrence is
independent of extrinsic innervation from ANS.
 Peristalsis is NOT blocked by removal and resuture of a
segment of intestine in its original position and it can only be
blocked only if the segment is reversed reversed before it is
sewn.
 Peristalsis is an example of the enteric nervous system. Local
stretch releases (i) Serotonin which activates sensory
neurons that activate the myenteric plexus.
 Cholinergic neurons passing in a retrograde direction in this
plexus activates neurons that release substance P,
acetylcholine, causing smooth muscle contraction behind
the bolus.
 Cholinergic neurons passing in an anterograde direction
activate neurons that secrete (i) NO and (ii) Vasoactive
Intestinal Polypeptide (VIP), producing the relaxation ahead
of the stimulus.
 Examples of peristalsis include:
 (1) Deglutition in the mouth, pharynx, esophagus;
(2) Gastric motility & Empting; and Vomiting (reverse
peristalsis);
(3) Segmentation and Tonic contractions in the small and
large intestine;
(4) Migrating Motor Complexes(MMCs) in small
intestine;
(5) Mass action complex (occurring about 10 times a
day;
(6) Defaecation;
(7) Evacuation of gases from the GIT- Belching &
Flatulence.

(A) MOVEMENT IN THE MOUTH: This is Mastication and

Deglutition.
MASTICATION: This is chewing, the first mechanical process in the GIT
by which the food particles are cut/torn into smaller particles and
crushed or ground into a small bolus. Saliva:
 Mixes with the food substances properly;
 Lubricate and moisten the dry food for easy deglutition;
 Allows the taste of the food to be appreciated;
 The muscles of mastication are (i) Masseter muscle (ii) Temporal
muscle, (iii) Pterygoid muscle (iv) Buccinator muscle. These
muscles allow (a) opening and closure of mouth (b) rotational
movement of jaw (c) Protraction and retraction of jaw for proper
chewing and grinding of foodstuff.
 Mastication is almost a reflex process BUT can be carried out
voluntarily. The centre of control for mastication is in Medulla
and Cerebral cortex. The muscles of mastication are supplied by
 the mandibular division of cranial nerve 5 (CN5) – the Trigeminal
nerve.
DEGLUTITION: (Swallowing)-This is the process by wish food moves
from the mouth into the stomach. It has three stages (i) Oral stage-
food move from mouth to the pharynx (i) Pharyngeal stage – food
moves from larynx to the esophagus and (iii) Esophageal stage –
food moves from esophagus to the stomach.
 Swallowing is a reflex response that is triggered by afferent
impulses in the trigeminal (CN5), glossopharyngeal (CN9) and
vagus (CN10) nerves.
 These impulses are integrated in the nucleus of the tractus
solitarius and the nucleus ambiguus.
 The efferent fibres pass to the pharyngeal musculature and the
tongue via the trigeminal(CNV), facial(CNVII) and hypoglossal
(CNXII) nerves.
ORAL STAGE (FIRST STAGE)
This is a voluntary stage. Bolus of food moves from the mouth into the
pharynx by in four (4) sequences:
(i) Bolus is put over the postero-dorsal surface of the tongue- the
preparatory position;
(ii) Anterior part of tongue is retracted and depressed;
(iii) Posterior part of tongue is elevated and retracted against the
hard palate to push the bolus backwards into the pharynx.
(iv) Forceful contraction of tongue against the palate produces a
positive pressure in the posterior part of oral cavity to push the
food into the Pharynx.
PHARYNGEAL STAGE (SECOND STAGE): This is an involuntary stage.
Since pharynx is communicated with the mouth, nose and larynx, and
esophagus, during this 2nd stage of deglutition, bolus from the pharynx
can enter into four (4) paths (i) back into the mouth (ii)upward into
nasopharynx (iii) forward into larynx and (iv) downward into the
esophagus- the only physiological path. However, (i) –(iii) are prevented
by:
(a)Position of tongue against the soft palate (roof of the mouth) and
high intraoral pressure developed by the movement of tongue;
(b)Elevation of soft palate along with its extension with Uvula;
(c) Movement of bolus into the larynx is prevented by (i)
Approximation of the vocal cords (ii) Forward and upward
movement of larynx (iii) Backward opening of epiglottis to seal the
opening of the larynx- the glottis. The actions (i) to (iii) as listed
cause temporary arrest of respiration for a few seconds- the
deglutition or swallowing apnoea- during pharyngeal stage of
deglutition.
(d) Entrance of bolus into the Esophagus is achieved by combine
efforts and action of the following factors:
1) Upward movement of larynx stretches the opening of
esophagus;
2) Simultaneously, upper 3- 4cm of esophagus relaxes i.e. the
Upper Esophageal Sphincter (UES) or Pharyngo-esophageal
sphincter;
3) At the same time, peristaltic contractions start in the
pharynx due to the contractions of pharyngeal muscles;
4) Elevation of larynx also lifts the glottis away from the bolus
passage.
All the actions listed work above together to facilitate easy movement
of the bolus into the esophagus. The process is purely involuntary and
takes 1-2s.
ESOPHAGEAL STAGE (THIRD STAGE): This stage is purely involuntary
and food bolus from the esophagus enter the stomach by esophageal
peristaltic waves. When bolus reaches the esophagus, two peristaltic
waves are initiated (1) Primary peristaltic contractions and (2)
Secondary peristaltic contractions.
Primary Peristaltic Contraction.
1. This is when the bolus reaches the upper part of the esophagus to
trigger the peristaltic movement;
2. The peristaltic contractions pass down the through the rest of the
esophagus propelling the bolus towards the stomach as a result of
the pressure thereby developed;
3. The stretching of the closed esophagus by the elevation of the of
the larynx would lead to NEGATIVE PRESSURE in the upper part of
the esophagus and immediately become POSITIVE to increase up
to 10-15cm of H2O.
Secondary Peristaltic Contraction.
1. If the 10 peristaltic movement fails to propel the bolus into the
stomach, the 20 peristaltic contractions appear and push the bolus
into the stomach;
2. The 20 peristaltic contractions are induced by the distension of
upper esophagus by the bolus which pass down like the 10
contraction producing a POSITIVE pressure.
3. The distal 1/3rd of the esophagus (i.e 2-5cm) is the esophageal
sphincter which is constricted always.
 4. The walls of the esophagus are lubricated by mucus which assist
the passage of the bolus during the peristaltic contraction of the
muscular wall.

DEGLUTITION REFLEX:
 Deglutition is a voluntary and involuntary reflex that later
becomes involuntary and it is carried out by the Deglutition
Reflex.
Stimulus = Bolus in the oropharyngeal region stimulates the
receptors therein.
Afferent Fibres = Receptors in the oropharyngeal region pass via
glossopharyngeal nerve fibres to the deglutition centre.
Centre = deglutition centre in the floor of the the 4th ventricle in
the Medulla Oblongata in the brain.
Efferent = efferent from the deglutition centre travel via
glossopharyngeal and Vagus (parasympathetic motor fibres) to
reach the soft palate, pharynx and esophagus. The
glossopharyngeal nerve is concerned with pharyngeal stage while
Vagus nerve is concerned with esophageal stage,
Response/Effector: The reflex causes upward movement of soft
palate to:
(i) Close Nasopharynx;
(ii) Close Respiratory passage that bolus enters the
esophagus;
 (iii) The peristalsis now occur in esophagus to push the
bolus into Stomach though the relaxed cardiac
sphincter.
(iv) The constriction of the cardiac sphincter of the
stomach prevents reflux of gastric acid into the
esophagus.

BASIC ELECTRICAL ACTIVITY & REGULATION OF MOTILITY.

 The smooth muscle of the GIT, except the esophagus & proximal
portion of the stomach, has spontaneous rhythmic fluctuations in
the membrane potentials between -65mV and -45mV, has BASIC
ELECTRICAL RHYTHM (BER).
 The BER is initiated the interstitial cells of Cajal which are stellate
mesenchymal pacemaker cells with smooth muscle like features
that send long multiply branched processes into the intestinal
smooth muscle.
 In the stomach and small intestine, these cells are located in the
outer circular muscle layer near the myenteric plexus.
 In the colon, they are at the submucosal border of the circular
muscle layer.
 In the stomach and small intestine, there is a descending gradient
in the pacemaker frequency, and as in the heart, the pacemaker
with the highest pacemaker predominates.
 BER rarely causes muscle contractions, but spike potentials
superimposed on the most depolarizing portions of the BER waves
do increase muscle tension.
  The depolarizing portion of each spike is due to Ca2+ influx and
repolarizing portion due to K+ efflux.
 Many polypeptides and neurotransmitters affect the BER e.g Ach
increases the number of spikes and the tension of the smooth
muscle, whereas Adr decreases the spikes and tension of the
smooth muscle.
 The rate of BER in the stomach is about 4/min in the stomach,
12/min in duodenum, 8/min in the distal ileum. In the colon the
BER rises from 2/min at the caecum to 6/min at the sigmoid.
 The function of the BER is to coordinate peristaltic and other
motor activity, like setting the rhythm of segmentation;
contractions can occur only during the depolarizing part of the
waves.
 After vagotomy or transection of the stomach wall, peristalsis in
the stomach becomes irregular and chaotic.
(B) MOVEMENTS OF THE STOMACH (GASTRIC MOTILITY &
EMPTYING: Food is stored in the stomach, mixed with acid, mucus and
pepsin. It is then released at steady rate into the duodenum. Activities
of the smooth muscles of stomach increase during digestion (when the
stomach is filled with food) and when the stomach is empty. There are
three (3) types of movements in the stomach:
1. Hunger contractions are of three (3)- types I, II & III.
2. Receptive relaxation.
3. Peristalsis.
(1) HUNGER CONTRACTIONS.
 Hunger contractions are the movements of empty stomach
related to hunger sensations and are peristaltic waves
superimposed over the contraction of gastric smooth muscle as a
whole;
  Hunger contractions of empty stomach involves the entire
stomach while digestive peristaltic contractions usually occur in
the body and pyloric part of the stomach.
Type I  First to appear on empty stomach when the
Contractions tone of the gastric muscle is low as last for
about 20s at an interval of about 3-4 secs. ;
 Tone of muscles does not increase between
contractions;
 Pressure produced by these contractions is
about 5cm of H20.
Type II  Appear when the tone of the gastric muscle is
Contractions stronger when food intake is postponed even,
after the appearance of type I contractions;
 It lasts for 20s but the pause between
contraction is reduced;
 Pressure produced by these contractions is 10-
15cm of H2O.
Type III  Appear when the hunger becomes severe ant
Contractions the tone increases to a great extent. Very rare
in man because food is taken before the
appearance of these contractions;
 It lasts for 1-5 mins and produce a pressure of
10-20cm of H2O.
 When the stomach is empty, the Type I < Type II
< Type III.
 As soon as food is consumed and in the
stomach, the hunger contractions disappear.
2. RECEPTIVE RELAXATION.
 This is the relaxation of the upper part of the stomach when food
enters the stomach from the esophagus.
 It involves the fundus and upper part of the body of the stomach,
 The significance is to accommodate the food easily (receptive
relaxation) without much increase in the pressure of the
stomach.
 This is the accommodation of the stomach.
 Receptive relaxation is, in part, vagally mediated and trigered by
the movement of the pharynx and esophagus. Intrinsic reflexes
also lead to relaxation as the stomach wall is stretched.
 Peristaltic waves controlled by the gastric Basic Electrical Rhythm
(BER), sometimes called antral systole, begin thereafter and
sweep towards the pylorus. It can last up to 10s and occurs 3-4
times per minute.
3.PERISTALSIS.
 When food enters the stomach, peristaltic contraction starts, and
starts from the lower part of the body of stomach, passes through
the pylorus till the pyloric sphincter.
 The contraction increases in tone from the greater and lesser
curvatures and travels towards the pylorus and ends with the
contraction of the pyloric sphincter.
 Each peristaltic wave takes about 1-3 min to travel from the point
of origin to the terminating point.
 The gastric peristaltic contractions are called digestive peristalsis
because it is responsible for the mixing with gastric juice and
grinding the food particles and permitting small, semiliquid
portions of it to pass through the pylorus and enters the
duodenum for digestive activities.
FILLING THE STOMACH:
 The food taken is arranged in different layers in the stomach:
(i) The first eaten food is placed against the greater curvature
in the fundus and body of the stomach;
(ii) The successive layers of food particles lie nearer the lesser
curvature, until the last portion of food eating lies near
the upper end of lesser curvature, adjacent to cardiac
sphincter;
(iii) The liquid remains in the lesser curvature and flows
towards the pyloric end of the stomach along the V-
shaped groove, made up of smooth muscle called
magenstrasse. Large amount of fluid flows around the
entire food mass and is distributed over the interior part
of stomach, between the wall of stomach and the food
mass.
STOMACH EMPTYING AND FACTORS AFFECTING: This is the process by
which the stomach empties the chyme (Acidic, semisolid, partially
digested food in the stomach) from the stomach into the intestine.
Swallowed food remains in the stomach for about 3-4 hrs for digestion
and formation of chyme.
 The slow emptying is necessitated to facilitate the final digestion
of and maximum (about 80%) absorption of the digested food
materials from small intestine.
 Gastric emptying occurs due to the peristaltic waves in the body
and pyloric part of the stomach and simultaneous relaxation of
the pyloric sphincter. In the regulation of the gastric emptying,
 the antrum, pylorus, and upper duodenum actually function as a
unit. Contraction of the antrum is followed by sequential
Contraction of the pyloric region and the duodenum.
 In the antrum, partial contraction ahead of the advancing gastric
contents prevents solid masses from entering the duodenum BUT
they are mixed and crushed instead.
 The more liquid gastric contents are squirted a little at a time into
the small intestine at regulated interval.
 Regurgitation from the duodenum is prevented by prolonged (i)
contraction of the pyloric segment and (ii) stimulation action of
cholecystokinin (CCK) and secretin on the pyloric sphincter.
 The Lower Esophageal Sphincter (LES) is tonically active but
relaxes on swallowing. The tonic activity of LES between meals
prevents reflux of gastric contents into the esophagus.
 The tone of the LES is under neural control. Release of Ach from
vagal endings causes the intrinsic sphincter to contract, and
release of NO and VIP from interneurons innervated by other
vagal fibres causes it to relax.
 The contraction of the crural portion of the diaphragm, which is
supplied by the phrenic nerves, is coordinated with respiration
and contractions of chest and abdominal muscles. The intrinsic
and extrinsic sphincters operate together to permit orderly flow
of food into the stomach and to prevent reflux of gastric contents
into the esophagus.
 Stomach emptying is influenced by (i) various of the dietary
gastric content and types of food (ii) hormonal factors and (iii)
nervous factors:
FACTORS AFFECTING STOMACH EMPTYING:
S/N Factors affecting Gastric Explanations
emptying
(i) For any type of meal, gastric
emptying is directly
Volume of gastric proportional to the volume.
content (ii)The more the stomach
1 content, the faster same is
emptied into the intestine.
2 Consistency of gastric (i)Inert liquids e.g H2O leave the
content (degree of stomach rapidly. (ii)Solid leave
density) food leave the stomach after
been converted to chyme. (iii)
Undigested solid particles are
not easily emptied.

3 Chemical composition or (i)Carbohydrates are emptied

types of food
4 pH of gastric content
5 Osmolar concentration
of gastric content.
6 Neural & hormonal
mechanism
faster than the Proteins (ii)
Proteins are emptied faster
than Fats.
Gastric emptying is directly
proportional to the pH of the
chyme.
Gastric contents which is
isotonic to blood leave the
stomach rapidly than the
hypertonic or hypotonic due to
the “duodenal osmoreceptors”
Fats, Carbohydrates and Acids
in the duodenum inhibits (i)
gastric acid & pepsin secretion
 and (ii) gastric motility via
neural and hormonal
mechanisms- the enterogastric
reflex. The messenger involved
is probably peptide YY. CCK has
also been implicated in the
inhibitor of gastric emptying.

The Enterogastric reflex is the reflex that inhibits gastric emptying. It

is elicited by the presence of Chyme in the duodenum, which
prevents further emptying of the stomach.
ENTEROGASTRIC REFLEX:
1. Presence of chyme in duodenum causes generation of nerve
impulses which are transmitted into the stomach by the
intrinsic fibres of GIT to inhibit emptying;
2. Impulses from the duodenum pass via extrinsic sympathetic
fibres also to stomach and inhibit emptying;
3. Some impulses from the duodenum travel through afferent
vagal fibres into the brain stem. Brain stem neurons now send
excitatory efferent vagal fibres and stimulates gastric emptying.
However, the impulses from the duodenum inhibits these
brainstem neurons and thereby inhibits gastric emptying
periodically.
Dietary factors which initiates enterogastric reflex:
1. Duodenal distention;
2. Irritation of the duodenal mucusa;
3. Acidity of chyme;
4. Osmolality of chyme;
5. Breakdown of protein and Fats.
Hormonal factors initiating enterogastric reflex: Chyme in the
duodenum causes the duodenal mucosal to release some hormones to
enter the stomach through the blood supply to inhibit the motility of
the stomach. The hormones that inhibits the gastric motility and
emptying are:
1. Vasoactive intestinal peptide (VIP).
2. Gastric inhibitory peptide (GIP).
3. Secretin.
4. Cholecystokinin (CCK).
5. Somatostatin.
6. Peptide YY.
(C)MOVEMENT OF SMALL INTESTINE.
 In the small intestine, the intestinal contents are mixed with the
(i) secretions of the mucosa cells (ii) Pancreatic juice and (iii) Bile.
The chyme is kept in the small intestine long enough for nutrient
absorption to take place.
 The small intestine is made up of (i) duodenum, jejenum (ii) and
(iii) the ileum. The duodenum and jejenum is the site most of the
digestive and absorptive processes take place in the GIT.
 The movements of the small intestine mix chyme with digestive
secretions, bring fresh chyme with the absorptive surface of the
microvilli and propel chyme towards the colon.
TYPES OF MOVEMENTS OF SMALL INTESTINES: Movements of small
intestine are essential for (i) mixing the chyme with digestive juices (ii)
propulsion of food and (iii) absorption. There are four (4) types:
1. Mixing movements: (i) Segmentation and (ii) Pendular
movements.
 2. Propulsive movements: (i) Peristaltic movements (ii) Peristaltic
rush.
3. Peristaltic movement in fasting (Migrating Motor Complex
(MMC).
4. Movement of Villi.
S/ Types of Movement Explanations
N
 Responsible for proper mixing
1 Mixing movement of chyme with digestive juices
such as (i) pancreatic juice (ii)
bile and (iii) intestinal juice.
 These are segmentation-
rhythmic sensation
contraction, 8-10 times per
min. The higher rates occur in
the duodenum and lower
rates occur in the ileum to
give a ‘’chain of sausages’’ to
the intestine. Segmentation
contractions depend mainly
on reflex signals generated in
the myenteric plexus of the
gut in response to distension
of the intestine. Segmentation
contractions chop the chyme
so many times and help in
mixing chyme with digestive
juice.
 and pendular (sweeping)
movements of small intestine
forward and backward and
upward and downward to mix
 chyme with digestive fluids.
 Peristaltic waves in the small
intestine follows sterling’s law
2 Propulsive movement of intestine and increase to a
certain extent immediately
after meal because of
gastroenteric reflex which is
initiated by the distention of
the stomach. Impulses are
transmitted from stomach
along the wall of the intestine
via myenteric plexus.
 Peristaltic rush (a powerful
contractions from the
duodenum and passes
through the entire length of
the small intestine to the ileo-
caecal valve)sweeps the
content of the intestine into
the colon to relief the small
intestine off irritants or
excessive distension.
 MMC ( also called migrating
myoeletric complex)is a type
of peristaltic movement in the
stomach and small intestine
3 Peristalsis in fasting
during periods of fasting for
(Migrating Motor
hours.
Complex)
 Occurs in every 21/2-2hrs.
 MMC sweeps the excess
digestive secretions into the
colon to prevent
 accumulation of same in
stomach and intestine.
 Sweeps the residual
undigested food materials
into the colon.
 Smooth muscle fibres of the
intestinal wall extend into villi
which move simultaneously
with intestinal movements.
 The villi movements are
shortening and elongation
4 Movement of villi
alternatively and empty
lymph from central lacteal
into the lymphatic system.
 The surface area of the villi
increase during elongation to
help absorption of digested
food particles from the lumen
of the intestine.
 Movements of villi are caused
by local nervous reflexes
initiated by presence of
chyme in the intestine and
hormone secreted from the
small intestine called
villikinin.

(D)MOVEMENT OF LARGE INTESTINE. The large intestine has three (3)

main functions (i) Absorption of water and electrolytes from the chyme
(ii) Storage of its content (faecal matter) until it can be expelled (iii)
Expulsion of its contents in a regulated and controlled fashion largely
under voluntary control. The movement in the colon is very sluggish
BUT important for (i) Mixing (ii) Propulsive and (iii) absorptive functions.
The proximal of the colon is concerned mainly with absorption while
distal half is concerned with storage.
 Movement of the large intestine are (i) Mixing movements
(segmentation contractions) which are circular constrictions in the
colon are at regular interval and distance. They are called mixing
segmentation contraction and
(ii) Propulsive movements (mass peristalsis) propel the faeces
from the colon towards the anus and occurs few times in a day.
The duration is about 10 mins in the morning before or after
breakfast as a result of the neurogenic factors like gastrocolic and
duodenocolic reflex and parasympathetic stimulation.
 As in other parts of the GIT, the intramural plexuses control the
contractile behavior of the colon, while autonomic nerve reflexes
modify the response.
 Mass movements can also be initiated by intense stimulation of
the parasympathetic nerves or by over distension of a segment of
the colon.
DEFAECATION: Voiding of faeces is called defaecation. It is a complex
behavior involving both involuntary (Reflex) and voluntary actions.
When faeces are pushed into the empty rectum by mass movement,
the urge to defaecate is felt. The anal sphincters (the internal &
external) prevent the escape of faeces unless the individual is prepared
for defaecation. The internal sphincter consists of a circular smooth
muscle in the wall of the anus while the external sphincter consists of
striated voluntary muscle that surrounds the internal sphincter and also
extends distal to same. The internal sphincter is supplied by
parasympathetic nerve fibres via pelvic nerves while the external
sphincter is supplied by somatic nerve fibres via pudendal nerves and
under voluntary control. Pudendal nerve always keeps the external
sphincter constricted and the sphincter can only relax when the
pudendal nerve is inhibited.
 The process of defaecation can be subdivided into two(2) main
components (i) The part under the defaecation reflex and (ii) The
part under voluntary control.
 There two (2) types of defaecation reflexes:
(i) The intrinsic defacation reflex and
(ii) The parasympathetic defaecation reflex.
 The reflex is triggered by mass movement which drives the faeces
into the sigmoid or pelvic colon where the faeces is stored. The
urge to defaecate occurs when some faeces enters the rectum by
mass movement.
 The desire to defaecate is elicited by an increase in the intrarectal
pressure to about 20-25 cm of H2O.
DEFAECATION REFLEX.
1. The intrinsic defaecation reflex is mediated via the myenteric
plexuses.
2. When faeces enter the rectum, distension of the rectal wall
initiates peristaltic waves via a local reflex circuit and spread to
the descending colon, sigmoid colon and rectum forcing faeces
into the anus.
3. As the peristaltic waves approach the anus, the internal sphincter
relaxes. If the external sphincter is also relaxed, defaecation will
occur.
4. The peristaltic waves produced by the intrinsic defaecation reflex
are usually weak and may NOT be effective for defaecation.
5. The weak intrinsic contraction is often reinforced by contractions
mediated by the Parasympathetic defaecation reflex which
involves parasympathetic nerves in the sacral segment of the
spinal cord.
6. Distension of the rectum causes afferent parasympathetic
impulses to be transmitted into the spinal cord.
7. From the spinal cord, efferent parasympathetic impulses are
conducted through the nervi erigentes back to the (i) descending
colon, sigmoid colon (iii) rectum and (iv) anus.
 These parasympathetic impulses augment the ineffectual weak
movements produced by the intrinsic defaecation reflex so that
they become very powerful and effective in emptying the bowel.
 In spite of the two reflexes above, defaecation can only occur if
the circumstance is socially favourable and acceptable for the act
due to the fact that the conscious mind takes over the voluntary
control of the external sphincter.
 Relaxation of the internal sphincter and forward movement of the
faeces towards the anus normally cause the an instantaneous
contraction of the external sphincter.
 Impulses from the cerebral cortex will pass through the somatic
(pudendal) nerve to the external sphincter will either inhibit the
sphincter to allow defaecation to occur or further contact it if the
circumstance is not conducive for defaecation.
 When the circumstance is right for defaecation to occur, the
defaecation reflex is followed by relaxation of the external anal
sphincter.
 Intra-abdominal pressure is elevated to aid in the expulsion of
faeces. Evacuation is normally preceded by deep breath, so that
the diaphragm descends towards the abdominal cavity. The glottis
is closed and full contraction of the respiratory muscles raises
 both the intra-thoracic and intra-abdominal pressure (bearing
down) as well as the strong contractions of the defaecation reflex
help to force faeces out the anus through the relaxed spincters.
 Flexure of the hips and relaxation of the of the pelvic wall muscles
with descent of the pelvic floor facilitates defaecation by
minimizing the angle between the rectum and the anus.