GI Week 1 Questions and Answers

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Lecture: Neuromuscular control of gastrointestinal motility Question Answer List 3 familial enteric neuropathies Hirshsprung's Disease, Parkinson's Disease and Chagas Disease What is Hirshsprung's Disease a blockage of the large intestine due to improper muscle movement in the bowel. It is a congenital condition, which means it is present from birth a degenerative disorder of the central nervous system a tropical parasitic disease caused by the flagellate protozoan Trypanosoma cruzi 1. Interstitial cells of cajal 2. Enteric Nervous system 3. Smooth Muscle Myenteric (Auerbach's) plexus and the submucosal (submucous, Meissner's) plexus type of interstitial cell found in the gastrointestinal tract that serves as a pacemaker which creates the basal electrical rhythm leading to contraction of the smooth muscle
stimulates GI motility and secretion and relaxes most sphincters Generally inhibits gastrointestinal motility and secretion and contracts most sphincters See notes see notes 80%

What is Parkinson's Disease? What is Chagas Disease?

What are 3 major components that when changed, lead to disease and disorders involving altered regulation of Gastrointestinal motility What are the two major ganglionated plexuses that form the enteric nervous system? What are interstitial cells of Cajal and what is their function?
What is the effect of parasympathetic nerve stimulation on the GI tract? What is the effect of sympathetic nerve stimulation on the GI tract? Draw a flow chart depicting the relationship between the parasympathetic and eneteric innervation of the GI tract Draw a flow chart depicting the relationship between the sympathetic and enteric innervation of the GI tract What percentage of the myenteric plexus are afferent nerves?

What is the total number of neurons in the ENS?

~10^8

Draw a simple enteric reflex arc List 6 major neurotransmitters in the ENS

What is the function of myenteric neurons? What are the major excitatory transmitters of the myenteric neurons that innervate the longitudinal muscles? What are the major excitatory transmitters of the myenteric neurons that innervate the circular muscles? What are the major inhibitory transmitters (motility) of the myenteric plexus? Approx how many neuron in myenteric ganglia are sensory? What are the functions of submucosal neurons?

see notes 1. Acetylcholine 2. Adenosine Triphosphate 3. Beta-Nicotinamide Adenine Dinucleotide 4. Nitric Oxide 5. Vasoactive Intestinal Peptide 6. Substance P Regulate smooth muscle contraction, exocrine and endocrine/paracrine secretion Acetylcholine (Ach) Ach, Substance P, serotonin (5-HT) VIP, NO, Purine (ATP; beta-NAD)

~1/3 Regulate: 1. Secretion: Endocrine/paracrine cells and exocrine cells 2. Motility of muscularis mucosae What are the major stimulatory secretomotor transmitters of Ach, VIP the submucosal plexus? What are the 3 types of electrical activity of gastrointestinal 1. Resting membrane potential smooth muscle? 2. Slow Waves 3. Spike potentials What determines the frequency of phasic smooth muscle Slow waves contractile events? What type of cells generate slow waves? Intersitital cells of Cajal What is the frequency of slow waves in the stomach Slower in the stomach (3-5 cycles / min) and faster in the small compared to the small intestine? intestine (12-15 cycles/min) Draw a slow wave action potential and label the different see notes phases including the channels that are involved What type of channels are involved in depolorization during voltage-dependent Ca2+ channels a slow wave? What type of channels are involved in repolarization phase Ca2+ dependent and other K+ channels of a slow wave? What type of cells are closely associated with enteric Interstitial cells of Cajal (ICC) neurons and smooth muscle cells? How is the relationship between the ICC and smooth muscle They are electrically coupled cells? GI smooth muscle contraction results from increases in intracellular calcium which ion?

List 6 major calcium fluxes involved in contraction of a GI smooth muscle cell

What factors modulate contraction by regulating the concentration of intracellular calcium? What is meant by 'en passage transmission' What are the four motility patterns in the GI tract?

What are the 5 steps of swallowing (oropharyngeal phase)

What are the 4 main functions of the esophagus?

Draw and label a simple diagram of the esophagus Draw and label a simple diagram of the innervation of the esophagus How does the pressures in the pharynx and esophagus see notes compare under resting conditions and following swallowing? Draw a flow-chart that outlines the neural pathways involved see notes in the initiation of pharyngeal peristalsis What are the two ways that peristalsis is initiated? 1. Swallowing --> primary peristalsis 2. Esophageal distention --> secondary peristalsis Draw a diagram of primary peristalsis in the esophagus see notes Draw a diagram of secondary peristalsis in the esophagus see notes Draw a diagram of the mechanism causing relaxation of the see notes lower esophageal sphincter (LES)

1. Voltage dependent calcium channels (VDCC) 2. Store operated calcium channels (SOCC) 3. Stretch-activated channels 4. Receptor-mediated IP3 production and SR calcium release 5. Receptor-operated channels 6. Ca2+ efflux Neurotransmitters, hormones, paracrines and mechanical factors (distension) Excitatory and inhibitory neurotransmitters spread diffusely from axonal varicosities to the intestinal cell networks 1. Tonic contraction 2. Rhythmic segmentation 3. Oscillatory movements 4. Peristalsis 1. Elevation of tongue 2. Closure of nasopharynx 3. UES relaxation 4. Closure and protection of airway 5. Pharyngeal peristalsis 1. Deglutition 2. Prevention of entry of air into the stomach and gastric reflux 3. Eructation (Belching) 4. Vomiting see notes see notes