Digestive system

Objectives
 At the end of this lecture students will be able to understand

 What is digestion and its different parts

 Functions of GIT
 Movement of food through the GIT
 Mixing and transport of food
 Secretary function of GIT
 digestion and absorption
 Contents
 Digestion
 Function of GIT
 Layers of GIT
 Electrical activity of gastrointestinal smooth muscles
 Neural control of GI function
 Gastrointestinal reflexes
 Hormonal control of GI motility
 Functional types of movements in the GIT
 Peristalsis
 Control of GIT blood flow
 Digestion
definition:-
The process of hydrolysis in which various
specific enzymes returns H+ and OH-to various food
stuffs and
split them to monomers that can be easily absorbed.
 Components
 Mouth
 Pharynx
 Esophagus
 Stomach
 Small Intestine
 Large Intestine
 Gall bladder
 Liver
 Pancreas
Functions of GIT
FUNCTIONS OF GIT

Ingestion

Help
Digestion
erythropoisis

Functions of GIT

Excretion
Secretion

Absorption
 Layers of intestinal wall

 Serosa
 Longitudinal muscle layer
 Circular muscle layer
 Submucosa
 Mucosa
 Muscularis mucosa

 Gastrointestinal smooth muscle its function as
a syncytium:

 GIT smooth muscle fibers & bundles r interconnected ,

so each muscle layer functions as a syncytium.

because
 Smooth muscle fibers are connected with one another
through gap junctions to allow flow of ions.

 Smooth muscle bundles r separated from one another

by loose connective tissue , but are connected at
many points to allow ionic flow
 Electrical activity of gastrointestinal
smooth muscles

It is of two types.
1. Slow waves or basic electrical rhythm
2. Spike potentials
 Potential changes of GIT smooth
muscle membrane
1.Resting membrane potential = -56 mV.
Multiple factor can change this level.

2.Depolarization due to depolarizing factors

Like a) stretch
b) ACh
c) parasympathetic stimulations
d) specific GIT hormones
3. Hyper polarization due to factors like

a) Epinephrine & nor-epinephrine.

b) Sympathetic stimulation.

4.Calcium ions & muscle contraction.

5.Tonic contraction of some GI smooth muscles.

Caused by
 repetitive series of spike potential
 Continuous depolarization of membrane by
hormones or other factors
 Continuous entry of ca++
 Neural control of GI function:

Three types
1. Enteric nervous system
division:
 Myenteric /Auerbach's plexus
 Submucosal or meissner ‘s plexus
2. Autonomic nervous system
 Parasympathetic NS
 Sympathetic NS
3. Sensory nervous system
 Gastrointestinal reflexes

Three types of GI reflexes that are essential to GI

control are
 Reflexes that occurs entirely within enteric nervous

system of GIT

 Reflexes from GIT to prevertebral sympathetic ganglia

then back to GIT

 Reflexes from GIT to spinal cord or brain then back

to GIT
 Hormonal control of GI motility

 Various hormones are there for controlling the GI

secretions some of them also affects motility these are

 Cholecystokinin
 Secretin
 Gastric inhibitory peptide
 cholecystokinin
Secreted by:
I-cells in Mucosa of jejunum in response to fats

Function:
 Increases contractility of gall bladder to expel bile into

duodenum
 Inhibit stomach motility

 Cause pancreas to secrete large amount of enzymes

 secretin
Secreted by:
s-cells in mucosa of duodenum & jejunum in response
to gastric acid juice
functions:
 Inhibit GI motility
 Causes pancreas to secrete high amount of HCO3 to
neutralize the acid.
 Causes increase HCO3 secretion by bile duct.
 Gastric inhibitory peptide

Secreted by:
mucosa of upper small intestine in response to fatty
acids & amino acids. And some CHO

Functions:
 Inhibit stomach motility
 Slow emptying of food from stomach to duodenum
 Functional types of movements in the GIT
Two types are there

1. Mixing movement
Keep intestinal contents thoroughly mixed
Caused by:
 peristaltic contraction
 Local constrictive contraction

.
2.Propulsive movement
Caused by:
 peristalsis
 Peristalsis
 Inherent property of many syncytial smooth muscles
tubes i.e. appearance of contractile ring causing any
material to move forward .

Occurs in:
 GITS
 BILE DUCT
 URETER
 GLANDULAR DUCT
 OTHER SMOOTH MUSCLES OF GUT
 stimulus for peristalsis
 Distension
 Irritation
 Extrinsic nervous signal

Role of myenteric plexus

 Cause peristalsis to occur
 Myenteric or peristaltic reflex

 Segments of GIT stimulated by distension

 Constriction above and receptive relaxation below
 Anal ward movement of food
 Receptive relaxation

 When peristalsis occurs, the gut relaxes several cms in

anal ward direction thus food is easily propelled in
anal ward direction this is called as receptive
relaxation.
Law of Gut
 The peristaltic reflex/myenteric reflex plus anal ward
direction of movement of the peristalsis is known as
gut law
 Control of GIT blood flow
 Local control
 Nervous control
Transport and mixing of food in the
alimentary canal
 Ingestion of food
 The amount of food that ingest is determine
by 2 ways
1. Huger

2. Appetite
 It is confined to mechanical aspects of food
ingestion especially
Mastication & swallowing .
1. Mastication (chewing):
Definition:
“The process in which food is cut and ground into small
Pieces with the help of teeth” .

 This process can be achieve through teeth.

 Incisors provide strong cutting action
 Molars provide grinding action
 It is caused by chewing reflex
Chewing reflex:-
Bolus in mouth  reflex inhibition of mastication muscles lower
jaws drops stretch reflex of jaw muscles rebound
contraction of jaws muscle closure of teeth compression of
bolus against mouth lining again reflex inhibition of
mastication muscle cycle repeats

Most of the muscle of mastication is innervated by trigeminal

nerve(5th cranial nerve)
Importance of chewing:-
 Digesting all foods especially fruits $ raw vegetables.
 Increase surface area of food particles .
 Grinding the food to very fine particles prevent excoriation of
GIT.
 Increases the ease with which food is emptied from stomach to
intestine.
2.Deglutition (swallowing):
Definition:-
“The process by which food is passed from mouth through
pharynx & esophagus into the stomach as a result of reflex
Phenomenon”

 It is divide into 3 stages

1. Voluntary stage
2. Pharyngeal stage (involuntary)
3. Esophageal stage (involuntary)
1. Voluntary stage:
 Food ready for swallowing is voluntarily rolled &
squeezed by the pressure of tongue and forces the food
bolus back into the pharynx.
2. Pharyngeal stage:
 The pharyngeal phase occurs involuntarily when food enters

the pharynx, as follows:

 The soft palate and uvula fold upward and cover the

nasopharynx to prevent the passage of food up and into the

nasal cavity.
 The epiglottis, a flexible cartilaginous flap at the top of the

larynx, folds down as the larynx rises. As a result, the opening

to the larynx is covered, and food can pass only into the
esophagus.
 During this stage swallowing centre inhibit respiratory center

for 1-2 seconds

3. Esophageal stage (involuntary)

 The esophageal phase occurs involuntarily in the esophagus.

During this stage food passes through esophagus to
stomach.
 The esophageal sphincter, normally closed, opens to allow
food to pass when the larynx rises during swallowing.
 When food reaches the lower end of the esophagus, the
cardiac sphincter opens to allow the food to enter the
stomach.


 Factors participate in this stage:

 Primary peristalsis
 Secondary peristalsis
 Gravity
 Function of the lower esophageal
Sphincter
 Normally it remain tonically constricted & prevents reflux of
acidic gastric contents into esophagus
 When peristaltic waves passes down ,receptive relaxation
relaxes it so that food can pass from esophagus into stomach.

Wave like closure of distal end of esophagus

 This valve like closure of lower esophagus prevents high intra-
gastric pressure from forcing the stomach contents into
esophagus.
 Motor functions of stomach

1. Storage of food with capacity of 1.5 liter

2. Mixing of food into semisolid mixture called as chyme
3. Slow emptying of chyme from stomach into intestine.

Anatomically : 2 parts
1. Body
2. antrum
Physiologically : 2 parts
1. Orad portion
2. Caudad portion
1. Storage of food:

 Food enters form concentric circles in the orad portion

 Vagovagal reflex from stomach to brain stem then back to
stomach
 Reduction of tone of muscle of stomach.
 Quantity of food in completely relaxed stomach is about 1.5
liters.
2. Mixing & propulsion of food in the stomach:

It occurs by
1) weak peristaltic constrictor waves (mixing waves)
 Begin in the mid portion of stomach wall moves towards
antrum .
 Every 15-20 seconds

Initiated by:
basic electrical rhythm (consist of slow waves )
Function:
• Mixing of food with gastric secretion
• Provide weak propulsion of mixed food towards antrum
2) Powerful peristaltic constrictor rings

• These are extremely intense form of weak peristaltic

constrictor waves.

Function:
• Forces antral contents under high pressure towards pylorus .
• Mix stomach contents due to retroplusion of antral contents
towards body of stomach from pylorus.
 Chyme:-
• After food has mixed with stomach secretion ,resulting mixture

passes to duodenum is known as chyme

• It is milky ,murky ,semi fluid or paste.

Hunger contraction:-
• Intense contractions occurs when stomach has been empty for

several hours or more.

• Rhythmical peristaltic contraction in the body .

• Lasts for 2-3 minutes.

Symptoms :
pain in the pit of the stomach called as hunger pangs .
3. Emptying of stomach:-
 It is promoted by intense peristaltic contractions of the
stomach antrum
 Opposed by pylorus.

 Intense antral peristaltic contractions during stomach

emptying –the pyloric pump:
• When pyloric tone is normal ,each strong peristaltic wave
forces up to several ml of chyme into duodenum .
• These peristaltic waves provide pumping action called as
pyloric pump.
 Role of pylorus in controlling stomach emptying :

• Pyloric circular muscle is known as pyloric sphincters

• Despite of tonic contraction of pyloric sphincter, the pylorus
usually opens enough for water & other fluids to empty from
stomach .
• Constriction of pylorus prevents passage of food particles until
they have become mixed in the chyme to fluid consistency.
 Regulation of stomach emptying

 The rate at which stomach emptying Is regulated by signal

from both stomach and the duodenum.

The weak gastric factors that promote emptying.

1. Effect of Gastric food volume
2. Effect of hormone Gastrin
The powerful duodenal factors that inhibit emptying :

1. Inhibitory effect of entero-gastric reflex

Produce By :
i. Distension of duodenum
ii. Irritation of duodenal mucosa
iii. Acidity of duodenal chyme
iv. Increase osmolality of chyme
v. Proteins and fat breakdown products in chymes

s
2. Hormonal feedback

 Release from upper intestine.

 Common stimulus is fats entering the duodenum.
 These are
i. Cholecystokinin
ii. Secretin
iii. Gastric inhibitory peptide.
 Movement of small intestine
These are of two types
 1. mixing contraction

 2.propulsive contractions

1-Mixing contraction :
 when the portion of small intestine becomes distended with
chyme,
 the stretch of intestinal wall elicit localized concentric
contractions spaced at intervals along the intestine.
 Longitudinal length is 1cm.

 Causes segmentation of small intestine.

 These segmentation contraction will chop the chyme about 2-3

times a minute.
function:
 Promote mixing of food particles with secretions of intestine.

Frequency:
 same as frequency of slow waves in the intestine i.e. BER.

 12/min in duodenum and jejunum

 8-9 contraction/min in terminal ielum.

2-Propulsive contraction:
Peristalsis in the small intestine:-
 Chyme is propelled through small intestine by peristaltic
waves
 occur in any part of small intestine.
 Move anal ward at velocity of 0.5-2.0 cm/sec.
 Faster in proximal slower in terminal.
 Normally very weak & die out after traveling 3-5 cm
 Net movement of chyme average only 1cm/min
Control of peristalsis by nervous and hormonal signal:
 Peristaltic activity of small intestines greatly increased after

meal. i.e. caused by

1. Entry of chyme into duodenum

2. Gastro enteric reflex initiated by distension of the stomach &
conducted through myenteric plexus from stomach down along
the wall of small intestine.

 Hormones like gastrin,cck, insulin and serotonin enhances

intestinal motility. Secreted during food processing.
 secretin & glucagons inhibit small intestine motilitys
Propulsive effect of the segmentation movement:

 Segmentation movements last for few seconds, travel in anal

direction.
 Helps to propel the food down the intestine similar to peristaltic
movements.
 peristaltic rush:
 Intense irritation of intestinal mucosa as occurs in

some infectious diarrhea can cause both powerful

and rapid peristaltic rush
Initiated by
 extrinsic nervous reflexes to the autonomic nervous

system ganglia and brain stem then back to GIT

 And also by direct myenteric plexuses

 Function: Relieving the small intestine of irritative

chyme or excessive distension
Function of illeocecal valve:

 To prevent backflow of fecal contents from colon into

small intestine
 Can resist reverse pressure of 50-60 cm of water
 It has thick muscular coat known as illeocecal
sphincter

 Normally remain mildly constricted and slows the

emptying of ileal contents into cecum except after
meal when gastroileal reflex intensify peristalsis
Function

 Resistance of emptying prolongs the stay of chyme in

ileum ,facilitate absorption
Factors that relaxes illeocecal sphincter
 Gastro enteric (gastroileal )reflex after meal

 Gastrin

 Factors that contract illeocecal sphincter

 Distension of cecum
 Irritants in cecum.
colon:
Function :
1. Absorption of water and electrolytes from chyme by
proximal ½
2. Storage of fecal matter until expelled by distil ½.
Movements of colon:

 Mixing (Haustrations)
 Circular and longitudinal muscle contract at stimulated
portion while unstimulated portion bulges outwards
into bag like sac. called Haustrations

 Propulsive (mass movement)

 Modified peristalsis characterized by
 Constrictive ring in colon
 Forcing of fecal contents anal ward.
Stimulus for mass movement:
1. Gastro-colic and duodeno -colic reflex after meal
2. Irritation in colon
3. Intense parasympathetic stimulation
4. Over distension of segment of colon.
 Defecation:

Process by which feces are excreted through anus.

Desire for defecation:

 Initiated when mass movement forces the feces into

rectum
Defecation reflex :
 Weak intrinsic defecation reflex

 Powerful Parasympathetic defecation reflex

Anal sphincter:
 Internal :composed of circular mass of smooth

muscles, involuntary
 External: composed of striated muscle ,voluntary
SECRETORY FUNCTION OF
GIT
 Anatomical types of GIT glands

• Single cell mucus gland or Mucus cells or Goblet cells.

 Secrete mucus

2. Pits or invaginations of epithelium into sub-mucosa .

 they have
 mucus cell that secrete mucus.
 Epithelial cell that secret serous fluid.
• Tubular glands.
 Found in stomach & upper duodenum.
 E.g.: oxyntic gland

4. Complex glands.
 E.g. salivary glands ,pancreas and liver.
 Stimulus for GIT glands
 1 Local stimuli:
 Tactile stimuli
 Chemical irritation
 Distension of gut
 Motility of gut

 2 Autonomic stimulations:
1. Parasympathetic stimulation increases GIT secretions
2. Sympathetic stimulation has dual effect
 Either slightly increases secretions

 Decrease the secretions

3. Hormonal stimulation:

In stomach and intestine several different GI hormones helps to

regulate the volume and character of secretions.

e.g.

 Gastrin increases acidic gastric juices secretions

 CCk increases the bile secretions
Mucus:
Thick secretion composed of water, electrolyte, and a mixture of
glycoprotein's
 Function:
1. Adhere tightly to food particles
2. Coats gut walls and prevent contact of food particles with
mucosa
3. Lubricate passage of food particles
4. Adhere fecal particles with each other

 Properties:
1. Resistant to digestion by GIT enzyme.
2. Glycoprotein's of mucus buffer acids and alkali
3. Bicarbonates ions neutralizes the acids.
 Saliva
Secreted by:
 Parotid gland (serous types)

 Submandibular and sublingual glands (both serous & mucous

types)
 Small buccal /mucus gland (mucous types)

Daily secretion:
 800 - 1500ml

Ph: 6 - 7.4
Constituents:
 Serous secretion contains ptyalin (alpha amylase)

 Mucous secretion contain mucin

 Ions:

 large quantities of k+ & Hco3 ,

 Smaller quantities of Na+ & Cl-.

 Functions of saliva
Mechanical Functions:
 Keeps mouth moist and helps in speech.

 Helps mastication of food.

 Prevents injury to mucous membrane.

Digestive functions:
 Ptyalin splits up starch into maltose.

Excretory Functions:
 Excretes urea, heavy metals, thiocyante, drugs and alkaloids,

ethyl alcohol, virulent micro-organism.

s
 Functions of saliva
Oral hygiene:
 Flow of saliva washes away pathogenic bacteria and food

particles (metabolites for pathogen)

 Thiocyante and proteolytic enzymes (e.g. lysozyme) have

bactericidal properties.
 Antibodies destroy oral bacteria.

Helps in sensation of taste:

Helps water balance by thirst mechanism:
Buffering action by HCO3:
 Esophageal Secretions
Functions:
 Both simple and compound mucous glands

secrete mucus which

1. Provide lubrication for swallowing
2. Prevent mucosal excoriation by food
3. Protect esophageal wall from digestion by gastric
juices
 Gastric Secretions
Single cell mucus gland secrete mucus
 Located in whole stomach mucosa

Oxyntic (gastric gland)

 Located in body and fundus except lesser curvature

 Types of cells and their secretions:

1. Mucous neck cell: secret mucus and some Pepsinogen

2. Peptic or Chief cell: secret Pepsinogen
3. Oxyntic and parietal cell: secret HCl and intrinsic factor

s
Pyloric gland
 Located in antrum of stomach

 Secrete:

1. Mucus for protection of pyloric mucosa

2. Some Pepsinogen
3. Gastrin

Cardiac gland
 Located in 1cm immediately surrounding entry point
of esophagus
 Secrete:

1. Mucus for protection of gastro-esophageal junction

s
Hydrochloric acid:
 Secreted from parietal cell
 160 mmol of HCl / liter
 Ph= 0.8

Pepsin:
 Proteolytic enzyme in highly acid medium (ph=1.8-3.5)
 Above 5 pH = little activity
 Enzymes in Gastric juices
 Pepsinogen :
1. Activated by HCl into pepsin
2. Has proteolytic activity
 Gastric lipase:
1. Example: Tributyrase digests Tributyrin (a butter fat)
 Gastric amylase:
1. Minor role in digestion of starch
 Gelatinase:
1. Liquefies some proteo-glycans in meat
 Daily secretions and pH of Gastric juice:
 Daily secretions: 1200-1500ml
 pH: 0.9 - 1.5

Regulation of gastric secretion

 Nervous regulation by vagal parasympathetic
stimulation and enteric nervous system
 Hormonal regulation by gastrin
 Pancreatic secretion
Secreted: in response to presence of chyme in upper intestine
pancreas secretes,
 Insulin by the islets of langerhans in the pancreas
 Digestive enzyme by the pancreatic acini
 Sodium bi carbonate from the ducts

Enzyme of pancreatic juice:

1. Proteolytic enzyme:
 Trypsin
 Chemotrypsin
 Procarboxypolypeptidase
 Ribonucleases
 Deoxyribonuclease
 Elastases
Activation of proteolytic enzyme:

 Proteolytic enzymes which are in inactive forms

 Some of them are responsible to digest the proteins into
peptides and some converts peptides into amino acids.

 Trypsinogen is activated by enterokinase ( secreted by

intestinal mucosa ) and trypsin
 Chymotrypsinogen is activated by trypsin
 Procarboxypolypeptidase is activated by trypsin.
2. Carbohydrate splitting enzyme

 Pancreatic amylase
 Which hydrolyses starches, glycogen and other carbohydrates
except cellulose to form disaccharides and few trisacchrides.

3. Lipolytic enzyme

 Pancreatic lipase: hydrolyses neutral fats into fatty acids and

monoglycerids.
 Cholesterol esterase: causes hydrolyses of cholesterol ester.
 Phospholipase: split fatty acids from phospholipids.
 Daily secretions and pH of pancreatic
secretion :
 Daily secretions: 1200 ml
 pH: 8

Regulation of pancreatic secretion

 Nervous regulation by vagal stimulation of pancreas
 Hormonal regulation by secretin, CCK, gastrin
 Basic stimulus for pancreatic secretion

• Acetylcholine from parasympathetic system

• Gastrin
• CCk
• Secretin
 Bile
 Secreted by the liver
 Composition :
 Water
 Inorganic salts: Na+ , K+, Ca+2, Cl-2 , HCO3-
 Bile salts
 Bile pigment : bilirubin and biliverdin.
 Lipids: cholesterol, lecithin and traces of fatty acids.
 Daily secretions
 700 – 1200 ml
 pH
 7.7- 8.6
 Functions of bile

 Emulsifies fats and help their absorption due to secretion of bile

acids.
 Excrete metals, toxins, bacteria's, bile pigments and excess of
cholesterol from the blood.
 Bile salts stimulates intestinal peristalsis.
 Bile salts stimulates secretion of bile
 Neutralizes acidic chyme.

Storage and concentration of bile in gall bladder

 Bile secreted by the liver cells stored in gall bladder Until
needed in the duodenum.
 Maximum volume of gall bladder is 30 – 60 ml.
 Emptying of gall bladder
 When food begins to be digest in upper GIT the gall bladder
begins to empty as fatty foods enters duodenum after meal,

 Basic cause of emptying is

1. Rhythmical contraction of wall of gall bladder to force the
bile into the bile duct.
 This is caused by
 CCK
 Vagal stimulation.
2. Relaxation of sphincter of Oddi
 This is caused by
 CCK.
 Neurogenic and myogenic reflexes.
 Receptive relaxations during peristalsis.
 Bile salts
 Include sodium glycocholate, sodium taurocholate.
 Daily formation 0.5-0.6 gm.
 Precursor for bile salt is cholesterol.

Functions:

1. Emulsifying or detergent function:

 Conversion of fat globules into minute size.
2. Micelles formation and ferried function
 Bile salts form complexes of fatty acids, monoglycerids,
cholesterol and other lipids and carry them to the intestinal
mucosa for absorption.
 Glands of small intestine
1. Compound mucous glands ( brunner’s glands):
 located in first few centimeters in duodenum

 Stimulus of secretion:

 Tactile stimuli

 Irritating stimuli

 Vagal stimuli

 GI hormone especially secretin

 Function:
 Secrete mucous that protects duodenal wall from digestion by
gastric juice
2. Single cell mucous glands :
 Located: whole surface of intestine
 Stimulus of secretion:
 Tactile stimuli and chemical stimuli
 Function:
 Secrete mucous

3. Intestinal crypts of lieberkuhn :

 Located: whole surface of intestine
 Stimulus of secretion:
 Tactile stimuli
 Irrititating stimuli
 GI hormone e.g. secretin and CCK
 Function:
 Provides the watery vehicle for absorption of substance from
the chyme
 Daily secretion:
 1800 ml
 pH:
 7.5 – 8
 Enzymes in small intestine:
1. Enterokinase
2. Proteolytic enzyme
 Aminopolypeptidase, Several dipeptidase
3. Carbohydrate spliting enzyme.
 Lactase, sucrase, maltase, isomaltase, alpha dextrinase
4. Fat spliting enzyme
 Enteric lipase.
 Function:
 They digest the food
 Glands in large intestine
1. Cryptus of leiberkuhn:
 Secretes fluids resembling ECF
2. Single cell mucous glands:
 Secretes mucous.
Disorders of swallowing and of esophagus:
1. Achalasia: condition in which lower esophageal sphincter
fails to relax during the swallowing mechanism
2. Mega esophagus: where peristalsis fails to occur properly
and the esophagus is enlarged.

Disorders of stomach;
1. Gastritis: Inflammation of gastric mucosa
2. Gastric atrophy: A condition in which the stomach muscles
shrink and become weak.
3. Pernicious anemia: Failure of absorption of vitamin B12
from the ileum due to the absence of intrinsic factor that is
glycoprotein. Results in failure of maturation in bone marrow.
4. Peptic ulcer: Excoriated area of mucosa cause by digestive
action of gastric juice.
Disorders of small intestine:
1. Pancreatitis: Inflammation of pancreas.
2. Malbsorption of food in intestine .

Disorders of large intestine

1. Constipation: slow movement of feces of through the large intestine
associated with accumulation of large quantity of dry and hard feces in
descending colon.
2. Mega colon: condition of extreme and irreversible dilation and poor
motility of the colon, usually combined with accumulation of fecal material.
3. Diarrhea: Rapid movement of fecal material through large intestine.
4. Enteritis: Infection cause by virus or bacteria (cause of diarrhea).
5. Ulcerative colitis: Inflammation and ulceration of extensive area of wall
of large intestine.
General disorder of GIT:
1. Vomiting: is the forceful expulsion of the contents of one's
stomach through the mouth and sometimes the nose by anti
peristaltic movement due to over distention, over excitation
and irritation of GIT.
 Vomiting act: once vomiting centre stimulated vomiting act
is initiated in the following way
 A deep breath
 Raising of hyoid bone and the larynx to pull the upper
esophageal sphincter open
 Closing of glottis
 Lifting of the soft palate to close the posterior nares.
 Strong downward contraction of abdominal wall muscle
results in vomiting.
JAZAK ALLAH