Movements of gastrointestinal

tract.
 MASTICATION
Features:

Makes it easier for the food to be swallowed

Mixes the food with the secretions of the

salivary glands to soften it

Increases the surface area of the food particles ,

thus helping in subsequent digestion of food
 Muscles of mastication

Center- Medulla and Cerebral cortex

 Deglutition

• BUCCAL STAGE (Voluntary stage)

• PHARYNGEAL STAGE (Involuntary stage)

• OESOPHAGEAL STAGE ( Involuntary stage)

 ORAL PHASE
• Voluntary

• Due to pressure gradient

 Buccal stage
 The bolus is placed over posterodorsal surface of the
tongue (Preparatory position)

 The anterior part of tongue is retracted and depressed

 The posterior part of the tongue is elevated

 The forceful contraction of tongue against the palate

produces a positive pressure in the posterior part of the
oral cavity
 PHARYNGEAL PHASE

• Involuntary

• Occurs in 1-2 seconds

• Respiratory centers of medulla are

inhibited
 Pharyngeal stage

BACK INTO THE MOUTH

The position of tongue against soft
palate
High intraoral pressure

UPWARDS INTO NASOPHARYNX

Upward movement of soft palate
 Pharyngeal stage
BACK INTO THE MOUTH
• The position of tongue against soft palate
• High intraoral pressure

UPWARDS INTO NASOPHARYNX

Upward movement of soft palate

FORWARDS INTO LARYNX

• Approximation of the vocal cords
• Forwards and upward movement of larynx
• Epiglottis swing backwards over the opening of the larynx
• Temporary arrest of breathing (Deglutition apnoea)

• ENTRANCE OF BOLUS INTO OESOPHAGUS

Upward movement of larynx – Enlarges the movement of oesophagus
• Upper oesophageal sphincter relaxes
• Entire muscle of pharynx contracts
 Oesophageal stage
 Primary oesophageal peristalsis: The initial
peristalsis, initiated by the swallowing reflex.

 Secondary oesophageal peristalsis

Any subsequent peristalsis, to get any remaining
food out of the esophagus. It is initiated by
distension of esophagus and mechanoreceptors on
smooth muscle.

• Relaxation of lower oesophageal sphincter

OESOPHAGEAL PERISTALSIS
 Oesophageal stage
 Primary oesophageal peristalsis
 Secondary oesophageal
peristalsis
 Relaxation of lower oesophageal
sphincter
 PROPULSIVE MOVEMENTS
• PERISTALSIS-Called as law of intestine
• FACTORS INFLUENCING-
• Parasympathetic stimulation+
• Sympathetic stimulation—
• HORMONES-CCK-PZ+
• SECRETIN---
 APPLIED ASPECTS

GASROOESOPHAGEAL REFLUX

DYSPHAGIA

ACHALASIA CARDIA
 DEGLUTITION REFLEX
Sensory receptors- Tonsillar pillars,
posterior pharyngeal wall, soft palate,
epiglottis
Afferent – V, IX, X cranial nerves
Deglutition center- Deglutition centre
Efferent - V, VII, IX, X, XII, cranial nerves
Effectors – Pharyngeal musculature and
tongue
Chewing and swallowing
 Movements of stomach
1. hunger contractions:
2. Receptive relaxation
3. peristalsis
 Gastric Emptying
• Most vigorous peristalsis and mixing occurs near the
pylorus
• Chyme is either:
– Delivered in small amounts to the duodenum or
– Forced backward into the stomach for further
mixing
Fluids pass quickly through the stomach
Solids linger, remaining until they are well mixed with
gastric juice and converted to a liquid state
 Regulation of Gastric Emptying
• Gastric emptying is regulated by:
– The neural enterogastric reflex
– Hormonal mechanisms
• These mechanisms inhibit gastric secretion and
duodenal filling
• Carbohydrate-rich chyme quickly moves through
the duodenum
• Fat-laden chyme is digested more slowly causing
food to remain in the stomach longer
Regulation of Gastric Emptying

Figure 23.19
Factors controlling gastric emptying
STOMACH FACTORS
Consistency of food
Volume of the gastric contents
Chemical composition of the food
Acidity
Osmolar concentration of the food
DUODENAL FACTORS
Osmotic receptors
Distention of duodenum
Acid in duodenum
NEURAL: enterogastric reflex
HORMONAL
Gastrin, CCK-PZ, VIP, GIP, Somatostatin
 Migrating Myoelectric Complex(MMC)

• Empty stomach rests for approximately 75-90 min

then intense contractions occur that last for 5-

10min in antral region

• Removes non digested remnants

 VOMITING (EMESIS)

• Abnormal emptying of the

stomach and upper intestine
through esophagus and mouth.
• Vomiting is a complicated reflex that can
be induced by:
1. Irritation of peripheral organs
2. Stimulation of vomiting centre of medulla
directly or through chemo receptor-trigger
zone
Stimuli that induce vomiting:
1. Irritation of :
a) Gastric mucosa
b) Duodenal and jejunal mucosa
c) Pharyngeal wall
d) Vestibular apparatus
e) Sight, smell also can induce
vomiting
Vomiting centre
is located bilaterally in the
reticular formation of the medulla
near the tractus solitarius
The sensory impulses from the
irritated or distended part of GIT
or other organs are transmitted
through vagus and sympathetic
afferent fibers
The motor impulses causing the act of
vomiting are transmitted from the
vomiting centre through V, VII, IX, X
and XII cranial nerves to the upper
part of the GIT
Through the spinal nerves to the
diaphragm and abdominal muscles
Chemoreceptor trigger zone(CTZ): It is
present in the vicinity of vomiting centre
( located bilaterally on the floor of the
fourth ventricle in or above the area
postrema)
• Some drugs act through chemoreceptor
trigger zone, e.g., Apomorphine, morphine etc
 Some chemicals present in the body when
accumulated in excess also cause vomiting
through chemo-receptor trigger zone.
 Stimulation of vestibular apparatus during
motion sickness induce vomiting through
chemo-receptor trigger zone.
 Vomiting is usually associated with

Nausea (Excess salivation)

 Pallor (white skin)
 Upper small intestine contracts emptying its contents
into the stomach
The pyloric sphincter and the pyloric antrum contracts
pushing the contents into the body and fundus of the
stomach which are relaxed and dilated
During the second phase

Lower esophageal sphincter, esophagus, and upper

esophageal sphincter relax
After an inspiratory effort, glottis closed and respiration
is arrested
Abdominal muscles contract in a jerky manner
(retching), this compresses the stomach against the
contracted diaphragm and abdominal organs
The stomach contents are ejected through relaxed
esophagus
Vomitus cannot enter the larynx as it is closed and
respiration is arrested (Excess salivation)
Drugs that induce vomiting are
called emetics
Apomorphine
Picrotoxin
 • Drugs, Smell, sight, emotions
• chemicals
• Radiation
• Abnormal
stimulation
Limbic system
of vestibular CTZ
apparatus

VOMITING CENTRE

NTS
Efferent effect
Nausea
Antiperistalsis in the upper GIT
Contraction of the diaphragm
Arrest of respiration
Irritation of Contraction of abdominal muscles
Visceral organs Relaxation of esophagus
Opening of Lower esophageal sphincter
&upper esophageal sphincter
 Movements of small intestine

1. Mixing movement
a. Segmentation movement
b. Pendular movement
2. Propulsive movements
a. Peristaltic movements
b. Peristaltic rush
3. Peristalsis in fasting- migrating motor complex
4. Movements of villi
– Pendular movements
• Some times seen in humans
• Simple constrictions of the intestinal wall which
moves up & down for short distances
• Causes to & fro movements of chyme
• Aids mixing & exposure to greater area of mucosa

– Tonic contractions
• Prolonged contraction of segments of intestine
• One segment – isolated from another

49
 MIXING MOMENTS
• SEGMENTATION CONTRACTION :
Initiated by pace maker cells within the
intestine( coordinated by myenteric
plexus)
• Gastrin, CCK-PZ, Motilin (Stimulant)
• Secretin, Glucagon(Inhibits)
• Doesn’t propel the food forwards. Only
helps in mixing &churning.
Motility — segmentation
Properties of segmental movement
• The frequency of the segmental movements
during digestion is the highest about 12/min in
man
• It is decreases at the distance from pylorus.
• The pace-maker cells are responsible for the
initiation of segmental contractions;
• are located in the 2nd part of the duodenum in
the neighborhood of the point of entry of the bile
and pancreatic ducts.
• Gastro-ileal reflex –
• food in the stomach causes relaxation of cecum
& ileocecal valve through vagus; which is
responsible for entering the food into the colon.
• Gastro-colic reflex:
• distension of the stomach causes contraction of
rectum through enteric plexus and initiate
defecation reflex.
• Emotions such as fear increase the motility
leading to diarrhea and Grief decrease motility
cause constipation.
2. Segmentation: mix contents to promote
digestion & absorption
 PROPULSIVE MOVEMENTS
• PERISTALSIS:
A COORDINATED MOVEMENT WHERE A
WAVE OF CONTRACTION PRECEDED BY A
WAVE OF RELAXATION .

• LOCAL REFLEX STIMULATED BY STRETCH.

Ach & SUBSTANCE P CAUSE CONTRACTION
NO,VIP,ATP CAUSE RELAXATION
 FACTORS INFLUENCING
PERISTALSIS
Parasympathetic stimulation(+)
Sympathetic stimulation(---)
HORMONES-CCK-PZ(+)
-SECRETIN(---)
Small Intestinal Motility
1. Peristalsis: movement along the tract
 Types of peristalsis
• Short range peristalsis
• Rush peristalsis
• Antiperistalsis
• Law of GUT: PERISTALSIS IS
Always from oral to aboral
DIRECTION called as law of GUT.
CAUSE IS DUE TO POLARITY OF
INTESTINE
 Peristaltic rush
• The intense irritation of the intestinal mucosa due to
infectious diarrhea can cause both very powerful and
rapid peristalsis called peristalsis rush.
• This is initiated partly by extrinsic nervous reflexes to the
brain stem and back again to the gut through the vagus
and partly by direct enhancement of the myenteric
reflexes.
• The peristalsis rush travel long distances in the small
intestine within minutes sweeping the contents of the
intestine into the colon and thereby relieving the small
intestine of either irritative chyme or excessive
distention.
 Movement of intestinal villi
• Show several types of movements
• Fasting – villi ~ inactive & lie flat
• Contact with food – initiates villus movements
– to & fro Lashing or swaying movements
– Shorten & elongate alternately
– Stirring of fluids – help in absorption, expulsion of
lymph from lacteals
• Dependent on intact submucosal plexus
• Stimulation
– Vagal – increases movements
– Sympathetic – pale & motionless

62
 Types of movement

– Similar to SI
– Segmentation contraction – present in
proximal region of colon (i.e, ascending &
transverse region)
– Haustral contractions or churning in which
colonic wall roll back over the content
– Kneading movements - alternate contraction
& relaxation of large segments of colon 63
– Pendular type of movement – peristalsis cum

anti peristalsis causing mixing of colonic content

– Peristalsis – wave of contraction sweeping down
LI

Frequency less
than SI

64
– Mass movement or mass peristalsis
• 1-3 times/day
• Forceful contractions
• Involve contraction of large segment of colon
• Propel contents into rectum & induce desire for
defecation
• Mass movement can occur after meal
– Gastro colic reflex
– Duodeno colic reflex Mediated by ANS

66
 Defecation
• Takes place as reflex mechanism involving distal
colon, internal & external anal sphincter
 The parasympathetic stimulation causes
contraction of colonic musculature and
relaxation of internal anal sphincter.
• The sympathetic stimulation inhibits colonic
motility & constrict internal anal sphincter.
• The Somatic (Pudendal) nerve supply external
anal sphincter is made up of skeletal muscle for
voluntary control
 Defecation reflex
• can brought two ways
 Intrinsic reflex –mediated by local enteric
nervous system (center myenteric plexus)
 Extrinsic (Parasympathetic) defecation
reflex
 Intrinsic reflex
• Feces in the rectum cause distention of rectal wall
• initiates afferent signals spread through myenteric plexus
to initiate peristaltic waves in the descending colon,
sigmoid colon and rectum
• forcing feces towards the anus.
• As the peristaltic wave approaches the anus,
• the internal anal sphincter is relaxed by the inhibitory
signals from the myenteric plexus and
• if the external anal sphincter is voluntarily relaxed at the
same time, defecation will occur.
• (But intrinsic defecation reflex is usually weak, it need to
be fortified by parasympathetic defecation reflex).
Extrinsic reflex