By: Abduljabbar Hamid Jabbar

University of Baghdad-College Of Medicine

M. B. Ch. B
By: Abduljabbar Hamid Jabbar
University of Baghdad-College Of Medicine
M. B. Ch. B
The digestive system prepares food for use by cells through five basic activities:
1. Ingestion or the taking of food into the body.
2. Peristalsis or the physical movement or pushing of food along the digestive tract.
3. Digestion or the breakdown of food by both mechanical and chemical mechanisms.
4. Absorption or the passage of digested food from the digestive tract into the cardiovascular and lymphatic systems for
distribution to the body’s cells.
5. Defecation or the elimination from the body of those substances that are indigestible and cannot be absorbed.

The primary function of the alimentary tract is to break down food and to
provide the body with a continual supply of water, electrolytes and nutrients.
In order to achieve these functions, the gastrointestinal tract (GIT) must
perform the following processes:

ingestion, movement, digestion, absorption, secretion and defecation. The

adult GIT is a tube running through the body from mouth to anus.
Anatomical features: The organizations of the structures that
make up the wall of the gastrointestinal tract (GIT) from the
posterior pharynx to the anus generally are as follow from the
outer surface inward
1. Serosa which continues onto the mesentery, which contains the
nerves, lymphatics, and blood vessels supplying the tract.

2. Longitudinal muscle.

3. Myenteric (Auerbach’s) plexus which controls mainly the GIT

movement.

4. Circular muscle which causes a decrease in the diameter of the

lumen of the GI tract when it contracts.

5. Submucous (Meissner’s) plexus which is important in controlling

secretion and blood flow and also subserves many sensory
functions, receiving signals from chemoreceptors in the gut
epithelium and from stretch receptors in the gut wall.

6. Mucosa and submucosa which consists of epithelium and

subepithelial connective tissue and are specialized for secretion
and absorption.
The enteric nervous system (ENS): The GIT has an intrinsic nervous system of its own called the enteric nervous system
which controls most GI functions, especially GIT movements and secretion.

The enteric nervous system is composed of two layers of neurons and connecting fibers, the outer layer is called the
myenteric (Auerbach’s) plexus, the inner layer is called the submucous (Meissner’s) plexus. The degree of activity of this
enteric nervous system can strongly be altered by extrinsic (autonomic) nervous system, i.e. parasympathetic and
sympathetic nervous systems.

Both systems send signals to GIT from the brain and spinal cord to modulate the activity of the enteric nervous system.
The parasympathetic nerve fibers: Stimulation of the parasympathetic nerves fibers releases acetylcholine and causes in
general:
• An increase in the activity of most GIT functions.
• Relaxation of sphincters (except the lower esophageal sphincter, which they stimulate).

The parasympathetic supply to the gut is divided into:

I. Cranial division: Is mediated almost entirely through the vagus (X cranial nerve). Vagus nerves innervate esophagus,
stomach, pancreas, gallbladder and first half of the large intestine, and little innervations to the small intestine

II. Sacral divisions: The sacral divisions originate in S2, 3, 4 sacral segments of the spinal cord, and pass through the
pelvic nerves to the distal half of the large intestine. These fibers function especially in the defecation reflex. Because
the parasympathetic nervous system plays a dominant role in the digestive process, it is often referred to as the “rest
and digest”division.
Reflexes of GIT are either occur entirely within the
enteric nervous system (short reflex arc), or the reflex
arc is originated from the gut and to the CNS (spinal
cord or brain stem) and then back to the gut (long
reflex arc)

Signals transmitted through these reflexes can cause

reflex excitation or inhibition of intestinal movements
or secretion. In addition to its anatomic complexity,
the ENS utilizes many different neurotransmitters,
including acetylcholine, adenosine triphosphate (ATP),
nitric oxide, and numerous peptides.
• Hirschsprung’s disease is a congenital absence of the myenteric plexus, usually involving a portion of the
distal colon. The pathologic non-ganglionic section of large bowel lacks peristalsis and undergoes
continuous spasm, leading to a functional obstruction.

• The normally innervated proximal bowel dilates as a result of the obstruction and can lead to the most
feared complication of Hirschsprung’s disease, toxic megacolon.
Types of GIT smooth muscle contractions: The smooth muscle of GIT is almost exclusively unitary smooth muscle while
that of pharynx, upper one third of the esophagus, and external anal sphincter are striated muscles. Although the upper
esophageal sphincter surrounds the upper part of the esophagus consists of skeletal muscle, but is not under conscious or
voluntary control. There are two main types of smooth muscle contractions:

[A] Phasic (rhythmical) contractions that occur in the esophagus, stomach, and intestine. They include

1. Peristaltic
2. Migrating Motor Complex (MMC),
3. Segmentation and haustration contractions
4. Distention-induced contraction

[B] Tonic contractions

In peristalsis, contraction of a small section of proximal muscle is followed immediately by relaxation of the muscle just
distal to it. The resulting wavelike motion moves food along the GIT in a proximal to distal direction. Peristaltic wave could
be of two types:

[1] Primary peristaltic wave which is a continuation of the peristaltic wave that begins proximally and mediated by
vagovagal reflexes, long reflex arc.

[2] Secondary peristaltic wave which is generated by the enteric nervous system (short reflex pathway), initiated from the
distension of the viscus by the retained food if the primary peristaltic wave fails to move all the food that has entered the
viscus.
MMC is a distinct pattern of electromechanical activity observed in
gastrointestinal smooth muscle during the periods between meals,
and it is interrupted by feeding. It is thought to serve a
"housekeeping" role and sweep residual undigested material through
the digestive tube. The cycle recurs every 1.5 to 2 hours.

These motor complexes trigger peristaltic waves, which facilitate

transportation of indigestible substances such as bone, fiber, and
foreign bodies from the stomach, through the small intestine, past the
ileocecal sphincter, and into the colon. An intact enteric nervous
system is essential for propagation of migrating motor complexes
along the bowel.

The MMC is thought to be partially regulated by motilin (by a direct

action on smooth muscle and by activation of excitatory enteric
nerves and it is released during the interdigestive period). MMC is
initiated in the stomach as a response to vagal stimulation. Control of
the MMC is complex.

MMC with an antral origin can be induced in humans through

intravenous administration of motilin, erythromycin or ghrelin,
whereas administration of serotonin or somatostatin induces MMC
with duodenal origin.

The role of the vagus nerve in control of the MMC seems to be

restricted to the stomach, as vagotomy abolishes the motor activity in
the stomach, but leaves the periodic activity in the small bowel intact.
In segmentation contraction, nonadjacent segments of alimentary tract organs, especially small intestine, contract and
relax, moving food forward then backward, resulting in food mixing and slow food propulsion. Segmentation contraction is
the primary motility pattern of the digestive period in humans, and is defined as irregular and uncoordinated contraction of
the circular muscle layer. This pattern, which develops in response to intestinal wall distention, is determined by activation
of preprogrammed neural circuits within the myenteric plexus.

The combined contractions of the circular and longitudinal smooth muscle cause the unstimulated portion in large intestine
to bulge outward into baglike sacs called haustration. Therefore, the fecal material in the large intestine is squeezed,
moving back and forth along the colon in a manner similar to that for the segmentation contractions in the small intestine.
Distention-induced contraction of gastrointestinal smooth muscle develops as the result of long (vago-vagal) and local
(enteric nerves) reflexes. The importance of long versus local reflex pathways varies along the gut.

Secondary esophageal peristalsis, intestinal segmentation, and migrating motor complexes are unaffected by vagotomy,
whereas primary peristaltic wave and proximal stomach peristalsis is decreased but not abolished by vagotomy.
Electrical slow wave activity in the gastrointestinal tract appears to originate from specialized pacemaker cells (interstitial
cells of Cajal) located between the longitudinal and circular muscle layers and within the submucosal and myenteric
plexuses. These pacemaker cells input directly onto the smooth muscle and receive input from Autonomic nerves.
[B] Tonic contractions that occur in the lower esophageal sphincter, pyloric sphincter, ileocecal sphincter, and
internal anal sphincter. Tonic contraction is continuous, occasionally increases or decreases in intensity.
Different Types of Neurotransmitters Secreted by Enteric Neurons
1. Acetylcholine 7. Substance P
2. Norepinephrine 8. Vasoactive intestinal polypeptide
3. Adenosine triphosphate 9. Somatostatin
4. Serotonin 10. Leu-enkephalin
5. Dopamine Acetylcholine most often excites
11. Met-enkephalin gastrointestinal activity.
6. Cholecystokinin 12. Bombesin Norepinephrine and epinephrine almost
always inhibit gastrointestinal activity.
Thank You
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