GIT physiology Lecture-4

The small intestine

It is the major site of digestion and absorption of carbohydrates, proteins, and fats.
Small intestinal motility:
- Contractile activity of the small intestine serves two functions:
1. Mixing the chyme with the digestive juices and bile to facilitate digestion and
absorption.
2. Propelling the chyme from the duodenum to the colon.

- Types of contractions:
1. Segmentation contractions.
- It is the most common type.
- It occurs throughout the digestive period to mix the intestinal contents.
- During segmentation, about 2 cm of the intestinal wall contracts for about 5-6 seconds
forcing the chyme backward, toward the stomach and forward, toward the colon.
When the muscle relaxes, the chyme returns to the area from which it was displaced.
- This back-and-forth movement enables the chyme to mix with the digestive juices and
to make contact with the absorptive surface of the intestinal mucosa.
- There is a stepwise decrease in frequency of segmentation contractions from the
duodenum (about 12 times/min) to the ileum (about 8 times/min). The higher
frequency in the proximal than in the distal intestine propels the chyme slowly toward
the colon.
- The frequency of segmentation contractions is controlled by pacemaker cells within
the wall of the intestine called the interstitial cells of Cajal (ICC).
- Segmentation contractions are controlled by the hormones released during digestion.
 Gastrin, CCK, motilin, and insulin increase segmentations.
 Secretin and glucagon reduce the segmentations.

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GIT physiology Lecture-4

- It usually takes about 2-4 hours for the chyme to move from one end of the small
intestine to the other, this is called the (intestinal transit time).
2. Peristaltic contractions:
Are highly coordinated and propel the chyme through the small intestine toward the large
intestine.
A. In fed states (digestive periods):
- Achieved by the peristaltic reflex which is coordinated by the enteric nervous system.
1. Food in the intestinal lumen is sensed by enterochromaffin cells, which release
serotonin (5-hydroxytryptamine).
2. 5-HT initiate the peristaltic reflex.
3. Behind the food bolus, excitatory transmitters (Ach and substance P) cause contraction
of circular muscle and inhibitory transmitters (NO and VIP) cause relaxation of
longitudinal muscle. In front of the bolus, inhibitory transmitters cause relaxation of
circular muscle and excitatory transmitters cause contraction of longitudinal muscle.
- Peristalsis is not considered to be so important component of intestinal transit because
it moves chyme only a few centimeters at a time (about 1 cm/min).

B. In fasting states (interdigestive periods):

- Achieved by the migrating motor complex (MMC) which is a type of peristaltic
contraction that occurs in stomach and small intestine during fasting.
- It is different from the regular peristalsis because, a large portion of stomach or
intestine is involved in the contraction. The contraction extends to about 20 to 30 cm
of stomach or intestine. This type of movement occurs once in every 1½ to 2 hours.
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GIT physiology Lecture-4

- It starts as a moderately active peristalsis in the body of stomach and runs through the
entire length of small intestine. It travels at a velocity of 6-12 cm/min. Thus, it takes
about 10 minutes to reach the colon after taking origin from the stomach.
- Migrating motor complex sweeps the excess digestive secretions into the colon and
prevents the accumulation of the secretions in stomach and intestine. It also sweeps
the residual indigested materials into colon.
- The MMC spreads over the intestine during the interdigestive period.
Motility reflexes
1. Gastroileal reflex:
- This reflex is initiated by the distension of stomach by the food.
- An increase in the peristaltic contractions of ileum (caused by reflex stimulation of
vagus) associated with relaxation of ileocecal sphincter (by gastrin), which occurs
immediately after the meals. As a result, the intestinal contents are delivered to the
large intestine.

2. Ileogastric reflex: ileal distention causes inhibition of gastric motility.

3. Intestinointestinal reflex: relaxation of smooth muscles of the rest of the small intestine
in response to overdistension of one segment of the intestine.