Physiology

• The goal of physiology is to explain the physical

and chemical factors that are responsible for the
origin, development, and progression of life.
• Viral physiology
• Bacterial physiology
• Cellular physiology
• Plant physiology,
• Human physiology
• Human physiology explains the specific
characteristics and mechanisms of the human
body that make it a living being.
 Books
Textbook of Medical Physiology by
• Arthur C. Guyton
• John E. Hall
Ganong’s review of Medical Physiology, 23rd
edition
Essentials of Medical Physiology by K
Sembulingam and Prema Sembulingam
Gastrointestinal System
 GENERAL PRINCIPLES OF
GASTROINTESTINAL FUNCTION
The alimentary tract provides the body with
continuous supply of water, electrolytes and
nutrients. This requires
 Motility
 Secretion
 Regulation
 Circulation of blood
 Nervous and hormonal control
Characteristics of Gastrointestinal wall
The intestinal wall is composed of following
layers
 Serosa
 Longitudinal muscle layer
 Circular muscle layer
 Submucosa
 Mucosa
 Neural control of Gastrointestinal
function
The gastrointestinal tract has its own nervous
system, called the Enteric nervous system. It
is composed of two plexuses
 The myenteric plexus or Auerbach’s plexus is
an outer plexus located between the muscle
layers.
 The submucosal plexus is an inner plexus that
lies in the submucosa
Autonomic control of Gastrointestinal
tract
The parasympathetic nervous system increases
the activity of the enteric nervous system. The
parasympathetic supply to the gut is made up of
cranial and sacral divisions.
 The cranial parasympathetic innervate, by way of
the vagus nerve, the esophagus, stomach,
pancreas, and first half of the large intestine.
 The sacral parasympathetic innervate, by way of
the pelvic nerves, the distal half of the large
intestine.
• The sympathetic nervous system usually
inhibits the activity in the gastrointestinal
tract, causing many effects opposite to those
of the parasympathetic nervous system.
 Gastrointestinal reflexes
Three types of reflexes are essential for
gastrointestinal control
 Reflexes that occur entirely within the enteric
nervous system
 Reflexes from the gut to the sympathetic
ganglia and back to the gut
 Reflexes from the gut to the spinal cord or
brain stem and then back to the gut
 Gastrointestinal Hormones
Four major hormones are
Secretin
 Secretin was the first gastrointestinal
hormone discovered and is secreted by the “S”
cells in the mucosa of the duodenum in response
to acidic gastric juice emptying into the
duodenum from the pylorus of the stomach.
 Secretin has a mild effect on motility of the
gastrointestinal tract and acts to promote
pancreatic secretion of bicarbonate which in turn
helps to neutralize the acid in the small intestine.
Gastrin
The primary actions of gastrin are
 stimulation of gastric acid secretion and
 stimulation of growth of the gastric mucosa.
Cholecystokinin
 This hormone strongly contracts the gallbladder, expelling
bile into the small intestine where the bile in turn plays
important roles in emulsifying fatty substances, allowing
them to be digested and absorbed.
 Cholecystokinin also inhibits stomach contraction
moderately.
Gastric inhibitory peptide
 Gastric inhibitory peptide is secreted by the
mucosa of the upper small intestine, mainly in
response to fatty acids and amino acids but to a
lesser extent in response to carbohydrate.
 It has a mild effect in decreasing motor activity of
the stomach and therefore slows emptying of
gastric contents into the duodenum when the
upper small intestine is already overloaded with
food products.
Functional movements in the Gastrointestinal tract
 Propulsive movements
Mixing movements
Gastrointestinal blood flow
 The blood vessels of the gastrointestinal tract are
a part of the Splanchnic circulation
 Parasympathetic stimulation increases the blood
flow
 Sympathetic stimulation decreases blood flow.
 Mastication
• Mastication (chewing) is the process for which teeth
are especially designed. The anterior teeth
(incisors) providing a strong cutting action and the
posterior teeth (molars), a grinding action.
• Most of the muscles of chewing are innervated by the
motor branch of the fifth cranial nerve (trigeminal
nerve), and the chewing process is controlled by nuclei
in the brain stem. Stimulation of specific reticular areas
in the brain stem taste centers will cause rhythmical
chewing movements. Also, stimulation of areas in the
hypothalamus, amygdala, and even the cerebral cortex
near the sensory areas for taste and smell can often
cause chewing.
Chewing reflex
• The presence of a bolus of food in the mouth at first
initiates reflex inhibition of the muscles of mastication,
which allows the lower jaw to drop. The drop in turn
initiates a stretch reflex of the jaw muscles that leads
to rebound contraction. This automatically raises the
jaw to cause closure of the teeth, but it also
compresses the bolus again against the linings of the
mouth, which inhibits the jaw muscles once again,
allowing the jaw to drop and rebound another time;
this is repeated again and again.
• Chewing is important for digestion of all
foods, but especially important for most fruits
and raw vegetables because these have
indigestible cellulose membranes around their
nutrient portions that must be broken before
the food can be digested.
• The rate of digestion is absolutely dependent
on the total surface area exposed to the
digestive secretions.
• In addition, grinding the food to a very fine
particulate consistency prevents damage to
the gastrointestinal tract and increases the
ease with which food is emptied from the
stomach into the small intestine, then into all
succeeding segments of the gut.
 SWALLOWING
• Swallowing, known scientifically as
deglutition, is the process in the human or
animal body that makes something pass from
the mouth, to the pharynx, and into the
esophagus, while shutting the epiglottis. If this
fails and the object goes through the trachea,
then choking or pulmonary aspiration can
occur. In the human body it is controlled by
the swallowing reflex.
 Eating and swallowing are complex
neuromuscular activities consisting essentially of
three phases, an oral, pharyngeal and esophageal
phase. Each phase is controlled by a different
neurological mechanism.
Oral phase This is voluntary stage and includes
 Moistening
 Mastication
 Trough formation
 Movement of the bolus posteriorly
• Pharyngeal phase : This stage is
involuntary and constitutes the passage of
food from the pharynx to the esophagus.
When the pharyngeal phase begins, other
activities such as chewing, breathing,
coughing and vomiting are concomitantly
inhibited
Closure of the nasopharynx
• The soft palate is tensed , and then elevated
to close the nasopharynx. There is also the
simultaneous approximation of the walls of
the pharynx to the posterior free border of
the soft palate, which is carried out by the
palatopharyngeus (pharyngeal plexus—IX, X)
and the upper part of the superior constrictor
muscles supplied by pharyngeal plexus—IX,
X.
The pharynx prepares to receive the bolus
• The pharynx is pulled upwards and forwards by
the pharyngeal muscles – stylopharyngeus (IX),
salpingopharyngeus(pharyngeal plexus—IX, X)
and palatopharyngeus (pharyngeal plexus—IX, X)
to receive the bolus. The palatopharyngeal folds
on each side of the pharynx are brought close
together through the superior constrictor
muscles, so that only a small bolus can pass.
Closure of the oropharynx
• The oropharynx is kept closed by
palatoglossus (pharyngeal plexus—IX, X), the
intrinsic muscles of tongue and styloglossus
(extrinsic muscle of tongue).
Laryngeal closure
• It is true vocal fold closure that is the primary
laryngopharyngeal protective mechanism to
prevent aspiration during swallowing.
 Nervous regulation of Swallowing
• The most sensitive tactile areas of the posterior
mouth and pharynx for initiating the pharyngeal
stage of swallowing are the tonsillar pillars.
• Impulses are transmitted from these areas
through the sensory portions of the trigeminal
and glossopharyngeal nerves into the medulla
oblongata, either into or closely associated with
the tractus solitarius, which receives essentially
all sensory impulses from the mouth.
• The successive stages of the swallowing process
are then automatically initiated in orderly
sequence by neuronal areas of the medulla and
lower portion of the pons. This area is known as
Swallowing center.
• The motor impulses from the swallowing center
to the pharynx and upper esophagus that
cause swallowing are transmitted successively
by the 5th, 9th, 10th, and 12th cranial nerves
 Esophageal stage
Esophageal stage of swallowing: The esophagus
normally exhibits two types of peristaltic
movements
1. Primary peristalsis
2. Secondary peristalsis
• Primary peristalsis is simply continuation of
the peristaltic wave that begins in the pharynx
and spreads into the esophagus
• If the primary peristaltic wave fails to move into the
stomach all the food that has entered the esophagus,
secondary peristaltic waves result from distention of
the esophagus itself by the retained food; these waves
continue until all the food has emptied into the
stomach.
• The secondary peristaltic waves are initiated partly by
intrinsic neural circuits in the myenteric nervous
system and partly by reflexes that begin in the pharynx
and are then transmitted upward through vagal
afferent fibers to the medulla and back again to the
esophagus through glossopharyngeal and vagal
efferent nerve fibers.
• The musculature of the pharyngeal wall and
upper third of the esophagus is striated
muscle.Therefore, the peristaltic waves in these
regions are controlled by skeletal nerve impulses
from the glossopharyngeal and vagus nerves.
• In the lower two thirds of the esophagus, the
musculature is smooth muscle, but this portion of
the esophagus is also strongly controlled by the
vagus nerves acting through connections with the
esophageal myenteric nervous system
Function of sphincter lower esophageal
sphincter (gastroesophageal sphincter)
• At the lower end of esophagus, extending
from about 2-5 cm above its juncture with the
stomach, the esophageal circular muscle
functions as lower esophageal sphincter or
gastroesophageal sphincter.
 Stomach
• The stomach is a small, 'J'-shaped pouch with
walls made of thick, elastic muscles, which stores
and helps break down food.
• Storage of large quantities of food until the food
can be processed in the duodenum
• Mixing of this food with gastric secretions until it
forms a semi fluid mixture called chyme
• Slow emptying of the food from the stomach into
the small intestine at a rate suitable for proper
digestion and absorption
Receptive relaxation of the stomach
• As the food bolus travels through the lower
esophagus, the stomach reflexly begins to
relax.
• This phenomenon allows the stomach to
accept large amounts of food with minimal
increase in gastric pressure; it also minimizes
esophageal reflux.
Mixing and propulsion of food in the stomach
• As long as food is in the stomach, weak
peristaltic constrictor waves, called mixing
waves, begin in the mid- to upper portions of
the stomach wall and move toward the
antrum about once every 15 to 20 seconds.
These waves are initiated by the gut wall basic
electrical rhythm.
• As the constrictor waves progress from the
body of the stomach into the antrum, they
become more intense, some becoming
extremely intense and providing powerful
peristaltic action potential–driven constrictor
rings that force the antral contents under
higher and higher pressure toward the
pylorus.
• As each peristaltic wave approaches the pylorus,
the pyloric muscle itself often contracts, which
further impedes emptying through the pylorus.
Therefore, most of the antral contents are
squeezed upstream through the peristaltic ring
toward the body of the stomach, not through the
pylorus. Thus, the moving peristaltic constrictive
ring, combined with this upstream squeezing
action, called “retropulsion,” is an exceedingly
important mixing mechanism in the stomach.
• Chyme
• After food in the stomach has become thoroughly
mixed with the stomach secretions, the resulting
mixture that passes down the gut is called chyme.
The degree of fluidity of the chyme leaving the
stomach depends on the relative amounts of
food, water, and stomach secretions and on the
degree of digestion that has occurred.The
appearance of chyme is that of a murky semifluid
or paste.
Emptying of the stomach
• Weak gastric factors that promote emptying
• Effect of gastric food volume on rate of emptying
• Effect of hormone Gastrin on stomach emptying
• Powerful duodenal factors that inhibit emptying
• Inhibitory effect of enterogastric nervous reflexes
from the duodenum
• Hormonal feedback from the duodenum inhibits
gastric emptying
Phases of digestion
1. Cephalic phase: in cephalic phase the sight
and even thought of food can stimulate
gastric secretions
2. Gastric phase: In gastric phase, after eating
has begun, the presence of food and
distension it causes also stimulate gastric
secretions
3- Intestinal Phase: In intestinal phase, the
entry of gastric contents stimulate release of
multiple factors, which then inhibit gastric
activity.
Movements of the Small intestine
• Most Digestion & Absorption occurs in the
small intestine
• No more digestion as food moves into large
intestine, where a little absorption of salt
& water does take place.
• The three segments of small intestine (which
is more than 6 meters long) are the:
– Duodenum, only few cms.
– Jejunum, more than 2 meters
– Ileum, more than 3 meters
• Types of movements in small intestine
• Mixing contractions (segmentation
contractions)
• Propulsive movements
MIXING CONTRACTIONS
• It is primary method of motility
• It mixes & slowly propels the food
• A ring like contraction appears
• Chyme is chopped & thoroughly mixed with digestive
juices.
• Segmentation contractions are initiated by the pace
setter cells which produce the basic electrical rhythm
• Segmentations are absent or slight between meals
• Both duodenum & ileum start segmentation after a
meal
• Duodenum produces segmentation in response
to local distention
• Ileum produces mixing due to release of gastrin
• The mechanism is called the GASTROILEAL
REFLEX
• Parasympathetic nerves enhance segmentation
contractions
• Sympathetic stimulation depresses them
• Segmentations cause mixing & slow movement of
food in the intestine
MECHANISM: When small intestine filled with
chyme, it is distended, myenteric plexus
stretched.
• Due to stimulation of myenteric plexus, a
series of constrictions occur throughout the
length of small intestine. (Area of constriction
is about 1cm),forming segmentation
• Segmentation consists of ring like contractions
along the length of small intestine.
• Within seconds, contracted area relaxes &
previously relaxed area contracts.
• This mixes the chyme.
• Rate of segmentation contractions in
duodenum is around 7-12 / minute
• In terminal ileum it is 9 / minute
• Contents take 3-5 hours to move through the
intestine
Movement of villi
• Villi present in jejunal mucosa.
• Increases surface area for absorption about 10 folds.
Peristalsis or Propulsive Movements
• Also called MMC (migrating motility complex)
• When most food is absorbed, segmentations cease
• Replaced by migratory motility complex (propulsive
movements) which propel unabsorbed residue from
small intestine to large intestine.
• Between meal motility consists of weak, repetitive,
peristaltic waves, that move a short distance & die
 Peristaltic waves
• The function of the peristaltic waves in the
small intestine is not only to cause progression
of chyme toward the ileocecal valve but also
to spread out the chyme along the intestinal
mucosa. As the chyme enters the intestines
from the stomach and elicits peristalsis, this
immediately spreads the chyme along the
intestine; and this process intensifies as
additional chyme enters the duodenum
• On reaching the ileocecal valve, the chyme is
sometimes blocked for several hours until the
person eats another meal; at that time, a
gastroileal reflex intensifies peristalsis in the
ileum and forces the remaining chyme
through the ileocecal valve into the cecum of
the large intestine.
 Movements Caused by the Villi
• The muscularis mucosae can cause short folds to
appear in the intestinal mucosa. In addition
individual fibers from this muscle extend into the
intestinal villi and cause them to contract.The
mucosal folds increase the surface area exposed
to the chyme, thereby increasing absorption.
Also, contractions of the villi—shortening,
elongating, and shortening again results into the
increase in the flow of lymph freely from the villi
into the lymphatic system.
 Function of the Ileocecal Valve
• A principal function of the ileocecal valve is to
prevent backflow of fecal contents from the
colon into the small intestine.
• The ileocecal valve itself protrudes into the
lumen of the cecum and therefore is forcefully
closed when excess pressure builds up in the
cecum and tries to push cecal contents
backward against the valve lips.
• The wall of the ileum for several centimeters
immediately upstream from the ileocecal
valve has a thickened circular muscle called
the ileocecal sphincter.This sphincter normally
remains mildly constricted and slows
emptying of ileal contents into the cecum.
• Resistance to emptying at the ileocecal valve
prolongs the stay of chyme in the ileum and
thereby facilitates absorption. Normally, only
1500 to 2000 milliliters of chyme empty into
the cecum each day.
 Movements of the Colon
• The principal functions of the colon are
(1)absorption of water and electrolytes from
the chyme to form solid feces
(2)storage of fecal matter until it can be
expelled.
 Haustrations
• Mixing Movements—“Haustrations”
• Large circular constrictions occur in the large intestine.
At each of these constrictions, about 2.5 centimeters of
the circular muscle contracts, sometimes constricting
the lumen of the colon almost to occlusion. At the
same time, the longitudinal muscle of the colon, which
is aggregated into three longitudinal strips called the
teniae coli, contracts. These combined contractions of
the circular and longitudinal strips of muscle cause the
unstimulated portion of the large intestine to bulge
outward into baglike sacs called haustrations.
• Each haustration usually reaches peak
intensity in about 30 seconds and then
disappears during the next 60 seconds. They
also at times move slowly toward the anus
during contraction, especially in the cecum
and ascending colon, and thereby provide a
minor amount of forward propulsion of the
colonic contents. After another few minutes,
new haustral contractions occur in other areas
nearby.
• Therefore, the fecal material in the large
intestine is slowly dug into and rolled over in
much the same manner that one spades the
earth. In this way, all the fecal material is
gradually exposed to the mucosal surface of
the large intestine, and fluid and dissolved
substances are progressively absorbed until
only 80 to 200 milliliters of feces are expelled
each day.
 Propulsive Movements—“Mass
Movements.”
• Propulsive Movements—“Mass Movements.”
• Much of the propulsion in the cecum and
ascending colon results from the slow but
persistent haustral contractions, requiring as
many as 8 to 15 hours to move the chyme
from the ileocecal valve through the colon,
while the chyme itself becomes fecal in
quality, a semisolid slush instead of semifluid.
• From the cecum to the sigmoid, mass
movements can, for many minutes at a time,
take over the propulsive role. These
movements usually occur only one to three
times each day, in many people especially for
about 15 minutes during the first hour after
eating breakfast.
• A mass movement is a modified type of peristalsis
characterized by the following sequence of events:
1. A constrictive ring occurs in response to a distended or
irritated point in the colon, usually in the transverse colon.
2. Then, rapidly, the 20 or more centimeters of colon distal
to the constrictive ring lose their haustrations and instead
contract as a unit, propelling the fecal material in this
segment further down the colon.
3. The contraction develops progressively more force for
about 30 seconds, and relaxation occurs during the next 2
to 3 minutes. Then, another mass movement occurs, this
time perhaps farther along the colon.
• A series of mass movements usually persists
for 10 to 30 minutes. Then they cease but
return perhaps a half day later.When they
have forced a mass of feces into the rectum,
the desire for defecation is felt.
• Initiation of Mass Movements by Gastrocolic
and Duodenocolic Reflexes.
• Appearance of mass movements after meals is
facilitated by gastrocolic and duodenocolic
reflexes. These reflexes result from distention
of the stomach and duodenum.
• The reflexes almost certainly are transmitted
by way of the autonomic nervous system.
 Defecation
• Most of the time, the rectum is empty of
feces. This results partly from the fact that a
weak functional sphincter exists about 20
centimeters from the anus at the juncture
between the sigmoid colon and the rectum.
There is also a sharp angulation here that
contributes additional resistance to filling of
the rectum.
• Continual dribble of fecal matter through the
anus is prevented by tonic constriction of
(1) an internal anal sphincter, a several-centimeters-
long thickening of the circular smooth
muscle that lies immediately inside the anus,
and
(2) an external anal sphincter, composed of striated
voluntary muscle that both surrounds the
internal sphincter and extends distal to it.
• The external sphincter is controlled by nerve
fibers in the pudendal nerve, which is part of
the somatic nervous system and therefore is
under voluntary, conscious or at least
subconscious control; subconsciously, the
external sphincter is usually kept continuously
constricted unless conscious signals inhibit the
constriction.
 Defecation Reflexes
• Ordinarily, defecation is initiated by defecation
reflexes.
• One of these reflexes is an intrinsic reflex
mediated by the local enteric nervous system in
the rectal wall. When faeces enter the rectum,
distention of the rectal wall initiates afferent
signals that spread through the myenteric plexus
to initiate peristaltic waves in the descending
colon, sigmoid, and rectum, forcing faeces toward
the anus.
• As the peristaltic wave approaches the anus,
the internal anal sphincter is relaxed by
inhibitory signals from the myenteric plexus; if
the external anal sphincter is also consciously,
voluntarily relaxed at the same time,
defecation occurs.
• The intrinsic myenteric defecation reflex
functioning by itself normally is relatively
weak. To be effective in causing defecation, it
usually must be fortified by another type of
defecation reflex, a parasympathetic
defecation reflex that involves the sacral
segments of the spinal cord
• When the nerve endings in the rectum are stimulated,
signals are transmitted first into the spinal cord and
then reflexly back to the descending colon, sigmoid,
rectum, and anus by way of parasympathetic nerve
fibers in the pelvic nerves. These parasympathetic
signals greatly intensify the peristaltic waves as well as
relax the internal anal sphincter, thus converting the
intrinsic myenteric defecation reflex from a weak effort
into a powerful process of defecation that is
sometimes effective in emptying the large bowel all the
way from the splenic flexure of the colon to the anus.