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GI Physiology II: GI Physiology II: Cephalic Phase of Cephalic Phase of DigestionDigestionIDP/DPT GI course, Fall 2011IDP/DPT GI course, Fall 2011
Jerome W. Breslin, PhD, Dept. of Jerome W. Breslin, PhD, Dept. of PhysiologyPhysiology
[email protected], 504-568-2669, 504-568-2669
MEB 7208MEB 7208
Lecture II OutlineLecture II OutlineCephalic Phase of DigestionCephalic Phase of Digestion
Initial Stimuli and ResponsesInitial Stimuli and Responses
Salivary SecretionsSalivary Secretions
Chewing and SwallowingChewing and Swallowing
Esophageal MotilityEsophageal Motility
Esophageal Sensation and PainEsophageal Sensation and Pain
Lower Esophageal Sphincter OpeningLower Esophageal Sphincter Opening
Initiation of Gastric SecretionsInitiation of Gastric Secretions
Required Reading:Required Reading:
• Barrett, Barrett, Gastrointestinal PhysiologyGastrointestinal Physiology
• Chapter 4 - section on salivary Chapter 4 - section on salivary secretionsecretion
• Chapter 7Chapter 7
Phases of Phases of DigestionDigestionCephalicCephalic
GastricGastric
Early IntestinalEarly Intestinal
Late IntestinalLate Intestinal
Cephalic PhaseStimuli:Auditory (Pavlov’s Dinner Bell), Cognitive, Visual, Olfactory, Taste
Higher Brain Centers
Dorsal Vagal Complex
Increased Parasympathetic
Signaling(Vagus Nerve)
Effector Response:Saliva SecretionGastric SecretionPancreatic Juice SecretionMild Contraction of the Gallbladder, however theSphincter of Oddi remains closed
Gustation and Gustation and OlfactionOlfactionPossible to distinguish up to Possible to distinguish up to 10,000 chemicals by taste (aided 10,000 chemicals by taste (aided by sense of smell).by sense of smell).
Five types of taste qualities: Five types of taste qualities: BitterBitter
SaltSalt
SweetSweet
SourSour
Umami (savoriness - detection of glutamate Umami (savoriness - detection of glutamate -- why MSG makes ordinary food taste good!)why MSG makes ordinary food taste good!)
Taste Transduction:Taste Transduction:Taste receptors usually can detect 2 Taste receptors usually can detect 2 or more basic tastes, and some can or more basic tastes, and some can detect all. There are variations based detect all. There are variations based on the cells’ sensitivity to different on the cells’ sensitivity to different compounds.compounds.
Smell is an important component (e.g. Smell is an important component (e.g. sensing the “nose” of a wine in wine sensing the “nose” of a wine in wine tasting).tasting).
““Good palate” is a detailed Good palate” is a detailed understanding of what things should understanding of what things should taste like and identify foods, taste like and identify foods, flavors, or ingredients by taste (and flavors, or ingredients by taste (and smell) alone.smell) alone.
Cephalic Phase of Cephalic Phase of Digestion:Digestion:• STAGES:
• Biting and chewing (mastication)• Stimulation of olfactory epithelia• Stimulation of gustatory receptors• Salivary secretions occur
• Food mixes with saliva• Softens and lubricates• Facilitates swallowing• Reduces food particle size
• (Gastric & pancreatic secretions)• Bolus Formation• Swallowing• Initiation of esophageal peristalsis• Relaxation of LES
Mastication Mastication (Chewing)(Chewing)
Incisors exert 30-80 pounds of pressure.Incisors exert 30-80 pounds of pressure.
Molars exert 100-160 pounds of pressure.Molars exert 100-160 pounds of pressure.
Mixing with saliva in the mouth:Mixing with saliva in the mouth:
Saliva acts as a lubricating agent.Saliva acts as a lubricating agent.
Saliva contains Saliva contains amylaseamylase for digestion of for digestion of carbohydrates, and may contain carbohydrates, and may contain lingual lipaselingual lipase for digestion of fats.for digestion of fats.
Convert chunks of food into a bolus for Convert chunks of food into a bolus for swallowing.swallowing.
Salivary Salivary Gland Gland
Structure:Structure:3 pairs of 3 pairs of large exocrine large exocrine glands:glands:1. Parotid1. Parotid2. Sublingual2. Sublingual3. Submaxillary 3. Submaxillary
Innervated by Innervated by the ANSthe ANSSecretes saliva into the buccal Secretes saliva into the buccal cavity in response to stimulation cavity in response to stimulation from the CNS.from the CNS.
Berne & Levy, Fig 32-1Berne & Levy, Fig 32-1
Regulation of Saliva Regulation of Saliva SecretionSecretionControlled by nerve impulses, Controlled by nerve impulses, originating from the salivary center originating from the salivary center of the medulla.of the medulla.
Most sensory afferents to the medulla Most sensory afferents to the medulla salivary center come from the mouth.salivary center come from the mouth.
Can be activated from GI tract or Can be activated from GI tract or eyes as a voluntary reflex.eyes as a voluntary reflex.
Both parasympathetic and sympathetic Both parasympathetic and sympathetic NS are activeNS are active
Parasympathetic > SympatheticParasympathetic > Sympathetic
Constituent Functions
Water Facilitates taste and dissolution of nutrients; aids in swallowing and speech
Bicarbonate Neutralizes refluxed gastric acid
Mucins Lubrication
Amylase Starch digestions
Lysozyme, Lactoferrin, IgA Innate and acquired immune protection
Epidermal and Nerve Growth Factors Assumed to contribute to mucosal growth and protection
Table 4-2 in Barrett: Constituents of saliva and their functions.
MAJOR ORGANIC COMPONENTS OF SALIVAComponent Region Gland Function
Proline-rich proteins Acinus P, SM LubricationAntimicrobialEnamel formation
Mucins Acinus SL, SM LubricationAntimicrobialProtease protective
Enzymes α−Amylase Lipase Ribonuclease Kallikrein
AcinusAcinus
DuctDuct
P, SMSLSMAll
Starch DigestionFat DigestionRNA digestion?
Other Lactoperoxidase Lactoferrin Lysozyme sec IgA Growth Factors
AcinusAcinus
DuctDuctDuct
SM?
SM?
SM`
AntimicrobialAntimicrobualAntimicrobialAntimicrobial?
Ionic Composition of Saliva:Ionic Composition of Saliva:
1. In humans, saliva is always 1. In humans, saliva is always hypotonic to plasma.hypotonic to plasma.2. Tonicity increases with flow rate.2. Tonicity increases with flow rate.3. Maximum tonicity is about 70% of 3. Maximum tonicity is about 70% of plasma.plasma.
Berne & Berne & Levy Fig. Levy Fig.
32-332-3
Similar to Similar to Fig. 4-9 Fig. 4-9
in Barrettin Barrett
Two stage model of saliva secretion:Two stage model of saliva secretion:
Berne & Berne & Levy Fig. Levy Fig.
32-432-4
Control of Salivary Secretion: Control of Salivary Secretion: Cellular Cellular MechanismsMechanisms
Berne & Berne & Levy, Fig. Levy, Fig.
32-732-7
Swallowing Swallowing (Deglutition)(Deglutition)Process by which material is Process by which material is transported from the mouth transported from the mouth through the pharynx and through the pharynx and esophagous to the stomach.esophagous to the stomach.
Stages based on region where Stages based on region where bolus passes:bolus passes:
• 1. Oral (Mouth)1. Oral (Mouth)
• 2. Pharyngeal (Pharynx)2. Pharyngeal (Pharynx)
• 3. Esophageal (Esophagous)3. Esophageal (Esophagous)
A normal swallow A normal swallow consists of three consists of three integrated phases:integrated phases:
PhasePhase MuscleMuscle Neural Neural ControlControl
Voluntary Voluntary ControlControl
OralOral StriatedStriated Cortex/Cortex/MedullaMedulla FullFull
PharyngealPharyngeal StriatedStriated MedullaMedulla SomeSome
EsophagealEsophageal Striated/Striated/SmoothSmooth Medulla/ENSMedulla/ENS NoneNone
The swallowing reflex is coordinated by the medulla oblongata, which stimulates the appropriate sequence of contraction and relaxation in the participating skeletal muscle, sphincters, and smooth muscle groups.
Figure 15-14
Swallowing
Timeline of events involved in swallowing:Timeline of events involved in swallowing:
Opening of the upper esophageal Opening of the upper esophageal sphincter is dependent upon sphincter is dependent upon multiple factors:multiple factors:
FactorFactor EffectEffect
Hyoid & Laryngeal Hyoid & Laryngeal ElevationElevation Pulls relaxed UES openPulls relaxed UES open
Cricopharyngeal Cricopharyngeal RelaxationRelaxation Allows opening to occurAllows opening to occur
Cricopharyngeal Cricopharyngeal ComplianceCompliance
Controls degree of Controls degree of openingopening
Pharyngeal Pressure WavePharyngeal Pressure Wave Pushes bolus through Pushes bolus through relaxed sphincterrelaxed sphincter
Note: Cricopharyngeal Relaxation is not synonymous with Note: Cricopharyngeal Relaxation is not synonymous with UES opening.UES opening.
Dysphagia:Dysphagia:Difficulty in Difficulty in SwallowingSwallowingCan result from anatomical Can result from anatomical abnormalities that alter the abnormalities that alter the mechanics of swallowing.mechanics of swallowing.
Can also arise secondary to Can also arise secondary to neurological problems (e.g. neurological problems (e.g. patients who have previously patients who have previously suffered a stroke)suffered a stroke)
The coordinated sequence of contraction and relaxation in the upper esophageal sphincter, the esophagus, and the lower esophageal sphincter is necessary to deliver swallowed food to the stomach.
Figure 15-15
1. Peristalsis of bolus to the stomach
2. Opening of LES
3. Receptive relaxation in stomach
Figure 15-15
Striated Muscle
Mixed Smooth and Striated Muscle
Smooth Muscle
Figure 15-15
Atmospheric Pressure
(0 mm Hg)
UES: 100 mm Hg
Intraesophageal Pressure: -5 mm Hg
LES: 20 mm Hg
Sphincters prevent influx of air into the stomach, as well as reflux of gastric contents into the esophagus.
Coordinated, directional contraction of smooth muscle propels ingested food forward (Peristalsis)
ESOPHAGEAL PERISTALSIS
SWALLOWING DISTENSION
PERISTALSISPERISTALSIS
PRIMARY SECONDARY
Distension in the esophagous can Distension in the esophagous can initiate peristalsis through initiate peristalsis through both local and vago-vagal both local and vago-vagal reflexes:reflexes:
Secondary peristaltic waves Secondary peristaltic waves sometimes occur to clear any sometimes occur to clear any
remnants of the bolus.remnants of the bolus.
Regulation of Esophageal PeristalsisRegulation of Esophageal Peristalsis
Esophageal SensationEsophageal Sensation
Esophageal StimuliEsophageal Stimuli
StimulusStimulus ReceptorReceptor ResponseResponse
AcidAcid ChemoreceptorChemoreceptorFeedback Feedback ControlControlPain?Pain?
TemperatureTemperature ThermoreceptorThermoreceptor Non-Painful Non-Painful SensationSensation
DistensionDistension MechanoreceptorMechanoreceptor Burning; PainBurning; Pain
Lee & Mitter, Lee & Mitter, GI MotilityGI Motility, 2006, 2006
Burning sensation in the Burning sensation in the esophagous in the absence of esophagous in the absence of acid:acid:
COMMON FACTORS THAT ALTER LES PRESSURE
• Protein
• Increased intra-abdominal pressure
• Elevated gastric pH
• Fat• Chocolate• Peppermint• Alcohol• Smoking• Gastric distension
(aerophagia)
INCREASE DECREASE
Three Phases of Gastric SecretionSlide number
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
1. The taste or smell of food, tactile sensations of food in the mouth, or even thoughts of food stimulate the medulla oblongata (green arrow).
2. Parasympathetic action potentials are carried by the vagus nerves to the stomach (pink arrow).
3. Preganglionic parasympathetic vagus nerve fibers stimulate postganglionic neurons in the enteric plexus of the stomach.
4. Postganglionic neurons stimulate secretion by parietal and chief cells and stimulate gastrin secretion by endocrine cells.
5. Gastrin is carried through the circulation back to the stomach (purple arrow), where it stimulates secretion by parietal and chief cells.
Cephalic Phase
Gastrin
Circulation
Secretionsstimulated
Taste or smell of foodTactile sensation in mouth
Medulla oblongata
Vagus nerves
Stomach
1
2 3
5
4