GIN 1 Proscribe: Sarah Stafford

September 10, 2007 Reviewer: Nicole Nelles

Dr. Raj Kumar Chief Reviewer: Kimberlyn Fitchett

What the Gut Does for a Living

(I tried to organize this scribe in a manner that was easier to follow, but the majority of the info can be
found in Dr. Kumar’s lecture slides)
Objectives
• Conceptual framework for how gut function is regulated
• Principles of communication and signaling within the gut
• Overview of GI function and introduction to organ specialization and diversity

I. Main organs
A. Mouth- Foodstuffs are broken down mechanically by chewing and saliva is
added as a lubricant.
1. Functions of chewing and salivary secretions
a. Reducing size of particles
b. Formation of bolus for swallowing
c. Initiation of starch and lipid digestion
d. Antibacterial
e. Neutralization of refluxed acid in
esophagus
B. Esophagus- A muscular tube that is a simple conduit
between the back of the mouth and stomach. Food
transfer is both voluntary and involuntary (striated
muscle, CNS control), while bolus transfer is
involuntary, due to smooth muscle, and under CNS
and ENS control. The upper esophageal sphincter
provides airway protection and the lower provides
esophageal protection from the stomach.
C. Stomach - Enzymatic digestion of proteins initiated
and foodstuffs reduced to liquid form.
D. Liver- The center of metabolic activity in the body - provide bile salts to the
small intestine, critical for digestion and absorption of fats.
E. Pancreas - Provides a potent mixture of digestive enzymes to the small
intestine, which are critical for digestion of fats, carbohydrates and protein.
F. Small Intestine- This is where the final stages of chemical enzymatic digestion
occur and where almost all nutrients are absorbed.
G. Large Intestine- Water is absorbed, bacterial fermentation takes place and feces
are formed.
II. Major physiologic processes of the gut
A. Motility- Contractions of smooth muscle in the wall of the tube that crush,
mix, and propel its contents.
B. Secretion- Delivery of enzymes, mucus, ions and the like into the lumen, and
hormones into blood
C. Digestion
D. Absorption -Transport of water, ions and nutrients from the lumen, across the
epithelium and into blood.
E. Elimination

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GIN 1 Proscribe: Sarah Stafford
September 10, 2007 Reviewer: Nicole Nelles
Dr. Raj Kumar Chief Reviewer: Kimberlyn Fitchett

III. How digestion works

A. Major food products
1. Carbohydrates
2. Proteins
3. Fats
4. Water
5. Ions/ Minerals/ Fibers/ Enzymes
B. Example of protein breakdown

C. First food must be swallowed, which involves a signaling cascade

1. Multiple cranial nerves transmit afferent and efferent control of swallow
2. Sensory: V, IX, and X
3. Motor: V, VII, IX, X, and XII
4. Medulla is the swallowing center
D. Mixing and Propulsive Movements of the GI tract
1. Food spends about 15 seconds in the esophagus
2. 15 minutes in the stomach
3. 2 hours in the small intestine
4. More than 24 hours in the large intestine, then elimination
E. Responses to a meal
1. Stimuli can be mechanical or chemical
2. Response programs come from the CNS (oropharynx) or the Enteric
Nervous System (ENS, esophagus and below)
3. Organs that contribute to an integrated response to a meal
a. Gastrointestinal Track
b. Brain
c. Spinal Cord
d. Cardiovascular System
e. Exocrine Glands
f. Endocrine Glands
g. Liver
h. Gallbladder
i. Pancreas
4. Phases of response:
a. Cephalic and oral

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GIN 1 Proscribe: Sarah Stafford
September 10, 2007 Reviewer: Nicole Nelles
Dr. Raj Kumar Chief Reviewer: Kimberlyn Fitchett

i. Triggered by anticipation, sight, smell, or taste

ii. Secretions are saliva, HCl, pepsinogen, IF, gastrin, and
enzymes
iii. Secretions cause different effects in different organ
systems
b. Gastric
i. the multiple secretions of the stomach are depicted in the
figure below.

SECRETION MOTILITY
-Prevention of reflux

LES/CARDIA Mucus -Entry of Food

HC03
-Belching

HCl
BODY -Reservoir
IF
Pepsinogen
-Tonic Force for Emptying
Lipase
Mucus/HC03

-Mixing/Grinding
ANTRUM/PYLORUS
-Sieving
Mucus
HC03 -Regulation of Emptying

c. Duodenal
i. Involves duodenal cluster unit
d. Small Intestinal
i. Covers an Enormous surface area, with a large blood
flow (up to 25% of cardiac output after meals), and
extensive ENS controlling motility autonomously
ii. Uses both segmental (Segmentation contractions are a
common type of mixing motility seen especially in the
small intestine - segmental rings of contraction chop
and mix the ingesta. Alternating contraction and
relaxation of the longitudinal muscle in the wall of the
gut also provides effective mixing of its contents) and
peristaltic (A ring of muscle contraction appears on the
oral side moves toward the anus, propelling the

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GIN 1 Proscribe: Sarah Stafford
September 10, 2007 Reviewer: Nicole Nelles
Dr. Raj Kumar Chief Reviewer: Kimberlyn Fitchett

contents of the lumen in that direction; as the ring

moves, the muscle on the other side of the distended
area relaxes, facilitating smooth passage of the bolus)
contractions
e. Colonic
i. Function as the final reabsorption of water and ions
(proximal colon) - 2 L entersà 200 ml leaves
ii. Another function is propulsion
iii. The final job is elimination of remaining waste products
(rectum)
f. Hepatic
g. Fasting
5. Chain of events
a. Stimuli activates mechanical and chemical sensors
b. Sensors activate the CNS through the ANS (vagus) and ENS
c. The CNS also activates the ENS through the ANS
d. Activation of the ENS leads to changes in motility, secretions,
and blood flow.
5. Similarities of ENS to CNS
a. Receives information from sensory neurons
b. Effector function is via distinct motor neurons
c. Contains interneurons and synaptic neuropils: essential elements
for information processing
d. Capable of complex programs
e. Multiple synaptic mechanisms and multiple neurotransmitters
f. Communicates efficiently with the other nervous systems
g. ENS is like the “mini-me” of the CNS
1. Capable of complex integrative functions just like the brain. These
include a variety of effector systems (contraction, secretion,
absorption) as well as activities (peristalsis, emesis etc.)
2. Receives information from sensory neurons
3. Interneurons: required for information processing circuits. Not
usually present in autonomic ganglia
4. Presence of synaptic neuropils: the meshwork of fine nonmyelinated
nerve fibers that provide the microcircuits for information
processing:only in brain or ENS (look up; possible figure)
5. Motor neurons
6. Glial elements: not Schwann cells but astroglia-like
7. Mutliple synaptic mechanisms and multiple neurotransmitters
8. Absence of connective tissue
9. Small extracellular space
10. Isolation from blood vessels

IV. Gut appearance

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GIN 1 Proscribe: Sarah Stafford
September 10, 2007 Reviewer: Nicole Nelles
Dr. Raj Kumar Chief Reviewer: Kimberlyn Fitchett

A. Epithelial cells cover the mucosa and differ in shape in the different regions of
the gut.

B. Layers of the gut depicted below

C. Two important components: muscle and ENS (the submucosal plexus and
circular plexus)

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GIN 1 Proscribe: Sarah Stafford
September 10, 2007 Reviewer: Nicole Nelles
Dr. Raj Kumar Chief Reviewer: Kimberlyn Fitchett

Myenteric Plexus

Circular Muscle

Long. Muscle

Submucous Plexus

Mucosa

V. Peristaltic Reflex

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GIN 1 Proscribe: Sarah Stafford
September 10, 2007 Reviewer: Nicole Nelles
Dr. Raj Kumar Chief Reviewer: Kimberlyn Fitchett

A. ENS reflex
B. Will be a detailed description in later lectures; Dr. Kumar just wanted us to
know that multiple systems were working together to produce this reflex.
VI. Communication in the Gut
A. Three methods: neural, paracrine, and endocrine
B. When ENS activated by ACh from Vagal efferents, the ENS then uses ACh to
induce parietal cells to produce acid, ECL cells to produce histamine, and G
cells to produce gastrin.
C. Multiple Sensory receptors
1. Mechanoreceptors
a. Muscle (stretch, tension, length)
b. Mucosal
2. Chemreceptors
a. Acids
b. Osmotic
c. Amino Acids
d. Lipids
e. Glucose
3. Thermoreceptors
4. Pain (?)- still not clear
D. Sympathetic prevertebral ganglia are in pathways for rapid transfer of signals
between separated regions of bowel (bypassing synaptic delays inherent in
ENS in signal transduction over long distances)
VII. Gastric emptying
A. The rate of gastric emptying is relate to the particle size (ingested particles of >
than 1-2mm are emptied only during phase III of the migrating motor
complex)
B. Rate most rapid for isotonic solutions.
C. Rate also related to caloric contents of isotonic meals (greater caloric content
takes longer to empty)
VIII. Fed and Fasting programs
A. Metabolic Programs (liver)
1. Fasting
a. Use stored fuel
b. Glycogenolysis by liver and muscle
c. Gluconeogenesis by liver
d. Net hepatic glucose release
e. Fat and protein catabolism by adipose and muscle tissue
2. Fed
a. Use ingested nutrients for fuel
b. Glycogen synthesis by liver and muscle
c. Net glucose uptake by liver
d. Fat and protein synthesis
B. Motility Programs (ENS)
1. Esophagus: Transit

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GIN 1 Proscribe: Sarah Stafford
September 10, 2007 Reviewer: Nicole Nelles
Dr. Raj Kumar Chief Reviewer: Kimberlyn Fitchett

2. Stomach: Storage and grinding

3. Small Bowel: Mixing
4. Large Bowel: Transit
C. Fasting Programs
1. Housekeeping
IX. Conclusions
A. Gastroenterology is a multi-system specialty
B. Immediate control of gut function is mainly via the ENS
C. CNS modulation occurs mainly via the vagus, which acts via the ENS
D. Neural, endocrine, and paracrine mechanisms interact with each other in a
complex way
E. Organs can communicate with each other with in the GI tract in both directions

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