1. Lecture 3 Dr. Zahoor Ali Shaikh
ESOPHAGUS, & STOMACH
Lecture 3
Dr. Zahoor Ali Shaikh

2. Esophagus Pharngoesophageal Sphincter, and Gastroesophageal Sphincter
Esophagus is straight muscular tube that extends from the pharynx to the stomach.
It lies in the thoracic cavity and penetrates the diaphragm and joins the stomach in the abdominal cavity.
Esophagus has sphincters at both ends.

3. Pharyngoesophageal Sphincter, Esophagus and Gastroesophageal Sphincter
What is Sphincter?
Sphincter is ring like muscular structure, when closed, it prevents the passage of food.
Upper Esophageal sphincter is Pharyngoesophageal Sphincter .
Lower Esophageal sphincter is Gastroesophageal Sphincter.

4. Pharyngoesophageal Sphincter
It remains closed by contraction of circular skeletal muscle of sphincter and prevents entry of air into the esophagus and stomach during breathing.
During swallowing, this sphincter opens and allows the bolus to pass into the esophagus.

5. Esophagus
Peristaltic waves in esophagus push the food down, when food comes in the esophagus, the swallowing center in medulla triggers peristaltic waves that sweeps from the beginning to the end of the esophagus forcing the bolus to the stomach.

6. Esophagus
The term ‘Peristalsis’ means ring like contraction of circular smooth muscle that moves forward pushing the bolus into relaxed area.
The peristaltic wave takes 5-9 sec to reach the lower end of esophagus.

8. Esophagus Esophageal secretion is entirely mucus.
Mucus does the job of lubrication so that food can pass easily.
Average transit time in the pharynx and the esophagus is 6-10 sec.
No digestion or absorption occurs in the esophagus.

9. Gastroesophageal Sphincter
This sphincter does not allow the contents of stomach to pass into esophagus [prevents reflux of gastric contents into esophagus].
It is a smooth muscle.
If stomach contents pass to esophagus, they cause discomfort known as ‘Heart burn’.

10. STOMACH
Stomach is ‘J-shaped chamber’, lying between esophagus and small intestine.
Stomach is divided into three sections:
1. The Fundus – upper part
2. The Body - middle part
3. The Antrum – lower part

11. STOMACH [cont]
Antrum leads to pyloric canal and pyloric sphincter [pyloric sphincter acts a barrier between stomach and duodenum].

13. STOMACH
The smooth muscle layer in fundus and body are thin, but smooth muscle layer is thick in the antrum.
Protein digestion begins in stomach.

14. STOMACH Stomach performs three main functions:
(i). Stores the food for 4-5 hours.
(ii). Secretes HCL and enzymes that
begin protein digestion.
(iii). Chyme is produced.

15. STOMACH
What is Chyme?
When ingested food is mixed with gastric secretions by mixing movements of stomach, a thick liquid mixture known as ‘Chyme’ is produced.
Chyme is emptied into the duodenum.

16. STOMACH
We will study four basic Digestive Processes in the stomach. These are:
1. Motility
2. Secretion
3. Digestion
4. Absorption

17. STOMACH 1. Motility There are four aspects of gastric motility:
i. Filling
ii. Storage
iii. Mixing
iv. Emptying
i,ii Gastric Filling and Storage
Stomach when empty has volume of 50ml, but it can expand to the capacity of 1 liter [1000ml] during meal [20 fold change in volume].

18. STOMACH [Filling & Storage]
HOW VOLUME INCREASES?
Because there are folds of mucus membrane in the stomach they flattens and cause relaxation when food is taken. It is called ‘Receptive Relaxation’.
If more than 1 liter is taken, intra-gastric pressure increases and person experiences discomfort.

19. STOMACH ( Motility ) Stomach – peristaltic wave occur.
Peristaltic waves are controlled by the gastric BER ( basic electrical rhythm )
The pace-maker cell [interstitial cells of Cajal] are located in the upper fundus region, they generate slow wave (BER) at the rate of 3 per min.

20. STOMACH ( Motility )
The slow wave or BER [Basic Electrical Rhythm] occur continuously and may or may not generate the contraction of stomach smooth muscle.
If slow wave reach threshold level then action potential occurs and initiate peristaltic waves.

21. STOMACH (Motility)
Once peristaltic wave occur, it spreads from the fundus, body to antrum and pyloric sphincter.
Peristaltic wave is weak at fundus and body [as muscle layer is thin].
In antrum, peristaltic wave is stronger and more vigorous [as muscle is thick].

22. iii. GASTRIC MIXING In Stomach, where mixing of food occurs?
Mainly in the Antrum. Why?
Because muscle in the fundus and body is thin and mixing movements are feeble and food is stored there.

23. iii. GASTRIC MIXING [cont]
When food comes to Antrum, mixing takes place in the antrum as muscle is thick, and peristaltic waves are strong.
NOTE- Fundus usually does not store food but contains gas.

25. iii.GASTRIC MIXING As food is mixed in antrum, Chyme is produced.
With each peristaltic wave, Chyme is propelled through pyloric sphincter.
Pyloric Sphincter is normally closed, only water or fluid can pass.

26. iii.GASTRIC MIXING
Antrum can hold 30ml of Chyme and only about 5ml of Chyme is pushed into the duodenum with each peristaltic wave.

27. iv. GASTRIC EMPTYING How Gastric Emptying is controlled?
By factors in the stomach and in the duodenum.
-- Factors in the stomach:
1. Amount of Chyme in the stomach – if increased Chyme, increased emptying.
2. Stomach distension – causes increased motility by direct effect on stretch receptors in the smooth muscle.

29. iv. GASTRIC EMPTYING Factors in the duodenum
Factors in the duodenum are more important. Duodenum can delay gastric emptying by decreasing peristaltic activity in the stomach.
Duodenal factors (when duodenum has)
-- Fat
-- Acid
-- Hypetonicity
-- Distension

30. iv. GASTRIC EMPTYING Duodenal Factors
Duodenal factors work through Neural or Hormonal response that decreases gastric peristaltic activity in the antrum.
Neural response is mediated through intrinsic plexus [short reflex] and Autonomic nerves [long reflex].
These are collectively called ENTROGASTRIC reflex.

31. iv. GASTRIC EMPTYING Duodenal Factors Hormonal reflex
Hormones released from small intestinal mucosa are collectively called ‘ENTROGASTRONES’.
Most important Entrogastrone are:
Secretin (produced by endocrine S cells in Duodenum and Jejunal mucosa)
Cholecystokinin [CCK] produced by I cells in Duodenum and Jejunal mucosa.

32. GASTRIC MOTILITY Factors outside GIT affecting Gastric Motility
-- Sadness and fear – causes decreased motility.
-- Anger and aggression – leads to increased motility.
-- Pain – Causes decreased motility (increased sympathetic activity)

33. STOMACH We have discussed gastric motility.
In next lecture, we will discuss secretion, digestion and absorption in the stomach.

34. What You Should Know From this Lecture
Pharyngoesophageal & Gastroesophageal Sphincter
Type of Motility in Esophagus
Transit Time in Esophagus
Stomach – Physiological Anatomy and Functions
Basic Processes – Motility in Stomach
Chyme produced where in the stomach?
Duodenal Inhibitory Factors for Gastric Emptying
Entrogastric Reflex
Entrogastrone – secretin & CCK

35. Thank you