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0:00Today, we shall proceed to
0:03the movement of the stomach, that is
0:05motility patterns of the
0:07uh stomach.
0:10But, before we do that, we need to
0:11refresh our memory on the
0:14anatomical and functional divisions of
0:16the stomach.
0:17Anatomically, the stomach is divided
0:20into three into
0:22four
0:24uh
0:25regions. The fundus, the corpus, the
0:28antrum, and the pylorus.
0:32However, when discussing physiology
0:35of the stomach, it is helpful to think
0:37of the stomach as being subdivided into
0:39two
0:41uh functional regions. They are the
0:43gastric reservoir
0:45and the gastric uh pump.
0:49The gastric reservoir, as you can see on
0:52the diagram B, extends from the fundus
0:55to the corpus. That's the body of the
0:57stomach.
0:59While the gastric pump comprises the
1:01antrum
1:02and the
1:04pylorus.
1:06Mhm.
1:07Two category of motility patterns
1:12are found within the stomach. They are
1:16one,
1:17gastric relaxation.
1:20Two, peristaltic peristalsis waves of uh
1:24contraction.
1:25The gastric relaxation
1:28is a motility pattern that is found
1:30within the region of the gastric
1:32reservoir. Thus, uh within the region of
1:36the fundus and the body.
1:38The
1:39function and the purpose of this
1:42motility pattern is to
1:45um
1:48uh
1:51help the stomach to accommodate
1:54and store the volume of what? Of the
1:57meal.
1:58And that's why
2:00that region of the stomach is called
2:02gastric reservoir.
2:06The peristal- peristaltic waves of
2:08contraction, on the other hand,
2:11ensures that
2:14um
2:14the meal is adequately mixed
2:18with digestive enzymes and properly
2:22what? Grounded.
2:24The peristaltic waves of contraction is
2:26found within the region of the gastric
2:29pump. That's from the
2:32um
2:33the
2:35antrum
2:36to the pylorus.
2:39Let's look at the gastric relaxation in
2:41details.
2:44Three kinds of gastric relaxation has
2:46been differentiated.
2:48They are
2:49receptive,
2:51adaptive,
2:53and feedback relaxation.
2:58One, receptive. Two, adaptive.
3:02And the last, but not the least,
3:04feedback relaxation
3:07of the gastric reservoir.
3:10Just like I
3:12uh earlier said, that the
3:15purpose, the function of the gastric
3:17relaxation, is to help the stomach to
3:22accommodate, to store
3:25the the meal.
3:27This is done
3:29through the
3:32uh
3:34the through the
3:36through increase in the compliance of
3:39the stomach.
3:42When the compliance is increased,
3:45the stomach is able
3:48to
3:50um
3:51accommodate
3:54meal
3:55up to about 1,500 meals of uh
4:00uh
4:01the meal
4:03with
4:05very little or minimal prayer what
4:07changes.
4:09This process is termed as gastric
4:12accommodation.
4:16Now,
4:18let's take a look at the receptive
4:21realization.
4:23The receptive realization usually occur
4:25in the stomach
4:28before the meals enters into the
4:31stomach.
4:33So, it it is a brief realization
4:36taking place in the stomach while food
4:40is
4:41being chewed
4:42and
4:43swallowed. So, it's a brief realization
4:46during chewing and swallowing.
4:50Um
4:52How is it How does this operate?
4:55During chewing and swallowing,
4:58mechanoreceptors we found within the
5:01mouth and the pharynx are activated.
5:03They are stimulated.
5:05And that will induce what we call
5:07vagovagal reflex.
5:10Um
5:12It is a reflex that had have both its
5:15afferent and the efferent limbs within
5:18the vagal what
5:19vagal nerve.
5:21This vagovagal reflex causes realization
5:25of the gastric what reservoir.
5:28Uh
5:29thereby preparing the the the stomach to
5:33accommodate the
5:35food
5:37that will
5:39eventually what enter into it after it
5:42has undergo chewing and what and
5:45swallowing.
5:47I have um um
5:50Uh on this slide
5:53I tried to
5:55again
5:57um reiterate
6:00on what I had earlier said. Like you can
6:02see
6:03on the slide
6:05the picture
6:07to the
6:10um
6:11to my to to my left right hand side
6:15>> side
6:17>> showing um receptive realization. You
6:20could see that
6:23mechanical stimulation of the
6:26mechanoreceptors in the mouth and in the
6:29pharynx during chewing and swallowing
6:32initiates
6:34um
6:37an impulse that
6:40is transmitted or travels
6:43through the afferent what? Uh
6:46nerves of the vagus nerve to reach the
6:50vagus
6:52center.
6:54The vagus center, after integration of
6:57the
6:58uh
6:59stimuli
7:00in turn sends what?
7:03Efferent impulse
7:05through the efferent what?
7:08Uh
7:11nerve
7:12of the vagus
7:16reaching the gastric pump and eventually
7:21uh
7:22causing realization
7:24of it.
7:26That is shown on this what? Uh diagram.
7:32Okay.
7:35Adaptive realization.
7:38Adaptive realization
7:40takes place
7:42after the food
7:44the digester the bolus
7:47must have um
7:49entered the stomach.
7:52So, when when the stomach is filled with
7:54food
7:56the
7:59bolus
8:05um
8:07activates
8:09mechano and chemo receptors in the
8:11stomach.
8:13The stimulation and the activation of
8:16the mechano and chemo receptors in the
8:18stomach
8:19um
8:21elicits what we call gastro
8:24gastric reflex.
8:27It's also
8:29a a a a reflex
8:33that is also
8:35the heart is efferent and afferent limbs
8:38within the vagus nerve.
8:40The
8:41This gastrocolic reflexes
8:43causes further relaxation of the gastric
8:47what? Reservoir in addition to the what?
8:51To the receptive what? Relaxation.
8:56This regulation
8:59uh provides a prolonged
9:03storage of the digester, that is the
9:05bolus. Another that is
9:07it's
9:10allows the stomach to
9:16store the
9:19ingested food for a prolonged period of
9:22what? Of time.
9:25Uh until when this food are sufficiently
9:28broken down
9:30for emptying into the duodenum.
9:35There are other
9:37um factors
9:39that are also involved in adaptive
9:42realization.
9:44They are gastrin,
9:47presence of gastrin,
9:49the presence of certain nutrients in the
9:51small intestine
9:53additionally cause realization of the
9:55gastric what? Reservoir. The
10:00last but not the least the feedback
10:01realization of the stomach. The
10:07f the feedback realization of the
10:09stomach
10:10usually take place when
10:14the
10:15certain nutrients found within the
10:18stomach
10:20emptied into the duodenum. So and
10:26the essence of this is to ensure that
10:30the rate at which the stomach
10:33empties is content into the duodenum is
10:37well adapted to the process of digestion
10:40and absorption of nutrients in the what?
10:42In the small intestine.
10:44I hope you understand that. That is the
10:50movement
10:51of
10:53the emptying of the content of the
10:54stomach which we call gastric emptying
10:56into the stomach must
11:00be regulated in such a way that
11:03it's adapted to the process of digestion
11:07and the absorption of nutrients in the
11:09small intestine.
11:10When the rate is high then process
11:17of digestions and absorption of
11:18nutrients in the small intestine will
11:22also what?
11:24Decrease. And
11:26that's the purpose of feedback what?
11:29Realization of the stomach.
11:35The receptive, adaptive, and feedback
11:37relation of the stomachs are
11:40both mediated by
11:43what we call NANC inhibition.
11:47Non-adrenergic, non-cholinergic
11:51mechanisms.
11:53And the mediators for this
11:55non-adrenergic, non-cholinergic
11:57inhibitions are the nitric oxide,
12:00the pituitary adenylate
12:02cyclase-activating
12:03peptides,
12:05vasoactive intestinal peptide,
12:07and adenosine triphosphate, all of which
12:10are released from motor pathways
12:13in the enteric nervous system.
12:17Okay?
12:18All that I've said
12:21um
12:22is well illustrated
12:24in this what? Diagram. Like number one
12:27is showing receptive what? Realization.
12:30Which are which are activated by
12:34mechanical stimulation of the
12:36mechanoreceptors in the what? In the
12:38mouth and the pharynx.
12:40Um
12:42the
12:43stimulation is transmitted to the vagus
12:46center.
12:47And then after integration in the vagus
12:49center,
12:51the vagus center sends what?
12:54Um
12:55efferent what? Impulses through the NANC
12:59uh pathway.
13:01Uh
13:02um
13:04pathway. That's the inhibitory vagal
13:06nerves.
13:07And this inhibitory vagal nerves secrete
13:12um substances like acetyl- like
13:16NO
13:17and VIP.
13:20Those are the missions
13:21uh a few.
13:23These mediators
13:25uh causes what?
13:27The re- the
13:29receptive realization of the stomach
13:33ahead of what? The food presently uh,
13:38undergoing uh, chewing and what? And
13:41swallowing.
13:42Number two is showing is um,
13:46re- Number two represents adaptive what?
13:49Realization.
13:52As you can see also see there
13:54the presence of uh,
13:58food
13:59that is when the stomach is already
14:01filled
14:03it will cause distension.
14:06And that distension will activate
14:09mechanoreceptors in the stomach.
14:12Also, nutrients that are in the stomach
14:15will also activate what? Chemoreceptors
14:19within the stomach.
14:21Afferent impulses are transmitted
14:24through
14:25the
14:27uh, afferent vagal what? Nerves. Also,
14:30to reach the vagal center.
14:34The These impulses are integrated in the
14:37vagal center. And efferent impulses
14:42are also what? Transmitted through the
14:45inhibitory vagal what? Fiber.
14:47And um,
14:48through the release of
14:51mediators such as nitric oxide and um,
14:55vasoactive inhibitory peptide and the
14:58likes the gas adaptive realization takes
15:04place within the what? The stomach.
15:08Number three represents feedback what?
15:10Realization.
15:12Like I said feedback realization
15:16takes place
15:18when the content of the stomach is
15:21emptied
15:23into the
15:24uh
15:26duodenum.
15:28And the purpose of feedback realization
15:31is to adapt
15:34the process of digestions and absorption
15:37in the small intestine with with gastric
15:40what? Emptying.
15:42So,
15:43the presence of nutrients within the
15:46small the first part of the small
15:48intestine duodenum
15:50um
15:52activates what?
15:55um
15:57chemoreceptors.
15:59And these chemoreceptors the the the the
16:02impulses that
16:04um
16:06the impulses
16:09activated by these um chemoreceptors are
16:12transmitted also through the
16:14afferent what?
16:16um
16:17vagal what? Nerves
16:19to the
16:20to reach the vagal center.
16:23And then
16:26through that um

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