Stomach

➢Cardia: the region which

receive the oesophageal
contents (bolus).
➢Fundus: Upper curvature
(contain parietal cells).
➢Body: Main central area.
➢Antrum: lower part
secrete gastrin by G-cells
➢Pylorus: lower part that
empty gastric contents into
duodenum
Gastric motility Peristalsis
 GIT motility is either propulsive or
mixing or both.
 Peristalsis: is a propulsive contractions
occurs in all parts of the GIT from the
pharynx to the rectum (oral-to-caudal
direction).
 it is a reflex initiated by distension of
gastric wall (stretch) when the stomach
receive the bolus .
 Stretch releases serotonin, that stimulates
sensory neurons activating the myenteric
plexus giving two responses (Circular
contraction behind the stretch via Ach &
substance P followed relaxation in front
of it via NO, VIP).
 Peristalsis is independent on extrinsic
innervation, but can be increased or
decreased by the autonomic nervous
system.
• Glands in the cardia & the
pyloric region secrete
mucus.
• In the body & fundus the
glands secrete pepsinogens,
Hcl, intrinsic factor &
mucus.
• The antrum secrete gastrin,
mucus & pepsinogens.
• Enterochromaffin like ECL
cells secrete histamine.
Gastric secretions (juice):
▪ Volume: 2.5 liters/day

▪ pH: Acidic (0.9- 4)

▪ Composition:-

➢ Water: the main component; a solvent

facilitates digestion.
➢ Inorganic substances: Na+, K+, Mg+2, H+,
Cl-, HPo4-2, So4-2.
➢ Organic substances mucus & intrinsic
factor & Enzymes (pepsins, lipase, rennin),
➢ Pepsins: the main enzymes, secreted
by the chief (peptic) cells as inactive
pepsinogens then activated by gastric
acid to pepsins for digestion of proteins.
➢ Gastric lipase: Has a minor role in lipid
digestion except in case of deficiency of
pancreatic lipase.
➢ Rennin: Found in the stomach of infants,
clots the milk proteins.
Mucus:-
 Secreted as glycoproteins (mucins) by
mucous neck cells & surface mucous cells
in gastric mucosal glands.
 Act as a barrier protecting the mucosa.

Intrinsic factor IF:-

 Glycoprotein secreted by the parietal cells to
facilitate absorption of vitamin B12 from the
terminal ileum.
 IF is lost when auto-antibodies attack the
parietal cells causing defective absorption of
vitamin B12 (pernicious anaemia)
Gastric acid secretion:
 Is the Hydrochloric acid HCl
secreted by the parietal cells in the
gastric mucosa of the body & the
fundus.
 Formation of gastric acid include:

➢ entry of CO2 from ECF into the

parietal cells.
➢ Reaction of CO2 with intracellular
water forming carbonic acid.
➢ Dissociation of H2CO3 to H+& HCO3-
➢ Secretion of H+ ions into the gastric
lumen by H+- K+ (Proton ) pump.
➢ Transport of HCO-3 ions to the ECF
in exchange with Cl- ions to the
parietal cells .
➢ Secretion of Cl- ions into the gastric
lumen via Chloride channels
➢ H+ + Cl- → HCl acid.
Other Functions of stomach:
▪ Starting digestion of proteins by enz
pepsins activated by gastric acid HCl.
▪ Absorption of some water &
electrolytes, drugs, alcohol,
▪ Gastric intrinsic factor facilitates
vitamin B12 absorption in the ileum.
▪ Mucus is lubricant & protects the
mucosa from auto-digestion by
gastric acid & pepsins (ulcer).
▪ Gastric acid HCl has many functions:
1. Activates pepsinogens to Pepsins &
provides the suitable acidic PH for
Pepsins action.
2. Facilitates iron absorption in
duodenum.
3. Has antimicrobial action.
4. Stimulates secretin secretion.
Regulation of gastric secretions &
motility:
 Neural mechanisms via:

1. Parasympathetic vagal fibers: ↑ gastric

secretions & motility.
2. Local enteric nervous system , made of
➢ Myenteric (Aurbach) plexus ↑ motility.

➢ Submucous (Meissner) plexus↑

secretions .
Both vagal & ENS fibers are stimulated
by distension of gastric lumen by meals
 Hormonal via Gastrin
• A peptide hormone (G17, G34, G14),
secreted by G cells of the antrum of
the stomach, in response to:
➢ Distension of gastric lumen by meals.
➢ Products of proteins digestion
(Oligopeptides, tryptophan, Phenylalanine)
➢ Parasympathetic vagal fibers.
➢ Blood calcium.
Physiologic effects of Gastrin:-
➢ Stimulates growth of gastric mucosa.

➢ Stimulates gastric motility &

secretions including Hcl & pepsins.
➢ In large doses stimulates contraction
of LOS & relaxes the ileocecal valve.
➢ In large doses stimulate insulin
secretion in response to protein meal.
➢ In the cephalic phase stimuli of unconditioned
reflex are tasting smelling, chewing &
swallowing while the stimuli of conditioned
reflex are sight & thought of food.
➢ The gastric phase is stimulated by presence of
food in the stomach mainly products of
protein digestion
➢ In intestinal phase when the chyme reaches
the duodenum gastric secretion initially
inhibited via enterogastrone then after 1-3 hrs
secretion increases (10%) via gastrin secreted
by intestinal cells,
Gastric acid & peptic ulcer:
 HCl is secreted by parietal cells in
gastric mucosa of body & fundus,
after meal mainly proteins.
 Acid secretion is stimulated by:

1. Gastrin: hormone secreted by antrum.

2. Acetylcholine (from parasympathetic

vagal fibers).
3. Histamine from Enterochromaffin
like cells in the wall of GIT.
 Gastric acid secretion is inhibited by:
1. Prostglandins.
2. Somatostatin, from D cells
3. Intestinal hormones: Secretin family
(secretin, VIP, GIP, glucagon) & enterogastrone
which inhibits gastrin release.
Normally mucosal barrier (mucus, trefoil peptide
& bicarbonate) protects gastric & duodenal
mucosa from pepsin mediated autodigestion.
Prostglandins stimulates secretion of mucus &
HCO-3 .
Pathophysiology of peptic ulcer:-
 Ulceration of the gastric or duodenal
mucosa results from auto-digestion by
pepsins & gastric acid due to:
Hypersecretion of gastric acid &/or decreased
mucosal barrier caused :
 Bacteria. (Helicobacter. pylori) which
damage the mucosal barrier &
somatostatin secreting cells.
 Gastrin secreting tumor (Zollinger-Ellison
syndrome) tumor usually in the pancreas
 Excessive use of Aspirin (Inhibitor of
Prostaglndins synthesis).
The pain of ulcer also ↑ by :
1. Causes that ↑ Acid secretion such as:
 Excessive ingestion of Caffeine.

 Emotions (Anger & hostility).

2. Causes of decreased mucosal blood

flow for healing, such as:
 Smoking.

 Alcohol.

3. Ingestion of irritants (Pepper )