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Mastication and Deglutition-II
•A 42-year-old woman reports difficulty in swallowing solid foods;
liquids are less difficult to swallow. She frequently regurgitates
after eating. When the recumbent patient underwent fluoroscopy
after a barium swallow, her lower esophagus was somewhat
dilated compared with normal, but her upper esophagus was of
normal caliber. Subsequent swallows initiated by the patient
showed that the barium was cleared from the esophagus very
slowly. Monomeric studies showed that resting pressure in the
lower esophageal sphincter decreased after a swallow. The
patient was treated with forceful dilation of the lower esophageal
sphincter. The patient’s ability to swallow solid food was
dramatically improved after the dilation procedure.
Prof. Dr. Rashid Mahmood
1. What is the mechanism of slow rate of
barium clearance from the
esophagus?
2. What will be the effect on esophageal
musculature of this patient?
3. How the above-mentioned therapy for
this patient’s improved swallowing
difficulties
3
Movements of GIT
Ingestion of food-II
Recap
• Ingestion of food involves two processes: Mastication
(Chewing) & Swallowing (Deglutition)
• Teeth cut & grind the bolus of food
• Mastication is brought about by Muscles of Chewing,
Controlled mainly by 5th Nerve.
• Chewing Reflex, initiated by bolus of food in mouth results in
reflex inhibition of Muscles of Mastication. This results in
Stretch Reflex, causing their Rebound Contraction
• Swallowing (Deglutition) occurs in three stages: Voluntary
Stage, Pharyngeal Stage and Esophageal Stage
• Voluntary Stage involves mainly tongue, pushing the bolus of
food in pharynx
• Pharyngeal Stage is Involuntary; in this stage swallowing
reflex results in Series of Automatic Pharyngeal Muscle
Contractions
Objectives
• Specific Objectives: At the end of the lesson
student will be able to:
• Explain the Esophageal Stage of swallowing
• Understand how food is transferred to stomach
• Classify types of peristalsis of esophagus
• Describe physiological anatomy of oesophagus
• Describe the Nervous Control of Lower esophageal
sphincter
• Describe the mechanism of Protection of
Esophageal Reflux
Goal/Aim: To give the understanding of the
physiology of Mastication and Deglutition
Lesson Contents
• Summary of voluntary and pharyngeal
stage of swallowing
• Function of Esophagus
• Peristalsis of Esophagus
• Musculature of Esophagus
• Gastro-esophageal Sphincter
• Nervous Control of Lower esophageal
sphincter
• Receptive Relaxation of the Stomach
• Protection of Esophageal Reflux
© Prof. Dr. Rashid Mahmood
6
Swallowing (Deglutition)
• Three stages;
–Voluntary Stage
–Pharyngeal Stage (Involuntary)
–Esophageal Stage (Involuntary)
Esophageal Stage (Involuntary)
• Function: Conduction of food
• Peristalsis: 2 types
–Primary
–Secondary
• Musculature of Esophagus
–Striated
–Smooth
Peristalsis of Esophagus
• Primary Peristalsis:
Continuation of Peristaltic wave of Pharynx
8-10 seconds
↓
Stomach
Upright: 5-8 seconds
Peristalsis of Esophagus
• Secondary Peristalsis
If Primary Peristalsis fails
distension→
1.vagal afferent fibers
↓
medulla
↓
vagus +glossopharyngeal nerve
2. simulation of intrinsic neuronal circuits
Assessment Q. No.5
• What is the roll of Secondary peristalsis in
normal Swallowing?
© Prof. Dr. Rashid Mahmood 11
Esophageal Stage (Involuntary)
Function: Conduction of food
Peristalsis: 2 types
Primary
Secondary
• Musculature of Esophagus
– Striated
– Smooth
Musculature of Esophagus
• Striated
• Pharyngeal wall and upper third of
esophagus
• Skeletal nerve fibers in 9th
, 10th
cranial
nerves
• Smooth
• Lower 2/3rd
of esophagus
• Vagus nerve → Myenteric Nervous
System
Summary of
stages of
swallowing
1. Voluntary
stage
2. Pharyngeal
stage
2. Pharyngeal stage (Contd….)
Epiglottis Opening of larynx
Pharyngeal stage
↓
Esophageal stage
Esophageal stage
Assessment Q. No.6
• In which stage of swallowing respiration
stops? What is its mechanism?
© Prof. Dr. Rashid Mahmood 19
Esophagus → Stomach
• Relaxation of lower
esophageal sphincter
• Receptive relaxation of
stomach
Gastro-esophageal Sphincter
• Lower Esophageal Sphincter
• Tonically constricted
• Protection of Esophageal Reflux
• Receptive Relaxation
• Esophageal mucosa not able to resist
gastric secretions except Lower 1/8th
• Valve-like closure of distal end of
Esophagus; ↑ intraabdominal pressure
Lower esophageal sphincter
Three components:
1.Internal sphincter
2.External Sphincter
3.Phrenoesophageal ligament
Nervous Control of Lower
esophageal sphincter
Cholinergic Fibers
• Tonic Constriction
VIP, NO
• Inhibitory effect
Vagus nerve
Receptive Relaxation of the Stomach
Esophageal peristaltic wave
→ Myenteric inhibitory Neurons
→ Relaxation of entire stomach (& even
duodenum)
Stages of deglutition
Assessment Q. No.7
• What is the mechanism of Receptive
Relaxation of the Stomach?
© Prof. Dr. Rashid Mahmood 26
Take home points
– Esophageal Stage is the 3rd
stage of swallowing & is involuntary.
– Two types of Peristalsis of Esophagus function to conduction of food from pharynx to
stomach.
– Primary Peristalsis is the continuation of Peristaltic wave of Pharynx that pushes the
food into stomach through Gastro-esophageal Sphincter.
– If Primary Peristalsis fails, then distension of Musculature of Esophagus results in
Secondary Peristalsis
– Upper 3rd
Musculature of Esophagus is Striated muscle, and lower 2/3rd
is Smooth
muscle
– Esophageal peristaltic wave ends in Receptive Relaxation of the Stomach through
Myenteric inhibitory Neurons. This occurs before food reaches the stomach.
– Lower Esophageal Sphincter (Gastro-esophageal Sphincter) is guarded by Internal
and External sphincters, and normally remains Tonically constricted under the effect of
Cholinergic Fibers of Vagus nerve
– It is only dilated during passage of the food; the inhibition is brought about by VIP and
NO secreted by Vagal fibers
– Tonic constriction of Gastro-esophageal Sphincter performs important function of
protection of Esophageal Reflux. This protection is aided by Valve-like closure of distal
end of Esophagus when intraabdominal pressure increases.
© Prof. Dr. Rashid Mahmood
Assessment Q. No.8
• What is the role of Sympathetic nervous
system stimulation in control of Gastro-
esophageal Sphincter?
© Prof. Dr. Rashid Mahmood 28
Learning resources
• Guyton and Hall (Text book of physiology),
13th
edition, P.708-709
• Ganong (Text book of physiology), 24th
Edition, P. 500-501
• Walter F. Boron Medical Physiology, 2nd
Edition, P.890-891
© Prof. Dr. Rashid Mahmood 29
© Prof. Dr. Rashid Mahmood 30

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Mastication and deglutition ii

  • 1. Mastication and Deglutition-II •A 42-year-old woman reports difficulty in swallowing solid foods; liquids are less difficult to swallow. She frequently regurgitates after eating. When the recumbent patient underwent fluoroscopy after a barium swallow, her lower esophagus was somewhat dilated compared with normal, but her upper esophagus was of normal caliber. Subsequent swallows initiated by the patient showed that the barium was cleared from the esophagus very slowly. Monomeric studies showed that resting pressure in the lower esophageal sphincter decreased after a swallow. The patient was treated with forceful dilation of the lower esophageal sphincter. The patient’s ability to swallow solid food was dramatically improved after the dilation procedure. Prof. Dr. Rashid Mahmood
  • 2. 1. What is the mechanism of slow rate of barium clearance from the esophagus? 2. What will be the effect on esophageal musculature of this patient? 3. How the above-mentioned therapy for this patient’s improved swallowing difficulties
  • 4. Recap • Ingestion of food involves two processes: Mastication (Chewing) & Swallowing (Deglutition) • Teeth cut & grind the bolus of food • Mastication is brought about by Muscles of Chewing, Controlled mainly by 5th Nerve. • Chewing Reflex, initiated by bolus of food in mouth results in reflex inhibition of Muscles of Mastication. This results in Stretch Reflex, causing their Rebound Contraction • Swallowing (Deglutition) occurs in three stages: Voluntary Stage, Pharyngeal Stage and Esophageal Stage • Voluntary Stage involves mainly tongue, pushing the bolus of food in pharynx • Pharyngeal Stage is Involuntary; in this stage swallowing reflex results in Series of Automatic Pharyngeal Muscle Contractions
  • 5. Objectives • Specific Objectives: At the end of the lesson student will be able to: • Explain the Esophageal Stage of swallowing • Understand how food is transferred to stomach • Classify types of peristalsis of esophagus • Describe physiological anatomy of oesophagus • Describe the Nervous Control of Lower esophageal sphincter • Describe the mechanism of Protection of Esophageal Reflux Goal/Aim: To give the understanding of the physiology of Mastication and Deglutition
  • 6. Lesson Contents • Summary of voluntary and pharyngeal stage of swallowing • Function of Esophagus • Peristalsis of Esophagus • Musculature of Esophagus • Gastro-esophageal Sphincter • Nervous Control of Lower esophageal sphincter • Receptive Relaxation of the Stomach • Protection of Esophageal Reflux © Prof. Dr. Rashid Mahmood 6
  • 7. Swallowing (Deglutition) • Three stages; –Voluntary Stage –Pharyngeal Stage (Involuntary) –Esophageal Stage (Involuntary)
  • 8. Esophageal Stage (Involuntary) • Function: Conduction of food • Peristalsis: 2 types –Primary –Secondary • Musculature of Esophagus –Striated –Smooth
  • 9. Peristalsis of Esophagus • Primary Peristalsis: Continuation of Peristaltic wave of Pharynx 8-10 seconds ↓ Stomach Upright: 5-8 seconds
  • 10. Peristalsis of Esophagus • Secondary Peristalsis If Primary Peristalsis fails distension→ 1.vagal afferent fibers ↓ medulla ↓ vagus +glossopharyngeal nerve 2. simulation of intrinsic neuronal circuits
  • 11. Assessment Q. No.5 • What is the roll of Secondary peristalsis in normal Swallowing? © Prof. Dr. Rashid Mahmood 11
  • 12. Esophageal Stage (Involuntary) Function: Conduction of food Peristalsis: 2 types Primary Secondary • Musculature of Esophagus – Striated – Smooth
  • 13. Musculature of Esophagus • Striated • Pharyngeal wall and upper third of esophagus • Skeletal nerve fibers in 9th , 10th cranial nerves • Smooth • Lower 2/3rd of esophagus • Vagus nerve → Myenteric Nervous System
  • 16. 2. Pharyngeal stage (Contd….) Epiglottis Opening of larynx
  • 19. Assessment Q. No.6 • In which stage of swallowing respiration stops? What is its mechanism? © Prof. Dr. Rashid Mahmood 19
  • 20. Esophagus → Stomach • Relaxation of lower esophageal sphincter • Receptive relaxation of stomach
  • 21. Gastro-esophageal Sphincter • Lower Esophageal Sphincter • Tonically constricted • Protection of Esophageal Reflux • Receptive Relaxation • Esophageal mucosa not able to resist gastric secretions except Lower 1/8th • Valve-like closure of distal end of Esophagus; ↑ intraabdominal pressure
  • 22. Lower esophageal sphincter Three components: 1.Internal sphincter 2.External Sphincter 3.Phrenoesophageal ligament
  • 23. Nervous Control of Lower esophageal sphincter Cholinergic Fibers • Tonic Constriction VIP, NO • Inhibitory effect Vagus nerve
  • 24. Receptive Relaxation of the Stomach Esophageal peristaltic wave → Myenteric inhibitory Neurons → Relaxation of entire stomach (& even duodenum)
  • 26. Assessment Q. No.7 • What is the mechanism of Receptive Relaxation of the Stomach? © Prof. Dr. Rashid Mahmood 26
  • 27. Take home points – Esophageal Stage is the 3rd stage of swallowing & is involuntary. – Two types of Peristalsis of Esophagus function to conduction of food from pharynx to stomach. – Primary Peristalsis is the continuation of Peristaltic wave of Pharynx that pushes the food into stomach through Gastro-esophageal Sphincter. – If Primary Peristalsis fails, then distension of Musculature of Esophagus results in Secondary Peristalsis – Upper 3rd Musculature of Esophagus is Striated muscle, and lower 2/3rd is Smooth muscle – Esophageal peristaltic wave ends in Receptive Relaxation of the Stomach through Myenteric inhibitory Neurons. This occurs before food reaches the stomach. – Lower Esophageal Sphincter (Gastro-esophageal Sphincter) is guarded by Internal and External sphincters, and normally remains Tonically constricted under the effect of Cholinergic Fibers of Vagus nerve – It is only dilated during passage of the food; the inhibition is brought about by VIP and NO secreted by Vagal fibers – Tonic constriction of Gastro-esophageal Sphincter performs important function of protection of Esophageal Reflux. This protection is aided by Valve-like closure of distal end of Esophagus when intraabdominal pressure increases. © Prof. Dr. Rashid Mahmood
  • 28. Assessment Q. No.8 • What is the role of Sympathetic nervous system stimulation in control of Gastro- esophageal Sphincter? © Prof. Dr. Rashid Mahmood 28
  • 29. Learning resources • Guyton and Hall (Text book of physiology), 13th edition, P.708-709 • Ganong (Text book of physiology), 24th Edition, P. 500-501 • Walter F. Boron Medical Physiology, 2nd Edition, P.890-891 © Prof. Dr. Rashid Mahmood 29
  • 30. © Prof. Dr. Rashid Mahmood 30

Notes de l'éditeur

  1. elevated pressure in the lower esophageal sphincter at rest and after a swallow contributes to the dilation of the lower esophagus during a barium swallow increased pressure in the lower esophageal sphincter is often associated with hypertrophy of the lower esophageal sphincter surgical weakening of the lower esophageal sphincter may cause long-term improvement of the patient’s swallowing