STOMACH Contractions of gastric smooth muscle serve two basic functions.

First, it allows the stomach to grind, crush and mix ingested food, liquefying it to form what is called "chyme." Second, it forces the chyme through the pyloric canal, into the small intestine, a process called gastric emptying.Empty, it is about the size of a large sausage, but it is the most distensible part of the GI tract and can accommodate a large quantity of food. In the stomach, digestion of starch and triglycerides continues, digestion of proteins begins, the semisolid bolus is converted to a liquid, and certain substances are absorbed.[4][6] The stomach is divided into four main regions[4]: The cardia is the opening from the esophagus into the stomach. The uppermost part of the stomach, located above the entrance of the esophagus, is the fundus. The fundus adapts to the varying volume of ingested food by relaxing its muscular wall; it frequently contains a gas bubble, especially after a meal. The largest part of the stomach is known simply as the body; it serves primarily as a reservoir for ingested food and liquids. The pyloric part is divisible into three regions. The first region, the pyloric antrum, connects to the body of the stomach. The second region, the pyloric canal, leads to the third region, the pylorus, which in turn connects to the duodenun.

Figure 12. Regions of Stomach [1] When the stomach is empty, its mucosal lining is thrown into numerous longitudinal folds, known as rugae; these tend to disappear when the stomach is distended. The pylorus communicates with the duodenum of the small intestine via a smooth muscle sphincter called the pyloric sphincter. The concave medial border of the stomach is called the lesser curvature. The convex lateral border is called the greater curvature.[1][4] The muscles of the stomach wall are arranged in three layers, or coats. The external coat, called the longitudinal muscle layer, is continuous with the longitudinal muscle coat of

the esophagus. Longitudinal muscle fibres are divided at the cardia into two broad strips. The one on the right, the stronger, spreads out to cover the lesser curvature and the adjacent posterior and anterior walls of the stomach. Longitudinal fibres on the left radiate from the esophagus over the dome of the fundus to cover the greater curvature and continue on to the pylorus, where they join the longitudinal fibres coming down over the lesser curvature. The longitudinal layer continues on into the duodenum, forming the longitudinal muscle of the small intestine.[4] The middle, or circular muscular layer, the strongest of the three muscular layers, completely covers the stomach. The circular fibres of this coat are best developed in the lower portion of the stomach, particularly over the antrum and pylorus. At the pyloric end of the stomach, the circular muscle layer becomes greatly thickened to form the pyloric sphincter. This muscular ring is slightly separated from the circular muscle of the duodenum by connective tissue. The innermost layer of smooth muscle, called the oblique muscular layer, is strongest in the region of the fundus and progressively weaker as it approaches the pylorus.[4] The stomach is capable of dilating to accommodate more than 1 L of food or liquids without increasing pressure on the stomach. This receptive relaxation of the upper part of the stomach to accommodate a meal is partly due to a neural reflex that is triggered when hydrochloric acid comes into contact with the mucosa of the antrum, possibly through the release of the hormone known as vasoactive intestinal peptide. The distension of the body of the stomach by food activates a neural reflex that initiates the muscle activity of the antrum.

Figure 13. Layers of Stomach [1] The stomach wall is composed of the same basic layers as the rest of the GI tract, with certain modifications. The surface of the mucosa is a layer of simple columnar epithelial cells called surface mucous cells. The mucosa contains a lamina propria (areolar

connective tissue) and a muscularis mucosae (smooth muscle). Epithelial cells extend down into the lamina propria, where they form columns of secretory cells called gastric glands. Several gastric glands open into the bottom of narrow channels called gastric pits.[1] The gastric glands contain three types of exocrine gland cells that secrete their products into the stomach lumen[6]: Mucous cells: Secrete an alkaline mucus that protects the epithelium against shear stress and acid. Parietal cells: Secrete hydrochloric acid. Chief cells: Secrete pepsin, a proteolytic enzyme. G cells: Secrete the hormone gastrin. The submucosa of the stomach is composed of areolar connective tissue. The muscularis has three layers of smooth muscle (rather than the two found in the esophagus and small and large intestines): an outer longitudinal layer, a middle circular layer, and an inner oblique layer. The oblique layer is limited primarily to the body of the stomach. The serosa is composed of simple squamous epithelium (mesothelium) and areolar connective tissue; the portion of the serosa covering the stomach is part of the visceral peritoneum.[1] Stomach Contractions Three types of motor activity of the stomach have been observed[4]: The first is a small contraction wave of the stomach wall that originates in the upper part of the stomach and slowly moves down over the organ toward the pyloric sphincter. This type of contraction produces a slight indentation of the stomach wall. Retrograde waves frequently sweep from the pyloric sphincter to the antrum and up to its junction with the body of the stomach, which results in a back-and-forth movement of the gastric contents that has a mixing and crushing effect. The second type of motor activity is also a contracting wave, but it is peristaltic in nature. The contraction originates in the upper part of stomach and is slowly propagated toward the pyloric sphincter. The contracting wave then moves over the antrum, propelling the material ahead of it into the duodenum. This contraction serves as a pumping mechanism for emptying the contents of the gastric antrum through the pyloric sphincter. The peristaltic waves can be halted by eating and can be induced by the hormone motilin. The third type of gastric motor activity is best described as a tonic, or sustained, contraction of all the stomach muscles. The tonic contraction decreases the size of the stomach lumen, as all parts of the gastric wall seem to contract simultaneously. Mixing contractions and peristaltic contractions normally occur simultaneously with the tonic contraction. As food is broken down, smaller particles flow through the pyloric sphincter, which opens momentarily as a peristaltic wave descends through the antrum toward it.

HCl secretion by parietal cells can be stimulated by several sources: acetylcholine (ACh) released by parasympathetic neurons, gastrin secreted by G cells, and histamine, which is a paracrine substance released by mast cells in the nearby lamina propria. Acetylcholine and gastrin stimulate parietal cells to secrete more HCl in the presence of histamine. Histamine acts synergistically, enhancing the effects of acetylcholine and gastrin. Receptors for all three substances are present in the plasma membrane of parietal cells. The

histamine receptors on parietal cells are called H2 receptors; they mediate different responses than do the H1 receptors involved in allergic responses.[1] The strongly acidic fluid of the stomach kills many microbes in food. HCl partially denatures (unfolds) proteins in food and stimulates the secretion of hormones that promote the flow of bile and pancreatic juice. The only proteolytic (protein-digesting) enzyme in the stomach is pepsin, which is secreted by chief cells. Pepsin severs certain peptide bonds between amino acids, breaking down a protein chain of many amino acids into smaller peptide fragments. Another enzyme of the stomach is gastric lipase, which splits the shortchain triglycerides in fat molecules into fatty acids and monoglycerides. This enzyme, which has a limited role in the adult stomach, operates best at a pH of 56. More important than either lingual lipase or gastric lipase is pancreatic lipase, an enzyme secreted by the pancreas into the small intestine.