The stomach

Structure of the stomach:
The stomach can be divided into: Fundus, body, antrum and pylorus regions lesser curvature and greater curvature. The stomach has three layers of muscle: an Outer longitudinal layer, a middle circular layer and an inner oblique layer. The stomach has very rich blood and lymphatic supply.
Motor Functions of stomach:
1- Storage of the food:
Until the food can be processed in the stomach, duodenum, and lower intestinal tract when the food enter the stomach there is receptors decrease the muscle tone of the stomach wall due to a vagovagal reflex.
2- Mixing of the food in stomach with gastric secretion:
To form a semi fluid mixture called chyme. When stomach is filled, weak peristaltic constrictor waves. mixing wave, move toward the antrum along stomach wall once every 20 seconds.
3-Slow empty of food:
From stomach into the to the small intestine at rate suitable for proper digestion and absorption by the small intestine. Stomach emptying the food is opposed to resistance of the pylorus, it is promoted by peristaltic waves in the antrum of the stomach. The pylorus remains not completely closed because of tonic contraction of the pyloric muscle, allowing water and other fluid to empty from stomach ,while prevents movement of semi-solid chyme into duodenum except when a strong antral peristaltic wave forces the chyme through.
This is controlled by signals from the stomach and from duodenum, When pyloric tone is normal. each strong antral peristaltic wave forces several ml of chyme into the duodenum, Thus, the peristaltic wave provide a pumping action that is frequently called the pyloric pump
Regulation of gastric emptying (pyloric pump):
A- The stomach excitatory signals:
1- Excitatory nervous reflexes caused by
distension of the antrum by food. This distension cause a stretch of the antral wall
which increases vagovagal and local enteric nervous system reflexes to increase
activity of the pyloric pump and inhibit the pylorus.
2- The hormone gastrin
released into the circulation from the antral mucosa in response to stretch the antral wall mediated by vagus nerve and enteric nervous system increase pyloric pumping force and inhibit the pylorus. The gastrin also has effect on gastroesophegal sphincter at lower of esophagus to prevent reflux of gastric contents into the esophagus during gastric activity.
B-The duodenal inhibitory signal:
Depress the pyloric pump and increase pyloric tone preventing the flow of chyme due to inhibitory nervous reflexes which are stimulated by high fat and H +ions in the duodenum. The hormones cholecystokinin (CCK) is released from duodenum in response to fat. It acts by blocking the" excitatory effects of gastrin on gastric muscle. Secretin is released from the duodenum in response to the presence of acid and has direct inhibitory effect on smooth muscle. When pH of chyme in duodenum falls below 5.5 – 4 reflex is elicited. Reducing or blocking further release of acidic stomach content into the duodenum until the duodenal chyme can be neutralized by pancreatic HCO3 .

Gastric motility:
There are two types of gastric motility:
A- Peristalsis: which is initiated near the fundal-body border and producing a
peristaltic wave that propels the food towards the pylorus. Peristaltic contraction occur every 20 seconds. These wave responsible for the rhythm and force of gastric contraction.
B- Retropulsion: It is the back and forth movement of the chyme caused by the
forceful propulsion or food against the closed pyloric sphincter.
Hunger Contractions.
Another type of intense contractions, called hunger contractions, often occurs when the stomach has been empty for several hours or more. The successive contractions become extremely strong, they often fuse to cause a continuing titanic contraction that sometimes lasts for 2 to 3 minutes,greatly increased by the person’s having lower than normal levels of blood sugar . Hunger contractions cause mild pain in the pit of the stomach, called hunger pangs.
Castric secretion:
About 2 L / day of gastric secretions are produced. The cells of the gastric mucous Secrete a fluid called gastric juice. The four major components of gastric juice are:
1- Hydrochloric acid (HCL).
2- Pepsinogen.
3- intrinsic factor.
4-mucous.
The function of HCI is to convert pepsinogen which is inactive to active form pepsin at low pH. Pepsin is the protease that initiates protein digestion. Intrinsic factor is necessary for the absorption of vitamin Bl2 in the ileum. Mucous protect the gastric mucous from the action of HCI, also lubricates the gastric contents.
The structure and cell types of gastric mucous:
The lumen of stomach is lined by epithelial cells, deeper are:
A-oxyntic gland consist of:-
1- Mucous cells :-Mucous secretion rich in alkaline bicarbonate protects the stomach from the Hydrochloric acid of the gastric juice.

2- Parietal oxyntic cells which have two secretary products (HCL and intrinsic factor) HCl acidifies the gastric contents to pH l-2.
3- Chief(peptic cells) which have one secretary product pepsinogen, which converted by HCL to pepsin
B- pyloric glands contain two cell types, the G cells and mucous cells. The G cells secrete gastrin into circulation.
Other cells Enterochromaffin-like cells or (ECL) cells which secret histamine , Delta cells (or D cells) are somatostatin-producing cells.D cellscan be found in the stomach, intestine and the Islets of Langerhans in the pancreas.



Function of HCL:
1-HCL participates in break down of protein.
2- It provides an optimal pH for the active of pepsin.
3- It hinders the growth of pathogenic bacteria.
Mechanism of HCI secretion: HCL is secreted by the following steps:
1- CL- ions is transported by active transport into the canaliculi. The flow of CL- create a negative potential inside the canaliculi, causing K+ to flow passively into the canaliculi.
2- H+ ion is then exchanged for K+ ion by H+-K+ ATPase pump. The source of H+ ion is from the dissociation of carbonic acid (H2C03) into H+ + HCO3- (CO2+ H2O = H2C03). H+ react with CL_ to form HCL, HC03- diffuse back to plasma. After meal sufficient H+ ions may be secreted.
3- Water enter canaliculi down the osmotic gradient created by movement of the HCL into the canaliculi.