Gastrointestinal Physiology

For HO and Dietetics Students-2022

BY ;
Yibeltal y (MSC)

University of Gondar

CMHS

Department of
Human Physiology
 Objectives
At the end of this lesson the student are expected to:
1. List general functions of the digestive system.

2. Explain the components of GIT.

3. Describe the neuro-hormonal regulation of the GIT

4. Describe the different types of motility patterns

5. Discuss about digestion, secretion & absorption.

6. List the digestive system abnormalities.

7. Differentiate metabolism, metabolic rate, and BMR

8. Discuss the regulation mechanisms of body temperature

 Introduction
• Food is essential for production of energy, growth and repair
of tissues.

• ~ 1 kg of solid food and 1- 2 liters of fluid consume in each

day.

• ~30 kcal/kg/day.

• The food that we ingest must be broken down into simple

molecules for efficient absorption.

• The GI system is responsible for digestion and absorption of

ingested nutrients.
 Introduction…
• Digestive tract:

– Is a series of hollow organs joined in a long, twisting tube

from the mouth to the anus.

• Main activities of Digestive Tract:

1. Motility

2. Secretion

3. Digestion

4. Absorption

5. Defense
 Processes carried out by the GIT
1. Ingestion: food intake, controlled by the feeding and satiety
center in the HT.

2. Mastication or chewing: mechanical grinding of food

3. Swallowing or deglutition: propulsion of food from the

mouth to the stomach.

4. Chemical digestion of food

5. Secretion of enzymes, electrolytes, mucous, and hormones

6. Absorption of nutrients, water & electrolytes

7. Defecation: excretion of fecal matters

FIG: Processes carried out by the GIT the GIT
FIG: Processes carried out by the GIT the GIT
 Roles of the GI-System:
1. Its roles in homeostasis
– The overall function of the GIT that sustains life
– Provide the body with a continuous supply of:
 Nutrients
 Water and
 Electrolytes
 Energy (ATP)
– Removal of waste materials
2. In fluid balance, and
3. In microbial defense
 Roles of the GI- System…
GIT in Fluid balance:
A. Secretion:
~ 7 Liters of fluid are secreted (added) from different organs
into the lumen daily
~ 2 Liters of fluid is drunk daily
Total= 9 Lit. of fluid is added into GIT/day
B. Absorption:
~ 8.5 Liters are absorbed by the SI
~ 400 ml is absorbed by the Large intestine.
C. Excretion: only ~ 50-to -100 ml of fluid is excreted daily
with feces
 Roles of the GI- System…
Natural defense of GIT:
• The GI-system can protect itself from hazards by some
defense mechanisms found in:
1. Mouth: Saliva contains lysozymes, IgA etc.
2. Stomach: HCl, Pepsin etc. have bactericidal effect
3. SI (e.g., Payer's patches):
• Immuno-competent lymph tissues
4. Macrophages: located in intestinal walls act to defend
from bacterial invasion etc.
Roles of the GI- System…
 Organs involved in GI-System
• The GIT extends from the mouth to the anus
• Composed of several organs with distinct functions.

Alimentary canal Accessory organs

• Organs • Organs
– Mouth, Pharynx – Teeth
– Esophagus – Tongue
– Stomach – Gallbladder
– Small intestine • Glands
– Large intestine – Salivary Gland
• Function – Liver
– Digestion, absorption & – Pancreas
waste removal • Function: aid digestion
Histological layers of the GIT

FIG: Histological layers of the GIT.

Histological layers of the GIT

FIG: Histological layers of the GIT

 Histological layers of the GIT…
Functions:
1. Mucosa:
– Protection, secretion & absorption of the luminal surfaces
2. Sub-mucosa:
– Blood vessels, glands, lymph, nerve plexuses are found.
– Sub-mucosa necessary for motility + secretion
3. Muscularis externa :
– Circular & Longitudinal smooth muscles
• Mix and propel the chyme.
4. Serosa:
– Outer most protective layer, consists of connective tissues.
 Regulation of GI Functions
• Three principal control mechanisms:
I. Neural

II. Endocrine

III. Paracrine
 Regulation of GI Functions…
1. The neuronal system

• Extrinsic control system by ANS

– Sympathetic NS = ↓GI function, ↓Motility, ↓Secretions

– Parasympathetic NS = ↑GI function ,↑Motility, ↑Secretions

• Intrinsic control system by enteric NS

– Submucosal plexus = controls GI secretion

– Myenteric plexus = controls gut motility

2. The hormonal system

– Cholecytokinin, Secretin, GIP ….

 Regulation of GI Functions…
3. Paracrine Regulation:

- Histamine (stimulates parietal cells to secrete HCl)

- Somatostatin (inhibit secretion of gastrin by G-cells)

 Neural Innervations of GIT
1. Autonomic Innervations (extrinsic regulation):
– Functions of the parasympathetic & sympathetic nerve
fibers.

– Parasympathetic fibers (cholinergic, Ach):

• Carried via the vagus and pelvic nerves.

• Is excitatory and causes

– Strong contractions on longitudinal muscles.

– Dilation at sphincters of circular SM

 Neural Innervations of GIT…
• Autonomic Innervations …
– Sympathetic fibers (adrenergic, NA & adrenaline):

• Is generally inhibitory in action and causes

– Dilatation at the longitudinal muscles of GI tract.

– Constriction at sphincters of the circular SM

 Neural Innervations of GIT…
2. Somatic innervations:
– The voluntary muscle fibers at the:

• Upper esophagus and

• Lower end of the GIT

– Are controlled by somatic nerves that are voluntary in

action.
 Neural Innervations of GIT…
3. Enteric NS (local or intrinsic regulation):
– The primary neural mechanism that controls GI function.

– Consists ≈ 100 million neurons.

– Located solely within GI tissues

– Coordinates and relays information from the ANS to the GI

tract.

– Several neurotransmitters: Ach, substance P, Nitric

Oxide……
 Neural Innervations of GIT…
• Components of ENS includes:

1. Myenteric plexus

 Auerbach’s plexus, or an Outer plexus

 Lies b/n the longitudinal and circular muscle layers

 Controls mainly the gastrointestinal movements

2. Submucosal plexus

 Meissner’s plexus or an Inner plexus

 Lies with in the sub-mucosa.

 Controls mainly GI secretion and local blood flow

Neural Innervations of GIT…

FIG: Micro-circuits of the enteric nervous system

 Hormonal control of GI function
• Entero-endocrine cells produce several GIT- hormones:

– Capable of regulation of motility & secretary activities.

 Hormonal control of GI function…
1. Cholecystokinin (CCK):

– Secreted by the mucosa of the jejunum

• In response to the presence of fatty food in the intestine.

– Has a very potent effect on gallbladder contractility for

• Expelling bile into the intestine in order to facilitate fat

digestion & absorption.

– Inhibits stomach motility in order to give adequate time for

fat digestion.

– Increase the release of pancreatic lipase from acinar cells.

 Hormonal control of GI function…
2. Secretin:

– Secreted by the mucosa of the duodenum

• in response to acidic gastric juice pumped from the

stomach.

– It increases NaHCO3 secretion by the pancreas.

3. Gastric inhibitory peptide (GIP):

– Secreted by the mucosa of the small intestine

• in response to fat & carbohydrate meal in the intestine.

– It inhibits the motor activity of the stomach.

 Paracrine control of GI function
1. Somatostatin:
– Is secreted by cells throughout the GI tract in response to
H+ in the lumen.
– Its secretion is inhibited by vagal stimulation
– Inhibits the release of all GI hormones.
– Inhibits gastric H+ secretion.
2. Histamine:
– Is secreted by ECL cells of the gastric mucosa.
– Increases gastric H+ secretion directly and
• by enhancing the effects of Gastrin and vagal stimulation.
 Neurocrine control of GI function
• Synthesized in neurons of the GI tract.

1. VIP:

– Produces relaxation of GI smooth muscle

– Stimulates pancreatic HCO3–secretion

– Inhibits gastric H+ secretion.

2. GRP (bombesin):

• Is released from vagus nerves that innervate the G cells.

• Stimulates gastrin release from G cells.

 Blood Supply to the GIT…
• Blood flow to the GIT is increased during mealing time.
 Possible causes

– The release of vasodilator GI hormones during digestive

processes. These include:
 CCk,
VIP,
Gastrin,
Secretin,
Bradykinin,
Nitric oxide.
 Blood Supply to the GIT…

• At rest ~1/3 of the CO flows and reaches the abdominal cavity

• It is named as splanchnic circulation.

– includes flow in the intestines, spleen, liver and pancreases.

– Its special characteristics is the presence of double blood or

capillary supply to the liver through:

• The Portal circulation and hepatic artery

– After clearing debris and bacteria (sinusoids of the liver),

• blood is directed to hepatic vein and lastly to inferior

vena cava.
Blood Supply to the GIT…
 Blood Supply to the GIT…
• Generally blood flow to the GIT is affected by factors like:

– Increased metabolic activity

– Release of Vasoactive substances and

– Neural mechanism
 Blood Supply to the GIT…
A. Metabolism:

– Blood flow to the gut generally increases by more than 8-

fold after a meal.

– This is because motor, secretory, and digestive activities

increase during eating.

– Increased metabolic activity O2-utilisation by tissues.

– The by-product of metabolism release Vasoactive agents.

– Vasoactive agents have the effect of dilating blood vessels

• increase blood flow to the GI-tract during rest.

 Blood Supply to the GIT…

B. Vasoactive substances and blood flow:

– Vasoactive substances dilate blood vessels or decrease the

resistance to flow.

– As the result, blood flow to the gut is raised.

– Some of the Vasoactive substances released as the result of

increased metabolic activity include:

CCK (Cholecystokinin), gastrin, secretin, bradykinin,

adenosine etc.
 Blood Supply to the GIT…
C. Blood flow and neural control of the Gut:
1. Sympathetic:
• Cause intense vasoconstriction and thus reduces blood
flow to splanchnic bed.
• The vasoconstriction is important during exercise, stress
and hemorrhage
– to shunt blood to skeletal muscles and
– to the general circulation, respectively
2. Parasympathetic:
• Generally, increases blood flow to the gut because of its
vasodilatory effect.
 Gastrointestinal motility
• The motor activity of the GI tract performs several functions:

– Mixing of contents

– Propulsion of bolus/food

– To act as reservoirs (sphincters)

– Prevent retrograde movement of contents

– Dispose of residues
 Functional movements of the GIT
• The law of the gut” movement always occurs from mouth- to-
anus unless pathological
• Two basic types of movements occur in the GIT:
1. Propulsive movements:
• Causes food to move forward along the tract at an
appropriate rate for digestion and absorption. Peristalsis:
• is the basic propulsive movement of the GIT that appears
in the form of contractile rings around the gut
and propels to the anal ward direction
• Longitudinal muscles produce the rippling wavelike
movement called peristalsis.
Functional movements of the GIT…
 Peristalsis
Factors that initiate peristalsis
• Distension (overstretching)
• Irritation of epithelial lining
• Nervous mechanisms-Parasympathetic nerve stimulation
-ENS:- myenteric plexus
• Hormonal mechanisms: Gastrin, Insulin, Motilin
• Drugs: Ach-like drugs: carbacoline, pilocarpin
 Peristalsis..
Factors that inhibit peristalsis

• Congenital absence of myenteric plexus

• Drugs: cholinergic antagonists

• Nervous mechanism: stimulation of SNS

• Hormonal mechanisms: secretin, GIP, somatostatin, VIP, sub-P

 2. Mixing movements :

• Keep the intestinal contents thoroughly mixed at all

times.
• Mixing contractions are beneficial to mix the food
contents with gastric juice (chyme).
• Increases surface area for enzymatic attack
Mixing movements…
 The Mouth
• The mouth (oral cavity) is responsible for mechanical
digestion of solid food by mastication.

• Mastication helps to mix food with saliva.

• Parts of the oral cavity:

– Cheeks, the lips

– Tongue

– Hard and soft palate

– Teeth

– Saliva
 Mouth or oral cavity ….
Tongue:

– Connected to the flour of the mouth.

– Is a thick mass of voluntary skeletal muscle

– Shows a high degree of movement in every angle.

Functions:

– Gripping & repositioning food during chewing

– Mixing food with saliva and forming the bolus.

– Initiation of swallowing and speech.

– Contains taste buds

 Mouth or oral cavity ….
Saliva:
– moisten food and contain enzymes for the breakdown of starchy
foods.
• Functions:
– Digestion:
• CHO-digestion begins in saliva
• The enzyme ptyline breaks starch- to-maltose.
• Lingual lipase begins fat digestion in the mouth.
– Protection:
• contains Lysozyme & thiocyanate that kills microbes.
– Involved in speech:
• Clear & fluent articulation is possible
 Mouth or oral cavity ….
Functions of saliva…
– Secretes HCO3- :
• good to maintain the pH to neutral range (6-to-7)
– the neutral pH is good for ptyline action.
– Lubrication:
• Muncin found in saliva facilitates moistening and
swallowing of food.
– Endocrine function:
• Sex steroids and peptides like VIP are found in saliva to
plasma levels. So
• sex steroids in saliva help to diagnose hypogonadism.
 Types of Salivary glands and their secretions

I. Parotid 25%:

– Secrete mainly serous watery fluid rich in ptyline.

II. Submandibular 70%:

– Produce both serous and mucous fluid

III. Sublingual ~5%:

– Secrete mainly thick mucous with little serous fluid

Types of Salivary glands and their secretions
 Constituents of saliva
Constituents of saliva:

A. H2O (99.5%):

B. Electrolytes ( 0.5%): Na+, Cl-, K+, HCO3- Mg, Iodine,

C. Other organic substances include:

– Enzymes (amylase), lingual lipases, Lysozymes,

– Thiocyanate, Glycoproteins

– Albumin, globulin, IgA, mucus, etc.

• Total secretion = about 1-1.5 L/day

 Salivary secretion
Reflex control of salivation (Nervous control):

• Sight, smell, and test or thinking of food  Receptors in oral

cavity or smell  Sensory fibers from the tongue to the nuclei
in brain stem (MO), so called Salivatory nuclei 
Parasympathetic fibers act on salivary glands to increase
copious salivary secretion.

• Salivation can also be controlled by higher centers like

hypothalamus which has nerve connections with salivatory
nuclei in the Medulla oblongata (MO)
• Appetite area in the HT are also involved in reflex control.
 Salivary secretion…
• Salivary innervations are mainly autonomic,

• Parasympathetic fibers:

– causes copious secretion of saliva (Cholinergic).

• Sympathetic fibers:

– Causes small and insignificant secretion which is viscous

(Adrenergic).

• Interrupting sympathetic fibers do not greatly affect salivary

secretions

• But parasympathetic denervation causes atrophy of the gland.

 Digestive processes in the mouth
Ingestion of food:

•The amount of food that a person ingests is determined

primarily by the intrinsic desire for food (hunger/appetite).

•It is controlled by 2 nuclei in the Hypothalamus

1. Feeding center in lateral nucleus

• initiate us to crave for food & the desire for a particular

type of food.

2. Satiety center in the ventromedial nucleus

• has an inhibitory effect on the appetite center.

 Digestive processes in the mouth…
• Mastication (Chewing):

– Mastication muscle are supplied mainly by the motor

branch of the trigeminal nerve.

– Mechanical digestion begins (chewing).

• Chemical breakdown of starch begins by

– Salivary amylase.

• Propulsion is initiated by swallowing.

– Pharynx & oesophagus serve as conduits to pass food from

the mouth to the stomach.
 Swallowing reflex (deglutition)
• Swallowing is an act of orderly propulsion of food from the
mouth to the stomach.

• It can be initiated voluntarily (mouth),

• but when it reaches the pharynx, it then becomes involuntary

and under reflex control.
 Swallowing reflex (deglutition)
• Reflex pathways:

– This reflex inhibits respiration and entrance of food into the

trachea.

– Stimulation of tactile receptors in the pharynx > Sensory

fibers carry impulses to > swallowing center found in MO
and lower pons > Reflex motor impulses reach back to the
pharynx and upper esophagus through different cranial
nerves causing swallowing reaction.
 Phases of Swallowing reflex
1. Voluntary phase in the Oral cavity:

– the tongue rolls and pushes the chyme against the hard and
soft palate in the oral cavity and pushes it to the pharynx.

2. Pharyngeal phase (involuntary):

– nuclei located in swallowing center of the MO stimulate the

closure of the nasal and tracheal openings and cause
inhibition of respiration.
 Phases of Swallowing reflex
3. Esophageal phase (involuntary):

– Upper esophageal sphincter closes and the bolus is pushed

down to the stomach.

– If the peristaltic contraction is not adequate to push the

bolus, then distention of the esophageal walls cause the
“secondary peristalsis” that is modified by enteric nerves
and strong enough to push the bolus to the stomach
 Phases of Swallowing reflex…
Bolus of food

Tongue
Uvula
Pharynx Bolus
Epiglottis
Epiglottis

Trachea Esophagus Bolus

(a) Voluntary stage, oral (b) Involuntary, pharyngeal (c) Involuntary esophageal
phase of swallowing stage of swallowing stage of swallowing

Relaxed Relaxed
muscles Circular muscles contract,
muscles
constricting passageway
and pushing bolus down Gastroesophageal
Bolus of food sphincter open

Longitudinal muscles
contract, shortening
passageway ahead of
bolus
Gastroesophageal
sphincter closed
Stomach

(d) (e)
FIG: The propulsion of food from mouth to the esophagus
 Gastro-esophageal sphincter
• Thickened circular smooth muscle at the junction b/n the
esophagus & the stomach.
– Prevents the reflux of gastric contents into the esophagus.
Disorders of esophagus
1. Gastro-esophageal reflux:
– the entry of gastric contents into the lower part of the
esophagus due to incompetence of the LES
– leads to ulcer of the mucosa of lower esophagus
2. Achalasia:
– failure of LES to be relaxed, swallowing is inhibited
– caused by increased in tone of LES due to high sensitivity to
gastrin, weak esophageal peristalsis
 Stomach
Anatomy of the Stomach

• Cardiac region: surrounds the cardiac orifice

• Fundus: dome-shaped region beneath the diaphragm

• Corpus (Body): midportion of the stomach

• Antrum (Pyloric antrum): the dilated part of the stomach before

the pyloric region.

• Pyloric region: made up of the antrum and canal which

terminates at the pylorus
pylorus is continuous with the duodenum through the
•
pyloric sphincter
 Microscopic Anatomy of the Stomach
• Muscularis:
– Allows the stomach to churn, mix, and pump food
physically.
• Epithelial lining:
– Contains Goblet cells that produce a coat of alkaline mucus
– The mucous surface layer traps a bicarbonate-rich fluid
beneath it
• Gastric pits:
– Contain gastric glands that secrete
• Gastric juice, Mucus, Gastrin.
Microscopic Anatomy of the Stomach
 Functions of the stomach
1. Storage of large quantities of food until it can be pumped into
the duodenum.
2. Mixing of food with gastric secretion to form chyme.
3. Slow emptying the food from the stomach into the small
intestine at a rate suitable for proper digestion & absorption
by the SI.
4. Secretary function: HCl, mucous, pepsin, gastrin, IF
5. Sterilization
6. Digestion of proteins, fats(minimal)
7. Facilitates defecation
8. Absorption
 Stomach Lining
• The stomach is exposed to the harshest conditions in
the digestive tract.

• To protect from digesting itself stomach:

– Has a mucosal barrier with a thick coat of bicarbonate-rich
mucus on the stomach wall

– Epithelial cells are joined by tight junction

– Gastric glands have cells impermeable to HCl

– Damaged epithelial cells are quickly replaced

 Stomach Lining…

FIG: Gastric mucosal barrier.

 Motility in stomach
• Motility of the stomach contents are accomplished by:
A. Mixing
B. Peristaltic waves
A. Mixing processes
• Mixing contractions are beneficial to mix the chyme with
gastric juice (chyme).
• Pacemaker cells are normally located at Fundus region
 fire spontaneously causing basic electrical rhythm( BER).

 are slow waves that result in tonic, weak

contractions of the stomach walls.
 Motility in stomach …
B. Peristaltic contractions
– When slow waves progress to the antrum,
• the peristaltic contractions becomes strong and
– cause a thorough mixing of the stomach contents.
• The contractions also close the pyloric sphincter
– aids in the repulsion of the chyme back to the
stomach.
–This process helps in mixing the chyme thoroughly
• Hunger pangs (no food in stomach) can sometimes produce
strong peristaltic contractions.
– Such contractions fuse together and cause pain sensations.
 Motility in stomach …
• Most vigorous peristalsis & mixing occurs near the pylorus

• Chyme is either:

1. Delivered in small amounts to the duodenum or

2. Forced backward into the stomach for further mixing

 Regulation of Gastric Emptying
• Gastric emptying is regulated by:
– Neural (entero-gastric reflex, PSNs, SNS)
– Hormonal mechanisms (CCK, GIP, Secretin, gastrin)
• The rate at which the stomach empties depends on the fluidity
of the chyme and its contents.
• Thus, liquids empty faster than solids (fast CHO> protein>
Slow fat).
– Carbohydrate-rich chyme quickly moves through the
duodenum
– Fat-rich chyme is digested more slowly causing food to
remain in the stomach longer
 Hormonal and neural factors that regulate stomach
emptying
Stimulatory stomach factors Inhibitory duodenal factors
Distension of the stomach Distension of the duodenum
Partially digested protein Fatty acids and glucose
Alcohol Partially digested protein
Caffeine
↑Secretion of
↑Gastrin Sensory CCK Entero-gastric reflex
Secretion impulse via vagus GIP
Secretin
Constrict LES
↑Stomach motility ↓Stomach motility
Relax pyloric sphincter ↑Pyloric sphincter tone

Stimulate gastric emptying Inhibit gastric emptying

 Absorption from the stomach
 An insignificant absorptive functions takes place in the
stomach, these are:

 Alcohol

 Certain drugs (aspirin, morphine etc.)

 Small quantities of H2O.

NB: Organic nutrients (glucose, amino acids, and FFA) etc. are not
usually absorbed from the stomach.
FIG: Secretary function of stomach
 HCl secretion by Parietal cells
1. H+ ions that result from the dissociation of H2o in the
cytoplasm of the parietal cells are continuously pumped
(actively) through the membrane of the gland (canaliculi) into
the gland lumen (pit).
2. Within the cell cytoplasm (intracellular), CO2 and OH-
combine to produce bicarbonate ions HCO3-.
3. Cl- ions are transported from the blood into the parietal cell
and finally into the lumen (pit) of the gland by facilitated
diffusion.
4. HCO3- in exchange to Cl- is transported in reverse direction
(from the cytoplasm into the blood, charge balance).
5. Finally, H+ and Cl- ions combine in the lumen of the gland
(pit) and produce HCl that is collected and stored in the pit
until used for different physiological functions.
 Regulation of HCL Secretion
• Factors stimulating secretions

– Local mechanical factors: distension, irritation, pH

– Nervous stimulation: ANS, ENS (submucosal plexus)

• Sympathetic stimulation inhibits GIT-secretions

• Parasympathetic stimulation increases GIT-secretions

• Emotions- stress, anger…

– Hormonal mechanisms:

• Gastrin &histamine increase HCL secretion

• Secretin increases NaHCO3 secretion from pancreas

 Phases of Gastric Secretion
• Stimulatory & inhibitory events occur in 3 phases:

1. Cephalic phase

– prior to food entry to the stomach

2. Gastric phase

– once food enters the stomach

3. Intestinal phase

– as partially digested food enters the duodenum

FIG: Phases of Gastric Secretion
 Small Intestine: Gross anatomy
• Runs from pyloric sphincter to the ileocecal valve
6.4m long & 0.03m in diameter
• Has 3 parts

1. Duodenum: 0.3m

2. Jejunum: 2.4m

3. Ileum: 3.7m
 Small Intestine: microscopic anatomy
• Structural modifications of the small intestine wall increase
surface area
• Intestinal mucosa has 3 structures that maximize surface area:
– Plicae circulares:
• deep circular folds of the mucosa and sub mucosa
– Villi
• finger like extensions of the mucosa
– Microvilli
• tiny projections of absorptive mucosal cells’ plasma
membranes
Small Intestine: microscopic anatomy
 The Villi
• Numerous finger like projections consist of a layer of
absorptive epithelial cells
• Each Villi contains minute microvilli (brush border) at their
surfaces that secrete
– digestive enzymes like sucrase, maltase, lactase, and
peptidases in the membranes of the microvilli.
• Intestinal Juice
– Secreted by intestinal glands in response to distension or
irritation of the mucosa
– Slightly alkaline and isotonic with blood plasma
– Largely water, enzyme-poor, and contains mucus
 Ileocecal sphincter
• Prevents back flow of fecal matter from the cecum to the ileum.
• Factors regulating the sphincter:
– Pressure & chemical irritation of ileum relax it & initiates
peristalsis
– Pressure & chemical irritation of
cecum inhibit peristalsis
of ileum and closes the sphincter
 Movement in the small intestine
• Two types of movements occur in the SI:

1. Mixing movement

2. Propulsive movement

1. Mixing movements (segmentation contractions)

~ Ring like contractions appear at regular intervals.

~ Segmentation contractions exert chopping action

on intestinal chyme & mix it with digestive juice.

 Movement in the small intestine
2. Propulsive movements

– Are peristaltic waves that propel chyme anal wards

– Initiated by intestinal distension

– Chyme is propelled in the SI until it reaches the terminal

ileo-cecal sphincter
 Secretion of the small intestine
• Mucosa of the SI secrets:
– Digestive enzymes, Mucous (protective & lubricant),
Electrolytes, Hormones
• Intestinal secretary glands:
1. Brunner’s gland: mucous glands, duodenal in distribution
2. Crypts of Lieberkun: source of new lining cells
3. Goblet cells: mucous glands
4. Enterocytes: digestive enzymes
5. Enteroendocrine cells: produce hormones
6. Enterochromaffin cells: serotonin producing cells.
 Digestive enzymes secreted in the SI
1. Peptidase: splits peptides into amino acids
2. Three enzymes hydrolysing disaccharides into
monosaccharaides: sucrase, maltase and lactase
3. Intestinal lipase: splits neutral fats into glycerol and
fatty acids.
Regulation of secretion in SI
• Local factors: tactile, distension, irritation, pH.
• Vagal stimulation increases intestinal secretion
• Sympathetic stimulation decreases intestinal secretion
• Enteric reflexes: stimulation of submucosal plexus
Enzymes secreted in the SI
 Digestion in the Small Intestine
• As chyme enters the duodenum:

– Carbohydrates, proteins and fat digestion have taken place

– Digestion continues in the small intestine

– Chyme is released slowly into the duodenum

 Because it is hypertonic and has low pH, mixing is

required for proper digestion
• Virtually all nutrient absorption takes place in the small
intestine
 Digestion in the Small Intestine
1. Digestion of Carbohydrates

Involved Enzymes and their site of Secretion

• Mouth: salivary amylase

• Esophagus & stomach: nothing happens

• Duodenum: pancreatic amylase

• Brush border enzymes (maltase, sucrase & lactase) act on

disaccharides and produce monosaccharides: fructose, glucose
& galactose
 Digestion of Carbohydrates…
Starch
- Salivary amylase (20-40%)
- Pancreatic amylase (50-80%)
Maltose and 3-9
glucose polymers Lactose Sucrose
-Maltase -Lactase -Sucrase
-Dextrase
Glucose + Glucose Glucose and Glucose and
Galactose Fructose
 2. Proteins Digestion:
• Enzymes acting in the small intestine
• Pancreatic enzymes
– trypsin, chymotrypsin, and carboxypolypeptidase
• split peptide bonds between different amino acids.

• Brush border enzymes

– enzymes break peptide bonds that attach terminal amino
acids to carboxyl ends of peptides (carboxypeptidases)
– enzymes break peptide bonds that attach terminal amino
acids to amino ends of peptides (aminopeptidases)
– enzymes split dipeptides to amino acids (dipeptidase)
 Digestion of Proteins...

Proteins
-Pepsin

Peptones Trypsin
Proteoses Chymotrypsin Amino acid
Polypeptides Carboxypolypeptidase Peptides

-Peptidase

Amino acids
 Digestion of fats
• Happens in the small intestine
in two phases:
1. Emulsification
– By bile salts
– Formation of emulsion
droplets
2. Chemical digestion
– Pancreatic lipase
– Enteric lipase
– Free fatty acids (Monoglycerides)
 Digestion of fats
Dietary source of fat
• Neutral fats (triglycerides), Cholesterol and cholesterol esters
Phospholipids
Fat Emulsified fat FFA + Glycerides
Bile salt -Lingual lipase
-Gastric lipase
-Pancreas lipase

Cholesterol Bile salt FFA + Glycerides

Cholesterol esters Cholesterol Esterase

Phospholipids-A2 Phospholipase FFA + Phopholipids

 Absorption in the Small Intestine
Absorption
– the passage of the end
products of digestion
from the GI tract into
blood and lymph.
Absorption occurs by:
1. Simple diffusion,
2. Facilitated diffusion,
3. Osmosis, and
4. Active transport.
 Small intestine, Absorption
• Absorption & transport

– Carbohydrates are degraded into their simpler forms;

glucose, galactose, and fructose are absorbed by secondary
active transport (diffusion together with Na+ ion).

– Fats are degraded into FFA + glycerol and taken by lacteals

that enter the thoracic duct and finally join the circulation.

– Protein are absorbed as amino acids by active transport.

– Electrolytes Na+, Ca2+, iron etc are absorbed by active

transport.
Absorption in the Small Intestine...
 Electrolyte Absorption
• Most ions are actively absorbed along the length of small
intestine
– Na+ is coupled with absorption of glucose & amino acids
– Ionic iron is transported into mucosal cells binds with ferritin
• Anions passively follow the electrical potential established by
Na+
• K+ diffuses across the intestinal mucosa in response to osmotic
gradients
• Ca2+ absorption:
– Is related to blood levels of ionic calcium
– Is regulated by Calcitonin & Parathyroid hormone
Where will the absorbed nutrients go?
 Water Absorption
• 95% of water is absorbed in the small intestines by osmosis.

• Water moves in both directions across intestinal mucosa

• Net osmosis occurs whenever a concentration gradient is

established by active transport of solutes into the mucosal cells

• Water uptake is coupled with solute uptake, and as water

moves into mucosal cells, substances follow along their
concentration gradients
Large Intestine
 Large intestine (colon)
Function of the large intestine

1. Digestion

 Bacterial fermentation , no further digestion takes place

2. Absorption

 water, Electrolyte (like Na, Cl), some drugs, minerals,

vitamins(K,B..)

3. Secretion

 mucous(goblet cells) k+ & HCO3- .

4. Storage, transport, and evacuation of feces

 Movement in the large intestine
• Two types of movements

1. Mixing movements (Haustral contractions)

– Slowly shuffle the colonic contents back and forth

2. Propulsive movements (mass movements)

– Initiated by local distension, gastro-colic reflex

– Poor motility of the transverse colon causes:

• greater absorption and constipation.

– Excess motility of the sigmoid colon causes:

• less absorption and diarrhoea or loose stool.

Valves and Sphincters of the Rectum and Anus

• The anus has two sphincters:

– Internal anal sphincter composed of smooth muscle

– External anal sphincter composed of skeletal muscle

• These sphincters are closed except during defecation

 Defecation reflex
1. Pressure in rectum from mass peristalsis sends afferent
stimuli to spinal cord.

2. Parasympathetic stimuli cause contraction of rectal muscle

and relaxation of internal anal sphincter.

3. Voluntary stimuli relax external anal sphincter and cause

abdominal contraction

4. Defecation
Fig: Defecation reflex
 The Pancreas
• Pancreas is divided into: Head, body and tail
• Connected to the duodenum via the main pancreatic duct and
accessory duct
• The head is encircled by the duodenum and the tail adjacent to
the spleen
• Major function of the pancreas
– Exocrine function
• Secretes pancreatic juice which breaks down all
categories of foodstuff
– Endocrine function
• Release of insulin and glucagon
 The Pancreas…
• Pancreas contains two types of secretary glands:
1. Endocrine cells (islets of Langerhans)
• Secrete hormones-Glucagon & Insulin
2. Exocrine cells (acinar cells)
• Secrete a mixture of fluid rich in NaHCO3 and digestive
enzymes called pancreatic juice.
• Involved in digestion processes by producing:
– Digestive enzymes: necessary to digest CHO, fat, and
protein
– Bicarbonates : to neutralize the gastric juice
– Water and electrolytes (Na+, K+ etc):
The Pancreas…
 Regulation of pancreatic secretion
• Secretin:
– Cause for secretion: acidity in intestine
– Effect: causes increased sodium bicarbonate release.
• GIP:
– Cause for secretion: fatty acids & sugar
– Effects: increased insulin release
• CCK:
– Cause for secretion: fats and proteins in the intestine
– Effects: increased digestive enzyme release
• Parasympathetic impulse
– Stimulate secretion of pancreatic enzyme
Regulation of pancreatic secretion
 Pancreatic enzymes
1. Proteolytic enzymes: used to digest proteins

– Trypsin: activated by enterokinase, a duodenal enzyme that

converts trypsinogen to trypsin

– Chymotrypsin: protein-digesting enzyme in pancreatic

juice, activated by trypsin

– Carboxypolypeptidase: activated by trypsin

– Ribonuclease: to digest nucleic acids

– Deoxyribonuclease, Elastase, collagenase

 Pancreatic enzymes
2. Pancreatic enzymes involved in CHO digestion:

– Pancreatic amylase

3. Pancreatic enzymes involved in fat digestion:

– Pancreatic lipase, Cholesterol esterase, Phospholipase

 LIVER & GALLBLADDER

Liver

• The heaviest gland in the body & the 2nd largest organ.

• Weighs 1.36kg.

• Located below diaphragm in the abdomen

• Divisible into left & right lobes

LIVER & GALLBLADDER
 Liver: Associated Structures…
• Gallbladder
– A sac located in a depression on the posterior surface of the
liver.
– Used to store & concentrate bile by absorbing H2o & ions
– Has fundus, body & neck
• Bile leaves the liver via
– Bile ducts (right & left hepatic duct) fuse into the common
hepatic duct
– The common hepatic duct fuses with the cystic duct & form
the common bile duct.
Liver: Associated Structures…
 Liver: Microscopic Anatomy
• Hexagonal-shaped liver lobules are the structural and
functional units of the liver.
• Composed of
– hepatocyte (liver cell)
– Portal triads are found at each of the six corners of each
liver lobule
Portal triads consist of:
1. Bile duct
2. Hepatic artery – supplies O2 rich blood to the liver
3. Hepatic portal vein – carries venous blood with nutrients
from digestive viscera
 Liver: microscopic structures…
• Liver sinusoids

– enlarged, leaky capillaries located b/n hepatic plates

• Kupffer cells

– hepatic macrophages found in liver sinusoids

• Hepatocytes’ functions include:

1. Production of bile

2. Processing blood-borne nutrients

3. Detoxification

4. Storage of fat-soluble vitamins

 Bile Production
• Bile is an alkaline fluid (pH 8)

• Secreted in the liver and functions in emulsification of fat in

the duodenum.

• Emulsification means changing greater fat globules into

smaller fat-droplets called micelles-

• micelle- An electrically charged particle built up from

polymeric molecules or ions and occurring in certain colloidal
electrolytic solutions like soaps and detergents
 Secretion of Bile
• Bile is secreted by hepatocytes in the liver for two
purposes
– It facilitates fat digestion and absorption of fat in the SI
– Serves as a means of excretion of waste products (bilirubin &
cholesterol)
• Bile contains the following constituents:
1. Bile salts (bile acids), ~11%
2. Bile pigment (bilirubin), ~1%
3. organic elements Cholesterol, protein ( ~3%)
4. Electrolytes (Na+, K+, Ca2+, Cl-,(~1%).
5. H2O (~ 84%)
 Regulation of Bile Release

• Acidic, fatty chyme causes the duodenum to release:

– Cholecystokinin (CCK) and secretin into the bloodstream

• CCK and secretin transported in blood stimulate the liver to

produce bile

• Vagal stimulation causes weak contractions of the gall bladder

Regulation of Bile Release
 Functions of the liver
1. Carbohydrate Metabolism: it is the site of:

* Glycogenesis

- turn excess glucose into glycogen & store in the liver

* Gluconeogenesis = turn proteins & triglycerides into glucose

* Glycogenolysis = turn glycogen back into glucose as needed

2. Lipid Metabolism :it is the site of:

• formation of phospholipids, lipoproteins,

• synthesis of cholesterol, and

• conversion of CHO into fat

 Functions of the liver...
3. Protein Metabolism

• Deamination of amino acids

- removes NH2 (amine group) from aas so can use what is

left as energy source

• Converts resulting toxic NH3 (ammonia) into urea for excretion

by the kidney

• Synthesizes plasma proteins utilized in the clotting mechanism

& immune system.

• Convert one amino acid into another

 Other Functions of the liver
4. Inactivation of drugs & hormones (Sulfonamide, penicillin,
thyroid hormone, steroids)

5. Removes the waste product; bilirubin

6. Releases bile salts that help digestion of fat by emulsification.

7. Stores: fat soluble vitamins (A, B12, D, E, K), iron, copper and
blood (a major blood reservoir)

8. Filtration of blood: phagocytizes worn out blood cells &

bacteria. Removes blood clots and toxins from portal
circulation
9. Activates vitamin D
THANK YOU!!