P.

01 FUNCTIONAL ANATOMY AND GENERAL PRINCIPLES

Clinical Correlation:
OF REGULATION IN THE GASTROINTESTINAL TRACT
Dr. W. Antonio | January 16, 2018 o Prolonged NPO
 Enterocytes will not function to produce
OUTLINE lymphocyte

I. Functional Anatomy
II. Physiologic Processes of GI Function
III. Overview
IV. GI Sphincters
V. Blood Supply
VI. Lymphatic Drainage
VII. Histology
VIII. GIT Regulatory Mechanisms

I. FUNCTIONAL ANATOMY

o Saliva
 protection from infectious microorganisms
 (+) lysozymes

o Stomach
 (+) Acid
 H. Pylori – able to survive in an acidic
environment (common causative agent of
peptic ulcer disease)

o Small Intestines
 With GUT associated lymphoid tissues

o GI tract is a hollow tube of major functional segments:
mouth, esophagus, stomach, small intestine
(duodenum, jejunum, ileum), large intestine (caecum,
ascending colon, transverse colon, descending colon),
rectum, and anus
o Accessory organs: tongue, teeth, salivary glands, liver,
gallbladder and pancreas; important for the functioning
of GI tract
o Overall function: absorption and excretion
o The GIT is an open system because it is exposed to the
external environment
o It is equipped with complex immune system
o The GI tract represents the largest immune organ of the
body.
o Contains 80% of total lymphocytes in the body
(GUT associated lymphoid bodies)
o Large Intestines
 Contains most of the microorganisms in the
GIT
II. PHYSIOLOGIC PROCESSES OF GI FUNCTION
1. DIGESTION
a. Mechanical/Physical
 Muscular movements of the digestive tract
 Physically breaks down food into smaller
particles
 Start at the mouth – chewing, churning
(mechanical digestion in stomach)
 is through the process of churning and the
small intestine segmentation
b. Chemical
 Hydrolysis – to break the H bonds (main
chemical process in digestion of nutrients)
reactions aided by enzymes

PHYSIOLOGY | 1 of 5 CAI, J. , PACLEB, K.

  Salivary amylase: for initial digestion of
carbohydrates in the mouth
 Chemical break down of food particles into
nutrient molecules / more absorbable
molecules
2. MOTILITY – moves and mixes food along GI tract
a. Peristalsis
 Reflexive contractions triggered by gut wall
distention
 Presence of bolus Stimulation of distention of
lumen proximal contraction (with
simultaneous relaxation of distal portion)
forward movement of food along GI tract
 Propulsion by swallowing
b. Segmentation (Small Intestines)
 Simultaneous contractions of GI tract
 to further digest the food particles that has
been ingested into smaller particles
 Does not result to forward propulsion of bolus,
but results to mixing and digestion of contents
of the intestine
3. SECRETION
 Important for chemical digestion
 Enzymes and hormones for hydrolysis
 Water (to make aqueous solution so that food bolus
could be easily mix with different secretions)
 Electrolytes (transport system needed to absorb
nutrients)
 Protein
 Humoral agents GI Tract represents the largest organ
for immune system
 Functions of mucous: digestive, protective and
facilitates movement of bolus
4. ABSORPTION
 Passage of nutrients from the GI tract into the
circulation
 majority of absorption occurs in the small intestine
 intestine folded into villi to increase surface area thru
which nutrients can be absorbed
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 molecules that cannot be absorbed by the capillaries
because of their large size goes to the lymph vessels
(e.g. fat soluble molecules)
** The GI tract also serves as an important organ for excretion
of substances. The GI tract stores and excretes waste substances
from ingested food materials and excretes products from liver
such as cholesterol, steroids, and drug metabolites.
III. OVERVIEW
MEMORIZE!!!!!!
KEY:
M- Motility
S – Secretion
D – Digestion
A – Absorption
o Oral Cavity and esophagus
M: swallowing, chewing (mechanical digestion)
S: saliva (salivary gland)
: contains amylase and lipase
D: carbohydrates, fats (minerals) (chemical digestion)
A: none (but some sublingual medications can be absorbed
in the oral cavity e.g Catapress)
o Esophagus
M: (+) peristalsis
S: (+) mucous secretion – important in lubrication of
esophageal wall.
D: Possible digestion due to the swallowed bolus with
amylase and lipase.
o Stomach
M: Peristaltic mixing and propulsion
S: HCL (secreted by gastric parietal cells), pepsinogen and
gastric lipase (secreted by chief cells), mucous and HCO3
(surface mucous cells), Gastrin (secreted by G cells),
Histamine (secreted by ECL)
D: proteins, fats (chemical digestion)
A: lipid-soluble substances such as alcohol and aspirin
(inhibits COX, decreased production of
prostaglandins →peptic ulcer disease)
o Small Intestines
M: mixing and propulsion primarily by segmentation
S: enzymes, HCO3, and enzymes (pancreas), bile (liver),
mucus (goblet cells), hormones: CCK, secretin, GIP, and
other hormones
D: Carbohydrates, fats, polypeptides, nucleic acids
A: peptides by active transport, amino acids, glucose, and
fructose by secondary active transport; fats by simple
diffusion, H2O by osmosis, ions, minerals, and vitamins by
active transport
o Large Intestines
M: Mass movement for propulsion
S: mucus (goblet cells)
D: none
A: ions, water, minerals, vitamins and small organic
molecules produced by bacteria
CAI, J. , PACLEB, K.
***Short Chain Fatty Acid – produced through bacteria

Clinical Correlation:

o Constipation
 Most of the water is absorbed in the large
intestine
 Health teaching
 Increase water intake
 Increase fiber intake (fiber absorbs water)
 If there is absence of excess water from
the small intestines the feces will solidify
IV. GI SPHINCTERS
1. Upper Esophageal Sphincter (UES)
 Prevents backflow of food swallowed Esophageal Phase of food propulsion
 Closed during inhalation; protects the inflow of air into
the esophagus (too much air in GI is painful)
 will only open when you swallow or when you vomit 3. Pylorus/ Pyloric ring
 Prevents food from going through windpipe  at the junction between duodenum and stomach
 Prevents backflow of chime from small intestines
2. Lower Esophageal Sphincter / Gastroesophageal  Regulates the outflow of the chyme from stomach to
sphincter small intestine (duodenum): ~ 3 mL to allow adequate
 Prevents regurgitation of food particles from the mixing (bolus + gastric contents) which is pushed into
stomach to the esophagus the duodenum)
 Separates esophagus from gastric region  Rapid outflow of chyme from the stomach: there is
 Closes to prevent reflux of acid from stomach to increase acidity and inefficient digestion (malabsorption)
esophagus  For GIT to have good functioning, the stomach contents
 Ensures efficient digestion (massive contraction when should be pushed slowly to the small intestines since
there is food; strong contractions may move food the stomach also has a greater capacity compared to
forward to duodenum or reflux back to the esophagus) the small intestines.
 Closes after the bolus reaches the stomach  If fast = may lead to malabsorption syndrome
 Stomach – only organ resistant to acid; without the
different sphincters, acid may reflux and injure other
organs

Clinical Correlation:

o Achalasia
 failure of relaxation of LES
 no reflex opening of LES
o Gastroesophageal reflux disease (GERD)
 Prolonged backflow of acid
 Causes esophagitis, ulcerations
 It can be physiologic because every time
we swallow the LES opens causing
minimal backflow of acid
 It is only pathologic when it persists Basic Anatomy of the Stomach
overtime and with manifestations already
4. Sphincter of Oddi
 Prevents back flow of food to bile or pancreatic tracts
 Prevents the entry of intestinal contents into the
hepato-biliary tree
 GI is exposed to the external environment (may ingest
microorganisms)  Sphincter of Oddi prevents inflow of
microorganism into the biliary tract
 Closes the tract that comes from the gallbladder and the
pancreas

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** Oral nutrition is better than parenteral nutrition (through
intravenous vessels) because parenteral nutrition is prone to
infection
** Use parenteral nutrition only if the gut is not functioning
5. Ileocecal valve
 Separates small intestine (chyme) from the cecum/large
intestine (fecal materials)
 Prevents backflow from LI to SI
 Prevents bacteria in the LI to go to the SI
 there are more bacteria in the colon than in the
intestines
Anatomy of the Ileocecal valve
6. Internal and external anal sphincters
 controls the defecation
 external anal sphincter can be controlled voluntarily
Clinical Correlation:
o Fecal incontinence
 Inability to control the external anal sphincter
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Figure 1 Anal sphincters
BLOOD SUPPLY
 The blood vessels of the gastrointestinal system are part
of a more extensive system called the splanchnic
circulation.
 It includes the blood flow through the gut itself plus
blood flows through the spleen, pancreas, and liver.
 The design of this system is such that all the blood that
courses through the gut, spleen, and pancreas then
flows immediately into the liver by way of the portal
vein.
 In the liver, the blood passes through millions of minute
liver sinusoids and finally leaves the liver by way of
hepatic veins that empty into the vena cava of the
general circulation
Figure 2 Diagrammatic representation of the Splanchnic
Circulation
 Venous drainage enters portal circulation
 Splanchnic blood flow: 25% of cardiac output
CAI, J. , PACLEB, K.
LYMPHATIC DRAINAGE
 The lymphatic drainage of the GI tract is important for
the transport of lipid-soluble substances that are
absorbed across the GI tract wall.
 Lipids and other lipid-soluble molecules (including some
vitamins and drugs) are packaged into particles that are
too large to pass into the capillaries and instead pass
into lymph vessels in the intestinal wall. These lymph
vessels drain into larger lymph ducts, which finally drain
into the thoracic duct and thus into the systemic
circulation on the arterial side.
 This has major physiological implications in lipid
metabolism and also in the ability of drugs to be
delivered straight into the systemic circulation.
HISTOLOGY
Figure 3 Typical cross-section of the GUT
1. MUCOSA – innermost layer; in contact with the food we eat
 small intestine: folded into villi and crypts
 large intestine: folded into crypts
 stomach: ruggae
Figure 4 Comparison of the morphology of the epithelium of the
small intestine and colon
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a) Epithelium
 GIT epithelial lining: Simple columnar
epithelium except esophagus and rectum
 Esophagus: Stratified Squamous Epithelium
 Why squamous epithelium? It is the protective
mechanism of the body because sometimes we
swallow food without chewing it. It is
protection from partially undigested food.
 Single cell layer lining of the GIT lumen
 stomach and small intestine: Simple columnar
epithelium
CHECKPOINT
1. Voluntarily controlled sphincter
2. Sphincter that prevents backflow of stomach content to
the esophagus
3. Pathological condition when the LES cannot relax
4. Sphincter that prevents contamination of the
hepatobiliary tree
5. Used for digestion of carbohydrates in the mouth
6. Reflexive contractions triggered by gut wall distention
7. Simultaneous contractions of GI tract that does not
result to forward propulsion of bolus, but results to
mixing and digestion of contents of the intestine
8. What are produced by the bacteria in the large intestine
9. Where is most of the water absorbed?
10. True or false: Fat soluble molecules are absorbed in the
lymph vessels due to its large size
11. The innermost layer of the small intestine that comes in
contact with the food
ANSWERS: (1) External anal sphincter, (2) Lower esophageal sphincter (3)
Achalasia, (4) Sphincter of Oddi/ Ampullary sphincter, (5) Salivary amylase, (6)
Peristalsis, (7) Segmentation, (8) short chain fatty acid, (9) Large intestine,
(10) True, (11) Mucosa
CAI, J. , PACLEB, K.