GASTROINTESTINAL

SYSTEM

dr. DODY TARUNA, M.Kes.AIFO

PHYSIOLOGY DEPT. MEDICAL FACULTY

HANG TUAH UNIVERSITY
Gastrointestinal system
 Overview
 Digestion of nutrients
 Absorption of
nutrients and water
 Principles of GI
regulation
 GI secretion and
regulation
 GI motility and
regulation
 The Digestive System and Body
Metabolism
• Digestion
•Breakdown of ingested food
• Absorption
• Passage of nutrients into the blood
• Metabolism
• Production of cellular energy (ATP)
Gastrointestinal system
 Overview
 Digestion of nutrients
 Absorption of nutrients and water
 Fate of nutrients in the liver
 Principles of GI regulation
 GI secretion and regulation
 GI motility and regulation
Overview
 Food for body:
Carbohydrates, proteins and lipids are absorbed in
a form that can not be taken up by the cells →
food needs to be broken a small pieces
(mechanical digestion) and broken down
chemically (chemical digestion)
Steps in food digestion
▪ Carbohydrates, proteins and lipids are absorbed in a
form that can not be taken up by the cells → food
needs to be broken a small pieces (mechanical
digestion) and broken down chemically (chemical
digestion)
▪ Chemical digestion refers to the degradation of:
1 2
▪ 1- Carbohydrates ---> disaccharides ---> monosaccharides

▪ 2- Proteins ---> peptides ---> amino acids

▪ 3- Lipids ---> diglycerides ---> monoglycerides and

fatty acids
Organs of the Digestive System

• Two main groups

• Alimentary canal – continuous coiled hollow
tube
• Accessory digestive organs
Accessory Organs of the Abdomen
PANCREAS AND LIVER
Pancreas
 Produces secretions to aid digestion
 Head
 Body
 Tail
 Pancreatic duct /duct of Wirsung
 Hepatopancreatic ampulla
 Sphincter of the heatopancreatic ampulla (sphincter of (Oddi)
 Regulates passage of pancreatic juice and bile
 Accessory duct (duct of Santorini)
Figure 23.13a
Figure 23.13b
Figure 23.13c
Histology of Pancreas
 Glandular epithelial cells
 99% exocrine clusters
 Secrete pancreatic juice
 Fluid and enzymes
 Pancreatic islets (islets of Langerhans)
 1% endocrine cells
 Hormones
 Glucagon
 Insulin
 Somatostatin
 Pancreatic polypeptide
Pancreatic Juice
 1200-1500 mL/day
 pH 7.1-8.2
 Water
 Salts
 Sodium bicarbonate
 Enzymes
 Pancreatic amylase
 Trypsin
 Entereokinase
 Chymotrypsin
 Carboxypeptidase
 Elastase
 Pancreatic lipase
 Ribonuclease and deoxyribonuclease
Liver and Gallbladder
 Liver
 Largest gland at 1.4 kg (~3 lb)

 Gallbladder
 Closely associated with liver
Anatomy of Liver
 Right and left lobe separated by falciform ligament
 Quadrate lobe
 Caudate lobe

 Round ligament (ligamentum teres)

 Remnant of umbilical vein
 coronary ligaments
Histology of Liver
 Lobule
 Hepatocytes radiating from central vein
 Sinusoids
 Reticuloendothelial (Kupffer) cells
 Stationary phagocytes
Figure 23.14a
Figure 23.14b
Figure 23.14c
Figure 23.14d
Bile Duct System
 Bile secreted by hepatocytes
 Bile canaliculi
 Bile ducts
 Right and left hepatic ducts
 Common hepatic duct
 Common bile duct

 Gallbladder for temporary storage of bile

 Cystic duct
Blood Supply of Liver
 Hepatic artery provides oxygenated blood
 Hepatic portal vein provides deoxygenated blood
 Nutrients, drugs, toxins, microbes
 Hepatic artery and vein carry blood to sinusoids
 Substances exchanged by hepatocytes
 Blood drains to central vein and eventually hepatic vein
 Portal triad
 Hepatic portal vein
 Hepatic artery
 Bile duct
Figure 23.15
Bile
 800-1000 mL/day
 pH 7.6 – 8.6
 Water
 Bile acids
 Bile salts
 Emulsification
 Cholesterol
 Lecithin
 Bile pigments
 Bilirubin
 Stercobilin
Liver Functions

 Metabolism of:
 Carbohydrates
 Lipids
 Proteins
 Process drugs and hormones
 Excrete bilirubin
 Synthesize bile salts
 Storage
 Glycogen
 Vtamins
 Minerals
 Phagocytosis
 Activate Vitamin D
Organs of the Digestive System
 Organs of the Alimentary Canal

• Mouth
• Pharynx
• Esophagus
• Stomach
• Small intestine
• Large intestine
• Anus
Slide 14.3
GI organization

 Composed of the GI tract,

a “tube” running from the
esophagus to the rectum

 Accessory organs are

emptying secretions into
the tract.
 Structure of the GI tract
 4 layers:
- 1- mucosa: epithelial cells (enterocytes)
→ role vary with location
- lamina propria = layer of connective
tissue under the epithelial, containing
blood vessels, nerves and lymphatic vessels
(Peyer’s patches)
- the muscularis mucosae: thin layer of
smooth muscles
- 2- submucosa: layer of connective tissue
rich containing the submucosal plexus
(Meissner’s plexus)
- 3- muscularis externa – radial and
longitudinal smooth muscles + Auerbach
plexus(in contact with Meissner’s)
- 4- serosa:connective tissue continuying
through the mesenteries (a thin
membranes rich in blood and lymphatic
capillaries) and the peritoneum (a double
layer membrane surrounding the
abdominal organs)
Layers of Alimentary Canal Organs
Gastrointestinal system
 Overview
 Digestion of nutrients
 Absorption of nutrients and water
 Fate of nutrients in the liver
 Principles of GI regulation
 GI secretion and regulation
 GI motility and regulation
Functions of the GI system

 Digestion:
- Mechanical digestion:
breaking food in small
particles so they are easily
broken down by enzymes →
mouth and stomach
- Chemical digestion:
pancreas and duodenum
 Nutrient absorption: small
intestine
 Water reabsorption: colon
Functional anatomy of the GI system
 Mouth: mostly mechanical
digestion → mastication →
food is broken down in small
particles so food particles
can be chemically digested
→ bolus

 Enzymes:
- lingual amylase
carb. (step 1)
- lingual lipase
lipid (step 1)
 Processes of the Mouth

• Mastication (chewing) of food

• Mixing masticated food with saliva
• Initiation of swallowing by the tongue
• Allowing for the sense of taste

Slide 14.7
 Pharynx Function
• Serves as a passageway for air and
food
• Food is propelled to the esophagus by
two muscle layers
• Longitudinal inner layer
• Circular outer layer
• Food movement is by alternating
contractions of the muscle layers
(peristalsis)
 Esophagus

• Runs from pharynx to stomach through

the diaphragm
• Conducts food by peristalsis
(slow rhythmic squeezing)
• Passageway for food only (respiratory
system branches off after the pharynx)

Slide
 Pharynx, esophagus:
passageway for food (from
mouth to stomach)
 Stomach
▪ Stomach: bolus is mixed with
gastric juice (liquid, mucus and
enzymes) → chyme

▪ Enzymes:
- pepsin: protein (step 1)
- gastric lipase
lipid (step 1)

Pepsin is first activated by HCl

(pepsinogen → pepsin)

Gastric juice pH=2

[chemical digestion is minimal)]

 Stomach Functions

• Acts as a storage tank for food

• Site of food breakdown
• Chemical breakdown of protein begins
• Delivers chyme (processed food) to the
small intestine

Slide
 Specialized Mucosa of the
Stomach
• Simple columnar epithelium
• Mucous neck cells – produce a sticky
alkaline mucus
• Gastric glands – secrete gastric juice
• Chief cells – produce protein-digesting
enzymes (pepsinogens)
• Parietal cells – produce hydrochloric acid
• Endocrine cells – G-Cell-produce gastrin
Slide
Structure of the Stomach Mucosa

• Gastric pits formed by folded mucosa

• Glands and specialized cells are in the
gastric gland region

Slide
Structure of the Stomach Mucosa
Gastric Barrier
 Duodenum
Receive juices from pancreas, liver
and its own wall

 Secretion from the duodenum:

They finish off the last step of
digestion.
- Peptidases (or dipeptidases)
break off the bond between
dipeptides to free 2 amino acids
- Disaccharidase (maltase, sucrase,
lactase) break off disaccharides into 2
monosaccharides (mostly glucose)
- Intestinal lipase breaks off
diglycerides into monoglycerides and
fatty acids.
 Nutrients are completely degraded
into forms that can be absorbed by
cell (step 2 of chemical digestion)
Intestinal Phase: Reflexes Direct Digestive
Action

Figure 21-18: The intestinal phase of gastric function

 Intestinal Phase: NEURAL RESPONSE

 High OsM of the chyme

 Neural osmoreceptors
 Sitmulates neural
secretion of an
unknown blood-borne
substance
 Inhibits gastric
motility
 Inhibits acid
secretion.
 Intestinal Phase: EXOCRINE RESPONSE
 Pancreatic bicarbonate secretions
 Secretin stimulates bicarbonate release.
 Neutralize HCl, add bile & enzymes

 Pancreatic exocrine enzyme secretions

 CCK stimulates pancreatic release of inactive enzymes
 Figure 21-20

 Liver adds bile via gall bladder

 CCK stimulates gall bladder contraction
 Bile; a non-enzyme
 Bile salts
 Act as detergents

 Bilirubin
 cholesterol
 Intestinal phase: intestinal secretions

 Bicarbonate
 Brush border enzymes
 Peptidases
 Disaccharidases
 Enteropeptidase
 Activates inactive pancreatic enzymes
 Stationary enymes
Jejunum-Ileum
 Nutrients will be reabsorbed
along the jejunum-ileum

 Brush border contains villi

which increase the surface
of absorption

 The villi are structured for

nutrient absorption
Colon
 Reabsorb water from food
and digestive juices
Gastrointestinal system
 Overview
 Digestion of nutrients
 Absorption of nutrients and water
 Principles of GI regulation
 GI secretion and regulation
 GI motility and regulation
 Steps in food digestion

1 2
 1- Carbohydrates ---> disaccharides ---> monosaccharides

 2- Proteins ---> peptides ---> amino acids

 3- Lipids ---> diglycerides ---> monoglycerides and

fatty acids
Absorption of carbohydrates

 Monosaccharides (mostly glucose) are

absorbed

 The monomers are carried by transporter

molecules across the epithelial cells and into
the blood capillary present in the villus →
portal vein → liver
Disaccharidases
Carbohydrate absorption in the intestine

Hydrolysis to simple sugars

Absorption: transport
Na+/ glucose symport
Fructose GLUT
Figure 21-24: Carbohydrate absorption
To ECF → capillary
Absorption of proteins

 Proteins are degraded into amino acids (a.a.)

 A.a. are carried by transporter molecules across

the cells and into the blood capillaries → portal
circulation → liver
Lipid absorption
 Lipids (triglycerides) are
degraded to monoglycerides and
fatty-acids.
 They are absorbed into the cell
by diffusion. The cell
resynthesizes triglycerides.
Because TG are not soluble in
H2O, the TG are surrounded
with proteins and packaged into
chylomicrons
 The chylomicrons are emptied
into lymphatic capillaries, the
lacteal → lymph circulation →
blood → cells and liver
Bile salts and fat digestion

Figure 21-23: Bile salts

Let’s remember what “fat” is. . .

 Phospholipids
 Triglycerides
 cholesterol
 Diet
Content Pritikin U.S. Average

Fat* 10-15% 33%

Saturated fat* <3% 11%
Protein* 15-20% 15%
Carbohydrates* 65-75% 52%
Fiber >40g/d 15.6g/d
High-fiber, whole-
grains
≥ 5 serv./d 1.0 serv./d
Fruits & Vegetables ≥ 7 serv./d 4.8 serv./d
Cholesterol <100mg 265mg
* = % of calories
NHANES IV (1999-2000), NHANES III (1988-94), CDC/NCHS.
U.S.D.A.’s Continuing Survey of Food Intake. (1994-1996).
Figure 21-26: Fat digestion and absorption
 Absorption of minerals
▪ Sodium: active absorption in
jejunum-ileum. Chloride follow by
electromagnetic attraction.
▪ Potassium: passive secretion or
absorption, depending on lumenal
concentration → if diarrhea,
hypokalemia due to loss of K+
▪ HCO3-: secreted by pancreas,
neutralizes H+ from stomach. Used
as a buffer
▪ Water: Two liters of fluids are
taken as food or drink per day. In
addition, 7 liters are used to
secrete digestive juices → need to
reabsorb most of H2O.
▪ H2O reabsorbed throughout the
small and large intestines. Colon is
especially designed to reabsorb
H2O.

▪ Calcium: need an active transport

to cross the intestinal epithelium.
Absorption promoted by a derivative
of Vit D

▪ Iron: actively reabsorbed. Stored as

ferritin
Gastrointestinal system
 Overview
 Functional anatomy of the GI system
 Digestion and absorption of nutrients and water
 Fate of nutrients in the liver
 Principles of GI regulation
 GI secretion and regulation
 GI motility and regulation
 Fate of nutrients
▪ Glucose:
- used as needed by liver cell
- blood stocked on glucose
- glycogen syntesized
- TG synthesized if needed and
sent to adipose tissue

▪ Amino acids:
- used to restock the blood
- used by the liver to synthesize its
own proteins
- used to synthesize blood proteins
- if excess: a.a. are deaminated →
NH2 used to make urea and the
rest used for energy or stored as
TG

▪ Lipids (next slide)

Lipids
http://www.lipidlibrary.co.uk/Lipids/lipoprot/index.
htm
Absorptive state
Post-absorptive state
Gastrointestinal system
 Overview
 Digestion of nutrients
 Absorption of nutrients and water
 Principles of GI regulation
 GI secretion and regulation
 GI motility and regulation
GI secretion and regulation

 Need to regulate GI function to

changing states (after or before
meals..)
 Sensors: 3 different receptors:
- mechanoreceptors: monitor
state of distention
- chemoreceptors monitor
concentrations of substances in
the lumen
- osmoreceptors monitor
osmolarity of lumen contents
 Integrating centers: CNS and
enteric NS
 Effectors: endocrine, exocrine
cells, smooth muscles
Control pathways
 Both hormonal and neural
 Short pathways: involves automatic regulation within the enteric
system itself
 Long pathways: involves the CNS (somatic and autonomic)
 Three phases: cephalic, gastric and intestinal phases
Cephalic phase: salivary and gastric
secretions
 Salivary secretion stimulated by
parasympathetic NS by odors,
sight, taste → saliva fluid and rich
in enzymes
 Stimulated by sympathetic NS
→thick secretion, rich in proteins

 Gastric secretion: increase acid

and enzymes secretion in
response to sight, smell and taste
of food
Gastric phase
 Stimuli: presence of food
in the stomach (both
distention and nutrients)
 Stimulation of the
parasympathetic NS and
secretion of gastrin
(hormone)
 Response: increased
motility and juice
secretion
Intestinal phase
 Arrival of nutrients in duodenum → decreased gastric
secretion and motility

 Promotes secretion of cholecystokinin (CCK) and

secretin
- CCK promotes:
- increased pancreatic enzyme secretion
- gallbladder contraction and sphincter of Oddi
relaxation
- secretin promotes:
- bicarbonate ion secretion (pancreas)
- bile secretion
Gastrointestinal system
 Overview
 Digestion of nutrients
 Absorption of nutrients and water
 Principles of GI regulation
 GI secretion and regulation
 GI motility and regulation
Motility and its regulation
 The wall has 2 layers of
smooth muscles with
radial and longitudinal
fibers. The fibers
communicate through
gap junctions
 The parasympathetic
NS stimulates smooth
muscle contraction
 Peristalsis: waves of
contraction of
longitudinal muscle
fibers moving down
the GI tract
 Segmentation: in small
intestine→ for mixing
chyme
 Chewing and
swallowing:
Gastric motility

 Gastric motility increases with the

presence of gastrin and decreased under
the influence of CCK, secretin and gastric
inhibitory peptide (GIP)

 Vomiting:
 - emotional stress, severe pain, illnesses,
toxins stimulate the vomiting center in the
medulla oblongata
 sensation of nausea, increased HR, skin
paleness is followed by food coming back up
Motility in the small intestine

 Segmentation and peristalsis increased by

distention of the wall

 Intestino-intestinal reflex: severe distention or

injury inhibits motility in the region.

 Ileo-gastric reflex: distension of ileum inhibits

gastric motility

 Gastro-ileal reflex: presence of chyme in stomach

increases motility in ileum
Motility in the colon

 Haustration: like segmentation, for mixing

 Colono-colonic reflex: distension in 1 part of the
colon induces relaxation in other parts
 Gastro-colic reflex: a meal in the stomach
increases colonic motility

 Defecation:
- triggered by distention of the rectal wall
- signal sent to sacral parasympathetic and cortex
- smooth muscle anal sphincter open
- if the person decides to go to the bathroom →
open voluntary muscle sphincter
Intestinal Phase:
Large Intestine, H2O Absorption & Defecation

Figure 21-27: Anatomy of the large intestine

Clinical applications

 Diarrhea: can be due to bacterial,

parasite infections, toxins, bowel
irritation
 Laxatives:
 - bulk-producing agents
 Stool softeners
 Hydratants (salines and osmotic)
 Stimulant or irritant
 Intestinal obstruction
 Hirshprung disease
 ANY QUESTIONS??
GUT LUCK
GOD BLESS U ALL....