CHAPTER 7 Gastrointestinal tract

1. Gastrointestinal tract is made up of mouth → anus. With accessory organs such as teeth, tongue, salivary
glands, liver, gallbladder, pancreas.
Function: ingestion, digestion, absorption, storage, secretion and excretion.

2. Oral physiology
① Hard palate: hard surface to smash food against
② Soft palate and uvula which move together to form a valve that helps make sure food flows down
instead of going up into the nose.
③ Salivary gland – lubricate food and have amylase to break down the carbohydrates.
④ Epiglottis: seals the airway off to prevent the food going into the lung.

3. 4 Layers of tissue (from esophagus to anus)

① Adventitia/ serosa – outermost fibrous / slippery serous membrane accordingly
② Muscularis externa
A. inner circular (changes the diameter of the tube so it constricts the tube behind the food), outer
longitudinal (shortens the tube) → perform peristalsis
B. Myenteric plexus/ Auerbach’s plexus: between the longitudinal and circular there’s a plexus or
networks of nerves which help coordinate muscle contraction and relaxation. When activated
causes smooth muscle relaxation.
③ Submucosa:
A. Consist of dense layer of tissue that contains blood vessels, lymphatics and nerves
B. Submuous plexus/ Meissner’s plexus: responsible for helping to control the size of the blood
vessels and secretion of digestive juices is present.
④ Mucosa : innermost lining
Consist of 3 cell layers
A. Muscularis mucosa(muscularis interna) – outermost, layer of smooth muscle that contracts and
help break down food
B. Lamina propria: contain blood and lymph vessels
C. Epithelial layer: absorb and secretes mucous and digestive enzymes.

4. Control by nervous and hormone

⑤ Nervous control
A. Extrinsic: mostly vagus
a. Parasympathetic- increase blood flow (Ach and vasoactive intestinal peptide), secretion
motility and decrease constriction of sphincters.
b. Sympathetic (mostly from thoracic and lumbar region). NE and ATP decrease the blood flow
(vasoconstriction)
B. Intrinsic – enteric nervous system: cause vasodilation
a. Myenteric plexus
b. Submucous plexus
⑥ Hormonal control
Substance Releasing Stimulus Structures acted on Primary function
cells
 Cholecytokinin I cells in Fats, fatty acids, amino Exocrine pancreas, Increase pancreatic
(CCK) duodenum acids in duodenum gallbladder and enzyme secretion,
stomach contracts gallbladder,
constriction of pyloric
sphincter
Gastrin G cells in Peptides, amino acids in Stomach Increased acid secretion
stomach gastric lumen, stomach and motility of stomach.
distention

GIP K cells in Fats and glucose in Stomach and Inhibits acid secretion
*GIP- gastric duodenum duodenum pancreas and releases insulin.
inhibitory
peptides
Motilin M cells Fat acid Smooth muscle. Increase MMC and
contraction
The migrating motor
complex (MMC) is a
cyclic, recurring motility
pattern that occurs in
the stomach and small
bowel during fasting;
Secretin S cells by Low pH in duodenum Pancreas and ↑HCO3 from pancreas
duodenum stomach and ↓gastric motility
and acid secretion

Ghrelin P/D cells of Before meals Hypothalamus ↑GH, ACTH, cor sol and
stomach (hunger) PRL (prolactin)

⑦ Paracrine
Substance Releasing cells Structures acted on Primary function
Histamine Enterochromaffin like cells Stomach Increase acid secretion
NO Numerous Smooth muscle, blood Relaxation of smooth
vessels muscle, increase blood flow
Prostaglandins Numerous Mucosa Increase mucus and HCO3-
secretion
Somatostatin D cells of pancreas, duodenum Parietal cells of stomach Inhibits secretion of
and stomach and beta cell of pancreas, hormone
PRL

5. Stages of gastric secretion.

① Cephalic phase (feed forward control)
A. Involves chemoreceptors and mechanoreceptors, located in mouth and nasal cavity
B. Stimulated by tasting, chewing swallowing, thought and smelling of food
C. This triggers reflexes to stimulate gastric secretion (parasympathetic vegal activation)
D. The parasympathetic nervous activity regulates 2 regions
a. In the fundic region, Ach stimulate parietal cells increase gastric secretion. It also act on
enterochromaffin cells located adjacent to the parietal cells to increase the secretion of
histamine.(paracrine)
b. antrum: increase gastrin secretion, which stimulates the parietal cells
② Gastric phase (local reflex)
A. Begin when food enters the stomach
B. Distention of stomach wall and contents (such as amino acid and peptides) stimulates gastric
secretion.
 C. Gastrin-histamine stimulation will increase acid production
D. Accounts for 70% of gastric secretion
③ Intestinal phase.
A. Left the stomach and entered into the small intestine. (acidic and high osmolarity food)
B. The constituents of the food such as proteins, fats and CHO will inhibit Gastric secretion which is
inhibited via enterogastric reflex and hormonal mechanism (e.g.secretin, CCK and GIP)
C. Enterogastric reflex
a. The H proton will act on the D cells of antrum which secrete somatostatin which binds to
the G cells
b. Secretin, GIP and CCK from duodenum travel via the blood and binds to the G cells
c. ↓gastric motility and emptying.

6. Stomach
① Have extra layer of muscularis externa: oblique middle, which helps the stomach to expand and
contract.
② Gastric pit dives down into the gastric glands which contain a variety of secretory cells
A. Gastric secretion contain HCl (kill and digest) mucus (protects the stomach), pepsin (enzyme that
chops up proteins) and water ( which turns the bolus into chyme)
B. pH of gastric secretion is 1.0~3.5
C. Secretory cells
a. Surface and neck cells
- Secretes mucus, (CHO rich) which adheres to stomach wall, and protects the gastric
mucosa from acidic secretion.
- Present in all area.
b. Parietal cells
- Present in fundus and body
- Produce
 HCl (digestion of protein starts here) increase by Ach gastrin and histamine.
 Intrinsic factor: a carrier required for the absorption of vit B12 by the ileum. (B12
is necessary for the formation of RBC if insufficient – pernicious anemia)
c. Chief cells
- Present in fundus and body
- Secretes pepsinogen (type of proenzyme/zymogens) converted to pepsin when acid is
present. Peptin breaks down protein into polypeptide
d. G cells: produce gastrin. Present in antrum of stomach
*peptic ulcers can result from ↑HCl, ↓mucous (due to drgus like NSAIDS) and H.pylori
Tx is by 3 ways – bicarbonate, histamine receptor antagonist, and proton pump inhibitor (brand name “pirosec
③ Acid secretion
A. Requires carbonic anhydrase CO2 + H2O = H2CO3 = HCO3- + H+
B. The proton is transported into the lumen of the stomach via the H-K ATPase (proton pump) and
the HCO3 exits from the basal surface(blood vessel) of the parietal cell via HCO3-Cl antiporter.
The chloride than exits at the luminal side of the Cl channel and form HCl

④ Chyme
A. Semi-liquid contents of the stomach
a. Consist of partially digested foods and gastric secretion
b. Passes through pyloric valve into duodenum
B. Volume and composition of chyme affect gastric mobility and gastric emptying.

7. Gastric emptying : a very slow process where the chyme moves from the stomach into the duodenum
(takes about 4 hours)
① It is slow because the duodenum needs to neutralize the acidic chyme, fatty meals also decrease the
gastric emptying lastly hypertonic
② Carbohydrate: in response to the CHO and secretes glucagon like peptide -1 and GIP work on the
pancreas beta cells which secretes insulin.
③ Fats and peptides: stimulate secretion of CCK
A. Act on the exocrine part of the pancreas acinar cells which secretes proenzymes through the
duct into the duodenum. (the trypsin is present in the duodenum and activates the proenzymes)
B. Causes contraction of Gall bladder will secrete bile through duct into the duodenum. Bile is a
detergent necessary for the digestion of the fats.
④ Secretin inhibits the G cell and also signals the pancreas duct cells to release bicarbonate to
neutralize the acid.
8. Digestion and absorption
① CHO
A. Digestion
a. Amylase
- breaks the 1-4 bonds of the starch (have 1,4 and 1,6 bonds). The amylase is produced
by salivary glands and pancreas
- ptyalin (α- amylase) is secreted by parotid glands.
- Hydrolyze the starch into disaccharide.(mostly in maltose)
b. Disaccharidases: breaks down disaccharide into monosaccharide.
- Present on brush border of small intestines
- Lactase, sucrose, maltase, and alpha-dextrinase.
c. Some CHO can’t be digested and absorbed which are cellulose, gums and pectins.
B. Absorption
nd
a. The monosaccharides are absorbed by Na cotransport (2 active transporters driven by the
sodium gradient) -2 Na ions with galactose or glucose with small water
b. Fructose absorption is mediated by facilitated diffusion. (GLUT-5)
c. When the CHO are taken from enterocytes to portal circulation it is by GLUT-2
d. Glucose transporters: membrane protein that facilitate the transport of glucose across the
plasma membrane with facilitated diffusion.
- GLUT1: highest in erythrocytes and BBB endothelial cells, bidirectional
- GLUT2: bidirectional present in renal, small intestine, liver and pancreatic Beta cells
(high frequency low affinity)
- GLUT3: bidirectional, expressed mostly in neurons and in placenta. (high affinity)
- GLUT4: bidirectional expressed in adipose tissue and striated muscle. (insulin-regulated
glucose transporter)
- GLUT5: in testes
② Protein
A. Digestion
a. Pepsin, trypsin and chymotrypsin hydrolyze the protein into oligopeptides
b. Trypsin activates other brush border enzymes.
c. The peptidase A and B (present on brush border) hydrolyze into amino acid and short
peptides.
B. Absorption
a. Small part – phagocytosis
b. Majority- Na or H co-transport mechanisms (different transporters are needed for different
classification of amino acids)
③ Lipids
A. Digestion
a. Lipase
- Lingual lipase and pancreatic lipase.
- Can break down tryglycerides into glycerol backbone and fatty acid
 b. Cholesterol esterase breaks down cholesterol ester into cholesterol and fatty acids.
c. Bile salts emulsify the fats
d. Colipase bind with lipase to undergo tryglyceride digestion ‘
B. Absorption
Mixed micelles happen because the lipids tend to cluster together in an aqueous env.
④ Majority of the absorption occurs in the jejunum. Bile acids are absorbed by the ileum
⑤ *duodenum absorbs – Fe (active transport, ferrous form is more easily absorbed than oxidized form,
enhanced by vit C) , jejunum – folate, and ileum –B12
⑥ Small intestine absorbs majority of the water with sugar and protein, the large intestine concentrates
the feces more, in cases of lacking the transporters that can move the nutrients the solutes act as
water keeper and the water can’t be absorbed. Diarrhea causes the net loss of sodium and
bicarbonate
⑦ Large intestine also absorb sodium and vit K aside from water and bicarbonate and mucus are
produced for protective purposes.

9. Motility
① Coordinated contraction and relaxation of the 2 muscle layers located in the muscularis externa.
② Enteric nervous system
A. The movement along the GI tract is regulated by the local enteric nervous system which is
modulated by Parasympathetic and sympathetic (make it hyperpolarization) – long reflex
B. Each plexus (short reflex) is a weblike formation of neurons that expands throughout the GI tract.
The web is composed of ganglia and connected to each other with multiple interneurons. Some
interneurons travel from submucosal plexus to myenteric plexus.
C. When food enters the chemoreceptors and mechanoreceptors send afferent information and
synapse with submucosal plexus which sends signal to glands and enteroendocrine cells that
help digestion and absorption. It also cause b.v. to dilate to bring more blood flow to GI tract.
D. Myenteric plexus are in charge of contraction of the smooth muscle.
E. Myenteric plexus has pacemaker cells (called Cajal cells) the electrical slow waves occur
spontaneously as cycles of depolarization and repolarization. When these slow waves reach to
the threshold it causes action potential and the muscle contracts. As for the stomach sometimes
the slow waves causes contraction too.
③ Patterns of the motility
A. Peristalsis (progressive movement)
a. Coordinated contraction with relaxation ahead.
b. Propels chyme forward
c. Outer muscle layer contracts and inner muscle layer relaxes to shorten the tube.
 d. Controlled by the enteric nervous system by local reflexes (stimulated by distention)
B. Segmentation(mixing)
a. Most common in small intestine. Are cyclic contraction of the muscle in local segments
which force the chyme to slosh back and forth for short distances. This is by inner circular
muscle.
b. Rhythmic contraction in a piece of gut
c. Chops chyme and mixes it with digestive enzyme juices
d. Ensures chyme comes into maximum contact with the gut wall to increase surface area for
digestion and absorption
e. Stimulated by distention
f. Occurs at rate of 11~ 12 cycles/min in duodenum rate declines along the length of the
intestines.
C. Tonic contraction: occurs at the sphincters
a. The sphincters have thicker inner circular muscle.
b. The tonic inhibition is always present. To open the sphincter turning off tonic inhibition
must be turned off.
D. Migrating motor complex: sweeps the GI tract clean during period of fasting to prevent bacterial
overgrowth due to stagnant food contents. Motilitin are thought to be involved with MMC.
E. Mass movements: waves of contraction that propel semi-solid feces into distal colon and then
into rectum and anal canal. Involves the inner circular layer of the muscularis externa.

10. Pancreas
① Pancreatic secretion is stimulated by Ach, CCK and secretin
② Acinar cells secretes enzymes for
A. Protein breakdown: trypsin, chymotrypsii and carboxypepsidase.
B. CHO breakdown: pancreatic amylase.
C. Fat breakdown: lipase, cholesterol esterase, and phospholipase.
③ Secretes bicarbonate fluid with a pH of 8.0~8.3

11. Liver: consist of hepatocytes, organized with sinusoids (blood vessels) and bile ducts.
① With the Kupffer cells (mononuclear phagocytes) that line the sinusoids forms part of the
lymphoreticular system (along with macrophages in the lymphoid tissue and spleen) and play an imp.
role by capturing and digesting bacteria, fungi, effete blood cells, and cellular debris.
② Produces blood clotting factors I, II, VII, IX, X and XI.
③ Bile
A. Produced by the liver
B. Stored in the gallbladder
C. pH of 7.8 and act as emulsifier
D. CCK stimulates the release of bile from gallbladder
④ Function
A. Stores mineral and vitamins (forms bile essential for fat digestion and absorption of fat-soluble
vitamins, and produces and stores this vitamin and vitamin B12)
B. Stores Fe as ferritin
C. Synthesize cholesterol and Conjugates steroids
Cholesterol is important for synthesis of bile salts, steroid hormones and vit, D
The synthesis of cholesterol is regulated by – feedback. Statin allosterically inhibits HMG CoA
reductase
 D. Metabolize CHO, lipid and protein and regulate blood glucose level.(during prolonged starvation
the kidneys become major glucose-producing organs)
E. Detoxifies
a. Water soluble toxins and waste can be eliminated via the kidney in the urine, but non-water
soluble toxins need to be chemically modified by the liver to allow this to occur.
b. First pass metabolism of drugs.

F. Destroy damaged RBC

G. Secretes bile.
a. Bile is made up of water, cholesterol, phospholipids, bicarbonate, bile pigments and bile
salts.
b. Produced by liver and stored in the gallbladder and discharge into the duodenum upon
eating
⑤ Glucokinase: converts glucose to glucose-6-phosphate using ATP to catalyze phosphorylation. (other
tissues use hexokinase)
⑥ Ethanol alcohol (EtoH) metabolism
A. Ethanol → acetaldehyde (highly toxic substance and carcinogen)
a. Enzyme: alcohol dehydrogenase
b. Produce NADH
B. Acetaldehyde → acetate
a. In mitochondria
b. Produce NADH
c. Acetate is eventually metabolized in the muscle to CO2 and water
C. ↑ NADH produc on with alcoholism → ↑ gluconeogenesis and FA synthesis → steatosis (is
abnormal retention of fat (lipids) within a cell or organ)
⑦ Jaundice – caused by increased levels of bilirubin in the blood.
A. Sublingual is the first location to spot jaundice.
B. Bilirubin: derived from broken-down hemoglobin (The heme-oxygenase act on heme to form
biliriverdin which in turn is converted into bilirubin.)
a. Bilirubin. Biliverdin and bilirubin are termed bile pigments. Bilirubin is not water-soluble
(unconjugated bilirubin) and needs a carrier (albumin) to be transported.
b. It is then conjugated with glucuronic acid by glucuronyltransferase at the liver and becomes
conjugated bilirubin (water-soluble)
c. Excreted into the intestine as a component of bile.
d. Normal plasma : -.5mg/100mL
e. In jaundice, can rise to 40mg/100mL