Introduction to General Principles

of Gastrointestinal Function

Dr Waqar Ahmed Siddiqui

Physiologic Anatomy of the
Gastrointestinal Wall
• The gastrointestinal tract is a continuous tube that
stretches from the mouth to the anus.

• Its primary function is to serve as a portal whereby

nutrients and water can be absorbed into the body
• Food is mixed with a variety of secretions that arise
from both the gastrointestinal tract itself and
organs that drain into it, such as the pancreas,
gallbladder, and salivary glands.
Movement of food through the digestive system
chewing and swallowing peristalsis

Secretions- exocrine (digestive enzymes and other

components)

Digestion- catabolism (hydrolysis of macromolecules)

Absorption- into blood

Elimination –of indigestible substances

Mucosa- absorption and secretion

Sub mucosa- supports mucosa highly

vascularized (absorption)

Muscularis-inner circular and outer

longitudinal layer; innervations stimulated
by parasympathetic nerves also intrinsic
system

Serosa- outer membrane

Chewing and swallowing are voluntary, the
rest of the process is not

Peristalsis pushes food through the esophagus

to the stomach

Esophageal sphincter keeps food from

regurgitating to the esophagus
Secretions of the stomach

Mucus- goblet cells

HCl- parietal cells
Pepsinogen (pepsin)- chief cells
Gastrin- G cells
Entrochromaffin-like- histamine, serotonin
Somatostatin- D cells
Intrinsic factor- parietal cells (necessary for
absorption of vitamin B12)

These all contribute to gastric juice

Why is stomach so acidic?

To digest proteins (pepsin works optimally

at low pH)

Very little is absorbed through the stomach

Peptic ulcers: erosions of the mucous membranes

most are caused by bacteria (H. pylori)

Treatment of gastritis
bicarbonate
histamine blockers
avoidance of acid-stimulating foods
Small intestine i.e duodenum, jejunum, ileum
Most food molecules are absorbed in duodenum and jejunum

Bile salts, water, electrolytes in ileum

Villi and microvilli facilitate absorption. gastrointestinal

epithelium is one of the most rapidly dividing tissues in the body
epithelial cells renewed every 2-7 days. These microvilli are
endowed with a dense glycocalyx (the brush border) that
protects the cells to some extent from the effects of digestive
enzymes.
Some digestive enzymes are also part of the brush border, being
membrane-bound proteins. These so-called "brush border
hydrolases" perform the final steps of digestion for specific
nutrients.
Large intestine

Consolidation of waste
Absorbs water , electrolytes and vitamins

Bacterial flora in intestine help ferment molecules

otherwise indigestible

Diarrhea
transport of salt into intestine, followed by water
inflammation
lactose intolerance
Secretory role of liver, gall bladder, pancreas

Liver secretes bile (via gall bladder) which

facilitates digestion of fat

Pancreatic juice helps with digestion in small

intestine

Liver performs a number of essential

functions
Detoxification of blood
Kupffer cells
conversion of toxic molecules to more
innocuous ones

Blood glucose to glycogen and back

Lipid metabolism- production and excretion

of cholesterol; ketone bodies

Synthesis of plasma proteins

Synthesis and secretion of bile

Gall bladder

Stores and concentrates bile

Gall stones
cholesterol has low solubility; clusters with
lecithin and bile salts in micelles

when these calcify they form gall stones

Pancreas

Exocrine and endocrine gland

Acini and islets of Langerhans secreting insulin

respectively

Pancreatic juice- water, bicarbonate, amylase,

lipase, trypsin- among others

Many are synthesized in inactive form

How and where does digestion happen?

Mouth- salivary amylase starts to digest starch

completed in small intestine (brush border)

Protein digestion- begins in stomach, completed

with help of pancreatic enzymes

Lipids- emulsified by bile salts, digested in small

Intestine eventually rebuilt into triglycerides
transported to blood via lymph
Innervation of GIT
• Autonomic nervous system comprising of
• Extrinsic nervous system ( sympathetic and
parasympathetic nervous system)
• Parasympathetic nervous system is usually stimulatory to GIT
and sympathetic nervous system is usually inhibitory to GIT.
• Intrinsic nervous system (enteric nervous system) it is
composed of
• Mynteric plexus( Auerbach’s plexus):- concerned with
motility of GIT
• Submucosal plexus( Meissner’s plexus):- concerned with
secretion and blood flow.