Gastrointestinal Physiology

ADEYEMI D.H.
Department of Physiology
CHS, UNIOSUN
 Course Outline
 Physiologic anatomy of the gastrointestinal tract
 Review of smooth muscle function
 Secretions in the G.I.T and their control
 Gastric motility and emptying
 Motor pattern of the small intestine
 Colonic motility
 Digestion and absorption of various food
substances
 Liver and its functions
 Disorders of G.I.T
 The Gut as an endocrine organ
 Physiologic Anatomy of the Gastrointestinal
• Alimentary canal – mouth,
pharynx, esophagus, stomach,
small intestine (duodenum,
jejunum, ileum), colon, rectum
and anus
• Associated glandular organs
salivary glands, liver gallbladder
and pancreas
• Other accessory GIT structures
are teeth and tongues
• This tract is a ‘disassembly line’
for easy absorption of nutrients and
elimination of waste end product
 Main functions of the GI
Gastrointestinal system functions can be broadly grouped
into:
1. Mechanical activities of the GIT
2. Absorption of nutrients from the gut lumen into the
blood stream
These activities can be further divided into:
• Motility
• Secretion
• Digestion
• Absorption
• Defecation
Tongue
Functions include:
Gripping and repositioning
of food during chewing
Mixing food with saliva
and forming the bolus
Initiation of swallowing
Note: Lingual frenulum
secures the tongue to the
floor of the mouth
Mouth
Oral or buccal cavity:
Is bounded by lips, cheeks,
palate, and tongue
Has the oral orifice as its
anterior opening
Is continuous with the
oropharynx posteriorly
To withstand abrasions:
The mouth is lined with
stratified squamous
epithelium
The gums, hard palate, and
dorsum of the tongue are
slightly keratinized
 Salivary Glands
 Parotid – lies anterior to the
ear between the masseter
muscle and skin
 Parotid duct – opens into
the vestibule next to the
second upper molar
 Submandibular – lies along
the medial aspect of the
mandibular body
 Sublingual – lies anterior to
the submandibular gland
under the tongue
 Permanent Teeth
Teeth are classified according
to their shape and function:
Incisors (8)– chisel-shaped
teeth adapted for cutting
Canines (4) – conical or
fanglike teeth that tear or
pierce
Premolars (8) (bicuspids) and
molars (12) (cuspid) – have
broad crowns with rounded
tips and are best suited for
grinding or crushing
Overview of the GI System
Functions of the Gastrointestinal Tract
1. Chewing (mastication)
2. Swallowing Four Basic Digestive Processes
(deglutition)
3. Gastric motility • MOTILITY
4. Motility of the small
• SECRETION
intestine
5. Motility of the colon • DIGESTION
6. Defecation (Passage of
faeces • ABSORPTION
 Blood Supply(Cont’d)
Blood Supply: Splanchnic Circulation

Arteries and the organs they serve include:

The hepatic, splenic, and left gastric: spleen, liver, and
stomach
Inferior mesenteric and superior mesenteric: small and large
intestines

Hepatic portal circulation:

Collects nutrient-rich venous blood from the digestive
viscera
Delivers this blood to the liver for metabolic processing and
storage
 Innervation
The wall of the GIT contains many neurons that are highly
interconnected.
A dense network of nerve cells in the submucosa forms the
submucosa plexus (Meissners’ plexus).
Between the circular and longitudinal muscle is the myenteric plexus
(Auerbach’s plexus)
GIT is supplied by both sympathetic (SN) and parasympathetic
nerves (PN). Most of the SN terminate in the submucosa and
myeneteric plexus, while PN supplies the whole GIT (mouth- anus).
Gastrointestinal Tract Secretions and their Control
GIT from the mouth to the anus, produces secretions that
make it possible for the tract to perform its functions of
mixing, propulsion, digestion and absorption of nutrients.
The main secretions of the GIT are:
1. Saliva (secretions of salivary glands)
2. Gastric secretions
3. Pancreatic secretions
4. Secretion of bile by the liver
5. Secretion of the small intestine
6. Secretion of the large intestine
 Salivary Secretion
Functions of Saliva
Digestion
Ptyalin (α-amylase): It is identical to pancreatic amylase
- cleaves α-1,4-glycosidic bonds of carbohydrates
- 75 % of starch, pH optimum 7
- functionally replaceable by pancreatic enzyme
Lingual lipase: It digests triglycerides
– lower acidic optimum
– remains active throughout the stomach and into the proximal
duodenum
Dissolves dietary constituents
Increases the sensitivity of taste buds
 Composition of Saliva and its Neural Regulation
1. Water- 95% of serous secretion

2. Alpha amylase (ptyalin)

3. Electrolytes (Na, K+, Ca, Cl-,

HCO3, and thiocyanate)

4. Mucin

5. Lysoxyme

6. blood group factor

7. Carbonic anhydrase

8. Lingual lipase
Anatomy of the Stomach and Gastric Secretion
Glands of the stomach
Cardiac glands: Enterochromaffin
cells (EC), Enterochromaffin-like
cells (ECL) and chief cells are
present in the cardiac glands.

Fundic glands These are chief

cells (pepsinogen), parietal cells
(oxyntic), Mucus cells, EC and ECL.

N.B: Parietal cells are different

from other cells of the gland
because of the presence of
canaliculi
Anatomy of the Stomach and Gastric Secretion
Parietal cells empty their secretions into
the lumen of the gland through the
canaliculi. But, other cells empty their
secretions directly into lumen of the
gland.

Pyloric Glands
Pyloric glands are short and tortuous in
nature. These glands are formed by G
cells, mucus cells, EC cells and ECL cells.

Enteroendocrine cells: these are the

hormone-secreting cells present in the GIT
particularly stomach and intestine. The
enteroendocrine cells are G cells, EC cells
and ECL cells
Secretory Functions of Gastric Gland
Composition of Gastric Juice
 Functions of Gastric Secretory Products
Hydrochloric acid
- conversion of pepsinogen to pepsine
- bacteriostatic effect
- Intrinsic factor
- binds B12 vitamin, absorption in the ileum
- the only indispensable substance in gastric juice
- Pepsin
- protein digestion
- replaceable by pancreatic enzymes
- Mucus
- protective coating, lubricant
- part of gastric mucosal barrier
 Phases of Gastric Secretion
I. Cephalic phase II. Gastric phase III. Intestinal phase
 Mechanism of Enzymes Secretion
Glycolytic enzymes
- secreted as active enzymes
- pancreatic α-amylase
- cleaves starch and glycogen into di- and trisacharides

Lypolytic enzymes
- secreted as active enzymes
- pancreatic lipase
- glycerol + fatty acids
 Gastric Motility

It allows the stomach to serve as a reservoir for large

quantity of food ingested until it can be accommodated
in the lower segments of the GIT
It helps in mixing the food inside it with gastric
secretions so that digestion can begin and the mixing
helps to form a semi-fluid mixture called chime.
It helps in emptying gastric contents into the small
intestine at a rate suitable for proper digestion and
absorption by the small intestine.
 Regulation of Gastric Motility

The rate of gastric emptying is regulated by signals from both the

stomach and the duodenum e.g.,
a. Distension of the stomach by food leading to generation of
nervous signals.
b. Presence of certain types of food in the stomach caused the
hormone gastrin to be released from the antral mucosa
Both a & b increase the force of antral peristalsis (pyloric
pumping) and at the same time inhibits the pyloric sphincter,
promoting stomach emptying
 Regulation of Gastric Motility

In the duodenum, excess volume of chyme or excess of certain

types of chyme in the duodenum initiates strong negative
feedback signals which are both nervous (enterogastric reflex) and
hormonal and these signals depress the pyloric pump and
increase the pyloric sphincter tone.
 Digestion of food substances
• Food can be grouped into three major classes which are
carbohydrates, proteins and fats.
• These food substances are not useful to the body in their
ingested form and hence, the need for proper digestion
and absorption.
• The basic principle behind digestion is hydrolysis which
involves the breakdown of water molecules to its
constituent hydrogen and hydroxyl parts and in the
process breaking down the large food classes into their
constituent units.
• This is catalyzed by digestive enzymes secreted from
different parts of the GIT.
 Digestion of food substances
• Absorption of food substances takes place mostly in the
small intestine and involves the basic principles of
membrane transport.
• The small intestine is well suited for this role due to the
presence of folds in the absorptive mucosa called
valvulae conniventes which increase the surface area of
the absorptive mucosa;
• The presence of villi on the intestinal epithelial cell also
increases the absorptive surface area and the presence
of the brush border at each villus which is made up of
1000 microvilli also increases the absorptive surface
area.
 Digestion and absorption of carbohydrates
• The most common form of carbohydrate found in
food is starch. Others are sucrose and lactose.
• Digestion of carbohydrates begins in the mouth via
the action of the amylase enzyme, ptyalin, which is
secreted from the parotid gland. The enzyme
hydrolysis starch into disaccharides.
• The action of ptyalin on starch continues with
swallowing of the food into the stomach and only
becomes inactivated when the stomach pH
becomes acidic due to secretion of gastric acid
from the parietal cells.
 Digestion and absorption of carbohydrates
• As much as 30-40% of starch is hydrolyzed to
maltose before gastric acidity inactivates it.
• When the chyme is passed into the duodenum,
pancreatic amylase is released from the pancreas
to complete the hydrolysis of starch.
• The cells lining the villi of the small intestine
contain the enzymes lactase, sucrase, maltase,
and α-dextrinase, which are capable of splitting
lactose, sucrose, and maltose into
monosaccharides.
 Digestion and absorption of carbohydrates
• Lactose splits into a molecule of galactose and a
molecule of glucose.

• Sucrose splits into a molecule of fructose and a

molecule of glucose.

• Maltose splits into multiple molecules of glucose.

• Glucose accounts for about 80% of the end-

product of carbohydrate digestion.
 Digestion and absorption of carbohydrates
• Absorption: Absorption of glucose from the intestinal lumen occurs
only via co-transport with sodium.
• First there is active transportation of sodium ions from the intestinal
epithelial cells into the blood, via Na-K-ATPase, thereby depleting
sodium inside the epithelial cells.
• The decrease of sodium inside the cells causes sodium from the
intestinal lumen to be transported into the cells. The movement of
sodium is via a co-transporter called the sodium-glucose transporter 1
(SGLT1).
• Therefore, movement of sodium into the intestinal cells from the
lumen, via SGLT1, must be accompanied by transportation of glucose.
• Once inside the intestinal epithelial cell, glucose is transported into the
blood stream via a process of facilitated diffusion which occurs with
the aid of a transport protein called the glucose transporter 2 (GLUT2).
 Digestion and absorption of carbohydrates
• Absorption of galactose follows the same pattern
as that of glucose.
• However, fructose absorption from the intestinal
lumen into the intestinal epithelial cells occurs via
GLUT5 transport protein and not through sodium
co-transport.
• On entering the cell, fructose becomes converted
to glucose and is then transported into blood.
Carbohydrate Absorption
 Digestion and absorption of proteins
• Digestion of proteins begins in the stomach via
the action of pepsin which is formed when the
inactive pepsinogen becomes activated by gastric
acid.
• Pepsin action in the stomach accounts for only
about 10% of protein hydrolysis in the stomach.
• It is however very important in the initial
breakdown of collagen fibres found in meat
products which enables other digestive enzymes
to complete its digestion.
 Digestion and absorption of proteins
• Once the chyme enters the duodenum, it is acted
on by pancreatic proteolytic enzymes which are
trypsin, chymotrypsin, carboxypolypeptidase and
elastase.
• Trypsin and chymotrypsin split protein molecules
into small polypeptides
• Carboxypolypeptidase cleaves individual amino
acids from the carboxyl ends of the polypeptides.
• Elastase digests elastin fibers that partially hold
meats together.
 Digestion and absorption of proteins
• Peptidase enzymes which are found in the
microvilli breaks the remaining large polypeptides
into amino acids, dipeptides and tripeptides.
• These are then absorbed into the intestinal
epithelial cells mainly via sodium co-transport
where other peptidase enzymes found within the
enterocytes breaks the remaining di- and
tripeptides into amino acids which is the final
product of protein digestion.
Protein Absorption
 Digestion and absorption of fats
• Digestion of fats begins with the secretion of lingual
lipase from the Ebner's gland of the mouth.
• The lingual lipase is also active in the stomach and
can digest as much as 30% of dietary triglyceride.
• However, majority of fat digestion occurs in the small
intestine.
• The first step in the intestinal fat digestion is a
process called emulsification.
• This step involves the breakdown of the fat globules
into very small sizes so that the digestive enzymes
can act on the globule surfaces.
 Digestion and absorption of fats
• The emulsification of fats is influenced by the
release of bile from the liver.
• After emulsification, the fat globules are easily
hydrolyzed by the enzyme pancreatic lipase,
breaking them down into free fatty acids and 2-
monoglycerides.
• The cholesterol portion of the fats are digested by
the enzyme cholesterol ester lipase.
• The bile salts also accelerate the digestion of fats by
facilitating the removal of the end products of
already digested fats from intestinal lumen.
 Digestion and absorption of fats
• This is achieved via formation of globules, called
micelles, from 20-40 bile salt molecules which
encapsulates individual free fatty acid and 2-
monoglyceride molecules.
• This is an important step because the presence of
end products of fat digestion in the intestinal
lumen inhibits the digestion of new fat molecules.
• The micelles also help to transport the free fatty
acids, monoglycerides and cholesterol to the
intestinal brush border for absorption.
 Digestion and absorption of fats
• At the brush border, the end products diffuse out
of the micelle and enter into the intestinal
epithelial cell.
• Long-chain fatty acids undergo esterification to
form triglycerides. These triglycerides become
coated with proteins and phospholipids to form
chylomicrons, which are then absorbed into the
circulation via the lymphatic system.
• Short- and medium-chain fatty acids are absorbed
directly into the circulation via the portal
circulation.
 Liver and its functions
• The largest single
organ in the human
body.
• In an adult, it weighs
about three pounds
and is roughly the
size of a football.
• Located in the upper
right-hand part of
the abdomen,
behind the lower
ribs.
 Gross Anatomy
Introduction
• The liver is divided) into four • The liver is the only human organ
lobes: the right (the largest that has the remarkable property of
lobe), left, quadrate and self-regeneration. If a part of the liver
caudate lobes. is removed, the remaining parts can
grow back to its original size and
• Supplied with blood via the shape.
portal vein and hepatic artery.

• Blood carried away by the

hepatic vein.

• It is connected to the
diaphragm and abdomainal
walls by five ligaments.

• Gall Bladder
– Muscular bag for the storage,
concentration, acidification
and delivery of bile to small
intestine
 Introduction
• Hepatocyte—functional
unit of the liver
– Cuboidal cells
– Arranged in
plateslobules
– Nutrient storage and
release
– Bile production and
secretion
– Plasma protein synthesis
– Rich in mitochondria,
golgi bodies etc
 Introduction
Microscopic Anatomy
• Kuppfer cells
– Phagocytic cells
• Fat Storing Cells
• Sinusoids
– Fenestrated vessel
– Wider than capillaries
– Lined with
endothelial cells
– Blood flow
• Branches of the
hepatic artery
• Branches of the
Hepatic portal vein,
central vein
• Bile canaliculi
 Functions of liver

• The liver has more

than 200 functions,
including:

– Storage of Nutrients
– Breakdown of
erythrocytes
– Bile Secretion
– Synthesis of plasma
Proteins
– Synthesis of
 Functions of liver
• An important function of the liver is to serve as a
filter between the blood coming from the GI tract
and the blood in the rest of the body.
• Blood from the intestines and other viscera reach
the liver via the portal vein.
• This blood percolates in sinusoids between plates
of hepatic cells and eventually drains into the
hepatic veins, which enter the inferior vena cava.
• During its passage through the hepatic plates, it is
extensively modified chemically.
 Metabolic functions
(a) Carbohydrate metabolism
– Gluconeogenesis (synthesis of glucose from certain amino
acids, lactate or glycerol)
– Glycogenolysis and glycogenesis (breakdown of glycogen to
glucose/ formation of glycogen from glucose)
b) Hormone metabolism
c) Synthesis of fatty acids, lipoproteins, cholesterol
d) Protein metabolism
e) Synthesis of plasma proteins
f) Urea synthesis (ammonia to urea)
g) RBC production (1st trimester of fetus)
 Storage of Nutrients

• Hepatocytes absorb and store excess nutrients in the blood

– Glucose (glycogen)
– Iron
– Retinol (Vitamin A)
– Calciferol (Vitamin D)

• Nutrients released when levels are too low

 Breakdown of Erythrocytes
Breakdown of Erythrocytes

• RBC’s have a life span of 120 days.

• RBC’s weaken and rupture, releasing
hemoglobin into the blood plasma.
• Hemoglobin is absorbed by
phagocytosis by Kuppfer cells in the
liver.
• Hemoglobin is split into
– Heme groups
• Iron is removed from heme
leaving a substance called
bilirubin (bile pigment).
– Iron is carried to
bone marrow where
it is used to new
hemoglobin for RBC’s
– Bilirubin becomes a
component of bile
– Globins
• Hydrolysed to amino acids • An electron micrograph of a Kupffer cell from the liver.
The Golgi apparatus (marked with arrows and *) is well
and returned to the blood developed. The dark granules associated with the Golgi
saccules are lysosomes. At the cell surface, identify the
filopodial processes.
 Secretion of Bile
• This is the most important function of the liver in
relation to the GIT. i.e. emulsification of fat and
absorption of fat.
• It is formed within the bile canaliculi located
within the hepatocytes.
• The bile contains water, bile acids, cholesterol,
bilirubin and electrolytes.
• The bile is either released directly into the
duodenum via the common bile duct or stored in
the gall bladder.
 Secretion of Bile
• Release of bile from the gall bladder is stimulated
by cholecystokinin which is released from the
duodenum in response to presence of fatty chyme
in the duodenum.
 Secretion of Bile
Bile Secretion
• Bile Contents
– HCO3- (Bicarbonate)
– Bile salts
– Bile pigment
– Cholesterol

• Stored in gall bladder

– Concentrated
– acidified

• Discharged into small intestine via bile duct

 Synthesis
Protein of (Synthesis
metabolism Plasma Proteins
and storage)
 The liver is the principal site of synthesis of all circulating proteins, which are produced in
the reticuloendothelial system.

 Plasma contains 60–80 g/L of protein, mainly in the form of albumin, globulin and
fibrinogen .
 Albumin main functions are first to maintain the intravascular oncotic (colloid osmotic)
pressure, and second to transport water-insoluble substances such as bilirubin, hormones,
fatty acids and drugs.

 The liver also synthesizes all factors involved in coagulation ( fibrinogen, prothrombin,
factors V, VII, IX, X and XIII, proteins C and S and antithrombin as well as components of
the complement system)
 
 The liver stores large amounts of vitamins, particularly A, D and B12, vitamin K and folate),
and also minerals – iron in ferritin and haemosiderin and copper.

• As The liver receives amino acids degraded by transamination and oxidative

deamination ammonia, converted to urea excreted by kidneys.
 Synthesis of Plasma Proteins

• Produced by RER of Hepatocytes

• 3 main types
– Albumin
– Globulin
– Fibrinogen
 Synthesis of cholesterol
• Produced by hepatocytes
• Some used for bile production
• Some trasnsported for use in the rest
of the body
– Synthesis and repair of cell
membranes or stored in the
liver.
– Precursor by testis, ovaries or
the adrenal gland to make
steroid hormones.
• progestins
• glucocortoids
• androgens
• estrogens
• mineralocortoids
– It is also a precursor to vitamin
 Hormone
Hormoneand
and drug inactivation
drug inactivation
• The liver catabolizes hormones such as insulin, glucagon,
estrogens, growth hormone, glucocorticoids and
parathyroid hormone.

• It is also the prime target organ for many hormones (e.g.

insulin). It is the major site for the metabolism of drugs
and alcohol .

• Fat-soluble drugs are converted to water-soluble

substances that facilitate their excretion in the bile or
urine.
 Immunological function
Immunological function
• The reticuloendothelial system of the liver contains many
immunologically active cells.

• The liver acts as a sieve for the bacterial and other

antigens carried to it through the portal vein from G.I.T.,
they are phagocytosed by Kupffer cells, these cells secrete
interleukins and tumour necrosis factor (TNF).

• The reticuloendothelial system plays a role in tissue repair,

T and B lymphocyte interaction, and cytotoxic activity in
disease processes.