The Digestive System

Contents:
Digestion Treatment of Ulcer
Mechanism of Action of PPI
GI System Parts short Description
Ulcer
Types of Ulcer
What is Peptic Ulcer?
GERD
Zollinger Ellison syndrome
Erosive Esophagitis
H. Pylori
Digestion:

The chemical Lipids to fatty acids

breakdown of
complex Proteins to
biological individual amino
molecules into acids
their component
parts. Carbohydrates into
simple sugars

Phases of Digestion
Ingestion
Peristalsis
Digestion
Absorption
 The Digestive System

COMPONENTS:
 Mouth
 Esophagus
 Stomach. ACCESSORY DIGESTIVE ORGANS
 Small Intestine  Teeth
 Tongue
 Large Intestine
 Gallbladder
 Salivary Glands
 Liver
 Pancreas
 Enzymes

Enzymes are protein molecules in cells

which work as catalysts. 
Enzymes speed up chemical reactions in
the body, but do not get used up in the
process.
Almost all biochemical reactions in living
things need enzymes.
With an enzyme, chemical reactions go
much faster.
MOUTH

Teeth mechanically break

down food into small
pieces.
Tongue mixes food with
saliva (contains amylase
enzyme, which helps
break down starch).
ESOPHAGUS
Approximately 20 cm long.
Functions include:
Secrete mucus
 Mucus, viscous fluid that moistens, lubricates,
and protects many of the passages of the
digestive and respiratory tracts in the body.
Moves food from the throat to the
stomach using muscle movement called
peristalsis
 STOMACH

 J-shaped muscular bag that stores the food we eat, breaks it

down into tiny pieces.
 Gastric acid is secreted to break down food
 Mixes food with Digestive Juices that contain enzymes to
break down Proteins and Lipids.
 Food found in the stomach is called Chyme.
 The stomach takes around 4 hours to do it’s job on the food,
depending on what kinds of food are digested.
 STOMACH PARTS
 Cardia
 Contains the cardiac sphincter
 Prevents food from traveling back up your esophagus
 Fundus
 Helps to breathe
 Body
 Contraction & mixing of food
 Antrum
 It holds food until your stomach is ready to send it to your small intestine. Enzyme pressent
 Pylorus
Pepsin
 Pyloric sphincter Gastric juice (HCL)
 When and how your stomach contents move to small intestine
 STOMACH LINING (PARIETAL
CELLS)
Parietal cells (also known as
oxyntic cells)
Are the epithelial cells that secrete
hydrochloric acid (HCl)
Located in the gastric glands found
in the lining of the fundus and in the
cardia of the stomach.
 SMALL INTESTINE

Small intestines are roughly 7 meters long.

Lining of intestine walls has finger-like
projections called villi, to increase surface
area.
The villi are covered in microvilli which
further increases surface area for absorption.
SMALL INTESTINE

Nutrients from the food pass into the

bloodstream through the small intestine
walls.
Absorbs:
 80% ingested water
 Vitamins
 Minerals
 Carbohydrates
 Proteins
 Lipids
 LARGE INTESTINE

About 1.5 meters long

Accepts what small intestines don’t
absorb
Rectum (short term storage which
holds feces before it is expelled).
 FUNCTIONS OF THE LIVER
Largest internal organ
Functions:
 Filters and processes nutrient-rich blood of carbohydrates,
proteins, and lipids from intestine
 Production and regulation of cholesterol
 Production of bile which emulsifies fats
 Removes drugs and hormones from circulation
 Storage of vitamins and minerals
PANCREAS

Pancreatic Juice secreted by acinar cells

Islets of Langerhans release insulin and glucagon (important in
glucose metabolism)
Pancreatic Juice contains:
 Sodium Bicarbonate (buffers HCl in stomach)
 Proteases (break down polypeptides/ protein)
 Pancreatic amylase (digests oligosaccharides and disaccharides into
monosaccharides)
 Pancreatic lipases (break down lipids into fatty acids and glycerol)
 Pancreatic nucleases (break down nucleic acids)
DISEASE PART
 ULCER

An open sore on an external or internal surface of the body,

caused by a break in the skin or mucous membrane which fails
to heal.
A peptic ulcer, also known as peptic ulcer disease (PUD), is the
most common ulcer
 TYPES OF ULCER

Gastric ulcers: ulcers that develop inside the

stomach.
Esophageal ulcers: ulcers that develop inside the
esophagus.
Duodenal ulcers: ulcers that develop in the upper
section of the small intestines, called the duodenum.
SYMPTOMS:
Abdominal pain, epigastric pain strongly related to
mealtimes.
In case of duodenal ulcers the pain appears about three
hours after taking a meal.
Loss of appetite and weight loss
Hematemesis (vomiting of blood)
 PEPTIC ULCERS
This occurs when the thick layer of mucus that protects
G.I. tract from digestive juices is reduced, thus
enabling the digestive acids to eat away at the lining
tissues of G.I. tract .

Peptic Ulcer can form on the lining of the stomach

(gastric ulcer), duodenum (Duodenal ulcer) or the
esophagus (Esophagitis).
 SIGN & SYMPTOMS OF
PEPTIC ULCER
Pain in ulcerated area
Nausea
Vomiting
Weight loss
Dark blood in stool.

Causes
A bacterium called H.pylori
Excessive use of NSAIDs
Smoking
Caffeine
 GASTRO-OESOPHAGEAL
(GORD) OR GASTRO
ESOPHAGEAL REFLUX
DISEASE (GERD)
Gastric reflux disease, or acid reflux
disease
Chronic symptom of mucosal damage.
Caused by stomach acid coming up from
the stomach into the esophagus.
GERD is usually caused by abnormal
relaxation of the lower esophageal
sphincter.
 GORD SYMPTOMS

Heartburn
Regurgitation (reflux of mixture of gastric juices & undigested
food)
Difficulty in swallowing (dysphagia)
Increased salivation (also known as water brash)
 NERD (NON EROSIVE REFLUX DISEASE)

Presence of classic GORD symptoms in the

absence of esophageal mucosal injury during
upper endoscopy
 EROSIVE ESOPHAGITIS

Esophagitis is a term used to indicate any inflammation, swelling, or irritation of the

esophagus. The esophagus becomes inflamed (swollen, irritated and red).

SYMPTOMS OF ESOPHAGITIS
Difficulty when swallowing
Pain when swallowing
Acid reflux (heartburn)
Bleeding, either as blood in vomit or in stools (turning stools black)
 REFLUX ESOPHAGITIS

Reflux Esophagitis is inflammation of esophagus usually caused

by reflux of food contents from stomach to the esophagus.

Signs & Symptoms

 Heartburn , water brash
Abdominal discomfort,
 Nausea, bloating and fullness
 BARRETT'S ESOPHAGUS

Barrett's esophagus is a serious complication of

GERD.
In Barrett's esophagus, normal tissue lining
the esophagus -- the tube that carries food from the
mouth to the stomach -- changes to tissue that resembles
the lining of the intestine.
 ZOLLINGER–ELLISON
SYNDROME
It is caused by a non–beta islet cell, gastrin-secreting tumor that stimulates the acid-
secreting cells of the stomach to maximal activity, with consequent gastrointestinal
mucosal ulceration.
SIGNS AND SYMPTOMS:
Pain in the esophagus, especially between and after meals at night
Nausea
Wheezing
Vomiting blood (digested blood)
Malnourishment
Loss of weight due to loss of appetite
 HELICOBACTER PYLORI

Helicobacter pylori (H. pylori) is a gram negative bacilli.

In stomach, H. pylori is able to change the environment around
them.
By reducing the acidity they can survive.
Their shape lets them penetrate stomach lining.
H. pylori destroy mucus coating due to which HCL damages
stomach or duodenum muscular layer .
H. pylori may cause gastric ulcer, duodenal ulcer.
 NSAIDS INDUCED GASTRO-INTESTINAL ULCER

Prostaglandins PGs protect GI mucosa and increases bicarbonate

ions production that neutralize gastric acidity.
NSAIDs act by inhibiting PGs synthesis, leads to reduction of
bicarbonate ions synthesis and reduced mucus production, which
causes gastro-duodenal ulcers.
TREATMENT OPTIONS
TREATMENT OPTIONS ACID RELATED DISORDERS

Antacids that neutralize stomach acid. 

(Aluminum hydroxide and magnesium hydroxide)
Histamine (H-2) blockers
These medications include ranitidine, famotidine, and cimetidine
 TREATMENT OPTIONS ACID RELATED DISORDERS
PROTON PUMP INHIBITORS

Omeprazole

Lansoprazole

Esomeprazole

Pantoprazole
PPIs block secretion of hydrogen ions into the stomach.
Rabeprazole

Dexlansoprazole
PROTON PUMP

Proton pumps are a special kind of transporter that push hydrogen ions from areas
of low concentration to areas with high concentration.
Occur in Parietal cells.
Involved in production of gastric acid
 MODE OF ACTION OF PPI

The PPI binds irreversibly to a

hydrogen/potassium ATPase enzyme
(proton pump) on gastric parietal cells.
Blocks the secretion of hydrogen ions,
which combine with chloride ions in
the stomach lumen to form gastric acid.