PHYSIOLOGY

OF
DIGESTIVE SYSTEM

Bahredin Abdella
.
 Introduction
The gastrointestinal system carries out the following activities:
 Ingestion: food intake, which is controlled by the feeding and
satiety center in the Hypothalamus (HT)
 Mastication or chewing: mechanical grinding of food with the
aid of the teeth.
 Swallowing or deglutition: propulsion of food from the mouth to
the stomach.
 Chemical digestion of food
 Secretion of enzymes, electrolytes (HCl, NaHCO3), mucus, and
hormones
 Absorption of nutrients, water and electrolytes into the blood
 Elimination: excretion of fecal matter through the process of
defecation
2
 Functional Structures of Digestive System
 Organs involved in the process of digestion are:

Principal structures that make up the alimentary canal: –

mouth, pharynx, esophagus, stomach, small intestine and
large intestine
Accessory structures: – teeth, tongue, gallbladder, salivary
glands, liver and pancreas
 Teeth aids mechanical breakdown of food

 Tongue assists chewing and swallowing

 Other accessory organs produce and send secretions that

facilitate chemical breakdown of food

3
 …cont’d
Mouth: Foodstuffs are broken down mechanically by
chewing and saliva is added as a lubricant
Esophagus: A simple conduit between the mouth and
stomach
Stomach: enzymatic digestion of proteins initiated and
foodstuffs reduced to liquid form.
Liver: The center of metabolic activity in the body - its
major role in the digestive process is to provide bile salts
to the small intestine, which are critical for digestion and
absorption of fats.

4
 Digestive organs

5
 …cont’d
Pancreas: Important roles as both an endocrine and
exocrine organ - provides a potent mixture of digestive
enzymes to the small intestine which are critical for
digestion of fats, carbohydrates and protein.
Small Intestine: The most exciting place to be in the
entire digestive system - this is where the final stages of
chemical enzymatic digestion occur and where almost all
nutrients are absorbed.
Large Intestine: Major differences among species in
extent and importance - water absorption, bacterial
fermentation takes place and feces are formed. In large
intestine critical importance for utilization of cellulose
exist.
6
 The Digestive Process
 Ingestion
Taking in food through the mouth
 Motility (movement of food)
Mastication, Swallowing
Peristalsis – propulsion by alternate contraction &relaxation
Segmentation, mass movement
 Mechanical digestion
Chewing
Churning in stomach
Mixing by segmentation
 Chemical digestion
By secreted enzymes: see later
 Absorption
Transport of digested end products into blood and lymph in wall
of canal
 Defecation
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Elimination of indigestible substances from body as feces
8
 Histology of the Alimentary Canal
 From esophagus to the anal canal the walls of the GIT have
the same four layers (from the lumen to outward)
1. Mucosa,
2. Submucosa ,
3. Muscularis externa, and
4. Serosa
 Each layer has a predominant tissue type and a specific
digestive function

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10
A. Mucosa

 Moist epithelial layer that lines the lumen of the alimentary canal

 Its three major functions are:

Secretion of mucus

Absorption of the end products of digestion

Protection against infectious diseases

 Consists of three layers:

1. A lining epithelium,

2. Lamina propria, and

3. Muscularis mucosae
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 1. Epithelial Lining:
Two types of epithelial cells along the GIT:
i. Non-keratinized stratified squamous epithelium: mouth,
esophagus and anal canal
Function: protection
ii. Simple columnar epithelium: through out the rest of the
tract Function: absorption and secretion
The mucus secretions:
 Protect digestive organs from digesting themselves
 Ease food along the tract
Stomach and small intestine mucosa contain:
 Enzyme-secreting cells
 Hormone-secreting cells (enteroendocrine cells)

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2. Lamina Propria:
Contains connective tissues, blood vessels and lymph vessels

Nourishes the epithelium and absorbs nutrients

Contains lymph nodes important in defense against bacteria

3. Muscularis mucosae
Smooth muscle cells that produce local movements of mucosa

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 B. Sub-mucosal layer
 Consists of loose connective tissues, secretory glands, lymph
nodes and blood vessels
 The sub mucosal layer contains enteric nerve plexus
 This plexus controls secretions by the GIT.
C. Muscularis externa
 The muscularis of the mouth, pharynx, and upper esophagus
consists of skeletal muscles that produce voluntary swallowing.
 The skeletal muscle also forms the external anal sphincter, which
permits voluntary control of defecation.
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 Through out the rest of the tract, the muscularis consists of
smooth muscles that is generally found in two sheets:
 Inner sheet of circular fibers and
 Outer sheet of longitudinal fibers
 Involuntary contraction of both smooth muscles help
breakdown of food physically, mix it with digestive
secretions, and propel it along the tract.
 The muscularis also contains the major nerve supply to the
GIT; the myenteric plexus (plexus of Auer Bach), which
consists of fibers from both autonomic divisions.
 This plexus mostly controls GIT motility.

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D. Serosa

 The serosa is the outer most layer of the GIT

 It is a serous membrane composed of connective tissue
and epithelium.
 Below the diaphragm, this layer is also called the
visceral peritoneum.

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 Regulation of GIT
 Regulation of digestion involves:
1. Mechanical and chemical stimuli:– stretch receptors,
osmolarity, and presence of substrate in the lumen
2. Extrinsic control system by ANS
Sympathetic NS = ↓GI function
Parasympathetic NS = ↑GI function
3. Intrinsic control system by enteric NS
Submucosal plexus (plexus of Meissner)
Myenteric plexus (plexus of auerbach)

17 4. The GIT hormonal system

 Receptors of the GI Tract
 Mechanoreceptors: respond to distension, spastic contraction

 Chemoreceptors: respond to osmolarity, irritation, pH, presence

of fat and protein food and end products of digested food

 Thermoreceptors: respond to warm or cold food/drinks

 Pain receptors: respond to tissue injury

 The receptors initiate GI-reflexes that:

Activate or inhibit digestive glands

Mix lumen contents and move them along the GIT

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 Nervous Control of the GI Tract
 Intrinsic control system: involves the enteric nerve plexuses
present with in the GIT.
 Nerve plexuses near the GI tract initiate short reflexes
 Submucosal plexus (plexus of Meissner): controls GI secretory
activities
 Myenteric plexus (plexus of auerbach): controls motility of the gut
 Extrinsic controls: involve CNS centers and extrinsic
autonomic nerves
 Sympathetic NS = ↓GI function, ↓Motility
↓Secretions
 Parasympathetic NS = ↑GI function, ↑Motility,
↑Secretions

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 Autonomic control of the GIT
1. Parasympathetic innervations to the gut
It is divided into cranial and sacral division.

i. Cranial PSI are transmitted almost entirely in the vagus

nerves
 Providing extensive innervation to the esophagus,
stomach, pancreas, and first half of the large intestine (but
rather little innervations to the small intestine).
ii. Sacral PSI originate in the 2nd, 3rd and 4th sacral segments of

spinal cord and pass through the pelvic nerves to the distal
half of the large intestine.
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 Autonomic…cont’d
The sigmoidal, rectal and anal regions are better supplied with
parasympathetic fibers. → These fibers function in the defecation
reflexes.
The postganglionic neurons of the PNS are located in the myenteric
and submucosal plexuses
Stimulation of PNS causes a general increase in activity of the entire
enteric NS, enhancing GI function.
2. Sympathetic innervations
Sympathetic fibers to the GIT originate in the spinal cord between

segments T5 and L-2.

The pregangionic fibers after leaving the cord → enter the

sympathetic chains and pass through the outlying ganglia, such as

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the celiac ganglion and mesenteric ganglia.
 Autonomic…cont’d
The postganglionic fibers terminated in the enteric nerve

plexuses.
Sympathetic fibers innervate all portion of the GIT but more

extensive in the oral and anal areas.

Sympathetic nerve endings secrete norepinephrine.

In general, stimulation of SNS inhibits activities of GIT.

Strong stimulation of sympathetic system can totally block

GIT motility.

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NTs secreted by the enteric neurons
Acetylcholine (excitatory)
Nor epinephrine (inhibitory)
ATP
VIP (Vasoactive intestinal polypeptide)

Serotonin, Bombasin,
Somatostatin, Leu-enkephalin,
Met-enkephalin
Cholecystokinin (CCK)
Substance-p
Nitric oxide, Dopamine

Groups of neurons secreting NTs are:

Cholinergic
23 Adrenergic
Hormonal control of GI function
Intero-endocrine cells: produce several GIT hormones → capable
of regulation of motility and secretory activities.
A. Cholecytokinin (CCK, 33aas) (intestinal and pancriozymine)
Secreted by the mucosa of the duodenum and jejunum in
response to the presence of fatty food in the intestine.
Has a very potent effect on gall bladder contractility→ for
expelling bile into the intestine in order to facilitate fat digestion
and absorption.
Inhibits stomach motility in order to give adequate time for fat
digestion.
B. Secretin (27aas)
Secreted by the mucosa of the duodenum in response to acidic
gastric juice pumped from the stomach.
 It increases NaHCO secretion by the pancreas and other
3
pancreatic secretions.
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Hormonal control of …cont’d
C. GIP: Gastric inhibitory peptide (43 aas)
Secreted by the mucosa of the upper small intestine in response to fat

and carbohydrate meal in the intestine. It inhibits the motor activity of

the stomach.

D. Other GIT- hormones:-

Glucagon (29aas) - Substance-p
Glucagon like peptides (GLP) - VIP (28 aas)
Gastrin (17aa residues) - Bombasins
Somatostatin - Opiates
Metilin, metenkephalin - Lea-enkephalin
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 Blood Supply to Digestive System
 The blood vessels of the GI-system are part of a more extensive
system called the splanchnic circulation.
Splanchnic BF =1000 ml/min
 Includes blood flow through the GIT plus through the spleen,
pancreas and the liver.
 All of the blood that flows through the gut, spleen and pancreas
then passes into the liver by way of the portal vein.
 In the liver, blood passes through millions of liver sinusoids and
finally leaves the liver by way of the hepatic veins that empty into
the inferior vena cava of the general circulation.
 The advantage of sinusoidal passage of blood is that:
The reticulo-endothelial cells in the liver remove bacteria and
other particles → entering the blood from the GIT & preventing
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pathogens
 Blood Supply to… cont’d

 The superior mesenteric and inferior mesenteric arteries: supply

blood to the wall of small and large intestine.

 The celiac artery: supplies blood to the stomach.

 Big arteries are branched and re-branched to encircle and penetrate

deep into the mucosal villi layers of the gut wall.

 Blood flow to the GIT is increased by 100% during meal time.

 Possible causes:
 The release of vasodilator GI hormones during digestive
processes.
 E.g. CCK, VIP, gastrin, secretin, bradykinin, nitric oxide.

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Blood Supply to GIT (cont’d)

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 Blood Supply For GIT

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 … cont’d

• Local factors affecting blood flow to the gut

O2 concentration.
metabolic products
Metabolic demand

• Nervous control of GIT- blood flow

 PNS: increase gut blood flow
 SNS: decrease gut blood flow

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 Functional types of movements in the GIT
Two basic types of movements occur in the GIT:
1. Propulsive movements: which cause food to move forward along
the tract at an appropriate rate for digestion and absorption.
2. Mixing movements: which keep the GI contents thoroughly
mixed at all times.

A. Propulsive Movements (Peristalsis):

(Peristalsis)
 Peristalsis is the basic propulsive movements of the GIT that
appears in the form of contractile rings around the gut and
propels to the anal ward direction.
 It is an inherent property of the smooth muscles in the GIT that
generate action potential rhythmically (basic electrical rhythm,
BER).

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 Peristalsis Segmentation

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 Factors that initiate peristalsis
Distension (overstretching)

Irritation of epithelial lining

Nervous mechanisms: Parasympathetic nerve stimulation and

ENS:- myenteric plexus

Hormonal mechanisms: Gastrin, CCK, Insulin, Motilin

Drugs: ACh-like drugs: carbacoline, pilocarpin

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 Factors that inhibit peristalsis
Congenital absence of myenteric plexus: Hurschsprungs

disease or aganglionic megacoli

Drugs: Atropin, scopolamin, cholinergic antagonists

Nervous mechanism: stimulation of SyNS

Hormonal mechanisms: secretin, glucagon, GIP,

somatostatin, VIP, Sub-P

Paralytic ileus: Paralysis of intestinal motility that is caused

by increased in sympathetic stimulation and damage to the

smooth muscles
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 B. Mixing Movements
Segmentation
Most areas of the small intestine.
These movements churn and fragment the digestive
materials, mixing the contents with intestinal secretions.
Haustration
At the same time, the longitudinal muscle of the colon,
which is aggregated into three longitudinal strips called the
teniae coli, contracts.
These combined contractions of the circular and
longitudinal strips of muscle cause the unstimulated portion
of the large intestine to bulge outward into baglike sacs
called haustrations.

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 Mouth
 Oral or buccal cavity

 Bounded by lips, cheeks,

palate and tongue

 Has the oral orifice at its

anterior opening
 Lined with stratified

squamous epithelium
 The gums, hard palate, and

dorsum of the tongue are

36 slightly keratinized.
Palate
 Hard palate (Anterior)
Assists the tongue in chewing
Slightly corrugated
 Soft palate (Posterior)
Mobile fold formed mostly of skeletal muscle
Closes off the nasopharynx during swallowing
Uvula projects downward from its free edge
Tongue
 Occupies the floor of the mouth and fills the oral cavity when
mouth is closed
 Functions include:
Gripping and repositioning food during chewing
Mixing food with saliva and forming the bolus
Initiation of swallowing, and speech
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Contains taste buds
Tongue..cont’d
 Is a skeletal muscle
 Superior surface bears three
types of papillae (taste buds)
1. Filiform : give the tongue
roughness and provide
friction
2. Fungiform : scattered
widely over the tongue and
give it a reddish blue
3. Circumvallate : V-shaped
row in back of tongue
 Sulcus terminalis – groove that
separates the tongue into two
areas:
 Anterior 2/3 residing in the
oral cavity
 Posterior third residing in
the oropharynx
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 Lips and Cheeks
 Have a core of skeletal muscles
 Lips: orbicularis oris
 Cheeks: buccinators
 Vestibule: bounded by the lips
and cheeks externally, and teeth
and gums internally
 Oral cavity proper: area that lies
within the teeth and gums
 Labial frenulum: median fold
that joins the internal aspect of
each lip to the gum

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Teeth
 There are two sets of teeth:
1. Primary/deciduous
2. Permanent

 Primary: 20 deciduous teeth that erupt at intervals between 6 and

24 months
 Permanent: enlarge and develop causing the root of deciduous
teeth to be reabsorbed and fall out between the ages of 6 and 12
years
 All but the third molars have erupted by the end of adolescence
 Usually 32 permanent teeth
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Deciduous teeth Permanent teeth

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Classification of teeth
 Teeth are classified according to their shape and function

 Incisors: chisel-shaped teeth for cutting or nipping

 Canines: fanglike teeth that tear or pierce

 Premolars (bicuspids) and molars: have broad crowns with

rounded tips; best suited for grinding or crushing

 During chewing, upper and lower molars lock together generating

crushing force

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Dental Formula: Permanent Teeth
 A shorthand way of indicating the number and relative position of

teeth
 Written as ratio of upper to lower teeth for the mouth

 Deciduous: 2I (incisors), 1C (canine), 2M (molars) = 20

 Permanent: 2I, 1C, 2PM (premolars), 3M =32

2I 1C 2PM 3M X 2 =(32 teeth)

2I 1C 2PM 3M

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 Types of Teeth
 Incisors:
 Useful for clipping or cutting
 Have a single root.
 The cuspids, or canines:
 Used for tearing or slashing
 Have a single root.
 Bicuspids, or premolars:
 Used for crushing, mashing, and
grinding.
 Have one or two roots.
 Molars:
 Crushing and grinding
 Typically have three or more roots.
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Tooth and Gum Disease
 Gingivitis: as plaque accumulates, it calcifies and forms calculus.
 Accumulation of calculus:
Disrupts the seal between the gingivae and the teeth
Puts the gums at risk for infection
 Periodontitis: serious gum disease resulting from an immune
response
Clinical Application:
Gum Disease: gradual demineralization of enamel and dentin by
bacterial action
Dental plaque, a film of sugar, bacteria, and mouth debris,
adheres to teeth
Acid produced by the bacteria in the plaque dissolves calcium
salts
Rx.: Daily flossing and brushing help prevent caries
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 Ingestion of food
 Prehension: is the process of siezing or grasping or otherwise
getting food into the mouth.
 The amount of food that a person ingests is determined
primarily by the intrinsic desire for food (hunger or appetite).

Control of Food Intake and Body Weight:

1. Role of the central nervous system

2. Pre-gastric factors

3. Gastrointestinal and post-absorptive factors

4. Long-term controls
46
 …cont’d
a) Role of the Central Nervous System
It is controlled by two nuclei of the hypothalamus

a. The feeding center in lateral nucleus; that initiate us to

crave for food and the desire for a particular type of food is
determined by the feeding center.
b. The satiety center in the ventromedial nucleus of the
hypothalamus→ has an inhibitory effect on the appetite
center.

47
 …cont’d

b)Pre-gastric Factors
Appearance of food: humans like or dislike certain

meals based on visual appearance.

Taste and/or odor of food

Learned preferences and aversions

Psychological factors: mental states such as fear,

depression and social interactions often affect food

intake.
48
 …cont’d
c) Gastrointestinal and Post absorptive Factors
The degree of gastrointestinal fill is the most important signal
from the digestive tract
A full stomach and intestine induce satiety, probably via the vagus
nerve relaying that fact back to the hypothalamus.
Cholecystokinin: induce satiety in experimental settings, while the
hormone ghrelin seems to be a potent stimulator of appetite.
d) Long-term control of food intake
If an animal is starved for a long period of time, then allowed
access to food, it eats a far greater amount of food than a normal
animal.
Conversely, if an animal is force fed for several weeks, and then
allowed access to free choice food, it will not eat very much.
In both cases, when weight returns to "set weight," feeding
behavior normalizes.
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 Digestive processes in the mouth
 After food is ingested
 Mechanical digestion begins → chewing/mastication
 Propulsion is initiated → by swallowing
 Salivary amylase begins chemical breakdown of starch
 The pharynx and esophagus serve as conduits to pass food from
the mouth to the stomach

Mastication (Chewing)
 It is a process of mechanical breakdown of food.
 Salivary secretion containing amylase involves chemical digestion
and lubrication of the food.
 Teeth, tongue, jaws and lips are involved in chewing.

50
Chewing (Mastication)…cont’d
 Teeth are well adapted for this function as: incisors for cutting,
canine for tearing, molars and premolars for grinding.
 Mastication muscles are supplied mainly by the motor branch of
the trigeminal nerve.
 Chewing center is located in the pons
 The movement of these organs are controlled by such centers
located in the brainstem, hypothalamus, amygdala and cerebral
cortex.
 Chewing reflex:
The presence of food in the mouth→ reflex relaxation of the
mastication muscle → drop of the mandible → stimulation of the
stretch receptors → reflex contraction of the mastication muscle →
bolus of food pressed against the jaws→→→ the process
continues like this.
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 Pharynx
 From the mouth, the oropharynx and

laryngopharynx allow passage of:

 Food and fluids to the

esophagus
 Air to the trachea

 Lined with stratified squamous

epithelium and mucus glands

 Has two skeletal muscle layers:

 Inner longitudinal

52  Outer pharyngeal constrictors

Esophageal Characteristics
Muscular tube going from the laryngopharynx to the stomach
Travels through the mediastinum and pierces the diaphragm
Joins the stomach at the cardiac orifice
Esophageal mucosa: non-keratinized stratified squamous
epithelium
The empty esophagus is folded longitudinally and flattens
when food is present
Glands secrete mucus as a bolus moves through the
esophagus
Muscularis changes from skeletal (superior third) to smooth
muscle (inferior third)
The pharynx and esophagus serve as conduits to pass food
53
from the mouth to the stomach
 Deglutition (Swallowing)
 It is the propulsion of food from mouth to the esophagus i.e.
controlled by the swallowing center in the medulla.
 Involves the coordinated activity of the tongue, soft palate, pharynx,
esophagus and 22 separate muscle groups.
 Has 3 stages
1. Voluntary stage of swallowing:
 Buccal/oral phase→bolus is forced into the oropharynx
voluntarily.
2. Pharyngeal stage of swallowing:
 It is the involuntary process and contributes the passage of food
through the pharynx to the esophagus.
 Controlled by the medulla and lower pons.
3. The esophageal stage of swallowing:
 Involuntary phase, promotes the passage of food to the stomach.
54
 Deglutition (Swallowing)….cont’d
Bolus of food

Tongue
Uvula
Pharynx Bolus
Epiglottis
Epiglottis

Trachea Esophagus Bolus

(a) Voluntary stage, oral (b) Involuntary, (c) Esophageal stage of

phase of swallowing pharyngeal stage of swallowing
swallowing
Relaxed Relaxed
muscles Circular muscles contract,
muscles
constricting passageway
and pushing bolus down Gastroesophage
Bolus of food al sphincter
open
Longitudinal
muscles contract, Gastroesophageal reflux?
shortening Achalasia?
passageway ahead
Gastroesophageal
of bolus
sphincter closed Stomach

(d) (e)
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A. Pharyngeal stage of swallowing
As the bolus of food enters the pharynx, it stimulates stretch
receptors on the wall of pharynx and impulse is transmitted
to the swallowing center to initiate the following series of
changes.
Soft palate and uvula pulled upward to close the posterior
nares (nasal openings)
Vocal cords fasten together
Epiglottis close the superior opening of the larynx
Respiration is temporarily interrupted
Trachea is closed and esophagus is opened

Controlled by TGN, GPN, VN

56
B. Esophageal stage of swallowing
 It functions primarily to conduct food from the pharynx
to the stomach
 It exhibits two types of peristalsis:
1. Primary peristalsis:
 It is simply a continuation of the peristaltic wave that
begins in the pharynx.
2. Secondary peristalsis:
 It is additional peristaltic wave that is initiated by the
bolus of food distending the esophageal wall.
 It is initiated partly by the enteric NS and partly by
the vagus nerve.

57
 Effect of the Pharyngeal Stage of Swallowing on
Respiration
The entire pharyngeal stage of swallowing usually occurs in
less than 6 seconds, thereby interrupting respiration for only
a fraction of a usual respiratory cycle.
The swallowing center specifically inhibits the respiratory
center of the medulla during this time, halting respiration at
any point in its cycle to allow swallowing to proceed.
Yet even while a person is talking, swallowing interrupts
respiration for such a short time that it is hardly noticeable.

58
 Lower esophageal (Gastro-esophageal) sphincter
It is a thickened circular smooth muscle at the junction b/n
the esophagus and the stomach.
Function: prevents the reflux of gastric contents into the
esophagus.
Gastro-esophageal reflux:
It is the entry of gastric contents into the lower part of the
esophagus due to incompetence of the LES → that leads to
ulcer of the mucosa of lower esophagus.
Achalasia:
Failure of LES to be relaxed, swallowing is inhibited.
Caused by increased in tone of LES due to high sensitivity
to gastrin, weak esophageal peristalsis
59
Lower esophageal sphincter… GERD

60
 Functional structure of the stomach
 Chemical breakdown of proteins begins and food is converted to

chyme.
Cardiac region: surrounds the cardiac orifice
Fundus: dome-shaped region beneath the diaphragm
Body: midportion of the stomach
Pyloric region: made up of the antrum and canal which
terminates at the pylorus
The pylorus is continuous with the duodenum through the
pyloric sphincter

61
Stomach Structure…cont’d
 Greater curvature:
 entire extent of the
convex lateral
surface
 Lesser curvature:
 concave medial
surface

62
 Function of the stomach
Storage of large quantities of food until it can be pumped
into the duodenum.
Stomach can accommodate large amount of food up to 1.5
Liters.
Mixing of food with gastric secretion to form a semi-fluid
chyme.
Slow emptying the food from the stomach into the small
intestine at a rate suitable for proper digestion and
absorption by the small intestine.
Secretory function: HCl, mucous, pepsin, gastrin, IF
Sterilization, digestion, absorption
Facilitates defecation
63
 Movements in the stomach
Propulsive movement
Mixing movement
Receptive relaxation: relaxation of stomach muscles as food
moves through esophagus and enters stomach.
Hunger contraction: Strong contractions of the stomach
associated with hunger pains.
Glands distribution
Body of stomach secretes:
 Parietal cells (HCl, IF)
 Chief cells (pepsinogen)
Antrum
 G-cells (gastrin)
 Chief cells (pepsinogen)
64 Mucus producing cells: all parts
65
 …cont’d
Nerve supply:
sympathetic and
parasympathetic
fibers of the
autonomic nervous
system

Blood supply:
celiac trunk, and
corresponding veins
(part of the hepatic
portal system)
66
 Stomach Lining
 The stomach is exposed to the harshest conditions in the

digestive tract
 To protect stomach from digesting itself

 The stomach has a mucosal barrier with:

 A thick coat of bicarbonate-rich mucus on the stomach wall

 Epithelial cells that are joined by tight junctions

 Gastric glands that have cells impermeable to HCl

 Damaged epithelial cells are quickly replaced

67
 Response of the Stomach to Filling
Stomach pressure remains constant until about 1L of food is
ingested
Relative unchanging pressure results from reflex-mediated
relaxation and plasticity
Reflex-mediated events include:
Receptive relaxation: as food travels in the esophagus,
stomach muscles relax
Adaptive relaxation: the stomach dilates in response to
gastric filling
Plasticity: intrinsic ability of smooth muscle to exhibit the
stress-relaxation response

68
 Mixing and propulsion of food in the stomach: The BER of the
stomach

When the stomach is filled → weak peristaltic constrictor

waves, also called mixing waves move toward the antrum

along the stomach wall once every 20 seconds.
These waves are called basic electrical rhythm (BER).

BER causes mixing secretions with the food and propulsion

of stomach contents.
Peristaltic mixing and churning contractions begin in a

pacemaker area in the middle of the stomach and move

69 toward the antrum.
 Gastric Contractile Activity

70
 Regulation of Gastric Emptying
Gastric emptying is regulated by:
The neural entero-gastric reflex
Hormonal mechanisms: gastrin enhances gastric
secretion and duodenal filling
Intestinal hormones inhibit gastric secretion and duodenal
filling
Carbohydrate-rich chyme quickly moves through the
duodenum
Fat-rich chyme is digested more slowly causing food to
remain in the stomach longer

71
 Hormonal and neural factors that regulate stomach
emptying
Stimulatory stomach factors Inhibitory duodenal factors
Distension of the stomach Distension of the duodenum
Partially digested protein Fatty acids and glucose
Distension Partially digested protein
Alcohol, Caffeine
↑Secretion of
CCK Entero-gastric
↑Gastrin reflex
Sensory GIP
Secretion impulse via vagus Secretin

-Constrict LES
-↑Stomach motility ↓Stomach motility
-Relax pyloric sphincter ↑Pyloric sphincter tone

Stimulate
72 gastric emptying Inhibit gastric emptying
 Gross Anatomy of Small Intestine
 Runs from pyloric sphincter to
the ileocecal valve
 20 feet long &1 inch in diameter
 Large surface area for majority
of absorption
 Has three subdivisions:
Duodenum: the bile duct and
main pancreatic duct join the
duodenum
Jejunum: extends from the
duodenum to the ileum
Ileum: joins the large
intestine at the ileocecal valve
73
 Microscopic Anatomy of SI
 Structural modifications
of the small intestine
wall increase surface
area
 Plicae circularis: deep
circular folds of the
mucosa and sub mucosa
 Villi: finger-like
extensions of the mucosa
 Microvilli: tiny
projections of absorptive
mucosal cells’ plasma
membranes
74
 …cont’d

75
 Movement in the small intestine
Two types of movements occur in the SI:
Mixing movement
Propulsive movement

A.Mixing movements (segmentation contractions)

Ring like contractions appear at regular intervals with 2-3
cm distance
The cycle is repeated at a rate of 12 x/min in the
duodenum and 8/min in the ileum
Segmentation contractions exert chopping action on
intestinal chyme and mix it with digestive juices

76
 …cont’d
B. Propulsive movements

Are peristaltic waves that propels the chyme onward

through the intestinal tract.

Peristaltic waves travel at a speed of 0.5-5 cm/s

Initiated by intestinal distension

Chyme is propelled in the SI until it reaches the terminal

ileocecal sphincter
Peristaltic rush = diarrhea

77
 Ileocecal sphincter
 Function: prevents back flow of fecal matter from the cecum to

the ileum
 Factors regulating the sphincter

Pressure and chemical irritation of ileum relax it and initiates

peristalsis
Pressure and chemical irritation of cecum inhibit peristalsis of

ileum and closes the sphincter

78
 Large Intestine

79
 Movement in the large intestine
 Two types of movements

 Mixing movements

 Propulsive movements (mass movements)

 Mass movement is initiated by local distension → gastro-colic

reflex
 Poor motility of the transverse colon causes → greater

absorption and constipation

 Excess motility of the sigmoid colon → causes less absorption

and diarrhea or loose stool

80
81
 Defecation reflex

 Rectal Stimulation
distension of myenteric plexus

Initiates peristaltic waves in

descending colon,
sigmoid colon and rectum

Relaxation of IAS by
 parasym. Stimulation
 myenteric plexus

Peristaltic wave
Voluntary forces feces
Relaxation to the anus
of EAS

82 Defecation
 SECRETORY FUNCTIONS OF GIT
 Primary secretory products of GIT are:
 Digestive enzymes
 GI-hormones
 Mucus
 Electrolytes, HCl, NaHCO3
 GIT secretory glands
1. Goblet cells: mucous producing glands
2. Brunner’s gland: mucous glands
3. Crypts of Lieberkuhn: water and electrolytes
4. Gastric glands: Oxyntic, pyloric and mucous glands
5. Complex glands: salivary, pancreatic glands and liver
6. Enteroendocrine cells: produce hormones
• Secretory volume: 6~8 L/ day
83
 …cont’d

84
 Factors stimulating GIT secretions
 Local mechanical factors: distension, irritation, pH
 Nervous stimulation: ANS, ENS
Sympathetic stimulation: inhibits GIT-secretions
Parasympathetic stimulation: increases GIT-secretions
Meissner’s plexus: increases GIT-secretion
 Hormonal mechanisms:
Gastrin: increases HCl secretion
Secretin: increases NaHCO3 secretion from pancreas

Mucus
Function Composition
 Lubrication - Water
 Protection - Electrolytes
- Glycoproteins
85 - Polysaccharides
 Salivary Glands
Produce and secrete saliva
Saliva:
is a fluid that is continuously secreted into the mouth for
moistening, lubrication, dissolving and chemical
breaking down of food.
Saliva contains two major types of protein secretion:
(1)A serous secretion : contains ptyalin (an α-amylase) (pH:
6-7) → for starch digestion
(2)Mucus secretion: contains mucin → for lubrication and
surface protection

86
 …cont’d
 Three pairs of extrinsic salivary glands:
1. Parotid
2. Submandibular and
3. Sublingual
 Intrinsic salivary glands (buccal glands): scattered throughout
the oral mucosa
 Functions of Saliva:
 Cleanses the mouth
 Moistens and dissolves food chemicals
 Aids in bolus formation
 Contains enzymes that break down starch
 Contains antimicrobial agents for protection

87
 …cont’d
1. The parotid glands:
 Located inferior and anterior to the ears b/n the skin and the
masseter muscle.
 They secrete saliva into the mouth through the parotid ducts
(Stensen’s ducts) that pierces the buccinators muscle to open
into the second maxillary molars.
2. The sub-mandibular glands:
 Found beneath the base of the tongue in the posterior part of
the floor of the mouth.
 Their ducts, the submandibular (Wharton’s) ducts and
opened at the base of the lingual frenulum.
3. Sublingual glands:
 Located superior to the submandibular glands.
 Their ducts, the lesser sublingual (Rivinus) ducts open in to
the floor of the mouth.
88
89
 …cont’d
 Daily secretion of saliva 1000 - 1500 ml/day
 Secretion is controlled by:
 Nervous parasympathetic stimulation  salivary output
 Chemical stimulation of taste buds
 Mechanical stimulation
 Psychic stimulation → smell, sight, hearing about food
Source and Composition of Saliva:
 Secreted from serous and mucous cells of salivary glands
 A 97-99.5% water, hypo-osmotic, slightly acidic solution
containing
 Electrolytes: Na+, K+, Cl–, PO42–, HCO3–
 Digestive enzyme: salivary amylase
 Proteins: mucin, lysozyme, defensins, and IgA
 Metabolic wastes: urea and uric acid
90
 Lingual lipase
It is present in the serous (von Ebner) glands of the
tongue, where it is localized in zymogen granules
Human lipase purified from lingual serous glands or
gastric.
These enzymes are essential for the digestion of milk fat
in the newborn
Because, contrary to other digestive lipases (pancreatic or
milk digestive lipase), lingual and gastric lipases can
penetrate into the milk fat globule and initiate the
digestive process.

91
 Regulation of salivary secretion
 Totally controlled by the PNS

 Integrated at the salivatory centre in the medulla

 The salivatory nuclei control salivary glands

 Are stimulated by impulses from

 Sensory impulses from the tongue (taste, touch)

 Sensory impulses from esophagus, stomach, SI

 Impulses from the cerebral cortex (sight, smell)

 Impulses from the feeding centre in the hypothalamus

92
 Gastric Secretion
 The stomach mucosa has two important types of tubular
glands:
i. Oxyntic glands/gastric glands/acid-forming glands:
 secrete HCl, pepsinogen, IF and mucus.
 located on the inside surfaces of the body and fundus of
the stomach
 Constituting the proximal 80% of the stomach.
ii. Pyloric glands:
 secrete mucus for protection of the pyloric mucosa from
the stomach acid.
 also secrete the hormone gastrin.
 located in the antral portion of the stomach, the distal
20% of the stomach
93
 Components of gastric juice
Secretory volume: 1~2.5 L/d
Character:
Achromic
Acidity （ pH 0.9-1.5 ）
Component:
Water
Inorganic salt: HCl, HCO3-, Na+, K+, etc.)
Organics: pepsinogen, muco-protein & intrinsic factor

94
 …cont’d
 Pepsinogen:
Secreted by the peptic and mucous cells of the gastric glands
It comes in contact with hydrochloric acid, it is activated to form
active pepsin.
 Pepsin:
An active proteolytic enzyme in a highly acid medium (optimum
pH 1.8 to 3.5)
but above a pH of about 5 it has almost no proteolytic activity
 Intrinsic factor:
Essential for absorption of vitamin B12 in the ileum,
Pernicious anemia developed because of failure of maturation of
the RBCs in the absence of vitamin B12 stimulation of the bone
marrow.
 Gastrin: plays a key role in controlling gastric secretion
95
 Function of pepsinogen

protein
HCl
Pepsinogen Pepsin
pH 2-3.5
peptone

96
 Regulation of Gastric Secretion
 Neural, hormonal and mechanical mechanisms regulate
the release of gastric juice
 Stimulatory and inhibitory events occur in three phases
1. Cephalic (reflex) phase: prior to food entry

2. Gastric phase: once food enters the stomach

3. Intestinal phase: as partially digested food enters the

duodenum

97
 Secretion of the Small Intestine
Mucosa of the SI secretes:
 Digestive enzymes
 Mucous: protective and lubricant
 Electrolytes Intestinal secretory out put = 2-3 L/d, pH=7.0
 Hormones
Intestinal secretory glands:
1. Brunner’s gland: mucous glands, duodenal in distribution
2. Crypts of Lieberkun: mucous and electrolytes. Distributed in the
SI below the duodenum and in the LI.
3. Goblet cells: mucous glands
4. Enterocytes: digestive enzymes
5. Enteroendocrine cells: produce hormones
6. Enterochromaffin cells: serotonin producing cells
98
 …cont’d
The epithelium of the mucosa is made up of:

Absorptive cells and goblet cells

Enteroendocrine cells

Interspersed T lymphocytes

Cells of intestinal crypts secrete intestinal juice

Brunner’s glands in the duodenum secrete alkaline mucus

99
 Digestive enzymes secreted in the SI
1. Peptidase: splits peptides into amino acids
2. Four enzymes hydrolyzing dissaccharides into
monosaccharides: sucrase, maltase, isomaltase and lactase
3. Intestinal lipase: splits neutral fats into glycerol and fatty
acids.

Regulation of SI secretion
1. Local factors: tactile, distension, irritation, pH.
2. Hormonal: secretin, CCK, VIP, glucagon, GIP
3. Nervous:
 Vagal stimulation increases intestinal secretion
 Sympathetic stimulation decreases intestinal secretion
100
 Enteroendocrine cells
G-cells = secrete gastrin
S-cells= secrete secretin
I-cells = produce CCK
EG-cells = enteroglucagon and Glucagon-like
Peptide
Gland-cells = GIP and VIP
D-cells = Somatostatin
Other cells = motilin, substance-P

101
 Secretion of the large intestine

Glands

 Crypts of Lieberkuhn Secrete H2O, electrolytes

 Goblet cells and mucous

 Regulated by local (tactile) factors

102
 Duodenum and Related Organs

103
 THE PANCREAS
Pancreas Location:
 Lies deep to the greater curvature of the stomach
 Divided into: Head, body and tail
 The head is encircled by the duodenum and the tail abuts
the spleen
 Connected to the duodenum via the pancreatic duct (duct
of Wirsung) and accessory duct (duct of Santorini).

Pancreas contains two types of secretory glands:

1. Endocrine cells (islets of Langerhans): secrete hormones and
2. Exocrine cells (acinar and duct cells): secrete a mixture of
fluid rich in NaHCO3 and digestive enzymes called pancreatic
104 juice.
 …cont’d

105
 Composition and Functions of Pancreatic Juice
Out put: 1-2 L/day, pH of 7.1 to 8.2
Contains water, low Cl-, digestive enzymes & high sodium
bicarbonate ion
Isotonic due to high water permeability to ducts

Digestive enzymes
1. Proteolytic enzymes:
Trypsinogen---activated by enterokinase (also a brush
border enzyme in the small intestine) = trypsin
Chymotrypsinogen----activated by trypsin
Carboxypeptidase---activated by trypsin
Elastase---activated by trypsin

106
 …cont’d
Trypsin inhibitor---combines with any trypsin produced

inside the pancreas

Ribonuclease---- to digest nucleic acids
Deoxyribonuclease

Collagenase

2. Pancreatic enzymes involved in CHO digestion: pancreatic

amylase

3. Pancreatic enzymes involved in fat digestion: pancreatic

lipase, cholesterol esterase, phospholipase
107
108
 Digestion of Carbohydrates
 Mouth---salivary amylase
 Esophagus & stomach---nothing happens
 Duodenum----pancreatic amylase
 Brush border enzymes (maltase, sucrase & lactase)
Act on disaccharide and produce monosaccharides--
fructose, glucose & galactose
Lactose intolerance (no lactase enzyme; bacteria ferment
sugar)--gas & diarrhea

109
 Digestion of Carbohydrates in Stomach

However, starch digestion sometimes continues in the body

and fundus of the stomach for as long as 1 hour before the
food becomes mixed with the stomach secretions.
Activity of the salivary amylase is blocked by acid of the
gastric secretions because the amylase is essentially non-
active as an enzyme once the pH of the medium falls below
about 4.0.
Nevertheless, on the average, before food and its
accompanying saliva do become completely mixed with
the gastric secretions, as much as 30 to 40 percent of the
starches will have been hydrolyzed mainly to form maltose.

110
 …cont’d

111
 Digestion of Proteins
Stomach
 HCl denatures or unfolds proteins
 Pepsin turns proteins into partially digested proteins
Pancreas
 Digestive enzymes: split peptide bonds between different
amino acids
Small Intestine
 Brush border enzymes:

aminopeptidase or dipeptidase: enzymes break peptide bonds that

attach terminal amino acids to carboxyl ends of peptides →

carboxypeptidases: enzymes break peptide bonds that attach terminal
amino acids to amino ends of peptides → aminopeptidases: enzymes
112 split dipeptides to amino acids (dipeptidase)
 …cont’d

113
 Digestion of Lipids
 Mouth: lingual lipase

 Most lipid digestion, in an adult, occurs in the small intestine.

Emulsification by bile of globules of triglycerides

pancreatic lipase: splits triglycerides into fatty acids &
monoglycerides

114
 …cont’d
Dietary source of fat
 Neutral fats (triglycerides)
 Cholesterol and cholesterol esters
 Phospholipids
Fat Emulsified fat
-Lingual lipase
-Pancreatic lipase
-Enteric lipase
FFA + Glycerides
Cholesterol and Bile salt FFA +
Cholesterol esters Cholesterol Glycerides
Esterase
Phospholipase FFA +
Phospholipids-A2 Phopholipids
115
 Digestion of Nucleic Acids
Nucleic acids are broken down into nucleotides for absorption.

Pancreatic juice contains 2 nucleases

– ribonuclease which digests RNA

– deoxyribonuclease which digests DNA

Nucleotides produced are further digested by brush border

enzymes (nucleosidease and phosphatase)

– To produce pentose, phosphate & nitrogenous bases

• Absorbed by active transport

116
117
 Definition

Absorption: is the passage of the end products of

digestion from the GI tract into blood or lymph and

It occurs by

Diffusion,

Facilitated diffusion,

Osmosis, and

Active transport.

118
 …cont’d
 Essentially all carbohydrates are absorbed as monosaccharides.

They are absorbed into blood capillaries.

 Absorption of Amino Acids, Dipeptides, and Tripeptides

Most proteins are absorbed as amino acids by active transport

processes.
They are absorbed into the blood capillaries in the villus.

119
 Absorption of Monosaccharides
 Absorption into epithelial cell
 Glucose & galactose by active transport
 Fructose by facilitated diffusion

 Movement out of epithelial cell into bloodstream by facilitated

diffusion

 Glucose and Galactose are transported by a sodium co-transport

mechanism SGLUT-1 and fructose by GLUT-5.

 Glucose, galactose and fructose are transported out of the

enterocyte through another hexose transporter (called GLUT-2)
in the basolateral membrane.
120
 Absorption of Lipids
Dietary lipids are all absorbed by simple diffusion.

Long-chain fatty acids and monoglycerides are absorbed as

part of micelles, resynthesized to triglycerides and formed
into protein-coated spherical masses called chylomicrons.
Chylomicrons are taken up by the lacteal of a villus.

From the lacteal they enter the lymphatic system and then
pass into the cardiovascular system, finally reaching the liver
or adipose tissue.
The plasma lipids - fatty acids, triglycerides, cholesterol - are
insoluble in water and body fluids.

121
 Absorption of Lipids ...cont’d
In order to be transported in blood and utilized by body cells,
the lipids must be combined with protein transporters called
lipoproteins to make them soluble.
The combination of lipid and protein is referred to as a
lipoprotein.
Small fatty acids enter cells & then blood by simple diffusion
Larger lipids exist only within micelles (bile salts coating)
Lipids enter cells by simple diffusion leaving bile salts
behind in gut
Bile salts reabsorbed into blood & reformed into bile in the
liver
Fat-soluble vitamins enter cells within micelles

122
 Absorption in the Large Intestine:
Formation of Feces
About 1500 ml of chyme normally pass through the ileocecal
valve into the large intestine each day.
Most of the water and electrolytes in this chyme are absorbed
in the colon, usually leaving less than 100 ml of fluid to be
excreted in the feces.
Also, essentially all the ions are absorbed, leaving only 1 to 5
mEq each of Na+ and Cl- to be lost in the feces
Most of the absorption in the large intestine occurs in the
proximal one half of the colon, giving this portion the name
absorbing colon
Functions: principally for feces storage until a propitious
time for feces excretion and is therefore called the storage
123
colon.
 …cont’d
Composition of the Feces
About 3/4ths water and
1/4th solid matter that is composed of
about 30% dead bacteria,
10 to 20% fat,
10 to 20% inorganic matter,
2 to 3% protein, and
30% undigested roughage from the food and dried
constituents of digestive juices (bile pigment and
sloughed epithelial cells).

124
 …cont’d
The brown color of feces is caused by stercobilin and
urobilin, derivatives of bilirubin.
The odor is caused principally by products of bacterial action;
these products vary from one person to another, depending
on each person's colonic bacterial flora and on the type of
food eaten.
The actual odoriferous products include indole, skatole,
mercaptans, and hydrogen sulfide.
Diarrhea: caused by
excess secretion of water and electrolytes in response to
irritation,
washes away irritant factors, which promotes earlier
recovery from the disease than might otherwise occur
125
 …cont’d
Colonic bacteria generate three vitamins that supplement
the dietary supply:
Vitamin K: a fat-soluble vitamin that the liver needs to
enable it to synthesize four clotting factors, including
prothrombin.
Intestinal bacteria produce roughly half of our daily
vitamin K requirements.
Biotin: a water-soluble vitamin important to a variety of
reactions, notably those involved with glucose
metabolism.
Vitamin B5 (pantothenic acid): a water-soluble vitamin
required in the manufacture of steroid hormones and
some neurotransmitters
126
 Gall Bladder Disease…cont’d
Causes of Gall Stone
 ↑Reabsorption of bile acid
 ↑Secretion of cholesterol
 Inflammation of epithelium of GB
 The fusion of individual crystals of cholesterol is the beginning of 95% of
all gallstones.
 Gallstones can cause obstruction to the outflow of bile in any portion of the
duct system.
 Treatment of gallstones consists of using gallstone-dissolving drugs,
lithotripsy or surgery.
Symptoms
 Abdominal fullness or gas
 Abdominal pain →right side or upper middle abdomen
 Occurs after meals; particularly after fatty food intake
 Worse during intake of deep breath
 Pain under sternum, fever and chills, nausea and vomiting; and Heartburn
127
 B. Crohn’s Disease
 Chronic inflammation of digestive tract (type of inflammatory
bowel disease)
Most commonly affects lower small intestine (ileum)
ileitis
Swelling deep into lining of wall of affected area
Severe pain
Severe diarrhea
Higher rates among Jewish people
African Americans at lower risk for disease
 Causes
Several theories
Autoimmune disease
Own body’s immune system attacks digestive system
Idipathatic
128
 C. Peritonitis
 Inflammation of peritoneum
 From perforating ulcer
Stomach contents leak into abdominal cavity
 From burst appendix
Leak feces into abdominal cavity
 Treatment
Antibiotics
Surgery to remove debris that has leaked into abdominal cavity

129
 D. Peptic ulcer disease (PUD)
 Inflammation of stomach wall (gastritis)
Chronic inflammation leads to stomach wall erosion
 Symptoms
Stomach pain 1-3 hrs after a meal
 Risks Common sites
Perforation - Cardiac region
Hemorrhage - Pyloric region
 Causes
Excessive HCl secretion
Poor blood supply to the mucosa
Poor secretion of mucous
Infection with Hilicobacter pylori: acid resistant bacteria
which destroy protective mucus layer of stomach
Irritation
130
 Treatments of PUD
Antacids:
Histamine receptor (H2) blockers: cemitidin, ranitidin
Proton pump inhibitors: Nexium, omeprazol
Antibiotics: Triple therapy
2 antibiotics + PPI/ HRB
Surgical intervention: gastrectomy

131
 E. Vomiting
Expulsion of stomach through the mouth
Due to extreme stretching of stomach, excessive
alcohol, foreign bacteria
Medulla signals diaphragm and abdomenal muscles to
contract and increases abdominal pressure
Contents of stomach forced upwards
Burning in mouth and vile taste due to acids that are
eliminated through the mouth
Treatment: anti-emetics

132
 GIT obstruction
Common sites
 Pyloric region: results acid
vomitus
 Below the duodenum: results
neutral or alkaline vomitus
 Sigmoid colon: causes
constipation
Causes
 Cancer
 Ulcer
 Spasm
 Paralytic ileus
 Adhesion

133
 Colorectal Cancer
 Cancer of the lower intestinal tract
10-15% of all cancer deaths yearly in US
 Increased incidence worldwide
 Cause unknown
 Risk factors
Age
Diverticulitis
Family history
 No early symptoms
 Typically diagnosed too late after tumor metastasis
Colorectal screening with colonoscopy every 5-10 yrs
beginning at age 50

134
 Gastric Bypass Surgery

135
 Appendicitis
Appendix attached to cecum (large intestine)
Produces mucus and antibodies
Delivered to colon
When opening from appendix to colon is blocked
Excessive mucus or stool
Bacteria invade wall of appendix
Inflammation
Surgery to remove appendix

136
 Appendicitis: Inflamed Appendix

137