The Digestive System

Digestive System
• The digestive system allows your body to obtain substances
required to sustain life that your body cannot make on its
own including:
– monosaccharides, amino acids, nucleic acids, fats,
vitamins, electrolytes (ions) and water
• The alimentary canal or gastrointestinal (GI) tract is a long
muscular tube lined with epithelial tissue passing through
the body which is closed off at each end by a sphincter of
skeletal muscle
• Opens to the outside world therefore the lumen and its
contents are part of the external environment
• Its primary function is to move water, nutrients and
electrolytes from the external environment into the body’s
internal environment
 Physiological anatomy of GI tract
• Functional Anatomy
– Digestive system comprises of gastrointestinal
tract (GIT) and accessory organs of digestion like
teeth, tongue, salivary glands, liver and exocrine
part of pancreas.
– GIT – Alimentary canal – Muscular tube extending
from mouth to Anus.
• The GI tract (gastrointestinal
tract)
The muscular alimentary canal
– Mouth
– Pharynx
– Esophagus
– Stomach
– Small intestine
– Large intestine
– Anus

• The accessory digestive

organs
Supply secretions contributing to
the breakdown of food
– Teeth & tongue
– Salivary glands
– Gallbladder
– Liver
– Pancreas
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• GIT measures about 10m (30 ft) and comprises of
following parts
1. Mouth: External opening or oral fissure, the cavity
containing anterior 2/3rd of tongue and teeth is the
mouth, oral or buccal cavity. Chewed food is mixed with
saliva.
a. Tongue
b. Teeth
2. Pharynx: It is a median passage that is common to the
gastrointestinal and the respiratory system. Divided in
three parts.
1. Naso-Pharynx
2. Oro-Pharynx
3. Laryngo-Pharynx
3. Esophagus: Fibro muscular tube 25 cm long.
Peristaltic movements of the esophagus propel the
food into stomach. It has 2 sphincters.
1. Upper esophageal sphincter
2. Lower esophageal sphincter
4. Stomach: Hollow muscular bag connected to the
esophagus at its upper end and to the duodenum
at the lower end. It serves following motor
functions.
1. Storage of food
2. Mixing of food with gastric secretion
3. Slow empting of food into the small intestine.
5. Small Intestine: It is a long tubular structure
divided into three parts.
1. Duodenum: C shaped, 25 cm in length
2. Jejunum: Middle part, 2.5 m long
3. Ileum: Last part, 3.5 m long
Gastric chyme → Enter duodenum where it
meets with pancreatic juice, bile and
secretion of the small intestine (succus
entericus). The movements of small intestine
help in mixing, digestion and absorption of
food.
6. Large Intestine:
It is 1.5 to 1.8 m long. Wider than small intestine but smaller in length. It
is divided into following parts:
1. Caecum – Blind ended sack which opens into the lower end of ileum. The
ileocaecal junction is guarded by the ileocaecal valve.
2. Appendix – Worm shaped tube arises from medial side of Caecum which in
human beings is a vestigial organ. 7.5cm long.
3. Ascending Colon – Extends upwards from the Caecum along the right side
of the abdomen upto the liver. On reaching the liver it bends to left, forming
the right hepatic flexure.
4. Transverse Colon – Extends from right hepatic flexure to the left splenic
flexure.
5. Descending Colon – Extends from left splenic flexure to the pelvic inlet
below.
6. Sigmoid Colon – Begins at pelvic inlet and joins the rectum in front of the
sacrum.
7. Rectum – Descends in front of the sacrum to leave the pelvis by piercing the
pelvic floor, here it becomes continues with anal canal.
8. Anal Canal – opens to the exterior through the anus and opening is guarded
by two sphincters.
In large intestine absorption of water and electrolytes take place,
remaining matter is called faecal matter.
 Functions of Digestive system
• Ingestion:
– Placing the food into mouth
– Chewing the food into smaller pieces (Mastication)
– Moistening the food with salivary secretion
– Swallowing the food (Deglutition)
• Digestion: Food broken down in smaller particles by grinding
action of GIT and then degraded by digestive enzymes into
usable nutrients
– Starch are degraded by Amylases into monosaccharide
– Proteins are degraded by Proteases into di-peptides and amino acids
– Fats are degraded by lipases and esterase into monoglcerides and free
fatty acids.
• Absorption: During absorption, nutrients
water and electrolytes are transported from
small intestine to the circulation
• Egestion: During egestion the undigeasted
food along with various secretion and
sloughed of epithelial cells from GIT pass into
rectum and constitute the faeces which are
void through anus.
4 Basic Processes of the Digestive System
Structural Characteristics of GIT
 Histology of alimentary canal wall
Same four layers from esophagus to anal canal

1. Mucosa
2. Submucosa
3. Muscularis
externa
4. Serosa

from lumen (inside) out

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General histology of digestive tract

17
• GIT from posterior pharynx to anus has the
following layers from inside outwards:
1. Mucosa: Innermost coat
1. Surface epithelium – Simple squamous to tall
columanar
2. Lamina Propria – Contains numerous glands, small
blood vessels, lymphatics, nerve fibres. Composed of
loose connective tissue.
3. Muscularis Mucosa – Composed of two thin layers of
smooth muscle fibres. Help in localised movement of
mucosa.
 Mucosal Epithelium
• Simple epithelium
– absorptive cells use integral transporting proteins in the
apical and basal membranes to absorb ions, water and
nutrients out of the lumen into the body by facilitated
diffusion, primary and secondary active transport
processes
– secretory cells (endocrine and exocrine)
• exocytose digestive enzymes and mucus into lumen
for digestion and protection against the autodigestion
of the mucosa, respectively
• exocytose hormones and/or paracrine molecules into
the ECF for digestive regulation
– sensory cells act as mechano- and chemoreceptors
which detect the presence of food by the distension of
the GI wall and by the presence of specific chemicals
(proteins, salts, acids, fats…)
2. Sub Mucosa: Layer of connective tissue. Contains
blood vessels, lymphatics, nerve fibres and nerve
plexus (Miessner’s plexus)
3. Muscle Coat: Thick layer of smooth muscle fibres.
Arranged in two layers.
1. Circular muscle fibre – Inner layer
2. Longitudinal muscle fibre – Outer Layer
Auerbach’s Plexus (Myenteric Plexus)
4. Serosa: Outermost layer of connective tissue. Helps
in attachment of gut to the surrounding structures.
 Histology of stomach

• Simple columnar
epithelium: secrete
bicarbonate-buffered
mucus
• Gastric pits opening into
gastric glands
– Mucus neck cells
– Parietal cells
• HCL
• Intrinsic factor (for B12
absorption)
– Chief cells
• Pepsinogen (activated to
pepsin with HCL)
• Stimulated by gastrin: a
stomach hormone

21
 Innervation of GIT

Intrinsic System Extrinsic System

(Enteric nervous system)

Myenteric plexus
Motor in function
•Increases tone of gut
•Increases intensity of
contraction
•Increases velocity of
conduction
•Parasympathetic
Meissner’s Plexus
•Sympathetic
Sensory in function
•Concerned with control
of exocrine and endocrine
secretions.
 Enteric Nervous System
• A specialized division of the nervous system associated only
with the alimentary canal
• Connected to the CNS via the Parasympathetic NS
(stimulates digestion) and Sympathetic NS (inhibits
digestion)
– Composed of two major nerve plexuses (groups) which
send both sensory and motor information throughout
the alimentary canal to control digestion
• Submucosal nerve plexus (submucosa layer)
– associated with mechano- and chemoreceptors in
the mucosa
– controls the endo- and exocrine secretion of the
mucosa
• Myenteric nerve plexus (muscularis layer)
– controls the contraction of smooth muscle
 Extrinsic Innervation
• Parasympathetic innervation
– Cranial parasympathetic fibers:
 Site of connecter cells- dorsal nucleus of Xth nerve (vagus)
 site of ganglion cell- myentreric plexus, meisner’s plexus.
 Structures supplied- gastric & intestinal glands, smooth
muscles of GIT upto the junction of proximal 2/3rd and distal
1/3rd of transverse colon.
– Sacral parasympathetic fibres :
 Site of connecter cells- segment 2,3 & 4 of sacral nerves
 site of ganglion cell- hypogastric ganglion
 Structures supplied- rest of the large intestine.
Parasympathetic
 Parasympathetic (cholinergic) nerves-
release A-ch- depolarization of smooth
muscle membrane- contraction of GIT
musculature.
I. Increase in motility and tone.
II. Relaxation of sphincters
III. Increased secretion from stomach and
intestine.
• Sympathetic innervation:
– The sympathetic fiber to gut arises from T8 to L2
spinal segment.
– These pre ganglionic fibres pass through the
lateral sympathetic chain , to continue a
splanchnic nerve.
– The pre ganglionic fibers relay in coelic and
mesenteric autonomic ganglia.
– The post ganglionic fibers terminate on enteric
nervous system.
– The sympathetic innervate all portions of GIT .
Sympathetic
• Sympathetic (adrenergic) nerves – release
epinephrine – hyperpolarisation – relaxation
of GIT musculature
– Decrease in motility and tone
– Contraction of sphincters
– Inhibition of secretion from stomach and intestine
 Water balance in GIT
• Total input (9000 ml/day)
1. Ingested-2000 ml
2. Endogenous secretion-7000 ml
a. Salivary gland : 1500 ml
b. stomach: 2500 ml
c. Bile : 500 ml
d. Pancreas: 1000 ml
e. Intestine: 1500 ml
• Reabsorbed (8800 ml/day)
1. Jejunum-5500 ml
2. Ileum-2000 ml
3. Colon- 1300 ml
 Physiology of Salivary secretion
• Salivary glands: Three pairs of salivary glands
– Parotid Glands: Largest salivary gland (20 to 30 gm each)
 located near the angels of jaw.
 Its secretion passes via Stensen’s duct.
 Opens opposite to the second molar tooth in mouth.
 It contains Serous cells.
 It forms 25% of total salivary secretion
 supplied by 9th cranial nerve
• Sub-Mandibular or Sub-Maxillary (8 to 10 gm
each)
 Location – Medial to the mandibal in sub
maxillary triangle.
 Its duct is Wharton’s duct, opens into floor of the
mouth along the side of the frenulum linguae.
 Mixed cells – Serous + Mucous cells in 4:1 ratio.
 It forms 70% of the total salivary secretion
 supplied by 7th nerve
• Sub Lingual gland:
 It is 2-3 gm each (smallest gland) located
subjacent to the mucosa of the floor of the
mouth.
 Its secretion are discharged by 5 -15 small ducts
known as ducts of rivinus into the sub lingual part
of the mouth.
 Mixed -serous + Mucous in 1:4 ratio.
 Forms 5% of total salivary secretion
 supplied by 7th nerve.
 Innervation of salivary glands
1. Efferent nerve supply:
– Parasympathetic division
– Sympathetic division
• Parasympathetic nerve supply-
– To parotid glands
• It originates from the cells in inferior salivary nucleus i.e.dorsal
nucleus of glossopharyngeal (IX) nerve.
– To submandibular and sublingual glands
• It originates from the cell of superior salivary nucleus i.e. dorsal
nucleus of facial (VII) nerve.
• Sympathetic nerve supply
– It originates from the lateral horn cells of
T1,2segments of the spinal cord; axon via ventral
roots enter paravertebral sympathetic chain to
synapse with the cells in superior cervical
ganglion to supply the salivary glands.
2. Afferent nerve supply
• Afferent nerve fibres from salivary glands are
found in chorda tympani ( branch of VII nerve)
and IX nerves. These fibres carry pain impulses
from salivary glands.
 Composition of Saliva
• Daily secretion: 1500 ml per day
• pH of saliva: 6 – 7
• Digestive enzymes: Ptyalin, Lysozymes, Kallikrein,
Lipase
• Mucin
• IgA
• Cations: Na+, K+, Ca2+
• Anions: Cl-, HCO3-, PO43-, Br-
• Organic content: Urea, uric acid, Creatinine, free
amino acids
 Functions of Saliva
1. Ptyalin (salivary alpha amylase): digestion of starch to
maltose, acts at pH 6.5
– Amylase: Digestion continue in stomach for half an hour
– Amylase is ready inactivated at pH <= 4
2. Mucin: Lubricates, protects and aides speech
3. Saliva keeps mouth moist
4. Minimises risk of buccal infection
• Lysozymes (Bactericidal)
• IgA
• Lactoferrin (Bacteriostatic)
5. Buffers in proline rich proteins in saliva helps to bind toxic
tannins and maintains the oral pH at 7.
6. It contains Somatostatin, Glucagon
7. Vehicle for excretion of certain drugs.
 summary of functions of saliva
• Protective function
– Dilute hot and irritant food
– Washes away food particles
– Destroys harmful bacteria
– Dilutes any hydrochloric acid and bile
• Role in mastication and deglutition
• Digestive functions
• Role in taste sensation
• Role in speech
• Excretory function
• Role in temperature function
Mechanism of Salivary secretion
• Mechanism of formation of saliva
– Primary secretion of saliva: Isotonic
– Modification of Saliva: Make saliva Hypotonic
Effect of flow rate on composition of Saliva

• At high flow rate

– There is less time for reabsorption and secretion therefore
saliva is similar to secretion of ACINAR cell.
– Both Sodium and chloride concentration increases.
(Always less than plasma)
– Potassium concentration decreases and bicarbonate
concentration increases
• At low flow rate
– Low sodium of Sodium, Chloride and bicarbonate
– High concentration of Potassium
 Phases of salivary secretion
• Cephalic phase-
– refers to secretion of saliva before entering of food into
the mouth
– Caused by conditioned reflex initiated by sight or smell.
• Buccal phase-
– Refers to secretion of saliva caused by stimulation of
buccal receptors by the presence of food in the mouth
– It is an unconditioned reflex ,partially regulated by the
appetite area of the brain.
• Esophageal phase
– Occurs due to stimulation of salivary glands to a
slight degree by the food passing through
esophagus.
• Gastric phase
– Refers to secretion of saliva by presence of food in
the stomach.
– Occurs when irritant food present in the stomach.
• Intestinal phase
– Refers to salivary secretion caused by presence of
irritant food in the upper intestine.
 Control of salivary secretion
• Effect of parasympathetic stimulation-
– Stimulation of parasympathetic nerve – liberate proteolytic
enzyme kallikrein from the gland cells- which act on alpha
2 globulin to form bradykinin.
– It also causes release of VIP
These increases the saliva production by-
 Increasing transport processes in the acinar and ductal
cells.
 Causing vasodilatation of blood vessels of salivary glands.
• It causes profuse secretion of watery saliva with
relatively low content of organic material .
• Effects of sympathetic stimulation-
– Stimulation of sympathetic fibres causes-
vasoconstriction in the salivary glands- transient
secretion of a very small amount of thick viscid
saliva rich in mucus and other organic
constituents.
 Parasympathetic reflexes
• Conditioned reflex:
– sight, smell or thought of food increase salivary secretion
by conditioned reflex.
– In conditioned reflexes , the parasympathetic supplying the
salivary glands are stimulated by impulses coming from
higher centres.
• Unconditioned reflexes:
– Initiated by stimulation of receptors in buccal cavity.
• Mechanoreceptors
• chemoreceptors
 Applied

• Aptyalism (xerostomia) i.e. suppression of

salivary secretion it is seen in:
– Anxiety, fear, fever, or dehydration- all these
causes temporary suppression of salivary
secretion.
– Duct obstruction- permanent suppression of
salivary secretion.
– Irradiation therapy in the area of salivary gland.
• Hypersecretion (sialorrhoea ) is seen in:
– Pregnancy
– Neoplasm
– Parkinsonism
– Schizophrenia
– Chorda tympani nerve ending.
Mouth and esophagus
 Mastication
• Mastication is a mechanical process which
breaks up larger food particles into smaller
pieces which:
– Makes it easier for the food to be swallowed
– Mixes the food with the secretions of the salivary
gland to soften it
– Increases the surface area of food particles thus
helping in subsequent digestion of food
• Chewing is specially important for most fruits
and raw vegetables because these have un
digestible cellulose membrane
• Chewing can be carried out voluntarily, but for
most part it is a reflex act
 Muscles of Mastication
Muscle Innervation Action
Masseter Mandibular division of 5th Raises the Mandible,
nerve clenches the teeth
and protracts the
mandible
Temporalis Mandibular division of 5th Raises the mandible,
nerve retracts the mandible
after protraction
Internal and Mandibular division of 5th Protudes the
External nerve mandible, depresses
pterygoid the chin, helps in
opening the mouth
Buccinator Facial 7th nerve Prevents
accumulation of food
between cheek and
teeth.
 Deglutition
• Deglutition or swallowing refers to passage of
food from the oral cavity into the stomach.
• Phases of Swallowing:
– Oral phase (Voluntary)
– Pharyngeal phase (Involuntary)
– Esophageal phase (Involuntary)
 Oral Phase
• It is the first stage of swallowing
• Bolus of food is formed after Mastication and
is put over the dorsum of tongue.
• The tongue forces the bolus into the
oropharynx by pushing up and back against
the hard palate
 Pharyngeal phase
• This is the second stage of swallowing
• Components of swallowing reflex
– Receptors present around the opening of pharynx are stimulated
when the bolus moves from the mouth into the pharynx and initiate
the reflex activity.
– Afferent arc that carries impulse from the receptors to the deglutition
centre comprises the trigeminal , glossopharyngeal and vagus nerve
– Deglutition centre co-ordinating the reflex activity is located in the
medulla oblongata and lower pons.
– Efferent arc which initiates a series of muscular contractions reaches
the pharyngeal musculature and tongue through the 5th, 9th, 10th and
12th cranial nerve.
 Events during Pharyngeal phase
• Events which take place during movement of bolus from
pharynx into esophagus occur in following sequence:
– Oral cavity is shut off from the pharynx
– Naso pharynx is closed by the upward movement of soft palate
– Palato pharyngeal folds are pulled medially to make a slit like opening
for food
– Vocal cords strongly approximate stopping the breathing temporarily
(deglutition apnea)
– Larynx pulled upward, epiglotis swings backwards
– Upper esophageal sphincter – tonically contracted – allows bolus to be
pushed into upper part of esophagus.
– Once bolus passed into esophagus cricopharyngeus contracts, vocal
cords open – normal breathing – UES tonic contraction
• Pharyngeal phase is completed in 1-2 seconds
 Food

Swallowing receptor areas of pharynx

(tonsilar pillars)

Sensory portion of 5th, 9th and 10th cranial nerve

Deglutition or swallowing center

(in medulla and lower pons)

1. Soft palate closes nasal

Respiration Motor impulse cavity
center 5th, 9th, 10th, 12th cranial nerve 2. Food passes to
esophagus
Deglutition 3. Vocal cords come closer –
apnea Series of automatic pharyngeal muscular
Larynx closed
contractions
4. Larynx pulled upwards
5. Pharyngo-esophageal
sphincter relaxed
 Esophageal phase
• Bolus propelled from upper part of esophagus
to the stomach by esophageal PERISTALSIS
and aided by gravity.
 Anatomy of Esophagus
• Fibro muscular tube – 25 cm long
• Separated from pharynx – UES
• Separated from stomach – LES
• MUSCULATURE of ESOPHAGUS
– Upper 1/3rd of esophagus – straited muscles
– Lower 2/3rd of esophagus – smooth muscles
 Upper Esophageal Sphincter
• UES – true sphincter – cricopharyngeal muscle
• UES – straited muscle – under the control of
vagal fibre
• UES is normally contracted tonically – tone is
maintained by continual firing of vagal fibres
originating from nucleus ambiguus –
Neurotransmitter – Acetylcholine
 Lower Esophageal Sphincter
• LES also known as cardiac sphincter – distal 2
cm of esophagus.
• It is not a true anatomical sphincter
• During non peristaltic periods the LES is
tonically contracted while the remainder of
smooth muscle within the esophagus is
relaxed
• Function of LES – to prevent regurgitation of
gastric contents into esophagus
• Swallowing or distension of esophagus with food
causes reflex relaxation of the sphincter within 1.5 to
2.5 seconds
– The reflex is mediated by 10th nerve and myenteric plexus
thus secrete nitric oxide and VIP
• When Peristaltic contraction reaches this region of
the sphincter closes and may undergo a strong and
prolonged after contraction, thereby preventing
regurgitation of food
• Gastrin – increases the tone of LES
• Secretin – decreases the tone of LES
 Esophageal peristalsis
• Primary esophageal peristalsis
– It is initiated by swallowing and begins when food passes
into esophagus from the pharyngeal cavity
– It is coordinated by vagal fibres originating from the
swallowing center within the medulla
• Secondary esophageal Peristalsis
– It is initiated by the presence of food within the esophagus
after primary peristalsis is completed
– Due to the stimulation of mechanical or irritant receptors
– It is coordinated by intrinsic nervous system
• Swallowing or local stimulation of esophagus at any
level causes development of peristalsis.
• It consists of a lumen obliterating contractions ,4-8
cm in length which moves down at a speed of 2-4 cm
per sec.
• Thus reaching the esophagus food is propelled into
the stomach by peristalsis.
• The strength of peristaltic contraction is proportional
to the size of the bolus entering the esophagus.
• The esophageal stage lasts for 1-2 sec.
 APPLIED
• Deglutition reflex
If abolished – regurgitation of food into nose
or aspiration of food into larynx
– Lesions involving medulla, 9th or 10th nerves
– Anesthetizing pharynx with cocaine – temporary
• Aerophagia – In nervous individuals the upper
esophageal sphincter resting tone is low,
therefore air is unavoidably swallowed in the
process of eating and drinking, the swallowed
air
– Gets regurgitated (belching)
– Some of the gases it contained gets absorbed
– Majority of it is passed on to the colon, and then
expelled as flatus
• Achalasia Cardia: condition is characterized by failure
of lower esophageal sphincter to relax completely on
swallowing due to destruction of local nerve plexus
• Constriction of sphincter causes food accumulation in
the esophagus and proximal esophagus thus dilates
• LES is hyper responsive to circulating gastrin
• Incompetence of lower esophageal sphincter
– causes reflex of acid gastric contents into
esophagus producing heart burn and
esophagitis (gastro esophageal reflex disease)
• Dysphagia – difficulty in swallowing
 STOMACH
General features
• Stomach is J shaped hollow muscular bag.
• The volume of stomach is 1200-1500 ml, but
its capacity is 3000 ml.
• Connected to oesophagus at its upper end to
the duodenum at its lower end.
• It consist of following parts:
– Fundus
– Body
– Pyloric part
• Pyloric antrum
• Pyloric canal
 Arrangement of musculature
• Stomach has outer longitudinal and an inner
circular smooth muscle layer .
• Between the mucous membrane and circular
layer there is an additional smooth muscle
layer whose fibers run obliquely . They
maintain the normal length of the lesser
curvature.
• The stomach and duodenum are divided by a
thickened circular smooth muscle layer called
pylorus or pyloric sphincter.
• Act as functional syncytium
 Gastric mucous membrane
• Three types of gastric glands
– Main gastric gland:
• maximum in number.
• Short ducts and long alveoli.
• The alveoli contains:-
– Parietal or oxyntic cells – HCL & I.F
– Chief ( peptic) cells - pepsinogen
– Surface epithelium – visible mucus
– Cardiac tubular glands: secrete soluble mucus.
– Pyloric or antral glands: secrete soluble mucous
 Pepsinogen
• Secreted as an inactive protien which is converted by
acid HCL to active proteolytic enzyme pepsin.
• Pepsin can also activate remaining pepsinogen ,
called autocatalytic action of pepsin.
• Functions:
– It digest protien to polypeptides by hydrolyzing peptide
bonds.
– Curdles milk: pepsin act on water soluble caseinogen (milk
protien) to form casein.this combines with calcium salts to
form insoluble calcium caseinate , which readily digested
enzymatically.
 Parietal cells
• Chiefly found in the body of the stomach.
• Pure parietal cell secretion is a clear colorless fluid
which contains H+ concentration having pH of 0.87.
• Functions:
– It provides H+ concentration necessary for optimum pepsin
activity.
– Activates pepsinogen to pepsin and prosecretin to secretin.
– Helps in killing ingested bacteria.(bactericidal effect)
– Helps in iron absorption.
– Stimulates bile and pancreatic juice secretion.
 Gastrin
• Secreted by G-cells or gastrin cells from the deeper
portion of pyloric glands in the gastric mucosa.
• Gastrin is also found in the pituitary gland,
hypothalmus, medulla oblongta, vagus and sciatic
nerve.
• Secreted as progastrin which get converted to gastrin
by HCL.
• G-cell appear to be neural in origin, because they
take up amine precursors and decarboxylate them.
Thus called APUD cells.
 Actions of gastrin
• Stimulates the gastric acid and pepsin
secretion.
• Stimulates the growth of mucosa of the
stomach, small and large intestine (trophic
action.)
• Stimulate the gastric motility.
• It has feeble influence on contraction o gall
bladder.
 Factors affecting gastrin secretion
• factors that increase gastrin secretion:
– Luminal factors
• Products of protien digestion
• Distention of pyloric antrum
– Neural factors
• Increased vagal discharge-mediated by GRP
– Blood born factors
• Calcium and epinephrine.
• Factors that inhibit gastrin release:
– Luminal factor
• Acid in the antrum
– Blood born factors
• Secretin
• Gastric inhibitory peptide
• Vasoactive intestinal peptide
• Glugagon
• calcitonin
Composition and functions of gastric juice
• Daily secretion: 2.5- 3 liters/ day
• pH: 1-2
• Electrolytes
– Cations: Na+ ,k+ ,H+ ,Mg 2+
– Anions : Cl-,HCO3- ,HPO42- ,SO42-
• Enzymes
• Pepsin
• Rennin
• Gelatinase
• Gastric lipase
• Lysozymes
• Urease
• Carbonic anhydrase
• Mucus
– Soluble mucus
– Visible mucus
• Intrinsic factor
• Water
Mechanism of secretion of HCL
Regulation of gastric acid secretion by
parietal cell
Regulation of secretion of gastric juice
 Phases of gastric juice secretion

• Cephalic phase:
– Occurs before the food enters the the stomach.
i.e, psychic stimulation of gastric juice in response
to sight , smell thought or taste of the food.
– It is vagally mediated.
– It accounts for 30-50% of total gastric juice
secretion.
• Gastric phase:
– It occurs when food enters in the stomach.
– Its influence on gastric juice secretion are
primarily local reflex responses and response to
gastrin.
– It accounts for 50-60% of the total gastric juice
secretion.
• Intestinal influence
– It occurs when the food enters in the duodenum.
– Its influence on gastric juice secretion are the
reflex and hormonal feedback effects initiated
from the mucosa of the small intestine.
– Its contribution to gastric juice secretion is much
less as compared to the cephalic and gastric
phase.
Phases of gastric juice secretion
Regulation of gastric motility and emptying

• Stomach shows a basic electrical rhythm (BER)

or gastric slow wave.
• BER is initiated by pacemaker cells situated
near the fundus on the greater curvature
which propagates initially slowly – less than 1
cm/ sec but faster as the wave reaches to the
antrum i,e 4 cm/ sec.
 Applied aspects
• Gastric mucosal barrier and pathophysiology
of peptic ulcer.
• Physiology of vomitting
• Gastrectomy
• Gastric function tests
 Gastric mucosal barrier
• Gastric mucosal barrier protects the gastric
mucosa from damage by intrluminal HCL.this
barrier is created by:
– Mucin secretion
– Bibcarbonate secretion
– Epithelial barrier
– High mucosal blood flow
– Prostaglandins
 Pathophysiology of peptic ulcer
• Defination : peptic ulcer is the term referred to breakdown
of the mucosal –epithelium of the stomach and duodenum.
• Etiology and pathogenesis : peptic can be caused by two
ways:
1. Diminished ability of the gastroduodenal mucosal barrier
to protect against the digestive properties of the acid
pepsin complex. Factors which tends to distrupt the barrier
includes:
1. Infection with a bacterium, helicobacter pylori
2. Other factors like :Ethanol, Vineager, Bile salts
3. NSAID
2. Hypersecretion of gastric acid:
Leads to the ulcers of duodenum and pre pyloric
portion of the stomach. Hypersecretion of
gastric acid may be due to:
– Increased parietal cell mass
– Increased sensitivity for secretory stimuli
– Increased basal acid secretory stimuli
– Excess gastric secretion.
• Parietal cells are hyperresponsive to gastrin.
• Zollinger –ellison syndrome – this syndrome is seen in
patients with gastrinomas i.e. tumor that secrete
gastrin.
 Physiological basis of management of
peptic ulcer
1. Antacids – They form a gel that coats the mucosa and
neutralizes the acid .
2. H2 receptor blocking drugs – like cimetidine, ranitidine.
3. Muscarinic receptor blocking drug- atropine and
pirenzepine.
4. Gastric H+-K+ ATPase inhibiting drugs- like omeprazole
5. Bilateral vagotomy combined with resection of gastrin
producing pyolric part of stomach- performed in very
severe duodenal and pyloric ulcers.
 Physiology of vomiting
• Vomiting refers to forceful expulsion of
contents of stomach and intestine.
• Initiation of vomiting:
1. Activation of vomiting centre: vomiting centre is
located in the reticular formation of medulla
oblongata near the vagal nucleus.
1. Direct activation of vomiting center
2. Afferent impulses activating vomiting center
 Afferent impulses activating vomiting
centre
1. Visceral afferent pathway impulses arise due to the
irritation of mucosa of upper GIT.
2. Afferent impulses from the vestibular nuclei
mediate nausea and vomiting of motion sickness.
3. Afferents from higher centres :mediate emetic
response to emotionally charged stimuli such as
nauseating smell, sickening sights, memory ,fear
and anticipation of vomiting.
2. Activation of chemoreceptor trigger zone:
CTZ is located in the area postrema .
Chemoreceptor cells present in the CTZ
contain dopamine receptors and 5HT
receptors and initiate the vomiting when
they are stimulated by:
Circulating emetic substances
Efferent impulses from vomiting centre and
CTZ

• They are transmitted by 5,7 ,9 ,10 and 12

cranial nerves to upper GIT and through spinal
nerves to the muscles of respiration.
Sequence of mechanical events of vomiting

1. Pre –ejection phase:

• Gastric relaxation and retroperistalsis.
• Feeling of nausea, excessive salivation, deep irregular
breathing .
2. Retching phase:
• Closure of glottis
• Rhythmic action of respiratory muscles
3. Ejection phase:
• During this GIT contents are actually expelled out.
 Following sequence of ejection phase
• Closure of glottis
• Pyloric part of stomach contracts firmly and its contents are
transferred to flaccid body of stomach
• Simultaneous intense contraction of abdominal muscles-
decent of diaphragm- raises the intra abdominal pressure –
contents are squeezed out of the stomach into the esophagus
as reflex relaxation of cardiac sphincter.
• From esophagus contents are expelled into mouth by
increasing intrapulmonary pressure.
• Soft palate is raised and shuts of the nasal cavity.
• In the end act of vomiting diaphragm relaxes.
 Total gastrectomy
• It means total removal of the stomach
• It produces effect on the:
– Effect on carbohydrate metabolism
– Effect on protien metabolism
– Effect on fat digestion
– Effect on absorption of vitamin B12.
– Effect on iron absorption
 Dumping syndrome
• Condition characterized by development of
weakness, dizziness and sweating after meals.
• Seen in the partial or total removal of stomach
• Causes of dumping syndrome
– Main cause is sharp oscillation between hyperglycemia
and hypoglycemia
– Rapid entry of hypertonic meal into the intestine-
movement of water into the gut – result in reduction of
plasma volume – decreases the cardiac output.