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THE DIGESTIVE SYSTEM

The digestive system is a tubular system that extends from the mouth to the anus which
contribute homeostasis by breaking down food into forms that can be absorbed and used by body
cells by the process of digestion and it eliminates wastes from the body.
2 groups of organs compose the digestive system
– Gastrointenstinal (GI) tract or alimentary canal – mouth, most of pharynx, esophagus,
stomach, small intestine, and large intestine
– Accessory digestive organs – teeth, tongue, salivary glands, liver, gallbladder, and
pancreas

Digestion is defined as the process by which food is broken down into simple chemical substances
that can be absorbed and used as nutrients by the body. Digestive process is accomplished by
mechanical and enzymatic breakdown of food into simpler chemical compounds.

Functions of digestive system:


 Provides fuel that keeps body running[Glucose,ATP]
 Provides building blocks needed for cell growth and repair[Monosaccharides (carbohydrates,
CHOs),Amino acids (proteins),Monoglycerides and fatty acids (lipids)]
Processes of the Digestive System
1. Ingestion: This process involves taking foods and liquids into the mouth (eating).
2. Mixing and propulsion:
– Deglutition: Swallowing
– Peristalsis: It moves material through digestive tract through radially symmertical
contraction and relaxaction of muscles that propagates a wave down the tube. MMC-
migrating motor complex trigger peristalsis.
3. Digestion
– Mechanical processing/digestion:
• Crushing/shearing of food that makes materials easier to move along GI tract
• Increases surface area of available to enzymes
• Teeth- tear, mash food (mastication)
• Tongue – squashes, compacts food
• Stomach and intestines – swirl, mix, churn
– Chemical Digestion
• Chemical breakdown of food into small organic fragments that can be absorbed
by digestive epithelium
• Simple molecules absorbed intact, e.g., glucose and Larger molecules must be
broken down by digestive enzymes (e.g., polysaccharides, proteins,
triglycerides)
4. Secretion: = Release of water, acids, enzymes, buffers, salts into digestive tract by digestive
tract epithelium or Glandular organs,[ e.g., pancreas] Into digestive tract
5. Absorption: Movement of organic substrates, electrolytes (ions), vitamins, water across
digestive epithelium and into interstitial fluid around digestive tract
6. Excretion: Wastes, indigestible substances, bacteria, cells sloughed from the lining of the GI
tract, and digested materials that were not absorbed in their journey through the digestive
tract leave the body through the anus in a process called defecation.

Layers of GI tract:
Wall of GI tract from lower esophagus to anal canal has same basic 4 layers
1. Mucosa – inner lining of GI tract
a. Epithelium: protection (non keratinized stratified sqauamus epithelium in mouth
pharynx esophagus and anal canal), secretion and absorption (simple columnar
epithelium in stomach and intestines)
b. Lamina propria – connective tissue with blood and lymphatic vessels and mucosa-
associated lymphatic tissue (MALT)
c. Muscularis mucosae – thin layer of smooth muscle making folds to increase surface
area
2. Submucosa :Consists of connective tissue binding mucosa to muscularis That contains many
blood and lymphatic vessels.Submucosal plexus- a network of neurons were also present.
3. Muscularis
a. Voluntary skeletal muscle found in mouth, pharynx, upper 2/3 of esophagus, and anal
sphincter
b. Involuntary smooth muscle elsewhere
i. Arranged in inner circular fibers and outer longitudinal fibers
ii. Myenteric plexus between muscle layers
4. Serosa :Outermost covering of organs suspended in abdominopelvic cavity consists of a serous
membrane composed of areolar connective tissue and simple squamous epithelium and also
called visceral peritoneum. Esophagus lacks serosa –but have adventitia

Control of Digestive Functions


Regulated by 3 types of mechanisms
• Neural
• Hormonal
• Local
Neural innervation
– Enteric nervous system (ENS): These are intrinsic set of nerves - “brain of gut”
• Neurons extending from esophagus to anus
• 2 plexuses
– Myenteric plexus – GI tract motility
– Submucosal plexus – controlling secretions
– Autonomic nervous system: Parasympathetic stimulation increases secretion and activity by
stimulating ENS and sympathetic stimulation decreases secretions and activity by inhibiting
ENS
Hormonal Mechanisms:Via hormones produced by digestive tract
– Hormones are peptides (e.g., gastrin, secretin, cholecystokinin CCK, gastric inhibitory peptide
GIP) produced by enteroendocrine cells in stomach (gastrin) or duodenum (secretin, CCK,
GIP) targets cells in stomach, small intestine, liver, pancreas that can stimulate or inhibit
smooth muscle cells’ responses to neural commands
Local Mechanisms
– Via local factors, [e.g.,pH, chemical messengers, e.g., prostaglandins, histamine ] Coordinates
response to local conditions
– Affect only that portion of tract, e.g.,Lamina propria of stomach releases histamine 
secretion of HCl by parietal cells.

MOUTH
– The mouth, also referred to as the oral or buccal cavity
– The cheeks form the lateral walls of the oral cavity. They are covered externally by skin and
internally by a mucous membrane, which consists of nonkeratinized stratified squamous
epithelium.
– The lips or labia are fleshy folds surrounding the opening of the mouth. They contain the
orbicularis oris muscle and are covered externally by skin and internally by a mucous membrane.
– The oral vestibule of the oral cavity is the space bounded externally by the cheeks and lips and
internally by the gums and teeth.
– The oral cavity proper is the space that extends from the gums and teeth to the fauces (the
– opening between the oral cavity and the oropharynx
– The palate is a wall or septum that separates the oral cavity from the nasal cavity, and forms the
roof of the mouth. The hard palate—the anterior portion of the roof of the mouth—is formed by
the maxillae and palatine bones and is covered by a mucous membrane; it forms a bony partition
between the oral and nasal cavities. The soft palate, which forms the posterior portion of the roof
of the mouth, is an arch-shaped muscular partition between the oropharynx and nasopharynx that
is lined with mucous membrane.
– Uvula is a fingerlike muscular structure hanging from the free border of the soft palate that
drawn superiorly during swallowing, closing off the nasopharynx and preventing swallowed
foods and liquids from entering the nasal cavity.

Tongue: The tongue is a voluntary muscular structure which occupies the floor of the mouth. It is
attached by its base to the hyoid bone) and by a fold of its mucous membrane covering, called the
frenulum, to the floor of the mouth The superior surface consists of stratified squamous epithelium,
with numerous papillae (little rojections), containing nerve endings of the sense of taste, sometimes
called the taste buds
– The extrinsic muscles of the tongue, which originate outside the tongue (attach to bones in
the area) and insert into connective tissues in the tongue, include the hyoglossus,
genioglossus, and styloglossus muscles.
– The intrinsic muscles of the tongue originate in and insert into connective tissue within the
tongue. They alter the shape and size of the tongue for speech and swallowing
– Lingual glands in the lamina propria of the tongue secrete both mucus and a watery serous
fluid that contains the enzyme lingual lipase

Salivary Glands: A salivary gland is a gland that releases a secretion called saliva into the oral
cavity.Based on amount of secretion, glands were divided into major or minor glands
Major glands are:
1. Parotid glands: Parotid glands are the largest of all salivary glands, situated at the side of the
face just below and in front of the ear. Each gland weighs about 20 to 30 g in adults.
Secretions from these glands are emptied into the oral cavity by Stensen duct.
2. . Submaxillary Glands: Submaxillary glands or submandibular glands are located in
submaxillary triangle, medial to mandible. Each gland weighs about 8 to 10 g. Saliva from
these glands is emptied into the oral cavity by Wharton duct, which is about 40 mm long.
3. Sublingual Glands:Sublingual glands are the smallest salivary glands situated in the mucosa
at the floor of the mouth. Each gland weighs about 2 to 3 g. Saliva from these glands is
poured into 5 to 15 small ducts called ducts of Rivinus.
Minor glands are:
The mucous membrane of the mouth and tongue contains many small salivary glands that open
directly, or indirectly via short ducts, to the oral cavity which all of which make a small
contribution to saliva. . These minor salivary glands include
1. Labial, in the lips
2. Buccal, in the cheeks
3. Palatal glands in the palate
4. Lingual glands in the tongue

Salivary glands are classified into three types, based on the type of secretion:
1. Serous Glands: Serous glands are mainly made up of serous cells. These glands secrete thin and
watery saliva. Parotid glands and lingual serous glands are the serous glands.
2. Mucus Glands: Mucus glands are mainly made up of mucus cells. These glands secrete thick,
viscous saliva with high mucin content. Lingual mucus glands, buccal glands and palatal glands
belong to this type.
3. Mixed Glands:Mix ed glands are made up of both serous and mucus cells. Submandibular,
sublingual and labial glands are the mixed glands.

Structure of Salivary glands:


Salivary glands are formed by acini or alveoli. Each acinus is formed by a small group of
cells which surround a central globular cavity. Central cavity of each acinus is continuous with the
lumen of the duct. The fine duct draining each acinus is called intercalated duct. Many intercalated
ducts join together to form intralobular duct. Few intralobular ducts join to form interlobular
ducts, which unite to form the main duct of the gland.

Composition of saliva.
Functions of saliva
1. Preparation of food for swallowing: Mucin of saliva lubricates the bolus and facilitates
swallowing.
2. Appreciation of taste
3. Digestive function: Saliva has three digestive enzymes, namely salivary amylase, maltase
and lingual lipase
– Salivary Amylase: Salivary amylase is a carbohydrate-digesting (amylolytic) enzyme.
It acts on cooked or boiled starch and converts it into dextrin and maltose
– Maltase:Maltase is present only in traces in human saliva and t converts maltose into
glucose.
– Lingual Lipase:Lingual lipase is a lipid-digesting (lipolytic) enzyme. It is secreted
from serous glands situated on the posterior aspect of tongue. It digests milk fats (pre-
emulsified fats). It hydrolyzes triglycerides into fatty acids and diacylglycerol
4. Cleansing and protective functions :Enzyme lysozyme of saliva kills some bacteria such
as staphylococcus, streptococcus and brucella.i. Proline-rich proteins present in saliva posses
antimicrobial property and neutralize the toxic substances such as tannins.
5. Role in speech: By moistening and lubricating soft parts of mouth and lips, saliva helps in
speech.
6. Excretory function:Many substances, both organic and inorganic, are excreted in saliva. It
excretes substances like mercury, potassium iodide, lead, and thiocyanate. Saliva also
excretes some viruses such as those causing rabies and mumps.
7. Regulation of body temperature
8. regulation of water balance

Salivation
The secretion of saliva, called salivation is controlled by the autonomic nervous system. Amounts of
saliva secreted daily vary considerably but average 1000–1500 mL.
Parasympathetic stimulation: Parasympathetic preganglionic fibers to submandibular and
sublingual glands arise from the superior salivatory nucleus, situated in pons and parasympathetic
preganglionic fibers to parotid gland arise from inferior salivatory nucleus situated in the upper part
of medulla oblongata. Stimulation of parasympathetic fibers of salivary glands causes secretion of
saliva with large quantity of water. It is because the parasympathetic fibers activate the acinar cells
and dilate the blood vessels of salivary glands.
Sympathetic stimulation: Sympathetic preganglionic fibers to salivary glands arise from the lateral
horns of first and second thoracic segments of spinal cord. Stimulation of sympathetic fibers causes
secretion of saliva, which is thick and rich in organic constituents suchas mucus. It is because, these
fibers activate the acinar cells and cause vasoconstriction. The neurotransmitter is noradrenaline.
.
Reflex regulation of salivary secretion
Salivary reflexes are of two types:
1. Unconditioned reflex:This reflex induces salivary secretion when any substance is placed in the
mouth. It is due to the stimulation of nerve endings in the mucus membrane of the oral cavity.
2. Conditioned Reflex:Conditioned reflex is the one that is acquired by experience and it needs
previous experience .Presence of food in the mouth is not necessary to elicit this reflex. The stimuli
for this reflex are the sight, smell, hearing or thought of food.

Teeth:

The teeth are embedded in the alveoli or sockets of the alveolar ridges of the mandible and the
Each individual has two sets, or dentitions,
– The temporary or deciduous teeth : At birth the teeth of both dentitions are present in
immature form in the mandible and maxilla. There are 20 temporary teeth, 10 in each jaw.
They begin to erupt when the child is about 6 months old, and should all be present after 24
months
– The permanent teeth . The permanent teeth begin to replace the deciduous teeth in the 6th
year of age and this dentition, consisting of 32 teeth, is usually complete by the 24th year.

Structure of a tooth
Although the shapes of the different teeth vary, the structure is the same and consists of:
• crown — the part which protrudes from the gum
• root — the part embedded in the bone
• neck — the slightly narrowed region where the crown merges with the root.
In the centre of the tooth is the pulp cavity containing blood vessels, lymph vessels and nerves, and
surrounding this is a hard ivory-like substance called dentine. Outside the dentine of the crown is a
thin layer of very hard substance, the enamel. The root of the tooth, on the other hand, is covered
with a substance resembling bone, called cement, which fixes the tooth in its socket. Blood vessels
and nerves pass to the tooth through a small foramen at the apex of each root.
small foramen at the apex of each root.
Functions of the teeth
The incisor and canine teeth are the cutting teeth and are used for biting off pieces of food, whereas
the premolar and molar teeth, with broad, flat surfaces, are used for grinding or chewing food
Digestion in the mouth
• Mechanical digestion in the mouth
– Chewing or mastication
– Food manipulated by tongue, ground by teeth, and mixed with saliva
– Forms bolus
• Chemical digestion in the mouth
– Salivary amylase secreted by salivary glands acts on starches
• Only monosaccharides can be absorbed
• Continues to act until inactivated by stomach acid
– Lingual lipase secreted by lingual glands of tongue acts on triglycerides
• Becomes activated in acidic environment of stomach
PHARYNX
• Passes from mouth into pharynx
• 3 parts
– Nasopharynx
• Functions only in respiration
– Oropharynx
• Digestive and respiratory functions
– Laryngopharynx
• Digestive and respiratory functions

ESOPHAGUS
The esophagus is a collapsible muscular tube, about 25 cm (10 in.) long, that lies posterior to the
trachea. It is continuous with the pharynx above and just below the diaphragm it joins the stomach.
 The mucosa of the esophagus consists of nonkeratinized stratified squamous epithelium,
lamina propria (areolar connective tissue), and a muscularis mucosae (smooth muscle) Near
the stomach, the mucosa of the esophagus also contains mucous glands.
 The submucosa contains areolar connective tissue, blood vessels, and mucous glands.
 The muscularis of the superior third of the esophagus is skeletal muscle, the intermediate
 third is skeletal and smooth muscle, and the inferior third is smooth muscle. At each end of
the esophagus, the muscularis becomes slightly more prominent and forms two sphincters
o The upper esophageal sphincter which consists of skeletal muscle which regulates the
movement of food from the pharynx into the esophagus
o The lower esophageal sphincter (LES), which consists of smooth muscle that regulates
the movement of food from the esophagus into the stomach
 Adventitia :The superficial layer of the esophagus is known as the, because the areolar
connective tissue of this layer is not covered by mesothelium.

STOMACH
The stomach is a J-shaped enlargement of the GI tract directlyinferior to the diaphragm in the
abdomen. The stomach has four main regions: the cardia, fundus, body, and pyloric part
 The cardia surrounds the opening of the esophagus into the stomach.
 The rounded portion superior to and to the left of the cardia is the fundus
 Inferior to the fundus is the large central portion of the stomach, the body.
 The pyloric part is divisible into three regions. The first region, the pyloric antrum, connects
to the body of the stomach. The second region, the pyloric canal, leads to the third region,
the pylorus which in turn connects to the duodenum.The pylorus communicates with the
duodenum of the small intestine via a smooth muscle sphincter called the pyloric sphincter.

5 MAJOR FUNCTIONS
o Storage of ingested food
o Mechanical breakdown of ingested food
o Disruption of chemical bonds in food through actions of acids/enzymes [gastric
juice]- formation of chyme.
o Production of intrinsic factor
 Glycoprotein required for vitamin B12 absorption in small intestine
 Essential for hematopoiesis and synthesis of bone proteins
 Only essential function of stomach
o Excretory function: toxins, alkaloids and metals
HISTOLOGY:
 Serosa or visceral peritoneum: Outermost
 Muscularis: Three layers
o Outer longitudinal
o Middle circular
o Inner oblique
 Submucosa
 Mucosa
o 3 types of exocrine gland cells –
 mucous neck cells (mucus),
 parietal cells (intrinsic factor and HCl),
 chief cells (pepsinogen and gastric lipase)
o G cell – endocrine cell – secretes gastrin
o Enterochromaffin (EC)- cells Serotonin
o Enterochromaffin like(ECL) cells- Histamine

DIGESTIVE ACTIVITIES OF STOMACH


• Mechanical digestion
– Mixing waves – gentle, rippling peristaltic movements – creates chyme
• Chemical digestion
– Digestion by salivary amylase continues until inactivated by acidic gastric juice
– Acidic gastric juice activates lingual lipase
• Digest triglycerides into fatty acids and diglycerides
– Digestion by gastric juice.

DIGESTIVE ACTIVITIES OF STOMACH


Surface mucous Secrete mucus Forms protective barrier that
cells and mucous prevents digestion of stomach
neck cells wall.
. Absorption. Small quantity of water, ions,
short-chain fatty acids, and some
drugs enter bloodstream.
Parietal cells Secrete intrinsic Needed for absorption of vitamin
factor. B12 (used in red blood cell
formation, or erythropoiesis).

Secrete Kills microbes in food; denatures


hydrochloric proteins; converts pepsinogen into
acid. pepsin.

Chief cells Secrete pepsinogen. Pepsin (activated form) breaks


down proteins into peptides.
Secrete gastric lipase. Splits triglycerides into fatty acids
and monoglycerides.
Gelatinase Gelatin and collagen of meat to
Peptides
Urase Urea to Ammonia

G cells Secrete gastrin. Stimulates parietal cells to secrete


HCl and chief cells to secrete
pepsinogen; contracts lower
esophageal sphincter, increases
motility of stomach, and relaxes
pyloric sphincter.
Muscularis Mixing waves Churns and physically breaks
(gentle peristaltic down
movements). food and mixes it with gastric
juice, forming chyme. Forces
chyme through pyloric sphincter.
Pyloric Opens to permit Regulates passage of chyme
sphincter passage of from stomach to duodenum;
chyme into prevents backfl ow of chyme from
duodenum. duodenum to stomach.
SMALL INTESTINE
• Site of greatest amount of digestion and absorption of nutrients and water . It averages 2.5 cm
in diameter; its length is about 3 m.
• Divisions
– Duodenum- first 25 cm beyond the pyloric sphincter.
– Jejunum- 2.5 m
– Ileum- 3.5 m. Peyer’s patches or lymph nodules
Histology:

mucosa
• epithelium
– Absorptive cells: cells with microvilli, produce digestive enzymes and absorb
digested food
– Goblet cells: produce protective mucus
– Endocrine cells: produce regulatory hormones
• S cells – secretin
• CCK cells - cholecystokinin
• K cells - glucose-dependent insulinotropic peptide (GIP)
– Granular cells (paneth cells): may help protect from bacteria
• The lamina propria : areolar connective tissue and abundance of mucosa-associated
lymphoid tissue (MALT), aggregated lymphatic follicles, or Peyer’s patches
• The muscularis mucosae of the small intestinal mucosa consists of smooth muscle.
Intestinal glands (crypts of Lieberkühn): tubular glands in mucosa at bases of villi
submucosa
Duodenal glands (Brunner’s glands): tubular mucous glands of the submucosa. secrete an alkaline
mucus that helps neutralize gastric acid in the chyme.
muscularis : Two layers of smooth muscle. The outer, thinner layer contains longitudinal fibers
serosa

Regulation of gastric secretion:


• Phases named for location of control center
– Cephalic phase
• Controlled by CNS (brain and spinal cord)
– Gastric phase
• Regulated by short reflexes of ANS
– i.e.,enteric nervous system (ENS) within parasympathetic sytem
• Involves submucosal and myenteric plexuses
• Coordinated in stomach wall
– Intestinal phase
• Regulated by intestinal hormones (e.g. CCK, GIP, secretin) from
enteroendocrine cells

SECRETION OF HYDROCHLORIC ACID


Carbon dioxide is derived from metabolic activities of parietal cell. Some amount of carbon dioxide
is obtained from blood also. It combines with water to form carbonic acid in the presence of
carbonic anhydrase. This enzyme is present in high concentration in parietal cells. Carbonic acid is
the most unstable compound and immediately splits into hydrogen ion and bicarbonate ion. The
hydrogen ion is actively pumped into the canaliculus of parietal cell. Simultaneously, the chloride
ion is also pumped into canaliculus actively. The chloride is derived from sodium chloride in the
blood. Then the hydrogen ion combines with chloride ion to form hydrochloric acid.

PANCREAS
Pancreas is a dual organ having two functions, namely endocrine function and exocrine function.
Endocrine function is concerned with the production of hormones . The exocrine function is
concerned with the secretion of digestive juice called pancreatic juice.
FUNCTIONS :
 Digestion of carbohydrate, fat and proteins.
 Neutralizing action of pancreatic juice: When acid chyme enters intestine from
stomach, pancreatic juice with large quantity of bicarbonate is released into intestine.
This alkaline pancreatic juice neutralizes acidity of chyme in the intestine.
Anatomy of the Pancreas
The pancreas a retroperitoneal gland that is about 12–15 cm long and 2.5 cm thick, lies posterior to
the greater curvature of the stomach. The pancreas consists of a head, a body, and a tail and is
usually connected to the duodenum by two ducts.
 The pancreatic duct, or duct of Wirsung
 Accessory duct (duct of Santorini),
The head is the expanded portion of the organ near the curve of the duodenum; superior to and to
the left of the head are the central body and the tapering tail. Pancreatic juices are secreted by
exocrine cells into small ducts that ultimately unite to form two larger ducts, the pancreatic
duct and the accessory duct. These in turn convey the secretions into the small intestine.

• Histology
– 99% of cells are acini
• Exocrine cells that Secrete pancreatic juice – mixture of fluid and digestive
enzymes
Exocrine part of pancreas is made up of acini or alveoli. Each acinushas a single layer of acinar cells
with a lumen in the center. Acinar cells contain zymogen granules, which possess digestive
enzymes. A small duct arises from lumen of each alveolus. Some of these ducts from neighboring
alveoli unite to form intralobular duct.
 Intralobular ducts unite to form the main duct of pancreas called Wirsung duct. Wirsung
duct joins common bile duct to form ampulla of Vater, ( hepatopancreatic ampulla)
which opens into duodenum The passage of pancreatic juice and bile through the
hepatopancreatic ampulla into the duodenum of the small intestine is regulated by a mass of
smooth muscle surrounding the ampulla known as the sphincter of the hepatopancreatic
ampulla, or sphincter of Oddi.
• Intralobular ducts unite to form accessory duct called duct of Santorini exists. It also opens
into duodenum, proximal to the opening of ampulla of Vater.

– 1% of cells are pancreatic islets (islets of Langerhans)


• Endocrine that secrete hormones glucagon, insulin, somatostatin, and
pancreatic polypeptide

Pancreatic Proteolytic Enzymes


• Secreted as inactive proenzymes
– Proenzymes converted to active enzymes after they reach small intestine
– Protects secretory cells from destruction by own enzyme products
Proenzyme Enzyme Catalyst Active Enzyme

Trypsinogen Enterokinase Trypsin


(brush border of duodenum)
Chymotrypsinogen Trypsin Chymotrypsin
Procarboxypeptidase Trypsin Carboxypeptidase
Proelastase Trypsin Elastase
DIGESTIVE ENZYMES OF PANCREATIC JUICE
ENZYMES ACTIVATOR SUBSTRATE END PRODUCTS

trypsin enterokinase proteins Proteoses and


polypeptides
chymotrypsin Trypsin proteins polypeptides
Carboxy peptidases Trypsin polypepdies Amino acids
nucleases Trypsin DNA &RNA Mono nucleotides
elastase Trypsin Elastin Amino acids
collagenase Trypsin collagen Amino acids
Pancreatic lipase Alkaline medium TG Monoglycerides and
fatty acids

Cholesterol ester Alkaline medium Cholesterol ester Cholestrol and fatty


hydrolase acids

Phospholipase A trypsin phospholipids lysophospholipids


Phospholipase B trypsin lysophospholipids Free fatty acids and
phosphoryl choline

Colipase trypsin Facilitase action of


trypsin

Bile salt – activated trypsin Phospholipids Lysophospholipids


lipase Cholestrol esters Cholestrol &FFA
TG Monoglyccerides and
FA

Pancreatic amylase starch Dextrin and maltose

Regulation
• Three phases:
– Cephalic
• Conditioned reflex
• Uncontioned relex
– Gastric
– Intestinal
SECRETION OF BICARBONATE IONS
– Carbon dioxide derived from blood or metabolic pro cess combines with water inside the cell
to form carbonic acid in the presence of carbonic anhydrase
– . Carbonic acid dissociates into hydrogen and bicarbonate ions
– 3. Bicarbonate ions are actively transported out of the cell into the lumen
– Hydrogen ion is actively transported into blood in exchange for sodium ion
– Sodium ion from the cell is transported into the lumen, where it combines with bicarbonate to
form sodium bicarbonate

LIVER
The liver is the heaviest gland of the body, weighing about 1.4 kg. The liver is inferior to the
diaphragm and occupies most of the right hypochondriac and part of the epigastric regions of the
abdominopelvic cavity. The liver is divided into for principal lobes—a large right lobe and a
smaller left lobe, ,an inferior quadrate lobe and a posterior caudate lobe
• Liver is composed of
– Hepatocytes – major functional cells of liver
• Wide variety of metabolic, secretory, and endocrine functions – secrete bile
(excretory product and digestive secretion)
– Bile canaliculi – ducts between hepatocytes that collect bile
• Exits livers as common hepatic duct, joins cystic duct from gallbladder to form
common bile duct
– Hepatic sinusoids – highly permeable blood capillaries receiving oxygenated blood
from hepatic artery and deoxygenated nutrient-rich blood from hepatic portal vein
Histology of the Liver
• Connective tissue septa branch from the visceral peritoneum into the interior
– Divides liver into lobules
– Nerves, vessels and ducts follow the septa
• Lobules: hepatic lobule as considered as the functional unit of the liver. Each hepatic lobule
is shaped like a hexagon (six-sided structure) At its center is the central vein, and radiating
out from it are rows of hepatocytes and hepatic sinusoids. Located at three corners of the
hexagon is a portal triad. portal triad at each corner – t hree vessels: hepatic portal vein,
hepatic artery, hepatic duct. Central veins unite to form hepatic veins that exit liver and
empty into inferior vena cava
• Hepatic cords: radiate out from central vein, Composed of hepatocytes
• Hepatic sinusoids: between cords, lined with endothelial cells and hepatic phagocytic
(Kupffer) cells
• Bile canaliculus: between cells within cords

Hepatic blood flow


FUNCTIONS OF THE LIVER
• 1. Bile production: 600-1000 mL/day. Bile salts ,cholesterol, fats, fat-soluble hormones,
lecithin
– Neutralizes and dilutes stomach acid
– Bile salts emulsify fats. Most are reabsorbed in the ileum.
– Secretin (from the duodenum) stimulates bile secretions, increasing water and
bicarbonate ion content of the bile
• 2. Storage
– Glycogen, fat, vitamins, copper and iron. Hepatic portal blood comes to liver from
small intestine.
• 3. Nutrient interconversion
– Amino acids to energy producing compounds
– Hydroxylation of vitamin D. Vitamin D then travels to kidney where it is
hydroxylated again into its active form-promotes bone growth and absorption of
calcium
• 4. Detoxification
– Hepatocytes remove ammonia and convert to urea
• 5. Phagocytosis
– Kupffer cells phagocytize worn-out and dying red and white blood cells, some
bacteria
• 6. Synthesis
– Albumins, fibrinogen, globulins, heparin, clotting factors
• 7. Carbohydrate, lipid & protein metabolism
CHO metabolism
– Hepatocytes stabilize blood glucose levels
– When blood glucose decreases
• Breaks down glycogen  glucose
• Synthesizes glucose from lipids or amino acids (gluconeogenesis)
– When blood glucose increases
• Glucose removed from blood
– Stored as glycogen
– Used to synthesize lipids, stored in liver or other tissues
– Regulated by hormones (insulin, glucagon from pancreas)
Lipid metabolism
– Hepatocytes regulate circulating TGs, FAs, cholesterol
– When TGs and FAs decrease
• Breaks down lipid reserves and releases them into bloodstream
– When TGs and FAs increase
• Removed for storage
Amino acid metabolism
– Hepatocytes remove excess amino acids from bloodstream
• Converted to lipids or glucose and stored
• Used to synthesize proteins

Composition of bile

– BILE SALTS
Bile salts are the sodium and potassium salts of bile acids, There are two primary bile acids in
human, namely cholic acid and chenodeoxycholic acid, which are formed in liver and enter the
intestine through bile.it helps in Emulsification of Fats, Absorption of Fats, Choleretic Action,
Laxative Action and Prevention of Gallstone Formation.
– BILE PIGMENTS
Bile pigments are the excretory products in bile. Bilirubin and biliverdin are the two bile pigments
and bilirubin is the major bile pigment in human beings.
GALLBLADDER
• The gallbladder is a pear-shaped sac that is located in a depression of the posterior surface of
the liver. It is 7–10 cm long and typically hangs from the anterior inferior margin of the liver.
• Sac lined with mucosa folded into rugae, inner muscularis, outer serosa
• Bile arrives constantly from liver is stored and concentrated
• Three anatomical regions:
• Fundus
• Body
• neck
• Stimulated by cholecystokinin (from the intestine) and vagal stimulation
• Bile exits through cystic duct then into common bile duct
Major functions
• Bile storage
• When bile cannot enter common bile duct (when hepatopancreatic sphincter
closed) it enters cystic duct and is stored in gallbladder
• Bile modification
• While stored, much of water absorbed, bile salts become more concentrated

SMALL INTESTINE
• Site of greatest amount of digestion and absorption of nutrients and water It averages 2.5 cm
in diameter; its length is about 3 m .
• Divisions
– Duodenum- first 25 cm beyond the pyloric sphincter.
– Jejunum- 2.5 m Gradual decrease in diameter, thickness of intestinal wall, number of
circular fold, and number of villi the farther away from the stomach
– Peyer’s patches: lymphatic nodules numerous in mucosa and submucosa
– Ileocecal junction: where ilium meets large intestine. Ileocecal sphincter and ileocecal
valve
– Ileum- 3.5 m. Peyer’s patches or lymph nodules

LAYERS OF SMALL INTESTINE:
• Mucosa
– : Epithellial Cells and glands of the mucosa
• Absorptive cells: cells with microvilli, produce digestive enzymes and absorb
digested food
• Goblet cells: produce protective mucus
• Endocrine cells: produce regulatory hormones
• CCK CELLS: cholecytokinin
• S CELLS: secretin
• K CELLS: GIP
• Granular cells (paneth cells): may help protect from bacteria
– Lamina propria: MALT
– Muscularis mucosa: smooth muscles.
• Submucosa: secrete alkaline mucosa
• Muscularis: two layers
• Serosa
Modifications to Increase Surface Area
1. Plicae circulares (circular folds)
2. Villi that contain capillaries and lacteals. Folds of the mucosa
3. Microvilli: folds of cell membranes of absorptive cells
Intestinal glands (crypts of Lieberkühn): tubular glands in mucosa at bases of villi
Duodenal glands (Brunner’s glands): tubular mucous glands of the submucosa

Movement in the Small Intestine


• 1. Segmental contractions mix
• 2. Peristalsis propels
• 3. Ileocecal sphincter remains slightly contracted until peristaltic waves reach it; it relaxes,
allowing chyme to move into cecum
• 4. Cecal distention causes local reflex and ileocecal valve constricts
– Prevents more chyme from entering cecum
– Increases digestion and absorption in small intestine by slowing progress of chyme
– Prevents backflow

Mechanical Digestion
– Governed by myenteric plexus
– Segmentations
• Localized, mixing contractions
• Mix chyme and bring it in contact with mucosa for absorption
– Migrating motility complexes (MMC)
• Type of peristalsis
• Begins in lower portion of stomach and pushes food forward
CHEMICAL DIGESTION:
Intestinal juice and brush-border enzymes
• Intestinal juice
– 1-2L daily
– Contains water and mucus, slightly alkaline
– Provide liquid medium aiding absorption
• Brush border enzymes
– Inserted into plasma membrane of absorptive cells
– Some enzymatic digestion occurs at surface rather than just in lumen

ABSORPTION:

• Absorption of:
– Monosaccharides
• All dietary carbohydrates digested are absorbed
• Only indigestible cellulose and fibers left in feces
• Absorbed by facilitated diffusion or active transport into blood
– Amino acids, dipetides and tripeptides
• Most absorbed as amino acids via active transport into blood
• ½ of absorbed amino acids come from proteins in digestive juice and dead
mucosal cells
– Lipids
• All dietary lipids absorbed by simple diffusion
• Short-chain fatty acids go into blood for transport
• Long-chain fatty acids and monoglycerides
– Large and hydrophobic
– Bile salts form micelles to ferry them to absorptive cell surface
– Reform into triglycerides forming chylomicrons
– Leave cell by exocytosis
– Enter lacteals to eventually enter blood with protein coat of chylomicron
keeping them suspended and separate
– Electrolytes
• From GI secretions or food
• Sodium ions (Na+) reclaimed by active transport
• Other ions also absorbed by active transport
– Vitamins
• Fat-soluble vitamins A, D, E, and K absorbed by simple diffusion and
transported with lipids in micelles
• Most water-soluble vitamins also absorbed by simple diffusion
– Water
• 9.3L comes from ingestion (2.3L) and GI secretions (7.0L)
• Most absorbed in small intestine, some in large intestine
• Only 100ml excreted in feces
• All water absorption by osmosis
LARGE INTESTINE
• Extends from ileocecal junction to anus
• Consists of cecum, colon, rectum, anal canal
• Movements sluggish (18-24 hours); chyme converted to feces.
• Absorption of water and salts, secretion of mucus, extensive action of microorganisms.
• 1500 mL chyme enter the cecum, 90% of volume reabsorbed yielding 80-150 mL of feces
Cecum
– Blind sac, vermiform appendix attached.
Colon
– Ascending, transverse, descending, sigmoid
– Circular muscle layer complete; longitudinal incomplete (three teniae coli).
Contractions of teniae form pouches called haustra.
– Mucosa has numerous straight tubular glands called crypts. Goblet cells predominate,
but there are also absorptive and granular cells as in the small intestine
Rectum
– Straight muscular tube, thick muscular tunic
Anal canal- superior epithelium is simple columnar; inferior epithelium is stratified squamous
– Internal anal sphincter (smooth muscle)
– External anal sphincter (skeletal muscle)
Histology of the Large Intestine
Mucosa: The mucosa consists of simple columnar epithelium, lamina propria (areolar connective
tissue), and muscularis mucosae (smooth muscle).
The epithelium:
– absorptive cells: function primarily in water absorption;
– goblet cells secrete mucus that lubricates the passage of the
colonic contents
Both absorptive and goblet cells are located in long, straight, tubular intestinal glands (crypts of
Lieberkühn) that extend the full thickness of the mucosa.
lamina propria :Solitary lymphatic nodules are also found in the lamina propria of the mucosa
muscularis mucosae
Submucosa: The submucosa of the large intestine consists of areolar connective tissue.
Muscularis: The muscularis consists of an external layer of longitudinal smooth muscle and an
internal layer of circular smooth muscle. Some GI tract, portions of the longitudinal muscles are
thickened, forming three conspicuous bands called the teniae that run most of the length of the large
intestine Tonic contractions of the bands gather the colon into a series of pouches called haustra.
serosa.
Secretions of the Large Intestine
• Mucus provides protection
– Parasympathetic stimulation increases rate of goblet cell secretion
• 2. Bacterial actions produce gases (flatus) from particular kinds of carbohydrates found in
legumes and in artificial sugars like sorbitol
• 3. Bacteria produce vitamin K which is then absorbed
• 4. Feces consists of water, undigested food (cellulose), microorganisms, sloughed-off
epithelial cells
• 5. Lactose intolerance
Digestion of the Large Intestine
• Mechanical digestion
– Haustral churning
– Peristalsis
– Mass peristalsis – drives contents of colon toward rectum
• Chemical digestion
– Final stage of digestion through bacterial action
• Ferment carbohydrates, produce some B vitamins and vitamin K
– Mucus but no enzymes secreted
• Remaining water absorbed along with ions and some vitamins
Digestion of carbohydrates

Digestion of proteins

Digestion of lipids

The Defecation Reflex


• Mass peristaltic movements in large intestine push fecal material from the sigmoid colon
into the rectum.
• Distension of the rectal wall stimulates stretch receptors
• Sensory nerve impulses to the sacral spinal cord.
• Motor impulses from the cord travel along parasympathetic nerves back to the descending
colon, sigmoid colon, rectum, and anus.
• The resulting contraction rectal muscles shortens the rectum, thereby increasing the pressure
within it.
• This pressure, along with voluntary contractions of the diaphragm and abdominal muscles,
plus parasympathetic stimulation, opens the internal anal sphincter.
• The external anal sphincter is voluntarily controlled.
• Voluntary contractions of the diaphragm and abdominal muscles aid defecation by increasing
the pressure within the abdomen, which pushes the walls of the sigmoid colon and rectum
inward.
• If defecation does not occur, the feces back up into the sigmoid colon until the next wave of
mass peristalsis stimulates the stretch receptors.
DISORDERS
Gastritis:
Inflammation of the mucosal lining of stomach due to damage or excessive production of acid
It may: Acute or Chronic

Cholecystitis:
An inflammation of gallbladder

Mumps
An acute inflammatory condition of the salivary glands, especially the parotids that caused by the
mumps virus.

Peptic ulcers :
Ulcers that develop in areas of the GI tract exposed to acidic gastric juice are called peptic ulcers.
Three distinct causes of PUD are recognized:
(1) the bacterium Helicobacter pylori ;
(2) nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin; and
(3) hypersecretion of HCl, as occurs in Zollinger– Ellison syndrome

Pancreatitis :
Inflammation of the pancreas, in association with alcohol abuse or chronic gallstones, is called
pancreatitis

Jaundice
Jaundice is a yellowish coloration of the sclerae (whites of the eyes), skin, and mucous membranes
due to a buildup of a yellow compound called bilirubin

.Hepatitis
Hepatitis is an inflammation of the liver that can be caused by viruses, drugs, and chemicals,
including alcohol.

Diverticular Disease
In diverticular disease saclike outpouchings of the wall of the colon, termed diverticula, occur in
places where the muscularis has weakened and may become inflamed.

Periodontal Disease
Periodontal disease is a collective term for a variety of conditions characterized by inflammation
and degeneration of the gingivae, alveolar bone, periodontal ligament, and cementum.

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