Case 2

Azalea, a 24-year old female, is pregnant. She developed morning sickness. On her next
prenatal visit, she was advised by her obstetrician on how to minimize the nausea and
emphasized that she must pay attention to her food intake. She was encouraged to take in
adequate amounts from varied food groups to provide sufficient nutrition for herself and her
baby. She was also warned that she might experience changes in her bowel movements due to
fluctuations in her hormones, the supplements that she’s taking, and, eventually, from bowel
displacement due to her growing uterus.

ANATOMY

1. What is the blood supply of the alimentary system?

Esophagus

Upper 3rd: Inferior Thyroid Artery

Middle 3rd: branches from descending thoracic aorta

-bronchial arteries

-esophageal arteries

Lower 3rd: -branches from left gastric artery

-Left inferior phrenic artery

Stomach

Righ gastric artery- branch of hepatic artery

- Lesser curvature of stomach, anastomose with left gastric artery

- Supplies right portion of lesser curvature of stomach

Left gastric artery- branch of celiac Trunk

- Lesser curvature of stomach, anastomose with right gastric artery

- supplies distal part of esophagus & lesser curvature of stomach

Right gastro-omental artery- branch of gastrodoudenal artery (branch of hepatic artery )

- right gastroepiploic artery

- Between layers of greater omentum of greater curvature to anastomose
with left gastro-omental artery

Left gastro-omental artery- branch of splenic artery

- Left gastroepiploic artery

 - Between layers of gastrosplenic ligament to stomach, then along greater
curvature in greater omentum to anastomose with right gastro-omental
artery

Posterior gastric artery- Branch of splenic artery

- Retroperitoneally along posterior wall of lesser omental bursa to enter

gastrophrenic ligament
- Supplies posterior wall & fundus of stomach

Short gastric artery- branch of splenic artery

- Passes between layers of gastrosplenic ligament to fundus of stomach

- Supplies fundus of stomach

Doudenum

Superior pancreaticodoudenal artery

- Branch of gastrodoudenal artery (a branch of common hepatic artery of

celiac trunk)
- Supplies duodenum proximal to the hepaticopancreatic ampulla

Inferior pancreaticodoudenal artery

- Branch of superior mesenteric artery

- Supplies duodenum distal to the hepatopancreatic ampulla

Jejunum and Ileum

Superior mesenteric artery – via jejunal and ileal arteries

- Rises at Abdominal aorta- level of L1 vertebra- 1cm from celiac trunk- runs
between layers of mesentery- 15-18 branches to jejunum and ileum-
arteries unite to form loops or arches called arterial archades- gives rise to
straight arteries called vasa recta

Large intestine

Cecum- Ilecolic artery (terminal branch of SMA)

Appendix- Appendicular artery (branch of ileocolic artery )

Ascending colon- Right colic (branch of SMA)

Transverse colon- Middle colic (SMA)

Descending colon- Left colic (IMA)

Sigmoid- sigmoid (n=3-4) (IMA)

 Proximal Part of rectum- Superior rectal (terminal branch IMA)

Midpart of rectum- Middle rectal (internal iliac artery)

Distal part of rectum- Inferior rectal (internal pudendal artery)

2. Trace the drainage of blood coming from the GIT.

There are two venous systems that drain abdominal structures – the portal venous system and
the systemic venous system. The portal system transports venous blood to the liver for
processing, whilst the systemic venous system returns blood to the right atrium of the heart.
The anatomy of these two venous systems – the major vessels involved, their anatomical
course, and their tributaries.
Systemic Venous System
The systemic venous system transports deoxygenated blood to the right atrium of the heart. The
major vessel in this system is the inferior vena cava.
Inferior Vena Cava
The inferior vena cava is the common convergence of venous drainage from all structures below
the diaphragm. It is located on the posterior abdominal wall; anteriorly to the vertebral column
and to the right of the abdominal aorta.The vessel is formed by the union of the common iliac
veins at the L5 vertebral level. Its ascends superiorly, and leaves the abdomen by piercing the
central tendon of the diaphragm at the T8 level (the caval hiatus). Within the thorax, the inferior
vena cava drains into the right atrium of the heart.During its long course, the inferior vena cava
shares an anatomical relationship with numerous abdominal structures – including the right
common iliac artery, the root of the mesentery, the head of the pancreas, the bile duct, the
portal vein and the liverThe inferior vena cava is responsible for the venous drainage of all
structures below the diaphragm. It receives tributaries from:
Common iliac veins – formed by the external and internal iliac veins. They drain the lower limbs
 and gluteal region.

Lumbar veins – drain the posterior abdominal wall.

Renal veins – drain the kidneys, left adrenal gland and left testis/ovary.

Right testicular/ovarian vein – drain the right testes or ovary respectively in men and women (the
left testicular/ovarian vein drains into the left renal vein).

Right suprarenal vein – drains the right adrenal gland (the left adrenal vein drains into the left renal
vein).

Inferior phrenic veins – drain the diaphragm.

Hepatic veins – drain the liver.

There are no tributaries from the spleen, pancreas, gallbladder or the abdominal part of the GI tract
– as these structures are first drained into the portal venous system. However, venous return from
these structures ultimately enters the inferior vena cava via the hepatic veins (after being processed
by the liver).

Portal Venous System

The portal system carries venous blood (rich in nutrients that have been extracted from food) to the
liver for processing.The major vessel of the portal system is the portal vein. It is the point of
convergence for the venous drainage of the spleen, pancreas, gallbladder and the abdominal part of
the gastrointestinal tract. The portal vein is formed by the union of the splenic vein and the superior
mesenteric vein, posterior to the neck of the pancreas, at the level of L2.As it ascends towards the
liver, the portal vein passes posteriorly to the superior part of the duodenum and the bile duct.
Immediately before entering the liver, the portal vein divides into right and left branches which then
enter the parenchyma of the liver separately.The portal vein is formed by the union of the splenic
vein and superior mesenteric vein. It receives additional tributaries from:

Right and left gastric veins – drain the stomach.

Cystic veins – drains the gallbladder.

Para-umbilical veins – drain the skin of the umbilical region.

Splenic Vein

The splenic vein is formed from a variety of smaller vessels as they leave the hilum of the spleen.

Unlike the splenic artery, the splenic vein is straight and it maintains contact with the body of the
pancreas as it crosses the posterior abdominal wall. As it reaches the neck of the pancreas, the
splenic vein joins the superior mesenteric vein to form the portal vein.

Tributaries to the splenic vein include:

Short gastric veins – drain the fundus of the stomach.

Left gastro-omental vein – drains the greater curvature of the stomach.

Pancreatic veins – drain the pancreas.

Inferior mesenteric vein – drains the colon.

The inferior mesenteric vein drains blood from the rectum, sigmoid colon, descending colon and
splenic flexure. It begins as the superior rectal vein and ascends, receiving tributaries from the
sigmoid veins and the left colic veins. As it ascends further it passes posteriorly to the body of the
pancreas and typically joins the splenic vein.

Superior Mesenteric Vein

The superior mesenteric vein drains blood from the small intestine, cecum, ascending colon and
transverse colon. It begins in the right iliac fossa, as a convergence of the veins draining the terminal
ileum, cecum and appendix. It ascends within the mesentery of the small intestine, and then travels
posteriorly to the neck of the pancreas to join the splenic vein.

Tributaries to the superior mesenteric vein include:

Right gastro-omental vein – drains the greater curvature of the stomach.

Anterior and posterior inferior pancreaticoduodenal veins – drain the pancreas and duodenum.

Jejunal vein – drain the jejunum.

Ileal vein – drain the ileum.

Ileocolic vein – drains the ileum, colon and cecum.

Right colic vein – drains the ascending colon.

Middle colic vein – drains the transverse colon.

vein for each branch of the superior mesenteric artery.

Porto-Systemic Anastomoses

A porto-systemic anastomosis is a connection between the veins of the portal venous system, and
the veins of the systemic venous system. The major sites of these anastomoses include:

Oesophageal – Between the oesophageal branch of the left gastric vein and the oesophageal
tributaries to the azygous system.
 Rectal – Between the superior rectal vein and the inferior rectal veins.

Retroperitoneal – Between the portal tributaries of the mesenteric veins and the retroperitoneal
veins.

Paraumbilical – Between the portal veins of the liver and the veins of the anterior abdominal wall.

When blood flow through the portal system is obstructed (e.g due to cirrhosis, portal vein
thrombosis, or external pressure from a tumour), the pressure within portal system increases. A
portal venous pressure in excess of 20mmHg is defined as portal hypertension.

In portal hypertension, blood may be re-directed through the porto-systemic anastomoses (as these
are now under a lower pressure). If a large volume of blood passes through these anastomoses over
a long period of time, the veins around the anastomosis can become abnormally dilated – known as
varices. Rupture of oesophageal or rectal varices can result in fatal blood loss.

3. What are the blood supply of the stomach and the area it supplied?

VESSELS OF STOMACH
The rich arterial supply of the stomach arises from the celiac trunk and its
branches. Most blood is supplied by anastomoses formed
along the lesser curvature by the right and left gastric arteries, and along the
greater curvature by the right and left gastro-omental (gastroepiploic)
arteries. The fundus and upper body receive blood from the short and posterior
gastric arteries.
Arteries of the stomach, duodenum, and
spleen.
The arterial supply of the abdominal part of the
esophagus, stomach, upper (superior and upper descending
parts) duodenum, and spleen is from the celiac artery. The direct
branches of the celiac trunk appear in boldface.

ARTERIAL SUPPLY TO ABDOMINAL

FOREGUT DERIVATIVES: ESOPHAGUS, STOMACH,
LIVER, GALLBLADDER, PANCREAS, AND SPLEEN
HISTO

1. Describe the small intestines. What are the characteristics of its mucosal lining?

SMALL INTESTINE

- long, approx. 5m

- Consists of 3 segments

* Duodenum

* Jejunom

* Ileum

MUCOSA

- lining shows permanent circular or semiluminar folds (plicae circulares), consisting of mucosa and
submucosa, increases the absorptive area

* VILLI

- Short mucosal outgrowths that project into the lumen

- Covers the entire mucosa of the small intestine

- Finger/leaf-like projections

- contains lamina propria connective tissue with microvasculature and lynphatics called lacteals

- covered with a simple columnar epithelium composed of absorptive enterocytes and goblet cells

* INTESTINAL GLANDS (crypts of Lieberkuhn)

- Openings of short tubular glands found between the villi

2. GI NERVE PLEXUSES
Digestive nerve plexus, intricate layers of nervous tissue that control movements in the
esophagus, stomach, and intestines. The mechanics of the nervous system’s regulation of
digestive functions is not fully known. Two major nerve centres are involved: the myenteric
plexus (Auerbach’s plexus) and the submucous plexus (Meissner’s plexus). The myenteric plexus
 is situated between the circular muscle layer and the longitudinal muscle layer in the lower
esophagus, stomach, and intestines. The submucous plexus, as its name implies, is located in the
submucosal tissue, which connects the surface mucous membrane lining to the deeper muscle
layers in the stomach and intestines.
The myenteric plexus receives its messages from the vagus nerve and responds by transmitting
the message to muscle cells, which are thereby activated to contract. Control of nerve impulses
is involuntary. The muscles of the stomach and intestines play an active role in digestion, as
waves of muscle contractions (peristaltic waves) push food through the parts of the digestive
tract. It is thought that the myenteric plexus stimulates the muscles to contract in peristaltic
waves and that it helps keep muscle tone throughout the intestine walls, promotes secretions of
intestinal juices, and allows muscular constrictions (sphincters) to open, thus permitting food to
pass from one part of the digestive system to another.
The function of the submucous plexus is not as clearly defined. In the stomach its role may be
partly inhibitory, working against the myenteric plexus to control the muscular contractions
more finely. In the intestines it is generally believed to work in accord with the myenteric plexus
in producing peristaltic waves and increasing digestive secretions.

3. Discuss the large intestine. What are the intestinal glands? What is the tenia coli?

The large intestine is lined by Simple columnar epithelium with goblet cells. Large intestine
absorbs water and electrolytes and forms indigestible material into feces, it consists of cecum,
appendix, colon and rectum. It lacks villi except in the rectum. The wall is puckered into a series
of large sacs called haustra. The mucosa of large intestine is penetrated throughout its length by
tubular intestinal glands, lined by goblet cells and absorptive cells. The muscularis of the colon
has longitudinal and circular layers. The fibers of the outer layer is gathered in three separate
longitudinal bands called tenia coli (tenia libera, tenia omental and tenia mesocolic). The cecum,
transverse and sigmoid colon is lined by serosa. And the ascending and descending colon is lined
by adventitia.

Intestinal gland is a gland found in the intestinal lining of the small and large intestine. The intestinal
gland of large intestine is also known as colonic crypts. Its function is to renew the lining of intestine
and to make mucus. The intestinal glands of large intestine are similar to small intestine except the
glands of large intestine is deeper and longer and it lacks Paneth cells.

4. Review the distinguishing features of each region/layer of the GI tract

4 layers:

MUCOSA:

 Innermost layer
 Composed of lining epithelium, lamina propia, muscularis mucosae

SUBMUCOSA
  Physically supports the mucosa
 Provides neural, vascular and lymphatic supply to mucosa
 Submucosal or Meissner’s plexus:control the motility of mucosa and secretory activities of
glands

MUSCULARIS EXTERNA

 Composed of an inner circular and outer longitudinal smooth muscle layer

 Responsible for churning and propelling the luminal contents along the digestive tract via
peristaltic action
 Myenteric or Auerbach nerve plexus:contains postganglionic parasympathetic neurons and
controls motility of smooth muscle

SEROSA

 Outermost layer
 Possessed by intraperitoneal regions of digestive tract
 Consists of mesothelium and connective tissue

ADVENTITIA

 Possessed by retroperitoneal organs

 Consists of connective tissue only

Biochemistry 1 GI
1)Enumerate the water soluble and fat soluble vitamins. Enumerate the Essential minerals as well.
Water soluble vitamins
************************
Water-soluble vitamins dissolve in water, which means these vitamins and nutrients dissolve quickly in
the body. Unlike fat-soluble vitamins, water-soluble vitamins are carried to the body’s tissues, but the
body cannot store them. Any excess amounts of water-soluble vitamins simply pass through the body.
Because these vitamins are needed by our bodies, we need to make sure we intake these vitamins on a
regular basis. Water soluble vitamins include Vitamin C and the vitamin B complex: thiamin (B1),
riboflavin (B2), niacin (B3), pantothenic acid (B5), Vitamin B6, biotin (B7), folic acid (B9), Vitamin B12.
Vitamin A in its Beta-Carotene form is also water-soluble.
Fat soluble vitamins
*********************
Fat-soluble vitamins are soluble in fats. They are absorbed by fat globules that travel through the small
intestines and into the general blood circulation within the body. Unlike water-soluble vitamins, fat-
soluble vitamins are stored in the body when they are not in use. Typically, they are stored in the liver
and fat tissues. Although only small amounts of these vitamins are necessary to maintain good health,
Vitamin D deficiency has been reported as a growing public health concern. It has been associated with
an increased risk of certain diseases. Fat-soluble vitamins include Vitamin A (palmitate form), Vitamin D,
Vitamin E and Vitamin K.
Essential vitamins and minerals
***********************************
There are 13 essential vitamins: vitamins A, C, D, E, K, and 8 B vitamins.
And also there are 16 essential minerals: calcium, phosphorus, potassium, sulfur, sodium, chloride,
magnesium, iron, zinc, copper, manganese, iodine, and selenium, molybdenum, chromium, and fluoride.

2. Briefly describe the roles and functions of the vitamins and minerals stated

1. Water-soluble vitamins
Water-soluble vitamins travel freely through the body, and excess amounts usually are excreted
by the kidneys. The body needs water-soluble vitamins in frequent, small doses. These vitamins
are not as likely as fat-soluble vitamins to reach toxic levels. But niacin, vitamin B6, folate,
choline, and vitamin C have upper consumption limits.
Water-soluble vitamins
Thiamine (vitamin B1)
Part of an enzyme needed for energy metabolism; important to nerve function
Found in all nutritious foods in moderate amounts: pork, whole-grain or enriched breads and
cereals, legumes, nuts and seeds
Riboflavin (vitamin B2)
Part of an enzyme needed for energy metabolism; important for normal vision and skin health.
Milk and milk products; leafy green vegetables; whole-grain, enriched breads and cereals
Niacin (vitamin B3)
Part of an enzyme needed for energy metabolism; important for nervous system, digestive
system, and skin health
Pantothenic acid
Part of an enzyme needed for energy metabolism
Biotin
Part of an enzyme needed for energy metabolism
Pyridoxine (vitamin B6)
Part of an enzyme needed for protein metabolism; helps make red blood cells

Folic acid
Part of an enzyme needed for making DNA and new cells, especially red blood cells
Cobalamin (vitamin B12)
Part of an enzyme needed for making new cells; important to nerve function
Ascorbic acid (vitamin C)
Antioxidant; part of an enzyme needed for protein metabolism; important for immune system
health; aids in iron absorption

Fat-soluble vitamins
Vitamin A (and its precursor*, beta-carotene)
*A precursor is converted by the body to the vitamin.
Needed for vision, healthy skin and mucous membranes, bone and tooth growth, immune
system health

Vitamin A from animal sources (retinol): fortified milk, cheese, cream, butter, fortified
margarine, eggs, liver
Beta-carotene (from plant sources): Leafy, dark green vegetables; dark orange fruits (apricots,
cantaloupe) and vegetables (carrots, winter squash, sweet potatoes, pumpkin)

Vitamin D
Needed for proper absorption of calcium; stored in bones

Egg yolks, liver, fatty fish, fortified milk, fortified margarine. When exposed to sunlight, the skin
can make vitamin D.

Vitamin E
Antioxidant; protects cell wall
plant oils (soybean, corn, cottonseed, safflower); leafy green vegetables; wheat germ; whole-
grain products; liver; egg yolks; nuts and seeds

Vitamin K
Needed for proper blood clotting
Leafy green vegetables such as kale, collard greens, and spinach; green vegetables such as
broccoli, Brussels sprouts, and asparagus; also produced in intestinal tract by bacteria

16 essential minerals
nitrogen
building block of protein for plants. it forms amino acids and the vitamins needed. it also affects
energy reactions in the plant.

phosphorus
needed for growing plants, plant genetics, and seed development. it aids plant maturity,
increases seed yield, fruit development, aids the plant resistance to disease and winter kill.

potassium
needed for strengthening plants. improves color and flavor of fruits, aids early growth, stem
strength and cold hardiness.
calcium
used for continuous cell division and formation. it reduces plant respiration and also increases
fruit set.

magnesium
key element of chlorophyll production. increases the use of phosphorus and iron in plants and
causes earliness of maturity.

sulphur
helps develop enzymes and vitamins. it aids seed production, chlorophyll formation and for
amino acids.

boron
 essential for seed and cell wall formation, germination of pollen grains and growth, promotes
maturity.

chlorine
promotes maturity of small grains in some soils

copper
improves flavor in fruits and veggies, increases sugar content, helps in reproductive stages,
brightens colors

iron
aids as an oxygen carrier, promotes formation of chlorophyll and takes part in cell division and
growth.

manganese
aids chlorophyll synthesis, and increases availability of P and Ca.

molybdenium
helps form legume nodules, forms enzymes, and is needed to convert inorganic phosphates to
organic forms in the plants.

3. Which of the micronutrients mentioned must be supplemented in a pregnant

woman? Why so?
What are the possible complications and disorders resulting from the deficiency or toxicity of
the micronutrients in a pregnant woman?
Essential vitamins and minerals in pregnancy
Good nutrition in pregnancy is vital for the healthy growth and development of your baby. You need to
consume enough nutrients to meet your baby’s needs, as well as your own.
When someone is pregnant, you need more of some nutrients, including protein, folate, iodine and iron.
folate (called ‘folic acid’ when in supplement form) helps prevent neural tube defects, such as spina
bifida
iodine is needed for brain and nervous system development
iron helps prevent anaemia in the mother, as well as low birth weight in the baby.
Others:
Calcium
Helps to build strong bones and teeth. Main sources include milk, cheese, yogurt, and sardines. During
pregnancy you need 1,000 milligrams (mg) daily.

Iron
Helps red blood cells deliver oxygen to your baby. Sources include lean red meat, dried beans, peas, and
iron-fortified cereals. During pregnancy you need 27 mg daily.

Vitamin A
You need this vitamin for healthy skin, eyesight, and bone growth. Carrots, dark, leafy greens, and sweet
potatoes are good sources. During pregnancy you need 770 micrograms daily.

Vitamin C
Promotes healthy gums, teeth, and bones, and helps your body absorb iron. Good sources include citrus
fruit, broccoli, tomatoes, and strawberries. During pregnancy you need 85 mg daily.

Vitamin D
Aids your body in the absorption of calcium to help build your baby’s bones and teeth. Sources include
exposure to sunlight, fortified milk, and fatty fish, such as salmon. During pregnancy you need 600
international units (IUs) daily.

Vitamin B6
Helps form red blood cells and helps your body use protein, fat, and carbohydrates. You can find vitamin
B6 in beef, liver, pork, whole-grain cereals, and bananas. During pregnancy you need 1.9 mg daily.

Vitamin B12
Helps form red blood cells and maintains your nervous system. You can find this vitamin only in animal
products. Good sources include liver, meat, fish, poultry, and milk. During pregnancy you need 2.6
micrograms daily.

Folate (Folic Acid)

A B vitamin important in the production of blood and protein, it also reduces the risk of neural tube
defects (a birth defect of the brain and spinal cord). You can find folate in green, leafy vegetables, liver,
orange juice, legumes (beans, peas, lentils), and nuts.

Complications for pregnant women if they won't take prenatal vitamins and minerals
A woman needs enough folic acid in her body before and during pregnancy.
If you do not get enough folic acid before and during pregnancy, your baby is at higher risk for neural
tube defects. Neural tube defects are serious birth defects that affect the spine, spinal cord, or brain and
may cause death.
Iron, vitamin D, iodine, and calcium. Getting the right amount of iron can prevent iron-related anemia.
Anemia is associated with premature birth and low birth weight, which are linked to issues affecting
brain development, breathing, and the immune system.

Vitamin D plays a role in preventing pregnancy complications such as diabetes, preeclampsia, even
depression.Vitamin D is also hard to get from food alone, which is why it’s a key part of prenatal
vitamins.

Iodine can lower your risk of several issues.iodine deficiency can be harmful to the baby’s healthy brain
development, and in extreme cases is linked to miscarriage and stillbirth.
As for calcium, if a pregnant woman doesn’t take in enough of this mineral for both herself and her
baby, her body will leech calcium from her bones and teeth to help the baby, putting her at risk for
weaker bones and osteoporosis.
Supplements to Avoid During Pregnancy ( can be toxic if many in pregnant women )
While supplementing with some micronutrients and herbs is safe for pregnant women, many should be
avoided.
1. Vitamin A
Although this vitamin is extremely important for fetal vision development and immune function, too
much vitamin A can be harmful.Because vitamin A is fat-soluble, the body stores excess amounts in the
liver.
This accumulation can have toxic effects on the body that can lead to liver damage. It can even cause
birth defects in babies.
For example, excessive amounts of vitamin A during pregnancy has been shown to cause congenital
birth defects.
2. Vitamin E
This fat-soluble vitamin plays many important roles in the body and is involved in gene expression and
immune function
While vitamin E is very important for health, it’s recommended that pregnant women do not
supplement with it.
Supplementing with vitamin E has not been shown to improve outcomes for either mothers or babies
and may instead increase the risk of abdominal pain and premature rupture of the amniotic sack
NUMBER 3, 4 AND ETC. ARE GOOD TO KNOW ONLY
3. Black Cohosh
A member of the buttercup family, black cohosh is a plant used for a variety of purposes, including
controlling hot flashes and menstrual cramps.
It is unsafe to take this herb during pregnancy, as it can cause uterine contractions, which could induce
preterm labor.
cohosh has also been found to cause liver damage in some people
4. Goldenseal
Goldenseal is a plant that is used as a dietary supplement to treat respiratory infections and diarrhea,
although there is very little research on its effects and safety.
Goldenseal contains a substance called berberine, which has been shown to worsen jaundice in infants.
It can lead to a condition called kernicterus, a rare type of brain damage that can be fatal.
For these reasons, pregnant women should avoid goldenseal.
Other Herbal Supplements Considered Unsafe During Pregnancy:
Saw palmetto
Tansy
Red clover
Angelica
Yarrow
Wormwood
Blue Cohosh
Pennyroyal
Ephedra
Mugwort
PHYSIO

1. Identify the approximate normal volumes of fluid entering and leaving the gastrointestinal tract
daily.

Types of secretion: Daily Volume (ml)

Saliva 1000
Gastric Secretion 1500
Pancreatic Secretion 1000
Bile 1000
Small Intestine Secretion 1800
Brunner’s gland Secretion 200
Large Intestine Secretion 200

2. Describe the overall role of the gastrointestinal system with respect to the whole body balance of
water, electrolytes, carbohydrates, fats, and proteins.

The Large intestine absorb massive quantities of water and electolytes.Sodium is absorbed from the
intestinal lumen by several mechanisms, most prominently by cotransport with glucose and amino acids,
and by Na+/H+ exchange, both of which move sodium from the lumen into the enterocyte.

Cardohydrates Digestion

The chemical digestion of starches begins in the mouth with salivary amylase which is released during
the process of chewing. amylase then breaks starches into maltose and polysaccharide. Glucose,
galactose, and fructose are the three monosaccharides that are commonly consumed and are readily
absorbed.

In the small intestine, pancreatic amylase does the ‘heavy lifting’ for starch and carbohydrate
digestion.After amylases break down starch into smaller fragments, the brush border enzyme α-
dextrinase starts working on α-dextrin, breaking off one glucose unit at a time. Three brush border
enzymes hydrolyze sucrose, lactose, and maltose into monosaccharides. Sucrase splits sucrose into one
molecule of fructose and one molecule of glucose; maltase breaks down maltose and maltotriose into
two and three glucose molecules, respectively; and lactase breaks down lactose into one molecule of
glucose and one molecule of galactose. Insufficient lactase can lead to lactose intolerance.
Fats Digestion

A healthy diet limits lipid intake to 35 percent of total calorie intake. The most common dietary lipids are
triglycerides, which are made up of a glycerol molecule bound to three fatty acid chains. Small amounts
of dietary cholesterol and phospholipids are also consumed.The three lipases responsible for lipid
digestion are lingual lipase, gastric lipase, and pancreatic lipase. However, because the pancreas is the
only consequential source of lipase, virtually all lipid digestion occurs in the small intestine. Pancreatic
lipase breaks down each triglyceride into two free fatty acids and a monoglyceride. The fatty acids
include both short-chain (less than 10 to 12 carbons) and long-chain fatty acids.

Proteins Digestion

Proteins are polymers composed of amino acids linked by peptide bonds to form long chains.Digestion
reduces them to their constituent amino acids. You usually consume about 15 to 20 percent of your
total calorie intake as protein.

The digestion of protein starts in the stomach, where HCl and pepsin break proteins into smaller
polypeptides, which then travel to the small intestine. Chemical digestion in the small intestine is
continued by pancreatic enzymes, including chymotrypsin and trypsin, each of which act on specific
bonds in amino acid sequences. At the same time, the cells of the brush border secrete enzymes such as
aminopeptidase and dipeptidase, which further break down peptide chains.This results in molecules
small enough to enter the bloodstream.
 3. What is the role of the GI tract in the processes of digestion, absorption, metabolic
production, metabolic consumption, secretion, and excretion?

GI tract is not just a pathway or a tract in which our food will pass, it encompasses different organs
and structures which have unique properties and function which will help in the metabolism of food
in our body.
The role of GI:
1. Ingestion
The first function of the digestive system is ingestion, or the intake of food. The mouth is responsible
for this function, as it is the orifice through which all food enters the body. The mouth and stomach
are also responsible for the storage of food as it is waiting to be digested. This storage capacity allows
the body to eat only a few times each day and to ingest more food than it can process at one time.

2. Secretion
In the course of a day, the digestive system secretes around 7 liters of fluids. These fluids include
saliva, mucus, hydrochloric acid, enzymes, and bile. Saliva moistens dry food and contains salivary
amylase, a digestive enzyme that begins the digestion of carbohydrates. Mucus serves as a protective
barrier and lubricant inside of the GI tract. Hydrochloric acid helps to digest food chemically and
protects the body by killing bacteria present in our food. Enzymes are like tiny biochemical machines
that disassemble large macromolecules like proteins, carbohydrates, and lipids into their smaller
components. Finally, bile is used to emulsify large masses of lipids into tiny globules for easy
digestion. Digestion
 3. Digestion is the process of turning large pieces of food into its component chemicals. Mechanical
digestion is the physical breakdown of large pieces of food into smaller pieces. This mode of digestion
begins with the chewing of food by the teeth and is continued through the muscular mixing of food by
the stomach and intestines. Bile produced by the liver is also used to mechanically break fats into
smaller globules. While food is being mechanically digested it is also being chemically digested as
larger and more complex molecules are being broken down into smaller molecules that are easier to
absorb. Chemical digestion begins in the mouth with salivary amylase in saliva splitting complex
carbohydrates into simple carbohydrates. The enzymes and acid in the stomach continue chemical
digestion, but the bulk of chemical digestion takes place in the small intestine thanks to the action of
the pancreas. The pancreas secretes an incredibly strong digestive cocktail known as pancreatic juice,
which is capable of digesting lipids, carbohydrates, proteins and nucleic acids. By the time food has
left the duodenum, it has been reduced to its chemical building blocks—fatty acids, amino acids,
monosaccharides, and nucleotides.
4.. Absorption
Once food has been reduced to its building blocks, it is ready for the body to absorb. Absorption
begins in the stomach with simple molecules like water and alcohol being absorbed directly into the
bloodstream. Most absorption takes place in the walls of the small intestine, which are densely folded
to maximize the surface area in contact with digested food. Small blood and lymphatic vessels in the
intestinal wall pick up the molecules and carry them to the rest of the body. The large intestine is also
involved in the absorption of water and vitamins B and K before feces leave the body.
5. Excretion
The final function of the digestive system is the excretion of waste in a process known as defecation.
Defecation removes indigestible substances from the body so that they do not accumulate inside the
gut. The timing of defecation is controlled voluntarily by the conscious part of the brain, but must be
accomplished on a regular basis to prevent a backup of indigestible materials.

4. For carbohydrates, differentiate the processes of ingestion, digestion, absorption, secretion, and
excretion, including the location in the GI tract where each process occurs. Repeat the analysis for
proteins and fats.