The Accessory Organs

The Pancreas
The pancreas is a fish-shaped, spongy, grayish-pink organ that is located laterally, directly
beneath the stomach, and is connected to the duodenum.. During digestion it is purple in color
and is whitish when at rest. The pancreas is composed of lobes, known as acini. Each acinus
functions as a small independent unit of the pancreas. Most pancreatic acinar cells produce
pancreatic juice, which enters the duodenum via the pancreatic duct (Fig. 1a).
The pancreatic juice has a density equal to plasma, and its pH is between 8.0 and 8.5. Its
alkalinity is due to the bicarbonate ions it contains. It is composed of:
a- The digestive enzymes that act upon different constituents of food which include :
1. Amylase (digests starch )
2. Trypsinogen (trypsin ), chemotrypsin, carboxypeptidase, Elastase (digests protein)
3. Lipase and lecithinase. (digests fat)
4. small amount of nuclease (digest nucleic acid and nucleotides)
b- Inorganic substances:
1. Sodium bicarbonate that neutralizes acid chyme from the stomach.
2. Water, chloride and small amount of phosphate.
3. Na, K, Ca and Mg ions may be found in pancreatic secretions
The islets of Langerhans are located between the acini of the pancreas. The hormones insulin and
glucagon, active during the regulation of the level of blood sugar, are secreted into the blood.

Figure 1: Accessory organs of the digestive system. a. The location of the liver, gallbladder, and
pancreas in relation to the small intestine. b. The liver contains over 100,000 lobules.
The Liver
The largest gland in the body, the liver, lies mainly in the upper right section of the abdominal
cavity, under the diaphragm. Its upper surface is concave and is adjacent to the diaphragm. The
lower, convex surface is in close proximity to the stomach, small intestine and the right kidney.
The liver is composed of four main lobes and the right lobe is the largest.
The liver is comprised of tissue, the membranes surrounding it and the bile duct. The outer
membrane of the liver is known as the peritonea, and connects the liver to the stomach and the
diaphragm. A secondary connective tissue located directly beneath the layer of peritonea
penetrates into the liver, and is responsible for the presence of lobules. The lobes are 1 to 2 mm in
diameter and are pentagonal or hexagonal in shape.
The liver is a major metabolic gland with approximately 100,000 lobules that serve as its
structural and functional units (Fig. 1b). Each lobule functions separately and may carry out more
than 500 different activities. Each lobe is separated from the others by a connective layer which
carries the branches of the hepatic artery and hepatic vein. These vessels branch out in each of the
lobes to form capillaries. The hepatic vein is formed at the point of their reconnection at the
center of each lobe, and there are star-like gaps between the lobes. Generally, arterial capillaries
are located in the outer portion of the lobe, whereas venal capillaries are found in the inner
portion. Kuppfer cells within each lobe eliminate all foreign substances entering the lobe by
phagocytosis.
The liver is supplied with blood by the hepatic artery and the hepatic portal vein. The common
bile duct leading from the gall bladder transmits bile salts, into the duodenum. The hepatic portal
vein (Fig. 1b) brings blood to the liver from the GI tract capillary bed. Capillaries of the lobules
filter this blood. In a sense, the liver acts as a sewage treatment plant when it removes poisonous
substances from the blood and detoxifies them.
Functions of the liver
• Formation and secretion of bile.
• Regulation of blood sugar level (glucose homeostasis). The excess glucose in the blood is
stored as glycogen in the liver. Glycogen is hydrolyzed and glucose is released into the blood
when the level of sugar in the blood decreases.
• Formation of plasma proteins (albumins ,fibrinogen and thrombogen) from amino acids,
which are active during blood clotting.
• Conversion of pro-vitamin A into vitamin A by the enzyme carotinase.
• Removes of Fe, Cu, proteins and vitamins A, D, E , K and B 12 from blood and stores them
• Degradation of old red blood cells by Kuppfer cells.
• Detoxification of blood by elimination of metabolizing poisonous substances and foreign
substances, which enter the liver through the blood.
• Synthesis of urine by the reaction of 2 mol CO 2 and ammonia, the waste product of amino
acid metabolism.
• Heparin, secreted by the liver, prevents clotting of blood within the vessels.
• Helps regulate blood cholesterol levels as well. Some cholesterol is converted to bile salts by
the liver.
• If need be, the liver converts glycerol (from fats) and amino acids to glucose molecules.
• The synthesis of red blood cells by reticulo-endothelial cells.

Gallbladder and Bile:

Gallbladder is a pear-shaped organ located below the right lobe of liver. Gallbladder stores the
bile produced by liver cells until it is sent via the bile ducts to the duodenum. Bile is a solution of
bile salts, water, cholesterol, bicarbonate, fatty acids, plasma electrolytes and bilirubin. It
has a yellowish-green color, because it also contains bilirubin, a pigment protein formed during
the breakdown of hemoglobin, which is a process also performed by the liver. Bile pigments are
converted to a brown color by the enzymatic activity of intestinal bacteria, and this conversion of
pigment gives feces its color.
Cholesterol accounts for approximately 1 g of the bile, and is insoluble in water. A reduction in
bile salts can result in the formation of gallstones by the precipitation of cholesterol. Gallstones
also form when liquid stored in the gallbladder hardens into pieces of stone-like material.
Bile salts are the water soluble metabolic wastes of liver cells. Approximately 1000 ml of bile is
secreted from the liver in a single day, and any excess is stored in the gallbladder. Water, sodium
chloride and other electrolytes are reabsorbed to concentrate it.
When needed, bile leaves the gallbladder and proceeds to the duodenum via the common bile
duct. In the small intestine, bile salts emulsify fat. When fat is emulsified, it breaks up into
droplets. The droplets provide a large surface area that can be acted upon by digestive enzymes.
Functions of bile
• It neutralizes the acidity of chyme entering the duodenum from the stomach, and facilitates
the activity of intestinal enzymes.
• It emulsifies lipids and facilitates the activity of the enzyme lipase.
• It enables the absorption of vitamins A, D, E and K.
• It increases absorption by accelerating movement of the villi.
Digestive Secretions
Digestive secretions originate from the salivary glands, gastric glands, pancreas, gallbladder and
small intestine.
a. Salivary glands and their secretions
Approximately 1000-1500 ml of saliva is secreted from salivary glands every day. The secretions
of these three glands are mixed within the mouth. These secretions are composed of 3% protein
and amylase enzymes, also known as ptyalin (salivary amylase). It also contains Lingual lipase
that play minor role in lipid digestion (See Table 1).
Regulation of Salivary Secretions
Salivary secretions are regulated by conditional and non-conditional reflexes.
1. In non-conditional reflexes, food stimulates the nerve endings in the mouth. The generated
impulse stimulates the secretory center of the medulla oblongata in the brain. The impulses
generated from this center stimulate secretions from the salivary glands.
2. Conditional reflexes are observed when the individual exercises, thinks about, sees, or smells
food. These actions stimulate the related centers in the brain which initiate saliva secretions.
The parasympathetic nerves of the autonomic nervous system stimulate diluted secretions,
whereas sympathetic nerves stimulate undiluted, cohesive secretions.

b. Gastric Juice
Gastric juice is secreted from the gastric glands located in the mucosa of the stomach, and
approximately 300 ml is produced per day. (See Table 1).
HCl in gastric juice has the following roles:
• converts pepsinogen to active pepsin.
• stimulates the secretions of the pancreas and intestinal glands.
• destroys microbes ingested with food.
• facilitates digestion by denaturing proteins.
Mucus, composed of glycoproteins and secreted by the gastric glands, protects the gastric mucosa
against peptic digestion and irritation by foreign substances. It forms a protective covering over
the internal surface of the stomach. Any damage to the gastric mucosa is repaired by
regeneration. Initial abrasion of the stomach is known as a gastrite, which may develop into an
ulcer. The pH value of the stomach is approximately 1 to 2, providing a strong acidic
environment for digestion to occur.
 Table 1: Digestive Enzymes
Location Substrate Enzyme Enzyme Optimum Product Site of
process

source pH absorption

Mouth Starch Salivary Amylase Salivary Neutral Maltose,

glands matotriose,
α-dextrin
Carbohydrates

Duodenum Starch Pancreatic Amylase Pancreas Alkaline Maltose

Digestion

α-Dextrin α –Dextrinase Small Alkaline Glucose

intestine.
Small Maltose Maltase Intestinal Alkaline Glucose + Capillary
Intestine gland Glucose network at
Sucrose Sucrase Intestinal Alkaline Glucose + the villi
gland Fructose
Lactose Lactase Intestinal Alkaline Glucose +
gland Galactose
Proteins Pepsin (activated Stomach Acidic Peptones &
from pepsinogen by chief cells Polypeptides
pepsin and HCl)
Stomach
Milk Proteins Rennin Stomach Acidic Casein
chief cells
Duodenum Peptones & Trypsin (activated Pancreatic Alkaline Peptides &
Polypeptides from trypsinogen by acinar cells. Amino acids
Digestion

enterokinase)
Duodenum Peptones & Chemotrypsin Pancreatic Alkaline Peptides &
Polypeptides (activated from acinar cells. Amino acids
chymotrypsinogen
by trypsin)
Duodenum Peptones & Elastase (activated Pancreatic Alkaline Peptides &
Polypeptides from proelastase by acinar cells. Amino acids
trypsin)
Proteins

Duodenum Amino acid at Carboxypeptidase Pancreatic Alkaline Amino acids

carboxyl end (activated from acinar cells. and peptides.
of peptides. procarboxypeptidase
by trypsin)
Small Amino acid at Aminopeptidase Intestinal Alkaline Amino acids
intestine. amino end of gland & peptides.
peptides.
Small Peptides, di & Erepsin Intestinal Alkaline Amino acids Capillary
intestine tripeptides (Dipeptidase) gland network at
the villi
Mouth Triglycerides Lingual Lipase Lingual Neutral Fatty acids &
and other glands diglycerides
Lipids Digestion

lipids
Stomach Triglycerides Gastric lipase Stomach Alkaline Fatty acids &
(fats and oils). chief cells. mono-
glycerides.
Duodenum Triglycerides Pancreatic lipase Pancreatic Alkaline Fatty acids & Lymph
& Small (fats and oils) acinar cells. mono- vessels at the
Intestine that have been glycerides villi
emulsified by
bile salts.
Duodenum DNA& RNA Nucleases Pancreas Alkaline Nucleotides
Nucleic Acid

& Small (Deoxyribonuclease

Digestion

Intestine & Ribonuclease )

Small Nucleotides Nucleosidases Small Alkaline base + sugar Capillary
Intestine intestine + phosphate network at
the villi
Regulation of Stomach Secretions
Stomach activity is regulated in three phases :(See Table 2)
Phase 1: The vagus nerve, located at the center of the medulla oblongata, stimulates the gastric
secretory cells.
Phase 2: The hormone gastrin stimulates the stomach, causing the release of pepsinogen and
HCl. Pepsinogen is then converted to pepsin, which consequently activates the release of more
pepsinogen.
Phase 3: The flow of stomach contents into the small intestine stimulates the secretion of
enterogastrin, secreted from the duodenum, preventing further gastrin secretion. The lipid and
acidic content of blood also activate this secretion.

c. Liver and Bile Secretion

The common bile duct leading from the gallbladder transmits bile salts, which emulsify fats in the
duodenum.
Regulation of Liver and Bile Secretion
Cholecystokinin (CCK) causes the liver to increase its production of bile and causes the
gallbladder to contract and release stored bile. The bile then aids the digestion of fats that
stimulated the release of more CCK (See Table 2)..

d. Pancreatic secretions
Acinar pancreatic cells secrete approximately 1.5 - 2.0 liters of pancreatic juices per day. It
contain the following enzymes: Pancreatic amylase, trypsinogen –Trypsin, chymotrypsinogen –
Chymotrypsin, Elastase, Carboxypeptidase, Pancreatic lipase, Nucleases: Ribonuclease,
Deoxyribonuclease) (See Table 1 for their action and function).
Regulation of Pancreatic Secretions
Pancreatic secretions are stimulated by the hormone secretin (produced by the duodenal wall)
(See Table 2). Normally, the inactive form of these pancreatic secretions is found in the mucosa
of the duodenum, and is activated by the acidic effects of chyme. Secretin is transported from the
cells lining the duodenum to the pancreas by the blood, and stimulates the secretion of pancreatic
juice. Pancreatic secretions are also regulated by CCK (cholecystokinin)- produced by the
duodenal wall- and the vagus nerve.
The islets of Langerhans are located between the acini of the pancreas. The hormones insulin
and glucagon, active during the regulation of the level of blood sugar, are secreted here.
 Table 2: Hormones and their Roles in digestion processes
Hormone Source Stimulating Target Response of
Factor Organ Target Organ
Gastrin Gastric mucosa Entry of food into the Gastric Gastric juice
stomach mucosa
Secretin Duodenal mucosa Acidic pH of the Pancreas Initiation of
duodenum enzyme secretion
Enterogastrin Intestinal mucosa Fatty acids Stomach Inhibition of
gastric activity
Cholecystokinin Intestinal mucosa Acidity of chyme Gallbladder Release of Bile
Pancreasamin Duodenal mucosa Acidity of chyme Pancreas Inhibition of
pancreatic activity

e. Small Intestine Secretions

The secretions of the small intestine include α–Dextrinase, Maltase, Sucrase, Lactase,
Enterokinase, Peptidases: aminopeptidase, dipeptidase (Erepsin), Nucleosidases. (See Table 1
for enzymes action and function).
The secretions of the small intestine are stimulated by the pressure of intestinal contents on its
internal surface, partially by the effect of parasympathetic nerves.

Overall Regulation of Digestive Secretions

The secretions of digestive juices are controlled by the nervous system and by digestive
hormones (See Table 2 and Figure 2).
1. Entry of food into the stomach (or when you look or smell food) stimulates secretion of gastric
juice by the effect of the vagus nerve (parasympathetic nervous system).
2. Gastric juice secretion (or when a meal particularly rich in protein) in turn stimulates the
stomach production and secretion of hormone gastrin, lowering the pH of the stomach. Gastrin
enters the bloodstream, and soon the secretory activity of gastric glands increases.
3. As the pH of the stomach decreases, this inhibits the secretion of gastrin.
4. The presence of chyme in the duodenum stimulates the production and secretion of
enterogastrin, secretin and cholecystokinin (CCK) by cells of the duodenal wall. Secretin release
is stimulated by acid, especially the HCl present in chyme. Partially digested proteins and fat
stimulate the release of CCK. Soon after these hormones enter the bloodstream, the pancreas
increases its output of pancreatic juice.
5. The presence of these peptides and fats in the duodenum trigger the secretion of pancreatic
enzymes, under the influence of CCK. Pancreatic juice buffers the acidic chyme entering the
intestine from the stomach and helps digest food.
6. The presence of CCK in turn triggers the liver to increase its production of bile and causes the
gallbladder to contract and release stored bile. The bile then aids the digestion of fats that
stimulated the release of CCK.
7. The build up of enterogastrin inhibits activity of the stomach.

Figure 2: The secretion of digestive enzymes is controlled by both hormones and by the
nervous system.
The Digestion of Food
Proteins, lipids and carbohydrates in food must be hydrolyzed into their monomers before they
can be utilized. Teeth, muscles, enzymes and water all play important roles in the digestive
process. Carbohydrates, proteins and lipids are gradually altered during digestion. Each different
food type is acted on by a different enzyme.
a. Digestion of Carbohydrate
Carbohydrates in food are in the form of glucose, fructose, sucrose, maltose, lactose, starch,
cellulose and glycogen. Cellulose, however, cannot be digested by humans or other animals, since
no enzyme exists to digest it. Microorganisms in the digestive system are, however, capable of
digesting cellulose. The enzymes that digest carbohydrates are called carbohydrases. The sites of
carbohydrate digestion are the mouth and small intestine.
MOUTH: The digestion of carbohydrates is initiated here. Starch is degraded to maltose
(disaccharide) or dextrin by the activity of the enzyme amylase. Dextrin is a part of a starch
molecule formed from eight glucose subunits.
STOMACH: No enzyme exists to digest carbohydrates in the stomach. However, foods are
mixed under acidic conditions in a process taking approximately 20-30 min. During this period,
40% of starch mixed with amylase is digested. Amylase fails to function when the acidity of the
stomach increases.
SMALL INTESTINE: The digestion of carbohydrates is completed in the small intestine.
Pancreatic amylase, more effective than salivary amylase, digests all previously undigested
carbohydrates to maltose and dextrin. The digestive products of starch and ingested sucrose,
lactose and maltose are broken down into their monomers (monosaccharides) by the enzymes
secreted by the intestinal mucosa. Digestion of carbohydrates is completed in the small intestine,
and digestive products pass through the villi into the blood.

b. Digestion of Proteins
They are digested in the stomach and small intestine. In the stomach, as explained previously, the
hormone gastrin is released into the blood when food enters the stomach. Gastrin functions as a
chemical messenger, stimulating the secretion of gastric juice from gastric glands.
Gastric juice includes inactive pepsinogen which, in the presence of HCI, is converted to active
pepsin. It is an enzyme which hydrolyzes protein molecules to peptones. Proteins, therefore, are
incompletely digested in the stomach (Figure 3).
The gastric glands of newborn infants and other mammals secrete the enzyme rennin. This
enzyme coagulates milk in order to increase the effect of pepsin.
 Figure 3: The steps in digestion of protein in small the intestine.
The chyme which enters the small intestine from the stomach is an acidic mixture. It causes the
secretion of the hormone secretin from the wall of the duodenum. This hormone passes into the
blood, and at the pancreas it consequently stimulates the secretion of pancreatic enzymes. An
effective enzyme, trypsinogen, is secreted, which is inactive upon entering the small intestine. It
is activated by enterokinase, secreted from intestinal glands, and is converted to active trypsin,
which hydrolyzes undigested protein molecules. Some peptides also digested into amino acids by
this enzyme. Peptides are then digested into amino acids by the action of different peptidases
(Figure 4). Amino acids pass through to the blood from the small intestine by absorption.

Figure 4: The process by which proteins are digested

c. Digestion of Lipids
Digestion takes place only in the small intestine. The digestion of lipids is complicated since they
are giant, water-insoluble molecules. The bile salts act like detergents to reduce the surface
tension of fats. Their action breaks large masses of fat into smaller emulsion droplets which
increase the surface area of the fats. As a result, lipase, the enzyme which provides chemical
digestion of fats, can act more effectively. The digestion of lipids is made considerably more
difficult if the gallbladder is removed. For this reason, such people should avoid lipid-rich foods.
Lipid+Lipase+Bile+H 2 O Fatty acids + Glycerol
The enzymes secreted during digestion are hydrolyzed into their component amino acids and
reabsorbed after digestion. Protein loss is therefore reduced to a minimum.

Absorption of the Nutrients

The most important property of the digestive system, absorption, and the digestion of all nutrients
is completed within the small intestine. The digested nutrients are then absorbed (Figure 3).
Some nutrients, such as vitamins and inorganic substances, pass directly through to the blood
without the need for any digestive process.
Absorption from the mouth and stomach is less than that in the small intestine. Some toxins,
medicines, ions and the drug cocaine, are absorbed in the mouth. Alcohol, aspirin, some ions,
such as K, Na, CI, Br, and some toxins are absorbed in the stomach.
Absorption occurs mainly within the small intestine, since its internal structure is highly suitable
for this purpose. The villi and microvilli increase the absorption surface of the small intestine to
approximately 600 m2.

The cells of the microvilli are rich in mitochondria, necessary for active absorption. Each villus
contains capillaries and lymph vessels of the lacteal, which transport nutrients both actively and
passively from the microvilli of each villus to absorptive cells. The nutrients are then transported
from these cells to capillaries and lymph vessels. Materials that have been absorbed into the
digestive tube’s lining pass into one of these capillaries. Water-soluble materials, such as sugars,
amino acids, and vitamins enter the blood capillary (Figure 5a, 5b), while fat-soluble material,
such as cholesterol and triglycerides, enter the lymphatic capillary (Figure 5c). All blood drained
away from the digestive tract goes directly to the liver.
The lipid droplets in the small intestine are split into triglycerides by lipase. These triglycerides
emulsified by bile, forming micelles, or water-soluble particles. The hydrophobic fatty acids
position themselves at the center of the micelle, whereas the hydrophilic glycerol molecules
position themselves on the surface, in direct contact with the water molecules in the environment.
These water soluble micelles are then able to pass into absorptive cells. The micelles are split and
the free triglycerides, together with phospholipids, cholesterol and free fatty acids (combined
with protein), to form lipoproteins called chylomicrons, which enter the lymphatic capillary of
the lacteal (Figure 5c). The fats in the lymphatic capillaries do not go directly to the liver, but
are dumped into the bloodstream by way of the jugular and subclavian veins in the neck. Once in
the bloodstream, lipoprotein lipase breaks chylomicrons down to short-chain fatty acids and
glycerol. These fats are sent around to the body and are used by the body’s tissues as a source of
energy or as structural materials needed for growth or repair of body tissues. Eventually, the
chylomicron remnants will be picked up by the liver. Moreover, lipids also facilitate the
absorption of lipid-soluble vitamins.
The venules from the villi flow into the hepatic portal vein, which transports all absorbed
nutrients from the small intestine to the liver. Blood leaves the liver by the hepatic vein and flows
into the inferior vena cava, and finally enters the right atrium of the heart.
Absorption in the Large Intestine:
All useful substances are absorbed before the chyme enters the large intestine, and only waste
materials, water and a small amount of electrolytes remain. The main function of the large
intestine is the absorption of water and electrolytes, and storage of insoluble wastes until their
removal. Furthermore, the symbiotic normal flora of the large intestine synthesizes vitamins B
and K. It has been suggested that the only source of vitamin K available for humans is from the
symbiotic bacteria of the large intestine.
Figure 5: Digestion and absorption of organic nutrients
Elimination (Defecation)
Defecation is the process of eliminating feces. Feces enter the rectum and travel to the anal canal.
The anal canal is short, and ends at the body opening called the anus (Figure 6).
There are two muscle sphincters in the anal canal, one at the beginning and one at the end
(Figure 6). They are both involved in the elimination of feces. By the time the content of the
digestive tube has reached the anal canal, it is made up of 60 to 90 milliliters of water, a mixture
of inorganic salts, dead epithelial cells, bacteria (about 30% by weight), unabsorbed material, and
undigested material.
Defecation results from the movement of chyme/feces through the large intestine by mass
peristaltic movements during the day, building up feces in the rectum. The feces cause the rectal
wall to stretch, resulting in initiation of the defecation reflex. This reflex involves local nerves
and the two sphincters of the anal canal. The sphincter at the beginning of the canal is made of
smooth muscle. The defecation reflex causes this sphincter to open, allowing feces to enter the
anal canal. The second sphincter, made of skeletal muscle, is under voluntary control and can
remain closed. At this point, local nerves send a signal to the brain of the need to have a bowel
movement. In the case of an infant human, the signal is not received in time to voluntarily keep
the second sphincter closed. When children become “potty trained,” they are able to keep this
sphincter closed until they choose to defecate. A person who has become incontinent has lost the
ability to keep the second sphincter closed.

Figure 6: Anal canal and its muscle sphincters