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I. OVERVIEW
The gastrointestinal (GI) system is a complex tube bounded by the mouth at one end
and the anus at the other. Food enters the mouth; travels through the esophagus,
stomach, small intestine (duodenum, jejunum, and ileum), large intestine (ascending,
transverse, and descending colon), and rectum; and then exits via the anus (Figure
29.1). This tube's primary function is the absorption of dietary nutrients. To maximize
nutrient absorption, secretions are added to food from the salivary glands, stomach,
liver, gallbladder, and pancreas to convert complex molecules into simpler ones. This
conversion, called digestion, is effected by enzymes and H+. Dietary contents and
secretions are mixed and propelled along the tube (motility) from one specialized
compartment to another by coordinated peristaltic contractions and relaxations of the
tube walls (Figure 29.2). Two other important GI functions include storage (e.g., food is
and excretion of
stored in the stomach and fecal matter in the colon)
undigested
materials and biliary waste products.
along the length of the tube. Moving from the lumen to the outside of the tube, the
layers include epithelium, lamina propria, muscularis mucosa, submucosa, submucosal
plexus, circular muscle, myenteric plexus, longitudinal muscle, and serosa (Figure 29.3).
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A. Mucosa
The epithelium, lamina propria, and muscularis mucosa together form the mucosa.
The epithelium is a single cell layer forming a continuous lining of the GI tract. GI
epithelial cells are shed and replaced every 2–3 days. The apical side of the epithelium
faces the GI lumen, and the basolateral side faces the interstitium and vasculature.
Apical surfaces may be enhanced with villi (thumblike projections)
and crypts (invaginations) to increase surface area and maximize contact between
epithelium and intestinal contents (Figure 29.4). Absorptive areas (e.g., small intestine)
contain numerous apical enhancements. Areas primarily involved with motility (e.g.,
esophagus) do not. The lamina propria is a loose connective tissue composed of
elastin and collagen fibers that contains sensory nerves, blood and lymph vessels, and
some secretory glands. The muscularis mucosa is a thin layer of smooth muscle that
further increases surface area by creating mucosal ridges and folds.
Figure 29.1
Gastrointestinal tract.
Figure 29.2
Peristalsis.
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Figure 29.3
B. Submucosa
C. Muscularis externa
The muscularis externa comprises circular muscle, the myenteric plexus,
and longitudinal muscle layers. The two smooth muscle layers are named based on
their orientation. The circular muscle layer is arranged in rings and pinches the tube
when it contracts. The longitudinal layer is arranged in parallel and shortens the tube
when it contracts. The ENS coordinates circular and longitudinal muscle contraction to
mix intestinal contents and move them between compartments. Circular muscle also
forms sphincters, which regulate flow of food from one compartment to the next by
modulating lumen diameter. The myenteric plexus (Auerbach plexus), also part of the
ENS, is located between the circular and longitudinal muscle layers.
D. Serosa
Figure 29.4
ENS.
Parasympathetic innervation is derived from the vagus (medulla oblongata) and pelvic–
splanchnic nerves (S2–S4) and has both motor and sensory components (Figure 29.5).
The sensory components respond to stretch, pressure, temperature, and osmolarity and
participate in vagovagal reflexes. Vagovagal reflexes occur when the vagus nerve
(cranial nerve X) participates in both afferent sensation and efferent responses without
central nervous system involvement. Primary neurotransmitters used directly or
indirectly by the PSNS are acetylcholine (ACh), gastric-releasing peptide,
and substance P (Table 29.1). In general, signals from the PSNS stimulate GI secretions
and motility, which facilitates digestion and absorption of nutrients.
Sympathetic nerves originate in the thoracic (T5–T12) and lumbar (L1–L3) regions and
synapse in one of three ganglia: celiac, superior mesenteric, or inferior mesenteric for
the lower GI system (Figure 29.6). The upper GI tract (e.g., salivary glands) is innervated
by SNS nerves that synapse within the superior cervical ganglion (see Figure 29.6).
Unlike the PSNS, the SNS component does not contain a direct sensory arm and
generally decreases GI secretions and motility when active. The primary SNS
neurotransmitters are norepinephrine and neuropeptide Y (see Table 29.1).
Figure 29.5
PSNS and SNS nerves usually synapse with components of the ENS. Although the ENS
is modulated by these extrinsic neural inputs, it can operate autonomously via intrinsic
regulation and sensory reflexes. ENS nerves are organized into myenteric and
submucosal plexuses.
Figure 29.6
Sympathetic innervation.
Submucosal and myenteric plexus neuropathy can impair motility. For example, a
protozoan infestation (Trypanosoma cruzi, often delivered by kissing bugs) of these
plexus neurons can lead to Chagas disease. Among other pathologies, Chagas disease
causes distention and structural enlargements of
the esophagus
Megaesophagus.
A. Hormones
GI paracrines are both released and act locally. The primary paracrine GI signaling
molecules are histamine, prostaglandins, and somatostatin (Table 29.3). Of these, only
somatostatin is a peptide. Histamine is classified as a monoamine, and prostaglandins
are eicosanoid-signaling molecules. Histamine is released in the stomach, whereas both
prostaglandins and somatostatin are more widespread in their release and actions.
Figure 29.7
V. DIGESTIVE PHASES
Stomach and duodenal function can be divided into three discrete phases: cephalic,
gastric, and intestinal.
A. Cephalic phase
Nasogastric tube.
B. Gastric phase
The gastric phase begins when food and oral secretions enter the stomach. It coincides
with distention and stomach contents (amino acids and peptides) and elicits neural,
hormonal, and paracrine GI responses. A good example of this combination of signaling
molecules is in gastric acid secretion, which includes ACh (neural), gastrin (hormonal),
and histamine (paracrine).
C. Intestinal phase
Chapter Summary
• Absorption is the process of transporting dietary contents across the gastrointestinal
barrier into the body.
• To prepare nutrients for absorption, the body mechanically and chemically breaks
down food into smaller, simpler particles. The chemical breakdown of food is digestion,
and the mechanical breakdown of food involves smooth (i.e., as in mixing) or skeletal
(i.e., as in chewing) muscle contractions.
• Secretion is the act of transporting molecules or fluid from the body to the
gastrointestinal lumen. Secretion facilitates digestion by delivering enzymes and water
and protects the endothelial surface by secreting HCO3− and mucus.
• The autonomic nervous system innervates the entire gastrointestinal (GI) system. The
parasympathetic nervous system most often facilitates secretion and motility, whereas
the sympathetic nervous system decreases these functions. The enteric nervous
system can operate independently and is involved with reflexes and the majority of GI
functions.
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