Gi system

GI tract divided into:

– Alimentary canal.
– Accessory digestive organs.
• GI tract is 30 ft long in an adult
– extends from mouth to anus.
Layers of GI Tract
Composed of 4 tunics (Layers)
•Mucosa
•Submucosa
•Muscularis
•Serosa
Neural Control of Gastrointestinal Function
Enteric Nervous System (ENS)
Two plexus
• 1. Myenteric plexus / Auerbach’s plexus:
– An outer plexus
– Lies between the longitudinal and circular muscle layers
– Controls the gastrointestinal motility
•Submucosal plexus / Meissner’s plexus
-An inner plexus
-Lies in the submucosa
-Controls gastric secretion and local blood flow
Autonomic Nervous System
 Parasympathetic Nerve:
Vagus nerves fibers
Innervate the esophagus, stomach, pancreas and up to first half
of the large intestine.
The sacral parasympathetic nerve fibers (S2,3,4)
• Innervate distal half of the large intestine and all the way to the anus.
Actions:
• Increase GI secretion
• Increase GI motility
The sympathetic fibers:
Originate in the spinal cord between T-5 and L-2 segments .
Actions:
• It inhibits smooth muscle except sphincter
• Reduces GI motility
• Reduces GI secretions
SALIVARY SECRETION
COMPOSITION OF SALIVA
• Volume – 1 to 1.5 L/ 24hrs
• pH - 6.0-7.0
• composition-
– Inorganic-
• HCO3-,Cl-, Na+, K+, Ca + +, PO4
 – Organic
• α-amylase, lingual lipase, mucin lysozyme, kallikrein, nerve growth
factor, IgA, Lactoferrin
Organic composition
• Ptyalin (α-amylase)
Starch (cooked) α - limit dextrins & maltose
Lingual lipase - digest 30% ingested triglycerides
Mucin – helps in food bolus formation
Lysozyme - destroy bacteria
IgA - bacteriostatic
Production of Saliva
• Primary secretion
• Ductal secretion
• Primary secretion
• From acini
• Rich in ptyalin and musin
• Isotonic

 Ductal Secretion
• Saliva entering the lumen – isotonic
• Saliva entering the mouth- hypotonic
– reabsorption of sodium and chloride by ductal cells
Nervous Regulation of Salivary Secretion
• Parasympathetic Innervation
– Secretomotor fiber
– Increase the volume of salivary secretion profoundly
• Sympathetic stimulation
– Causes vasoconstriction and reduces blood supply to the glands
– It causes small amount of secretion which is thick and viscous due to
high musin content
– No effect on parotid gland
Regulation of secretion
Unconditioned reflex :
• secretion after stimulus.
• presence of food in the mouth.
• prolonged dental manipulation.
• acidic food.
• stimulation of mechanoreceptors present in oropharynx.
• Stimulation of peripheral sensory nerve fibers
spontaneous secretion
Occurs without any known stimulus
Helps in keeping mouth moist.
Functions of saliva
• Helps in dissolving food substances to stimulate taste buds.
• Keeps the mouth clean and moist.
• Facilitates speech.
• Helps in food bolus formation.
• Maintains oral pH (act as buffers).
• Swallowing of food
• Constant flow washes food debris & prevents bacterial growth.
• Digests cooked starch & 30% of ingested triglycerides.
• Protects tooth enamel
Applied aspects
Mumps - A viral infection affecting the gland
Sialorrhoea - Increase in salivary secretion
Xerostomia - decrease in salivary secretion
Mastication (Chewing)
–First mechanical process in the GIT
–Breakdown of food particle
–Mix with salivary content
–A voluntary process
Deglutition (Swallowing)
• Stages of swallowing
– Voluntary stage (Oral or buccal phase)
– Involuntary Stage
• Pharyngeal stage/phase
• Esophageal stage/phase

Voluntary stage /Oral phase of swallowing

–Preparatory position - Formation of bolus
–Bolus is voluntarily squeezed posteriorly in to the pharynx by the
tongue
–Initiation of swallowing reflex
Involuntary Stage
• Pharyngeal stage/phase
• Esophageal stage/phase
Pharyngeal stage of swallowing
– Stimulation of the swallowing receptor area (around the pharynx and
on tonsilar pillars ) by bolus
– Initiate pharyngeal muscle contraction
• Prevent reflux of food into the nasal cavities
• Approximation of vocal cord and prevention of aspiration
• Enlarges the opening to the esophagus by upward movement of larynx.
• Upper esophageal sphincter (pharyngeal- esophageal sphincter) relaxes
• Propulsion of food into esophagus by

Esophageal Phase
• Conduct food from pharynx to stomach
– Primary peristalsis
– Secondary peristalsis
• Distension will produce secondary peristalsis
• Gravity aids the conduction during upright position
Neural regulation
• Medulla and Lower pons are the swallowing centers
• Receive sensory input from the mouth through 5th and 9th cranial
nerves
• It sends motor impulses to pharyngeal muscles and upper
esophagus by 5th, 9th, 10th and 12th cranial nerves.
• Deglutition apnea – for <2 sec.
Dysphagia
• Achalasia cardia;
– Lower region of the esophagus undergoes a spastic contraction due to
degeneration of myenteric plexus.
– Accumulation of food in the lower esophagus
– Very little food or sometime none will get in to the stomach
• Chalasia:
– It is opposite of achalasia.
– GERD
• Heart burn
GASTRIC SECRETION
STOMACH
• Oxyntic glands (gastric glands) consists of;
– Mucus neck cells - mucus
– Peptic (chief) cells - pepsinogen
– Parietal (oxyntic) cells – Hydrochloric acid and intrinsic factor
• Pyloric glands consists of;
• Mucus cells - Secrete mucus for protection of the pyloric mucosa from
the stomach acid
• G-cells - secrete the hormone gastrin
• Enterochromaffin cells - secrete histamine
Composition of gastric juice
• 1 – 1.5 L per day
• HCl (0.4-0.5%)
• pH – 1.2
• Specific gravity 1006-1009
• Organic (0.4%)
– Enzyme
• Pepesin, rennin, lipase & gastrin
– Mucin
– Haemopoietic factor (Intrinsic factor).
Functions of HCl
• Antiseptic function
• Convert pepsinogen in to pepsin
• Convert collagen protein in to gelatin
• Remove iron from its bound form
• Provide suitable acid environment for action of pepsin, lipase and
rennin
Secretion of Intrinsic Factor
– Secreted by the parietal cells along with HCl
– Essential for absorption of vitamin B12 in the ileum
– Absence of this factor in case of achlorhydria (lack of stomach acid
secretion), causes pernicious anemia
Functions of Gastrin
• Stimulates gastric acid and pepsinogen secretion
• Stimulate growth of the mucosa of the stomach, small intestine and
large intestine (tropic action)
• Stimulate gastric motility
• Stimulate insulin secretion after a protein meal
Surface mucous cells
• The entire surface of the stomach has surface mucous cells.
• They secrete large quantities of a very viscid mucus.
• Mucus coats the stomach mucosa of about 1 mm thick
– Provide protection for the stomach
– Lubrication of food transport.
– It is alkaline which protect stomach wall from highly acidic,
proteolytic secretion.
Different Phases of Gastric Secretion
Cephalic phase
- Stimulus
- Sight, Smell, Taste, Thought
- Effect
- Parasympathetic impulses increase gastric secretion
- Accounts for 20% of total gastric secretion
- Starts in about 5min and continues for about 20-30min
Different Phases of Gastric Secretion
Gastric phase
Accounts for 70% of total gastric secretions
• Neural mechanisms
– Distension activates stretch receptors causing myenteric and vagus
nerves to release Ach
• Ach stimulates gastric juice secretion
Different Phases of Gastric Secretion
Intestinal phase
• Very short phase
• Initiated by chyme entry into duodenum
• Stretch receptors stimulate release of intestinal (enteric) gastrin
• Chemoreceptors detect fatty acids, & glucose in the duodenum
– Stimulate enteric gastrin release
•Applied aspects:
•Gastritis
– Inflammation of gastric mucosa- disruption of gastric barrier
- Bacterial infections, alcohol, aspirin may lead to ulcer
Applied aspects:
• Achlorhydria
– Deficiency or absence of HCl in the gastric juice in atrophic gastritis
– Associated with pernicious anemia
PANCREAS
It is a dual organ has an endocrine portion and an exocrine portion
Innervation: Autonomic Nervous System
Parasympathetic - By the vagus nerve
Sympathetic - From celiac ganglion.
Secretions:
The acinar cells - secrete various enzymes of the pancreatic juice.
The centroacinar and duct cells - contribute to the secretion of
electrolytes, most important of which is HCO3-

Composition of pancreatic juice

• Pancreatic juice is a colorless odorless, highly alkaline fluid of low
viscosity,
• H2O – 98%
• Solids – 2%
• Organic
• Inorganic
• Cations : Na+, K+, Mg++, Ca++
• Anions: HCO3-, Cl-, SO4- -, HPO4-
• pH = 8 - 8.4. Alkaline because of more HCO3-

• Organic Contents(0.8%)
• Protein-digesting ezymes
 – Trypsinogen
– Chymotripsinogen
– Nuclease
– Procorboxipeptidase
– Proelastase
• Fat-digesting enzymes
– Pancreatic Lipase
– co-lipase
– Cholesterol esterase
– Phospholipase
• Carbohydrate-digesting enzymes
– Pancreatic amylase
Regulation of Pancreatic secretion:
Regulated by neural and hormonal mechanism
Three phases are:
Cephalic phase – 25% of secretion
Gastric phase – 10-20% of secretion
Gastro-pancreatic reflex
Intestinal phase – 50-80% of secretion
Secretin
CCK-PZ
Secretin:
• Released from S-cells of the duodenum, and jejunum of the small
intestine
• Secretin is released into circulation and/or intestinal lumen in response
to low duodenal pH of the chyme
• Acts on ductular cells of pancreas
Actions of secretin:
• Increases the volume of pancreatic juice which is rich in HCO3- and
water
• It potentiates action of CCK-PZ on pancreas.
• Inhibits gastric motility and delays gastric emptying by contraction of
pyloric sphincter.
• Inhibits gastrin release and gastric secretion.
Cholecystokinin Pancreozymin (CCK-PZ):
• It is produced from mucosa of duodenum and jejunum.
• Products of protein, fat and carbohydrate digestion – all can release
CCK-PZ
• Amino acids and fatty acids of the chyme are powerful stimuli
Actions:
1. Acts on pancreatic acini to release pancreatic enzyme
2. CCK PZ is a very powerful cholegogue.
3. Inhibits gastric motility
4. Promotes pancreatic cell growth
5. Potentiates the action of secretin on pancreas.
Pancreatic function test: (exocrine pancreas)
• Pancreatic juice is collected and analyzed for HCO3- content and
trypsin activity.
Acute Pancreatitis
Chronic pancreatitis
Effect of total pancreatectomy
- Done for the carcinoma of the pancreas .
- Removal of pancreas leads to following abnormalities:-
▪ Diabetes mellitus
▪ Steatorrhoea
▪ increased nitrogen content of stool
▪ carbohydrates digestion is not affected significantly because salivary
amylase and enzymes present in intestinal secretion keep carbohydrate
absorption – digestion normal
Liver and Bile Secretions
Structure of Liver
• Liver largest internal organ.
– Hepatocytes form hepatic plates that are 1–2 cells thick.
– Arranged into functional units called lobules.
• Plates separated by sinusoids.
– More permeable than other capillaries.
• Contains phagocytic Kupffer cells.
• Secretes bile into bile canaliculi, which are drained by bile ducts.
Bile Production and Secretion
• The liver produces and secretes 250–1500 ml of bile/day.
• Bile pigment (bilirubin) is produced in spleen, bone marrow, and liver.
– Derivative of the heme groups (without iron) from hemoglobin.
• Free bilirubin combines with glucuronic acid and forms conjugated
bilirubin.
– Secreted into bile.
• Converted by bacteria in intestine to urobilinogen.
– Urobilogen is absorbed by intestine and enters the hepatic vein.
• Recycled, or filtered by kidneys and excreted in urine.
• Bile acids are derivatives of cholesterol..
• Principal bile acids are:
– Cholic acid.
– Chenodeoxycholic acid.
• Combine with glycine or taurine to form bile conjugate
– Bile salts aggregate as micelles.
• 95% of bile acids are absorbed by ileum.
Formation of bile salts:
Bile acids are synthesized in the liver from cholesterol by the
hepatocytes.
Bile acids are cholic acid and cheno deoxy cholic acid. –primary bile
acids.
Deoxycholic and lithocholic acid –secondary bile acids.
They combine with glycine or taurine to form glycho cholic or tauro
cholic acid.
This in turn combines with sodium or potassium to form sodium and
potassium salts of glychocholic or tauro cholic acid. ---bile salts.
Functions of the bile salts
• Bile salts are very powerful surface tension lowering agents.
– This helps in the emulsification of fats.
– The larger fat molecules are broken down to smaller ones so that
a larger surface area is made available for the pancreatic lipase to
act.
• Bile salts with phospholipids, cholesterol, free fatty acids and
monoglycerides form micelles and help in the absorption of fats
• Helps in the absorption of fat soluble vitamins-A, D, E, K.
• Very powerful choleretic agents.
– Choleretic agents are those substances, which increase the
secretion of bile from the liver cells .
• Activate pancreatic lipase.
• Act as mild laxative agents.
Detoxification of the Blood
• Liver can remove hormones, drugs, and other biologically active
molecules from the blood by:
– Excretion into the bile.
– Phagocytosis by Kupffer cells.
– Chemical alteration of the molecules.
• Ammonia is produced by deamination of amino acids in the liver.
• Liver converts it into urea.
– Excreted in urine.
 – Inactivation of steroid hormones and drugs.
• Conjugation of steroid hormones
• Can be transported into bile
• Liver helps regulate blood glucose concentration by:
– Glycogenesis.
– Glycogenolysis and gluconeogenesis.
• Contains enzymes required to convert free fatty acids into ketone
bodies.
Production of Plasma Proteins
• Albumin and most of the plasma globulins (except immunoglobulins)
are produced by the liver.
• Albumin:
– Constitutes 70% of the total plasma protein.
• Contributes most to the colloid osmotic pressure in the blood.
• Globulins:
– Transport cholesterol and hormones.
– Inhibit trypsin.
– Produce blood clotting factors I, II, III, V, VII, IX, XI.
Enterohepatic Circulation
• Compounds that recirculate between liver and intestine.
– Many compounds can be absorbed through small intestine and enter
hepatic portal blood.
– Variety of exogenous compounds are secreted by the liver into the bile
ducts.
• Can excrete these compounds into the intestine with the bile.

Gall bladder
Sac-like organ attached to the inferior surface of the liver.
• Stores and concentrates bile.
• When small intestine is empty, sphincter of Oddi closes.
– Bile is forced up to the cystic duct to gallbladder.
Function of the Gall bladder :
1. It stores bile. It can store about 30- 60 ml of bile
2. Absorption–
While it is being stored sodium, chloride, bicarbonates and water are
reabsorbed.
Important of water reabsorption
Due to water absorption the bile in the gall bladder gets concentrated by
about 10 to 14 times
By absorption of water it tries to maintain a low pressure in the biliary
tree so that the bile secretion remains a continuous process .
By absorption of water it maintains a high concentration ratio between
bile salts and cholesterol. This prevents the precipitation of cholesterol
and therefore the formation of gallstones .
5. Expulsion of bile-
contraction of the gall bladder will bring about expulsion of the bile in to
the intestineAny substance that brings about the contraction of the gall
bladder and releases or increases the bile flow into the intestine is known
as a cholegogue substance.
Bile salts, CCK-PZ are very powerful cholegogues.
Highest rate of gall bladder emptying occurs in intestinal phase
ofdigestion.