Prof GE Mann, Waterloo Campus (Email: giovanni.mann@kcl.ac.

uk)

MBBS Year 1 Gastrointestinal Lectures

Overview of the digestive system

Fri 20 Jan 2023 09:00 – 10:00
Digestion and absorption of nutrients
Thu 26 Jan 2023 14:00 – 15:00
Salivary, gastric and pancreatic secretions
Fri 27 Jan 2023 11:00 – 12:00

Bile and biliary system

Fri 27 Jan 2023 14:00 – 15:00
Motility of the gut
Thu 2 Feb 2023 10:00 – 11:00

Physiology, 5th Edition, eds. RM Berne, MN Levy, BM Koeppen, BA Stanton

(2004) (see Chapters 31-33) [see also more recent Editions]
Medical Physiology, eds. WF Boron & EL Boulpaep (2003)
Color Atlas of Physiology, 4th Edition, eds. A. Despopoulos & S. Silbernagl,
(1991) 1
MBBS Year 1 Gastrointestional Lectures

Digestion and absorption of nutrients

Learning Objectives

•Describe the digestion of protein, carbohydrates and fat from mouth to colon
•Describe mechanisms involved in intestinal absorption of carbohydrates, proteins, fats:
uptake sugars, amino acids, di- and tri-peptides and fats
•Describe role of pancreas and liver in the digestion of fat
•Describe clinical consequences associated with malabsorption of nutrients

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Arterial supply and venous drainage in intestinal epithelium

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Arterial supply, venous and lymphatic drainage
in intestinal epithelium

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Histological organisation of intestinal villous and crypt

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Digestion of carbohydrates and absorption across intestinal villi

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Digestion and absorption of peptides and amino acids

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Absorption of peptides and amino acids across intestinal villi

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Intestinal absorption of oligopeptides

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Absorption of vitamins A (retinol & derivatives), E and K

Vitamin A is absorbed from intestine and transported in newly synthesised chylomicrons or

VLDLs, and chylomicrons taken up by liver for further hydrolysis of retinyl esters.

Fat-soluble vitamin E absorbed from intestine primarily in form of alpha and gamma
tocopherol, incorporated in chylomicrons and VLDL with other products of lipid digestion,
pass via lymph into blood stream, transported to into liver, which is the major site of
discrimination between the two form. Alpha tocopherol is resecreted as component of
hepatically derived VLDL and perhaps HDL. Gamma tocopherol metabolised/excreted by
liver.

Vitamin K produced by intestinal bacteria and absorption similar to A, D and E vitamins.

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 Overview of intestinal absorption of dietary vitamin A and carotenoids

Chylomicrons (retinyl esters/carotenoids)

Dietary retinyl esters (RE) hydrolyzed in lumen by pancreatic triglyceride lipase (PTL)
and pancreatic lipase-related protein 2 (PLRP2), and the intestinal brush border
enzyme, phospholipase B (PLB). Unesterified retinol (ROH) is taken up by the enterocyte,
perhaps via passive diffusion. Once in cell, retinol is complexed with cellular retinol binding
protein type 2 (CRBP2) and the complex serves as a substrate for re-esterification of
the retinol by the enzyme lecithin:retinol acyltransferase (LRAT). Chylomicrons containing retinyl
esters and carotenoids (RE, car) secreted into the lymph. Unesterified retinol also absorbed into
portal circulation and its efflux from the basolateral cell membrane is facilitated by the 16
lipid transporter, ABCA1. [see Biochim Biophys Acta . 2012 January ; 1821(1): 70–77]
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Absorption of Ca2+ across intestinal epithelium

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GI tract important role in excretion, fluid and electrolyte balance

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 Summary of intestinal nutrient absorption

None

Proteases

Amylase

Intracellular
Hydrolysis

Lipase

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