Gastrointestinal System

I Putu Adiartha Griadhi

Physiology Department
2013
 OVERVIEW
• The gastrointestinal system consists of the
gastrointestinal tract and the accessory
exocrine glands.
• The major functions of the gastrointestinal
system are assimilation of nutrients and
excretion of waste products via the biliary
system.
 OVERVIEW
Movement of food through the gastrointestinal
system (motility) is carefully coordinated with
the delivery of appropriate fluid and enzyme
solutions (secretion) so that the
macromolecules in food can be hydrolyzed
(digestion) and the nutrient molecules, which
are liberated, can be transported into the
circulatory system (absorption).
 OVERVIEW
• Coordinating multiple • Elaborate control
organs and physiologic mechanisms are
processes is a significant provided by the enteric
challenge that must be nervous system (ENS),
solved to achieve the a large intrinsic
overall functions of the network of neurons in
gastrointestinal system. the wall of the
gastrointestinal tract,
and by several
hormones
STRUCTURAL FEATURES OF THE
GASTROINTESTINAL TRACT
 CONTROL MECHANISMS IN
GASTROINTESTINAL PHYSIOLOGY
The major regulated processes that can generate
change (effectors) in the gastrointestinal
physiology are gut motility, epithelial
secretion, and blood flow.
Each of these processes has a level of intrinsic
activity, referred to as gastrointestinal tone.
Inputs from nerves and hormones are
integrated with intrinsic tone to produce a final
integrated response.
 CONTROL MECHANISMS IN
GASTROINTESTINAL PHYSIOLOGY

Resulted
Control

GI Tone

Enteric
Hormone
Nervous
s System
 ENTERIC NERVOUS SYSTEM
• The ENS is a division of the autonomic nervous
system
• The ENS can be thought of as a “minibrain”
• The ENS is responsible for much of the
moment to-moment control of gut motility
and secretion.
 ENTERIC NERVOUS SYSTEM
It also called Intrinsic
Nervous System
The ENS is arranged as:
• The myenteric plexus
(Auerbach’s plexus)
 gut motility
• The submucosal plexus
(Meissner’s Pexus)
 coordinates intestinal
absorption and secretion
ENTERIC NERVOUS SYSTEM
 ACh

NE

ACh

ACh
 GASTROINTESTINAL HORMONES
• Hormones play a prominent role in the control
of gastrointestinal function, and in most cases
these hormones are secreted by the
gastrointestinal mucosa itself.
• Gastrointestinal hormones have a specific
sites and stimuli for secretion, and specific
actions.
GASTROINTESTINAL HORMONES
 GASTROINTESTINAL HORMONES
• Gastrointestinal hormones are first secreted
into the capillary blood in the gastrointestinal
tract and must pass through the portal venous
system and liver before entering the systemic
circulation, a process known as first-pass
metabolism.
 PARACRINE CONTROL
• Three major examples of paracrine mediators :
– Serotonin - enterochromaffin (EC) cells  response to
distension  excitatory  increased intestinal motility
and secretion.
– Somatostatin - D cells  a potent inhibitor  inhibits
pancreatic and gastric secretion, relaxes the stomach and
gallbladder, and decreases nutrient absorption. Inhibit
gut hormones, gastrin, secretin, gastric inhibitory peptide
(GIP), and motilin.
– Local histamine - Enterochromaffi n-like (ECL) cells 
potent stimulatory effect on acid secretion.
THE MOUTH AND ESOPHAGUS
 SALIVARY SECRETION
• The volume + 1.5 L per day, mildly alkaline.
– The submandibular glands secrete 70%.
– The parotid glands secrete 25%.
– The sublingual glands secrete 5%.
• Three major functions of saliva
– Lubrication : swallowing, speech, taste
– Protection : oral bacteria
– Digestive : α-Amilase, Lingual lipase
 SALIVARY SECRETION

Saliva becomes hypotonic because the striated duct cells reabsorb NaCl, but not water.
Aldosterone increases ductal Na+
absorption and K+ secretion.
 SALIVARY SECRETION
• Stimuli are integrated by the salivary nuclei in
the pons, and salivation is determined by the
resulting parasympathetic tone.
• Stimulated by the thought, smell, or taste of
food by conditioned reflexes and by nausea.
• Sleep, dehydration, fatigue, and fear all inhibit
salivation.
 SWALLOWING
• Swallowing (deglutition) carries food from the
pharynx into the esophagus.
• Coordinated by a center in the reticular
formation, which also inhibits breathing until
food is in the esophagus.
SWALLOWING
SWALLOWING
SWALLOWING
 ESOPHAGUS
• The esophagus has three functional zones:
1. The upper zone, which is 6–8 cm long, is closely
related to the pharyngeal musculature and
consists of striated muscle.
2. The middle zone (main body), which is 12–14 cm
long, consists of smooth muscle.
3. The lower zone, which is 3–4 cm long, consists of
smooth muscle and corresponds with the lower
esophageal sphincter.
THE STOMACH
OVERVIEW OF THE ANATOMY OF THE
STOMACH
 OVERVIEW OF GASTRIC FUNCTIONS

• The stomach is an important control point in

the gastrointestinal tract. It must regulate the
delivery of ingested food to the small intestine
and present it :
– At an appropriate rate
– In a form that can be digested.
• This is achieved by integration of the following
gastric motor and exocrine functions.
 GASTRIC FUNCTIONS
The motor (motility) functions of the stomach :
1. As a reservoir for ingested food,
2. Mixing and grinding of food
 GASTRIC FUNCTIONS
Gastric motility.
1. The stomach is quiescent most of
the time between meals.
2. Receptive relaxation of the proximal
stomach facilitates the entry of food
from the esophagus after swallowing.
Accommodation is progressive
relaxation of the entire stomach as it
fills to prevent increased intragastric
pressure during a meal.
3. Peristalsis begins in the midstomach.
4. Antral systole is the vigorous
peristaltic rhythm in the distal
stomach. Retropulsion is forceful
reflection of food off the closed
pyloric sphincter.
 GASTRIC FUNCTIONS
The exocrine secretions of the stomach are:
1. Water : to dissolve and dilute ingested food.
2. Acid (HCl) : denature proteins & kill
microorganisms.
3. Enzymes (pepsin & gastric lipase) : protein & fat
digestion.
4. Intrinsic factor : vitamin B12 ileum absorption.
5. A mucus-bicarbonate barrier : to protect against
the corrosive properties of gastric juice.
 GASTRIC FUNCTIONS
• Endocrine functions of stomach, secretion of :
– Gastrin and somatostatin are produced in the
gastric antrum and regulate gastric acid secretion.
– Ghrelin is produced in the body of the stomach
and is a factor involved in the regulation of hunger
and satiety.
 MECHANISM OF GASTRIC ACID SECRETION

The mechanism of gastric acid

secretion by the oxyntic (parietal)
cells. H+ and HCO3 are generated
inside the cell by the action of
carbonic anhydrase. H+ is pumped
across the luminal membrane by
H+/K+-ATPase. HCO3− exits the
basolateral membrane; the
alkaline tide is the resulting
alkalinity of gastric venous blood
that is created during gastric
stimulation. ATP, adenosine
triphosphate.
STIMULATION OF GASTRIC ACID
PRODUCTION
Regulation of gastric acid
secretion. Efferent vagal nerve
fibers and local enteric nervous
system (ENS) stretch reflexes
stimulate oxyntic (parietal) cells
directly and stimulate antral G
cells to secrete gastrin. Gastrin
stimulates the oxyntic cells
directly and
stimulates histamine release
from the enterochromaffi n-like
(ECL) cells. Histamine stimulates
acid secretion by the oxyntic
cells. ACh, acetylcholine.
INHIBITION OF STOMACH SECRETION AND
MOTILITY
GASTRIC MUCOSAL PROTECTION

The mucus-bicarbonate barrier for gastric mucosal protection.

Surface epithelial cells secrete HCO3−, which become trapped in
a layer of mucus at the mucosal surface. H+ is neutralized by
HCO3− as it diffuses through the surface mucus.
THE SMALL INTESTINE
 THE SMALL INTESTINE
• The small intestine is several meters long and
extends from the pyloric sphincter of the stomach to
the junction with the large intestine at the ileocecal
sphincter.
• Three regions: the short duodenum proximally and
the jejunum and the ileum distally.
• Anatomic features of the small intestine amplify the
surface area for absorption : transverse folds mucosa
(plicae circulares), villi, and the presence of
microvilli.
THE SMALL INTESTINE
• The villus is the functional
unit of the intestine
• The villus epithelium
consists of enterocytes,
mucous-secreting goblet
cells, and endocrine cells.
• Three regions of a villus
form a functional
continuum: the crypt, the
maturation zone, and the
villus tip.
 MOTILITY
• Fed state : great deal of motor activity
• Three functions of motility :
– Mixing with digestive secretions and enzymes
– Distribution luminal contents around the mucosa
for absorption
– Propulsion of the luminal contents in the aboral
direction (away from the mouth)
 MOTILITY
• Two major types of
motility during the fed
state :
– Segmentation
– Peristalsis
• These contractions appear
chaotic and overlap.
• Peristaltic contribute to
segmental contraction and
segmental contraction
enhance the propulsion
 MOTILITY
• Segmentation contractions : string of segments, form
and reform. The main function is mixing of the
luminal contents
• Peristalsis is a reflex, the main stimulus is moderate
distension of the gut wall. The circular muscle
contracts in the upstream contracting segment,
forcing the bolus forward; receptive relaxation of the
circular muscle in the downstream segment reduces
the force needed to move the bolus aborally
 MOTILITY
• Alternative classification of intestinal
movement defines three variations.
– Tonic contraction of sphincters.
– Rhythmic phasic contractions (small peristaltic
contractions and segmentation).
– Giant migrating contractions (powerful peristaltic
contractions).
 FLUID ABSORPTION
• The intestine receives a large daily fluid load
that must be absorbed. Daily fluid load to the
jejunum is 7–10 L per day, about 1–2 L each of
dietary water, saliva, gastric juice, pancreatic
juice, and intestinal secretion, and about 0.5 L
of bile.
• The small intestine reabsorbs about 6–8 L per
day of fluid by isosmotic transport (max rate
approximately 12 L per day).
 FLUID ABSORPTION
• High epithelial water permeability  rapid
osmotic equilibration between the duodenal
chyme and plasma.
– If food has a high water content and is hypotonic
to plasma, there is rapid water uptake.
– More frequently, a meal is hypertonic and water
initially enters the small intestine from the
extracellular fluid by osmosis.
 FLUID ABSORPTION
In the upper small intestine is mainly coupled to Na+/nutrient uptake,
although Na+/H+ exchange is also present in this area of the gut. By
the time the food reaches the ileum, most sugars have been absorbed
and fluid absorption is more dependent on NaCl reabsorption.
 FLUID SECRETION
• Small intestine and the large intestine secrete
fluid from the crypt cells. It is necessary for :
– Lubrication,
– Source of Na+ for coupling to nutrient and
– Antibodies secretion.
• The key step in the mechanism of fluid
secretion from the crypt enterocytes is opening
of the Cl− channels in the luminal cell
membrane
FLUID SECRETION

There are two types of Cl−

channels present:
1. cAMP-activated Cl− channels,
for which the ENS
neurotransmitter VIP is an
important secretagogue.
2. Ca2+- activated Cl− channels,
for which acetylcholine from
ENS neurons and serotonin
from the EC cells are both
secretagogues.
NUTRIENT DIGESTION AND ABSORPTION

• The major classes of nutrients are

carbohydrates, proteins, and fats. Most
nutrients are large molecules that must be
broken down into smaller molecules that can
be absorbed.
NUTRIENT DIGESTION AND ABSORPTION

• Digestion is the chemical breakdown of food by

enzymes and can occur at three sites :
• Luminal digestion occurs within the lumen of the
gastrointestinal , mediated by enzymes from the
salivary glands, the stomach, and the pancreas.
• Membrane digestion is the action of enzymes fixed to
the brush-border membrane of enterocytes, synthe-
sized by enterocytes & inserted into the membrane.
• Intracellular digestion is mediated by cytoplasmic
enzymes within enterocytes.
NUTRIENT DIGESTION AND ABSORPTION
 INTESTINAL Ca ABSORPTION 2+

• In the duodenum & upper

jejunum. 30–80% of dietary
Ca2+ typically is absorbed.
• One third uptake passively
via the paracellular route
across the tight junctions.
• The remaining fraction
occurs actively through
regulated Ca2+ transport
pathways in the
enterocytes
 IRON HOMEOSTASIS
• Iron homeostasis is unusual compared to other
minerals because it centers on the control of
dietary uptake rather than on renal excretion.
• About 70% of total body iron is associated with
hemoglobin, and an additional 3% is associated
with the muscle oxygen-binding protein
myoglobin.
• Most of the remainder of total body iron is in a
tissue storage form bound to the protein ferritin.
 IRON HOMEOSTASIS

The iron bound to transferrin is in equilibrium with very small

amounts of free Fe2+. When the iron ferritin store in the liver is full,
the liver releases an iron regulatory factor called hepcidin. Increased
hepcidin inhibits Fe2+ uptake by the intestinal enterocytes,
preventing iron overload.
CARBOHYDRATE DIGESTION
CARBOHYDRATE ABSORPTION
PROTEIN DIGESTION & ABSORBTION
FAT DIGESTION & ABSORPTION
VITAMIN ABSORPTION
THE LARGE INTESTINE
 THE LARGE INTESTINE
Nutrient absorption should be completed by the
time the luminal contents reach the large
intestine.
The main functions of the large intestine are
completion of fluid absorption and the
storage and elimination of fecal waste.
THE LARGE INTESTINE
 COLONIC MOTILITY
• Both segmentation and peristalsis in the colon
produce motility patterns that facilitate fluid and
electrolyte absorption and allow the storage and
orderly evacuation of feces
• Segmenting contractions (haustral shuttling)
– occur most often in the large intestine
– to gradually turn over the fecal contents.
– more rapid in the left colon than in the right colon,
– which tends to slow the movement of feces,
– allowing more time to complete fluid absorption
COLONIC MOTILITY
 COLONIC MOTILITY
• Peristaltic contractions
– occur infrequently
– to forcefully propel feces into the rectum prior to
defecation.
– are giant migrating-type contractions called mass
movements
– typically occur 3–5 times per day,
– each wave moves the fecal contents aborally 20
cm or more.
 COLONIC FLUID TRANSPORT
• Colonic fluid absorption reduces the 2 L per
day of fluid that enters from the small
intestine to about 0.1 L of fluid excretion in
feces.
• The colon is also capable of fluid secretion,
which is produced from the colonic crypts by
the same mechanism as described above for
the small intestine.
 COLONIC FLUID TRANSPORT
The mechanisms for Na+ absorption that
function in the right and left colon are as follows
• In the right (proximal) colon, most Na+ uptake
occurs via the Na+/H+ exchange, via a
mechanism that resembles Na+ uptake in the
ileum.
• In the left (distal) colon, Na+ absorption occurs
via a Na+ channel, and K+ secretion occurs at
the same time via K+ channels.
COLONIC FLUID TRANSPORT

PROXIMAL COLON DISTAL COLON

LEARNING TASK
 Thank You !
Terima Kasih