UNIVERSITY OF GUYANA

SCHOOL OF MEDICINE
MED 1106 – PHYSIOLOGY
I
DR KALIMA THOMPSON
The Digestive System
 The Digestive System
Composed of two groups of organs

1. The gastrointestinal tract

2. The accessory digestive organs
 The gastrointestinal tract

 A continuous tube that extends from the mouth to the anus through the
thoracic and abdominopelvic cavities
 In a living person Length is about 5–7 meters when the muscles along the
wall of the GI tract are in a state of tonus (sustained contraction).
 Organs include
 the mouth
 most of the pharynx
 esophagus
 stomach
 small intestine
 large intestine
 The Accessory Digestive Organs
Include
 teeth
tongue
salivary glands
 liver and gallbladder
 pancreas
 The Six Basic Processes of the Digestive Tract
1. Ingestion -
involves taking foods and liquids into the mouth

2. Secretion -
cells within the walls of the GI tract and accessory digestive organs daily secrete a
total of about 7 liters of water, acid, buffers, and enzymes into the lumen of the
tract

3. Mixing and propulsion

-alternating contractions and relaxations of smooth muscle in the walls of the GI
tract allows for mixing of food and secretions and propulsion of them toward the
anus - the capability of the GI
tract to mix and move material along its length is referred to as motility
4. Digestion
- involves break down of ingested food into small molecules by mechanical and chemical processes
- in mechanical digestion the teeth cut and grind food before it is swallowed
- smooth muscles of the stomach and small intestine then churn the
food
- churning allows for food molecules to dissolve and thoroughly
mix with digestive enzymes
- in chemical digestion large carbohydrates, lipids, proteins, and nucleic acids molecules
split into smaller units by hydrolysis
- digestive enzymes produced by the salivary glands, tongue, stomach, pancreas, and small intestine
catalyze the catabolic reactions in chemical digestion
5. Absorption
- involves the entrance of ingested and secreted fluids, ions,
and the products of digestion into the epithelial cells lining the
lumen of the GI tract
- absorbed substances pass into blood or lymph and then circulate
to cells throughout the body
6. Defecation
-involves elimination through the anus of wastes, indigestible substances,
bacteria, cells sloughed from the lining of the GI tract, and digested
materials that were not absorbed in their trajectory through the digestive
tract
- eliminated material is termed feces
The Oral Cavity
 The Oral Cavity
 Represents the first part of the digestive tube

 Primary functions
an entrance of the alimentary tract
to initiate the digestive process by salivation and
propulsion of the alimentary bolus into the pharynx
 The Oral Cavity
 Oval shaped
 Separated into
 the oral vestibule
 the oral cavity proper
   Bounded by
 the lips anteriorly
 the cheeks laterally
 the floor of the mouth inferiorly
 the oropharynx posteriorly
 the palate superiorly
 Its bony base is represented by the maxillary and mandibular bones
 The Oral Vestibule
Bounded by
 the lips and the cheek mucosa externally
 the alveolar processes and the teeth internally
 Lips
 The longer upper lip and shorter lower lip are connected to each other by
the labial commissures at the corners of the mouth
 Separated from the cheeks by the nasolabial fold
 Has an interior pale wet vermilion and an outer darker dry vermilion,
separated from each other by the red line
 A white line on the outside is the purely cutaneous part of the lip
 The inner surface of each lip is connected in the midline to the
corresponding gum by a fold of mucous membrane, known as the labial
frenulum
 The upper labial frenulum is larger than the lower labial frenulum
 Cheeks
 A musculomembranous structure

 Bounded by
the upper and lower vestibules superiorly and inferiorly
the labial commissure anteriorly
the retromolar trigone and the intermaxillary
commissure posteriorly
 The Palate
 The horseshoe-shaped, domed roof of the oral cavity

 Separates the oral cavity from the nasal cavity, thus makes it
possible to chew and breathe at the same time

 Divided into
a hard portion
a soft portion
 The Hard Palate
 The hard palate is part of the oral cavity and separates it from
the nasal cavities
 Itis concave, and is occupied mostly by the tongue when it is at
rest
 The anterior two thirds is formed by the incisive bone, or
premaxilla, and the palatine processes of the maxilla
 The horizontal plates of the palatine bone form the posterior
third
 Has transverse ridges (rugae) on the anterior third that serve to
retain the food bolus
 Hard Palate
Subdivided into
the primary palate
separated from the secondary palate by a small
depression behind the central incisors termed the
incisive fossa (the incisive foramen opens)
the secondary palate
presents a midline elevated suture line termed the
median or palatine raphe
 The Soft Palate
 Marks the beginning of the oropharynx and separates it from
the nasopharynx

 The movable posterior third of the palate

 Forms an incomplete septum between the mouth and the

pharynx

 Marked by a median raphe and is continuous with the roof

of the mouth and the mucous membrane of the nasal floor
 A conicalmuscular process called the uvula hangs from the free
border of the soft palate

 Thesoft palate and uvula are drawn superiorly during

swallowing to close off the nasopharynx and prevent swallowed
foods and liquids from entering the nasal cavity

 Themouth opens into the oropharynx through the fauces at the

posterior border of the soft palate
The Tooth
Types
Dentitions and times of eruptions
 Salivary Gland
 Themucous membrane of the mouth and tongue contains many small salivary glands which
secrete saliva into the oral cavity

 Most of the saliva is secreted via the major salivary glands, which lie beyond the oral mucosa

 Three pairs of major salivary glands

1. the parotid
2. submandibular
3. sublingual glands

 Secretion of saliva increases when food enters the mouth and has three basic functions
1. lubricate food
2. dissolve food
3. initiate the chemical breakdown of the food
 Composition and Functions of Saliva
 Chemically, 99.5% water and 0.5% solutes
 Solutes
include, sodium, potassium, chloride, bicarbonate, and
phosphate ions
 Enzymes include
 the bacteriolytic enzyme lysozyme
a digestive enzyme salivary amylase, that breaks down starch
 Includealso dissolved gases and various organic substances,
including urea and uric acid, mucus, immunoglobulin A
 Salivation
 The secretion of saliva is controlled by the autonomic nervous system

 Parasympathetic stimulation promotes continuous secretion of a saliva

which keeps the mucous membranes moist and lubricates the
movements of the tongue and lips during speech

 Daily secretion of saliva vary considerably but average 1000–1500 mL

 Saliva is swallowed to help moisten the esophagus. However, eventually,

most components of saliva are reabsorbed
 The Tongue
 An accessory digestive organ composed of skeletal muscle covered with mucous
membrane
 With its associated muscles, forms the floor of the oral cavity
 Divided into symmetrical lateral halves by a median septum that extends its
entire length
 The dorsum and lateral surfaces of the tongue are covered with papillae that
contain taste buds, the receptors for gustation
 Some papillae lack taste buds, but contain receptors for touch and increase
friction between the tongue and food, making it easier for the tongue to move
food in the oral cavity
 Lingual glands secrete lingual lipase which act on 30% of dietary triglycerides
and converts them to simpler fatty acids and diglycerides
 Mechanical and Chemical Digestion in the Mouth
 Mechanical digestion results from mastication, in which food is manipulated by the tongue,
ground by the teeth, and mixed with saliva
 As a result, the food is reduced to a soft, flexible, easily swallowed mass called a bolus
 Food molecules begin to dissolve in the water in saliva, an important activity because
enzymes can react with food molecules in a liquid medium only
 Two enzymes, salivary amylase and lingual lipase, contribute to chemical digestion in the
mouth
 Salivary amylase, which is secreted by the salivary glands, initiates the breakdown of starch
 Dietary carbohydrates are either monosaccharide and disaccharide sugars or complex
polysaccharides such as starches
 Most of the carbohydrates we eat are starches, but only monosaccharides can be absorbed
into the bloodstream
 Functional Types of Movement in the Gastrointestinal Tract

Mainly two types

1. Propulsive movements
cause food to move forward along the tract at an appropriate
rate to accommodate digestion and absorption
peristalsisis the basic propulsive movement of the
gastrointestinal tract
2. Mixing movements
 keep the intestinal contents thoroughly mixed at all times
 Peristalsis
 An inherent property of many syncytial smooth muscle tubes
 Stimulation at any point in the gastrointestinal tract can cause a
contractile ring to appear in the circular muscle
 The contractile ring then spreads along the gut tube, moving any material
in front of the ring forward
 Distention of the gut is the usual stimulus for intestinal peristalsis
 When a large amount of food collects at any point in the gut, the
stretching of the gut wall stimulates the enteric nervous system to
contract the gut wall 2 to 3 centimeters behind this point, and a
contractile ring appears that initiates a peristaltic movement
 Directional Movement of Peristaltic Waves Toward the Anus
 Theoretically, can occur in either direction from a stimulated
point but it usually dies out rapidly in the orad direction while
continuing for a considerable distance toward the anus

 The exact cause of this directional transmission of peristalsis

has never been ascertained
 The Peristaltic Reflex and the “Law of the Gut”

When a segment of the intestinal tract is excited by distention

 peristalsis is initiated
 the contractile ring begins on the orad side of the distended segment and
moves toward the distended segment
 intestinal contents is the propelled in the anal direction for 5 to 10
centimeters before dying out
 simultaneously, the gut sometimes relaxes several centimeters downstream
toward the anus ( “receptive relaxation”), allowing food to be propelled
more easily toward the anus than toward the mouth
 Mixing Movements
 Peristaltic waves
 insome areas, the peristaltic contractions cause most of the mixing.
This is especially true when forward progression of the intestinal
contents is blocked by a sphincter
 ifblocked by a sphincter, a peristaltic wave can only churn the
intestinal contents, rather than propel them forward

 Local intermittent constrictive contractions

 occur every few centimeters in the gut wall
 normally last only 5 to 30 seconds; then new constrictions occur at
other points in the gut, thus “chopping” and “shearing” the contents
first here and then there
 Layers of the Four Layers of the
Gastrointestinal Tract
The four-layered arrangement of tissues
from deep to superficial are
1. Mucosa
2. Submucosa
3. Muscularis
4. Serosa
 Mucosa
 A mucous membrane composed of
1. a layer of epithelium
 located among the epithelial cells are exocrine cells and several types of endocrine cells
(enteroendocrine cells)
2. a layer of connective tissue (lamina propria)
 supports the epithelium and binds it to the muscularis mucosae
 contains many blood and lymphatic vessels, which absorb nutrients from the GI tract
 contains the majority of the immune cells of the mucosa associated lymphatic tissue
3. a thin layer of smooth muscle (muscularis mucosae)
 consists of many small folds in the stomach and small intestine
 the folds increase the surface area for digestion and absorption
 movements of the muscularis mucosae fully expose all absorptive cells to the contents of the
GI tract
 Submucosa

 Consists
of areolar connective tissue that binds
the mucosa to the muscularis

 Contains
 many blood and lymphatic vessels that
receive absorbed food molecules
an extensive network of neurons known as the
submucosal plexus
glands and lymphatic tissue
 Muscularis
 Skeletal muscles form the muscularis of the mouth,
pharynx, and superior and middle portions of the esophagus
that produces voluntary swallowing
 Skeletal muscle forms the external anal sphincter and permits voluntary
control of defecation
 The muscularis throughout the rest of the tract, consists of smooth
muscle
 Involuntary contractions of the smooth muscle contribute to digestion, by
allowing for mixing with digestive secretions and propulsion along the GI
tract
 Between the layers of the muscularis is a second plexus of neurons
(myenteric plexus)
 Serosa
 A superficiallayer that surrounds those portions of the GI tract
that are suspended in the abdominopelvic cavity

 A serous membrane composed of areolar connective tissue and

simple squamous epithelium (mesothelium)

 The esophagus lacks a serosa, instead the adventitia a single layer

of areolar connective tissue forms its superficial layer
Layers of the Digestive Tract
 Neural Control of the GI tract
(Enteric Nervous System)
 The enteric nervous system is responsible for the neural control
of the GI tract

 Lies entirely in the wall of the gut, begins in the esophagus and
extends all the way to the anus

 Consists of about 100 million neurons arranged in plexuses

The neurons of the ENS are arranged into two plexuses

1. Myenteric plexus (Auerbach’s plexus)

2. Submucosal plexus (Meissner’s plexus)
 The Myenteric Plexus
 A linear chainof many interconnecting neurons that
extends the entire length of the gastrointestinal tract

 Liesbetween the longitudinal and circular layers of

intestinal smooth muscle,

 Concerned mainly with controlling muscle activity along

the length of the gut
 Upon stimulation of the myenteric plexus, its principal effects are
 increased tonic contraction of the gut wall
 increased intensity of the rhythmical contractions
slightly increased rate of the rhythm of contraction
increased velocity of conduction of excitatory waves along the
gut wall, thus increasing peristaltic waves
 The Submucosal Plexus
 Concerned mainly with controlling function within the inner wall of each
minute segment of the intestine

 Integrate many sensory signals that originate from the gastrointestinal

epithelium and are responsible for
 control of local intestinal secretion
 control of local contraction of the submucosal muscle that results in
various degrees of infolding of the gastrointestinal mucosa
 control of local absorption
GI Plexuses
 Deglutition
 Moves a bolus from the mouth to the stomach

 Consists of
1. A voluntary stage - initiates the swallowing process
2. A pharyngeal stage (involuntary) - constitutes passage of food
through the pharynx into the esophagus
3. An esophageal stage (involuntary) - transports food from the
pharynx to the stomach
 Voluntary Stage of Swallowing

 Food is “voluntarily” squeezed or rolled posteriorly into the

pharynx by pressure of the tongue upward and backward against
the palate

 Swallowed food passes from the mouth into the oropharynx and
laryngopharynx, where muscular contractions help propel food
into the esophagus and then into the stomach
 Pharyngeal Stage of Swallowing
 The bolus of food that enters the posterior mouth and pharynx
stimulates epithelial swallowing receptor areas all around the
opening of the pharynx (especially receptors on the tonsillar
pillars)

 Impulses from receptor areas then pass to the brain stem to

initiate a series of automatic pharyngeal muscle contractions

 Thesoft palate is pulled upward closing the posterior nares, to

prevent reflux of food into the nasal cavities
 The palatopharyngeal folds on each side of the pharynx are
pulled medially to approximate each other, forming a sagittal
slit through which the food enters into the posterior pharynx

 Thesagittal slit performs a selective action, allowing food that

has been masticated sufficiently to pass with ease
 The vocal cords are strongly approximated, and the larynx is
pulled upward and anteriorly by the neck muscles causing the
epiglottis to swing backward over the opening of the larynx
 upward movement of the larynx also pulls up and enlarges the
opening to the esophagus and at the same time, the upper 3 to 4
centimeters of the esophageal muscular wall
(pharyngoesophageal sphincter)relaxes
 Relaxation of the pharyngoesphageal sphincter allows food to move
easily and freely from the posterior pharynx into the upper esophagus

 The raised larynx and relaxation of the pharyngoesophageal sphincter

allows the entire muscular wall of the pharynx to contract

 Contraction begins in the superior portion of the pharynx, then spreads

downward over the middle and inferior pharyngeal areas to propel the
food by peristalsis into the esophagus
 Nervous initiation of the pharyngeal stage of swallowing
 The most sensitive tactile areas of the posterior mouth and pharynx for
initiating the pharyngeal stage of swallowing located as a ring around
the pharyngeal opening, with greatest sensitivity on the tonsillar pillars

 Impulses are transmitted from the sensory areas through the sensory
portions of the trigeminal and glossopharyngeal nerves into the
medulla oblongata, either into or closely associated with the tractus
solitarius

 The
tractus solitarius receives essentially all sensory impulses from the
mouth
 Nervous initiation of the pharyngeal stage of swallowing
 The successive stages of the swallowing process are automatically initiated
in orderly sequence by neuronal areas of the reticular substance of the
medulla and lower portion of the pons

 The areas in the medulla and lower pons that control swallowing are
collectively referred to as the deglutition or swallowing center

 Motor impulses from the swallowing center to the pharynx and upper
esophagus are transmitted successively by the fifth, ninth, tenth, and
twelfth cranial nerves and a few of the superior cervical nerves
The Oesophagus
 Oesophageal Stage of Swallowing
The esophagus primarily functions to conduct food rapidly from the
pharynx to the stomach. This is accomplished normally by two types of
peristaltic movements:
1. Primary peristalsis
a continuation of the peristaltic wave that begins in the pharynx and
spreads into the esophagus during the pharyngeal stage of swallowing
(swallow-induced peristalsis)
 This wave travels all the way from the pharynx to the stomach in about
8 to 10 seconds
2. Secondary peristalsis
 activated by oesophageal distension
Sequence of Events in the Oesophageal Stage of Swallowing
 As part of the swallowing reflex, the upper esophageal sphincter relaxes to
allow the entry of food into the oesophagus
 There is then contraction of the upper esophageal sphincter to prevent
reflux of food into the pharynx
 A primary peristaltic contraction then creates an area of high pressure
behind the food bolus which propels it along
 Gravity accelerates the movement of the food bolus
 A secondary peristaltic contraction clears the esophagus of remaining
food
 The lower esophageal sphincter relaxes as the food bolus approaches the
lower end of the esophagus
Nucleus Tractus Solitarius and Swallowing
 The Stomach
 Has four anatomic divisions
1. The fundus
2. The body
3. The cardia
4. The antrum
 Divided into two regions
1. The orad region
 includes the fundus and the proximal body
 receives the ingested food
 contains oxyntic glands
2. The caudad region
 includes the antrum and the distal body.
 responsible for the contractions that mix food and propel it into the duodenum
The Stomach
The Stomach
Blood Supply
Lymphatic Drainage
 General Functions of the Stomach
 Functions as reservoir for food before release into small intestine
 Forms chyme by mixing saliva, food, and gastric juice
 Slow emptying of chyme into the small intestine at a rate suitable for
proper digestion and absorption by the small intestine
 Secretes
 gastric juice ( with antibacterial properties and denatures protein)
 pepsin (begins the digestion of proteins)
 intrinsic factor (aids absorption of vitamin B12)
 gastric lipase (aids digestion of triglycerides)
 gastrin into blood
 The Stomach as a Reservoir for Food
 As food enters the stomach, concentric circles of the food in the orad
portion of the stomach is formed
 The newest food lies closest to the esophageal opening and the oldest food
lies nearest the outer wall of the stomach
 When food stretches the stomach, a “vagovagal reflex” from the stomach
to the brain stem and then back to the stomach reduces the tone in the
muscular wall of the body of the stomach (Receptive relaxation)
 The reduced muscle tone causes progressive bulging out of the stomach
wall, thus, accommodating greater and greater quantities of food up to a
limit in the completely relaxed stomach of 0.8 to 1.5 liters
 Mixing and digestion
 The caudad region of the stomach contracts to mix the food with gastric
secretions and the size of food particles is reduced. This begins the process
of digestion in the stomach
 After food in the stomach has been thoroughly mixed with the stomach
secretions , chyme (a murky semifluid or paste) is produced
 During mixing a wave of contraction closes the distal antrum. Thus, as the
caudad stomach contracts, food is propelled back into the stomach to be
mixed (retropulsion)
 Gastric emptying
 Food is propelled into the duodenum by contraction of the
caudad region of the stomach
 When the stomach contents are isotonic, the rate of gastric
emptying is fastest
 When the stomach contents are hypertonic or hypotonic,
gastric emptying is slowed
 Even during fasting, contractions (the “migrating
myoelectric complex”) occur at 90-minute intervals to
clear the stomach of residual food
 Digestion in the Stomach
Classified as

1. Mechanical Digestion
2. Chemical Digestion
 Mechanical Digestion in the Stomach
 Gentle, rippling, peristaltic movements (mixing waves) pass over the stomach every 15
to 25 seconds several minutes after food enters the stomach
 These mixing waves macerate food, mix it with secretions of the gastric glands, and
reduce it to a soupy liquid called chyme
 As digestion proceeds vigorous mixing waves begin at the body of the stomach and
intensify as they reach the pylorus
 When food reaches the pylorus, each mixing wave periodically forces chyme (~3ml)
into the duodenum through the pyloric sphincter (gastric emptying)
 Most of the chyme, however, is forced back into the body of the
stomach, where mixing continues
 The next wave, again pushes the chyme forward and empties a little more into the
duodenum
 Chemical Digestion in the stomach
 The stomach aids in chemical digestion by means of its glandular secretions

 Gastric glands located in different regions of the stomach include

1. Oxyntic glands(gastric glands)
 located in the fundus and body of the stomach
 acid-forming glands
 secrete hydrochloric acid, pepsinogen, intrinsic factor, and mucus
2. Pyloric glands
 located in the antrum of the pyloris
 mainly secrete mucus for protection of the pyloric mucosa from gastric acid
 secrete the hormone gastrin produced by their G cells
3. The cardiac glands
 located in the cardia of the stomach
 primarily secrete mucus
Oxyntic Gland
 Phases of Gasrtic Secretion

Occur in three “phases”

1. A cephalic phase
2. A gastric phase
3. An intestinal phase
 Cephalic Phase
 Normally accounts for about 20 per cent of the gastric secretion
associated with eating a meal
 Occurs even before food enters the stomach, especially while it is being
ingested
 It results from the thought, sight, smell, or taste of food
 The greater the appetite, the more intense the stimulation
 Neurogenic signals that are responsible for the cephalic phase of gastric
secretion originate in the
 Cerebral cortex
 The appetite centers of the amygdala
 Hypothalamus
 Gastric Phase
 Accounts for about 70 per cent of the total gastric secretion
associated with eating a meal
 Entry of food into the stomach excites
 long vagovagal reflexes from the stomach to the brain and back to
the stomach
 local enteric reflexes
 the gastrin mechanism
 All
of the above in turn cause secretion of gastric juice during
several hours while food remains in the stomach
 Intestinal Phase

 Stimulated by the presence of food in the upper portion of the

small intestine (especially in the duodenum)
 Stimulation
accounts for the continual secretion of small
amounts of gastric juice by the stomach
 Small
amounts of gastrin released by the duodenal mucosa may
account for secretions
 Summary
 Digestive activities occur in three overlapping phases
1. Cephalic phase
2. Gastric phase
3. Intestinal phase
 The cephalic phase
 salivary glands secrete saliva
 gastric glands secrete gastric juice in order to prepare the mouth and stomach for food that is about to be eaten
 The gastric phase
 presence of food in the stomach causes the gastric phase of digestion
 Presence of food promotes gastric juice secretion and gastric motility
 The intestinal phase of digestion
 food is digested in the small intestine
 gastric motility and gastric secretion decrease so as to slow the exit of chyme from the stomach
 Slowing of gastric secretion and gastric motility prevents the small intestine from being overloaded chyme
 GI Reflexes
Three types of gastrointestinal reflexes are necessary for
gastrointestinal function
1. Reflexes that are integrated entirely within the gut wall
enteric nervous system
2. Reflexes from the gut to the prevertebral sympathetic
ganglia and then back to the gastrointestinal tract
3. Reflexes from the gut to the spinal cord or brain stem and
then back to the gastrointestinal tract
 Reflexes Integrated within Gut Wall Enteric Nervous System

Include
reflexes that control gastrointestinal secretion
reflexes that control peristalsis
reflexes that control local inhibitory effects
Peristalsis Reflex
Reflexes from the Gut to the Prevertebral Sympathetic Ganglia and back to
the Gastrointestinal Tract
 Transmit long distance signals to other areas of the gastrointestinal tract

 Include
 The gastrocolic reflex
 transmit signals from the stomach to cause evacuation of the colon
 The enterogastric reflexes
 transmitsignals from the colon and small intestine to inhibit stomach motility
and stomach secretion
 The colonoileal reflex
 transmit signals from the colon to inhibit emptying of ileal contents into the
colon
Gastrocolic Reflex
Reflexes from the Gut to the Spinal Cord or Brain Stem and then back to the
Gastrointestinal Tract

Include
 reflexesfrom the stomach and duodenum to the brain stem and back to
the stomach
 reflexesby way of the vagus nerves that control gastric motor and
secretory activity
 pain reflexes that result in general inhibition of the entire
gastrointestinal tract
 defecationreflexes with signal from the colon and rectum to the spinal
cord and back again to produce powerful colonic, rectal, and
abdominal contractions required for defecation
Defecation Reflex
The Small Intestine
Blood Supply to Small Intestines
The Duodenum
Lymphatic Drainage and Innervation of the Duodenum
Mesentery and Layers of Small Intestine
Lymphatic Drainage of Abdominal and Pelvic Organs
 The Small Intestine

 A convoluted tube that extends from the pyloric sphincter to the ileocecal sphincter
 It is about 7 meters long
 Contained in the central and lower part of the abdominal cavity, and is surrounded
above and at the sides by the large intestine; a portion of it extends below the superior
aperture of the pelvis and lies in front of the rectum
 It is in relation, in front, with the greater omentum and abdominal parietes
 It is connected to the vertebral column by a fold of peritoneum, the mesentery
 Its glands secrete fluid and mucus
 the circular folds, villi, and microvilli of its wall provide a large surface area for
digestion and absorption
 Dextrins, maltose, sucrose, lactose, peptides, and nucleotides are digested at the surface
of mucosal epithelial cells by brush-border enzymes
 Mechanical digestion involves
 segmentation
 migrating motility complexes
 Absorption occurs via
 diffusion
 facilitated diffusion
 osmosis
 Active transport
 Divided into
 duodenum
 Jejunum
 FUNCTIONS OF THE SMALL INTESTINE

 Peristaltic propulsion of chyme

 Mixing of chyme with digestive juices by means of
segmentation and bringing it into contact with mucosa for
absorption
 Completion of digestion of carbohydrates, proteins, and
lipids
 Begins and completes nucleic acids digestion
 Absorption of nutrients and water (~90%) that pass through
digestive system
 The Ileocaecal Valve
 A principal function is to prevent backflow of fecal contents
from the colon into the small intestine
 The ileocecal valve itself protrudes into the lumen of the cecum
and thus is forcefully closed when excess pressure builds up in
the cecum and tries to push cecal contents backward against
the valve lips
 Normally, the valve can resist reverse pressure of at least 50 to
60 centimeters of water
 Movements of the Small Intestines

 Responsible for mechanical digestion

 Governed mainly by the myenteric plexus

 Divided into
1. Mixing contractions (segmentation contractions)
2. Propulsive contractions
 Mixing Contractions (Segmentation Contractions)

 Starts with the contraction of circular muscle fibers in a section of the

small intestine that constricts the intestine into segments
 The contractions cause “segmentation” of the small intestine dividing it
into spaced segments that have the appearance of a sausage-like chain
 Distension with chyme stretches the intestinal wall and elicit localized
concentric contractions spaced at intervals along the intestine, lasting a
fraction of a minute
 Segmentation contractions “chop” the chyme and promote progressive
mixing of the food with secretions
 Occur most rapid in the duodenum (~12 times/min) and progressively
slow to about 8 times/min in the ileum
 Peristaltic Propulsive Contractions

 Mainly peristaltic migrating motility complex (MMC) movements

 Occur in any part of the small intestine
 Beginin the lower portion of the stomach and pushes chyme forward
along a short stretch of small intestine before dying out
 Move toward the anus at a velocity of 0.5 to 2.0 cm/ sec
 Faster in the proximal intestine and slower in the terminal intestine
 Slowlymigrates down the small intestine, reaching the end of the ileum
in 90–120 minutes
 In total, chyme remains in the small intestine for 3–5 hours
 Functions of the Peristaltic waves in the Small Intestine

 Responsible for progression of chyme toward the ileocecal valve

 Spreads out the chyme along the intestinal mucosa
 As chyme enters the intestine and elicits peristalsis, it is immediately
spread along the intestinal mucosa. This process intensifies as additional
chyme enters the duodenum
 At the ileocecal valve, the chyme is sometimes blocked for several hours
until another meal is eaten
 Upon eating another meal, a gastroileal reflex intensifies peristalsis in the
ileum and forces the remaining chyme through the ileocecal valve into the
cecum of the large intestine
 Peristaltic Rush
 Powerful and rapid peristalsis
 Occurs due to Intense irritation of the intestinal mucosa
 Initiated partly by
 nervous reflexes
 intrinsic enhancement of the myenteric plexus reflexes
 Powerful peristaltic contractions travel a long distance in the small
intestine within minutes and sweep the contents of the intestine into the
colon
 A peristaltic rush, usually relieve the small intestine of irritative chyme and
excessive distention
 Secretions of the Small Intestines
 The entire surface of the small intestine is composed of small pits called crypts of Lieberkühn
 Lieberkuhn crypts lie between the intestinal villi
 The surfaces of both the crypts and the villi are covered by an epithelium composed of two
types of cells
1. a moderate number of goblet cells
 secrete mucus that lubricates and protects the intestinal surfaces
2. a large number of enterocytes
 In the crypts, secrete large quantities of water and electrolytes
 The flow of fluid from the crypts into the villi supplies a watery vehicle for absorption of
substances from chyme when it comes in contact with the villi
 enterocytes over the surfaces of adjacent villi, reabsorb water and electrolytes along with
end products of digestion
A Crypt of Lieberkuhn
 Brunner’s Glands
 Compound mucous glands, called Brunner’s glands, is located in
the wall of the first few centimeters of the duodenum
 Brunner’s glands secrete large amounts of alkaline mucus in
response to
 tactile or irritating stimuli on the duodenal mucosa
 vagal stimulation
 gastrointestinal hormones, especially secretin
Mucus secreted by Brunner’s glands offers protection to the
duodenal wall against digestion by the highly acidic gastric juice
that empties from the stomach
Brunner’s Glands
 Pancreatic and Intestinal Brush-Border Enzymes

 Pancreatic amylase - break down starches into maltose, maltotriose, dextrins

 Dextrinase - dextrins into glucose
 Maltase - maltose to glucose
 Sucrase - sucrose to glucose and fructose
 Lactase - lactose to glucose and galactose
 Trypsin, chymotrypsin, and elastase - proteins into peptides
 Carboxypeptidases - break off amino acids at the carboxyl ends of peptides
 Aminopeptidases - break off amino acids at the amino ends of peptides
 Dipeptidases - split dipeptides into amino acids
 Lipases - triglycerides to fatty acids and monoglycerides
 Nucleosidases and phosphatases - nucleotides to pentoses and nitrogenous bases
Digestion of Carbohydrates
Digestion of Proteins
Digestion of Fats
The Large Intestine
 General Principles of Large Intestine

 Extends from the ileocecal sphincter to the anus

 Responsible for the last stages of chemical digestion through
bacterial action where substances are further broken down, and
some vitamins are synthesized
 Absorbs water, ions, and vitamins
 Feces consist of water, inorganic salts, epithelial cells, bacteria,
and undigested foods
 Defecation is a reflex action aided by voluntary contractions of
the diaphragm and abdominal muscles and relaxation of the
external anal sphincter
 Divided into
The cecum
Colon (ascending, transverse, descending, and sigmoid colon)
Rectum
Anal canal
 Mucosa contains many goblet cells
 Its muscularis consists of
Teniae coli
Haustra
Arterial Blood Supply
Histology
 Movements of the Colon
 Are normally sluggish
 Still have characteristics similar to those of the small intestine
and
 Include
Haustral churning (mixing movements)
Peristalsis
Mass peristalsis
 Mixing Movements- Haustrations
 Large circular constrictions(In the same manner as segmentation
movements in the small intestine)
 About 2.5 cm of the circular muscle contract (sometimes constrict) the
lumen of the colon almost to occlusion
 Simultaneously, the longitudinal muscle of the colon (teniae coli) contracts
 These combined contractions cause the un-stimulated sections of the large
intestine to bulge outward into baglike sacs (haustrations)
 Usually, each haustration reaches peak intensity in 30 s then disappears in
60 s
 After few minutes, new haustral contractions occur in adjacent areas
 Contractions function to mix the content of the large intestines
 Intestinal contents also move slowly toward the anus during mixing
contraction (especially in the cecum, ascending colon)
 Fecal material is gradually exposed to the mucosal surface of the large
intestine
 Fluid and dissolved substances are absorbed leaving only 80 to 200
milliliters of feces to be expelled daily
 Peristalsis
 Occurs at a slower rate than in the most proximal portions of the
digestive tract

 Occurs at a rate of 3-12 contractions per minute

 Mainly occur in the cecum and ascending colon

 Mass Movement
 A modified type of peristalsis
 May be initiated by gastrocolic or duodenocolic reflexes
 Force faecal material rapidly in mass down the colon
 Move large intestinal contents over long distances (from the
transverse colon to the sigmoid colon)
 Occur only one to three times daily, especially for about 15
minutes during the first hour after breakfast in most people
 Entry of fecal matter into the rectum triggers the
defecation reflex
 Mass Movement
 Characterized by the following sequence of events
1. A constrictive ring forms in response to distension or irritation in the colon,
usually in the transverse colon
2. 20 or more centimeters of colon distal to the constrictive ring lose their
haustrations and contract as a unit, thus propelling the fecal material in this
segment en masse down the colon
3. The contraction develops progressively more force for about 30 seconds,
followed by relaxation during the next 2 to 3 minutes
4. Another mass movement then occurs, perhaps farther along the colon
5. A series of mass movements persist usually for 10 to 30 minutes, then cease and
return perhaps a half day later
6. When a mass of feces is forced into the rectum, the defecation reflex is
stimulated and the desire to defecate is felt
 Secretions of the Large Intestine
 The mucosa of the large intestine possess many crypts of
Lieberkühn but no villi
 Epithelial cells secrete almost no digestive enzymes
 Mucous cells secrete mucus
 Mucus contains moderate amounts of bicarbonate ions secreted
by a few non-mucus-secreting epithelial cells
Defecation Reflex
The Defecation Reflex
Accessory Organs
Pancreas
Blood Supply
Liver
Blood Supply
Liver Damage
Clinical Manifestations of Chronic Liver Disease
Gallbladder
Layers of the Gall Bladder
Blood Supply
Cholelithiasis