Physiology of the Digestive System

(GIT)

1
 Objectives
At the end of this lesson the student are expected to:
1. List functions of the digestive system.
2. Explain the components of GIT.
3. Discuss about digestion, secretion & absorption.
4. Enumerate the functions of digestive tracts .

2
 Introduction
• Digestion
– Is the process of turning food into fuel for
energy, & for maintenance of body structure
and function.
• Digestive tract
– Is a series of hollow organs joined in a long,
twisting tube from the mouth to the anus.
– Inside this tube is a lining called the mucosa.
• In the mouth, stomach & small intestine, the
mucosa contains tiny glands that produce
enzymes to help digest food. 3
 Introduction …
• Liver, gallbladder & pancreas
– produce enzymes & substances to help with
digestion in the small intestine.
• Digestive process
– food passes down the throat, through esophagus & into
the stomach, where food continues to be broken down.
– partially digested food passes into a short tube called the
duodenum - jejunum - ileum (small intestine).
– the resulting waste materials travels downstream to the
colon - rectum - anus (large intestine)
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 Digestive System (GIT)
What are the basic
functions of GIT ??
1.Provide the body
with a continuous
supply of:
• Nutrients
• Water and
• Electrolytes
2. Removal of waste
materials.
 Organs involved in the process of
digestion
Alimentary canal Accessory digestive
a. Organs a. Organs
– Mouth, Pharynx, – Teeth,
– Esophagus – Tongue
– Stomach – Gallbladder
– Small intestine b. Glands
– Large intestine – Salivary
b. Function – Liver
– Digestion, absorption – Pancreas
& waste removal  aid digestion 6
 Basic processes of the digestive system
The GI system carries out the following basic activities
 Ingestion:
• food intake, which is controlled by the feeding and
satiety center in the HT.
 Mastication /chewing:
• mechanical grinding of food with the aid of teeth.
 Swallowing /deglutition:
• propulsion of food from the mouth to the
esophagus.

7
 Basic processes of …
 Chemical digestion
• enzymatic hydrolysis which breaks complex
molecules into their subunits.
 Secretion
• release of mucus, enzymes, hormones, electrolytes
& water
 Absorption
• transport of digestive end products into the blood
and lymph.
 Defecation= excretion of fecal matter
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 Phases of the Digestive System
 Mouth
- Food ingestion (intake) and physical break down
 Esophagus
- Simple passage of food (bolus)
 Stomach
- Mixing, digestion, secretion, temporary storage, emptying
 Small intestine
- Digestion, secretion and absorption
 Large Intestine
- Storage, absorption, passage of faecal matter (excretion)

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 Phases
of
the
Digestive
System

10
Histology of the Digestive Tract

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Histology of the Digestive Tract …

Mucosa – secretion & absorption

Submucosa - nourishment ,control, &

secretion
Muscularis - propels food

Serosa - provides protection

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 Regulation of GIT
1. The Neuronal System
• Extrinsic control system by ANS
* Sympathetic NS = ↓GI function, ↓Motility, ↓Secretions
* Parasympathetic NS =↑GI function ,↑Motility, ↑Secretions

• Intrinsic control system by enteric NS

* Submucosal plexus = controls GI secretion
* Myenteric plexus = controls gut motility

2. The Hormonal System

* Cholecystokinin, Secretin, GIP …
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Nervous Control of the GI Tract

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 GIT Reflexes
1. Reflexes that occur entirely within the ENS.
e.g. GI-secretion, peristalsis, mixing-contractions
2. Reflexes that arise from the gut to sympathetic
ganglia & then back to the GI-tract.
Examples:
o The gastro-colic reflex :
– Signals send from the stomach to cause evacuation of
the colon.

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 GIT reflexes...
o The Entero-gastric reflexes:
– Signals from the colon & small intestine to
inhibit stomach motility & secretion.
o The Colono-ileal Reflex:
– Reflexes from the colon to inhibit emptying of
ileal contents into the colon.
3. Reflexes from the gut to spinal cord/brain stem
& then back to GIT:
e.g. Defecation Reflex

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 Hormonal control of GI function
• Entero-endocrine cells produce several GIT- hormones,
capable of regulation of motility & secretary activities.
1. Cholecytokinin (CCK)
• Secreted by the mucosa of the jejunum in response to the
presence of fatty food in the intestine.
– has a very potent effect on Gallbladder Contractility
for expelling bile into the intestine in order to facilitate
fat digestion & absorption.
• Inhibits stomach motility in order to give adequate time
for fat digestion.

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 Hormonal…
2. Secretin
 Secreted by the mucosa of the duodenum in
response to acidic gastric juice pumped from the
stomach.
 It increases NaHCO3 secretion by the pancreas.

3. Gastric Inhibitory Peptide (GIP)

• Secreted by the mucosa of the upper small
intestine in response to fat & carbohydrate
meal in the intestine.
• It Inhibits the Motor Activity of the Stomach.
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 Blood
Supply
to the
GIT
Splanchni
c
circulatio
n
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Blood Supply to GIT…

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Mouth
Functions of Tongue:
1.Gripping & repositioning food
during chewing.
2. Mixing food with saliva
& forming the bolus.
3. Initiation of swallowing
& speech.
4. Contains taste buds

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 Salivary Glands
 moisten food and contain enzymes for the breakdown of
starchy foods.
Functions of Saliva
1. Moistening the mouth & aids
speech.
2. Keeps oral hygiene, contains
bactericidal substances:
thyocyanide, lysozymes.
3. Lubricates food & assist
swallowing.
4. Buffers sudden change of
oral pH. 22
 Digestive processes in the mouth
• Ingestion of food
• The amount of food that a person ingests is
determined primarily by the intrinsic desire for
food (hunger/appetite).
• It is controlled by 2 nuclei in the Hypothalamus
1. Feeding center in lateral nucleus
– initiate us to crave for food & the desire for a
particular type of food.
2. Satiety center in the ventromedial nucleus
– has an inhibitory effect on the appetite center.
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Digestive processes in the mouth...
• Mechanical digestion begins (chewing).
• Chemical breakdown of starch begins by
– Salivary amylase.
• Propulsion is initiated by swallowing.
– Pharynx & esophagus serve as conduits to
pass food from the mouth to the stomach.

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 Mastication (Chewing)

• A process of mechanical breakdown of food.

• Salivary secretion containing amylase involves:
– chemical digestion & lubrication of chewing.
• Teeth, tongue, jaws & lips are involved in chewing.

• Mastication muscle are supplied mainly by the

motor branch of the trigeminal nerve.

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 Deglutition (Swallowing)
the propulsion of food from mouth to the esophagus
Bolus of food

Tongue
Uvula
Pharynx Bolus
Epiglottis
Epiglottis

Trachea Esophagus Bolus

(a) Voluntary stage, oral (b) Involuntary, pharyngeal (c) Involuntary esophageal
phase of swallowing stage of swallowing stage of swallowing

Relaxed Relaxed
Circular muscles contract,
muscles muscles
constricting passageway
and pushing bolus down Gastroesophageal
Bolus of food sphincter open

Longitudinal muscles
contract, shortening
passageway ahead of
bolus
Gastroesophageal
sphincter closed Stomach

(d) (e)

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 Functional movement of the GIT
Two basic types of movements occur in the GIT:
1. Propulsive movements:
• which cause food to move forward along the tract at an
appropriate rate for digestion & absorption.
– Peristalsis is the basic propulsive movement of the GIT
that appears in the form of contractile rings around the
gut & propels to the anal ward direction.

2. Mixing movements :
• which keep the intestinal contents thoroughly mixed at
all times.
– Segmentation
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Peristalsis

 Longitudinal muscles
produce the rippling
wavelike movement
called peristalsis.
 Muscles alternately
shorten & lengthen
which propels matter
along the alimentary
canal.
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 Segmentation

 Circular muscles
alternately contract
and relax along the
alimentary canal.
 This mixes and
liquefies the food as
well as helping to
propel it along.

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 Lower esophageal
(Gastro-esophageal sphincter)
• Thickened circular smooth muscle at the junction between the
esophagus & the stomach.
– Prevents the reflux of gastric contents into the esophagus.
 Gastro-esophageal reflux:
– the entry of gastric contents into the lower part of the
esophagus due to incompetence of the LES
– leads to ulcer of the mucosa of lower esophagus.
 Achalasia:
– failure of LES to be relaxed, swallowing is inhibited
– caused by increased in tone of LES due to high sensitivity
to gastrin, weak esophageal peristalsis
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 Functional structure of the stomach
Gastroesophageal
Sphincter
Fundus
Pyloric
Sphincter
Body

Pyloric
Antrum

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 Functions of the stomach
1. Storage of large quantities of food until it can be
pumped into the duodenum.
2. Mixing of food with gastric secretion to form a semi-
fluid chyme.
3. Slow emptying the food from the stomach into the
small intestine at a rate suitable for proper digestion
& absorption by the SI.
4. Secretary function: HCl, mucous, pepsin, gastrin
5. Sterilization, digestion, facilitates defecation

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 Stomach…
Movements in the Glands distribution
stomach Body of stomach
Parietal cells (HCl, IF)
1. Propulsive movement Chief cells (pepsinogen)
2. Mixing movement Pyloric Antrum
3. Receptive relaxation G-cells (gastrin)
Chief cells (pepsinogen)
4. Hunger contraction
(hanger pangs) All parts
 Mucous producing cells

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 Stomach Lining
• The stomach is exposed to the harshest conditions
in the digestive tract.
• To protect from digesting itself stomach:
•

1. Has a mucosal barrier with a thick coat of

bicarbonate-rich mucus on the stomach wall.
2. Epithelial cells are joined by tight junctions
3. Gastric glands have cells impermeable to HCl
4. Damaged epithelial cells are quickly replaced

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 Gastric Contractile Activity
• Most vigorous peristalsis &
mixing occurs near the
pylorus
• Chyme is either:
1. Delivered in small amounts
to the duodenum or
2. Forced backward into the
stomach for further mixing

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 Regulation of Gastric Emptying
• Gastric emptying is regulated by:
 The neural entero-gastric reflex
 Hormonal mechanisms
• These mechanisms inhibit gastric secretion & duodenal
filling
• Carbohydrate-rich chyme quickly moves through the
duodenum
• Fat-rich chyme is digested more slowly causing food to
remain in the stomach longer

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 Hormonal and neural factors that
regulate stomach emptying
Stimulatory stomach factors Inhibitory duodenal factors
Distension of the stomach Distension of the duodenum
Partially digested protein Fatty acids and glucose
Alcohol Partially digested protein
Caffeine
↑Secretion of
↑Gastrin Sensory CCK Entero-gastric
Secretion impulse via vagus reflex
GIP
Constrict LES Secretin
↑Stomach motility
Relax pyloric sphincter ↓Stomach motility
↑Pyloric sphincter tone
Stimulate gastric emptying
Inhibit gastric emptying
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Small Intestine: gross anatomy
• Runs from pyloric
sphincter to the
ileocecal valve
•

• 6.4m long &

0.03m in diameter
• Has 3 parts
* Duodenum: 0.3m
* Jejunum: 2.4m
* Ileum: 3.7m

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 Small Intestine: microscopic anatomy
Large surface area for the
majority of absorption.
• Plicae circulares:
– deep circular folds of
the mucosa and sub
mucosa
• Villi
– fingerlike extensions of
the mucosa
• Microvilli
– tiny projections of
absorptive mucosal
cells’ plasma membranes 39
 Movement in the small intestine
~ Two types of movements occur in the SI:
1. Mixing movement
2. Propulsive movement
1. Mixing movements (segmentation contractions)
~ Ring like contractions appear at regular intervals.
~ Segmentation contractions exert chopping action
on intestinal chyme & mix it with digestive juice.

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 Movement in the small intestine..
Propulsive movements
• Are peristaltic waves that
propel chyme anal wards
• Initiated by intestinal
distension
• Chyme is propelled in the
SI until it reaches the
terminal ileocecal sphincter

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 Ileocecal sphincter
• Prevents back flow of fecal
matter from the cecum to the
ileum.
Factors regulating the sphincter
• Pressure & chemical irritation
of ileum relax it & initiates
peristalsis
• Pressure & chemical irritation
of cecum inhibit peristalsis of
ileum and closes the sphincter

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Large Intestine

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 Large Intestine…
• Absorbs water from indigestible food residues.
• Digestive processes
a. No breakdown
b. Water and vitamin absorption
c. Major function peristaltic movement of fecal
material.

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 Movement in the large intestine
Two types of movements
1. Mixing movements (Haustration)
2. Propulsive movements (mass movements)
 Mass movement
- is initiated by local distension, gastro-colic reflex
• Poor motility of the transverse colon causes
greater absorption and constipation.
• Excess motility of the sigmoid colon causes
less absorption and diarrhoea or loose stool.
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 Defecation reflex
1) Pressure in rectum from
mass peristalsis sends
afferent stimuli to spinal
cord.
2) Parasympathetic stimuli
cause contraction of rectal
muscle and relaxation of
internal anal sphincter.
3) Voluntary stimuli relax
external anal sphincter
and cause abdominal
contraction … defecation
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 Secretary function of GIT
 Primary secretary products of GIT are:
~ Digestive enzymes ~ GI-hormones
~ Mucous ~ Electrolytes (HCl, NaHCO3)
 Factors stimulating GIT secretions
 Local mechanical factors: distension, irritation, pH change
 Nervous stimulation: ANS, ENS
 Sympathetic stimulation inhibits GIT-secretions
 Parasympathetic stimulation increases GIT-secretions
 Hormonal mechanisms:
 Gastrin increase HCl secretion.
 Secretin increases NaHCO3 secretion from pancreas.
 Regulation of Gastric Secretion
• Neural and hormonal mechanisms regulate the
release of gastric juice
• Stimulatory & inhibitory events occur in 3 phases
1. Cephalic phase
– prior to food entry to the stomach
2. Gastric phase
– once food enters the stomach
3. Intestinal phase
– as partially digested food enters the duodenum
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Release of Gastric Juice

49
 Secretion of the small intestine
Mucosa of the SI secrets:
• Digestive enzymes, Mucous (protective & lubricant),
Electrolytes, Hormones
Intestinal secretary glands:
1. Brunner’s gland: mucous glands, duodenal in distribution
2. Crypts of Lieberkun: source of new lining cells, they are
sometimes called intestinal glands b/c the cells they
produce are secretory cells for enzymes & other substances
3. Goblet cells: mucous glands
4. Enterocytes: digestive enzymes
5. Enteroendocrine cells: produce hormones
6. Enterochromaffin cells: serotonin producing cells.
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 Digestive enzymes secreted in the SI
1. Peptidase: splits peptides amino acids
2. Sucrase, maltase & lactase
hydrolyze diasaccharides monosaccharides
3. Intestinal lipase: splits neutral fats glycerol & fatty acids.

Regulation of SI secretion
• Local factors: distension, irritation, pH change.
• Hormonal: Secretin, CCK, VIP, Glucagon, GIP
• Nervous:
– Vagal stimulation increases intestinal secretion
– Sympathetic stimulation decreases intestinal secretion
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Anatomy of the Pancreas
• Lies deep to the greater
curvature of the stomach
• The head is encircled by the
duodenum & the tail adjacent to
the spleen
• Divided into:
- Head, body & tail
• Connected to duodenum via:
– main pancreatic duct
• duct of Wirsung
– accessory duct
• duct of Santorini 52
 THE PANCREAS
• Pancreas contains 2 types
of secretary glands:
1. Endocrine cells
(islets of Langerhans)
* Secrete 2 hormones:
- Insulin & glucagon.
2. Exocrine cells (acinar cells)
* Secrete a mixture of:
- fluid rich in NaHCO3 &
- digestive enzymes called
pancreatic juice. Acinus of the Pancreas53
 Pancreatic digestive enzymes
1. Proteolytic enzymes:
* Trypsin, Chymotrypsin
* Carboxypolypeptidase
* Ribonuclease, Deoxyribonuclease
* Elastase , Collagenase
2. Pancreatic enzymes involved in CHO digestion:
* Pancreatic amylase
3. Pancreatic enzymes involved in fat digestion:
* Pancreatic lipase, Cholesterol esterase,
Phospholipase
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Regulation of Pancreatic Secretions

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 LIVER & GALLBLADDER
Liver
• Weighs 1.36kg.
• Located below
diaphragm in the
abdomen.
• The heaviest gland
in the body & the 2nd
largest organ after
the skin.
• Divisible into left &
right lobes.
56
 Liver and Gallbladder…
• Right lobe larger
– Gallbladder on right lobe.
– Size causes right kidney
to be lower than left.

Gallbladder
• A sac located in a
depression on the posterior
surface of the liver.
• Has fundus, body & neck.
57
 Liver: Associated Structures…
Bile leaves the liver via

• Bile ducts (right & left

hepatic duct) fuse into
the common hepatic
duct
• The common hepatic
duct fuses with the
cystic duct & form the
common bile duct.

58
 Liver: Microscopic Anatomy
•
•
Hexagonal-shaped liver lobules
- Structural & functional units of the liver.
- Composed of hepatocyte plates (liver cell)
radiating outward from a central vein
- Portal triads are found at each of the 6 corners
of each liver lobule. Portal triads consist of:
1. Bile duct
2. Hepatic artery - supplies O2 rich blood to the liver
3. Hepatic portal vein - carries venous blood with
nutrients from digestive viscera.
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 Liver: microscopic structures…
• Liver sinusoids
– enlarged, leaky capillaries located b/n hepatic plates
• Kupffer cells
– hepatic macrophages found in liver sinusoids
• Hepatocytes’ functions include:
1. Production of bile
2. Processing blood-borne nutrients
3. Detoxification
4. Storage of fat-soluble vitamins
60
 Functions of the liver
1. Carbohydrate Metabolism: it is the site of:
* Glycogenesis
- turn excess glucose into glycogen & store in the liver
* Gluconeogenesis = turn proteins & triglycerides into glucose
* Glycogenolysis = turn glycogen back into glucose as needed

2. Lipid Metabolism :it is the site of:

• formation of phospholipids, lipoproteins,
• synthesis of cholesterol, and
• conversion of CHO into fat

61
 Functions of the liver...
3. Protein Metabolism
• Deamination of amino acids
- removes NH2 (amine group) from aas so can use what is
left as energy source
• Converts resulting toxic NH3 (ammonia) into urea
for excretion by the kidney
• Synthesizes plasma proteins utilized in the clotting
mechanism & immune system.
• Convert one amino acid into another

62
 Other functions of the liver
4. Inactivation of drugs & hormones
e.g. Sulfonamide, penicillin, thyroid, steroids
5. Removes the waste product; bilirubin
6. Releases bile salts that help digestion of fat by
emulsification
7. Stores:
– fat soluble vitamins (A, B12, D, E, K),
– iron, copper and
– blood (a major blood reservoir)
63
 Other functions of the liver...
8. Activates vitamin D
9. Filtration of blood:
– phagocytizes worn out blood cells & bacteria
– removes blood clots & toxins from portal
circulation
10. Synthesis of blood clotting factors
- Factor-I, II, VII, IX, X

64
 Regulation of Bile Secretion
Bile is secreted by
hepatocytes in the liver
for two purposes
1. Facilitates fat
digestion
& absorption in the SI
2. Serves as a means of
excretion of waste
products
• bilirubin &
• cholesterol 65
Digestive & absorptive
function of
the GIT
 Digestion in the Small Intestine
• As chyme enters the duodenum:
– Carbohydrates & proteins are only partially
digested
– Almost no fat digestion has taken place
• Digestion continues in the small intestine
– Chyme is released slowly into the duodenum
Because it is hypertonic & has low pH, mixing
is required for proper digestion
• Virtually all nutrient absorption takes place in the
small intestine.
67
 Digestion of Carbohydrates
• Mouth: salivary amylase.
• Esophagus & stomach: nothing happens.
• Duodenum: pancreatic amylase.
• Small intestine: Brush border enzymes
– maltase, sucrase & lactase which act on
disaccharides & produce monosaccharides:
 Fructose
 Glucose
 Galactose
68
 Digestion of Carbohydrates…
Starch
- Salivary amylase (20-40%)
- Pancreatic amylase (50-80%)
Maltose
glucose polymers Lactose Sucrose
-Maltase -Lactase -Sucrase
-Dextrase
Glucose + Glucose Glucose and Glucose and
Galactose Fructose

69
 Digestion of Proteins
• Enzymes used in the stomach pepsin.
• Enzymes acting in the small intestine
* Pancreatic enzymes
– Trypsin
– Chymotrypsin
– Carboxypeptidase
* Brush border enzymes
– Aminopeptidases
– Dipeptidases
– Carboxypeptidases
70
 Digestion of Proteins...

Proteins
-Pepsin

Peptones Trypsin
Proteoses Chymotrypsin Amino acid
Polypeptides Carboxypolypeptidase Peptides

-Peptidase

Amino acids
71
 Digestion of fats
• Happens in the small intestine in two phases:
1. Emulsification
– By bile salts
– Formation of emulsion
droplets
2. Chemical digestion
– Pancreatic lipase
– Enteric lipase
• Free fatty acids [FFA]
• Monoglycerides
72
 Digestion of fats...
Dietary source of fat
• Neutral fats (triglycerides), Cholesterol, cholesterol esters and
Phospholipids.

Fat Emulsified fat

Bile salt FFA + Glycerides
- Lingual lipase
- Gastric lipase
- Pancreas lipase
- Enteric lipase

Cholesterol Bile salt

Cholesterol esters Cholesterol esterase FFA + Glycerides

Phospholipids-A2 Phospholipase FFA + Phopholipids

73
 Enzymes (summary)
 Pancreatic Enzymes
• Amylase: polysaccharides → disaccharides
• Trypsin, chymotrypsin: polypeptides → dipeptides
• Carboxypeptidase: dipeptides → amino acids
• Lipase: fats → glycerol & fatty acids
 Brush border enzymes (intestinal)
• Aminopeptidase, carboxypeptidase:
dipeptides → amino acids
• Sucrase, lactase, maltase:
disaccharides → monosaccharides
74
 Absorption in the Small Intestine
Absorption
– the passage of the
end products of
digestion from the
GI tract into blood
and lymph.
Absorption occurs by:
1. Simple diffusion,
2. Facilitated diffusion,
3. Osmosis, and
4. Active transport.
75
Where will the absorbed nutrients go?

76
 Absorptive function of GIT
Carbohydrates and Proteins
• Essentially all carbohydrates are absorbed as
monosaccharides into blood capillaries.
• Proteins are absorbed in the form of amino acids,
dipeptides, and tripeptides
• Most proteins are absorbed as amino acids by
active transport processes into the blood capillaries
in the villus.

77
 Absorption of Lipids
• Dietary lipids are all absorbed by simple diffusion.
• Long-chain fatty acids & monoglycerides are
absorbed as part of micelles, re-synthesized to
triglycerides & formed into protein-coated
spherical masses called chylomicrons - taken up
by the lacteal of a villus.
• From the lacteal they enter the lymphatic system
and then pass into the cardiovascular system,
finally reaching the liver or adipose tissue.
• The plasma lipids (fatty acids, triglycerides,
cholesterol) are insoluble in water and body fluids.
78
 Absorption of Lipids...
• In order to be transported in blood & utilized by
body cells, the lipids must be combined with
protein transporters called lipoproteins to make
them soluble.
• Small fatty acids enter cells & then blood by simple
diffusion. Larger lipids exist only within micelles
(bile salts coating)
• Lipids enter cells by simple diffusion leaving bile
salts behind in gut.
– Bile salts reabsorbed into blood & reformed into
bile in the liver. Fat-soluble vitamins enter cells
within micelles
79
 Electrolyte Absorption
• Most ions are actively absorbed along the length of
small intestine
– Na+ is coupled with absorption of glucose & amino acids
– Ionic iron is transported into mucosal cells where it binds
to ferritin
• Anions [-Ve charge ions] passively follow the
electrical potential established by Na+
• K+ diffuses across the intestinal mucosa in response
to osmotic gradients
• Ca2+ absorption:
– Is related to blood levels of ionic calcium
– Is regulated by Calcitonin & Parathyroid hormone
80
 Water Absorption
• 95% of water is absorbed in the small intestines by
osmosis.
• Water moves in both directions across intestinal
mucosa
• Net osmosis occurs whenever a concentration
gradient is established by active transport of solutes
into the mucosal cells
• Water uptake is coupled with solute uptake, and as
water moves into mucosal cells, substances follow
along their concentration gradients
81