1st year BS Nursing, Batch 2023

Large Group Interactive Session (LGIS)

Physiology of GIT

Usman Date:-15th August 2023

Sr # Content Slide #
1 Motto, Vision 4
2 Professor Umar Model of Integrated Lecture 5
3 Bloom’s Taxonomy (Domains of learning) 6
4 Diagrammatic Representation of Blooms Taxonomy 7
5 Learning Objectives 8
6 Horizontal Integration 11-13
7 Core Concept 14 – 36
8 Vertical Integration 116
9 Biomedical Ethics (lesson of the day) 41-42
10 Brainstorming (SEQ/MCQs relevant with lecture) 43-47
11 Suggested Research Article 48
12 Promoting IT and research culture(Digital Library) 49
13 References of this lecture 50
Motto Vision; The
Dream/Tomorrow
To impart evidence based
research oriented medical
education
To provide best possible patient
Truth care
To inculcate the values of
Wisdom
mutual respect and ethical
practice of medicine
Professor Umar Model of Integrated Lecture

20%
HORIZONTAL
60%
INTEGRATION
CORE SUBJECT
Physiology
biochemistry

7% 8%
VERTICAL VERTICAL
INTEGRATION INTEGRATION
Clinical Pathology
integration pharmacology

5%
VERTICAL
INTEGRATION
Research,
professionalism
Ethics
Digital library

5
BLOOM'S TAXONOMY : DOMAINS OF LEARNING

Sr. # Domain of Abbreviation Levels of the Meaning

learning domain

1 cognition C C1 Recall / Remembering

2 C2 Understanding
3 C3 Applying / Problem solving
4 Psychomotor P P1 Imitation / copying
5 P2 Manipulation / Follows instructions
6 P3 Precision / Can perform accurately
7 Attitude A A1 Receiving / Learning
8 A2 Respond / Starts responding to the
learned attitude
9 A3 Valuing / starts behaving according to the
learned attitude
BLOOM'S TAXONOMY OF THE
COGNITIVE DOMAIN
LEARNING OBJECTIVES

Sr. # Learning Objective Domain of

Learning
1 To illustrate components of GIT C3

2 To describe the functions of gastrointestinal tract and its C2

components

3 To understand the concept of digestion and Sites of digestion. C1

4 To identify and describe the Liver microenvironment, and its role C2

in digestion
5 To apply the knowledge of regulation of digestion C3
to practical scenarios:
Horizontal integration

Horizontal integration
(With Anatomy)
peritoneum
 Mesenteries

• Greater omentum
and transverse colon
reflected
 Mesenteries

• Superficial view
of the
abdominal
organs
Regions of Small Intestine
Small intestine
 Duodenum and Related Organs
Liver
Bile

Gall-
bladder
Stomach

Bile
Pancreas
Acid chyme

Intestinal enzymes

Pancreatic
Duodenum of juice
small intestine
CORE CONCEPT
 Function of the digestive system
 ingestion: taking food and liquid
into mouth
 Secretion: total about 7 liter into
 lumen
Mixing and propulsion: through GI
 muscle and peristalsis and motility
Digestion: Breakdown of ingested
 food (mechanical and chemical)
Absorption: Passage of nutrients into the
blood
 Metabolism: Production of cellular
 energy (ATP)
Defecation: waste substance leave the GI
tract through anus
Organs of the Digestive System

 Two main groups

 Alimentary canal or gastrointestinal tract
– continuous coiled hollow tube from
mouth to anus(5-7 meter)
 Accessory digestive organs: teeth ,tongue
,salivary gland ,liver ,gallbladder ,and
pancreas
Organs of the Digestive System
 Organs of the Alimentary Canal

 Mouth
 Pharynx
 Esophagus
 Stomach
 Small intestine
 Large intestine
 Anus
 Mouth (Oral Cavity) Anatomy
 Lips (labia) – protect
the anterior opening
 Cheeks – form the
lateral walls
 Hard palate – forms
the anterior roof
 Soft palate – forms
the posterior roof
 Uvula – fleshy
projection of the
soft palate
 Mouth (Oral Cavity) Anatomy
 Vestibule – space
between lips
externally and teeth
and gums internally
 Oral cavity – area
contained by the
teeth
 Tongue – attached at
hyoid bone and
styloid processes of
the skull, and by the
lingual frenulum
 Tongue

 Dorsum (upper part of tongue

covered with papillae taste
receptor and buds)
 filiform papillae

 fungiform papillae

 circumvallate papillae

 Paltine tonsil and

lingual tonsil
 Salivary glands
-Parotid gland: In the parotid fossa, three main
structures transverse this gland – facial nerve,
external carotid artery, and retromandibular vein.
The parotid duct opens near the upper 2nd molar
tooth. The gland is completely serous.
-Submandibular gland: Sitting most
posteriorly in the submandibular triangle, it is
supplied by the facial artery and vein.
Submandibular ducts, which cross the lingual
nerves, open on both sides of the tongue
frenulum. It is mostly serous but partially
mucus,.
-Sublingual gland: The smallest salivary gland
sits beneath the oral mucosa in the floor of the
mouth. It has multiple small openings.
This gland is almost completely mucus-
secreting.
Teeth
• Teeth
(mechanical breakdown)
– Incisors used for cutting
– Canines used for stabbing
and holding
– Molars large surface area
used for grinding
• Primary or deciduous
teeth 20
• Secondary or permanent
teeth 32
 Structure of Teeth

Crown - exposed surface of tooth

Neck - boundary between root and crown

Enamel - outer surface (the hardest substance in the

body 95% calcium salts)
Dentin – bone-like, but noncellular(70% calcium
salts)
Pulp cavity - hollow with blood vessels and
nerves
Root canal - canal length of root
gingival sulcus - where gum and tooth meet
 Processes of the Mouth

 Mastication (chewing) of food

 Mixing masticated food with saliva to
produse easy digestied food called
bolus
 Saliva contain 2 enzyme,salivary
amylase and lingual lipase
 Initiation of swallowing by the
tongue
 Allowing for the sense of taste
Layers of Alimentary Canal Organs

 Submucosa
 Just beneath the mucosa
 Soft connective tissue with blood vessels,
nerve endings, and lymphatics also contain
submucosal plexus
Layers of Alimentary Canal Organs
 Mucosa
 Innermost layer
 Moist membrane
1. Surface epithelium : secretion and
absorbtion,renew every 5-7 days also
contain enteroendocrine cells
2. Small amount of connective tissue
(lamina propria): contain blood and
lymphatic vessele also contain MALT
3. Small smooth muscle layer
Layers of Alimentary Canal Organs
 Muscularis externa – smooth muscle
1. Inner circular layer
2. Outer longitudinal layer Between
them is myenteric plexus
 Serosa
 Outermost layer – visceral peritoneum
 Layer of serous fluid-producing cells
(mesothelium)
Layers of Alimentary Canal Organs
Digestive Anatomy: Histological
 Pharynx Anatomy
 Nasopharynx –
not part of the
digestive system
 Oropharynx –
posterior to oral
cavity
 Laryngopharynx –
below the oropharynx
and connected to
the esophagus
 Pharynx Function
 Serves as a passageway for air and
food
 Food is propelled to the esophagus by
two muscle layers
 Longitudinal inner layer
 Circular outer layer
 Food movement is by alternating
contractions of the muscle layers
(peristalsis)
 Esophagus
 Runs from pharynx to stomach through
the diaphragm( 25 cm)
 Conducts food by peristalsis
(slow rhythmic squeezing): contraction of
circular layer above the food and
contraction of longitudinal below the
food
 Passageway for food only (respiratory
system branches off after the pharynx)
 Esophagus
-The esophagus is posterior to the larynx
and trachea in the neck region and upper
thorax. It travels on the right side of the
descending aorta, passes through the
diaphragm, and connects with the stomach.

-There are also inner circular and outer

longitudinal muscle layers.
-The upper third is skeletal muscle (voluntary),
middle third is mixed, and lower third is
smooth muscle (involuntary).

-esophagogastric junction is located

approximately at the level of the diaphragm.
Contractions of the diaphragm create sphincter-
like effects, preventing reflux of stomach acids
and content. The esophagogastric junction is a
functional, not anatomical, sphincter.
 Peristalsis in Esophagus
Muscles contract

Muscles
contract, Muscles relax
Bolus of constricting
food passageway
and
pushing
Muscles relax, bolus down
allowing Muscles contract
passageway
to open

Muscles
Stomach relax
 Stomach Anatomy

 Located on the left side of the

abdominal cavity
 Food enters at the
cardioesophageal sphincter
Site where food is churned into chyme
Protein digestion begins
 Stomach Anatomy

 Regions of the stomach

 Cardiac region – near the heart
 Fundus
 Body
 Phylorus – funnel-shaped terminal end
 Food empties into the small intestine at
the pyloric sphincter
Stomach
 Stomach Anatomy

 Rugae – internal folds of the mucosa

 External regions
 Lesser curvature
 Greater curvature
Stomach
 Stomach Anatomy

 Layers of peritoneum attached to the

stomach
 Lesser omentum – attaches the liver to the
lesser curvature
 Greater omentum – attaches the greater
curvature to the transverse colon which
Contains fat to insulate, cushion, and
protect abdominal organs
Stomach Anatomy
 Stomach Functions

 Acts as a storage tank for food

 Site of food breakdown and mixing
 Chemical breakdown of protein begins
 Delivers chyme (processed food) to the
small intestine
 Specialized Mucosa of the
Stomach
 Simple columnar epithelium
 Mucous neck cells – produce a sticky
alkaline mucus
 Gastric glands – secrete gastric juice
 Chief cells – produce protein-digesting
enzymes (pepsinogens)
 Parietal cells – produce hydrochloric acid
and Intrinsic factor(B12 absorption)
 Endocrine cells (G cell) – produce gastrin
which stimulates both parietal and chief cells)
Structure of the Stomach Mucosa

 Gastric pits
formed by
folded mucosa
 Glands and
specialized
cells are in the
gastric gland
region
Structure of the Stomach Mucosa
 Peritoneum
• Is the largest serous membrane of the body consist of
mesothelium
• Divide into
1. Parietal peritoneum: lines the wall of abdominopelvic
cavity internally
2. Visceral peritoneum: cover some oh the organs in the
cavity
3. The space between them contain fluid and called
peritoneal cavity this cavity may be accumulated by
several liters of fluid state called ascites
 Membranes
Mesenteries - double sheets of peritoneum, surrounding
and suspending portions of the digestive
organs
Pe
1. ritattach the liver to anterior abdominal
falciform ligament:-
wall and diaphragm
on
2. Greater omentum - "fatty apron", hangs anteriorly from
ea encloses fat
stomach, double layer
3. Lesser omentum - lbetween stomach and liver
4.
fol
Mesentery proper - suspends and wraps the small
intestine ds
5. Mesocolon - suspends and wraps the colon, parts are
i. transverse mesocolon
• ii. sigmoid mesocolon
Ascending and descending ,pancreas, first 2 parts of the
duodenum and kidneys are Retroperitoneal structure
peritoneum
 Mesenteries

• Greater omentum
and transverse colon
reflected
 Mesenteries

• Superficial view
of the
abdominal
organs
 Small Intestine

 The body’s major digestive organ

 Site of nutrient absorption into the blood
 Muscular tube extending form the
pyloric sphincter to the ileocecal valve
 Suspended from the posterior
abdominal wall by the mesentery
Subdivisions of the Small Intestine

 Duodenum(25cm)
 Attached to the stomach
 Curves around the head of the pancreas
 Fixed retroperitoneal structure
 Jejunum (2.5m)
 Attaches anteriorly to the duodenum
 Ileum (3.5m)
 Extends from jejunum to large intestine
Regions of Small Intestine
Small intestine
 Duodenum and Related Organs
Liver
Bile

Gall-
bladder
Stomach

Bile
Pancreas
Acid chyme

Intestinal enzymes

Pancreatic
Duodenum of juice
small intestine
 Chemical Digestion in the Small
Intestine

 Source of enzymes that are mixed with

chyme
Intestinal cells
Pancreas
 Bile enters from the gall bladder

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide

 Villi of the Small Intestine

 Fingerlike
structures formed
by the mucosa
 Give the small
intestine more
surface area

Figure 14.7a
Microvilli of the Small Intestine

 Small projections of the

plasma membrane
 Found on absorptive cells

Figure 14.7c
 Structures Involved in Absorption of
Nutrients

 Absorptive cells
 Blood capillaries
 Lacteals (specialized
lymphatic capillaries)

Figure 14.7b

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide

 Folds of the Small Intestine

 Called circular folds or plicae circulares

 Deep folds of the mucosa and
submucosa
 Do not disappear when filled
with food
 The submucosa has Peyer’s patches
(collections of lymphatic tissue)
 Digestion in the Small Intestine
 Enzymes from the brush border
 Break double sugars into simple sugars
 Complete some protein digestion
 Pancreatic enzymes play the major
digestive function
 Help complete digestion of starch
(pancreatic amylase)
 Carry out about half of all protein digestion
(trypsin, etc.)
Chemical Digestion in the Small
Intestine
 Digestion in the Small Intestine

 Pancreatic enzymes play the major

digestive function (continued)
 Responsible for fat digestion (lipase)
 Digest nucleic acids (nucleases)
 Alkaline content neutralizes acidic chyme
 Absorption in the Small Intestine
 Water is absorbed along the length of the
small intestine
 End products of digestion
 Most substances are absorbed by active
transport through cell membranes
 Lipids are absorbed by diffusion
 Substances are transported to the liver by
the hepatic portal vein or lymph
 Propulsion in the Small Intestine

 Peristalsis is the major means of

moving food
 Segmental movements
 Mix chyme with digestive juices
 Aid in propelling food
 Digestive Secretions:
(7 L / Day From Tissues
• into
Salivary glands Lumen)
•Pancreas
•Water
•Enzymes
•Mucus
•Ions: H+, K+,
Na
• HCO3-, Cl-
+

• Mass Balance (H2O)

Large Intestine

 Larger in diameter, but shorter than the

small intestine
 Frames the internal abdomen
Large Intestine

Figure 14.8
Regions of Large Intestine
Cecum – pocket at proximal end with
Appendix
Colon
Ascending colon - on right, between
cecum and right colic flexure
Transverse colon - horizontal portion
Descending colon - left side, between
left colic flexure and
Sigmoid colon - S bend near terminal
end
Rectum – terminal end is anal canal - ending at the anus - which
has internal involuntary sphincter and external voluntary sphincter
 Histology of Large Intestine

1. Mucosa - abundant goblet cells,

stratified squamous epithelium near anal
canal
2. No villi

3. Longitudinal muscle layer incomplete, forms

three bands or taenia coli
4. Circular muscle - forms pockets or haustra
between bands
 Functions of the Large Intestine

 Absorption of water
 Eliminates indigestible food from the
body as feces
 Does not participate in digestion of
food
 Goblet cells produce mucus to act as a
lubricant
 Structures of the Large Intestine

 Cecum – saclike first part of the large

intestine
 Appendix
Accumulation of lymphatic tissue that
sometimes becomes inflamed
(appendicitis)
Hangs from the cecum
 Structures of the Large Intestine

 Colon
 Ascending
 Transverse
 Descending
 S-shaped sigmoidal
 Rectum
 Anus – external body opening
Food Breakdown and Absorption in
the Large Intestine
 No digestive enzymes are produced
 Resident bacteria digest remaining
nutrients
 Produce some vitamin K and B
 Release gases
 Water and vitamins K and B are
absorbed
 Remaining materials are eliminated via
feces
 Propulsion in the Large Intestine
 Sluggish peristalsis
 Mass movements
 Slow, powerful movements
 Occur three to four times per day
 Presence of feces in the rectum causes a
defecation reflex
 Internal anal sphincter is relaxed
 Defecation occurs with relaxation of the
voluntary (external) anal sphincter
 Saliva

 Mixture of mucus and serous fluids

 Helps to form a food bolus
 Contains salivary amylase to begin
starch digestion
 Dissolves chemicals so they can be
tasted
Chemistry of
Digestion:
Carbohydrates
Enzymes in Small Intestine
 Pancreas
 Produces a wide spectrum of digestive enzymes
that break down all categories of food
 Enzymes are secreted into the duodenum
 Alkaline fluid introduced with enzymes
neutralizes acidic chyme
 Endocrine products of pancreas (langerhans
island)
 Insulin
 Glucagons
 Somatostatin
Exocrine Pancreas: Histology
 Composition and Function of
Pancreatic Juice
• Examples include
• Trypsinogen is activated to trypsin
• Procarboxypeptidase is activated to
carboxypeptidase
• Active enzymes secreted
• Amylase, lipases, and nucleases
• These enzymes require ions or bile for
optimal activity
 Pancreas

• Retroperitoneal :compose
of head, body and tail

• Endocrine and exocrine

gland

• Common bile duct and

major pancreatic duct lead
to ampulla of vater then
to second part of
duodenum through
sphincter of oddi
 Liver
 Largest gland in the body
 Located on the right side of the body
under the diaphragm
 Consists of four lobes suspended from the
diaphragm and abdominal wall by the
falciform ligament
 Connected to the gall bladder via the
common hepatic duct
 Liver
On right under diaphragm,
largest organ made up of 4
lobes (left and right, e
caudat and quadrate) ,

Hilus (porta hepatis) –

underside "entry" point

Gall bladder

Microscopic anatomy: Liver

lobules and triads
Microscopic Anatomy of
Liver
Visceral Surface of the Liver
 Role of the Liver in Metabolism

 Several roles in digestion

 Detoxifies drugs and alcohol
 Degrades hormones
 Produce cholesterol, blood proteins
(albumin and clotting proteins)
 Plays a central role in metabolism
Bile

 Produced by cells in the liver

 Composition
 Bile salts
 Bile pigment (mostly bilirubin from the
breakdown of hemoglobin)
 Cholesterol
 Phospholipids
 Electrolytes
Gall Bladder

 Sac found in hollow fossa of liver

 Stores bile from the liver by way of the
cystic duct
 Bile is introduced into the duodenum in
the presence of fatty food
 Gallstones can cause blockages
Chemical Digestion in the Small
Intestine
 Gallbladder
• Stores and concentrates bile to ten folds
• Expels bile into duodenum
– Bile emulsifies fats
Processes of the Digestive System

 Ingestion – getting food into the mouth

 Propulsion – moving foods from one
region of the digestive system to
another
Processes of the Digestive System

 Peristalsis – alternating
waves of contraction
 Segmentation – moving
materials back and forth
to aid in mixing
Processes of the Digestive System

 Mechanical digestion
 Mixing of food in the mouth by the tongue
 Churning of food in the stomach
 Segmentation in the small intestine
Processes of the Digestive System

 Chemical Digestion
 Enzymes break down food molecules into
their building blocks
 Each major food group uses different
enzymes
 Carbohydrates are broken to simple
sugars
 Proteins are broken to amino acids
 Fats are broken to fatty acids and
Processes of the Digestive System

 Absorption
 End products of digestion are absorbed in the
blood or lymph
 Food must enter mucosal cells and then
into blood or lymph capillaries
 Defecation
 Elimination of indigestible substances as
feces
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide
Processes of the Digestive System
 Control of Digestive Activity

 Mostly controlled by reflexes via the

parasympathetic division
 Chemical and mechanical receptors are
located in organ walls that trigger reflexes
Nutrition
 Nutrient – substance used by the
body for growth, maintenance, and
repair
 Categories of nutrients
 Carbohydrates: simple sugars, starches,
fiber
 Lipids: triglycerides, phospholipids, fatty
acids
 Proteins: amino acids
 Vitamins
 Mineral
 Water Slide
 Vertical Integration
with Gastroenterology/
Surgery
Promoting Biomedical Ethics Culture

Understanding
Biomedical Ethics

 The core pillars/principles of medical ethical

include:
 Understanding
Biomedical Ethics
Beneficence
The principle of beneficence is the obligation of
physician to act for the benefit of the patient and
supports a number of moral rules to protect and
defend the right of others, prevent harm, remove
conditions that will cause harm, help persons with
disabilities, and rescue persons in danger.
Promoting IT &
Research
Culture
Suggested research article

https://doi.org/10.3390/jcdd9110402
 Promoting IT &
Research Culture

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References

REFERENCE BOOKS:
1.Guyton AC, Hall JE. Textbook of Medical Physiology. 14th
ed. Philadelphia, PA: Saunders; 2020.
2.Boron WF, Boulpaep EL. Medical Physiology: A Cellular
and Molecular Approach. 3rd ed. Philadelphia, PA: Elsevier;
2017.
3.Sherwood L. Human Physiology: From Cells to Systems.
10th ed. Boston, MA: Cengage Learning; 2020.
4.Widmaier EP, Raff H, Strang KT. Vander's Human
Physiology: The Mechanisms of Body Function. 16th ed. New
York, NY: McGraw-Hill Education; 2021.
5.Costanzo LS. Physiology. 7th ed. Philadelphia, PA: Saunders;
2021.
6. Google Images and Wikipedia Images for concepts.
Thank You