GASTROINTESTINAL PHYSIOOGY

Dr. Joy Suubo

Department of Physiology, Faculty of Biomedical
Sciences, Kampala International University,
Western Campus, Uganda
Mobile: +256751131394
E-mail: jsuubohope@gmail.com
OVERVIEW OF THE DIGESTIVE SYSTEM

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• The GI system is made up of the GIT and some associated glandular organs
that produce secretions that make the functions of the GIT possible.
• GIT consists of hollow tube that starts in the mouth and ends in the anus.
• The main functions of the GI system are:
– Digestion of nutrients
– Absorption of nutrients from the gut lumen into bloodstream
• In order to perform these functions, the GI system carries out certain
activities. These activities can be broadly grouped into:
a) Motility
b) Secretion
c) Digestion and absorption
Motility
• Movements of the GIT which helps to mix and grind the contents of the tract
and propel it along the length of the tract in a proximal-distal direction i.e.
from the mouth to the anus.
Secretion
• Processes by which the glands associated with the GI system pour water and
other substances (enzymes, mucus, electrolytes etc) into the tract. 3
Absorption
• Refers to processes by which nutrients molecules are transported from
the gut lumen into the blood stream.
• The digestive system consists of the following from above
downwards:
1. Oral cavity (mouth)
2. Pharynx
3. Esophagus
4. Stomach
4. Small intestine (duodenum, jejenum & ileum)
5. Large intestine (colon, caecum, appendix, rectum & anal canal)
6. Anus
• The accessory/associated glandular organs include :
1. Salivary glands
2. Liver
3. Gall bladder and the pancreas 4
 FUNCTIONAL ANATOMY OF THE GATRO-INTESTINAL SYSTEM

FIGURE 2: Structure of intestinal wall with intrinsic nerve plexus

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The GIT has three (3) layers :
1.The mucosa
2. The submucosa
3. The muscularis externa (Ciruclar and Longitudinal
muscles)
4. The serosa (Outer covering)

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The Mucosa:
• Made up of the epithelium (a single layer of specialized cells that
line the lumen of the GIT& morphology of the epithelium varies
from one part of the GIT to another)
• The lamina propria (composed of largely loose connective tissue
containing collagen and elastin fibers).
• Contains many glands, lymph nodes & capillaries.
• Muscularis mucosae (thin innermost layer of the intestinal smooth
muscle and contractions here throw the mucosa into folds and
ridges)
The submucosa
• Consists largely of loose connective tissue with collagen and elastin
fibers
• Sub-mucosal glands are present in some parts
• Nerves and blood vessels of the intestinal wall travel in the
submucosa 7
The muscularis externa
• Consists of an inner circular layer & outer longitudinal layer
• Contractions of the muscularis externa mix and circulate the contents
of the lumen and propel them along the GI tract.

The serosa (Adventitia/Fibrous layer

• Outermost layer of the wall of GI tract
• Formed by the connective tissue
• It covers stomach, small intestine and Large intestine
• The fibrous layer covers pharynx and esophagus & formed by the
connective tissue

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Nerve Supply to Gastrointestinal Tract
The wall of the GI tract
contains many neurons that
are highly interconnected.
GI tract has two types of
nerve supply:
I. Extrinsic nerve supply
II. Intrinsic nerve supply
I. Extrinsic nerve supply to
GI tract:
T5 = 5th thoracic segment of
spinal cord
L1 = 1st lumbar segment of
spinal cord
S2 = 2nd sacral segment of
spinal cord
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GENERAL STRUCTURES OF ORGANS
Oral cavity
• Lips and cheeks are involved in facial expression,
mastication and speech
• The tongue is involved with speech, taste, mastication and
swallowing.
Tooth types are : Molars, Canine, Pre molars, Incisors
Tooth consists of a: Crown, Neck, Root.
Components of the tooth include: Dentin, Pulp cavity
(nerves, blood vessels), Crown.
• Teeth are held in the alveoli by peridontal ligaments.
• The muscles of mastication include: Masseter, Temporal,
Medial pterygoid and Lateral pterygoid.
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Esophagus
• The esophagus connects the pharynx to the stomach
• The upper and lower esophageal spincters regulate
movement in the esophagus
The esophagus consists of four layers:
• Fibrous layer – outer
• Muscular layer - circular and longitudinal
• Submucosal
• Stratified squamous epithelium (Refer to Fig. 2 above)
• The esophagus is approx. 25 cm long, position is as follows
• Lies in the mediastinum
• Anterior to vertebra
• Posterior to the trachea
• Passes through the esophageal hiatus – opening 11
Structures of the stomach
include:
i. Opening into the esophagus
(gastroesophageal) – cardiac
ii. Opening into the duodenum
(pyloric )
The wall of the stomach
includes:
i. External serosa
ii. Muscle layer (circular,
longitudinal, oblique )
iii. Submucosa
iv. Simple columnar (interior
mucosal) (Refer to Fig. 2 above)
v. Rugae are the folds in the
stomach when empty Stomach 12
• Gastric pits are the
openings into the gastric
glands
i. Mucosal neck cells- Mucus
ii. Parietal cells- Hcl
iii. Chief cells- Zymogenic-
pepsinogen
iv. Endocrine cells

Gastric glands 13
FUNCTIONAL ANATOMY OF THE STOMACH INCLUDE
Fundus
• Cardiac region, Greater curvature, Lesser curvature, Pyloric
antrum, Pyloric canal, Pyloric orifice
Small intestine
• Divided into three portions: Total 20ft in length
- Duodenum- 10 inches
- Jejunum
- Ileum
• The wall of the small intestine includes:
- Refer to Fig. 2 above
- Villi and micro-villi increase surface area
- Absorptive, goblet, and endocrine cells develop in intestinal
glands, crypts of lieberkuhn secrete digestive enzyme
- Duodenal glands produce mucus 14
Structure of the duodenum :
• Contains a 180 degree arc
• Greater and lesser duodenal papilla greater : bile and
pancreatic ducts join this forms the hepato-pancreatic
ampulla opening: hepato-pancreatic ampullar spincter
• Accessory pancreatic duct is present in most people, found
at lesser papilla
The mucosa of the duodenum
• Is simple columnar of three types:
• Contain absorptive cells (micro-villi )
• Contain also Goblet cells (produce mucus )
• And also endocrine cells (regulatory hormones)

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• The submucosa
• contain cells called : brunners glands these cells produce
mucus
• The jejunum and ileum
• Are similar in structure to the duodenum, except :
a) Gradual decrease in diameter
b) Decrease in thickness
c) Decrease in folds and villi
• The jejunum and ileum are the site of most nutrient
absorption
• The junction between the ileum and the large intestine is
the ileocecal junction (sphincter)

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MECHANICAL ACTIVITIES OF THE GASTRO-INTESTINAL
TRACT
• Some mechanical activities occur in different
regions of the GI tract. These activities are:
– Chewing (Mastication)
– Swallowing (Deglutition)
– Gastric motility
– Motility of the small intestine
– Motility of the colon
– Defecation (Passage of feces)

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Chewing
• Food taken into the mouth is broken down into smaller pieces by teeth
and mixed with saliva to make it easier to swallow and also make it
enjoyable. Thus releasing taste – producing substances.
• Chewing ensures the food is mixed more readily with digestive
secretions of the stomach and duodenum.
• Tongue and cheek muscles are used to keep the food mass between teeth
during mastication.
• Its a well coordinated reflex but sometimes it can be carried out
voluntarily.
• Frequency of the chewing cycle (open-close cycle) is once per second,
but can also be faster depending on the consistency of the food.
• Closure of the mouth during chewing is associated with pressure on the
teeth, gums, tongue and hard palate leading to a reflex relaxation of the
jaw.
• In addition to up and down movement of the jaw, chewing also involves
forward and backward, side to side jaw movements that assist in grinding
the food. 18
Swallowing or Deglutition
• Process by which food is propelled from the oral cavity into the stomach.

• Can be initiated voluntarily, but once it starts, it’s almost entirely under
reflex control and cannot be stop.

• Receptors for the swallowing reflex are: touch receptors (oropharyngeal

receptors) -located mostly on the palate and near the opening of the
pharynx.

• Sensory impulses (afferent fibers) from these receptors are transmitted in

certain cranial nerves (glossopharyngeal nerve fibers) to the Deglutition
center in the medulla oblongata and lower pons.

• From the deglutition center (efferent fibers) motor impulses travel through
cranial nerves (glossopharyngeal and vagus nerves) and reach the
musculature of the pharynx, soft palate and upper esophagus.
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Stages of deglutition

A. Preparatory stage

B. Oral stage

C. Pharyngeal stage

D. Esophageal stage

Swallowing or Deglutition

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• Swallowing can be divided into 3 phases:
– The oral voluntary phase
– The pharyngeal phase
– The esophageal phase

Oral voluntary phase

• This phase is initiated by separating a bolus of food from the
quantity of food in the mouth with the tip of the tongue and moving
it into the mid-line of the tongue
• Bolus to be swallowed is moved upward and backward in the
mouth by first pressing the tip of the tongue and later the more
posterior portions of the tongue as well against the hard palate
• This propels the bolus into the pharynx where it stimulates the
touch (oropharyngeal) receptors that initiate the swallowing reflex

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Pharyngeal Phase
• Pharyngeal stage is an involuntary stage.
• In this stage, the bolus is pushed from pharynx into the esophagus.
• Pharynx is a common passage for food and air & it divides into larynx
and esophagus.
• Larynx lies anteriorly and continues as respiratory passage.
• Esophagus lies behind the larynx and continues as GI tract.
• Since pharynx communicates with mouth, nose, larynx and esophagus,
during this stage of deglutition, bolus from the pharynx can enter into
four paths:
i. Back into the mouth
ii. Upward into the nasopharynx
iii. Forward into the larynx
iv. Downward into the esophagus.
• However, due to various coordinated movements, bolus is made to enter
only the esophagus.
• Entrance of bolus through other paths is prevented as follows: 22
Back into Mouth
• Return of bolus back into the mouth is prevented by:
i. Position of tongue against the soft palate (roof of the mouth)
ii. High intraoral pressure, developed by the movement of tongue.
Upward into Nasopharynx
• Movement of bolus into the nasopharynx from pharynx is prevented by
elevation of soft palate
Forward into Larynx
• Movement of bolus into the larynx is prevented by the following actions:
i. Approximation of the vocal cords
ii. Forward and upward movement of larynx
iii. Backward movement of epiglottis to seal the opening of the larynx (glottis)
• All these movements arrest respiration for a few seconds- called deglutition
apnea.
Deglutition apnea or swallowing apnea
• Refers to temporary arrest of breathing or the arrest of breathing during
pharyngeal stage of deglutition.
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Entrance of Bolus into Esophagus
• As the other three paths are closed, the bolus has to pass only through
the esophagus by the combined effects of various factors:
i. Upward movement of larynx stretches the opening of esophagus
ii. Simultaneously, upper 3 to 4 cm of esophagus relaxes. This part of
esophagus is formed by the cricopharyngeal muscle and it is called
upper esophageal sphincter or pharyngoesophageal sphincter
iii. At the same time, peristaltic contractions start in the pharynx due to
the contraction of pharyngeal muscles
iv. Elevation of larynx also lifts the glottis away from the food passage.
• All the factors mentioned above act together so that, bolus moves
easily into the esophagus.
• Whole process takes place within 1 to 2 seconds and this process is
purely involuntary.

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Oesophageal phase
• Is an involuntary stage and in this stage, food from esophagus enters the stomach.
• Esophagus forms the passage for movement of bolus from pharynx to the stomach.
• Movements of esophagus are specifically organized for this function and the
movements are called peristaltic waves
• Peristalsis means a wave of contraction, followed by the wave of relaxation of
muscle fibers of GI tract, which travel away from mouth.
• By this type of movement, the contents are propelled down along the GI tract.
• When bolus reaches the esophagus, the peristaltic waves are initiated.
• Usually, two types of peristaltic contractions are produced in esophagus:

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Gastric Motility

• This sub-serves the following important functions:

1. It allows the stomach to serve as a reservoir for large quantities
of food ingested until it can be accommodated in the lower
segments of the GI tract
2. It helps in mixing the food inside it with gastric secretions so
that digestion can begin and mixing helps to form a semi-fluid
mixture called chyme
3. It also helps in emptying gastric contents into the small intestine
at a rate suitable for proper digestion (this prevents duodenal
ulceration)

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 The structure of the
stomach
 Stomach consists of
the following:
1. The fundus
2. The body
3. The antrum

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The fundus and body
• - Contractions of the fundus and body of the stomach are normally weak
• - And the walls are relatively thin and distensible
• - Hence the fundus and body of the stomach can accommodate volume
increases as large as 1.5L without an appreciable increase in intra-gastric
pressure
• - Hence serves as reservoir function of the stomach
The antrum
• This however capable of vigorous contractions
• These contractions mix antral chyme thoroughly with gastric juice
• Thus help in breaking the food particles into small bits
• Antral contractions also helps in emptying the stomach contents in small
quantities at a time into the duodenum
Note:
• That the rate of gastric emptying is well controlled so that chyme is not
delivered into the duodenum too rapidly (preventing duodenal
ulceration) 28
Note:
• Cholecystokinin (CCK)
• Gastrin
• Gastric inhibitory polypeptide and Secretin cause constriction of the
pyloric sphincter
Regulation of gastric emptying
• The rate of gastric emptying is regulated by signals from both:
• A. The stomach
• B. The duodenum
• - The stomach signals are elicited by
• 1. Distension of the stomach by food leading to generation of nervous
signals
• 2. Presence of certain types of food in the stomach cause the hormone
(gastrin) to be released from the antral mucosa
• - Both 1 and 2 increase the force of antral peristalsis i.e pyloric pumping
• - And at the same time inhibit the pyloric sphincter promoting stomach
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emptying
In the duodenum
• Excess volume of chyme or excess of certain types of chyme in the duodenum
initiates strong negative feedback signals which are both nervous and hormonal
• These signals depress the pyloric pump and increase pyloric sphincter tone
• The neural component of the duodenal signal is known as the enterogastric
reflex and the reflex can be elicited by:
1. The degree of distension of the duodenum
2. Irritation of the duodenal mucosa
3. Degree of acidity of the chyme reaching the duodenum. Duodenal pH < 3.5 to 4
elicits this reflex
4 . Osmolarity of the chyme (Hypo or Hypertonic) fluids especially hypertonic
fluids will elicit the reflex
5. Presence of certain breakdown products of proteins and probably fats
Note
• Cholecystokinin hormone
• Secretin hormone
• Gastric Inhibitory Peptide all can inhibit gastric emptying through the
enterogastric reflex
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Motility of the small intestine
• The small intestine consists of the:
1. Duodenum
2. Jejunum
3. ileum
• The duodenum and the jejunum is the site of the digestion
and absorption in the GIT
• The movements of the small intestine mix chyme with
digestive secretions
• And bring fresh chyme into contact with the absorptive
surface of the microvilli and propel chime toward the colon
• There are two types of movement in the small intestine viz:
1. Mixing contraction or segmentation contractions
2. Propulsive movements or peristaltic movements 31
Movements of small intestine
This division into two types of movements is artificial because all movements of the
small intestine cause at least some degree of both mixing and propulsion
Note:
the contents of the ileum empty gradually into the colon through the ileo-caecal valve
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Motility of the colon
• The colon has the following functions:
1. Absorption of water and electrolytes from the chyme.
• Colon receives 500 to 1,500 ml of chyme per day from the ileum
• Feces normally contain 50 to 100 ml of water each day
• Hence most of the water and salts that enter the colon is absorbed
2. Storage of fecal matter until it can be expelled.
• Proximal half of the colon is concerned mainly with absorption
• Distal half is concerned with storage
• Intense movements are not required for these functions, movements
of the colon are normally sluggish
• Motility of the colon is similar to that of the small intestine and can
be divided into:
a) Mixing movements
b) Propulsive movements 34
DEFECATION
• Act of passing feces
• Complex behavior involving both reflex and voluntary actions
• Defecation center is located in the sacral segments of spinal cord
• The rectum is normally empty
• When feces are pushed into the rectum by mass movements the
urge to defecate is felt
• Anal sphincter however prevent escape of feces unless the
individual is prepared for defecation

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• There are two anal sphincters:
1. Internal anal sphincter
• -Consists of circular smooth muscle that is in the anal wall
and supplied by parasympathetic nerves
2. External anal sphincter
• Consists of striated voluntary muscles surrounding the
internal anal sphincter and extends distally and supplied by
somatic nerves and is under voluntary control
• Process of defecation can be subdivided into two main
components:
1. The part under the defecation reflexes
2. The part under voluntary control
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 The defecation reflexes
• There are two types of defecation reflexes:
1. Intrinsic defecation reflex
• Mediated through the myenteric plexuses
• Occurs when feces enter the rectum causing distension of the
rectal wall which initiate peristaltic waves.
• These peristaltic waves spread to the descending colon,
sigmoid colon and rectum forcing feces towards the anus
• As the peristaltic waves approach the anus, the internal anal
sphincter relaxes
• If the external anal sphincter is also relaxed, defecation occur
• Peristaltic waves produced by the intrinsic defection reflex is
normally weak and may not be effective in causing defecation
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2. Parasympathetic defecation reflex
• Peristaltic waves produced by the intrinsic defecation reflex is
normally weak and may not be effective in causing defecation
• This weak contraction is often reinforced by contractions
mediated by the parasympathetic defecation reflex which
involves parasympathetic nerves in the sacral segment of the
spinal cord
• Distension of the rectum causes afferent parasympathetic
impulses to be transmitted into the spinal cord
• From the spinal cord, efferent parasympathetic impulses are
conducted through the nervi erigentes back to the descending
colon, sigmoid colon, rectum and anus
• These parasympathetic impulses augment the ineffectual weak
movements produced by the intrinsic defecation reflex so that
they become very powerful and effective in emptying the 38
• Sometimes, the movements are so powerful that they cause emptying
of the large bowel in one movement all the way from the splenic
flexure to the anus
• In spite of the two reflexes above, defecation can only occur if the
circumstance is socially acceptable for the act
• For example, if a student feels the urge to defecate during a lecture,
The student will not give way to that urge, neither will any normal
grown up person give way to the urge to defecate in a public bus
• The ability not to defecate in such circumstances is due to the fact that
the conscious mind takes over voluntary control of the external anal
sphincter
• Relaxation of the internal anal sphincter and forward movement of the
feces towards the anus normally cause an instantaneous contraction of
the external anal sphincter
• Impulses coming from the cerebral cortex which pass through the
somatic nerves to the external anal sphincter will either inhibit the
sphincter (relax) to allow defecation occur or further contract it if 39the
• If the situation is not conducive for defecation to occur, after a few
minutes, the urge to defecate passes off and will not return until more
feces enter the rectum and another reflex is initiated
• When the situation is right for defecation to occur, the defecation
reflex is followed by relaxation of the external anal sphincter
• In addition, intra-abdominal pressure is elevated to aid in the
expulsion of feces
• Evacuation is normally preceded by a deep breath, so that the
diaphragm descends towards the abdominal cavity
• The glottis is closed is closed and contraction of the respiratory
muscles on full lungs raises the intra-thoracic and intra-abdominal
pressure
• Contraction of the muscles of the wall of the abdomen causes a
further increase in intra-abdominal pressure
• The additional pressure generated by this bearing down effort as well
as the strong contractions of the defecation reflex helps to force feces
out of the anus through the relaxed sphincter 40
GASTROINTESTINAL SECRETIONS
• The GI tract from the mouth to the anus, produces secretions
that make it possible for the tract to perform its functions of:
i. Mixing
ii. Propulsion
iii. Digestion and absorption of nutrients
• The main secretions of the GI tract are:
1. Saliva (secretion of salivary glands)
2. Gastric secretion
3. Pancreatic secretion
4. Secretion of bile by the liver
5. Secretions of the small intestine
6. Secretions of the large intestine
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Secretion of Saliva
• Saliva is the watery fluid secreted into the mouth and it is produced by the
major salivary glands as follows:
1. The parotid – Produces entirely serous type of secretion
2. The sublingual – Produces only the mucous
3. The submaxillary or submandibular glands- secretes both serous and
mucous
Properties of saliva
1. Volume: 1000 mL to 1500 mL of saliva is secreted per day and
approximately about 1 mL/minute. ¼ comes from the submandibular glands
& 2/3 comes from parotids. Under normal conditions, output of saliva is
about 0.5 mL per minute. But during mastication, output can rise to about 4
mL per minute. Rate of secretion of saliva varies with the activities of the
body
2. Reaction: Mixed saliva from all the glands is slightly acidic with pH of
6.35 to 6.85
3. Specific gravity: It ranges between 1.002 and 1.012
4. Tonicity: Saliva is hypotonic to plasma. Saliva has a pH of about 7.0 42
COMPOSITION OF SALIVA
Saliva contains:
1. Water – Account for 99.5 % of the serous secretion
2. Alpha amylase – (ptylin)
3. Electrolytes – Na+, K+, Ca+, Cl-, HC03-, Thiocyanate, Iodide
4. Mucin
5. Lysozymes
6. Blood group factors
7. Carbonic anhydrase
8.Lingual lipase

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Functions of saliva
1. The alpha-amylase helps in digestion of cooked starch
- Amount of cooked starch which the alpha-amylase in saliva can digest depends
upon how much the food is mixed with saliva
- Alpha-amylase is active until pH falls below 4 and up to 50% of the starch may
have been hydrolyzed before inactivation occurs
2. It aids speech by keeping the mouth moist so that the lips and tongue can move
easily to produce speech (Clear fluent speech facilitation)
3. It is important for taste
- Enables molecules to dissolve on the surfaces of the tongue, thereby bringing
the molecules in contact with the taste buds and this leads to stimulation of the
taste buds
4. It keeps the teeth and the mouth clean
- Thereby preventing dental caries and unpleasant odor from the mouth
- Saliva helps to wash away oral pathogenic bacteria and the food particles that
provide metabolic support for the oral pathogens

44
- Dental caries is inhibited by salivary bicarbonates which neutralizes
residual acid either ingested acid or that produced by oral bacterial
(Buffering action)
5. Saliva is bactericidal
- Thiocyanate ions, immunoglobins and the proteolytic enzymes in
the saliva (lysozymes) help to kill oral bacteria
6. It prevent calcium from dissolving out of the teeth
- At its normal pH 7.0, saliva is saturated with Ca2+ which prevents
loss of Ca2+ ions from the teeth into saliva
7. It aids swallowing
- The mucin content act as a lubricant during swallowing
- Water in the saliva mixes with the food (e.g dry biscuits) during
chewing converting it into a semi-solid consistency that can be easily
swallowed
8. It provide optimal pH for the digestive action of salivary amylase
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Gastric secretion
Functional anatomy of the stomach
The stomach is a muscular sac which can
be divided into four parts:
1. The cardia
2. The fundus
3. The body
4. The pyloric antrum
1. Cardiac orifice:
• Opening of the oesophagus into
stomach
• Kept closed by a functional sphincter
(cardiac sphincter)
2. Pyloric orifice
• Connection of the pyloric antrum to
the duodenum
• Pyloric sphincter keeps this orifice
closed & controls the rate of
movement of the stomach contents Gastric Glands
46
into the duodenum
• Gastric mucosa consists of simple branched tubular glands, packed tightly together
and arranged perpendicular to the surface
• Groups of glands open into gastric pits which in turn open into the mucosa surface
• In the mucosa of the antrum, the gastric glands are lined by mucus-secreting cells
only
• While in the mucosa of the remaining parts of the stomach the glands are lined with:
1. Mucus cells- produce mucus
2. Parietal (oxyntic) cells – Produce HCl + intrinsic factor
3. Peptic (chief) cells - Pepsinogen
• The tubular glands of the gastric mucosa secrets the gastric juice
Gastric juice contains
i. HCl
ii. Pepsinogens
iii. Mucus
iv. Water
v. Electrolytes (Na+, K+, HC03-)
vi. Intrinsic factor
vii. Other enzymes: gastric lipase, lysozymes, renin, urease, carbonic anhydrase,
gastric amylase &gelatinase (small quantities) 47
Functions of gastric secretions
1. Gastric HCl provides the acid environment necessary for the
activation and optimum activity of the gastric proteolytic enzymes, the
pepsins
2. Acid also plays a protective role, destroying bacteria and other
potential pathogens
3. Pepsins have optimum proteolytic activities between pH 2 and 3.
• Formed from precursor (inactive) pepsinogens (stored in chief cells)
• Pepsinogens are activated by the action of acid or autocatalytic action
of the pepsins
• Once exposed to acid in the gastric lumen, the pepsinogen molecules
are cleaved and active pepsins are released
• Pepsin act as auto-catalyst and thereby promote activation of more
pepsins
• Pepsins catalyze the hydrolysis of dietary proteins to form
polypeptide & few free amino acids 48
4. The mucus protects the mucosal cells from the gastric
contents
• Mucus cells are stimulated by parasympathetic fibers in the
vagus nerves and directly by mechanical or chemical
irritation
5. Intrinsic factor is a muco-protein produced by the oxyntic
cells
• It is important for the absorption of vitamin B12 from diet
Intrinsic factor combines with the free vitamin B12 and
protects it from digestion
• Vitamin B12 is usually bound to protein in food and is
released from it either by cooking or by proteolytic enzymes
• Absorption of vitamin B12 occurs in the ileum and intrinsic
factor is required for this process
• Deficiency of intrinsic factor leads to pernicious anemia 49
Composition of the pancreatic juice
1. Water
2. Electrolytes [Na+, K+, Ca2+, Cl-, S042-, HC03-, and P042-]
3. Enzymes:
• Trypsinogen
• Chymotrypsinogen =} these are proteolytic enzymes for digestion of
protein into amino acids and Nucleotides into sugar, phosphates and
bases
• Ribonuclease
• Pro-elastase
• α – amylase [starch→maltose, maltoriose and α-limit dextrin]
• Lipase [Neutral fat → fatty acids +monoglycerides
• Cholesteryl esterase [Cholesterol esters → cholesterol + fatty acids

50
• The digestive enzymes present in pancreatic juice include
enzymes that will break down food substances such as: Proteins,
carbohydrates, fats and nucleic acids.
• Proteolytic enzymes are secreted in an inactive form and this is
to prevent the enzymes from digesting the cells that produce
them
• In addition the epithelial lining of the pancreatic duct is weak
• Hence when enzymes are required for digestion, they are
activated by specific enzymes
Examples:
• Enzyme trypsinogen→ Active Trypsin by enterokinase present in
the intestinal villi
• Chymotrypsinogen → Active Chymotrypsins by trypsin
• Proelastase → Active Elastase by trypsin
• Procarboxypeptidase → Active Carboxypeptidases by trypsin
51
 Pancreatic enzymes and their actions
Enzyme Substrate Products
Trypsin Proteins &Large peptides Smaller peptides, Amino acids

Chymotrypsin Proteins Smaller peptides

Large peptides Amino acids

Elastase Elastin Peptides, Amino acids

Carboxypeptidase Proteins and peptides containing amino Acidic amino acids

acids

α- amylase Starch Maltose

Maltotiose&Dextrins

Lipase Triglycerides Monoglycerides

Free fatty acids

Ribonuclease RNA Nucleotides

Deoxy-ribonuclease DNA Nucleotides

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Functions of the alkaline pancreatic juice
1. The alkaline pancreatic juice neutralizes gastric acid poured into the
duodenum
2. It provides an optimum pH for the action of pancreatic enzymes
3. CCK causes secretion of large quantities of digestive enzymes

53
SECRETION OF BILE
Functional anatomy of the biliary system
• Liver produces bile which has an
important role in lipid digestion in the
duodenum
• Bile is initially secreted by the liver
cells in the bile canaliculi
• From the bile canaliculi, the bile passes
into the left and right hepatic ducts
• The two ducts unite to form the
common hepatic duct
• The CHD units with cystic duct of the
gall bladder to form the CBD
• The CBD unites with the pancreatic duct
just before they enter the ampulla of bile
duct (The ampulla of vater) in the
duodenum
Connections of the bile cystic and
• The opening into the duodenum is
pancreatic ducts
guarded by the sphincter of oddi
54
Bile flow
• About 1L of alkaline bile (pH 7.8) is secreted per day by the liver
• During rest the sphincter of oddi is tonically contracted and bile flow into
the gall bladder
• During digestion, the sphincter of oddi is relaxed and bile flows from gall
bladder and liver directly into the duodenum.
• While the bile is stored in the gall bladder, selective reabsorption of
some its constituents occurs
• Ions are absorbed, this is followed by water
• The organic components are not absorbed so that their concentration
increases
• The volume of bile may be reduced to just 10 % of its original value after
the re-absorptive processes
Properties of Bile
1. Volume : 800 to 1,200 mL/day; 2. Reaction : Alkaline
3. pH : 8 to 8.6 4. Specific gravity : 1.010 to 1.011
5. Color : Golden yellow or green. 55
Composition of Bile
• Bile is considered as secretion of (bile salts-made of cholesterol) and an
excretion of (bile pigments)
• Bile released from the gall bladder into the duodenum has the following
composition:
1. Water
2. Organic constituents [Bile salts, bilirubin,, fatty acids, lecithin and other lipds]
3.Inorganic constituents - Electrolytes [Na +, K+, Ca2+, Cl-, HC03-]
Formation of Bile
• Bile pigments (mainly bilirubin) are derived principally from the breakdown
of Hb, myoglobin and cytochromes which are waste products of these
breakdown
• Bile acids (cholic and chenodeoxycholic acids in man) are produced in the
liver from cholesterol
• These acids are conjugated with glycine or taurine in the liver
• The conjugated bile acid then combines with Na + to from a bile salts:
i. Sodium glycocholate, sodium taurocholate and
ii. Sodium glycochenodeoxycholate and sodium taurochenodeoxycholate
56
Gall stones formation
• In the gall bladder an iso-osmotic electrolyte solution is reabsorbed leaving
behind a concentrated solution of bile salts, bile pigments, lecithin and
cholesterol
• Too much cholesterol or insufficient bile salts or lecithin in bile can result
in the precipitation of cholesterol → resulting to the formation of gall-
stones
Entero-hepatic circulation
• Bile is released by the contraction of the gall bladder and it enters the
duodenum after relaxation of the sphincter of oddi
• Bile salts travel along the small intestine and actively reabsorbed in the
terminal ileum where they enter the portal circulation and return to the
liver for recycling – called entero-hepatic circulation of bile salts
• This results to the bile salts being used over and over again (about 16 X)
• Bile salts emulsify fats thereby facilitating digestion
• Other substances which aid in the emulsification process include
cholesterol, lecithin, fat digestion products themselves (Monoglycerides&
fatty acids) 57
Factors affecting rate of bile secretion
1. Vagal stimulation
• During the cephalic phase of gastric secretion,
vagal impulses are transmitted leading to the
formation of bile by the liver and weak
contraction of the gall bladder
2. Secretin hormone
• Increases the bile flow by increasing
bicarbonate and water secretion by biliary
duct
3. Hepatic blood flow
• Rate of bile secretion is proportionate to the
hepatic blood flow
4. Bile salts
• Increase bile flow from the liver
• They don’t stimulate the formation of new
bile salts by the liver cells
• But when they reach the liver, they are rapidly
secreted, and so increasing the flow of bile Enterohepatic circulation
58
Gallbladder
• Bile secreted from liver is stored in gallbladder.
• The capacity of gallbladder is approximately 50 mL.
• Gallbladder is not essential for life and it is removed (cholecystectomy) in
patients suffering from gallbladder dysfunction.
• After cholecystectomy, patients do not suffer from any major disadvantage.
In some species, gallbladder is absent.
Functions of gallbladder
1. Storage of Bile
• Bile is continuously secreted from liver. But it is released into intestine only
intermittently and most of the bile is stored in gallbladder till it is required.
2. Concentration of Bile
• Bile is concentrated while it is stored in gallbladder.
• Mucosa of gallbladder rapidly reabsorbs water and electrolytes, except
calcium and potassium.
• But the bile salts, bile pigments, cholesterol and lecithin are not reabsorbed
and so, the concentration of these substances in bile increases 5 to 10 times.
59
3. Alteration of pH of Bile
• The pH of bile decreases from 8 – 8.6 to 7 – 7.6 and it becomes
less alkaline when it is stored in gallbladder.
4. Secretion of Mucin
• Gallbladder secretes mucin and adds it to bile. When bile is
released into the intestine, mucin acts as a lubricant for movement
of chyme in the intestine.
5. Maintenance of Pressure in Biliary System
• Due to the concentrating capacity, gallbladder maintains a
pressure of about 7 cm H2O in biliary system.
• This pressure in the biliary system is essential for the release of
bile into the intestine.

60
Filling and emptying of
gallbladder
• Sphincter of Oddi is closed
during fasting and the pressure
in the biliary system is only 7
cm H2O.
• Because of this pressure, the
bile from liver enters the
gallbladder.
• When chyme enters the
intestine, gallbladder contracts
along with relaxation of
sphincter of Oddi the pressure
increases to about 20 cm H2O.
• Because of the increase in
pressure, the bile from Formation of bile from liver and changes
gallbladder enters the intestine. taking place in the composition of gallbladder
bile
61
Functions of Bile salts
1. Facilitate lipid digestion
• Emulsification of fat: Detergent action of bile salts lower the
surface tension of fat globules leading to breaking of fat globules
into smaller ones that can make an emulsion with water
• Activation of pancreatic and intestinal lipases which secondary to
the emulsification effects on fats which increases the exposed
surface area for enzymatic action
2. Increase bile flow from the liver
• That is choleretic effect: when bile salts are absorbed in the
intestine and go to the liver (enterohepatic circulation)
• They are rapidly secreted and recirculated, thus increasing the
bile flow
3. Solvent action
• Bile salts help the dissolution of cholesterol and prevent its
62
precipitation and formation of cholesterol stones
4. Stimulate intestinal peristalsis
• This occurs through helping the digestion and absorption of fat
because accumulation of fat inhibits intestinal peristalsis
5. Prevent protein putrefaction
• This effect is secondary to digestion and absorption of fat
• Undigested lipids inhibit intestinal secretion and motility making
good amount of protein reaching the colon undigested and colonic
bacteria then act on protein causing its putrefaction
6. Facilitate lipid absorption
• Bile salts has a hydrotropic effect i.e. it makes lipid miscible with
water which form water soluble complex with phospholipids called
micelles
• These micelles carry the insoluble FAs and cholesterol at the center
and ferry them across the unstirred water layer in the small intestine
• Near the villi, FFAs and cholesterol are liberated to be absorbed
• Without micelles the Fats and cholesterol cannot pass through63 the
Bile salts
• Bile salts are made up from cholesterol.
• There are two types of bile salts:
1. Primary bile salts
• Secreted by the liver.
• They are sodium glyco- and tauro-salts of cholic and
chenodeoxycholic acids i.e. sodium glycocholate, sodium
taurocholate, sodium glycochenodeoxycholate and sodium tauro-
chenodeoxycholate.
2. Secondary bile salts
• Derived from primary bile salts by the action of bacteria in the
large intestine.
• Secondary bile salts are the sodium glyco- and tauro-salts of
deoxycholic acid (i.e. derived from cholic acid) and lithocholic acid
(i.e. derived from chenodeoxycholic acid)
64
Bile pigments
• Are the excretory products in bile.
• Formed during the breakdown of Hb released from the destroyed RBCs in the
reticuloendothelial system
• Bilirubin and biliverdin are the two bile pigments and bilirubin is the major bile
pigment in human beings

65
Fate of Conjugated Bilirubin
1. In intestine, 50% of the conjugated bilirubin is converted into
urobilinogen by intestinal bacteria. First the conjugated
bilirubin is deconjugated into free bilirubin and reduced into
urobilinogen.
2. Remaining 50% of conjugated bilirubin from intestine is
absorbed into blood and enters the liver through portal vein
(enterohepatic circulation). From liver, it is re-excreted in bile
3. Most of the urobilinogen from intestine enters liver via
enterohepatic circulation. Later, it is reexcreted through bile
4. About 5% of urobilinogen is excreted by kidney through
urine. In urine, due to exposure to air, the urobilinogen is
converted into urobilin by oxidation
5. Some of the urobilinogen is excreted in feces as
stercobilinogen. In feces, stercobilinogen is oxidized66 to
Secretions of the Small Intestine
• Secretions of the small intestine consist of:
1. Large quantities of mucus secreted by the Brunner’s glands (1st part of
duodenum)
2. Goblet cells (profusely distributed over the surface intestinal mucosa)
3. Additional mucus is secreted by the goblet cells located in the intestinal
pits called the crypt of Lieberkuhn
• Crypt of Liebarkuhn is located on the entire surface of the small
intestine except the Brunner’s gland area of the duodenum
• Intestinal secretions by crypt of Lieberkuhn is at the rate of about 2L
per day and once secreted, the secretions are rapidly reabsorbed by the
villi
• Rapid movement of fluid from crypts to villi provides a watery
medium for the absorption of digested food substances that come into
contact with the small intestinal villi
• Secretion of mucus in the small intestine is in response to direct
contact or irritating stimuli of the intestinal mucosa by chyme, vagal
67
Duodenal Ulceration
• ­Large quantity of mucus
produced by the
Brunner’s glands protect
the duodenal wall from
digestion by gastric juice
• Failure to produce
adequate mucus by the
Brunner’s gland can lead
to development of peptic
ulcer in the first part of
the duodenum

Intestinal gland and villus

68
Enzymes of the small intestinal secretion
• Secretions of the small intestine without cellular debris contain no
enzymes
• However, epithelial cells of the small intestine mucosa contain
digestive enzymes e.g:
1. Aminopeptidase
2. Amylases (sucrase, maltase, and lactase)
3. Phosphatases
4. Intestinal lipase (small amount)
• Most of these enzymes are in the brush border of the epithelial
cells
• These enzymes at the brush border are not intestinal secretions
• But are released from desquamated intestinal cells
69
Regulation of intestinal secretions
1. Regulated largely by local neural reflexes initiated by irritating or touch
stimuli
2. Secretion occurs in response to the presence of chyme, the greater the
amount of chyme, the greater secretion
3. Hormones (secretin & CCK) – cause small intestinal secretion
Large Intestinal Secretion
• Large intestine secretes mainly mucus which is mainly controlled by local
myenteric reflexes (a reflex responsible for the wave of peristalsis moving
along the intestine & involves contraction of digestive tube above and
relaxation below the place where it is stimulated by an accumulated mass
of food)
• If the large intestine is intensely irritated the mucosa then secretes large
quantities of water and electrolytes in addition to normal thick (viscid)
solution of mucus
• This copious secretion helps dilute the irritants and cause rapid movement
of feces towards the anus resulting in diarrhea with loss of large quantities
of water and electrolytes 70
Digestion and Absorption the Gastrointestinal Tract
• Food eaten by man can be classified into three main groups:
1. Carbohydrates 2. Fats and 3. Proteins
• These are complex molecules that cannot be absorbed in their natural
forms through the gastrointestinal mucosa
• Before they are made available for body use, they must be broken down
into smaller molecules which can be absorbed
Digestion : Process of breaking down complex food molecules into smaller
molecules which can be absorbed by the body for use. End-products of the
digestive process, as well as water, electrolytes, vitamins and other
substances are then absorbed
Carbohydrates : Made up of monosaccharides joined together to form
disaccharides or polysaccharides of varying length
Proteins : Formed from amino acids joined by means of peptide bonds
Fats : Most of the fat in the diet consists of triglycerides (neutral fats)
which are combinations of three fatty acids molecules joined to a single
glycerol molecule
71
Digestion of carbohydrates
• The normal human diet contains 3 main types of carbohydrates:
1. Sucrose (a disaccharide known as cane sugar)
2. Lactose (a disaccharide in milk)
3. Starches (Large polysaccharides present in almost all foods especially in grains
and tubers e.g. yam

• Dietary carbohydrate is mainly amylopectin which consists of chains of glucose

molecules joined by 1-4α – linkages, with some branches linked by 1-6 α –
linkages
• Amylose consists of straight chains with 1-4α – linkages
• Amylases (most important pancreatic amylase) →hydrolyze carbohydrate to
produce [disaccharides and oligosaccharides)
• Disaccharides and oligosaccharides are then hydrolyzed by the brush border
enzymes (oligosaccharidase) to → monosaccharides
• Starch [Digested by ptylin in saliva (20 - 40%) and pancreatic amylase (50 -
80%] →Maltose and Isomaltose [digested by Maltase &Isomaltase in the
intestine] to → Glucose
• Lactose [Digested by lactase in the intestine] to → Glucose + Galactose 72
Digestion of carbohydrates 73
Note:
• Glucose form about 80 % of the final products of carbohydrate digestion
• While galactose and fructose account for about 10 % each of the
products of carbohydrate digestion
Digestion of proteins
• Proteins in the diet are derived mainly from: 1. Meat and 2. Vegetables
• The protein molecule consist of long chain of amino acids bound
together by peptide linkages
• Protein digestion involves hydrolysis of these peptides bond by specific
enzymes
• Protein digestion begins in the stomach by hydrolysis of protein by
pepsins to produce polypeptides + few free amino acids
• Once in the duodenum, chyme is subjected to a variety of proteolytic
enzymes produced by the pancreas which releases free amino acids and
small peptides
• Where it hydrolyzes single amino acids from the terminal end of
polypeptides 74
• Although, pepsins have a pH of 2-3, appreciable activity
persist in the duodenum
• Once trypsinogen has been activated to trypsin by entero-
peptidases
• Trypsin activate more trypsinogen to trypsin
• And chymotrypsinogens A and B to chymotrypsins A and B
• These enzymes hydrolyze polypptides to oligopeptides 2-6
residues
• The pancreatic protease pro-carboxypeptidase is activated by
trypsin to carboxypeptidase in the duodenum
Summary of protein digestion
• Proteins [Pepsin in stomach] → Proteoses + Peptones + Large
polypeptides [In presence of Trypsin, Chymotrypsin, Carboxy-
peptidase] →Polypeptides + Amino acids → [Peptidases in
75
Small intestine] → Dipeptides + 2 Amino acids
Digestion of proteins 76
Digestion of Fats
• The most common fats in the diet are:
1. The neutral fats – also called triglycerides and each triglyceride molecule
is composed of 3 fatty acids and a glycerol nucleus
2. Phospholipids (small quantities)
3. Cholesterol
• Has no fatty acid but exhibits some of the physical & chemical properties
of fat.
• Derived from fats and it is metabolized like fats & these reasons,
cholesterol is considered from the dietary point of view to be fat
4. Cholesterol esters : Contain fatty acids and can be regarded as fats.
• Ebner’s glands on the dorsal surface of the tongue secrete lingual lipase
and stomach also secretes a gastric lipase.
• Gastric lipase does not play any important role in fat digestion
• Lingual lipase which is active in the stomach and can digest as much as
30 % of the triglyceride in the diet
• Digestion of fat occurs in the small intestine and pancreatic lipase is77 one
• Also the churning action of the stomach assists in the formation of a coarse
emulsion
• Further emulsification occurs in the small intestine via mixing movements of
the intestine itself & the combined action of bile salts, lecithin and cholesterol
and fat digestion products themselves.
Note:
• Problem in fat digestion and absorption is not the number of enzymes involved
(only one enzyme is mainly involved)
• Or difficulty in absorption (because fat is relatively transported through cell
membrane)
• But the fact that fats and water do not mix and fats tend to form a separate
layer or large droplets in water
• Pancreatic lipase is a protein which is water soluble and therefore can only act
on the surface of fat droplet, thereby breaking the fat droplets into large
number of very small droplets, so that the lipase has a sufficiently large
surface area on which to act.
• The bile salts produced by the liver carryout this emulsification of fat, thereby
facilitating its hydrolysis by digestive enzymes
78
• Dietary fats are classified into two types:
1. Saturated fats
• Are the fats which contain triglycerides formed from only
saturated fatty acids (FAs).
• FAs having maximum amount of hydrogen ions without any
double bonds between carbon atoms are called saturated FAs.
2. Unsaturated fats.
• Fats containing unsaturated fatty acids are known as
unsaturated fats.
• Unsaturated FAs are FAs formed by dehydrogenation of
saturated fatty acids.
• Unsaturated fats are classified into three types:
i. Monounsaturated fats
ii. Polyunsaturated fats
iii. Trans fats. 79
i. Monounsaturated fats
• Fats which contain one double bond between the carbon atoms.
ii. Polyunsaturated fats
• Fats with more than one double bond between the carbon atoms.
• Belong to the family of essential FAs (FAs required in diet).
• Polyunsaturated fats are of two types:
 Omega-3 fats or omega3
• FAs having double bond in the third space from the end of the carbon
chain
 Omega-6 fats or omega6
• FAs having double bond in the sixth space from the end of the carbon
chain.
• Both omega-3 and omega-6 FAs are beneficial to the body.
• However, consuming too much of omega6 FAs results in hazards than
benefits.
• So, the diet containing 3 : 1 ratio of omega-6 to omega-3 FAs is often
recommended by experts. 80
• The pancreas secretes 3 Lipolytic enzymes thus:
1. Pancreatic lipase (main Lipolytic enzyme)
• Hydrolyzes triglycerides to release the 2-monglyceride and
2- free fatty acids molecules
2. Esterase
• Hydrolyzes 2-monoglyceride to glycerol and free fatty acids
(FFA)
• Also hydrolyzes triglycerides provided they have been made
soluble by bile salts mixed micelles
3.Phospholipase
• Main enzyme for hydrolysis of phospholipids particularly
lecithin
• Also hydrolyzes phospholipids that have been made soluble
by bile salt mixed micelles to lysolecithin and FFA
81
Digestion of lipids 82
Sources and functions of dietary fats
83
Gastrointestinal Absorption
• The end products of the digestion of the different types of food:
1. Ingested or secreted electrolytes
2. Vitamins
3. Large quantity of water secreted in the various digestive juice
• All the above mentioned must be moved from the lumen of the gut across the
epithelium to the intestinal fluid.
Absorption
• Process of transport of digested products from the gut lumen into the body interstitial
fluid
Note:
• Nature has provided the main absorptive portion of the gut (small intestine with a
large surface area
• This is achieved by the presence of mucosal in-folding called valvulae conniventes
or kerchring folds (mucosal folds of small intestine starts from 2 nd part of duodenum
& are large and thick at the jejunum & decrease considerably in size distally in the
ileum)
• Millions of small villi which project about 1mm from the surface of the mucosa and
a brush border consisting of about 600 microvilli per cell
• Combination of the mucosal in folding, the villi and the microvilli increase 84 the
• Absorption through the gastrointestinal mucosa occurs by:
1. Active transport
2. Diffusion
Glucose Absorption
• Glucose are rapidly absorbed across the wall of the small intestine
• Glucose molecules pass from the mucosal cells to the blood in the capillaries &
drains into the portal vein.
• Glucose in the small intestine enters the cells by secondary active transport using a
common symport carrier with Na+
• Transport of glucose is affected by the amount of sodium in the intestinal lumen
because glucose and sodium share the same co-transporter or symport- called the
SGLT(sodium-dependent glucose transporter) or sodium-glucose co-transporter
(SGLT1 and SGLT2).
• SGLT1 and SGLT2 are responsible for facilitated diffusion in that they cross the
cell membrane 12 times
• Since the intracellular concentration of Na+ is low in intestinal cell, Na+ moves into
the cell along its concentration gradient. Glucose moves with the Na+ and is
released in the cell
• Na+ is transported into the lateral intercellular spaces and the glucose is transported
85
from the inside of the cell by GLUT 2 into the interstitium (ECF) and from there to
• Absorption of glucose is by secondary active transport in that the energy
for glucose transport is provided indirectly by the active transport of Na +
out of the cell
• The removal of transported Na+ from the intracellular space ensures the
maintenance of the concentration gradient of Na+ across the luminal
border of the cell
• So that more Na+ and consequently more glucose can enter the cell
Note:
• Galactose utilizes the same mechanism as glucose
• Fructose utilizes a different mechanism
• Absorption of fructose is independent of Na+ unlike the transport of
glucose and galactose
• Fructose is transported by facilitated diffusion from the intestinal lumen
into the cell of the intestine by GLUT 5 and out of the cells into the
interstitium by GLUT 2
• Some fructose is converted to glucose in the mucosal cells
• All monosaccharides are absorbed into the portal blood draining the small
86
Absorption of proteins
• Amino acids (some small peptides) are absorbed in the duodenum
and upper jejunum into portal blood
• D-amino acids are absorbed passively and slowly across cell
membrane
• While L-amino acids are absorbed actively by secondary active
transport with Na+ in the same way as glucose
• There seems to be four different types of carriers for amino acids
absorption:
i. One for neutral amino acids
ii. One for basic amino acids
iii. One for acidic amino acids
iv. One for imino acids (proline, sarcosine)
• In infants antibodies and other proteins contained in colostrum may
be absorbed in their intact form by pinocytosis
• This enables the new born to absorb the antibodies in the maternal
87