Digestive System

alimentary canal and accessory

organs

Basic Functions

Ingestion, mastication, deglutition - eating

Movement of food along the GI - peristalsis

Digestion - chemical and physical
breakdown of food

Absorption of food breakdown products
into circulatory and lymphatic systems

Elimination - excretion of waste products
and toxins

The Digestive System

Composed of a two parts


*A long tube - termed the alimentary canal.
The alimentary canal extends from mouth to
anus and is about 30 ft in length


*Accessory structures -these structures aid
in digestion (salivary glands, teeth, liver,
GB, pancreas)

Digestion Begins in the Mouth

Oral or buccal cavity - moistens and aids
mechanical digestion of food (minor
amount of saliva secreted here)

Tongue - helps to manipulate food, moves
food to the back of the mouth for
swallowing, contains taste buds, glands
located here secrete lingual lipase

allows for speech

Salivary Glands

The majority of saliva comes from
three paired structures

Parotid, submandibular, and
sublingual glands

Saliva pH is 6-7 and composed of
99.5% H2O.

1000 to 1500 ml secreted daily
under nervous system control
(salivary nuclei triggered by smell,
sight, thought or presence of food
in mouth)

These glands secrete Salivary
Amylase which breaks
polysaccharides into disaccharides

Teeth

Mastication - chewing

1st step of digestion

Two dentitions

1. Deciduous teeth

-appear in 6 months

-20 teeth

-formula 2 incisors,

1 canine, 2 molars

2. Permanent Teeth

-appear 6-12 years

-32 in all

-formula 2 incisors,

1 canine (cuspids), 2 bicuspid

(premolars) and 3 molars

Schimmels Dental Chart

Digestion Begins With

Mastication - chewing/teeth 20-30 bites

Moistening - saliva

Chemical -


Salivary Amylase - polysaccharides
(starch) into disaccharides


Lingual Lipase - triglycerides to fatty acids
and monoglycerides

Deglutition - Swallowing

Voluntary stage - tongue moves food back into the oropharynx

Pharyngeal stage - bolus stimulates receptors in oropharynx causing a
cessation of respiration and epiglottis covers airway

Esophageal stage - dilation of upper/lower esophageal sphincters,
food moves into esophagus and down to the stomach via peristalsis

Esophageal bolus moves behind heart!

Lower esophageal sphincter must now open

4 layers of the GI tract

Mucosa - mucous membrane, first layer,
composed of epithelium (stratified. sqamous/
simple columnar), and is in contact with food

Submucosa - composed of loose areolar
connective tissue and binds mucosa to muscle
layer, contains immune system of the gut

Muscularis - skeletal muscle in mouth, pharynx
and esophagus. The rest of the tract is smooth
muscle. This layer usually contains 2 layers (3 in
stomach) - inner circular/outer longitudinal

Serosa - serous membrane, made up of connective
tissue and epithelium. Below the diapham this
layer is termed the visceral peritoneum.

4 layers of the GI tract

Peritoneum

The Peritoneum is a serous membrane that lines
the walls of the abdomen and organs

The parietal layer lines the walls of the abdomen

The visceral layer covers the the internal organs

The space between these layers is called the
peritoneal cavity and contains serous fluid

Organs behind this cavity (kidneys/pancreas) are
termed retroperitoneal

Infection in this area is called peritonitis

Stomach

Stomach

The mucosa of the stomach consists of gastric pits lined with 4
types of cells


1. Chief cells - pepsinogen/gastric lipase


2. Parietal cells - HCL/Intrinsic factor


3. Mucous cells - mucous barrier


4. G cells - gastrin

All secretions equal gastric juice (2000 to 3000 ml per day)

Gastric Pits

Mechanical digestion

Peristaltic mixing waves q 15-25 secs

Food mixed with HCL and reduced to chyme

Food is stored in the fundus then ground down in the body
and pylorus

Each wave ejects chyme through the pyloric sphincter into
the duodenum

H. pylori-bacteria associated with Ulceration

Reflux -smoking, coffee, alcohol, and vitamin deficiency ?

Chemical Digestion in the

Stomach

1. HCL denatures protein - destroys three
dimensional structure of protein

2. HCL converts pepsinogen (zymogen) into
pepsin (active protease)

3. Pepsin breaks large polypeptides into peptides

4. Gastric Lipase digests buttermilk in infants

Alcohol, ASA and water are absorbed in stomach

Mucus prevents auto-digestion of this layer

Nerve/hormonal interactions

1. HCL denatures protein - destroys three
dimensional structure of protein

2. HCL converts pepsinogen (zymogen)
into pepsin (active protease)

3. Pepsin breaks large polypeptides into
peptides

4. Gastric Lipase digests buttermilk in
infants

Alcohol, ASA and water are absorbed in
stomach

Mucus prevents auto digestion of this layer

The hormones of digestion

Acetylcholine - parasymp nervous output
stimulates parietal HCL production, peptic
pepsinogen release, and mucous secretion

Histamine - amino acid derivative that stimulates
HCL production via H2 parietal cell activation.
This compound is required for gastrin and
acetylcholine activation of parietal cells. Blocked
by tagamet-cimetidine

Gastrin - secreted by G-cells in response to the
presence of peptides/amino acids in the stomach.
This hormone increases HCL production,
contracts LES, increases stomach motility, and
relaxes the pyloric sphincter leading to the SI

Alcohol, caffeine, and amino acids stimulate
gastric production as well

More hormones

Secretin - secreted by endocrine cells located in
the duodenum in response to the presence of
acidic chyme. This hormone triggers the release
of bicarbonate from the pancreas to neutralize
acidic chyme and create the proper pH for
pancreatic enzyme activity

CCK(cholecystokinin) - fat entering the small
intestine triggers the release of CCK from local
endocrine cells. CCK enhances the action of
secretin, stimulates pancreatic enzyme secretion
and causes the GB to contract releasing bile into
the SI.

Both Secretin/CCK slow stomach emptying

CCKs more interesting aspect

CCK in the brain is related to anxiety

CCK injected into humans creates feeling of
panic and intense anxiety

Drugs that Block CCK in the brain reduce
anxiety

GIP

Glucose insulinotropic peptide is released in
response to glucose and fat in the small
intestine

It slows gastric gland secretion and
emptying

GIP also stimulates the release of insulin
which allows for cellular uptake of glucose/
glycogen storage

The Liver, GB , Pancreatic interface

Right and Left Hepatic ducts

Cystic duct

Common Hepatic duct

Pancreatic duct and Accessory duct

Hepatopancreatic ampulla

The Liver

Generation of bile salts

from cholesterol via
HMG - CoA reductase

Lipid metabolism

Protein synthesis and
recycling

Phase1/2 detox
reactions

Hormone metabolism

Storage of glycogen,
vitamins (A,B,D,E,K)
and iron

Activation of multiple
vitamin prestages

Phagocytosis of worn
out blood cells

Gall Bladder

Stores and concentrates bile by reabsorbing water

Bile salts and lecithin combine with cholesterol to
form micelles that are soluble and keep cholesterol
in solution preventing stone formation

Ejection of bile primed by CCK

Cholelithiasis - cholecystitis 1. Too much H2O
absorbed from bile 2. High fat high cholesterol
diet 3. Too much cholesterol in bile chenodeoxycholic bile acid therapy for the
dissolution of stones

Pancreas

Exocrine function

Digestive enzyme release
(CCK)

Bicarbonate - primed by
secretin

Endocrine function

Glucagon

Insulin

Somatostatin

What does insulin do to
blood sugar?

Netters

Pancreatic Enzymes

Pancreatic amylase -


starches to disaccharides

Trypsin, chymotrypsin and carboxypeptidase -


proteins into peptides

Pancreatic lipase


triglycerides into fatty acids and monosaccharides

Pancreatic nucleases -

RNA/DNA into nucleotides

 Duodenum, Jejunum
and Ileum

Consists of 4 layers with
modifications to the
mucosa and submucosa to
increase surface area

Villi-absorptive finger has
a LP core that contains
blood vessels+lymphatics
(lacteal)

Microvilli-threadlike
projection of the epithelial
cell. Each cell has about
1,700 - this creates the
brush border and
secretes digestive
enzymes

Plica circularis - The
submucosa is thrown into

Small Intestine

Villi and Plica Circularis

Glandular types of the small

intestine

Intestinal Glands - Crypts of leiberkuhn


these glands secrete intestinal juice (combined
with the brush border secretions)

Duodenal glands - Brunners glands - secrete an
alkaline mucous that combines with bicarbonate
ions from the pancreas to neutralize acidic chyme
from the stomach - inhibited by symp. Activity or
chronic stress leading to ulcer formation

Intestinal Juice

1 to 2 liters produced per day

Derived from intestinal glands and the surface of
enterocytes (brush border)

Brush border enzymes include;


*maltase, sucrase, lactase, alpha destrinase disaccharides into monosaccharides


*peptidases


peptides into amino acids


*nucleosidases and phosphatases - nucleotides
into N bases, pentose and P

Chemical Digestion in the Small Intestine revisited

Pancreatic enzymes

Pancreatic amylase -


starches to disaccharides

Trypsin, chymotrypsin
and carboxypeptidase -


proteins into peptides

Pancreatic lipase


triglycerides into fatty
acids and
monosaccharides

Pancreatic nucleases -


RNA/DNA into
nucleotides

Brush border enzymes

Maltase, sucrase, lactase,
alpha destrinase
disaccharides into
monosaccharides

Peptidases


peptides into amino acids

Nucleosidases and
phosphatases


nucleotides into N bases,
pentose and P

Enzymes reviewed

Mechanical Digestion

Inner circular and outer longitudinal muscle


muscle layers allow for segmentation

Chyme is confined to one region of the small
intestine

It washes back and forth to make contact with the
mucosa

Peristalsis then moves the the chyme to the next part
of the small intestine where segmentation occurs
again

Regulation of secretion in the

small intestine

The intestine has a localized nervous
system called the Enteric nervous
system

*it responds to the presence of chyme
and performs visceral reflexes

This division is influenced heavily by
both sympathetic and parasympathetic
branches of the ANS.

Absorption in the Small Intestine

To be absorbed

Carbohydrates must be converted onto
monosaccharides

Proteins must be converted to amino acids

Lipids must be converted to fatty acids
and monoglycerides

90% of absorption occurs in the small
intestine, 10% in the rest of the tract

Absorption

Vitamin Absorption

Fat soluble vitamins ADEK pass into
lacteals with triglycerides

Water soluble vitamins pass by diffusion

Vitamin B12 absorption requires intrinsic
factor from the parietal cells - no intrinsic
factor = Pernicious anemia secondary to a
lack of B12 absorption

Gastroileal reflex

Ileocecal valve opens

Chyme passes into the cecum via peristalsis

This initiated by the hormone gastrin

Fecal material moves from one haustra to the next
(haustral churning)

Haustral churning continues until the second half
of the transverve colon where mass peristalsis
moves it into the retum

Fiber

Water Soluble Fiber -1. slows uptake of sugar
from the intestine thus preventing large spikes in
blood sugar and the resulting insulin resistance 2.
Serves as a food source for GI flora (FOS-fructo
oligosaccharides) 3. Short chain fatty acids
production as a results of bacterial mediated
breakdown supplying the preferred energy supply
for the cells lining the colon

Water Insoluble Fiber - 1. Bulking agent that
improves bowel motility 2. Absorbs toxins in the
GI tract improving excretion

In the Colon

Water is reabsorbed

Bacteria break down whats left of the chyme

E coli; synthesis of vitamins B1, B2, B6, B5, B12,
folate, Biotin, Vitamin K

Deranged flora no longer produce these vitamins.
Instead they scavenge vitamins polyamine
formation, scatole, indole

Fungal infections as an indicator

Lactobacillus acidophilus/bacterium bifidum/coli
culture preps

MALT

Physiology of Defecation

Mass peristalsis of fecal material from
sigmoid colon into the rectum

Rectal wall stretching initiates defecation
reflex

Parasympathetic nervous system (sacral
portion)

Diarrhea

Constipation