The Digestive System

Dr. Othman Al-Shboul Department of Physiology

Digestive System = GI tract + accessory organs

Digestive tract organs:
mouth; pharynx (throat) esophagus stomach small intestine (duodenum, jejunum, and ileum) large intestine (cecum, appendix, colon, and rectum) anus

Accessory digestive organs:

salivary glands exocrine pancreas biliary system (liver and gallbladder)
Digestive tract lumen is continuous with the external environment.
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Basic Digestive Processes

1. 2. 3. 4. Motility Secretion Digestion Absorption

Basic Digestive Processes

1. MOTILITY: the digestive tracts muscular contractions Two types: i. ii. Propulsive movements:
propel or push the contents forward through the digestive tract

Mixing movements:
facilitate digestion by mixing food with the digestive juices facilitate absorption by exposing all parts of the intestinal contents to the absorbing surfaces of the digestive tract

The ends of the tract: motility involves skeletal muscle

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2. SECRETION:
Digestive juices consist of water, electrolytes, enzymes, bile salts, and mucus. Energy-dependent process Requires neural or hormonal stimulation Reabsorbed back into the blood
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3.

DIGESTION:

Biochemical breakdown of the structurally complex foodstuffs of the diet into smaller, absorbable units by the enzymes produced within the digestive system. Carbohydrates:
Polysaccharides/disaccharides monosaccharides

Proteins:
Polypeptides a.a

Fat:
Triglycerides monoglycerides and free fatty acids,

Hydrolysis
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4. ABSORPTION:
The small absorbable units that result from digestion, along with water, vitamins, and electrolytes, are transferred from the digestive tract lumen into the blood or lymph.

Most absorption occurs in small intestine

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The digestive tract wall

From the innermost layer outward:
1. 2. 3. 4. mucosa, submucosa, muscularis externa, serosa

1. MUCOSA:
Protective role, secretion and absorption Contains: - exocrine gland cells - endocrine gland cells - epithelial cells Highly folded
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2. SUBMUCOSA
Thick layer of connective tissue Gives GI tract distensibility and elasticity Contains: - blood and lymph vessels
- submucous plexus

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3. MUSCULARIS EXTERNA:
Two smooth muscle layers:
- inner circular layer: contraction constricts or decreases the diameter of the lumen - outer longitudinal layer: contraction shortens the tube

Myenteric plexus & submucosal plexus

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Muscularis Externa

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4. SEROSA:
Outer connective tissue covering Secretes a watery, slippery fluid; lubricates and prevents friction with surrounding organs

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Regulation of GI function
GI hormones

Neural regulation

Autonomous smooth muscle function & Gland secretion

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Regulation of GI function
1. Autonomous smooth-muscle function
Sheets of smooth muscle cells are connected by gap junctions (functional syncytium)
varicosity
NTs
NTs

smooth muscle
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1. Autonomous smooth-muscle function

Display rhythmic, spontaneous variations in membrane potential slow-wave potentials (basic electrical rhythm (BER) or pacesetter potential) Slow waves are generated by ICC (pacemaker cells)

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Tonic vs. Phasic smooth muscles

Tonic smooth muscle:
contraction is maintained for prolonged periods of time.

e.g. fundus, sphincters

Phasic smooth muscle:

twitch-like contraction evoked by action potentials.

e.g. antrum, esophagus, intestine

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Regulation of GI function
2. Intrinsic nerve plexuses:
Digestive tract has its own intramural (within-wall) nervous system Contains as many neurons as the spinal cord 2 major networks: - Submucous plexus - Myenteric plexus

ENS

Functional classification of ENS neurons: - Sensory - Motor - Interneurons

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Regulation of GI function
3. Extrinsic nerves:
Sympathetic & parasympathetic of ANS

Either directly on the smooth muscle and glands or indirectly via ENS

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Regulation of GI function
4. Gastrointestinal hormones
Endocrine gland cells within the mucosa

Either excitatory or inhibitory influences on smooth muscle and exocrine gland cells

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Regulation of GI function
Digestive tract wall receptors:
1. Chemoreceptors 2. Mechanoreceptors 3. Osmoreceptors

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Pathways controlling digestive system activities

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MOUTH
Muscular lips:
Procure, guide, and contain the food in the mouth Important in speech Sensory receptor

The palate:
Separates the mouth from the nasal passages Uvula; sealing off the nasal passages during swallowing
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MOUTH
The tongue:
The floor of the oral cavity Skeletal muscle Guiding food within the mouth during chewing and swallowing Role in speech Contains taste buds

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MOUTH
Chewing:
The motility of the mouth that involves the slicing, tearing, grinding, and mixing of ingested food by the teeth Grinds and breaks food up into smaller pieces to facilitate swallowing Mixes food with saliva Stimulates the taste buds; sensation of taste & reflexly increases salivary, gastric, pancreatic, and bile secretion

Voluntary, but mostly a rhythmic reflex; activation of the skeletal muscles of the jaws, lips, cheeks, and tongue in response to the pressure of food against the oral tissues

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MOUTH
Saliva:
Components: 99.5% H2O 0.5% electrolytes and proteins (amylase, mucus, & lysozyme) Functions: s.amylase Begins digestion of carbohydrate (polysaccharide maltose) Facilitates swallowing, providing lubrication through mucus Antibacterial action via lysozyme & rinsing effect Solvent for molecules that stimulate the taste buds Aids speech Oral hygiene (helping keep the mouth and teeth clean) Contains bicarbonate buffers, which neutralize acids

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Control of Salivary Secretion

Both sympathetic and parasympathetic stimulation increase salivary secretion

Parasympathetic:
Prompt and abundant flow of watery saliva Rich in enzymes

Sympathetic:
Much smaller volume Thick saliva Rich in mucus. Entirely under neural regulation No hormonal regulation
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Control of Salivary Secretion

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Oral Digestion
Digestion in the mouth is minimal & involves the hydrolysis of polysaccharides into disaccharides by salivary amylase
Most digestion by this enzyme is done in the body of the stomach Gastric acid inactivates amylase, except in the center of the food mass No absorption takes place in the mouth

Nitroglycerin
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Pharynx and Esophagus

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Pharynx and Esophagus

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Swallowing
ALL or NON: Swallowing is initiated voluntarily, but once begun it cannot be stopped
Food in the mouth

Pressure receptors in the pharynx

Swallowing center in the medulla

Skeletal muscles in the pharynx & upper 1/3 of esophagus

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Swallowing stages
1. Oropharyngeal stage

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Swallowing stages
2. Esophageal stage
Starts after food passes pharyngoesophageal sphincter Peristalsis starts here pharyngoesophageal sphincter

Esophageal secretion is entirely mucus (lubrication)

gastroesophageal sphincter

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Esophageal peristalsis

1 The swallowing center triggers a primary peristaltic wave 2 Remaining bollus distension stimulates pressure receptors, mediated by the intrinsic nerve plexuses at the level of the distension

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STOMACH

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Anatomy of the stomach

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Gastric Motility
Filling, storage, mixing, emptying

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Gastric Motility
1. Gastric filling
Stomach volume; 50-1000mL Receptive relaxation:
Increase in stomach (Fundus) volume with little change in tension in its walls and little rise in intragastric pressure upon food reception Folds get smaller and nearly flatten out as the stomach relaxes Stimulated by eating and is mediated by the vagus nerve

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Gastric Motility
2. Gastric storage:
Gastric storage takes place in the body (Fundus) of the stomach:
Tonic contraction in fundus Peristaltic contractions of the thin muscular wall of the body are too weak to mix the contents

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Gastric Motility
3. Gastric mixing
Gastric mixing takes place in the thick-muscled antrum as a result of vigorous peristaltic contractions against the almost closed pyloric sphincter

The stomach absorbs alcohol and aspirin but no food

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Gastric Motility
4. Gastric emptying
The amount of chyme that escapes into the duodenum with each peristaltic wave before the pyloric sphincter tightly closes depends largely on the strength of peristalsis Gastric emptying is influenced by factors in both the stomach and the duodenum These factors influence the stomachs excitability by slightly depolarizing or hyperpolarizing the gastric smooth muscle

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Gastric Emptying and Mixing

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Factors Regulating Gastric Motility and Emptying

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Vomiting
Vomiting (or emesis): the forceful expulsion of gastric contents out through the mouth

Vomiting is coordinated by a vomiting center in the medulla.

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Vomiting
The stomach, the esophagus, and associated sphincters are all relaxed during vomiting The major force for expulsion comes from contraction of the respiratory muscles; (diaphragm abdominal muscles) Vomiting begins with a deep inspiration and closure of the glottis.

Gastroesophageal sphincter

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 Causes of vomiting:
Tactile (touch) stimulation of the back of the throat Irritation or distension of the stomach and duodenum Elevated intracranial pressure Rotation or acceleration Chemical agents (emetics, e.g., syrup of ipecac) Psychogenic vomiting induced by emotional factors pregnancy
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 Effects of vomiting: Harmful effects:

Dehydration Metabolic alkalosis

Beneficial effects:
Removing noxious material from the stomach rather than letting it stay and be absorbed
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GASTRIC SECRETION

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Gastric Mucosa

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The Stomach Mucosa and the Gastric Glands

stem cells

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Pepsinogen activation in the stomach lumen

Chief cell

Parietal cell

Protein digestion starts in stomach

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Phases of Gastric Secretion

Stimulatory

Intestinal phase of gastric secretion

Fat, acid, hypertonicity, distention

inhibitory
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The gastric mucosal barrier protects the stomach lining from gastric secretions

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PANCREATIC AND BILIARY SECRETIONS

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Pancreas is a mixture of exocrine and endocrine tissue

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Pancreatic Secretions
Pancreatic enzymes
By the acinar cells

Aqueous alkaline solution

By the duct cells Rich in sodium bicarbonate (NaHCO3)
o to allow optimal functioning of the pancreatic enzymes o to prevent acid damage to the duodenal mucosa
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Pancreatic Enzymes
1. Proteolytic enzymes
i. Trypsinogen ii. Chymotrypsinogen iii. Procarboxypeptidase Secreted in an inactive form Trypsin inhibitor

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Pancreatic Enzymes
2. Pancreatic amylase:
Secreted in the pancreatic juice in an active form Polysaccharides disaccharide maltose

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Pancreatic Enzymes
3. Pancreatic lipase
Secreted in its active form The only enzyme secreted throughout the entire digestive system that can digest fat Triglycerides monoglycerides + free fatty acids

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Regulation of exocrine pancreatic secretion

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The Liver

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Liver blood flow

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The liver is organized into functional units known as lobules

Liver lobules: hexagonal arrangements of tissue surrounding a central vein

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The liver is organized into functional units known as lobules

Each hepatocyte is in contact with a sinusoid on one side and a bile canaliculus on the other side

Bile
Bile constituents:
1. 2. 3. 4. Bile salts (derivatives of cholesterol) Cholesterol Lecithin Bilirubin (heme waste product excreted in the bile) (All derived from hepatocyte activity) No digestive enzymes In an aqueous alkaline fluid (added by the duct cells) similar to the pancreatic NaHCO3 secretion

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Enterohepatic circulation of bile salts

Bile is not transported directly from the liver to the gallbladder When sphincter of oddi is closed, most of the bile secreted by the liver is diverted back up into the gallbladder

Amount of bile secreted per day ranges from 250 ml to 1 liter

Only about 5% of the secreted bile escapes into the feces daily
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Structure of Bile Salts

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Detergent action of bile salts facilitates fat digestion

Bile salts ability to convert large fat globules into a lipid emulsion consisting of many small fat droplets suspended in the aqueous chyme, thus increasing the surface area available for attack by pancreatic lipase.

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Bile salts facilitate fat absorption through formation of micelles

Micelles are lipid molecules that arrange themselves in a spherical form in aqueous solutions

Can dissolve water-insoluble substances in their lipid soluble cores

Vehicle for carrying water insoluble substances (monoglycerides, free fatty acids, & fat-soluble vitamins) through the watery luminal contents

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Bilirubin
The primary bile pigment derived from the breakdown of worn-out red blood cells by macrophages Extracted from the blood by the hepatocytes and is actively excreted into the bile

Yellow pigment; gives brown color of feces & urines yellow color

Jaundice:
Bilirubin formation >>> excretion Bilirubin accumulates in the body Yellowish patients (most clearly in the whites of the eyes)

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The gallbladder
Stores and concentrates bile (5-10 times) CCK stimulates contraction of the gallbladder and relaxation of the sphincter of oddi

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SMALL INTESTINE

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Small intestine motility

1. Segmentation:
Oscillating, ring-like contractions of the circular smooth muscle along the small intestines length

Between the contracted segments are relaxed areas containing a small bolus of chyme

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Gastroileal Reflex

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Small intestine motility

2. The migrating motility complex
Between-meal motility Consists of weak, repetitive peristaltic waves that move a short distance down the intestine before dying out. Start at the stomach and migrate down the intestine Each new peristaltic wave is initiated at a site a little farther down the small intestine Intestinal housekeeper: sweeping any remnants of the preceding meal plus mucosal debris and bacteria forward toward the colon Regulated by hormone motilin
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Small-intestine secretions

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Brush border enzymes

Inserted into microvilli covering Enzymatic digestion occurs at surface rather than in the lumen
Enterokinase, Disaccharidases (maltase, sucrase, and lactase), Aminopeptidases

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Digestive Processes for the Three Major Categories of Nutrients

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Small intestine absorption

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Small intestine absorption

Most absorption occurs in the duodenum and jejunum adaptations that increase the small intestines surface area: circular folds villi microvilli

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Structure of a villus

Secretes water and electrolytes

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Carbohydrate & protein absorption

Lumen Interstitial fluid

Na+
Glucose/ galactose or a.a

Co-T

Glucose/ galactose or A.A.

Na+

carrier

Glucose/ galactose or A.A.

Na+

K+

P
K+

Na+
K+

Fructose is absorbed into the blood solely by facilitated diffusion

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Fat Absorption

Lipid emulsion Micelles diffusion

Lumen

Lumen Micelles

Micelle Microvillus Fatty acids, monoglycerides

Aggregate and coated with lipoprotien Epithelial cell of villus

Short or medium chain

Passive absorption Basement membrane Capillary

(Exocytosis) Central lacteal

Fig. 15-23, p. 500

Vitamin absorption
Water-soluble vitamins: passively with water
Fat-soluble vitamins: carried in micelles & absorbed passively Vitamin B12: needs gastric intrinsic factor for absorption

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LARGE INTESTINE

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Anatomy of the large intestine

To store feces before defecation Absorption of H2O, salts, & vitamin K (no villi) Secretes alkaline (NaHCO3) mucus solution

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Large intestine movements

Haustral contractions
Slow and nonpropulsive, shuffle the contents in a back-and-forth mixing movement Similar to small-intestine segmentations but occur much less frequently

Mass movements
Stimulated by presence of food in stomach or chyme in doudenum Push the colonic contents into the distal part of the large intestine
Three to four times a day

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Gastrocolic reflex
Food entering the stomach stimulates mass movements in the colon. Mediated from the stomach to the colon by:
o Gastrin o Extrinsic autonomic nerves

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Defecation reflex
Triggered by distention of rectal walls Rectum is usually empty but, development of mass movements (by gastrocolic reflex) push feces into the rectum this leads to intiation of defecation reflex. The desire for defecation is elicited when the intrarectal pressure increases. Center for defecation is in the sacral segment of spinal cord.
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The END
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Regulation of the Digestive System

1) 2) 3) 4)

Autonomous smooth-muscle function Intrinsic nerve plexuses Extrinsic nerves Gastrointestinal hormones

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Gastric secretions
HCl activates pepsinogen denatures protein kills bacteria

Pepsinogen once activated, initiates protein digestion mucus provides a protective coating to gastric mucosa

intrinsic factor vitamin B12 absorption, a constituent essential for normal red blood cell production

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Gastric secretion gradually decreases as food empties from the stomach into the intestine.

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Segmentation
Duodenum segmentation in response to local distension Empty ileum segmentation by gastrin Gastrin secreted in response to the presence of chyme in the stomach, (gastroileal reflex) Segmentation moves chyme through the small intestine as the frequency of segmentation declines along the length of the small intestine BER: Duodenum 12/minute, ilium 9/minute
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Iron and calcium absorption

absorption is subject to regulation, depending on the bodys needs for these electrolytes

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defecation reflex

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Liver functions
Metabolic processing of the major categories of nutrients (carbohydrates, proteins, and lipids) after their absorption from the digestive tract Detoxifying or degrading body wastes and hormones as well as drugs and other foreign compounds Synthesizing plasma proteins, including those needed for blood clotting and those that transport steroid and thyroid hormones and cholesterol in the blood Storing glycogen, fats, iron, copper, and many vitamins Activating vitamin D, which the liver does in conjunction with the kidneys

Removing bacteria and worn-out red blood cells, (role of macrophages)

Excreting cholesterol and bilirubin, the latter being a breakdown product derived from the destruction of worn-out red blood cells
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Exocrine gland cells in the mucosa secrete into the lumen:

Aqueous salt Mucus solution

Small intestine-synthesized digestive enzymes:

Act intracellularly within the borders of the epithelial cells Not secreted with the juice

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Control of bile secretion

Hormonal mechanism (secretin):
stimulates an aqueous alkaline bile secretion by the liver ducts

Neural mechanism (vagus nerve):

minor role cephalic phase of digestion

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Na+ & Water absorption

Lumen Interstitial fluid

Na+
Na+

Na+

K+

Na+
K+

K+

Water is reabsorbed passively down the osmotic gradient produced by active reabsorption of Na+
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Large-intestine secretion
Does not secrete any digestive enzymes

Alkaline (NaHCO3) mucus solution

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Large intestine absorption

Less absorptive surface area than the small intestine (no villi) Does not have the specialized transport mechanisms found in the small intestine for absorbing glucose or amino acids.

Absorbs:
Na+, Cl-, H2O Vitamin K (synthesized by colonic bacteria)

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Reflexes in Colon and Rectum:

Water and Ions:

Water
Can move in either direction across wall of small intestine depending on osmotic gradients

Ions
Sodium, potassium, calcium, magnesium, phosphate are actively transported

Fat Absorption

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