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Focus on the Mechanics of Mastication, Deglutition,

Digestion, and Peristalsis; the Absorption of


Nutrients; and Liver and Gallbladder Function
 Digestive System is aka, Gastrointestinal (GI) tract
or Alimentary Canal
 Divided either by:
◦ Function:
 Main Organs of the gastrointestinal tract: mouth, most of the
pharynx, esophagus, stomach, small intestine, and large
intestine
 Accessory digestive organs: teeth, tongue, salivary glands,
liver, gallbladder, and pancreas
◦ Location: (important in the comparison of some
disorders and/ or signs like bright, red bloody stool
versus melena)
 Upper GIT: mouth, teeth, tongue, salivary glands, most of
the pharynx, esophagus, stomach
 Lower GIT: small intestine, liver, gallbladder, pancreas, and
large intestine
1. Ingestion
◦ involves taking foods and liquids into the mouth (eating)
◦ Hunger: intrinsic desire for food that principally determines the
amount of food that a person ingests
◦ Appetite: determines the type of food that a person preferentially
seeks
2. Secretion
◦ Daily function: a total of about 7 liters of water, acid, buffers, and
enzymes into the lumen (interior space) of the tract
3. Mixing and propulsion
◦ Motility: capability of the GI tract to mix and move material along
its length
 Alternating contractions and relaxations of smooth muscle in the walls
of the GI tract mix food and secretions and propel them toward the
anus
◦ Peristalsis: circular, squeezing movement of the INTESTINAL
organs to propel food/ waste substances forward (made possible
through motility)
4. Digestion
◦ The actual process of breaking down of foods both mechanically and chemically
 mechanical digestion: involves teeth cutting and grinding food before it is
swallowed, and then smooth muscles of the stomach and small intestine churns the
food.
 RESULT: food molecules become dissolved and thoroughly mixed with digestive
enzymes
 chemical digestion: involves the splitting of large carbohydrates, lipid, protein, and
nucleic acid molecules in food are into smaller molecules by hydrolysis
5. Absorption
◦ Entrance of ingested and secreted fluids, ions, and the products of digestion into the
epithelial cells lining the lumen of the GI tract
 Absorbed substances pass into blood or lymph and circulate to cells throughout the
body
6. Defecation
◦ Wastes, indigestible substances, bacteria, cells sloughed from the lining of the GI
tract, and digested materials that were not absorbed in their journey through the
digestive tract leave the body through the anus
◦ A combined involuntary (Motility  Peristalsis) and voluntary (Anal sphincter)
function
 Lower esophagus to
the anal canal has
the same basic,
four-layered
arrangement of
tissues
 Four layers of the
tract (deep to
superficial):
1. Mucosa
2. Submucosa
3. Muscularis
4. Serosa
 “Life of Pie”
◦ Food (Mouth)  Bolus (Pharynx, Esophagus) 
Chyme (Stomach and Small Intestine)  Feces
(Large Intestine/ Colon to Anus)
◦ Order of Physiologic Functions: Ingestion 
Mastication  Digestion (Mouth)  Deglutition
(Swallowing)  Digestion (Rest of GIT)  Motility
(Peristalsis)  Absorption  Defecation
 Aka, oral or buccal cavity
◦ Involved in three main functions: Ingestion, Mastication,
Deglutition
 Digestion – the mouth has some participation in carbohydrate
digestion (5% of all the starches converted in mouth upon
swallowing  30% - 40% of all starches converted before
salivary amylase are deactivated), through the enzyme Ptyalin
(an α-amylase enzyme that breaks Starch down into the
disaccharide maltose and other small polymers of glucose that
contain three to nine glucose molecules)
◦ Ingestion: taking in food (a purely voluntary process by
jaw muscles and upper extremity muscles)
◦ Mastication: the process of chewing
 During chewing, contraction of the buccinator muscles in the
cheeks and orbicularis oris muscle in the lips helps keep food
between the upper and lower teeth
 Lips: or labia, are fleshy folds surrounding the opening of the
mouth and contain the orbicularis oris muscle and are covered
externally by skin and internally by a mucous membrane
 The different types of teeth performs specific functions in
breaking down food particles PHYSICALLY
 Canines – tears food
 Incisors – cuts food
 Molars – grinds food
 The tongue moves the food inside the buccal cavity to
ensure food is broken down properly prior to pushing it
down to the pharynx (see Deglutition)
 The extrinsic muscles move the tongue from side to side and
in and out to maneuver food for chewing, shape the food into
a rounded mass (BOLUS)
 Palate – wall or septum that separates the oral cavity from
the nasal cavity, forming the roof of the mouth
 This makes chewing and breathing at the same time possible
 The extrinsic muscles of the tongue force the food to the
back of the mouth for swallowing
 Hyoglossus, genioglossus,and styloglossus muscles:
originate outside the tongue (attach to bones in the area)
and insert into connective tissues in the tongue
 Intrinsic muscles: alter the shape and size of the tongue
for speech and swallowing
 originate in and insert into connective tissue within the
tongue
 Includes longitudinalis superior, longitudinalis inferior,
transversus linguae, and verticalis linguae muscles
 Lingual Frenulum: a fold of mucous membrane in the
midline of the undersurface of the tongue, is attached to
the floor of the mouth and aids in limiting the movement of
the tongue posteriorly (Ankyloglossia: results to being
“tongue-tied,” a speech defect)
◦ Salivary glands – secrete Salivary amylase
 Labial glands – in the lips
 Buccal glands – in the cheeks
 Palatal glands – in the palate
 Lingual glands – in the lamina propria of the tongue,
secrete both mucus and a watery serous fluid that
contains the enzyme lingual lipase (which acts on
triglycerides)
◦ Salivary glands (cont)
 Major salivary glands – source of most saliva
 Parotid glands: located inferior and anterior to the ears,
between the skin and the masseter muscle
 Parotid duct: pierces the buccinator muscle to open into the
vestibule opposite the second maxillary (upper) molar tooth
 Submandibular glands: found in the floor of the mouth and
are medial and partly inferior to the body of the mandible
 Submandibular ducts: run under the mucosa on either side of
the midline of the floor of the mouth and enter the oral cavity
proper lateral to the lingual frenulum
 Sublingual glands: beneath the tongue and superior to the
submandibular glands
 Lesser sublingual ducts: open into the floor of the mouth in the
oral cavity proper
Review: Secretory vesicles are
closely related to the RER and the
Ptyalin: enzyme that
Golgi Apparatus digests carbohydrates
 Both the oropharynx and laryngopharynx
have digestive as well as respiratory functions
 Collapsible muscular tube, about 25 cm (10
in.) long, that lies posterior to the trachea
and pierces through the diaphragm
◦ Hiatus hernia – condition wherein a part of the
stomach protrudes above the diaphragm through
the esophageal hiatus
◦ Consists of nonkeratinized stratified squamous
epithelium, lamina propria (areolar connective
tissue), and a muscularis muscosae (smooth
muscle)
 The esophagus secretes mucus and
transports food to the stomach.
◦ Deglutition: the
process of swallowing
 Facilitated by the
secretion of saliva and
mucus and involves the
mouth, pharynx, and
esophagus
 Majority of the process is
involuntary
 Involved structures:
 Tongue
 Epiglottis
 Hard and Soft Palate
 Uvula
 Pharyngeal Muscles
 Process:
 Three Stages:
1. the voluntary stage, in which the bolus is passed into the
oropharynx;
 Swallowing starts when the bolus is forced to the back of
the oral cavity and into the oropharynx by the movement
of the tongue upward and backward against the palate
2. the pharyngeal stage, the involuntary passage of the bolus
through the pharynx into the esophagus
 Begins with the passage of the bolus into the oropharynx
 Bolus stimulates receptors in the oropharynx, which send
impulses to the deglutition center in the medulla
oblongata and lower pons of the brain stem. The returning
impulses cause the soft palate and uvula to move upward
(drawn superiorly) to close off the nasopharynx, which
prevents swallowed foods and liquids from entering the
nasal cavity
 Epiglottis closes off the opening to the larynx, which
prevents the bolus from entering the rest of the
respiratory tract.
 The bolus moves through the oropharynx and the
laryngopharynx. Once the upper esophageal sphincter
relaxes, the bolus moves into the esophagus
3. the esophageal stage, the involuntary passage of
the bolus through the esophagus into the stomach
 Made possible through:
 Peristalsis – a progression of coordinated
contractions and relaxations of the circular and
longitudinal layers of the muscularis, pushes the
bolus onward
 Peristalsis occurs in other tubular
structures, including other parts of the GI
tract and the ureters, bile ducts, and uterine
tubes; in the esophagus it is controlled by
the medulla oblongata
 Mucus secreted by esophageal glands lubricates
the bolus and reduces friction.
 How Peristalsis Works in the Esophagus:
 In the section of the esophagus just superior to the
bolus, the circular muscle fibers contract,
constricting the esophageal wall and squeezing the
bolus toward the stomach.
 The longitudinal fibers inferior to the bolus also
contract, which shortens this inferior section and
pushes its walls outward so it can receive the bolus.
 The contractions are repeated in waves that push
the food toward the stomach.
 As the bolus approaches the end of the esophagus,
the lower esophageal sphincter relaxes and the
bolus moves into the stomach.
 Incomplete closure of this sphincter results to
Gastroesophageal reflux disorder (GERD),
resulting to “heartburn”
 The passage of solid or semisolid food from the
mouth to the stomach takes 4 to 8 seconds, very
soft foods and liquids pass through in about 1
second.
 J-shaped enlargement of the GI tract
directly inferior to the diaphragm in the
epigastric, umbilical, and left
hypochondriac regions of the abdomen
 Connects the esophagus to the
duodenum
 Serves as a mixing chamber and
holding reservoir
◦ Position and size of the stomach vary
continually; the diaphragm pushes it
inferiorly with each inhalation and pulls it
superiorly with each exhalation
 Empty, it is about the size of a large sausage, but it
is the most distensible part of the GI tract and can
accommodate a large quantity of food.
 In the stomach, digestion of starch
continues, digestion of proteins and
triglycerides begins, the semisolid
bolus is converted to a liquid, and
certain substances are absorbed
 Anatomy:
◦ Four main regions:
 Cardia – surrounds the superior opening of the stomach
 Fundus – rounded portion superior to and to the left of the
cardia
 Body – large central portion of the stomach that is inferior to
the fundus
 Pylorus – region that connects to the duodenum
 has two parts:
 pyloric antrum: which connects to the body of the stomach
 Where the G cell is mainly located: a special type of enteroendocrine
cell of the gastric glands, secreting the hormone gastrin into the
bloodstream (important for stimulation of gastric activity)
 Pyloric canal, which leads into the duodenum
 Pyloric sphincter: smooth muscle sphincter that controls the
communication between the pylorus and the duodenum of the small
intestine
◦ Rugae: large folds of the mucosa that can be seen with
the unaided eye when the stomach is empty
◦ Curves:
 lesser curvature: concave medial border of the stomach
 greater curvature: convex lateral border

 Histology:
◦ Main Layers:
 Surface of the mucosa: simple columnar epithelial cells
called surface mucous cells
 surface mucous cells: secrete mucus
 Lamina propria (areolar connective tissue)
 Muscularis mucosae (smooth muscle)
◦ Accessory Cells:
 Gastric glands: columns of secretory cells formed by the
Epithelial cells as they extend down into the lamina propria
 Several gastric glands open into the bottom of narrow
channels called gastric pits
 Secretions from several gastric glands flow into each gastric pit
and then into the lumen of the stomach
 Contain three types of exocrine gland cells that secrete their
products into the stomach lumen:
 mucous neck cells: secrete mucus
 chief cells: secrete pepsinogen and gastric lipase.
 parietal cells: produce intrinsic factor (needed for absorption of
vitamin B12) and hydrochloric acid.
 GASTRIC JUICE
 Formed by the secretions of the mucous, parietal, and chief
cells
 totals 2000–3000 mL (roughly 2–3 qt.) per day.
◦ Three additional layers lie deep to the mucosa.
 The submucosa of the stomach is composed of areolar
connective tissue
 The muscularis has three layers of smooth muscle (rather than
the two found in the esophagus and small and large intestines):
 outer longitudinal layer
 middle circular layer
 inner oblique layer
 The oblique layer is LIMITED PRIMARILY to the body of the stomach
 The serosa is composed of simple squamous epithelium
(mesothelium) and areolar connective tissue; the portion of the
serosa covering the stomach is part of the visceral peritoneum.
 Lesser curvature of the stomach: the visceral peritoneum extends
upward to the liver as the lesser omentum
 Greater curvature of the stomach: the visceral peritoneum continues
downward as the greater omentum and drapes over the intestines
 MECHANICAL AND CHEMICAL DIGESTION
◦ Mechanical Digestion: Mixing Waves
 Gentle, rippling, peristaltic movements passing over the
stomach
 Occurs every 15 to 25 seconds
 Happens after several minutes after food enters the stomach
 Macerate food, mix it with secretions of the gastric glands, and
reduce it to a soupy liquid called chyme
 Fundus: primarily has a storage function, thus mixing waves are few
 Pylorus: mixing wave periodically forces about 3 mL of chyme into
the duodenum through the pyloric sphincter
 Called GASTRIC EMPTYING
 The rest (MOST) are forced back into the body of the stomach
◦ Gastric juice (acidic), inactivates salivary amylase and
activates lingual lipase, which starts to digest triglycerides
into fatty acids and diglycerides
◦ Parietal cells:
 Secrete hydrogen ions (H) and chloride ions (Cl) separately
into the stomach lumen  combines, resulting to formation
of HCl (Hydrochloric acid)
 HCl secretion by parietal cells can be stimulated by several
sources:
 Acetylcholine (ACh) released by parasympathetic neurons
 Gastrin secreted by G cells
 Histamine: paracrine substance released by mast cells in the
nearby lamina propria
 But, it is HISTAMINE that allows Acetylcholine and gastrin
stimulate parietal cells to secrete MORE HCl (Synergistic
action of Histamine = enhancing the effects of Acetylcholine
and Gastrin)
 Functions of HCl:
 Anti-microbial
 partially denatures (unfolds) proteins in food
 stimulates the secretion of hormones that promote the flow of
bile and pancreatic juice
 Proton pumps: actively transport H+into the lumen while
bringing potassium ions (K+) into the cell
 Powered by H+/K+ ATPases
 Cl-and K+diffuse out into the lumen through Cl- and K+
channels in the apical membrane
 Carbonic anhydrase: especially plentiful in parietal cells
 Catalyzes the formation of carbonic acid (H2CO3) from water
(H2O) and carbon dioxide (CO2)
 When carbonic acid dissociates, it provides a ready source of
H+ for the proton pumps, but also generates bicarbonate
ions (HCO3)
 As HCO3 builds up in the cytosol, it exits the parietal cell in
exchange for Clvia Cl/HCO3 antiporters in the basolateral
membrane (next to the lamina propria).
 HCO3 diffuses into nearby blood capillaries
 This “alkaline tide” of bicarbonate ions entering the
bloodstream after a meal may be large enough to elevate
blood pH slightly and make urine more alkaline
◦ Chemical Digestion: Fat
 Recall: Chemical for Lipid/ Fat digestion is produced in
the mouth (Lingual Lipase)
 Fat digestion in the stomach through gastric lipase
 Splits the short-chain triglycerides in fat molecules into
fatty acids and monoglycerides
 Limited role in the adult stomach, since gastric lipase
operates best at a pH of 5–6 (slightly acidic)
 FAT is mostly digested through Pancreatic lipase, an
enzyme secreted by the pancreas into the small intestine.
 Protein digestion starts in the stomach
 Through the CHIEF CELLS that secrete Pepsin: the ONLY
proteolytic enzyme in the stomach
 Pepsinogen – inactive form, converted into Pepsin by HCl
 Stomach epithelial cells are protected from gastric juices by a
1–3 mm thick layer of alkaline mucus secreted by surface
mucous cells and mucous neck cells: Affected in Peptic Ulcer
 Most effective in the very acidic environment of the stomach
(pH 2); it becomes inactive at a higher pH (alkaline)
◦ ABSORPTION:
 Limited: Only a small amount of nutrients are absorbed in
the stomach because its epithelial cells are impermeable to
most materials (remember that the mucus layer is THICK)
 Absorbs: absorb some water, ions, and short-chain fatty
acids, as well as certain drugs (especially aspirin) and alcohol
 TRANSIT TIME: 2-4 hours
◦ Foods rich in carbohydrate spend the least time in
the stomach
◦ High-protein foods remain somewhat longer
◦ Emptying is slowest after a fat-laden meal
containing large amounts of triglycerides
 Retroperitoneal gland that is about 12–15 cm (5–
6 in.) long and 2.5 cm (1 in.) thick, lies posterior
to the greater curvature of the stomach
◦ Made up of small clusters of glandular epithelial cells
 Has three regions:
◦ Head: expanded portion of the organ near the curve of
the duodenum
◦ Body: central, superior to and to the left of the head
◦ Tail: tapering portion
 Usually connected to the duodenum by two ducts
 HISTOLOGY: Two types of secretory cells –
◦ Exocrine Cells
 Acini – constitute the exocrine portion of the organ
 Constitutes ~99% of the clusters
 Responsible for secreting the pancreatic juice: mixture of
fluid and digestive enzymes
 Secretes Pancreatic juices into small ducts that ultimately
unite to form two larger ducts:
 pancreatic duct (duct of Wirsung): larger, joins the common
bile duct through the hepatopancreatic ampulla (ampulla of
Vater)
 Opens on an elevation of the duodenal mucosa known as the
major duodenal papilla, which lies about 10 cm (4 in.)
inferior to the pyloric sphincter of the stomach
 regulated by a mass of smooth muscle known as the
sphincter of the hepatopancreatic ampulla (sphincter of
Oddi)
 accessory duct
 Aka duct of Santorini, leads from the pancreas and empties
into the duodenum about 2.5 cm (1 in.) superior to the
hepatopancreatic ampulla
 Pancreatic Juice
 1200–1500 mL (about 1.2–1.5 qt) is produced daily
 clear, colorless liquid consisting mostly of water, some salts,
sodium bicarbonate, and several enzymes
 Sodium Bicarbonate gives pancreatic juice a slightly alkaline pH
(7.1–8.2) that:
 buffers acidic gastric juice in chyme
 stops the action of pepsin from the stomach
 creates the proper pH for the action of digestive enzymes in
the small intestine
 Pancreatic Enzymes:
 pancreatic amylase: starch digesting enzyme
 pancreatic lipase: principal triglyceride-digesting enzyme in
adults
 ribonuclease and deoxyribonuclease: nucleic acid–digesting
enzymes
 Protein digesting enzymes: produced in an inactive form =
do not digest the cells of the pancreas
 Trypsin – from trypsinogen
 Trypsin inhibitor: combines with any trypsin formed
accidentally in the pancreas or in pancreatic juice and blocks
its enzymatic activity; Secreted by pancreatic acinar cells
 Enterokinase – brush-border enzyme within the lumen of the
small intestine that activates the trypsinogen into trypsin (by
splitting off part of the former)
 Chymotrypsin – from chymotrypsinogen, activated by
Trypsin
 Carboxypeptidase – from procarboxypeptidase, activated
by Trypsin
 Elastase – from proelastase, activated by Trypsin
 Pancreatic enzymes
digest starches
(polysaccharides),
proteins, triglycerides,
and nucleic acids
◦ Endocrine Cells
 Constitute the pancreatic
islets (islets of
Langerhans), which
accounts for the
remaining 1% of the
clusters
 Secrete the hormones
glucagon, insulin,
somatostatin, and
pancreatic polypeptide
 Liver
◦ heaviest gland of the body, weighing about 1.4 kg
(about 3 lb) in an average adult
◦ second only to the skin in size
◦ Inferior to the diaphragm and occupies most of the right
hypochondriac and part of the epigastric regions of the
abdominopelvic cavity
 Gallbladder
◦ pear-shaped sac
◦ located in a depression of the posterior surface of the
liver
 typically hangs from the anterior inferior margin of the liver
◦ 7–10 cm (3–4 in.) long
 ANATOMY
◦ LIVER
 almost completely covered by visceral peritoneum
 completely covered by a dense irregular connective tissue layer
that lies deep to the peritoneum
 right and left coronary ligaments are narrow extensions of the
parietal peritoneum that suspend the liver from the diaphragm
 divided into two principal lobes by the falciform ligament
(derivative of fold of the mesentery)
 right lobe – larger
 Connected with the quadrate and caudate lobes based on the
internal morphology (primarily the distribution of blood vessels)
 left lobe – smaller
 Contains the quadrate and caudate lobes
 Falciform ligament
 Ligamentum teres – fibrous cord which is a remnant of umbilical
vein of the fetus, extending from the free border of the falciform
ligament of the liver to the umbilicus
◦ Gallbladder
 Parts:
 Fundus: broad, projects inferiorly beyond the inferior border of
the liver
 Body: central portion, projects superiorly
 Neck: tapered portion, projects superiorly
 Histology
◦ Liver
 Hepatocytes: major functional cells of the liver, performing a
wide array of metabolic, secretory, and endocrine functions
 Specialized epithelial cells with 5 to 12 sides that make up about
80% of the volume of the liver
 Hepatic laminae: complex three-dimensional arrangements
formed by the hepatocytes
 plates of hepatocytes one cell thick bordered on either side by the
endothelial-lined vascular spaces called hepatic sinusoids
 Grooves in the cell membranes between neighboring hepatocytes
provide spaces for canaliculi
 highly branched, irregular structures
 Bile canaliculi – small ducts between hepatocytes that
collect bile produced by the hepatocytes
 From here bile passes to bile ductules  bile ducts 
merges to form larger right and left hepatic ducts  unite
and exit the liver to form common hepatic duct  joins
the cystic duct (of gallbaldder) to form common bile duct
 Hepatic sinusoids – highly permeable blood capillaries
between rows of hepatocytes that receive oxygenated
blood from branches of the hepatic artery and
nutrient-rich deoxygenated blood from branches of
the hepatic portal vein
 Hepatic sinusoids (cont)
 Hepatic portal vein – brings venous blood from the
gastrointestinal organs and spleen into the liver (NOTE:
venous blood carries blood that absorbed the nutrients from
the intestines and stomach)
 Pathway: Hepatic Sinusoids (Artery + Portal Vein)  Central
Vein  Hepatic Vein  Inferior Vena Cava
 Because blood from the gastrointestinal tract passes through
the liver as part of the hepatic portal circulation, the liver is
often a site for metastasis of cancer that originates in the GI
tract
 Stellate reticuloendothelial (Kupffer) cells
 Fixed phagocytes which are present in the hepatic sinusoids
 Destroy worn-out white and red blood cells, bacteria, and
other foreign matter in the venous blood draining from the the
gastrointestinal tract.
 Histology of the Liver:
◦ The PORTAL TRIAD
1. bile duct
2. hepatic artery branch
3. hepatic vein branch
 Can be organized into anatomical and functional units
in three different ways (models of hepatic unit):
1. Hepatic lobule
2. Portal lobule
3. Hepatic acinus
 Hepatic lobule: traditionally, the functional unit of the liver
 shaped like a hexagon
 at its center is the central vein, and radiating out from it
are rows of hepatocytes and hepatic sinusoids
 at three corners of the hexagon is a portal triad
 based on a description of the liver of adult pigs
 In humans however, it is difficult to find such well-
defined hepatic lobules surrounded by thick layers of
connective tissue
 Portal lobule: emphasized the exocrine function of the
liver (bile secretion)
 Triangular in shape and is defined by three imaginary
straight lines that connect three central veins that are
closest to the portal triad
 Bile duct as the center of the portal lobule
 Has not gained widespread acceptance
 Hepatic acinus: recently, the preferred structural and
functional unit of the liver is the hepatic acinus
 smallest structural and functional unit of the liver
 approximately oval mass that includes portions of two
neighboring hepatic lobules
 Short axis of the hepatic acinus is defined by branches of
the portal triad — branches of the hepatic artery, vein,
and bile ducts — that run along the border of the hepatic
lobules
 Hepatocytes in the hepatic acinus are arranged in three zones
around the short axis, with no sharp boundaries between
them
 long axis of the acinus is defined by two imaginary
curved lines, which connect the two central veins closest
to the short axis
 ZONING of Cells in the Hepatic Acinus:
 Cells in zone 1:
 are closest to the branches of the portal triad and the
first to receive incoming oxygen, nutrients, and toxins
from incoming blood
 first ones to take up glucose and store it as glycogen
after a meal and break down glycogen to glucose during
fasting.
 first to show morphological changes following bile duct
obstruction or exposure to toxic substances.
 last ones to die if circulation is impaired and the first
ones to regenerate
 Cells in zone 2:
 have structural and functional characteristics
intermediate between the cells in zones 1 and 3.
 Cells in zone 3:
 farthest from branches of the portal triad
 the last to show the effects of bile obstruction or
exposure to toxins,
 the first ones to show the effects of impaired circulation,
and the last ones to regenerate
 the first to show evidence of fat accumulation.
 HISTOLOGY OF THE GALLBLADDER:
◦ mucosa consists of simple columnar epithelium
arranged in rugae resembling those of the stomach
◦ Wall lacks a submucosa
 The middle, muscular coat of the wall consists of smooth
muscle fibers
 Contraction of the smooth muscle fibers ejects the contents
of the gallbladder into the cystic duct
◦ Visceral peritoneum: gallbladder’s outer coat
 FUNCTIONS OF THE GALLBLADDER:
◦ to store and concentrate the bile produced by the liver
(up to tenfold) until it is needed in the small intestine
◦ Water and ions are absorbed by the gallbladder mucosa
in the concentration process
The pathways for bile Splanchnic Circulation includes the
blood vessels of the
and blood gastrointestinal system
 ROLE AND COMPOSITION OF BILE
◦ From the hepatocytes:
 Secrete 800–1000 mL (about 1 qt) of bile
 Yellow, brownish, or olive-green liquid. It has a pH of 7.6–
8.6
 Consists mostly of water, bile salts, cholesterol, a
phospholipid called lecithin, bile pigments, and several
ions
 Principal bile pigment: bilirubin
 From phagocytosis of aged red blood cells  liberates
iron, globin, and bilirubin (derived from heme)
 Partially an excretory product and partially a digestive
secretion
 Bilirubin is secreted into the bile and is eventually broken
down in the intestine
 Bile salts:
 sodium salts and potassium salts of bile acids (mostly
chenodeoxycholic acid and cholic acid)
 liver cholesterol forms bile acids: Pathway of cholesterol –
 new LDLs and atherogenic plaques; or
 Bile acids (esp, after eating Oat Bran):
 Most of the cholesterol formed in the liver is converted into
bile acids and secreted in this form into the duodenum 
more than 90 percent is reabsorbed in the terminal ileum
and used over and over again in the bile
 Result: any agent that combines with the bile acids in the
gastrointestinal tract and prevents their reabsorption into
the circulation can decrease the total bile acid pool in the
circulating blood.
 Bile Salts (cont)
 play a role in emulsification, the breakdown of large lipid
globules into a suspension of small lipid globules
 Increase in surface area that allows pancreatic lipase to more
rapidly accomplish digestion of triglycerides
 aid in the absorption of lipids following their digestion
 Gallstones: Formed from crystallization of cholesterol that
occurs when bile contains either insufficient bile salts or
lecithin or excessive cholesterol
 Although hepatocytes continually release bile, they increase
production and secretion when the portal blood contains
more bile acids
 As digestion and absorption continue in the small intestine,
bile release increases
 Between meals, after most absorption has occurred, bile
flows into the gallbladder for storage because the sphincter
of the hepatopancreatic ampulla (sphincter of Oddi) closes off
the entrance to the duodenum
◦ Summary of Liver Functions:
 Secreting bile
 Carbohydrate metabolism
 Low blood glucose:
 liver can break down glycogen to glucose
 convert certain amino acids and lactic acid to glucose
 convert other sugars, such as fructose and galactose, into
glucose
 High blood glucose: (esp after meals)
 converts glucose to glycogen and triglycerides for storage
 Lipid metabolism
 store some triglycerides
 break down fatty acids to generate ATP
 synthesize lipoproteins, which transport fatty acids,
triglycerides, and cholesterol to and from body cells;
synthesize cholesterol
 use cholesterol to make bile salts
 Protein metabolism
 Deaminate (remove the amino group, NH2, from) amino
acids so that the amino acids can be used for ATP
production or converted to carbohydrates or fats
 Resulting toxic ammonia (NH3) is then converted into the
much less toxic urea, which is excreted in urine
 In liver failure, glutamate reacts with Ammonia resulting
to decrease excitatory neurotransmitters
 Synthesize most plasma proteins, such as alpha and beta
globulins, albumin, prothrombin, and fibrinogen
 Processing of drugs and hormones
 Detoxify substances such as alcohol and excrete drugs such
as penicillin, erythromycin, and sulfonamides into bile
 First-Pass Metabolism: Medicine absorbed by the GIT goes to
the liver via the hepatic portal
 Results to great reduction of concentration of a drug
before it reaches the systemic circulation
 Liver metabolizes many drugs, sometimes to such an extent that
only a small amount of active drug emerges from the liver to the
rest of the circulatory system
 First-Pass Metabolism (cont)
 Major factors are enzyme activity, plasma protein and
blood cell binding, and gastrointestinal motility
 Four primary systems that affect the first pass effect of a drug
are the enzymes of the gastrointestinal lumen, gut wall
enzymes, bacterial enzymes, and hepatic enzymes
 Drugs that experience a significant first-pass effect
are morphine, lidocaine, propanolol, diazepam,
neostigmine, nifedipine
 Drugs with high first pass effect have a considerably
higher oral dose than sublingual or parentral dose
 Inhalation or buccal, rectal or transdermal administration may,
in part, obviate the problems of extensive first-pass
metabolism of an oral dose
 Can also chemically alter or excrete thyroid hormones and
steroid hormones such as estrogens and aldosterone
 Excretion of bilirubin
 Most of the bilirubin in bile is metabolized in the small
intestine by bacteria and eliminated in feces
 Synthesis of bile salts
 used in the small intestine for the emulsification and
absorption of lipids
 Storage
 the liver is a prime storage site for certain vitamins (A,
B12, D, E, and K) and minerals (iron and copper), which are
released from the liver when needed elsewhere in the
body
 Phagocytosis
 Stellate reticuloendothelial (Kupffer) cells of the liver
phagocytize aged red blood cells, white blood cells, and
some bacteria
 Activation of vitamin D
 Skin, liver, and kidneys participate in synthesizing the
active form of vitamin D
 Sunlight converts 7-dehydrocholesterol in the skin to
cholecalciferol (vitamin D3)
 A liver enzyme then converts cholecalciferol to 25-
hydroxycholecalciferol
 second enzyme in the kidneys converts 25-
hydroxycholecalciferol to calcitriol (1,25-
dihydroxycalciferol), which is the active form of vitamin D
 Most is excreted in bile
 Where most digestion and absorption of
nutrients occur
 Features:
◦ Increased surface area for digestion and absorption
secondary to:
 Length
 Further increased by circular folds, villi, and microvilli
◦ Dimensions:
 It averages 2.5 cm (1 in.) in diameter
 Its length is about 3 m (10 ft) in a living person
 About 6.5 m (21 ft) in a cadaver due to the loss of smooth
muscle tone after death
◦ Parts:
 Start: pyloric sphincter of the stomach
 Duodenum
 Aka, 12 finger-widths
 shortest region, retroperitoneal
 extends from pyloric sphincter about 25 cm (10 in.) until it
merges with the jejunum
 Jejunum
 about 1 m (3 ft) long and extends to the ileum
 Ileum
 measures about 2 m (6 ft)
 joins the large intestine at a smooth muscle sphincter called
the ileocecal sphincter
 final and longest region of the small intestine
◦ Histology
 Layer:
1. Mucosa
 Composed of:
 layer of epithelium
 consists of simple columnar epithelium that contains many types
of cells:
 Absorptive cells – digest and absorb nutrients in small intestinal
chyme
 Goblet cells – secrete mucus
 Intestinal glands (crypts of Lieberkühn) - secrete intestinal juice
 Paneth cells – secrete lysozyme, a bactericidal enzyme, and are
capable of phagocytosis; regulates the microbial population in
the small intestine
 Enteroendocrine cells – S cells, CCK cells, and K cells, which
secrete the hormones secretin, Cholecystokinin or CCK, and
glucose-dependent insulinotropic peptide or GIP, respectively
 lamina propria
 contains areolar connective tissue and has an abundance of
mucosa-associated lymphoid tissue (MALT)
 Solitary lymphatic nodules: most numerous in the distal part
of the ileum
 Aggregated lymphatic follicles (Peyer’s patches): Groups of
lymphatic nodules also present in the ileum
 muscularis mucosae
 Layer of smooth muscle
2. Submucosa
 In the duodenum contains duodenal (Brunner’s) glands:
secrete an alkaline mucus that helps neutralize gastric acid
in the chyme
 lymphatic tissue of the lamina propria may at times extend
through the muscularis mucosae into the submucosa
3. Muscularis
 Consists of two layers of smooth muscle
 Outer, thinner layer contains longitudinal fibers
 the inner, thicker layer contains circular fibers
4. Serosa
 Except for a major portion of the duodenum, the serosa (or
visceral peritoneum) completely surrounds the small
intestine
◦ Histology
 Special Structures: to facilitate the process of digestion
and absorption
 Circular folds
 Aka, Plicae circulares
 Permanent ridges/ folds of the mucosa and submucosa
extending in a fully or partially circular manner
 about 10 mm (0.4 in.) long, begin near the proximal
portion of the duodenum and end at about the midportion
of the ileum
 enhance absorption by:
 increasing surface area
 causing the chyme to spiral, rather than move in a
straight line, as it passes through the small intestine
 Villi
 Finger-like projections of the mucosa that are 0.5–1 mm long
 Large number of villi (2 0–40 per square millimeter) vastly
increases the surface area of the epithelium available for
absorption and digestion and gives the intestinal mucosa a
velvety appearance
 Covered by epithelium and has a core of lamina propria;
embedded in the connective tissue of the lamina propria are
the following:
 Arteriole
 Venule
 blood capillary network
 Lacteal: is a lymphatic capillary
 Nutrients absorbed by the epithelial cells covering the villus
pass through the wall of a capillary or a lacteal to enter blood
or lymph, respectively
 Microvilli
 projections of the apical (free) membrane of the absorptive
cells
 Each is a 1 m-long cylindrical, membrane-covered
projection that contains a bundle of 20–30 actin filaments
 Form a fuzzy line (called the brush border) extending into
the lumen of the small intestine
 ~200 million microvilli per square millimeter of small
intestine
 greatly increase the surface area of the plasma
membrane
 also contains several brush-border enzymes that have
digestive functions
 INTESTINAL JUICES
 About 1–2 liters (1–2 qt) of intestinal juice secreted each
day
 clear yellow fluid, contains water and mucus, and slightly
alkaline (pH 7.6)
 brush-border enzymes: synthesized from absorptive cells
of the small intestine and inserted in the plasma membrane
of the microvilli
 Allows some enzymatic digestion to occur at the surface
of the absorptive cells that line the villi, rather than in the
lumen exclusively, as occurs in other parts of the GI tract
 Brush-border enzymes:
 four carbohydrate-digesting enzymes called -dextrinase,
maltase, sucrase, and lactase
 protein-digesting enzymes called peptidases (aminopeptidase
and dipeptidase)
 two types of nucleotide-digesting enzymes, nucleosidases and
phosphatases.
◦ DIGESTION
 Mechanical Digestion
 Two types of movements of the small intestine: governed
mainly by the myenteric plexus
 Segmentations: localized, mixing contractions that occur in
portions of intestine distended by a large volume of chyme
 Starts with the contractions of circular muscle fibers
 Followed by muscle fibers that encircle the middle of
each segment also contract
 The fibers that first contracted relax, and each small
segment unites with an adjoining small segment so that
large segments are formed again
 Segmentations occur most rapidly in the duodenum,
about 12 times per minute, and progressively slow to
about 8 times per minute in the ileum
 Migrating motility complexes (a type of peristalsis)
 Aka MMC
 After most of a meal has been absorbed, which lessens
distension of the wall of the small intestine,
segmentation stops and peristalsis begins
 Begins in the lower portion of the stomach and pushes
chyme forward along a short stretch of small intestine
before dying out
 Slowly migrates down the small intestine, reaching the
end of the ileum in 90–120 minutes
 Altogether, chyme remains in the small intestine for 3–5
hours
 Chemical Digestion
 Review:
 Mouth: salivary amylase + starch (polysaccharide) 
maltose (disaccharide), maltotriose (trisaccharide), and -
dextrins (short-chain, branched fragments of starch with
5–10 glucose units)
 Stomach: pepsin + proteins  peptides (small fragments of
proteins); lingual and gastric lipases + some triglycerides
 fatty acids, diglycerides, and monoglycerides
 Chyme entering the small intestine contains partially
digested carbohydrates, proteins, and lipids
 The completion of the digestion of carbohydrates,
proteins, and lipids is a collective effort of pancreatic
juice, bile, and intestinal juice in the small intestine
 Absorption:
◦ Long-chain fatty acids and monoglycerides are absorbed into
lacteals; other products of digestion enter blood capillaries.
 Absorption
 Absorption
◦ Absorption of Vitamins
 The fat-soluble vitamins A, D,
E, and K are included with
ingested dietary lipids in
micelles and are absorbed via
simple diffusion.
 Most water-soluble vitamins,
such as most B vitamins and
vitamin C, also are absorbed
via simple diffusion.
 Vitamin B12, however,
combines with intrinsic factor
produced by the stomach,
and the combination is
absorbed in the ileum via an
active transport mechanism.
 Terminal portion of the GI tract
◦ Functional Overview:
 the completion of absorption
 The production of certain vitamins
 The formation of feces
 The expulsion of feces from the body
 Anatomy:
◦ Dimensions: 1.5 m (5 ft) long and 6.5 cm (2.5 in.) in
diameter
◦ Boundaries: extends from the ileum to the anus
 Parts:
◦ ileocecal sphincter (valve): Opening from the ileum into the
large intestine is guarded by a fold of mucous membrane
◦ Cecum: a small pouch about 6 cm (2.4 in.) long
◦ appendix or vermiform appendix: twisted, coiled tube,
measuring about 8 cm (3 in.) in length
 Mesoappendix: Mesentery of the appendix, attaches the appendix to
the inferior part of the mesentery of the ileum
◦ Colon: long tube merging with the open end of the cecum;
divided into ascending, transverse, descending, and sigmoid
portions
◦ Rectum: last 20 cm (8 in.) of the GI tract, lies anterior to the
sacrum and coccyx
 anal canal: terminal 2–3 cm (1 in.) of the rectum
 anal columns: longitudinal fold arrangement of the mucous membrane of
the anal canal
 Anus: opening of the anal canal to the exterior
 internal anal sphincter of smooth muscle (involuntary)
 external anal sphincter of skeletal muscle (voluntary)
 Histology of the Large Intestine
◦ Layers:
 Mucosa: of the large intestine does not have as many
structural adaptations that increase surface area, except
for microvilli are present on the absorptive cells
(compared with Small Intestine)
 Simple columnar epithelium
 intestinal glands (crypts of Lieberkühn): long, straight,
tubular glands, extend the full thickness of the mucosa
 lamina propria (areolar connective tissue)
 Solitary lymphatic nodules – may extend through the
muscularis mucosae into the submucosa
 muscularis mucosae (smooth muscle)
 Submucosa
 Muscularis
 Longitudinal smooth muscle – external
 Teniae coli: three conspicuous bands formed from the
thickened portions of the longitudinal muscles
 Separated by portions of the wall with less or no longitudinal
muscle
 Tonic contractions of the bands gather the colon into a
series of pouches called haustra (singular is haustrum),
which give the colon a puckered appearance
 Circular smooth muscle – internal
 Serosa
 Part of the visceral peritoneum
 Small pouches of visceral peritoneum filled with fat are
attached to teniae coli and are called omental (fatty)
appendices
 Functions:
1. Haustral churning, peristalsis, and mass
peristalsis drive the contents of the colon into
the rectum.
2. Bacteria in the large intestine convert proteins to
amino acids, break down amino acids, and
produce some B vitamins and vitamin K.
3. Absorbing some water, ions, and vitamins.
4. Forming feces.
5. Defecating (emptying the rectum).
 Mechanical Digestion
◦ Passage of chyme from the ileum into the cecum is
regulated by the action of the ileocecal sphincter
 Whenever the cecum is distended, the degree of contraction
of the ileocecal sphincter intensifies
◦ Gastroileal reflex intensifies peristalsis in the ileum and
forces any chyme into the cecum
◦ Hormone gastrin also relaxes the sphincter
◦ Haustral churning
 Haustra remain relaxed and become distended while they fill
up
 When the distension reaches a certain point, the walls
contract and squeeze the contents into the next haustrum
◦ Peristalsis
 Also occurs, although at a slower rate (3–12
contractions per minute) than in more proximal
portions of the tract
 Mass peristalsis: a strong peristaltic wave that begins
at about the middle of the transverse colon and quickly
drives the contents of the colon into the rectum
 Because food in the stomach initiates this gastrocolic
reflex in the colon, mass peristalsis usually takes place
three or four times a day, during or immediately after
a meal.
 Chemical Digestion
◦ final stage of digestion occurs in the colon through
the activity of bacteria that inhabit the lumen
◦ Mucus is secreted by the glands of the large
intestine
◦ no enzymes are secreted
◦ Bacteria:
 Ferment any remaining carbohydrates and release hydrogen,
carbon dioxide, and methane gases
 Contribute to flatus (gas) in the colon
 Convert any remaining proteins to amino acids and break
down the amino acids into simpler substances: indole,
skatole, hydrogen sulfide, and fatty acids
 indole, skatole:
 Some that remains contribute to fecal odor
 The rest is absorbed and transported to the liver and are
converted to less toxic compounds and excreted in the urine
 Decompose bilirubin to simpler pigments, including
stercobilin, which gives feces their brown color.
 Their products that are absorbed in the colon include several
vitamins needed for normal metabolism, among them some
B vitamins and vitamin K.
 Absorption and Feces Formation
◦ Feces: solid or semisolid because of water
absorption, after staying in the large intestine for
3–10 hours
◦ Chemical composition of feces:
 Water
 inorganic salts
 sloughed-off epithelial cells from the mucosa of the
gastrointestinal tract
 Bacteria
 products of bacterial decomposition
 unabsorbed digested materials
 indigestible parts of food
◦ Absorbed Substances
 H2O
 0.5–1.0 liter enters large intestine minus 100–200 mL leaves large
intestine = absorbed by large intestine
 ions, including sodium and chloride
 Some vitamins
 Defecation
◦ Defecation reflex –
1. Activation of the stretch receptors 
2. Receptors send sensory nerve impulses to the sacral spinal cord 
3. Motor impulses from the cord travel along parasympathetic nerves
back to the descending colon, sigmoid colon, rectum, and anus 
4. Resulting contraction of the longitudinal rectal muscles shortens
the rectum, thereby increasing the pressure within it 
5. The pressure, along with voluntary contractions of the diaphragm
and abdominal muscles, plus parasympathetic stimulation, opens
the internal anal sphincter 
6. External anal sphincter is voluntarily controlled (contraction
postpones defecation, absent in infants)
Digestive Accessory Function Food Enzyme Absorbed At this Transit
Organ Organ/s Digested/ Nutrients point Time
Prepared processe
for d food is
Digestion called

Mouth Teeth Mechanical Carbohydra Salivary None None 1 minute


Digestion te amylase
Tongue Chemical
Digestion
Salivary Ingestion Lipids Lingual
Glands Deglutition lipase

Pharynx None Pathway None None None Bolus None


indicate
d

Esophagus None Pathway None None None 4-8


seconds
Digestive Organ Accessory Function Food Enzyme Absorbed At this Transit
Organ/s Digested/ Nutrients point Time
Prepared for processed
Digestion food is
called
Stomach None Mechanical Carbohydrat Pepsin some water Chyme 2-4 hours
Digestion e
Ions,
Chemical Protein alcohol
Digestion Gastric Some drugs
Lipase (e.g.
Aspirin)
Absorption Lipids short-chain
fatty acids
Small Intestine Pancreas Mechanical Carbohydrat Pancreatic Most 3-5 hours
Digestion e juice substance
s from
Liver Chemical Protein
food and
Digestion
drink
Gall bladder Absorption Lipids Brush
(nutrients,
border
enzymes water, etc.)

Large Intestine None Fermentation None None some B Feces 10 hours


vitamins to several
Absorption Vitamin K days
Defecation Water
ENZYME SOURCE SUBSTRATES PRODUCTS
SALIVA
Salivary amylase Salivary glands Starches Maltose
(polysaccharides) (disaccharide),
maltotriose
(trisaccharide),
and -dextrins
Lingual lipase Lingual glands in Triglycerides (fats Fatty acids and
the tongue and oils) and other diglycerides
lipids
GASTRIC JUICE
Pepsin (activated Stomach chief Proteins Peptides
from pepsinogen cells
by pepsin and
hydrochloric acid)
Gastric lipase Stomach chief Triglycerides (fats Fatty acids and
cells and oils) monoglycerides
ENZYME SOURCE SUBSTRATES PRODUCTS
PANCREATIC JUICE
Pancreatic amylase Pancreatic Starches Maltose
acinar cells (polysaccharides) (disaccharide),
maltotriose
(trisaccharide), and –
dextrins
Trypsin (activated Pancreatic Proteins Peptides
from trypsinogen acinar cells
by enterokinase)
Chymotrypsin Pancreatic Proteins Peptides
(activated from acinar cells
chymotrypsinogen
by trypsin)
Elastase (activated Pancreatic Proteins Peptides
from proelastase acinar cells
by trypsin)
ENZYME SOURCE SUBSTRATES PRODUCTS
PANCREATIC JUICE
Carboxypeptidase Pancreatic Amino acid at Amino acids and
(activated from acinar cells carboxyl end of peptides
procarboxypeptidase peptides
by trypsin)
Pancreatic lipase Pancreatic Triglycerides (fats Fatty acids and
acinar cells and oils) that have monoglycerides
been emulsified
by bile salts
Nucleases
Ribonuclease Pancreatic Ribonucleic acid Nucleotides
acinar cells
Deoxyribonuclease Pancreatic Deoxyribonucleic Nucleotides
acinar cells acid
ENZYME SOURCE SUBSTRATES PRODUCTS
BRUSH BORDER
α-Dextrinase Small intestine α-Dextrins Glucose
Maltase Small intestine Maltose Glucose
Sucrase Small intestine Sucrose Glucose and
Fructose
Lactase Small intestine Lactose Glucose and
Galactose
Enterokinase Small intestine Trypsinogen Trypsin
Peptidases
Aminopeptidase Small intestine Amino acid at Amino acids and
amino end of peptides
peptides
Dipeptidase Small intestine Dipeptides Amino acids
Nucleosidases and Small intestine Nucleotides Nitrogenous
phosphatases bases, pentoses,
and phosphates