Happ Finals Week 15

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DIGESTIVE DIVISION OF DIGESTIVE SYSTEM

SYSTEM Alimentary Tube it consists of the oral cavity,


pharynx, esophagus,
stomach, small intestine,
and large intestine
Prof: Mr. Red Steven Nillo, RMT
Accessory Organ it consists of teeth, tongue,
salivary glands, liver,
PRIMARY FUNCTION gallbladder, and pancreas
● The function of the digestive system is to
change these complex organic nutrient
molecules into simple organic and inorganic
molecules that can be absorbed into the TYPES OF DIGESTION
blood or lymph to be transported to cells.
A. Mechanical
● mechanical digestion is the physical
FUNCTIONS breaking up of food into smaller
pieces
★ Ingestion – is the intake of solid or liquid ● chewing is an example of this
food into the stomach
B. Chemical
★ Mastication – is the process by which the ● the work of the digestive enzymes
teeth chew food in the mouth is the chemical digestion of
broken-up food particles, in which
★ Propulsion – is the movement of food from complex chemical molecules are
one end of the digestive tract to the other. changed into much simpler
These movements include: chemicals that the body can utilize
Swallowing – moves liquids or a
soft mass of food and liquid, called
a bolus END PRODUCT OF DIGESTION
Peristalsis – propels material Carbohydrates carbohydrates, such as
through most of the digestive tract. starches and
❖ peristaltic waves are disaccharides, are
muscular contractions digested to
consisting of a wave of monosaccharides, such as
relaxation glucose, fructose, and
galactose
Mass movements are contractions
that move material in some parts of Proteins proteins are digeProteins
the large intestine are digested to amino
acids
★ Mixing – movement of food back and forth
within the digestive tract to mix it with Fats fats are digested to fatty
digestive secretions and help break it into acids and glycerol
smaller pieces

★ Secretion – as food moves through the


digestive tract, secretions are added to
lubricate, liquefy, buffer, and digest the food

★ Digestion – is the breakdown of large


organic molecules into their component parts

★ Absorption – movement of molecules out of


the digestive tract and into the circulation or
into the lymphatic system

★ Elimination – the process by which the


waste products of digestion are removed
from the body
nerve fibers are also present, part
of what is called the enteric
nervous system

➔ Meissner’s Plexus
(submucosal plexus) –
regulates mucosal
secretion
❖ Parasympathetic:
increases secretion
❖ Sympathetic: decreases
secretion

★ External Muscle Layer – 3rd Layer


● The external muscle layer typically
contains two layers of smooth
muscle: an inner, circular later and
ALIMENTARY TUBE an outer, longitudinal layer.
● Function: contractions of this
muscle layer help break up food
and mix it with digestive juices

➔ Auerbach’s plexus
(myenteric plexus) –
portion of ENS
❖ Parasympathetic:
increases contraction and
peristalsis to promote
digestion
❖ Sympathetic: decreases
contraction and peristalsis

★ Serosa – 4th Layer (Outermost Layer)


● Composed of fibrous connective
tissue. Below the diaphragm, the
STRUCTURAL LAYER OF ALIMENTARY TUBE serosa is the mesentery or visceral
★ Mucosa – 1st Layer peritoneum, a serous membrane.
● The mucosa, or lining, of the ● The serous fluid between the
alimentary tube is made of: peritoneum and mesentery
1. Epithelial tissue – prevents friction when the
secretes mucus, which alimentary tube contracts and the
lubricates the passage of organs slide against one another.
food, and also secretes
the digestive enzymes of
the stomach and small
intestine
2. Areolar CT and
Lymphatic nodules –
protection against
pathogens
3. Two thin layers of
smooth muscle – creates
folds in the mucosa. In the
stomach and small
intestine this is important
for absorption

★ Submucosa – 2nd Layer


● “brain of the gut”
● Made of areolar connective tissue
with many blood vessels and
lymphatic vessels. Many millions of
MOUTH (ORAL CAVITY)
● Food enters the oral cavity (or buccal cavity)
by the way of the mouth. The boundaries of
the oral cavity are the hard and soft palates
superiorly; the cheeks laterally; and the floor
of the mouth inferiorly.

● Within the oral cavity are the teeth and


tongue and the openings of the ducts of the
salivary glands.

★ Lower Esophageal Sphincter (LES)


❖ Circular smooth muscle located at
the junction with the stomach and
the lumen of the esophagus.
❖ The LES relaxes to permit food to
enter the stomach, then contracts
to prevent the backup of stomach
contents.

PHARYNX
GASTROESOPHAGEAL REFLUX (GERD)
● When the bolus of food is pushed backward
by the tongue, the constrictor muscles of the ● If the LES does not close permanently,
pharynx contract as part of the swallowing gastric juice may splash up into the
reflex. esophagus; this is a painful condition we call
heartburn, or gastroesophageal reflux
● Swallowing is rather complicated, but disease (GERD).
because it is a reflex, we don’t have to think
about making it happen correctly.

STOMACH
ESOPHAGUS
● Although part of the alimentary tube, the
● The esophagus is a muscular tube that takes stomach is not a tube, but rather a sac that
food from the pharynx to the stomach; no extends from the esophagus to the small
digestion takes place here. intestine. Because it is a sac, the stomach
is a reservoir for food, so that digestion
● Peristalsis of the esophagus propels food in proceeds gradually and we do not have to
one direction and ensures that food gets to eat constantly.
the stomach even if the body is horizontal or ● Both mechanical and chemical digestion
upside down. take place in the stomach.
polypeptides, and also gives gastric juice its
PARTS OF THE STOMACH pH of 1 to 2.
Cardiac Orifice The cardiac orifice is the opening
of the esophagus

Fundus Portion above level of cardiac


orifice

Body Large central portion, bounded


laterally by the greater curvature
and medially by the lesser
curvature. The fundus and body
are mainly storage areas

Pylorus Adjacent to the duodenum of the


small intestine. Most digestion
takes place in here ALKALINE TIDE
Pyloric Sphincter Surrounds the junction of the two ● Blood pH increases after eating due to
organs parietal cells secretion of bicarbonate to the
blood in exchange of chloride to use in the
Rugae Wrinkles of fold within the stomach production of hydrochloric acid.

Gastric pits Glands of the stomach and consist


of several types of cells; their
collective secretions are called
gastric juice
a. Mucous cells –
secretes mucus and
prevents stomach from
corrosion from gastric
acids
b. Chief cells – secrete
pepsinogen, an inactive
form of the enzyme
pepsin
c. Parietal cells – produce
hydrochloric acid (HCl);
these cells have
enzymes called proton
pumps, which secrete
H+ ions into the
stomach cavity
d. Enteroendocrine
glands – secretes
hormone gastrin that
stimulates production of
gastric acid

GASTRIC EMPTYING TIME


PHYSIOLOGY OF STOMACH ACID
PRODUCTION ● Approximately about 1 to 2 hours before the
food gets totally move from stomach to small
❖ The ability of the parietal cell to secrete acid intestine.
is dependent on active transport which is
the H+/K+ pump or the “proton pump”.

❖ The H+ ions unite with Cl– ions that have


diffused from the parietal cells to form HCl in
the lumen of the stomach.

❖ HCl converts pepsinogen to pepsin, which


then begins the digestion of proteins to
SMALL INTESTINES with abundant lymphatic
tissue
● The small intestine is about 1 inch (2.5 cm)
in diameter and approximately 20 ft (6 m)
Ascending, Descending and Sigmoid Colon
long and extends from the stomach to the
cecum of the large intestine.
Rectum 6 inches long
● Digestion is completed in the small
intestine, and the end products of digestion
are absorbed into the blood and lymph. Anus the terminal end of the
colon

PARTS OF SMALL INTESTINE Taenia coli longitudinal smooth


muscle layer of the
Duodenum First 10 inches (25 cm) of colon is in three bands
the small intestine. The
common bile duct enters Haustra pockets of the colon
the duodenum at the
ampulla of Vater (or
hepatopancreatic ampulla).

The jejunum is about 8 ft long

Ileum about 11 ft in length

LARGE INTESTINES
● The large intestine, also called the colon, is
approximately 2.5 inches (6.3 cm) in
diameter and 5 ft (1.5 m) in length. It extends FUNCTION OF LARGE INTESTINE
from the ileum of the small intestine to the
anus, the terminal opening. ● The functions of the colon are absorption of
● No digestion takes place in large intestine water, minerals, and vitamins and the
elimination of indigestible material.
● About 80% of water that enters the colon is
absorbed (400-800 mL per day),.
PARTS OF THE LARGE INTESTINE
● It contains about trillions of normal flora that
one of the function is to prevent growth of
Cecum the first portion, and at pathogens.
its junction with the
ileum is the ileocecal
valve, which is not a ELIMINATION OF FECES
sphincter but serves the
● Feces consist of cellulose and other
same purpose
indigestible material, dead and living
bacteria, and water.
Appendix a small, dead-end tube
● Elimination of feces is accomplished by the
defecation reflex, a spinal cord reflex that TEETH
may be controlled voluntarily. ● The function of the teeth is, of course,
● Stretch receptors in the smooth muscle layer chewing. This is the process that
of the rectum generate sensory impulses mechanically breaks food into smaller pieces
that travel to the sacral spinal cord. The and mixes it with saliva.
returning motor impulses cause the smooth ● 2 SETS OF TEETH
muscle of the rectum to contract. ★ Deciduous Teeth (milk teeth) –
starts to erupt at about 6 mos of
ANAL SPHINCTER age and the set of 20 teeth is
usually completed by the age of 2
★ Internal Anal Sphincter – made of smooth years old.
muscle that surrounds the anus. As part of ★ Permanent Teeth – starts to show
the reflex, this sphincter relaxes, permitting at the age of 6 years old and a
defecation to take place. complete set of 36 teeth.
★ External Anal Sphincter – the external anal
sphincter is made of skeletal muscle and ● TYPES OF TEETH
surrounds the internal anal sphincter. ❖ The types of teeth are incisors,
canines, premolars, and molars.
ACTION OF SPHINCTER The wisdom teeth are the third
➢ If defecation must be delayed, the external molars on either side of each
sphincter may be voluntarily contracted to jawbone.
close the anus. The awareness of the need
to defecate passes as the stretch receptors
of the rectum adapt. These receptors will be
stimulated again when the next wave of
peristalsis reaches the rectum.

BRISTOL CHART

● STRUCTURE OF A TOOTH

ACCESSORY ORGANS

TONGUE
● The tongue is made of skeletal muscle that
is innervated by the hypoglossal nerves
(12th cranial).
● Elevation of the tongue is the first step in
swallowing. This is a voluntary action, in
which the tongue contracts and meets the
resistance of the hard palate. The mass of
food, called a bolus, is thus pushed
backward toward the pharynx.
LIVER
● The liver is the LARGEST internal organ
that weighs around 1.2-1.6 kg. It consists of
two large lobes, right and left, and fills the
upper right and center of the abdominal
cavity, just below the diaphragm.
● Liver Lobule – hexagonal structural unit of
the liver that contains hepatocytes.

LIVER BLOOD CIRCULATION


SALIVARY GLAND ● Between adjacent lobules are branches of
the hepatic artery and portal vein.
● The digestive secretion in the oral cavity is
saliva, produced by three (3) pairs of salivary ● The capillaries of a lobule are sinusoids,
glands. These glands are: large and very permeable vessels between
★ Parotid gland – located just below the rows of liver cells. The sinusoids receive
and in front of the ears blood from both the hepatic artery and portal
★ Submandibular gland – located at vein, and it is with this mixture of blood that
the posterior corners of the the liver cells carry out their functions.
mandible
★ Sublingual glands – located below ● The hepatic artery brings oxygenated
the floor of the mouth blood, and the portal vein brings blood from
the digestive organs and spleen.

● Each lobule has a central vein.


➢ The central veins of all the lobules
unite to form the hepatic veins,
which take blood out of the liver to
the inferior vena cava

HEPATIC CIRCULATION
● Hepatic Artery – provides oxygenated blood
to the liver that contributes to 25% of hepatic
circulation.
COMPOSITION OF SALIVA ● Hepatic Vein – connects to inferior vena
● Saliva is mostly water, which is important to cava that brings back blood to the heart
dissolve food for tasting and to moisten food ● Portal Vein – brings deoxygenated blood
for swallowing. from abdominal organs to the liver.
● Salivary Amylase – digestive enzyme in Contributes to about 75% of hepatic
saliva is salivary amylase, which breaks circulation.
down starch molecules to shorter chains of
glucose molecules, or to maltose, a
disaccharide.
● Saliva is made from blood plasma and
thus contains many of the chemicals that are
found in plasma.
complete, new amino acid
molecule

Deamination Excess amino acids, those not


needed right away for protein
synthesis, cannot be stored.
However, they do serve another
useful purpose. By the process
of deamination, which also
occurs in the liver, the NH2 group
is removed from an amino acid,
and the remaining carbon chain
may be converted to a simple
carbohydrate molecule or fat.

★ Lipid Metabolism
● The liver forms lipoproteins, which
as their name tells us, are
molecules of lipids and proteins, for
the transport of fats in the blood to
other tissues. The liver also
synthesizes cholesterol and
excretes excess cholesterol into
bile to be eliminated in feces.

★ Beta Oxidation – the long


carbon acids are split into
two-carbon molecules
called acetyl groups, which
are simple carbohydrates.
These acetyl groups may
OTHER FUNCTIONS OF THE LIVER be used by the liver cells
★ Carbohydrate Metabolism to produce ATP or may be
● The liver regulates the blood combined to form ketones
glucose level. Excess glucose is to be transported in the
converted to glycogen blood to other cells. These
(glycogenesis) when blood other cells then use the
glucose is high; the hormones ketones to produce ATP in
insulin and cortisol facilitate this cell respiration.
process
● During hypoglycemia or stress ★ Synthesis of Plasma Proteins
situations, glycogen is converted ● The liver synthesizes many of the
back to glucose (glycogenolysis) proteins that circulate in the blood.
to raise the blood glucose level. Albumin, the most abundant
Epinephrine and glucagon are the plasma protein, helps maintain
hormones that facilitate this blood volume by pulling tissue fluid
process. into capillaries.
GLYCOGEN is the storage ● The clotting factors are also
produced by the liver:
form of glucose!
Prothrombin, fibrinogen,
★ Amino Acid Metabolism and Factor VIII, which
● The liver regulates blood levels of circulate in the blood until
amino acids based on tissue needs needed in the chemical
for protein synthesis. The liver is clotting mechanism.
able to synthesize 12, called the
nonessential amino acids. ★ Formation or Bilirubin
● This is another familiar function:
The liver contains fixed
Transamination process of transfer of an amino macrophages that phagocytize old
group (NH2) from an amino acid
red blood cells (RBCs).
present in excess to a free
carbon chain that forms a ★ Bilirubin is then formed
from the heme portion of
the hemoglobin. The liver
also removes from the
blood the bilirubin formed
in the spleen and red bone
marrow and excretes it
into bile to be eliminated in
feces.

★ Phagocytosis of Kupffer Cells


● The fixed macrophages of the liver
are called Kupffer cells. They
phagocytize pathogens or other
foreign material that circulate
through the liver. Many of the
GALLBLADDER
bacteria that get to the liver come
from the colon. These bacteris are ● The gallbladder is a sac about 3 to 4 inches
part of the normal flora of the colon (7.5 to 10 cm) long located on the
but would be very harmful undersurface of the right lobe of the liver.
elsewhere in the body. Bile in the hepatic duct of the liver flows
through the cystic duct into the gallbladder,
★ Storage which stores bile until it is needed in the
● The liver stores the fat-soluble small intestine. The gallbladder also
vitamins A, D, E, and K, and the concentrates bile by absorbing water.
water-soluble vitamin B12 such as
minerals like iron and copper. ★ Cholecystokinin – secreted by
enteroendocrine cells in duodenum.
★ Detoxifaction This hormone stimulates smooth
● The liver is capable of synthesizing muscle in the wall of the gallbladder
enzymes that will detoxify harmful which forces bile into the cystic
substances, that is, change them to duct, then into the common bile
less harmful ones. duct, and on into the duodenum.
● Alcohol, for example, is changed to
acetate, which is a two carbon
molecule (an acetyl group) that can
be used in cell respiration.
● Ammonia that is toxic to the body is
converted to ammonia in the liver
for excretion in the kidneys.

BILE PRODUCTION
● Digestive function of liver cells is bile
production.
BILE COMPOSITION & FUNCTION
● Production of bile is stimulated by the
hormone secretin, which is produced by the ● Bile is mostly water and has an excretory
duodenum when food enters the small function in that it carries bilirubin and excess
intestine. cholesterol to the intestines for elimination in
feces.
● Bile enters the small bile ducts, called bile ● Bile salts responsible in emulsification of
canaliculi, on the liver cells, which unite to fats in the small intestines.
form larger ducts and finally merge to form ★ Emulsification – means that large
the hepatic duct, which takes bile out of the fat globules are broken into smaller
liver. The hepatic duct unites with the cystic globules. This is mechanical, not
duct of the gallbladder to form the common chemical digestion, the fat is still fat
bile duct, which takes bile to the duodenum. but now has more surface area to
facilitate chemical digestion. The
emulsifying or fat-separating action
of bile salts increases the surface
area of fats so that lipase works
effectively.
PANCREAS ABSORPTION
● The pancreas is located in the upper left ● Most absorption of the end products of
abdominal quadrant between the curve of digestion takes place in the small intestine.
the duodenum and the spleen and is about ● Plica circulares, or circular folds, are
6 inches (15 cm) in length. macroscopic folds of the mucosa and
● The exocrine glands of the pancreas are submucosa, somewhat like accordion pleats.
called acini. They produces enzymes that
are involved in the digestion of all three ● The mucosa is further folded into projections
types of complex food molecules. called villi, which give the inner surface of
the intestine a velvet like appearance. Each
columnar cell (except the mucus-secreting
PANCREATIC ENZYMES goblet cells) of the villi also has microvilli on
its surface.
Pancreatic digests starch to maltose
Amylase
● The absorption of nutrients takes place from
the lumen of the intestine into the vessels
Lipase converts emulsified fats to fatty
acids and glycerol
within the villi wherein capillaries and lacteal
which is the dead-end lymph capillary can be
Trypsinogen An active enzyme that is changed found.
to active trypsin in the duodenum.
Trypsin digests polypeptides to ★ Osmosis and Active Transport –
shorter chains of amino acids. manner of absorption for water
soluble vitamins/water and some
The pancreatic enzyme juice is carried by small ducts ions.
that unite to form larger ducts, then finally the main
pancreatic duct. An accessory duct may also be present.
The main pancreatic duct emerges from the medial side FAT ABSORPTION
of the pancreas and joins the common bile duct to the
duodenum. 1. Fat-soluble nutrients are absorbed into the
lymph in the lacteals of the villi.
Bicarbonate juice neutralize the acidic pH that enters 2. Bile salts are necessary for the efficient
the duodenum absorption of fatty acids and the fat-soluble
vitamins (A, D, E, and K).
Secretion of pancreatic juice is stimulated by the 3. Once absorbed, fatty acids are recombined
hormones secretin and cholecystokinin which are with glycerol to form triglycerides. These
produced by the duodenal mucosa when chyme enters triglycerides then form globules that include
the small intestine. cholesterol and protein; these lipid-protein
complexes are called chylomicrons.
Secretin stimulates the production of bicarbonate juice by 4. In the form of chylomicrons, most absorbed
the pancreas.
fat is transported by the lymph and
eventually enters the blood in the left
Cholecystokinin stimulates the secretion of the
subclavian vein.
pancreatic enzymes
DIGESTIVE DISORDER

GLUTEN ENTEROPATHY (Celiac Disease)


● It is an autoimmune disorder of the small
intestine. Normally, the body’s immune
system is designed to protect it from foreign
invaders.
● When people with celiac disease eats foods
that contain gluten, their immune systems
attack the lining of the intestine.
➔ This causes inflammation (swelling)
in the intestines and damages the
villi, the hair-like structures on the
lining of the small intestine.
➔ Nutrients from food are absorbed
by the villi. If the villi are damaged,
the person cannot absorb nutrients
and ends up malnourished, no
matter how much he or she eats.
INTUSSUSCEPTION
● Intussusception occurs when a part of the
intestine folds into itself like a telescope. This
prevents the passage of food through the
intestine.

IRRITABLE BOWEL DISEASE (IBD)


● Localized inflammatory degeneration that
may occur anywhere along the digestive
tract but most commonly involves the distal
ileum and proximal colon; the intestinal wall
often becomes thickened, constricting the
lumen, with ulcers and fissures in the
damaged areas; symptoms include:
➔ diarrhea, abdominal pain, fever,
fatigue, and weight loss
● Cause is unknown
● Treatments involve anti-inflammatory drugs,
avoidance of foods that produce symptoms,
and surgery in some cases; also called
Crohn disease or ulcerative colitis

● Disorder of unknown cause marked by


alternating bouts of constipation and
diarrhea; may be linked to stress or
depression; high familial incidence

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