Physiology of the Digestive System

Suggested Ref Book Salivary gland

 Ganong. Review of medical Mouth Pharynx
physiology. 2010.

Esophagus
Digestive System:
Liver
Stomach
A group of organs that work
collectively to fulfill the Pancreas
process of digestion and Gall bladder
Duodenum
absorption of Large
water, electrolytes, vitamins, Intestine
and organic nutrients. Small
intestine
Rectum1
Anus
 Digestive System – Functional anatomy
(4 components)

1. Upper Digestive Tract: mouth, esophagus, stomach

 Chewing and salivation and then swallowing
 Salivary α-amylase (Ptyaline)initiates the
carbohydrate digestion.
o Stomach: storage organ for food
- It discharges its content into duodenum at
controlled rate
- HCl aids in digestion and activates pepsin

2
2. Middle part: Small Intestine:
duodenum, jejunum and ileum
o The muscular movements
facilitate digestion & absorption
and move unabsorbed materials
into the large intestine.
o Practically all carbohydrates,
proteins and lipids, and most
water and inorganic ions are
absorbed in the small intestine.

3. Lower part: cecum, colon and rectum

oAbsorption of Na+ and water is complete in the proximal part
oWhen the rectum is distended, the defecation reflex is
activated 3
4. Accessory structures: salivary
glands, liver and pancreas
• Salivary glands: involved in digestion,
lubrication and protection
• Exocrine Pancreas: HCO3- for
neutralization of gastric acid, enzymes
• Bile
 Secreted into duodenum in response
to the ingestion of food.
 Bile salts for:
• fat emulsification
• solubilization of fat products

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 Six Processes of Digestive System
1. Ingestion: taking in of the food
2. Motility: mixing and propulsive movements
3. Secretion: digestive enzymes, hormones, inorganic ions,
mucin, liver products, vitamines.
4. Digestion: breakdown of food into small molecules
o Mechanical vs. Chemical digestion
5. Absorption: transfer of micronutrients to blood and lymph
6. Defecation: removal of waste

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 Two Major Types of Movements in the GI tract:
Phasic and Tonic

1. Phasic contractions
 Periodic contractions followed by relaxation; such as in gastric
antrum, small intestine and esophagus

2.Tonic contraction - Sustained

contraction found in the proximal part of
stomach and in sphincters.
 Lower esophageal sphincter, pyloric sphincter, Oddi
sphincter, ileocecal sphincter, & internal anal sphincter.
 The magnitude of tone is controlled by nerves
and hormones.
 UES and external anal sphincter consist of Ileocecal
skeletal muscle under voluntary control. 6
 Regulation of GIT Activities
• They initiate reflexes that: Activate or inhibit digestive gl
ands and/or mix lumen contents and move them along
• Regulated by
• Neural
• Hormonal
• Paracrine
 Specifically the controls and systems are:
• The Long reflexes (Feed forward, emotional reflexes -initiated
and integrated entirely outside the GI tract - cephalic reflexes)
• Short Reflexes (Integrated in the ENS: ganglionic-gastrocolic)
• GI peptide reflexes (enterogastric reflex)
 Enteric Nervous System
mini/visceral/Gut brain
 Intrinsic Innervation (Autonomous = Enteric Nervous System).
 Has as many neurons as spinal cord (~ 100 million)
o Myenteric (Auerbach’s or outer) plexus between longitudinal and
circular muscle fibers and is concerned primarily with motor
control (intensity of rhythm of contraction).

oSubmucosal plexus (Meissner’s or

inner plexus) innervates the
glandular epithelium, intestinal
endocrine cells, and submucosal
blood vessels
primarily controls intestinal
secretion and blood flow.
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 Extrinsic Neural Control of GI Tract
- Extrinsic Innervation
(increase or decrease ENS)
- PSNS (vagus & pelvic
nerves): Excitatory to
smooth muscles and
cholinergic ENS

- SNS (T5-L2): Inhibitory to

cholinergic ENS and
reduce intestinal blood flow,
increase sphincter tension,
lower motility
 Two Major Types of Movements in the GI tract:
Propulsive and Mixing
1. Propulsive Movements - Peristalsis
 A contractile ring appears around the gut and then
moves forward (Law of the gut: mouth to anus)
 An inherent property of many syncytial smooth muscle
= Mass movement in large intestine
 Stimuli:
• Distension,
• Chemical or physical
Irritation of epithelial lining
• Strong parasympathetic signals

10
 Control of Peristalsis by
Vagovagal Reflexes in the Lower Esophagus

11
2. Mixing Movements - differ in different part of GI tract.
 Causes most of the mixing.
o Occurs when forward progress of intestinal contents is blocked
by a sphincter.
 Segmentation: constrictive contractions in small intestine.
 Haustration: segmentation in large intestine.

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Sites of production of GI hormones
along the length of the GI tract
13
 Mouth and Esophagus

Chewing, Salivary Secretion, and Swallowing

 Chewing (mastication) reduces the size and mixes with saliva.
o brings food into contact with taste receptors and releases odors.
o voluntary and automatic initiated by buccal receptors.
o prevents overeating
 Allow passage of food & fluids to esophagus & air to trachea.
 Esophagus: Skeletal (upper 1/3rd) and smooth (lower 2/3rd)
 Salivary secretion is regulated by long neural reflexes.

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CHEMICAL DIGESTION

Chemical digestion of starch

begins by salivary amylase
present in saliva produced mainly
by the parotid, buccal, submandi
bular glands.

Mumps is an inflammation and enlargement of parotid glands

accompanied by extreme pain in the throat, especially when
swallowing sour foods or acid juices.

15
 Formation and secretion of saliva
 Two stages in secretion: acini x salivary duct
(by acini)
(α-amylase)

isoosmotic to plasma

Modification of saliva by Duct cells:

- high potassium
- low osmolarity 16
 Functions of Saliva
1. Digestion
 Ptyalin (α-amylase): identical to pancreatic amylase, 75 % of starch, p
H optimum 7
 Increases the sensitivity of taste buds
 Bollus formation
2. Lubrication
 Facilitates swallowing and speech
3. Protection
 Dilution and buffering of harmful substances
 Salivation before vomiting
 Lysozyme (bacteriocidal), IgA, lactoferin (binds iron)

CC- xerostomia - frequent oral infections

 Esophagus
Functional anatomy: 25 cm long, C6 – T12, upper 1/3rd striated,
lower 1/3rd smooth. UES = striated, LES = smooth and tonically
contracted and prevent GERD.
Deglutition (Swallowing) reflex
 Moves food from the mouth to the stomach. It is facilitated by
saliva and mucus and involves mouth, pharynx, & esophagus.
 Three stages:
1) Buccal (Oral, voluntary) stage: in which the bolus is moved from
mouth into the oropharynx by the tongue.
2) Pharyngeal stage: the involuntary passage of bolus through the
pharynx into the esophagus
3) Esophageal stage: the passage through the esophagus into the
stomach by involuntary muscular movements called peristalsis.
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Pharyngeal stage

 Begins when food reaches oropharynx (sensitive tactile receptor area)

 The bolus stimulates receptors on the oropharynx, which send impulses
to the deglutition center in the medulla/pons(via IX, V).
 The trachea is closed (breathing is temporarily stopped), esophagus is
opened.
 Soft palate and uvula move upward to close off nasopharynx, and the
larynx is pulled forward and upward and seals off glottis.
 A fast peristaltic by pharynx forces the bolus into esophagus, the entire
process occurring in less than 2 seconds ( 2 sec, V, IX, X).

In anesthesia cough and swallowing are depressed, hence no protective

reflexes, secretion/vomitus accumulate in the pharynx and enter trachea
- choking. 19
 Stomach STOMACH
Fundus, corpus and antrum are the functional parts
Esophagus
Fundus
(thin)
Serosa
Cardia Muscularis
Longitudinal layer
Circular layer
Corpus (Body) Oblique layer
Lesser curvature (proximal half)

Duodenum Antrum
(thicker, pump)
Pyloric Greater curvature
sphincter Rugae of mucosa
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Physiological events: Mechanical & chemical digestion, propulsion, absorption
 From the motility/functional standpoint:
 Proximal stomach (cardia, fundus, and
proximal 1/3 of corpus)
o Food reservoir (1 – 2 liters)
 Distal stomach (distal 2/3 of corpus,
antrum, and pylorus)
 Mixing/grinding, controlling delivery
of chyme to duodenum.

 Chemical breakdown of proteins begins

and food is converted to chyme (semifluid,
homogeneous, creamy material).
 The chemical digestion of carbohydrates,
which begin in the oral cavity, is
terminated due to a decrease in pH.

21
 Peristalsis in Stomach
Smooth muscle cells of the proximal stomach show sustained tonic contraction. They
relax to accommodate food in response to swallowing reflex mediated by
mechanoreceptors in the pharynx (= Receptive relaxation)

Esophagus

Stretch receptors in orad stomach intiate

Stomach vagovagal reflex/NO or VIP
Pyloric
sphincter

Duodenum
retropulsion
Initiated by -seeing, smelling, thought (coditioned reflex mediated by X nerve)
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-tasting & esophagus muscle stretch (vagovagal reflex)
 Gastric Emptying
 For ~ 20% of the time while food is in the stomach, the peristaltic
contractions become intense, providing pumping action through the
pylorus.
 The stomach usually empties completely within 4 hours after a meal.
 The rate of gastric emptying is regulated by signals (neural and
hormonal) from both stomach and duodenum.
 Hyperosmotic, fat/protein-rich and acidic chime and duodenal distension
 Enterogastric reflex (CCK, Secretin)

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 CCK

Gall Oddi
Pancreas Stomach
Bladder Sphincter

Enzyme Contraction Reduced Relaxation

secretion emptying

• Carbohydrate, protein, lipid digestion and absorption

• Matching of nutrients to digestive and absorptive capacity
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 Secretin

Biliary
Stomach Stomach Pancreas
ducts

Stim. Pepsin sec Reduced Stimulates Stimulates

Inhib. HCl sec emptying HCO3- sec HCO3- sec

• Protein digestion. Neutralizes the intestinal contents

• Matching of nutrients to digestive and absorptive capacity
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Gastric Secretion
• Mucous neck Cells/goblet
cells: Mucus
• Parietal Cells:
- HCl – bacteriolytic, iron Mucous cell
absorption, prevent ca++ ppt
- Intrinsic factor
(for absorption of vitamin B12 ) Parietal
cell
• Chief Cells: Pepsinogen
Zymogenic
(peptic) cell
- Pepsinogen is
converted to
pepsin by H+ or HCl.

Enteroendocrine cells – 26
secrete gastrin, histamine...
 Stomach Lining: Protection against auto digestion
 The stomach is exposed to the harshest conditions in the GIT.
 To keep from digesting itself, the stomach has a mucosal barrier with the f
ollowing strategies :

o A thick coat of bicarbonate-rich mucus on the stomach wall

o Epithelial cells that are joined by tight junctions

o Gastric glands that have cells imperme

able to HCl
o Damaged epithelial cells are quickly r
eplaced (high turnover)
Regulation of Gastric Secretion

Cephalic phase (30-40%)

via vagus
- Excite pepsin and HCl production
- Prepares stomach for digestion

Gastric phase (50-60%)

1. Local nervous
secretory reflexes
2. Vagovagal reflexes
3. Gastrin-histamine stimulation

Intestinal phase (10%)

1. Nervous mechanisms
(enterogas reflex
2. Hormonal mechanisms
(int gastrin, sec-cck)
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Pancreas, gallbladder and associated ducts

DD7
DD-7

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 Pancreatic Secretion
Islet of
Langerhans
(Endocrine)
Capillary
Pancreas: Mixed gland
Endocrine function
– Release insulin, glucagon, somatostatin,
pancreatic polypeptide 腺胞
Acinar

Exocrine function Acinar cells

- Secretes pancreatic juice which breaks (Enzyme
down all food stuff secretion)
- Acini (clusters of secretory cells) contain Intercalated
zymoges with digestive enzymes duct

• Ductule Cell: HCO3. Ductule cells

(Bicarbonate
• Acinar Cell: Enzymes (Amylase, lipase, trypsin, secretion)
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nucleases, carboxypetidase) To pancreatic duct
 Control of Pancreatic Secretion Parasympathetic (vagus)
(sight, smell, taste, thought,
chewing, swallowing --)
Sympathetic inhibits
Chyme containing partially digested
carbohydrates, proteins, fat, hypertonic or Cephalic phase : 20%
hypotonic fluids, or irritating substances ↑pancreatic
enzyme secretion
Intestinal
Phase : 80%
of secretion
A diet high in one type of
food (protein, CHO, fat)
results in the preferential
production of enzymes
for that particular food.

↑pancreatic ↑pancreatic
bicarbonate enzyme
secretion secretion
Secretin
Cholecystokinin (CCK) 31
 Activation of Pancreatic Proteolytic Enzymes
Intestinal
lumen Proteases are released in inactive form
and activated in the duodenum.
Other enzymes secreted in active form
-Amylase: alpha linkages
-lipases: with co-lipases, Ch-esterase
-nucleases:
Pancreas

Epithelial
cells

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Trypsin Inhibitor Prevents Digestion of the Pancreas Itself
 Bile Secretion
 Bile secreted by liver cell (hepatocytes, 0.5 – 1 L/day) is diverted through
cystic duct into the gall bladder where it is concentrated.
 After meal, contractions of gall bladder move bile through the common bile
duct and Oddi sphincter into duodenum.
 Bile contains bile pigment (bilirubin, biliverdin), bile salts, cholesterol,
lecithin, fatty acids, inorganic salts and water.
 Bile salts play an essential role in the digestion and absorption of fat.
 Bile salts are recycled between the liver and small intestine (enterohepatic
circulation).

If the cholesterol concentration exceeds the capacity of the bile salts and
lecithin to dissolve cholesterol, it precipitates out of solution, forming small
crystals which grow gradually into large gall stones.
33
 Bile Secretion 4. CCK stimulates muscular layer of gall
Gall bladder bladder wall to contract (ACh)

5. Bile passes down bile duct to duodenum

Blood vessel
6. HP Sphincter relaxes and bile enters
1. Chyme with fat enters duodenum(VIP & NO mediation)
small intestine
HP = hepathopancreatic sphincter
2. Cells of intestinal mucosa
secrete CCK

3. Blood transports CCK

away from duodenum
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Duodenum
 Liver Function
Liver is the largest gland in the body
1. Bile formation and secretion
2. Synthesis of plasma proteins (Acute-phase proteins, albumin,
clotting factors....) and coagulation factors
3. Metabolic function
o Glycogen – glycogen storage, glycolysis, gluconeogenesis
o Fat metabolism – Fat synthesis and degradation, phospholipid and
cholesterol synthesis
o Protein – synthesis of plasma protein, urea and deamination
3. Protection and detoxification (Kupffer’s cell)
4. Blood volume control – blood storage and release,
erythropoiesis in fetus (gestation 4 - 5 month)
5. Storage (iron, vitamines) 35
 The Small Intestine (6 - 7 m, diameter 2.5 cm)

Physiological events: Mechanical,chemical digestion, absorption, propulsion

36
 The Small Intestine
• Motility
Segmentation contractions (mixing movement) and peristalsis
(propulsive movement).
– Segmentation Movement (common)
- Circular muscle contracts at several places, dividing intestinal
contents into a series of segments.
- Each segment divides, with adjoining halves, and their content
coming together to form new segment (controlled by ENT).

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Migrating motor/Mobility complexes (MMC).
 a strong peristaltic contraction wave passes down the length in
intestine from stomach to the ileocecal valve (motilin, every 2 hrs)
 The MMC clear food debris, mucus, and sloughed epithelial cells
from the intestine between meals (= housekeeping function).
 If they are pathologically absent, then bacterial overgrowth results.
 Common during fasting.
Peristaltic rush
 Powerful and rapid peristalsis caused by intense irritation of the
intestinal mucosa, as in severe of infectious diarrhea
 Sweeping the contents into the colon and thereby relieving the small
intestine of irritative chyme and excess distension.
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Ileocecal valve and ileocecal sphincter
 Prevent backflow of fecal contents from the colon into the small intestine.
 Retains the majority of GI flora within the colon, opening only
intermittently to permit the residue of digested meal to enter the large
intestine.

Bacterial flora: Colonize the colon, ferment indigestible carbohydrates,

release irritating acids and gases (flatus) and synthesize vit.B complex &K

Intestinal secretions (Succus Entericus)

 Mucus - Preventing from acidic chyme from stomach
 Brunner’s glands (mucus, HCO3-)
 Goblet cells
 Digestive juice
 Water and Electrolytes (1L-1.5L/d)
 Crypts of Leiberkhun- produce enteropeptidase.
• Enzymes = enteropeptidase and glycosidase(=maltase, sucrase, lactase)
Carbohydrate Digestion and Absorption
 Luminal and Microvillus Membrane Digestion.
 Enzymes used: salivary amylase, pancreatic amylase, and brush
border enzymes

Absorption: via cotransport with Na+, and facilitated diffusion. Transp

orted to the liver via the hepatic portal vein.
Protein Digestion and Absorption
o Digestive enzymes used: pepsin in the stomach (??), intraluminal
pancreatic proteases (endopeptidases), brush border/ectopeptidases
(amino/carboxy/di peptidases), cytosolic (peptidases)
Absorption of protein products: like carbohydrates
 Amino acids are transported into the portal blood by specific
carrier-mediated transport systems in the microvilli.

PEPT1

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Fat Digestion and Absorption
Fat Bile Emulsified fat
 Bile salts interact with MG and FFA to form micelles rendering
them water soluble →↑ surface area for lipase action
Glycerol and short chain fatty acids are:
Absorbed into the capillary blood in villi
& transported via the hepatic portal vein
Long-chain fatty acids and Mono- Free fatty
glycerides acids
monoglycerides: a layer of
phospholipid and protein is added to
each droplet forming chylomicron,
which enters central lacteal of the
Triglyceroles
villus and carried by lymphatic
system. smooth ER
Protein Phospholid
Chylomicron: Chylomicron
Have a core of tri-glyceride Rough ER
Golgi
surrounded by phospholipids,
Exocytosis
cholesterol ester and proteins, vit.
Central
lacteal

Steatorrhea: Impaired fat digestion or absorption. Supplies of calories and

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absorption of fat-soluble vitamins (A, D, E, K) may be inadequate.
 LARGE INTESTINES
PHYSIOLOGICAL EVENTS
1. Absorption
VITAMINS,
ELECTROLYTES,
AND WATER

2. Propulsion

Though essential for comfort,

colon is not essential for life 45
 Modes of electrolyte and Water Absorption

• Most water is absorbed in the small intestine

~ 7-9 L/ 24 hours!),
~ 400- 600 mL/d is absorbed in the colon.

• Small intestine- water follows nutrients

• Large intestine- water follows electrolytes!

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 Water Balance of The Digestive System

Volume Entering the GI Tract .

Ingestion 2000 ml/day
Salivary Secretion 1500
Gastric Secretion 2500
Biliary Secretion 500
Pancreatic Secretion 1500
S. Intestinal Secretion 1000 (Total Sec 7000)
Total Entering 9000 .
Volume Absorbed from GI Tract
Small Intestine 8500
Large Intestine 400
Total absorbed 8900 .
Feces 100
47
 Segmenting contractions (“haustrations”, mixing movements)
promote water absorption from the proximal colon, resulting in a
firm fecal mass.

 Mass movements occur within the large intestines.

 long slow-moving waves that occur 3 or 4 times per day.
 The presence of food in the stomach activates the gastroileal reflex
and then the gastrocolic reflex.
 Then defecation reflex is elicited by distension of the rectum.
 Typically mass movements occur during or after eating.
 However defecation is under voluntary control as the external
anal sphincter is skeletal muscle.

48
Afferent and efferent pathways for defecation reflex

49
 Regulation of Food Intake

Energy intake
 Energy intake is calories consumed as food, which is determined by hunger
(hypothalamus) and choice (cerebral cortex).
– Lateral hypothalamus: hunger
– Ventromedial hypothalamus: satiety
 Hunger is determined by the impact of the hormones on the hypothalamus.

Energy expenditure
 Is mainly a sum of internal heat produced and external work.
– The internal heat produced = BMR and the thermic effect of food.
– External work = estimated by measuring physical activity level (PAL).
Factors affecting appetite and satiety
 Energy-Balance Equation= DCI-TCB

 TCB = total calories burned (energy during day-to-day

activities).

o BMR = basal metabolic rate - the amount of energy used by

cells/tissues and the body to perform vital functions
~ 60 – 75% TCB

 DCI = Daily Caloric Intake (total calories ingested in a 24 hr.)

Metabolic Phases:4
1. digestive or absorptive (~ caloric surplus)
 Occurs during the 2 to 3 hours that it takes to digest a discrete meal

2. Inter-digestive or postabsorptive
 Occurs between meals

4. strenuous exercise
 Imposes an intense energy demand for a relatively short period.
 Energy source ~ intensity and duration of exercise
(ATP---PC/ADP ---Glycolysis----Aerobic respiration)
(Fat vs. Carbohydrate)

3. Fasting
 Occurs between the last snack before bedtime and breakfast.
 Prolonged fasting and starvation are extreme forms of fasting
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