Digestion and Absorption in the

Gastrointestinal Tract
Dr. Ebaa Alzayadneh, DDS, PhD

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Basis for Digestion - Hydrolysis

Digestion involves the breakdown or
hydrolysis (addition of water) of nutrients to
smaller molecules that can be absorbed in
small intestine
Carbohydrates - monosaccharides
Proteins - small peptides and amino acids
Fats - 2-monoglycerides and fatty acids

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Types of Digestion
Luminal or cavital digestion -

occurs in lumen of GI tract

enzymes from salivary glands, stomach, pancreas
pancreatic enzymes can do all

Membrane or contact digestion enzymes on brush border of enterocytes

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Digestive Enzymes
Intestinal Mucosa
Salivary glands Pancreas
enterokinase
-amylase
amylase
sucrase
lingual lipase trypsin
maltase
chymotrypsin
Stomach
carboxypeptidase lactase
trehalase
pepsin
elastase
-dextrinase
lipase-colipase
phospholipase A2
(isomaltase)
aminocholesterol
oligopeptidase
esterase
dipeptidase
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Anatomical Basis for Absorption

Total surface area of small intestine is
250 - 400 m2

Small intestine - 4 m long

Folds of Kerckring - 3-fold
Villi - 10-fold
Microvilli - 1000-fold

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 Anatomical Basis for Absorption

Figure 65-5

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Histological Basis for Absorption

Figure 65-6

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Histological Basis for Absorption

Figure 65-7

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Mechanisms of Absorption
Four mechanisms are important in transport
of substances across intestinal cell
membrane
Active Transport - primary
- secondary (co-transport, countertransport)

Passive Diffusion

Facilitated Diffusion - carrier mediated

Endocytosis

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Sodium Electrochemical Gradient

Single most important process in small
intestine to make absorption of nutrients
possible is establishment of electrochemical
gradient of sodium across epithelial cell
boundary of lumen (apical membrane).

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Sites of Absorption
Stomach - ethanol, NSAIDs, aspirin
Duodenum and Jejunum - nutrients,
vitamins, various ions, water and
electrolytes
Ileum - bile salts and vitamin B12
- major clinical significance
Colon- water and electrolytes
Rectum - drugs such as steroids and
salicylates
Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Digestion

Carbohydrates
Proteins
Fats

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Digestion of Carbohydrates
Starch digestion -

Begins with -amylase in saliva (5% digestion in

mouth, up to 40% in stomach)
Continues in small intestine with pancreatic
amylase
Final digestion occurs at brush border

Lactose and sucrose - digestion only

occurs at brush border

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Digestion of Carbohydrates
Starches
- amylase (saliva)
pancreatic amylase

Maltose + 3-9 glucose polymers

Maltase + -dextinase

Glucose

Sucrose

Lactose

Sucrase

Lactase

Galactose

Fructose

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Monosaccharides are Final Product

The final products of carbohydrate digestion
are all monosaccharides, mostly glucose.
1 lactose
1 galactose
1 glucose

1 sucrose
1 fructose
1 glucose

1 maltose & Glu- polymers

glucose

80% glucose
10% fructose
10% galactose

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Absorption of Carbohydrates
Absorption is rate limiting step in
carbohydrate assimilation
Glucose and galactose - secondary active
transport
compete for membrane carrier (SGLUT-1)
energy from Na+-K+ ATPase

Fructose - facilitated diffusion (GLUT-5)

does not require energy
requires concentration gradient

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Abnormalities of
Carbohydrate Assimilation
Lactose Intolerance - most common

Symptoms - abdominal cramps, bloating, diarrhea, and

flatulence
Diagnosis - feed lactose - look for glucose in plasma
Cause - absence of brush border lactase

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Digestion of Proteins
Digestion of proteins to AA occurs in 3
locations Intestinal lumen Stomach - pepsin (digests collagen)
Small intestine - endopeptidases
- exopeptidases
- Brush border - oligopeptidases, dipeptidases
- Cytoplasm of mucosal cells - dipeptidases
-

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Activation/Destruction of Proteases
Proteolytic enzymes are activated and
destroyed very rapidly
Enterokinase activates trypsinogen
Trypsin is autocatalytic
Trypsin activates other proenzymes
Proteolytic enzymes digest themselves

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Protein Digestion and Absorption

Luminal digestion produces 40% amino acids
and 60% small peptides Amino acids - secondary active transport (Na+ dependent) - facilitated
diffusion

Di- and Tri- peptides different carrier system than amino acids
- absorbed faster than amino acids
- hydrolyzed to amino acids in cytoplasm
-

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Protein Digestion and Absorption

Protein
Pepsin
Pancreatic proteases
Di- and Tripeptides

Large
peptides

Free
amino acids

Carriers

Peptidases

Carriers

Dipeptides and tripeptides

Cytoplasmic peptidases

Small
amounts

Amino acids

Amino acids
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Abnormalities of Protein
Assimilation
Pancreatic insufficiency -

pancreatitis or cystic fibrosis

decreased absorption - nitrogen in stool

Congenital absence of trypsin

no trypsin - no other proteolytic enzymes
protein malabsorption

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Assimilation of Lipids
Overall Scheme

Triglyceride
Duodenum
Fatty acid
2-monoglyceride
Enterocyte
Triglyceride
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Basic Steps of Lipid Assimilation

Most dietary lipid is neutral fat or
triglyceride. Three main processes must
occur for triglyceride to be absorbed into
blood:

Emulsification - large aggregates of dietary triglyceride

are broken down.
Enzymatic digestion - to yield monoglyceride and fatty
acids. Both can diffuse into enterocyte.
Reconstitution of triglyceride and chylomicron
formation

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Assimilation of Lipids

FOOD

lecithin
bile salts

apoprotein + TG

Emulsified
fat

(enterocyte)

TG

2-MG
FFA

lipase-colipase

micelles

2-MG
FFA

bile salts
2-MG
FFA
(micelles)

chylomicrons

lymph vessel

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Summary of Lipid Digestion

Products
1- Triglyceride
1- 2-MG
2- FFA
or
1- glycerol
3- FFA

1 cholesterol-ester 1 phospholipid
1- cholesterol
1- lysolecithin
1- FFA
1- FFA
Chylomicron
90% triglyceride
7% phospholipid
2% cholesterol
1% protein

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Chylomicrons - Life Cycle

Formed in enterocyte
and packaged by
Golgi apparatus

Secreted by exocytosis
into interstitial space

FFA and glycerol respired

by cells or resynthesized to
triglycerides for storage

Familial lipoprotein lipase deficiency

Enter central lacteal

of villi and transported
to venous system via
thoracic duct

Lipoprotein lipase (on capillary

EC) works w/ apolipoprotein C
to degrade triglyceride to FFA
and glycerol within
chylomicron
Chylomicron remnant is
phagocytized in hepatocytes

Hypertriglyceridemia
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Chylomicrons - Life Cycle

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Digestion of Triglycerides
1
2
3
Triglyceride

Pancreatic
Lipase

+
2-Monoglyceride Free Fatty Acid
Cholesterolester
Hydrolase

+
Free Fatty Acid glycerol

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Malabsorption
Malabsorption as a general phenomenon is defined
clinically in terms of fat malabsorption because fat
can be measured easily in stool, unlike
carbohydrates and proteins.
Motility disorders - moving through too rapidly
Digestion disorder - pancreatitis / cystic fibrosis (not enough lipase)
Absorption disorder - tropical and nontropical
sprue - resection of small intestine
Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Fluid and Electrolyte Absorption

and secretion

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Fluid Entering and Exiting the Gut

Volume (L/day)

10
8

Volume
entering

Volume
absorbed

Diet (2)

Duodenum
and
Jejunum (4)

Saliva (1)

6
4
2

Stomach
(2)
Bile (1)

Ileum
(3.5)

Pancreas (1)
S.I. (2)

Colon (1.4)

Volume
Excreted
100-200 ml

0
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Water Movement in Small Intestine

Water moves into or out of gut lumen by
diffusion in accordance with osmotic
forces Hypotonic chyme - water is absorbed
Hypertonic chyme - water enters intestine

Chyme is isosmotic with plasma except in

colon. Stool water is hypertonic.

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Sodium Absorption Causes

Water Absorption
Sodium is absorbed by epithelial cells
(enterocytes) of small intestine.
Sodium uptake creates negative electrical
potential in gut lumen, that provides gradient
for chloride uptake.
Water follows sodium and chloride in
accordance with osmotic forces.

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Intestinal Sodium Balance

15% of total body sodium is absorbed each day
by intestine

Diet
S.I. secretion
Intestinal absorption Excretion in feces -

5-8 g/day
20-30 g/day
25-35 g/day
0.1 g/day

Decreased absorption of sodium can lead to

rapid sodium depletion and death.

Copyright 2011 by Saunders, an imprint of Elsevier Inc.

Water Secretion by Small Intestine

Large quantities of water are secreted into
lumen of small intestine during digestive
process.
Two processes establish an osmotic
gradient that pulls water into lumen of
intestine:

Increased osmotic pressure resulting from digestion of foodstuffs

Crypt cells actively secrete electrolytes, leading to water secretion

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Diarrhea
Diarrhea is the third leading cause of death
by disease worldwide

5-8 million children per year worldwide

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Common Causes of Diarrhea

Increased secretion and/or increased motility
of large or small intestine.

Infectious diarrhea - viruses, bacteria, protozoa

Ulcerative colitis Drug related Psychogenic diarrhea -

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