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The

Digestive
System-
Chapters 62-
66; 70; 78
Figure 62-1; Guyton & Hall 1
Digestive Processes
Ingestion
Propulsion
Digestion: Mechanical and
Chemical digestion
Absorption- nutrients and
water
Defecation

2
Layers Alimentary Canal
1. Serosa
2. Longitudinal muscle
(muscularis externa)
3. Myenteric
(Auerbachs) nerve
plexus
4. Circular muscle
5. Submucosa
6. Submucosal
(Meissners) nerve
plexus
7. Muscularis mucosae
8. Mucosa
9. Epithelial lining
3
Autonomic nerve
fibers
Both divisions found in myenteric
and submucosal nerve plexi
What do they do?
Sensory neurons that monitor
tension, and efferent visceral
motor fibers. OWN SYSTEM!
Myenteric-GI motility control
Stimulatoryinfluences

toniccontraction(tone)
contractionfrequency/
intensity(propulsion)
Inhibitoryinfluences

DecreasedSphinctertone
(relax)pyloricsphincter,
ileocecalsphincter,LES
Submucosal- Local control
Secretion
Absorption
Contractionofmuscularismucosa
4
Control of the digestive
system
Movement of materials
along the digestive
tract is controlled by:
Neural mechanisms
Parasympathetic (Ach)
and local reflexes
Hormonal mechanisms
Enhance or inhibit
smooth muscle
contraction
Local mechanisms
Coordinate response to
changes in pH or
chemical stimuli and
stretching
5
Digestive Enzymes
Salivary glands Intestinal Mucosa
-amylase enterokinase
sucrase
lingual lipase maltase
lactase
Stomach Pancreas
pepsin amylase amino-
trypsin oligopeptidase
chymotrypsin dipeptidase
carboxypeptidase
lipase
cholesterolesterase

6
The mouth opens into the Primary Secretion

oral or buccal cavity


Alpha-amylase

Its functions include:


Analysis of material
before swallowing
Mechanical processing by
the teeth, tongue, and
palatal surfaces
Lubrication
Limited digestion
Lingual lipase (negligible
fat digestion)
Salivary amylase (limited
carbohydrate digestion)
Antibodies and
proteolytic enzymes

7
Digestion and absorption in
the stomach
Short-term storage
reservoir
Secretion of intrinsic
factor
Pepsinogen
gastrin
Chemical and enzymatic
digestion is initiated,
particularly of proteins
Liquefaction of food
Slowly released into the
small intestine for further
processing
8
Gastric glands
Two types glands -
Gastric HCl
(oxyntic) pepsinogen
intrinsicfactor
mucus

Pyloric gastrin
mucus

9
Gastric glands- 3 types of
cells
Mucous Neck cell
(goblet)- release
mucus to protect 80%
mucosa from acid and
pepsin
Parietal cells- HCl and
intrinsic factor (B12
absorption by small
intestine).
Chief- numerous and
release pepsinogen

10
Acid production and
secretion
BLOOD LUMEN
H2O HO- + H
+

CO2 CO2
C.A. Final Results
HCO HCO P
H +
HCl - 155 mEq/L
3 + 3 K+ K+ K +
KCl - 15 mEq/L
K H2O
P NaCl - 3 mEq.L
Na+ Na+ Na+ P Na+
Cl-
P pH = 0.8
Cl- Cl Cl-
-
H2O
osmosis
11
2 cell types of Pyloric gland
Gcellsreleasegastrin
Enteroendocrine cells
-stimulates parietal
cells to secrete acid
and increases pyloric
contraction; relaxes 20%
pyloric sphincter

Mucusneckcells
mucous

12
Gastric and
Duodenal ulcers
Weakens
H.pylori,aspirin,ethanol,
NSAIDs,
Strengthens
bilesalts mucus,HCO3secretion,
gastrin,PGs,epidermalgrowth
factor

Peptic ulcers occur when damaging effects of


acid and pepsin overcome ability of mucosa
to protect itself
Gastriculcersmainproblemisdecreasedabilityof
mucosatoprotectitself
Duodenalulcersmainproblemisexposuretoincreased
amountsofacidandpepsin 13
What is the Gastric Mucosal
Barrier?
alkaline mucus resists the acid and enzymes
Tight junctions-gastric juice cant seep into
lamina propria
Epithelial cell replacement- 3-6 day life span.
PhysiologicaldiffusedH+ionsaretransportedback to
lumen
Damaged Gastric Mucosal Barrier
H+ back-leaks into mucosa in exchange for Na+. This is a
forerunner to gastric ulcer -
DecreasedcellpHleadstocelldeath
Damagedmastcells(ECLcells)leakhistamine
ViscouscycleHistamine..vasculardamage.. local ischemia .. greater leakage of
14
H+.. more cell death ...
Helicobacter pylori
H. pylori found in 95% patients with DU
and 100% patients with GU (when alcohol,
aspirin, NSAIDS are eliminated)

Gramnegativebacterium
HighureaseactivityhighNH4+activity
- can withstand acid environment
- NH4+ damages epithelial cells (GU)
- Increases acid secretion (DU)

15
Treatment of Peptic Ulcers
Antacids
H2 receptor blockers - Rantidine (Zantac)
- Cimetidine (Tagamet)
Proton pump inhibitors - Omeparazole
(Prilosec)
Antibiotics
Surgical (rare) - vagotomy
- antrectomy

16
Stimulation of acid
secretion Seeing, smelling and anticipating food is perceived in brain. Brain tells stomach to
prepare for receipt of meal
Accounts for 30% of acid response to meal

Gastric secretion is
stimulated by local
(distention), neural, and
endocrine mechanisms
Acetylcholine - HCl
secretion
- mucus, pepsinogen, and
gastrin 60%
Histamine - HCl
secretion
Gastrin - HCl
secretion (1500x more
powerful compared to 10%
histamine)

17
Small intestine
Important digestive and
absorptive functions
Secretions and buffers
provided by pancreas,
liver, gall bladder
Three subdivisions:
Duodenum
Jejunum
Ileum
Ileocecal sphincter
Transition between small
and large intestine

18
Histology of the small intestine
Plicae
Transverse folds of the intestinal lining
Villi
Fingerlike projections of the mucosa
Lacteals
Terminal lymphatic in villus
Microvilli
Brush border: increases surface area 20-fold

19
Intestinal glands
secretin to stimulate
pancreas to release
bicarbonate mucus
cholecystokinin to
stimulate pancreas
and gallbladder
Gastric Inhibitory
peptide (GIP)-
inhibits gastrin
secretion and
decreases stomach
emptying
Duodenal glands-
bicarbonate mucus.
20
The Activities of Major Digestive Tract
Hormones

21

Figure 24.22
Small Intestine- digestive
enzymes
Maltase- splits maltose into 2 glucose
units
Lactase- splits lactose into glucose
and galactose
Sucrase- splits sucrose into glucose
and fructose
Peptidase- breaks down small
peptides into amino acids
Intestinal lipase- breaks down
triglycerides into free fatty acids and
monoglycerides
Enterokinase- Activates trypsinogen
to trypsin (trypsin then activates
chymotrypsinogen and
procarboxypeptidase)
22
Pancreas
As chyme floods into small intestine two
things must happen:
Acidmustbeneutralizedtopreventdamageto
duodenalmucosa
Macromolecularnutrientsproteins,fatsandstarch
mustbebrokendownmuchfurthersotheir
constituentscanbeabsorbed
Pancreas plays vital role in accomplishing both objectives

Digestive enzymes for all food types

Bicarbonate solution to neutralize acid chyme


23
Regulation of Pancreatic
Secretion
Secretin and CCK are
released when fatty or acidic
chyme enters the duodenum
CCK and secretin enter the
bloodstream
Upon reaching the pancreas:
CCK induces the secretion of
enzyme-rich pancreatic juice
Secretin causes secretion of
bicarbonate-rich pancreatic
juice
Vagal stimulation also causes
release of pancreatic juice

24
The Pancreas

Exocrine function
(98%)
Acinar cells make,
store, and secrete
pancreatic enzymes
Endocrine function
( cells) release
somatostatin (inhibitory
to gastrin and insulin and
glucagon)
-cells release insulin
-cells-Release glucagon
25
The Pancreas as an Endocrine
Gland
Insulin
Beta cells
Skeletal muscle and
adipose tissue need it to
make glucose receptors
Promotes glucose uptake
Prevents fat and glycogen
breakdown and inhibits
gluconeogenesis
Epi/Norepi inhibit insulin!
Increases protein Help maintain glucose levels
synthesis during times of stress and
Promotes fat storage increase lipase activity in
order to conserve glucose
levels

26
Picture from:http://www.dkimages.com/discover/Home/Health-and-Beauty/Human-Body/Endocrine-System/Pancreas/Pancreas-1.html
The Pancreas as an Endocrine
Gland
Glucagon
Maintains blood glucose
between meals and during
periods of fasting.
Nervous tissue (brain) do
not need insulin; but are
heavily dependent on
glucose levels!
Increases blood glucose
levels.
Initiates glycogenolysis in
liver (within minutes)
Stimulates amino acid
transport to liver to Image from: http://www.dkimages.com/discover/previews/768/74261.JPG

stimulate gluconeogenesis
27
Disorders of the Pancreas:
Diabetes Mellitus
Gestational Diabetes
Type I diabetes develops
suddenly, usually before
age 15
Destruction of the beta cells
Skeletal tissue and adipose
cells must use alternative
fuel and this leads to
ketoacidosis
Hyperglycemia results in
diabetic coma

28
Disorders of the Pancreas:
Diabetes Mellitus
Type II diabetes and
metabolic syndrome
adult onset
Usually occurs after age
40
Cells have lowered
sensitivity to insulin
Controlled by dietary
changes and regular
exercise

29
30
Pancreatic Failure
Digestion is abnormal when pancreas
fails
to secrete normal amounts of

enzymes.
Pancreatitis
Removalofpancreaticheadmalignancy

Without pancreatic enzymes -


60%fatnotabsorbed(steatorrhea)
3040%proteinandcarbohydratesnotabsorbed

31
Pancreatitis
Pancreatitis means inflammation of pancreas.
Autodigestion theory can explain condition.

Chronic pancreatitis - (multiple shared


causes)
alcoholmostcommoncauseinadults
cysticfibrosismostcommoncauseinchildre
CF patients lack chloride transporter at apical membrane.
Watery ductal secretion decreases which concentrates acinar secretions in
ducts.
Precipitation of proteinaceous secretions block ducts and can destroy
gland by autodigestion.

Acute pancreatitis - (multiple shared causes)


Gallstonesmostcommoncause
32
Absorption of digested polymers is
linked to Salt Absorption in Small
Intestine
Sodium is absorbed across apical cell
membrane by 4 mechanisms -
1. Diffusion - through water-filled channels
2. Co-transport - with AA and glucose
3. Co-transport - with chloride
4. Counter-transport - in exchange for H+

Chloride follows electrical gradient created


by absorption of sodium

33
Sodium Absorption in Small
Intestine 1 Na Na + +

Na+ S
2 S Na+ Na+ Na+
P
Na+ K+ K+
3 Cl-
Cl- Na+
4 Na+
H+ Na+
Aldosterone H+
increases
Cl- Cl-
Na+ reabsorption
and K+ secretion in
S.I. and colon. 34
Chemical Digestion:
Carbohydrates
Begins in the mouth (minimal) and
mostly occurs in small intestine when
pancreatic enzymes are released
Absorption of monosaccharides occurs
across the intestinal epithelia
Absorption: via cotransport with Na+,
and facilitated diffusion
Enter the capillary bed in the villi
Transported to the liver via the hepatic
portal vein lumen

Enzymes used: salivary amylase,


pancreatic amylase, and brush border
enzymes (maltase, lactase, and
sucrase)
35
Chemical
Digestion:
Proteins
Absorption: similar to
carbohydrates (sodium co-
transport)
Enzymes used: pepsin in
the stomach
Enzymes acting in the
small intestine
Pancreatic enzymes
trypsin, chymotrypsin, and
carboxypolypeptidase
(these must be activated!)
Brush border enzymes
peptidases

36
Lipid digestion and
absorption
Lipid digestion utilizes
lingual and pancreatic
lipases, cholesterol esterase
(cleaves ester bond to
release cholesterol) and
phospholipases release fatty
acids and monoglycerides.
Bile salts improve chemical
digestion by emulsifying lipid
drops
Lipid-bile salt complexes called
micelles are formed

37
Fatty Acid
Absorption
Fatty acids and
monoglycerides enter
intestinal cells via
diffusion; bile salts can be
reused to ferry more
monoglycerides
They are combined with
proteins within the cells
Resulting chylomicrons are
extruded
They enter lacteals and are
transported to the
circulation via lymph

38
Sprue
Diseases that result in decreased
absorption even when food is well digested
are often classified as sprue -
- Nontropical sprue - also called celiac disease
allergictogluten(wheat,rye)
- destroys microvilli and sometimes
villi
- Tropical sprue - bacterium (?)
- treated with antibacterial agents

Steatorrhea - if stool fat is in the form of


FFA - digestion has occurred

39
Fluid Entering and Exiting the
Gut Volume Volume 95% of water is
10 entering absorbed in the small
absorbed intestines by osmosis
Duodenum Water moves in both
8
Volume(L/day)

Diet(2) directions across


and
intestinal mucosa
Saliva(1) Jejunum(4) Net osmosis occurs
6 Stomach
whenever a
concentration gradient
(2) is established by active
4 Ileum transport of solutes into
Bile(1) (3.5) the mucosal cells

Pancreas(1)
2 Volume
S.I.(2) Excreted
Colon(1.4) 100200ml
0 40
The Liver
Digestive function bile
production; emulsifies fats
Bilirubin- decomposed
hemoglobin
Urobilinogen- by-
product of bilirubin
metabolism
bile salts- keep
cholesterol dissolved
in bile
Performs many metabolic
functions- stores vitamins,
processes fats, detoxifies,
makes blood proteins

41
Physiology of the large
intestine
Reabsorption in the large
intestine includes:
Water and electrolets
Bacteria make: Vitamins
K, biotin, and B5
Organic wastes
urobilinogens and
sterobilinogens
Bile salts
Toxins
Mass movements of material
through colon and rectum
Defecation reflex triggered
by distention of rectal walls
42
Figure 8-18 Agents that stimulate and inhibit H+ secretion by gastric parietal cells. ACh, Acetylcholine; cAMP, cyclic adenosine monophosphate;
CCK, cholecystokinin; ECL, enterochromaffin-like; IP3, inositol 1,4,5-triphosphate; M, muscarinic.

Downloaded from: StudentConsult (on 23 April 2010 06:51 PM)


2005 Elsevier
Figure 8-19 Regulation of HCl secretion during cephalic and gastric phases. ACh, Acetylcholine; GRP, gastrin-releasing peptide (bombesin).

Downloaded from: StudentConsult (on 23 April 2010 06:51 PM)


2005 Elsevier
Figure 8-20 Balance of protective and damaging factors on gastroduodenal mucosa. H. pylori, Helicobacter pylori; NSAIDs, nonsteroidal anti-
inflammatory drugs.

Downloaded from: StudentConsult (on 23 April 2010 06:51 PM)


2005 Elsevier
Figure 8-15 Secretory products of various gastric cells.

Downloaded from: StudentConsult (on 23 April 2010 06:51 PM)


2005 Elsevier

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