DIGESTIVE SYSTEM

INTRODUCTION A. Food contains substances and energy the body needs to construct all cell components. The food must be broken down through digestion to molecular size before it can be absorbed by the digestive system and used by the cells. The organs that collectively perform these functions compose the digestive system. The medical professions that study the structures, functions and disorders of the digestive tract are gastroenterology for the upper end of the system and proctology for the lower end.

B.

C.

OVERVIEW OF THE DIGESTIVE SYSTEM A. Organization 1. The two major sections of the digestive system perform the processes required to prepare food for use in the body (Fig. 24.1). 2. The gastrointestinal tract is the tube open at both ends for the transit of food during processing. The functional segments of the GI tract include the mouth, esophagus, stomach, small intestine and large intestine.

3. The accessory structures that contribute to the food processing include the teeth, tongue, salivary glands, liver, gallbladder and pancreas.

B.

Digestion includes six basic processes 1. 2. Ingestion is taking food into the mouth (eating). Secretion is the release by cells within the walls of the GI tract and accessory organs, of water, acid, buffers and enzymes into the lumen of the tract. Mixing and propulsion result from the alternating contraction and relaxation of the smooth muscles within the walls of the GI tract. Digestion a) b) Mechanical digestion consists of movements of the GI tract that aid chemical digestion. Chemical digestion is a series of catabolic (hydrolysis) reactions that break down large carbohydrate, lipid and protein food molecules into smaller molecules that are usable by body cells.

3.

4.

5.

Absorption is the passage of end products of digestion from the GI tract into blood or lymph for distribution to cells. Defecation is emptying of the rectum, eliminating indigestible substances from the GI tract.

6.

LAYERS OF THE GI TRACT A. The basic arrangement of layers in the gastrointestinal tract from the inside outward includes the mucosa, submucosa, muscularis and serosa (visceral peritoneum) [Fig. 24.2].

B.

The mucosa consists of an epithelium, lamina propria and muscularis mucosa. 1. The epithelium consists of a protective layer of nonkeratinized stratified cells, simple cells for secretion and absorption , and mucus secreting cells, as well as some

enteroendocrine cells that put out hormones that help regulate the digestive process. 2. The lamina propria consists of three components, including loose connective tissue that adheres the epithelium to the lower layers, the system of blood and lymph vessels through which absorbed food is transported, and nerves and sensors. a) The lymph system is part of the mucosa-associated lymph tissues (MALT) that monitor and produce an immune response to pathogens passing with food through the GI tract. It is estimated that there are as many immune cells associated with the GI tract as in all the rest of the body.

b)

3.

The muscularis mucosa causes local folding of the mucosal layer to increase surface area for digestion and absorption.

C.

The submucosa consists of aerolar connective tissue. It is highly vascular, contains a part of the submucosal plexus (plexus of Meissner), and contains glands and lymphatic tissue. 1. The submucosal plexus is a part of the autonomic nervous system.

D.

Muscularis 1. The muscularis of the mouth, pharynx and superior part of the esophagus contains skeletal muscle that produces voluntary swallowing. Skeletal muscle also forms the external anal sphincter. Through the rest of the tract, the muscularis consists of smooth muscle in an inner sheet of circular fibers and an outer sheet of longitudinal fibers. The muscularis also contains the major nerve supply to the GI tract the myenteric plexus (plexus of Auerbach) which consists of fibers from both divisions of the ANS. This plexus mostly controls GI tract motility.

2.

3.

E.

The serosa is the superficial layer of those portions of the GI tract that are suspended in the abdominopelvic cavity. 1. 2. The esophagus is covered by an adventitia. Inferior to the diaphgram, the serosa is also called the visceral peritoneum.

ESOPHAGUS A. The esophagus is a collapsible, muscular tube that lies behind the trachea and connects the pharynx to the stomach (Fig. 24.1).

B.

The wall of the esophagus contains mucosa, submucosa and muscularis layers. The outer layer is called the adventitia rather than the serosa due to structural differences (Fig. 24.9). Physiology of the Esophagus a) b) The esophagus contains an upper and a lower esophageal sphincter. During the esophageal stage of swallowing progressive contractions of the muscularis push the bolus onward. There propulsive contractions are termed peristalsis (Fig. 24.10).

C.

D.

Gastroesophageal reflux disease occurs when the lower esophageal sphincter fails to close adequately after food has entered the stomach, resulting in stomach contents refluxing into the inferior portion of the esophagus. HCl from the stomach contents irritates the esophageal wall resulting in heartburn.

STOMACH A. INTRODUCTION 1. The stomach is a J-shaped enlargement of the GI tract that begins at the bottom of the esophagus and ends at the pyloric sphincter (Fig. 24.11). 2. It serves as a mixing and holding area for food, begins digestion of proteins, and continues the digestion of triglycerides, converting a bolus to a liquid called chyme. It can also absorb some substances. Anatomy of the Stomach 1. Include the cardia, fundus, body and pyloris. 2. When stomach is empty, the mucosa lies in folds. 3. Pylorospasm and pyloric stenosis?

B.

C.

Histology of the Stomach 1. Mucosa mucosa surface cells (Fig. 24.12). gastric pits and gastric glands gastric glands: 3 types of exocrine glands :

- mucous neck cells (secrete mucus) - chief or ezymogenic cells (secrete pepsinogen and gastric lipase) -parietal or oxyntic cells (secrete HCl) Enteroendocrine cells G-cells (secrete gastrin) 2. 3. 4. Submucosa Muscularis 3 layers of smooth muscle; longitudinal, circular,oblique Serosa

D.

Mechanical and Chemical Digestion in the Stomach 1. Mechanical digestion: peristaltic movement and mixing waves. 2. Chemical Digestion- pepsin, HCl 3. gastric lipase (limited role in adult stomach)

The stomach is impermeable to most substances except aspirin, alcohol , some electrolytes and water.

E.

Regulation of Gastric Secretion and Motility 1. Gastric secretion regulated by nerves and hormones (Fig. 24.13). Stimulation occurs in three overlapping phases: cephalic (reflex), gastric and intestinal . 2. Cephalic Phase a) consists of reflexes initiated by sensory receptors in the head. b) stimulates gastric secretion and motility. Gastric phase a) Begins when food enters the stomach . b) Activation of stretch receptors and chemoreceptors when stomach walls are distended, pH increases or proteins entered the stomach Fig. 24.14). - Peristalsis, continued flow of gastric juice.

3.

c)

Hormonal negative feedback regulates gastric secretions. 1. Chemoreceptors and stretch receptors stimuli the ANS to release ACh which stimulates G-cells to release gastrin. Gastrin stimulates growth of the gastri glands and secretion of large amounts of gastric juice. 3. 4. Strengthens contraction of the lower esophageal sphincter Increases motility of the stomach Relaxes the pyloric and ileocecal sphincters.

2.

ACh and gastrin stimulate parietal cells to secrete more HCl when histamine is present. Intestinal Phase a) The intestinal phase is due to activation of receptors in the small intestine. Partially digested food in the small intestine triggers the enterogastric reflex secretion of GIP, secretin, CCK by the intestinal mucosa. The effect; inhibition of gastric secretion.

b)

5.

Regulation of Gastric Emptying a) Gastric emptying is the periodic release of chime from the stomach into the duodenum Fig. 24.15). is stimulated by nerves and gastrin. most food leaves the stomach 2-6 hours after ingestion; CHO>protein>fats inhibited by the enterogastric reflex and CCK, GIP Vomiting

b) c)

d)

e)

PANCREAS A. Connected to the duodenum via the duct of Wirsung (pancreatic duct) and accessory duct (duct of Santorini) [Fig. 24.16].

B.

Pancreatic islets (islets of Langerhans) secrete hormones and acini secrete a mixture of fluid and digestive enzymes called pancreatic juice (Fig. 24.17).

C.

Pancreatic juice 1. contains enzymes that digest starch (amylase), proteins (trypsin, chymotrypsin carboxypeptidase), fats (pancreatic lipase), and nucleic acids (ribonuclease, deoxyribonuclease). contains sodium bicarbonate, return pH to 7.1-8.2, inhibiting pepsin activity, promoting pancreating enzymes activity. Pancreatitis trypsin digests pancreatic cells.

2. 3.

D.

Pancreatic secretion is regulated by nervous and hormonal mechanisms.

LIVER AND GALLBLADDER A. B. C. Heaviest gland and second largest organ in the body after the skin. Gallbladder, a sac in a depression on the posterior surface of the liver. Lobes made up of lobules contain hepatic cells (hepatocytes), sinusoids, stellate reticuloendothelial (Kupffers) cells and a central vein.

D.

Liver receives a double supply of blood from the hepatic artery and the hepatic portal vein. Leaves via the hepatic vein.

E.

Hepatocytes produce bile transported by a duct system to the gallbladder for concentration and temporary storage. 1. 2. Bile is partially an excretory product and partially a digestive secretion. Bile emulsifies triglycerides.

F.

Bile secretion is regulated by nervous and hormonal mechanisms, volume of hepatic blood flow and the concentration of bile salts in the blood (Fig. 24.20).

G.

The liver also functions in CHO, lipid and protein metabolism; removal of drugs and hormones In blood; excretion of bilirubin; synthesis of bile salts; storage of vitamins and minerals; and activation of vitamin D. Gallstones the fusion of individual crystals of cholesterol. cause obstruction in any portion of the duct system.

H.

SUMMARY OF DIGESTIVE HORMONES 1. Gastrin promotes secretion of gastric juice and increases gastric motility.

2.

Secretin promotes secretion of bicarbonate ions into pancreatic juice and bile. inhibits secretion of gastric juice promotes normal growth

3.

CCK stimulates secretion of pancreatic juice rich in digestive enzymes. stimulates ejection of bile into the duodenum (Fig. 24.21).

4.

Other hormones secreted by and having effects on the GIT: motilin, substance P, bombesin, vasoactive intestinal peptide (VIP), gastrin releasing peptide, somatostatin and GIP.

SMALL INTESTINE The major events of digestion and absorption occur in the small intestine (SI). The SI extends from the pyloric sphincter to the ileocecal sphincter. The SI is divided into : duodenum, jejunum, ileum. Projections called circular folds or plicae circularies enhance absorption by increasing surface area (Fig. 24.22). A. Histology of the Small Intestine 1. Mucosa forms villi (Fig. 24.22a). a) b) embedded in the villus is a lacteal (lymphatic capillary) for fat absorption. cells of the mucosal epithelium include: absorptive cells, goblet cells, enteroendocrine cells, Paneth cells (Fig. 24.22b).

c) d) 2.

microvilli, form brush border containing several enzymes (Fig. 24.22c). mucosa contains the intestinal glands (crypts of Lieberkuhn).

Submucosa contains duodenal (Brunners) glands which secrete an alkaline mucus. the submucosa of the ileum contains lymphatic nodules (Peyers patches).

B.

Mechanical Digestion in the Small Intestine 1. 2. Segmentation ia localized contraction. Peristalsis propels the chyme onward.

C.

Chemical Digestion in the Small Intestine. 1. CHO are broken down into monosaccharides for absorption. a) Intestinal enzymes break down: b) Starches into maltose, maltotriose and alphadextrin (pancreatic amylase). Alpha-dextrins into glucose (alphadestrinase). Maltose to glucose (maltase). Sucrose to glucose and fructose (sucrose). Lactose to glucose and galactose (lactase).

Lactose intolerance failure of the intestinal mucosal cells to produce lactase, the inability to digest the sugar lactose in milk.

2.

Protein digestion starts in the stomach. a) b) Proteins are converted to peptides by trypsin and chymotrypsin. Peptides to amino acids by aminopeptidases.

3.

Most lipid digestion in an adult occurs in the small intestine. a) Emulsification bile salts break the globules of triglycerides (fats) into droplets.

b)

Pancreatic lipase hydrolyze triglycerides into fatty acids and monoglycerides.

4.

Nucleic acids are broken down into nucleotides for absorption.

D.

Regulation of Intestinal Secretion and Motility 1. 2. 3. The most important mechanism reflexes in response to chime. Hormones VIP also assume a role. Parasympathetic impulses increase motility. Sympathetic impulses decrease motility. is the action of local

E.

Absorption in the Small Intestine. 1. Absorption is the passage of the end products of digestion from the GIT into blood or lymph and occurs by diffusion, facilitated diffusion, osmosis and active transport. Absorption of Monosaccharides a) 3. Essentially all CHO are absorbed as monosaccharides into blood capillaries (Fig. 24.24).

2.

Absorption of Amino Acids, Dipeptides and Tripeptides.

Most proteins are absorbed as amino acids by active transport processes into blood capillaries in the villus.

4.

Absprption of Lipids a) b) Dietary lipids are absorbed by simple diffusion. Long-chain fatty acids and monoglycerides are absorbed as part of micelles, resynthesized to triglycerides and formed into protein-coated spherical mass called chylomicron. - Chylomicrons are taken up by the lacteal of a villus. - From the lacteal chylomicrons enter the lymphatic system to CVS, finally reaching the liver or adipose tissue. c) The plasma lipids; fatty acids, triglycerides, cholesterol are insoluble in water and body fluids. the lipids combined with protein transporter called lipoproteins to make them soluble.

5.

Absorption of Electrolytes a. Many absorbed electrolytes by the SI comes from gastrointestinal secretions and some are part of digested foods and liquids. Absorption is primarily by active transport.

b.

6.

Absorption of Vitamins a. Fat - soluble vitamins (A,D, E and K) are included along with ingested dietary lipids in micelles and are absorbed by simple diffusion. Water soluble vitamins (B and C) are absorbed by simple diffusion.

b.

7.

Absorption of Water (Fig. 24.25) a. b. All water absorption in the GIT occurs by osmosis. Absorption depends on electrolytes and nutrients to maintain an osmotic balance with the blood.

LARGE INTESTINE The large intestine (colon) extends from the ileocecal sphincter to the anus. The subdivisions : cecum, colon, rectum and anal canal (Fig. 24.26). Inferior to the cecum is the appendix. - Appendicitis (inflammation of the appendix). - A ruptured appendix results in gangrene or peritonitis. The colon is divided into the ascending, transverse, descending and sigmoid portions.

A.

Histology of the Large Intestine (LI) 1. Mucosa no villi or circular folds, present of globlet cells (Fig. 24.27).

2.

Muscularis contains taeniae coli which contract and gather the colon into a series of pouches called haustra.

B.

Mechanical movements of the LI include haustral churning, peristalsis and mass peristalsis.

C.

The last stages of chemical digestion through bacterial rather than enzymatic action. Some vitamins are synthesized by bacterial action.

D.

Absorption and Feces Formation in the Large Intestine 1. 2. 3. The LI absobs water, electrolytes and some vitamins. Feces The LI absorbs water to maintain the bodys water balance although most water absorption occurs in the SI.

E.

Defecation Reflex 1. Defecation. 2. is a reflex action aided by voluntary contractions of the diaphragm and abdominal muscles. the external anal sphincter is controlled voluntarily.

Diarrhea

3. 4.

Constipation Dietary fiber : soluble (lower blood cholesterol) and insoluble (protect colon cancer).

DISORDERS: HOMEOSTATIC IMBALANCES 1. 2. 3. 4. Peptic ulcers Diverticular diverticulitis Tumors- colorectal cancer Hepatitis A does not cause lasting liver damage) Hepatitis B , C, D (cirrhosis, cancer, liver damage) Hepatitis E (high mortality rate in pregnant women). 5. Anorexia nervosa (predominantly in young single females, may be inherited, may die of starvation!).