Gastro Intestinal Tract

Gastrointestinal tract can be described as a specialized tube communicating with external environment both at its upper and lower ends. There is regional specialization suited for local functions. The main functions of GIT are: 1. Secretion Exocrine enzymes Endocrine hormones of GI tract 2. Motility 3. Digestion & absorption 4. Storage and excretion of undigested waste materials. The functions of gastro intestinal tract are controlled by both neural and hormonal mechanisms. Motility of GIT is mainly due to function of smooth muscle found in most part of GIT. Movement helps in two ways: 1. Local mixing of food components 2. Forward propulsion of food materials GIT can be described as a barrier between blood and components of food that has been eaten. Unless nutrients, vitamins, minerals and other substances pass through wall of GIT into blood, they are not useful to body. Absorption is process by which nutrients, minerals, vitamins, water and other substances pass into blood across wall of GIT. BASIC HISTOLOGY OF GIT, The wall has got four layers. Outside to inside Serous coat: serous membrane (or serosa) is a smooth membrane consisting of a thin layer of cells which secrete serous fluid. Muscular coat: Contributed by smooth muscles arranged generally in two layers; an outer longitudinal and an inner circular. The latter is thickened in region of sphincters. Between two layers of muscles there is

myenteric or Auerbachs plexus formed by sympathetic and parasympathetic fibers. Sub mucous coat: Formed of fibrous tissue, lymphatic and blood vessels. Between muscular and sub mucous coats is another nerve plexus namely sub mucous or Meissners plexus formed by sympathetic and parasympathetic nerves and also fibers from myenteric plexus. Mucous coat: Epithelium besides lining GIT is also modified into Specialized glands (endocrinal & exocrine cells, mucosal cells) Acts as receptors (chemoreceptors, mechanoreceptors (stretch) The entire digestive processes namely secretion, motility and absorption are under dual control.
1. Neural

regulatory mechanism: mainly through autonomic nervous system controlled by hypothalamus, various parts of limbic system and cerebral cortex.

Hormonal regulation: GIT hormones as well as hormones from other specialized endocrine glands outside GIT help to regulate GIT functions. The various physiological aspects discussed on GI tract are: a) Mastication (chewing) b) Salivary secretion c) Deglutition (Swallowing) d) Gastric secretion e) Gastric motility f) Pancreatic secretion g) Biliary secretion h) Intestinal motility i) Functions of colon including movements j) GI hormones secretion and their actions k) Digestion and absorption Salivary secretion
2.

Saliva is the first digestive juice to come in contact with food. Saliva is secreted by three major salivary glands namely Parotid Submandibular Sublingual Nerve supply: Salivary glands and its blood vessels are well supplied by sympathetic and parasympathetic nerve fibers. Parasympathetic: These fibers are important because they are known as secreto-motor fibers to salivary gland. On stimulation they bring about (1) Secretion from glands and (2) Increase blood flow to salivary glands. Origin of parasympathetic fibers From Salivary nuclei in medulla oblongata, from here parasympathetic fibers arise and passes through glossopharyngeal and facial nerve to supply the salivary glands. Sympathetic supply is from T1 & T2 SEGEMNTS OF SPINAL CORD Stimulation of this nerves decrease the blood flow and salivary secretion Reflex regulation a) Unconditioned reflex: This reflex is present at birth. This is due to stimulation of receptors in mouth either by chemical substances which are present in food and even mechanical stimulation brought about by food in mouth. Presence of food in mouth brings about immediate secretion. Exclusive mechanical stimulation of oral cavity by any means also stimulates salivary secretion. For example maneuver of oral cavity by dentists, movement of tongue thereby coming in contact with cheeks. The most important stimulus is presence of food in mouth.
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b) Conditioned reflex: This reflex is acquired during life.

Here stimulation process originates not from mouth but from organs of special senses, especially sight and smell to a certain extent even hearing. Incase of human beings previous experiences associated with supply of food like sight, smell can give rise to secretion of saliva. In animals conditioned reflex for secretion of saliva can be experimentally produced for sight, sound or smell of food. Functions of saliva: A. Lubrication of food B. Solvent action C. Cleansing action D. Digestive Function: Salivary amylase or ptyalin is a carbohydrate splitting enzyme. It acts at a pH of 6.8. It can act only on cooked starch. When starch is boiled, cellulose covering of starch granules break and amylase can penetrate cellulose. F. Helps in speech Mastication or Chewing Mastication or chewing is first mechanical process to which food is subjected in GIT. There are different muscles involved in movement of mandible. Muscles of mastication are a. Masseter b. Temporalis c. Pterygoid medial pterygoid d. lateral pterygoid Deglutition or swallowing Deglutition: Is complex and coordinated physiological process by which food placed in mouth moves down into stomach by passing through pharynx and esophagus. Stages of deglutition: There are 3 important stages

1. Oral or buccal stage: In which food passes from mouth to pharynx 2. Pharyngeal stage: In which food passes from pharynx to esophagus. In this phase there will deglutition apnea (temporary arrest of breathing). 3. Esophageal stage: In which food passes from esophagus to stomach. Of these 3 stages1st stage is voluntary initially but later on becomes involuntary. 2nd and 3rd stages are exclusively involuntary and therefore occur by a reflex action. Swallowing can be considered as a reflex for which Receptors: are situated around oropharynx. Afferents: Through V, IX and X cranial nerves. Centre: swallowing center (deglutition center) is located close to respiratory centers in floor of4th ventricle of medulla oblongata. Anatomists believe that nucleus Ambiguus and nucleus of Tractus solitarius act as swallowing centers. Efferent: IX and XII cranial nerve for first and second stages X nerve for3rd stage. Effectors: Muscles of tongue, palate, pharynx, esophagus (upper 1/3rd esophagus has skeletal muscle while lower 2/3rd contains smooth muscle) Deglutition apnea is due inhibition of respiratory center in the medulla by swallowing center during pharyngeal phase of deglutition. Gastric Secretion Functions of stomach: 1. Temporary storage organ: As the food enters into stomach it will go for relaxation that increase the volume of the stomach this is called as receptive relaxation. 2. Secretory function: It secretes HCl and pepsin apart from other things including mucus. G cells of pyloric region secrete gastrin hormone which is one of GI tract hormones.
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3. 4.

5.

6.

Mucosal cell secretes mucin which protects against the HCl Digestive function is because of pepsin enzyme. It is a proteolytic enzyme. Protective function as follows gastric mucosal barrier is the property of the stomach that allows it to contain acid. The barrier consists of three protective components. These provide the additional resistance for the mucosal surface of the stomach. The three components include: a compact epithelial cell lining (tight junctions) Cells in the epithelium of the stomach are bound by tight junctions that repel harsh fluids that may injure the stomach lining. a special mucus covering The mucus covering is derived from mucus secreted by surface epithelial cells and mucosal neck cells. This insoluble mucus forms a protective gel-like coating over the entire surface of the gastric mucosa. The mucus protects the gastric mucosa from autodigestion by e.g. pepsin and from erosion by acids and other caustic materials that are ingested. bicarbonate ions The bicarbonate ions are secreted by the surface epithelial cells and these ions are trapped by mucosa and these ions act to neutralize harsh acids. Absorptive function is also one of functions of stomach. Some amount of water and alcohol is absorbed in stomach region. Hemopoietic function is because of intrinsic factor which is secreted by gastric glands. Intrinsic factor is essential for absorption of vitamin B12 in ileum. Gastric glands have following cells

1. Mucous neck cells:

Secrete soluble mucin. Mucous cells also secrete bicarbonates.

2. Chief/peptic: These secrete enzymes of gastric juice,

most important of which is pepsinogen. 3. Parietal cell: Located inside walls of gland. These cells secrete HCl and intrinsic factor of castle. 4. The G cells present in pyloric antral region secrete gastrin, one of the important hormones of GI tract with few important actions. Innervation of stomach Parasympathetic Vagus supplies the gastric glands and smooth muscle . Sympathetic nerve supply: are from lateral horn cells of T5 T10 segments of spinal cord.

There are three phases of gastric secretion 1. Cephalic phase 2. Gastric phase 3. Intestinal phase Cephalic phase of gastric secretion: Presence of food in mouth stimulates gastric secretion through taste pathways. This is an inherent reflex. Sight, smell and thought of food also stimulate gastric secretions through conditioned reflexes acquired during childhood. For all these stimuli to evoke gastric secretion vagus should be intact. Since all above stimuli act through higher centers in CNS, this is known as cephalic phase. Gastric phase: Is also called chemical or hormonal phase. Presence of food in stomach stimulates gastric secretion Specific stimuli responsible for this phase are a) Mechanical distension of stomach by food, stimulates the mechanoreceptors as well as endocrinal cells b) Proteins and derivatives in food, stimulates chemoreceptors and endocrinal cells. The above stimuli releases gastrin Actions of gastrin

Physiological actions i. Stimulates secretion of gastric juice rich in HCl and pepsin ii. Stimulates gastric motility Intestinal phase of gastric secretion: Presence of food in small intestine stimulates gastric secretion. Specific stimuli are: Partially digested proteins and polypeptides stimuli Absence of acid in gastric juice is Achlorhydria Peptic ulcer: Refers to chronic type of ulcer caused due to acid-peptic digestion of gastric or intestinal mucosa. Classical sites of peptic ulcer are: Stomach (called gastric ulcer) Duodenum (called duodenal ulcer) Esophagus (called Esophageal ulcer) A peptic ulcer is an ulcer (defined as mucosal erosions equal to or greater than 0.5 cm) of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. As many as 70-90% of ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach (this destroys the natural mucosa barrier); however, only 40% of those cases go to a doctor. Ulcers can also be caused or worsened by drugs ex: aspirin Contrary to general belief, four times as many peptic ulcers arise in the duodenum (first part of the small intestine, just after the stomach) rather than in the stomach itself. Motor functions of stomach . All smooth muscles are supplied by vagus and sympathetic fibers. Types of movements:

Receptive relaxation: As food fills stomach, smooth muscle undergoes relaxation increasing capacity of stomach to accommodate incoming food. 2. Mixing and propulsive movements: conversion of solid food into smaller particles

PANCREAS
: pancreas is a dual organ. It has endocrine portion (refer endocrinology) and exocrine portion- secrete the enzymes and Ductal cells secrete the organic and inorganic constituents. A. Composition of Pancreatic Juice 1. 1.2 - 1.5 liters per day 2. water and electrolytes (mainly bicarbonate ions), by Ductal cells 3. Enzymes - by acinar cells. B. Proteolytic enzymes: 1. Trypsinogen (activated by enterokinase from the small intestine and trypsin the active form has autocatalytic action and also active all other enzymes). 2. Chymotrypsinogen 3. Procarboxypeptidase A and B: 4. Proelastase C. Lipolytic enzymes: 1. Pancreatic lipase 2. Prophospholipase 3. Cholesterol esterase D. Glycolytic enzymes 1. Pancreatic amylase: Actions similar to salivary amylase. . E. Regulation of Pancreatic Secretion 1. Parasympathetic - causes release during cephalic and gastric phases of gastric secretion 2. Secretin (acts on ductal cells) - hormone that causes release of "bicarbonate-rich" pancreatic juices in response to the presence of HCl in the duodenum.
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3. Cholecystokinin (on acinar cells) - hormone that

causes release of "enzyme-rich" pancreatic juice in response to the presence of proteins and fats in the duodenum.

Liver and bile secretion

Liver has many functions. One of them is to secrete bile. Liver cells per day secrete about 600 to 1000 ml of bile. Bile secretion is a continuous process. Certain substances are actively secreted and certain other substances are passively transported. Water molecules follow transported substances. Functions of liver: 1. Secretion of bile: hepatocytes are responsible for secretion of bile. 2. Synthetic function: All plasma proteins except gamma globulin fraction are synthesized in liver. 3. Storage function: Many of vitamins, glycogen, iron etc are stored in liver. 4. Hemopoietic function: In fetal life liver is one of the sites of erythropoiesis. 5. Detoxification function: Several drugs, toxins, are detoxified in liver. Detoxification may involve oxidation, reduction, hydrolysis etc. 6. Inactivation of hormones: Most of the hormones especially steroidal group of hormones is inactivated in liver. Bile salts: Are derived from bile acids. Two important bile acids are cholic acid and chenodeoxy cholic acid which are produced in liver from cholesterol. These acids are conjugated with glycine or taurine and then form a salt with sodium or potassium. Hence bile salts are nothing but sodium or potassium glycocholate or taurocholate. Functions of Gall bladder: a) It stores bile. It can store about 30- 60 ml of bile

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absorption of water it maintains a high concentration ratio between bile salts and cholesterol. c) Expulsion of bile-contraction of gall bladder will bring about expulsion of bile in to intestine. Any substance that brings about contraction of gall bladder and releases or increases bile flow into intestine is known as a cholegogue substance. Bile salts, CCK are very powerful cholegogues. Functions of bile/bile salts: 1. Bile salts are very powerful surface tension lowering agents. This helps in emulsification of fats. Larger fat molecules are broken down to smaller ones so that a larger surface area is made available for pancreatic lipase to act. 2. Bile salts with phospholipids, cholesterol, free fatty acids and monoglycerides form micelles and help in absorption of fats. 3. They also help in absorption of fat soluble vitamins-A, D, E, and K. 4. They activate pancreatic lipase. 5. They also act as mild laxative agents. Movements of small intestine Motility of small intestine: Movements of small intestine are brought about by smooth muscle present in its wall. 1. Movements are subjected to neural control through plexus of nerves, namely myenteric and Meissners plexuses, through extrinsic autonomic nerves. It is subjected to hormonal control and to local control as well. Aims of small intestinal motility a. Agitation of food or chyme: This helps in 3 ways: 1. Mixing food with enzymes of pancreatic and intestinal juice thus facilitating enzyme action. 2. Breaks food into very small particles which again helps in digestion and absorption.

b) By

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b. Propulsion: chyme is moved overlarge area of

small intestine to facilitate digestion and absorption and residues are propelled downwards to Ileo caecal junction into large intestine, mostly for excretion. Types of intestinal movements: Rhythmic segmentation contractions Rhythmic segmentation contractions are ring like contractions of small segments of small intestine a few cm long. These contractions are caused by distension due to food. Contractions are so organized that in a given segment, contractions and relaxations alternate and at next instant, contracted segment relaxes and relaxed segment goes into contraction. This type of movement chops food and helps in mixing of food with intestinal secretions. Peristalsis: It is defined as a wave of contraction preceded by a wave of relaxation which travels down a hollow organ always towards anus. That peristaltic wave always travels in aboral direction is called law of intestine which is dependent on myenteric reflex. Pendular movements: Here, long segments of about 20 cm move forwards and backwards, up and down helping mainly agitation of food. These and peristalsis are superimposed on rhythmic segmentation contractions. These can also occur in absence of extrinsic nerve. Secretions of small intestine Following enzymes Enterokinase, Tripeptidases, Dipeptidases, Amionpeptidases, Sucrase Malatase, and lipases

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LARGE INTESTINE Functions of Large intestine:

Secretion: glands secrete a watery fluid containing H2O and HCO3- to which is added mucin from globlet cells. Mucin is meant for lubrication of chyme. Absorption: About 1-2 liters of chyme enters colon. This volume is reduced to less than 200 ml by time is reaches rectum mainly by active reabsorption of Na+, Water and Cl- following passively. Synthesis: Colon has got variety of bacteria. These bacteria are in a way beneficial because they can synthesize vitamin of B complex group, Vitamin K. This fact is taken into consideration when broad spectrums antibiotics are administered. B-complex vitamins are always given with broad spectrum antibiotics because the latter also kills beneficial bacterial flora of intestine. Movements: presence of smooth muscle in colon is responsible for colonic motility. There are two major types of movements Mixing movement reducing bulk of chyme. There are also called kneading movements. Mass peristalsis (Movements): Peristalsis does not occur in large intestine the way it occurs in small intestine. Instead mass peristalsis is found. It occurs a few times in a day usually in hour after breakfast lasting for duration of 10 minutes. It can start in any part of colon; it occurs usually in transverse or descending colon. Storage and expulsion of feces

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