5 Sinh Lý Hệ Tiêu Hóa

The Digestive System
LECTURER:
ASSOC.PROF. NGUYEN THI THU HUONG
19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-1

The Digestive System
1. General Anatomy and Digestive Processes

2. Mouth Through Esophagus
3. Stomach
4. Small Intestine
5. Liver, Gallbladder and Pancreas
6. Large Intestine

1. The Digestive System
 Most nutrients eaten cannot be used in their

existing form
 Gastroenterology – the study of the digestive tract
and the diagnosis and treatment of its disorders
 Digestive system: the organ system that processes
food, extracts nutrients from it, and eliminates the
residue

1.1. Digestive
Function

1.1. Digestive Function
 5 stages of digestion
1. ingestion - selective intake of food
2. digestion – mechanical and chemical breakdown of food into a
form usable by the body
3. absorption - uptake of nutrient molecules into the epithelial
cells of the digestive tract and then into the blood and lymph
4. compaction - absorbing water and consolidating the
indigestible residue into feces
5. defecation - elimination of feces

1.1. Digestive Function

1.2. Facets of Digestion
some nutrients are present in a usable form in ingested

food
 absorbed without being digested
 vitamins, free amino acids, minerals, cholesterol, and
water

1.3. General Anatomy
 digestive system has two anatomical subdivisions

 digestive tract (alimentary canal)
 mouth, pharynx, esophagus, stomach, small intestine, and
large intestine
 gastrointestinal (GI) tract is the stomach and intestines
 accessory organs
 teeth, tongue, salivary glands, liver, gallbladder, and
pancreas
19-Apr-16 603065_THE DIGESTIVE SYSTEM Figure 25.1 25-8

General Anatomy
Most of the digestive tract follows the basis structural plan
with digestive tract wall consisting of the following
tissue layers, in order from inner to outer surface
 mucosa
 submucosa
 muscularis externa
 serosa

1.4. Tissue Layers of GI Tract
Diaphragm
Esophageal hiatus
Enteric nervous system:
Mucosa: Myenteric plexus

Stratified squamous
epithelium
Submucosal plexus
Lamina propria
Muscularis mucosae
Parasympathetic ganglion of
myenteric plexus
Submucosa:
Esophageal gland
Lumen
Muscularis externa:
Inner circular layer
Outer longitudinal layer
Blood vessels
Serosa

1.5. Enteric Nervous System
 enteric nervous system –

 a nervous network in the esophagus, stomach, and
intestines that regulated digestive tract motility,
secretion, and blood flow
 functions completely independently of the central
nervous system
 contains sensory neurons that monitor tension in gut
wall and conditions in lumen

1.5. Enteric Nervous System

1.6. Relationship to Mesenteries
 mesenteries – connective tissue sheets that loosely

suspend the stomach and intestines from the
abdominal wall
 allows stomach and intestines to undergo strenuous
contractions
 hold abdominal viscera in proper relationship to each other
 prevents the intestines from becoming twisted and tangled
 provides passage of blood vessels and nerves that supply
digestive tract

1.7. Relationship to Peritoneum
 parietal peritoneum – a
serous membrane that lines
the wall of the abdominal
cavity
 lesser omentum – a ventral
mesentery that extends
from the lesser curvature of
the stomach to the liver

1.7. Relationship to Peritoneum
 greater omentum – hangs from the greater curvature of the

stomach
 mesocolon – extension of the mesentery that anchors the
colon to the posterior abdominal wall
 intraperitoneal – when an organ is enclosed by mesentery on
both sides
 retroperitoneal – when an organ lies against the posterior
body wall and is covered by peritoneum on its anterior side
only

1.8. Regulation of Digestive Tract

Regulation of Digestive Tract
Hormonal control of
Digestive Tract

Panacrine secretion
Feedback regulation of gastric acid
secretion by release of somatostatin
and its action on G cells in the gastric
antrum

2. Mouth Through Esophagus

2.1. Tongue
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
Epiglottis
Intrinsic muscles of
the tongue
Lingual Buccinator m.
Root tonsils
1st molar
Palatine
Styloglossus m.
tonsil
Terminal
sulcus
Vallate Hyoglossus m.
papillae
Genioglossus m.
Foliate Mandible
papillae
Sublingual gland
Body
Fungiform Submandibular gland
papillae Mylohyoid m.
Hyoid bone
(a) Superior view (b) Frontal section, anterior view

2.2. The Teeth
 dentition – the teeth

 masticate food into
smaller pieces
 32 adult teeth – 20
deciduous (baby) teeth
25-26
2.3. Saliva
 saliva
 Lubricating the mouth
 Moistening and lubricating food in the mouth
 Dissolving chemicals that can stimulate the taste
buds & provide sensory information about the food
 Beginning the digestion of complex carbonhydrates

Saliva glands
 hypotonic solution of 97% to Parotid

gland Parotid duct
99.5% water and the following
Tongue
Sublingual
solutes: ducts
 salivary amylase - lingual lipase

 mucus - lysozyme
Masseter
 immunoglobulin A (IgA)
muscle
electrolytes - Na+, K+, Cl-, Submandibular

duct
Lingual
Submandibular
phosphate and bicarbonate gland
frenulum
Sublingual Opening of
 pH of 6.8 to 7.0 gland Mandible submandibular
duct

Salivation
 Food stimulats
receptors
 Parasympathetic
stimulation speeds
up secretion by all
the salivary glands
=> production saliva

2.4. Pharynx
 pharynx – a muscular funnel that connects oral cavity to

esophagus and allows entrance of air from nasal cavity
to larynx
 digestive and respiratory tracts intersect
 when not swallowing, the inferior constrictor remains
contracted to exclude air from the esophagus

2.5. Esophagus
 esophagus
 extends from pharynx to cardiac orifice of stomach
passing through esophageal hiatus in diaphragm
 prevents stomach contents from regurgitating into the
esophagus
 protects esophageal mucosa from erosive effect of the
stomach acid heartburn – burning sensation produced
by acid reflux into the esophagus

3. Stomach
 stomach – J shaped organ that receives the bolus

from esophagus
 mechanically breaks up food particles, liquefies the
food, and begins chemical digestion of protein and
fat
 most digestion occurs after the chyme passes on to
the small intestine

3.1. Gross Anatomy of Stomach
 divided into four regions

1. cardiac region (cardia)
2. fundic region (fundus)
3. body (corpus)
4. pyloric region

3.1. Gross Anatomy of Stomach

3.2. Innervation and Circulation
 stomach receives:
 parasympathetic fibers from vagus
 sympathetic fibers from celiac ganglia
 supplied with blood by branches of the celiac trunk
 all blood drained from stomach and intestines enters
hepatic portal circulation and is filtered through
liver before returning to heart


Gastric secretion phases


3.3. Pyloric and Gastric Glands
Mucous neck cell
Parietal cell
Mucous cell
Chief cell
G cell
(b) Pyloric gland (c) Gastric gland

Cells of Gastric Glands
 mucous cells – secrete mucus
 regenerative (stem) cells
 parietal cells
 secrete hydrochloric acid (HCl), intrinsic factor, and a hunger
hormone called ghrelin
 chief cells
 secrete gastric lipase and pepsinogen
 enteroendocrine cells
 secrete hormones and paracrine messengers that regulate
digestion

Cells of Gastric
Glands

3.4. The secretion of HCl
Gastric juice has a high concentration of
hydrochloric acid
◦ pH as low as 0.8
Parietal cells produce HCl and contain

carbonic anhydrase (CAH)
◦ CAH
◦ CO2 + H2O  H2CO3  HCO3- + H+
◦ H+ is pumped into gastric gland lumen by
H+- K+ ATPase pump
◦ antiporter uses ATP to pump H+ out and K+ in
◦ HCO3- exchanged for Cl- (chloride shift)
from blood plasma
◦ Cl- (chloride ion) pumped into the lumen of gastric
gland to join H+ forming HCl
◦ elevated HCO3- (bicarbonate ion) in blood causes
alkaline tide increasing blood pH

3.5. Functions of Hydrochloric Acid
 activates pepsin and lingual lipase
• Create the optimum pH for pepsin
• Pepsinogen (inactive form) HCl pepsin (active form)
 breaks up connective tissues and plant cell walls
 converts ingested ferric ions (Fe3+) to ferrous ions (Fe2+)
 Fe2+ absorbed and used for hemoglobin synthesis
 contributes to nonspecific disease resistance by destroying
most ingested pathogens (Kill bacteria taken in with the
food)
3.6. Pepsin
 pepsinogen – zymogen secreted by the chief cells

 hydrochloric acid removes some of its amino acids and
forms pepsin that digests proteins
 autocatalytic effect – as some pepsin is formed, it
converts more pepsinogen into more pepsin
 pepsin digests dietary proteins into shorter peptide chains

Production and Action of Pepsin
Parietal cell Removed Dietary

peptide proteins
HCl
Pepsin
(active enzyme)
Chief cell Pepsinogen

(zymogen)
Partially digested
protein
Gastric gland
Figure 25.15
3.7. Gastric Lipase
 gastric lipase – produced by chief cells
 gastric lipase and lingual lipase play a minor role in

digesting dietary fats
 digests 10% - 15% of dietary fats in the stomach
 rest digested in the small intestine

3.8. Intrinsic Factor
 intrinsic factor – a glycoprotein
secreted by parietal cells
 essential to absorption of vitamin
B12 by the small intestine
 vitamin B12 is needed to synthesize
hemoglobin
 secretion of intrinsic factor is the
only indispensable function of the
stomach
3.9. Digestion and Absorption
 salivary and gastric enzymes partially digest

protein and lesser amounts of starch and fat in the
stomach
 most digestion and nearly all absorption occur
after the chyme has passed into the small intestine
 stomach does not absorb any significant amount of
nutrients

3.10. Protection of the Stomach
 living stomach is protected in three ways from the

harsh acidic and enzymatic environment it creates
 mucous coat
 tight junctions
 epithelial cell replacement
 breakdown of these protective measures can result
in inflammation and peptic ulcer


Acid-base balance

Stomach disorders

3.11. Regulation of Gastric Function
 cephalic phase
 stomach responds to site,
smell, taste, or thought of
food
 stimulate the enteric
nervous system of
stomach
 in turn, stimulates gastric
secretion

4. Small Intestine
4.1. Anatomy

4.1. Small Intestine Anatomy
Duodenum
 The first and the shortest portion of the small intestin
 Partially digested foods pass through here via the
stomach. The duodenum helps to chemically digest the
chyme (partially digested foods) and prepares them for
being absorbed into the smaller intestines.

Jejunum
 As the mid-section of the smaller intestines, the
jejunum serves as a site for nutrients to be absorbed
into the body.
 It measures approximately 3 feet and helps to improve
nutrient absorption in the body. Without this step, the
nutrients wouldn't be properly prepared for utilization.

Ileum
 The final section of the small intestine completes the
absorption process of the nutrients. The ileum empties
into the larger intestines through the ileocecal sphincter.
Terminal Ileum
 Is the portion of the smaller intestines that intersects
together with the larger intestine and controls how the
chyme flows into the larger intestine.

Ileocecal Valve (Tulp's valve)
 Is located where the large and the small intestines unite.
 restricts the flow of fluids to just one direction. It is
circular in shape and contracts as required to help limit
the reflux of the colonic contents.
 About 2 liters of liquid will pass through the ileocecal
valve into the colon on a daily basis. The ileocecal valve
absorbs both bile and Vitamin B 12 and is the only part of
the body to absorb bile as well as Vitamin B12.
4.2. Small Intestine Function
 The small intestine is the longest part of the digestive
system. The small intestine is 22 feet (6.7 meters) long,
while the large intestine is only 6 feet (1.8 m) long.
 Food comes into the small intestine from the stomach. It
starts out as semi-solid sludge, but bile from the liver,
enzymes from the pancreas, as well as water and
mucous mix with the sludge in a process called
peristalsis. The mixture is quite watery by the time it
gets to the large intestine.
4.2. Small Intestine Function

4.2. Small Intestine Villi and microvilli

 The villi (villi is Latin for "shaggy hair") are about 0.5 to 1.6
mm in length, the very small finger type projections
protruding from the epithelial lining in the intestinal wall.
The villi contract and expand which allows for the increase
in surface, thus enhancing nutrients absorption.
 The villi are also connected to blood vessels and the blood
that circulates then carries the nutrients away to be
eliminated when they are not being used by the body.

4.2. Small Intestine Villi

 The small intestine villi and the microvilli help increase

the surface area that absorbs the nutrients.
 Each and every one of the small intestine villi has their
own unique network of capillaries. These capillaries also
have fine lymph vessels which are called lacteals. The
lacteals reside close to the surface. Here, nutrients are
transported from the lumen of the intestines and
combine with amino acids and with carbohydrates (or
carbs) and with the lacteals or lipids.
 Everything that is absorbed is moved through the

blood vessels into the various organs in the body
where they combine to create the complex proteins
that your body requires to survive.
 Any remaining foods are then passed into the large
intestines where they are eventually eliminated
through having a bowel movement.

4.3. Intestinal Secretion
 intestinal crypts secrete 1 to 2 L of intestinal juice per day

 in response to acid, hypertonic chyme, and distension of
the intestines
 pH of 7.4 to 7.8
 contains water, mucus, and little enzyme
 most enzymes that function in the small intestine are
found in the brush border and pancreatic juice

4.4. Intestinal Motility
 contractions of small intestine serve 4 functions:

 to mix chyme with intestinal juice, bile, and pancreatic
juice
 to neutralize acid: digest nutrients more effectively
 to churn chyme and bring it in contact with the mucosa
for contact digestion and nutrient absorption
 to move residue toward large intestine

 segmentation – the movement in which stationary ringlike
constrictions appear in several places along the intestine
 they relax and new constrictions form elsewhere
 most common kind of intestinal contraction
 pacemaker cells in muscularis externa set rhythm of
segmentation
 when most nutrients have been absorbed and little remains but
undigested residue, segmentation declines and peristalsis
begins
4.4. Intestinal Motility-Peristalsis
 gradual movement of contents towards colon

 followed by another wave starting further down the tract
 migrating motor complex – successive, overlapping
waves of contraction
 milk chyme toward colon over a period of two hours
25-73

Ileocecal valve
 ileocecal valve usually closed

 food in stomach triggers gastroileal reflex that enhances
segmentation in the ileum and relaxes the valve
 as cecum fills with residue, pressure pinches the valve
shut
 prevents reflux of cecal contents into the ileum
25-75
4.5. Intestinal absorption


Fluid and electrolyte absorption in the
intestine


4.5. Intestinal
absorption
Carbonhydrate
Absorption

Lipid Absorption

Lipid Absorption
25-82
5. Liver, Gallbladder, and Pancreas
 small intestine receives chyme from stomach

 also secretions from liver and pancreas
 enter digestive tract near the junction of
stomach and small intestine
 secretions are so important to the digestive
process of the small intestine

5.1. The Liver
 the body’s largest gland

 weighs about 1.4 kg (3 pounds)
 variety of functions
 secretes bile which contributes to digestion

5.1.1. Gross Anatomy of Liver
Inferior vena cava

Bare area
Caudate lobe Posterior
Right lobe
Left lobe
Falciform
ligament
Round ligament
Porta hepatis:
Hepatic portal vein
Proper hepatic artery
Common hepatic
duct Anterior
Quadrate lobe
Gallbladder Right lobe
(b) Anterior view (c) Inferior view

5.1.2. Microscopic Anatomy of Liver
Hepatocytes
Bile
canaliculi
Stroma
Central vein
Hepatic triad:
Hepatic
Branch of sinusoid
hepatic
portal vein
Branch of
proper hepatic Stroma
artery
Bile ductule
(a)
Figure 25.20a
25-87
5.1.3. Functions of Hepatocytes
 after a meal, the hepatocytes absorb from the blood
 glucose, amino acids, iron, vitamins, and other nutrients for
metabolism or storage
 removes and degrades
 hormones, toxins, bile pigments, and drugs
 secretes into the blood:
 albumin, lipoproteins, clotting factors, angiotensinogen, and other
products
 between meals, hepatocytes breaks down stored glycogen and
releases glucose into the blood

5.1.3. Functions of Hepatocytes

5.1.4. Liver damages



5.2. Gallbladder
 gallbladder
 serves to store and concentrate bile by a factor of
20 by absorbing water and electrolytes
 internally lined by highly folded mucosa with simple
columnar epithelium
 head (fundus) usually projects slightly beyond
inferior margin of liver
 neck (cervix) leads into the cystic duct

5.3. Bile
 bile – yellow-green fluid containing minerals,
cholesterol, neutral fats, phospholipids, bile pigments,
and bile acids
 bilirubin – principal pigment derived from the
decomposition of hemoglobin
 bacteria in large intestine metabolize bilirubin to
urobilinogen

5.3. Bile
 responsible for the brown color of feces
 bile acids (bile salts) – steroids synthesized from
cholesterol
 bile acids and lecithin, a phospholipid, aid in fat
digestion and absorption
 gallstones may form if bile becomes excessively
concentrated
 bile gets to the gallbladder by first filling the bile duct
then overflowing into the gallbladder
5.3. Bile
 liver secretes about 500 – 1000 ml of bile daily
 80% of bile acids are reabsorbed in the ileum and
returned to the liver
 bile – yellow-green fluid containing minerals,
cholesterol, neutral fats, phospholipids, bile pigments,
and bile acids
 hepatocytes absorb and resecrete them

5.3. Bile
 enterohepatic circulation – this route secretion,
reabsorption, and resecretion of bile acids two or more
times during digestion of an average meal
 20% of the bile acids are excreted in the feces
 this is the body’s only way of eliminating excess
cholesterol
 liver synthesizes new bile acids from cholesterol to
replace those lost in feces

5.3. Bile

5.4. Pancreas
PAN KREAS is Greek and means all meat

5.4. Pancreas

Control of pancreatic secretion

5.5. Intestinal Enzymes

6. Anatomy of Large Intestine
Greater
Right colic omentum
flexure (retracted)
Left colic
flexure
Transverse
colon
Superior Taenia coli

mesenteric
artery
Mesocolon
Haustrum
Ascending Descending
colon colon
Ileocecal Omental
valve appendages
Ileum
Cecum
Appendix
Sigmoid
colon
Rectum
Anal canal
External anal
sphincter
25-105
19-Apr-16
(a) Gross anatomy 603065_THE DIGESTIVE SYSTEM 25-105
4. External sphincter is
voluntarily controlled

Seminar
1. Define the terms digestion and absorption, describe how
molecules are digested, and indicate which molecules are
absorbed.
2. Explain the actions of autonomic nerves on the
gastrointestinal tract.
3. List the secretory cells of the gastric mucosa and the
products they secrete.

Seminar
4. Explain how smooth muscle contraction in the small
intestine is regulated. What is the function of
segmentation?
5. Explain how the liver inactivates and excretes compounds
such as hormones and drugs.
6. Describe the positive and negative feedback mechanisms
that operate during the gastric phase of HCl and
pepsinogen secretion.

Seminar
7. Describe functions of the pancreas. Explain the hormonal
mechanisms involved in the production and release of
pancreatic juice and bile.
8. Describe the mechanisms involved in the intestinal phase
of gastric regulation and explain why a fatty meal takes
longer to leave the stomach than a meal low in fat.
9. Describe the structures and mechanisms involved in
defecation.

Thanks for your attention

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The Digestive System

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-1

1. General Anatomy and Digestive Processes

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-2

 Most nutrients eaten cannot be used in their

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-3

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-4

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-5

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-6

some nutrients are present in a usable form in ingested

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-7

 digestive system has two anatomical subdivisions

19-Apr-16 603065_THE DIGESTIVE SYSTEM Figure 25.1 25-8

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-10

Enteric nervous system:

Mucosa: Myenteric plexus

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-11

 enteric nervous system –

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-12

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-13

 mesenteries – connective tissue sheets that loosely

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-14

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-17

 greater omentum – hangs from the greater curvature of the

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-18

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-19

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-22

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-23

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-24

(a) Superior view (b) Frontal section, anterior view

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-25

 dentition – the teeth

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-27

 hypotonic solution of 97% to Parotid

 salivary amylase - lingual lipase

electrolytes - Na+, K+, Cl-, Submandibular

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-28

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-29

 pharynx – a muscular funnel that connects oral cavity to

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-30

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-31

 stomach – J shaped organ that receives the bolus

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-33

 divided into four regions

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-34

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-35

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-36

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-37

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-38

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-39

Mucous neck cell

(b) Pyloric gland (c) Gastric gland

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-40

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-41

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-42

Parietal cells produce HCl and contain

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-43

 pepsinogen – zymogen secreted by the chief cells

19-Apr-16 603065_THE DIGESTIVE SYSTEM 25-45

Parietal cell Removed Dietary

Chief cell Pepsinogen

 gastric lipase – produced by chief cells

 gastric lipase and lingual lipase play a minor role in