CHAPTER 66: DIGESTION AND ABSORPTION IN starches become hydrolyzed by the

THE GASTROINTESTINAL TRACT time food is swallowed

• 30-40% of starch digestion continues in
GASTROINSTEINAL DIGESTION
the body and fundus as long as 1 hr
- Actually pare-parehas lang ang before food is mixed with stomach
hydrolysis sa carbohydrates, proteins secretions
and fats pero lahi-lahi ilang enzymes • Salivary amylase activity is inactivated
GETS? once pH <4.0 and is blocked by gastric
acid
Digestion of Carbohydrates
Digestion of Carbohydrates in the Small
Intestine

• Pancreatic Amylase – powerful enzyme;

carbohydrates are hydrolyzed within
15-30 min after chyme empties from
stomach to duodenum and mixes with
pancreatic juice
• Carbohydrates totally converted to
maltose/other glucose polymers before
passing beyond duodenum/upper
jejunum
• Enterocytes lining the villi of small
• Hydrogen ion removed from one intestine contain digestive enzymes
monosaccharide; hydroxyl ion removed capable of splitting disaccharides
from another -> monosaccharides lactose, sucrose, maltose and other
combine at sites of removal to form small glucose polymers into their
di/polysaccharides -> H and OH ions constituent monosaccharides
form H2O • The final products of carbohydrate
• Process is reversed in carbohydrate digestion is glucose (80%) and galactose
digestion; H and OH ions are returned and fructose (>10%); all of which are
to polysaccharides to form water soluble and absorbed
monosaccharides immediately into portal blood
• Major sources of carbohydrates:
- Sucrose (cane sugar)
- Lactose (milk)
- Starches (potatoes and grains)
• Other sources:
- Amylose
- Glycogen
- Alcohol
- lactic acid
- pyruvic acid
- pectins
Digestion of Proteins
- dextrins
- carbohydrates derivatives in meats
- cellulose (enzyme capable for its
hydrolysis not found in human)
• Chewed food is mixed with ptyalin
(from saliva) that is secreted by the
parotid glands
• Ptyalin – (α-amylase) enzyme that
hydrolyzes starch into disaccharide
maltose and other 3-9 glucose
polymers; not more than 5% of all
 • Dietary proteins are long chains of
amino acids linked by peptide linkage
• Pepsin – most active at pH 2.0-3.0 and
inactive at pH above 5.0
• By the time HCl (pH 0.8) is mixed with
stomach contents and secretions from
non-oxyntic glandular cells, pH become
2.0-3.0
• Pepsin is able to digest collagen
(albuminoid protein that is affected
little by other digestive enzymes);
collagen is a major constituent of meat
• Pepsin only provides 10-20% of total
protein digestion
Protein Digestion from Pancreatic Proteolytic
Enzymes
• Most protein digestion occurs in the
upper intestine, duodenum and
jejunum under influence of pancreatic
proteolytic enzymes
• Upon entering small intestine, partial
breakdown of protein are attacked by
trypsin, chymotrypsin,
carboxypolypeptidase and elastase
• Trypsin and chymotrypsin cleaves
protein to small polypeptides
• Carboxypolypeptidase cleaves A.A from
carboxyl ends of polypeptides
• Proelastase converted to elastase –
digests elastin fibers which hold meat
together
• Only a small % of proteins are digested
into amino acids; most remain as
dipeptides and tripeptides
Protein Digestion by Peptidases in the
Enterocytes
• Last digestive stage of proteins is
achieved by the enterocytes in the villi
of the small intestine (duodenum and
jejunum)
• Peptidases are located on the microvilli
of the cells
• Aminopolypeptidase and dipepetidases
split larger polypeptides into
tripeptides, dipeptides and amino acids
• > 99% of final protein digestive
products absorbed are individual A.A
Digestion of Fats
• In fat hydrolysis, fat digesting enzymes
return H2O molecules to the
triglyceride molecule to split fatty acid
molecule away from the glycerol
• Most abundant fats of the diet:
triglyceride
• Other source of fats in the diet:
phospholipids, cholesterol and
cholesterol esters
Digestion of Fats in the Small Intestine
• 10% of fat is digested in the stomach by
lingual lipase (secreted by lingual
glands)
• Fat digestion occurs mainly in the small
intestine
• First step in fat digestion is fat
emulsification – break down of fat
globules into small sizes so that water
soluble digestive enzymes can act on
the globule surfaces
• Most of emulsification occurs in the
duodenum under the influence of bile
• Bile – secretion from the liver and
doesn’t contain any digestive enzymes;
contains bile salts and lecithin
important for fat emulsification
• Low interfacial tension of non-miscible
globule can be broken up easily; major
function of bile salts and lecithin is to
make fat globules readily fragmentable
by agitation with water
• Emulsification of fat causes: diameter of
fat soluble to decrease (to less than 1
micrometer) = increased total surface
area of fat (1000 fold)
• Lipase enzymes are water soluble and
can attack fat globules only on their
surfaces
Triglycerides Are Digested by Pancreatic Lipase
• Pancreatic lipase – present enormous
quantities in pancreatic juice; enough to
digest all triglyceride within 1 minute
• Enterocytes of small intestine contain
enteric lipase but is usually not needed
• End products: free fatty acids and 2-
monoglycerides
Bile Salts Form Micelles That Accelerate Fat
Digestion
• Accumulation of monoglycerides
and free fatty acids in the vicinity of
digesting fats blocks further
digestion
• Bile salts remove monoglycerides
and free fatty acids in the vicinity of
digesting fats as fast as they are
formed
• High concentration of bile salts ->
micelles
• Micelles – small spherical,
cylindrical globules 3-6 nm in
diameter composed of 20-40 bile
salt molecules; they develop due to
its sterol nucleus (highly fat-soluble)
and polar group (water soluble)
• Sterol nucleus encompasses fat
globule -> forms small fat globule in
middle of micelle;
• Due to the negatively charged polar
group projecting outward of the
micelle, it allows the entire micelle
(including fat globule in the middle)
to dissolve in water of digestive
fluids
• Bile salt also acts as transport
medium to carry monoglycerides
and free fatty acids to brush
borders of intestinal epithelial cells
where they are absorbed into the
blood; bile salts released into
chyme
Digestion of Cholesterol Esters and
Phospholipids
• Cholesterol ester = free cholesterol
+ 1 molecule fatty acid
• Cholesterol ester hydrolase to
hydrolyze cholesterol ester
• Phospholipase A2 hydrolyze
phospholipids
• Cholesterols are “ferried” the same
way as monoglycerides and free
fatty acids
• Cholesterol cannot be absorbed
without micelles
_______________________________________
GASTROINTESINAL ABSORPTION
Anatomical Basis of Absorption
• About 8-9 L (1.5 L ingested fluid + 7 L GI
secretions) is absorbed by the intestines
• All but 1.5 of this fluid is absorbed in
the small intestine; the 1.5 L pass
through ileocecal valve into the colon
per day
• Stomach is a poor absorptive area since
it lacks villus and also has tight
junctions; only small amounts of highly
lipid-soluble substances (alcohol,
aspirin) can be absorbed
• Fold of Kerckring or valvulae
conniventes in the small intestine
(duodenum and jejunum) increase
surface area of the mucosa by 3-fold;
they often protrude up to 8 mm into
intestinal lumen
• Small villi (located on epithelial surface
of small intestine to ileocecal valve)
project about 1 mm from mucosal
surface; they increase total absorptive
area by 10-fold
• Each villus is characterized by brush
border consisting of 1000 microvilli (1
μm length and 0.1 μm diameter);
increases surface area by 20-fold
• Combination of Kerckring, villi and
microvilli increases absorptive area by
1000-fold making a total area of 250 or
more sq. m for entire small intestine
• Actin filaments extending from
epithelial cell body to microvillus
contract rhythmically to cause continual
movement of microvilli to keep them
constantly expose to new quantities of
intestinal fluid
Absorption in the Small Intestine
• Absorptive capacity of a normal small
intestine:
- Several kg carbohydrates
- 500 g fat
- 500-700 g proteins
- 20 or more L water
Absorption of Water
• Water is transported through osmosis
• When chyme is dilute enough, H2O is
absorbed through intestinal mucosa
into blood of villi
• Reverse transport can also occur (water
from plasma into chyme); H2O diffuses
so that hyperosmotic chyme can be
isosmotic with the plasma
Absorption of Ions
• 20-30 g of Na ions secreted in intestinal
secretion each day; average person eats
5-8 g of Na each day
• Amount of Na that should be ingested
to prevent net loss of Na into feces: 25-
30 g/day
• < 0.5% of intestinal sodium is lost in
feces each day since it is rapidly
absorbed through intestinal mucosa
• Negatively charged Cl ions mainly
passively “dragged” by positive
electrical charges of Na ions
• Active transport of Na through
basolateral membrane of cell reduces
its concentration to approx. 50 mEq/L
• Sodium co-transported via:
(1) Sodium-glucose co-transporter
(2) Sodium-amino acid co-transporters
(3) Sodium-hydrogen exchanger
• Osmosis of water occurs due to the
large osmotic gradient created by
elevated concentration of ions in the
paracellular space
• Osmosis occurs through tight junctions
between epithelial cells (paracellular
pathway) or through cells themselves
(transcellular pathway)
• In dehydrated persons, aldosterone is
secreted by the cortices of adrenal
glands to activate enzyme and transport
mechanisms for sodium absorption;
increased Na ions -> increased Cl ions
and water absorption
• Cl ion absorbed rapidly by diffusion in
the upper part of small intestine; also
absorbed across brush border
membrane of ileum and large intestine
by chloride bicarbonate exchanger
• Absorption of Na ions through
epithelium creates electronegativity in
the chyme and electropositivity in the
paracellular spaces between the
epithelial cells
• Bicarbonate ions are absorbed
indirectly in the duodenum and
jejunum
• In the lumen: H ions + bicarbonate =
carbonic acid (H2CO3); H2CO3
dissociates to H2O and CO2; CO2
readily absorbed into blood and expired
through lungs
• Secretion of bicarbonate in exchange
for absorption of chloride in the ileum
and large intestine is important to
neutralize acid products formed by
bacteria
• Calcium ions actively absorbed into
blood from the duodenum
• Parathyroid hormone (from parathyroid
glands) activates vitamin D and
activated vit. D enhance Ca absorption
• Iron ions actively absorbed from small
intestine
• Potassium, magnesium, phosphate and
other ions actively absorbed through
intestinal mucosa
• Monovalent ions are absorbed with
ease and great quantities; bivalent ions
absorbed only in small amounts
Absorption of Nutrients
• All carbohydrates in food are absorbed
in form of monosaccharide; small
 fraction of disasccharides and none of
larger carbohydrates
• Glucose is the most abundant
monosaccharide absorbed (80%);
remaining 20% is galactose and fructose
• All monosaccharides absorbed by
secondary active transport process
• Active transport of Na ions to interstitial
fluid -> depletion of intracellular Na ->
Na from intestinal lumen move to cell
interiors via secondary active transport
• Na ion combines with transport protein
but it won’t transport Na until the
transport also combines with glucose
• Galactose transported similarly to
glucose; fructose is transported by
facilitated diffusion and not coupled
with Na transport
Absorption of Proteins
• Co-transport (secondary active
transport) of the amino acids and
peptides – similar mechanism to the
glucose transport (needs a sodium co-
transport for it to be transported inside
the cell)
• A few amino acids are transported via
facilitated diffusion
• 5 types of transport proteins for amino
acids and peptides are found in luminal
membranes of intestinal epithelial cells
Absorption of Fats
Please refer to “Bile Salts Form Micelles That
Accelerate Fat Digestion”
• Essentially bile micelle functions to
transport fat into the interior of
epithelial cells (lipids can easily diffuse
through the cell membrane)
• Abundance of bile micelles = 97% fat
absorbed
• Absence of bile micelle = 40-50% fat
absorbed
• After entering epithelial cell, lipids are
taken up by cell’s smooth endoplasmic
reticulum to form new triglycerides
released in the form of chlyomicrons (it
flows through thoracic lymph duct and
empty into circulating blood)
• Small quantities of short and medium
chain fatty acids (butterfat) are
absorbed directly without being
converted to triglycerides; possible
since short chain fatty acids are more
water soluble; this allows direct
diffusion of these fatty acids from
epithelial cells directly to capillary blood
Absorption in the Large Intestine
• 1500 mL of chyme pass through
ileocecal vale into large intestine
• Most water and electrolytes absorbed
in the colon; 100 mL of fluid excreted in
the feces
• Only 1-5 mEq each of Na and Cl ions are
lost in feces
• Absorbing colon – proximal half of the
colon is where most absorption
happens
• Storage colon – distal colon is for
storage of feces until it is time for feces
to be excreted
Absorption and Secretion of Electrolytes and
Water
• Large intestine have high capability for
active absorption of Na and Cl ions
• Mucosa of the large intestine have
tighter junctions than that of the small
intestine which prevents back-diffusion
of ions through these junction
• Large intestine secretes bicarbonate
ions while simultaneously absorbing
equal number of Cl ions
• Absorption of Na and Cl ions creates an
osmotic gradient across large intestinal
mucosa which causes water absorption
• Large intestine can absorb maximum of
5-8 L of fluid and electrolytes per day
• When total quantity entering large
intestine through ileocecal valve
exceeds this amount -> diarrhea
• Toxins from cholera/other bacterial
infection causes crypts in terminal
ileum and large intestine to secrete 10
or more L of fluid each day
Bacterial Action in the Colon
• Numerous bacteria especially colon
bacilli are present even normally in
the absorbing colon
• They are capable of digesting small
amounts of cellulose
• Other substances formed as result
of bacterial activity:
- Vitamin K – important
because the amount of this
vitamin in daily ingested
 food is normally insufficient
to maintain adequate blood
coagulation
- Vitamin B12
- Thiamine
- Riboflavin
- Flatus (various gases e.g.
CO2, hydrogen gas and
methane)

Composition of the Feces

• ¾ water and ¼ solid matter

• Solid matter:
- 30% dead bacteria
- 10-20% fat
- 10-20% inorganic matter
- 2-3% protein
- 30% undigested roughage from
food and dried matter of
digestive juice (bile pigment
and sloughed epithelial cells)
• Stercobilin and urobilin – derivatives of
bilirubin responsible for brown color of
feces
• Odor is caused by products of bacterial
action; products may vary depending on
each person’s colonic bacterial flora and
food eaten
• Actual odoriferous products: indole,
skatole, mercaptan and hydrogen
sulfide