Chapter 23

The Digestive System

Use the video clips:
CH 23 Digestive System General Anatomy,
CH 23 Anatomy of the Mouth and Esophagus, CH 23
Anatomy of the Stomach, CH 23 Anatomy of the Pancreas,
CH 23 Anatomy of the Liver, CH 23 Anatomy of the Small
Intestine and CH 23 Anatomy of the Large Intestine for a
review of digestive system structure

G.R. Pitts, Ph.D., J.R. Schiller, Ph.D. and

James F. Thompson, Ph.D.

Digestive Processes
Ingestion
Movement of food
Digestion
Mechanical digestion
Chemical digestion
Absorption
Defecation

General Structure
Digestive organs
divided into 2
main groups
GI (alimentary)
tract
Accessory
structures
cheeks, teeth,
tongue, salivary
glands
liver, gallbladder,
pancreas

Salivary Glands
3 pairs salivary glands

Parotid glands
Submandibular glands
Sublingual glands

Salivary Glands
Composition of Saliva
99.5% water, 0.5% solutes
Na+, K+, Cl-, HCO3-, and PO4-, proteins,
waste products
lysozyme
salivary amylase digests carbohydrates

Saliva composition differs among the 3 glands

parotid - watery saliva, amylase
submandibular - thicker mucous, amylase
sublingual - mostly mucous, a little amylase

Salivary Glands
Functions of Saliva
Water dissolves food for taste and digestion
Mucous moistens and lubricates food
Mucous lubricates oral surfaces for smooth
actions in swallowing and speech
Cl- ions activate amylase
HCO3- and PO4- ions buffer bacterial acids

IgA, lysozymes, cyanide, defensins: protect

against microorganisms

Salivary Glands
Secretion of Saliva - 1-1.5 L l day
Primarily under nervous control
Parasympathetic (ANS) normal salivary
secretions
saliva swallowed
most reabsorbed
Sympathetic (ANS) reduced flow (dry mouth)

Food (mechanically, chemically) stimulates

salivation
behavioral memories from cortex
starts digestion
continues after ingestion is complete
irritating foods or nausea

Physiology of Digestion in
Mouth

Mechanical digestion

Chewing = mastication
Food mixed with saliva
Shaped into a bolus
Chemical digestion salivary amylase
breaks down and converts
polysaccharides (starches) to
disaccharides (maltose) and
monosaccharides (glucose) [no enzymatic
action with cellulose which is also a
polymer of glucose]

Physiology of Deglutition
(Swallowing)

Moving bolus from

mouth to stomach
Three phases
Facilitated by saliva,

mucous secretions
Involves mouth,
pharynx, esophagus

1. Buccal phase
Voluntary
Moves bolus to
oropharynx

Physiology of Deglutition
2.Pharyngeal phase
Involuntary
Receptors in oropharynx
stimulate medulla and
pons to:
1.Block mouth with tongue
2.Block nasopharynx with

soft palate
3.Raise larynx to seal
epiglottis, blocking airways
4.Relax upper esophageal
sphincter

Bolus is moved through

pharynx into esophagus

Physiology of Deglutition
3. Esophageal stage
Upper esophageal

sphincter closes
Gastroesopaheal
sphincter opens
Esophagus controls
involuntary peristaltic
movement
Epiglottis reopens
Bolus moves from
esophagus to
stomach

Esophagus
Peristalsis
Involuntary, rhythmic
contraction of
muscularis
Controlled by
medullary centers
A movement activity:
inner circular layer of
smooth muscle
contracts behind
bolus to push it
forward; outer
longitudinal muscle
contracts to pull
esophagus wall up

Esophagus
Physiology
Upper esophageal
sphincter
Peristalsis
Lower esophageal
(cardiac) sphincter
Sharp transition from
nonkeratinized stratified
squamous epithelium to
simple columnar epithilium
Esophageal epithelium
resistant to abrasion but
not to acid and proteolytic
enzyme attack acid
reflux disease

Stomach
Physiology of digestion - Mechanical digestion
peristaltic movement (mixing waves) back and
forth between body and pylorus
3 muscle layers: longitudinal, circular, and oblique
chyme

Stomach

Physiology of digestion - Chemical

digestion
parietal cells secrete intrinsic factor for B12

absorption
parietal cells secrete HCl by active transport
kills microbes, denatures proteins
causes some acid hydrolysis of food molecules
stimulates secretion of hormones for bile &
pancreatic juice flow

chief cells secrete pepsinogen (inactive

precursor)
activated to pepsin by HCl acid and by other pepsins
only an effective protease at acid pH
cleaves proteins into smaller peptides

Stomach: Mucosa
Gastric gland chief cells

Secrete pepsinogen (inactive

precursor)

activated to pepsin by HCl acid

and by other activated pepsin
enzymes
only an effective protease at acid
pH
cleaves proteins into smaller
peptides

Secrete rennin in neonates

curdles milk to increase time for
gastric processing

Secrete gastric lipase in neonates

splits short chain triglycerides
common in milk
limited role in digestion since it
works best at pH 5-6

Stomach: Mucosa
Simple columnar epithelium
with goblet cells and gastric
pits
Secretes 2-3 L l day

Gastric gland parietal cells

Secrete intrinsic factor for B12

absorption
Secrete HCl by active transport

kills microbes, denatures

proteins
causes some acid hydrolysis of
food molecules
stimulates secretion of
hormones for bile & pancreatic
juice flow

Goblet & gastric pit mucous

cells secrete mucin
1-3 mm mucus layer in the

stomach prevents self-digestion

Stomach: Mucosa
Gastric gland G cells
(enteroendocrine)
Secrete gastrin,
histamine, serotonin,
somatostatin

Absorption
Impermeable to diffusion
of most molecules into
the bloodstream

Absorbs a few lipid

soluble compounds:
certain drugs (e,g., aspirin)
alcohol

Stomach: Regulation of Secretion

and Motility

Regulated by combination of neuronal

and hormonal factors

3 phases
1. Cephalic
2. Gastric
3. Intestinal

Stomach: Regulation of Secretion

and Motility
1.Cephalic phase
- Stimuli
-

sight
smell
taste
thoughts/memories

- Effect
- Parasympathetic

impulses increase
gastric secretion

Stomach: Regulation of Secretion

and Motility
2.Gastric phase
Neural negative feedback
mechanisms
Distension activates stretch
receptors causing myenteric
and vagovagal reflexes to
release Ach

Ach stimulates gastric juice

secretion

Chemoreceptors respond to
partially digested proteins,
caffeine and rising pH

Stimulate gastrin secretion

from G cells

Stomach: Regulation of Secretion

and Motility

2.Gastric phase (cont.)

Gastrin

Inhibited at pH < 2
Gastrin transported in the
blood to the gastric glands
Greatly stimulates HCl
secretion
Stimulates histamine
secretion
Slightly stimulates
pepsinogen secretion
Contracts lower
esophageal sphincter
Increases gastric motility
Relaxes pyloric sphincter

Stomach
KHCO3

2. Gastric phase (continued)

Control of HCl secreting parietal
cells
stimulation by three signal
chemicals

gastrin
acetylcholine
histamine

All three needed for strong H+

HCl

secretion
H+ pumps work in conjunction
with carbonic anhydrase
blockage of the histamine H2
receptor decreases HCl secretion
Tagamet
Zantac

Stomach: Regulation of Secretion

and Motility

3. Intestinal phase has

excitatory and inhibitory

components:

Excitatory
Very short phase
Initiated by chyme entry into
duodenum

Stretch receptors stimulate

release of intestinal (enteric)
gastrin

Chemoreceptors detect fatty

acids, & glucose in the
duodenum

Stimulate enteric gastrin release

Stomach: Regulation of Secretion

and Motility

3.Intestinal phase (cont.)

Inhibitory
Enterogastric reflex: stretch

receptors, chemoreceptors trigger

3 reflexes that

1.Inhibit vagoval reflex

2.Inhibit myenteric reflex
3.Activate sympathetic nervous

system to close pyloric sphincter

Inhibit gastric secretion

Enterogastrone secretion
Enteroendocrine cells in the small

intestine release:
Cholecystokinin (CCK)
Gastric inhibitory peptide (GIP)
Secretin
Vasoactive intestinal peptide
(VIP)
Hormones inhibit gastric secretion

Stomach: Regulation of Gastric

Emptying
Food normally passes
through stomach in 4 hours

Hormonal/neuronal reflexes
regulate gastric emptying

Large meals and large

amounts of liquid increase
stomach distension
increasing rate of emptying

Stomach emptying inhibited

by the enterogastric reflex,
enterogastrones, and fat in
the duodenum

Stomach

Summary

Pancreas
Pancreatic juice
1.2-1.5 L/day
Mostly water some salts, bicarbonate, enzymes
alkaline, pH 7.1-8.2
buffers acidic gastric juice, stops pepsin activity,

creates proper alkaline pH for enzymes acting in the

intestine

Enzymes include:
pancreatic amylase
trypsinogen, chymotrypsinogen,

procarboxypeptidase (inactive zymogens)

pancreatic lipase
ribonuclease and deoxyribonuclease

Regulation of Pancreatic
Secretion
Neural control from

parasympathetic division
of ANS via vagus nerve
Autoregulation by sensing
the presence of fatty acids
and amino acids in the
acidic chyme
Hormonal control by the
secretion of
enteroendocrines from
duodenum
Secretin stimulates
secretion of water, HCO3-

CCK stimulates secretion of

enzymes

Liver: Blood Supply

Two sources
Hepatic artery - oxygenated
blood from aorta

Hepatic portal vein

-deoxygenated blood:

absorbed nutrients and toxins

from the stomach and
intestines
hormones from the pancreas
breakdown products of RBCs
from the spleen

Blood mixes in the sinusoids

Hepatocytes (liver cells)
modify and exchange
molecules with the blood

Note the
portal triads
and
fenestrated
capillary
sinusoids

Liver

Central
veins
return
blood to
the
systemic
circulation
via the
hepatic
vein and
inferior
vena cava
hepatic portal venous
blood and arterial
blood mix in the
sinusoids

Liver: Bile Secretion

Bile from the hepatocytes
enters bile capillaries
(canaliculi)

Canaliculi empty into

small bile ducts

Hepatic ducts join the

cystic duct from the

gallbladder to form the
common bile duct

Gallbladder stores bile

Common bile duct meets

pancreatic duct at the

hepatopancreatic ampulla
(of Vater)

Liver
Bile
800-1000 ml/day
Yellow, brownish, or olive-green liquid
pH 7.6-8.6, mostly water, bile salts, bile acids,
cholesterol, lecithin (phospholipid), bile
pigments, ions

Part digestive secretion, part excretory product

bile salts help in emulsification of ingested fats
bilirubin and other bile pigments are wastes from
lipid catabolism

Liver:
Bile Synthesis
Cholecystokinin =
gall bladder moves

Regulation of bile
production/secretion
nervous control from
parasympathetic
division of ANS via
vagus nerve

autoregulation by
sensing the resence
of fatty acids and
amino acids in the
acidic chyme

hormonal control by
the secretion of the
enteroendocrines,
CCK and secretin,
from the duodenum

Liver
Physiology of the liver processes vital to life
Carbohydrate metabolism regulates blood glucose levels
glycogenesis (insulin)
glycogenolysis (glucagon)
gluconeogenesis (glucagon)
Lipid metabolism stores, metabolizes some triglycerides
synthesizes new cholesterol
degrades excess cholesterol for bile salt production
Protein metabolism deaminates AAs by removing amino groups (-NH 2) from AAs
deaminated AA's used for ATP production or changed to carbohydrates
or fats as needed
detoxifies ammonia (NH3) by synthesizing urea (1 CO2 + 2 NH3 = urea)

can convert AA's from one to another (transamination)

synthesizes and secretes most plasma proteins

Liver
Physiology of the liver - processes vital to life
Storage oil-soluble vitamins, iron, other nutrients
and minerals
Phagocytosis
Removal of dietary toxins, hormones, drugs
detoxify or store or secrete compounds into bile
metabolize thyroid, steroid hormones
Synthesis of bile salts
Excretion of bile - bilirubin
Activation of Vitamin D (?)

Pathologies of the liver hepatitis (viral, toxic),

cirrhosis, cancer

Gall Bladder
Pear-shaped sac,
7-10 cm long

Physiology
stores and
concentrates bile
between meals
CCK stimulates bile
release for fatty
meals
when the small
intestine is empty,
the
hepatopancreatic
sphincter closes,
forcing bile into the
gallbladder for
storage

Pathology:
gallstones

Summary: Digestive Hormones

enteroendocrines

Gastrin
Gastric Inhibitory Peptide
Secretin
Cholecystokinin
(There are others.)

Small Intestine: Segmentation

primary action of small
intestine when food is
present

a form of mechanical
digestion

a mixing activity
alternate contraction,

relaxation of antagonistic
smooth (circular and
longitudinal) muscle
segments in the intestine

controlled by the

autonomic nervous
system

Small Intestine: Peristalsis

as absorption
continues, distension
decreases and true
peristalsis starts

a movement which
propels chyme onward

these weak movements

which occur only after
most nutrients have
been absorbed

Small Intestine: Motility and

Secretion

Intestinal secretions

1-2 L/day, pH 7.6

mostly water and mucus
bicarbonate buffer neutralizes gastric acid
provide enzymes for final chemical digestion

Regulation of intestinal secretion and motility

stimulated by distension and acidic chyme
local reflexes increase Ach release
VIP stimulates production of intestinal secretions
basal motility is controlled by autorhythmic
pacemakers
local hormones and parasympathetic ANS reflexes
increase motility

Small Intestine: Chemical

Digestion
Intestinal secretions
1-2 L/day, pH 7.6
mostly water and mucus
along with pancreatic
secretions provide acid
neutralization, final
chemical digestion, and
more water for
absorption

Brush border enzymes

brush border enzymes
complete digestion of
protein and
carbohydrate molecules

Small Intestine: Chemical

Digestion

Brush border enzymes

Enteropeptidase

(enterokinase) converts
trypsinogen to trypsin
Trypsin activates other
zymogens

Various other brush

border enzymes
complete digestion of
protein and
carbohydrate
molecules

Small Intestine: Chemical

Digestion

Complete digestion is a function of bile,

pancreatic secretions and intestinal

secretions
Although produced by different organs, they all
function in the small intestine

Prior to small intestine, only limited

activity
mouth salivary amylase
stomach
pepsin
lingual lipase

Small Intestine: Chemical

Digestion

Chemical digestion in the small intestine:

Carbohydrate digestion
pancreatic amylase digests starches
disaccharidases liberate monosaccharides

Protein digestion
pancreatic proteases (trypsin, chymotrypsin, carboxypeptidase)
finished by brush border proteases in the lining epithelium

Lipid digestion
bile salts for emulsification
pancreatic lipase

Nucleic acid digestion

pancreatic ribonuclease and deoxyribonuclease
brush border enzymes digest nucleotides

Small Intestine: Absorption

About 90% of all

absorption takes place

in small intestine

Nutrient absorption
Monosaccharides:

facilitated diffusion and

Na+-driven secondary
active transport

Nutrients enter capillaries

Amino acids: primary and via diffusion, facilitated
Na+-driven secondary
diffusion, or active
active transport
transport
Di- and tripeptides: H+- Nutrients are transported
driven secondary active
in the blood to the liver via
transport

Small Intestine: Nutrient

Absorption

Electrolytes (minerals)

Na+: Primary active transport

K+: facilitated diffusion
Fe: Active transport
Ca2+: Active transport, vitamin D is a cofactor

Vitamins
Water-soluble vitamins (B complex & C)
absorbed by diffusion - B12 absorbed with
intrinsic factor
Fat-soluble vitamins (A, D, E, K) included with
other lipids in micelles/chylomicrons

Small Intestine: Nutrient

Absorption
Lipids (neutral fats,
cholesterol, phospholipids,
etc.) are emulsified by bile
salts, forming micelles
Pancreatic Lipase breaks

triglycerides into 2 fatty acids

and 1 monoglyceride

monoglycerides, fatty acids and

other lipids diffuse into cells

SER re-synthesizes triglycerides

all lipids packaged into

chylomicrons by Golgi
apparatus
chylomicrons leave the cell
by exocytosis and enter
lacteals of the lymphatic
system

Small Intestine: Water

Absorption
Total volume added to the
small intestine/day - 9.3 L
~2.3 L from ingestion
~7.0 L from secretions

Small intestine absorbs

~8.3 L /day
passive absorption following

nutrient molecules
osmosis

The rest of the water

(~1.0L/day) passes to
large intestine where most
is reabsorbed (~0.9 L/day)

Large Intestine
Functions
Completion of

absorption, especially
final absorption of H2O
Normal flora
manufacture certain
vitamins (B complex,
K)
Formation and
expulsion of feces

Anatomy
1.5 m L, 6.5 cm W
Divided into 4 general
areas:

cecum
colon
rectum
anal canal

Large Intestine: Digestion

Mechanical digestion
Chyme passage regulated by ileocecal sphincter
valve generally closed - slow passage
following a meal gastroileal reflex: ileal motility increases,
sphincter relaxes, chyme moves to the cecum
when the cecum is full, the sphincter contracts

Colon movements start when chyme passes sphincter

haustral churning
haustra relaxed, distended until full
then contract, squeeze contents into next haustrum

peristalsis is slow
mass peristalsis (gastrocolic reflex)
during or immediately following a meal, 3-4 times day
strong peristaltic waves from middle of transverse colon
push contents into the rectum

Large Intestine: Digestion

Chemical digestion
much mucus but no enzymes are secreted
some digestion of chyme by bacteria in
colon

final breakdown of substances, mostly

carbohydrates

bacteria produce some vitamins, B complex and K

some bacterial metabolites are toxic, but the liver
normally deals successfully with them

Large Intestine
Absorption and feces formation
Chyme
after 3-10 hours in the large intestine, chyme
becomes solidified (due to water reabsorption)
into feces
large intestine absorbs water, electrolytes, some
vitamins and any toxins

Feces
water, inorganic salts, sloughed off intestinal
epithelial cells, bacteria, products of bacterial
decomposition, undigested parts of food
most water is reabsorbed in small intestine, but
the large intestine is also important in water
reabsorption

Large Intestine
Physiology of defecation
Mass peristalsis
pushes fecal matter into rectum
distension stimulates stretch
receptors initiating reflex for
defecation

Parasympathetic ANS
stimulated by stretch receptors
stimulates contraction of rectum
shortens and increases pressure in
rectum
parasympathetic stimulation relaxes internal sphincter

Conscious stimulation relaxes external sphincter

feces expelled