The Digestive System

JEN ARAGON,MD
NOVEMBER 2015
2 groups of organs compose the
digestive system
◦Gastrointenstinal (GI) tract or alimentary
canal – mouth, most of pharynx,
esophagus, stomach, small intestine, and
large intestine
◦Accessory digestive organs – teeth,
tongue, salivary glands, liver, gallbladder,
and pancreas
ORGANS OF THE
DIGESTIVE SYSTEM
6 functions of the digestive
system
1. Ingestion
2. Secretion of water, acid, buffers, and
enzymes into lumen
3. Mixing and propulsion
4. Digestion
◦ Mechanical digestion churns food
◦ Chemical digestion – hydrolysis
5.Absorption – passing into blood or lymph
6.Defecation – elimination of feces
 LAYERS OF THE GI TRACT
Wall of GI tract from lower esophagus to anal
canal has same basic 4 layers
1. Mucosa – inner lining
◦ Epithelium protection, secretion, absorption
◦ Lamina propria – connective tissue with blood
and lymphatic vessels and mucosa-associated
lymphatic tissue (MALT)
◦ Muscularis mucosae – thin layer of smooth
muscle making folds to increase surface area
2. Submucosa
◦ Connective tissue binding mucosa to
muscularis
◦ Contains many blood and lymphatic vessels
◦ Submucosal plexus
3. Muscularis
◦ Voluntary skeletal muscle found in mouth,
pharynx, upper 2/3 of esophagus, and anal
sphincter
◦ Involuntary smooth muscle elsewhere
◦ Arranged in inner circular fibers and outer
longitudinal fibers
◦ Myenteric plexus between muscle layers
4. Serosa
◦ Outermost covering of organs suspended in
abdominopelvic cavity
◦ Also called visceral peritoneum
◦ Esophagus lacks serosa – has adventitia
NEURAL INNERVATION
Enteric nervous system (ENS)
◦ Intrinsic set of nerves - “brain of gut”
◦ Neurons extending from esophagus to anus
◦ 2 plexuses
◦ Myenteric plexus – GI tract motility
◦ Submucosal plexus – controlling secretions
Autonomic nervous system
◦ Extrinsic set of nerves
◦ Parasympathetic stimulation increases
secretion and activity by stimulating ENS
◦ Sympathetic stimulation decreases secretions
and activity by inhibiting ENS
PERITONEUM
Largest serous membrane of the body
Divided into
◦ Parietal peritoneum – lines wall of cavity
◦ Visceral peritoneum – covers some organs
◦ Also called serosa
◦ Space between is peritoneal cavity
◦ 5 major peritoneal folds
◦ Greater omentum, falciform ligament, lesser omentum,
mesentery, and mesocolon
MOUTH
Oral or buccal cavity
Formed by cheeks, hard and soft palates, and
tongue
Oral cavity proper is a space that extends from
gums and teeth to fauces (opening between oral
cavity and oropharynx)
Salivary glands release saliva
◦ Ordinarily, just enough is secreted to keep
mouth and pharynx moist and clean
◦ When food enters mouth, secretion increases
to lubricate, dissolve and begin chemical
digestion
◦ 3 pairs of major salivary glands secrete most of
the saliva
◦ Parotid, submandibular, and sublingual
SALIVA
Saliva
◦ Mostly water 99.5%
◦ 0.5% solutes – ions, dissolved gases, urea, uric
acid, mucus, immunoglobulin A, lysozyme, and
salivary amylase (acts on starch)
◦ Not all salivary glands produce the same saliva
Salivation
◦ Controlled by autonomic nervous system
◦ Parasympathetic stimulation promotes
secretion of moderate amount of saliva
◦ Sympathetic stimulation decreases salivation
TONGUE
◦ Accessory digestive organ
◦ Skeletal muscle covered by mucous membrane
◦ Maneuvers food for chewing, shapes mass,
forces food back for swallowing
◦ Lingual glands secrete salivary lipase
TEETH OR DENTES
◦ Accessory digestive organ
◦ 3 major regions – crown, root, and neck
◦ Dentin of crown covered by enamel
◦ 2 dentitions – deciduous and permanent teeth
•There are 20 teeth in a complete deciduous set
and 32 teeth in a complete permanent set.
DIGESTION IN THE MOUTH
Mechanical digestion in the mouth
◦ Chewing or mastication
◦ Food manipulated by tongue, ground by teeth,
and mixed with saliva
◦ Forms bolus
Chemical digestion in the mouth
◦ Salivary amylase secreted by salivary glands acts
on starches
◦ Only monosaccharides can be absorbed
◦ Continues to act until inactivated by stomach acid
◦ Lingual lipase secreted by lingual glands of tongue
acts on triglycerides
◦ Becomes activated in acidic environment of
stomach
ESOPHAGUS
Secretes mucous, transports food – no enzymes
produced, no absorption
Mucosa – protection against wear and tear
Submucosa
Muscularis divided in thirds
◦ Superior 1/3 skeletal muscle
◦ Middle 1/3 skeletal and smooth muscle
◦ Inferior 1/3 smooth muscle
◦ 2 sphincters – upper esophageal sphincter (UES)
regulates movement into esophagus, lower esophageal
sphincter (LES) regulates movement into stomach
Adventitia – no serosa – attaches to surroundings
DEGLUTITION
Act of swallowing
Facilitated by secretions of saliva and mucus
Involves mouth, pharynx, and esophagus
3 stages
◦ Voluntary – bolus passed to oropharynx
◦ Pharyngeal – involuntary passage through
pharynx into esophagus
◦ Esophageal – involuntary passage through
esophagus to stomach
◦ Peristalsis pushes bolus forward
STOMACH
Serves as mixing chamber and holding reservoir
4 main regions
◦ Cardia, fundus, body, pylorus
Same 4 layers
◦ Mucosa – gastric glands open into gastric pits
◦ 3 types of exocrine gland cells – mucous neck cells
(mucus), parietal cells (intrinsic factor and HCl), and
chief cells (pepsinogen and gastric lipase)
◦ G cell – endocrine cell – secretes gastrin

◦ Submucosa
◦ Muscularis – additional 3rd inner oblique layer
◦ Serosa – part of visceral peritoneum
MECHANICAL & CHEMICAL
DIGESTION
Mechanical digestion
◦ Mixing waves – gentle, rippling peristaltic movements
– creates chyme
Chemical digestion
◦ Digestion by salivary amylase continues until
inactivated by acidic gastric juice
◦ Acidic gastric juice activates lingual lipase
◦ Digest triglycerides into fatty acids and diglycerides
◦ Parietal cells secrete H+ and Cl- separately but
net effect is HCl
◦ Kills many microbes, denatures proteins
◦ Pepsin secreted by chief cells digest proteins
◦ Secreted as pepsinogen
◦ Gastric lipase splits triglycerides into fatty acids
and monoglycerides
Small amount of nutrient absorption
◦ Some water, ions, short chain fatty acids,
certain drugs (aspirin) and alcohol
PANCREAS
Lies posterior to greater curvature of stomach
Pancreatic juice secreted into pancreatic duct
and accessory duct and to small intestine
◦ Pancreatic duct joins common bile duct and
enters duodenum at hepatopancreatic ampulla
PANCREAS
Histology
◦ 99% of cells are acini
◦ Exocrine
◦ Secrete pancreatic juice – mixture of fluid and
digestive enzymes
◦ 1% of cells are pancreatic islets (islets of
Langerhans)
◦ Endocrine
◦ Secrete hormones glucagon, insulin,
somatostatin, and pancreatic polypeptide
PANCREATIC JUICE
◦ 1200-1500ml daily
◦ Mostly water
◦ Sodium bicarbonate – buffers acidic stomach chyme
◦ Enzymes
◦ Pancreatic amylase
◦ Proteolytic enzymes – trypsin (secreted as trypsinogen),
chymotrypsin (chymotrypsinogen), carboxypeptidase
(procarboxypeptidase), elastase (proelastase)
◦ Pancreatic lipase
◦ Ribonuclease and deoxyribonuclease
LIVER
Liver is the heaviest gland of the body
Liver is composed of
◦ Hepatocytes – major functional cells of liver
◦ Wide variety of metabolic, secretory, and endocrine
functions – secrete bile (excretory product and digestive
secretion)
◦ Bile canaliculi – ducts between hepatocytes that
collect bile
◦ Exits liver as common hepatic duct, joins cystic duct from
gallbladder to form common bile duct
◦ Hepatic sinusoids – highly permeable blood
capillaries receiving oxygenated blood from
hepatic artery and deoxygenated nutrient-rich
blood from hepatic portal vein
3 different ways to organize units
◦ Hepatic acinus – preferred method
◦ Hepatocytes arranged in 3 zones around short axis
with no sharp boundaries
GALLBLADDER
◦ Contraction of smooth muscle fibers eject
contents of gall bladder into cystic duct
◦ Functions to store and concentrate bile
produced by the liver until it is needed in the
small intestine
◦ Absorbs water and ions to concentrate bile up
to ten-fold
HEPATIC BLOOD FLOW
Liver receives blood from
Hepatic artery carrying oxygenated blood
Hepatic portal vein carrying deoxygenated blood
with newly absorbed nutrients and possibly
drugs, microbes or toxins from GI tract
ROLE AND COMPOSITION OF BILE
◦ Hepatocytes secrete 800-1000mL of bile daily
◦ Mostly water, bile salts, cholesterol, lecithin, bile
pigments and several ions
◦ Bilirubin – principal bile pigment
◦ Derived from heme of recycled RBCs
◦ Breakdown product stercobilin gives feces brown color
◦ Bile salts play a role in emulsification
◦ Also aid in absorption of lipids following digestion
SMALL INTESTINE
3 regions – duodenum, jejunum, and ileum
Same 4 layers
1. Mucosa
◦ Absorptive cells (digest and absorb), goblet cells
(mucus), intesrinal glnds (intestinal juice), Paneth
cells (lysozyme), and enteroendocrine cells
◦ Abundance of MALT
2. Submucosa
◦ Duodenal glands secrete alkaline mucus
3. Muscularis
4. Serosa
◦ Completely surrounds except for major portion of
duodenum
SPECIAL STRUCTURAL
FEATURES
- increase surface area for digestion and absorption
◦ Circular folds
◦ Permanent ridges of mucosa and submucosa
◦ Villi
◦ Fingerlike projections of mucosa
◦ Contains arteriole, venule, blood capillary, and lacteal
◦ Microvilli
◦ Projections of apical membrane of absorptive cells
◦ Brush border with brush border enzymes
Intestinal juice
◦ 1-2L daily
◦ Contains water and mucus, slightly alkaline
◦ Provide liquid medium aiding absorption
Brush border enzymes
◦ Inserted into plasma membrane of absorptive cells
◦ Some enzymatic digestion occurs at surface rather
than just in lumen
 MECHANICAL DIGESTION
◦ Governed by myenteric plexus
◦ Segmentations
◦ Localized, mixing contractions
◦ Mix chyme and bring it in contact with mucosa for
absorption
◦ Migrating motility complexes (MMC)
◦ Type of peristalsis
◦ Begins in lower portion of stomach and pushes food
forward
CHEMICAL DIGESTION
◦Carbohydrates
◦ Pancreatic amylase
◦ α-dextrinase, sucrase, lactase, maltase in brush border
◦ Ends with monosaccharides which can be absorbed
◦Proteins
◦ Trypsin, chymotrypsin, carboxypeptidase, and elastase
from pancreas
◦ Aminopeptidase and dipeptidase in brush border
LIPIDS AND NUCLEIC ACIDS
◦Lipids
◦ Pancreatic lipase most important in triglyceride
digestion
◦ Emulsification by bile salts increases surface area
◦ Amphipathic – hydrophobic and hydrophilic regions
◦Nucleic acids
◦ Ribonuclease and deoxyribonuclease in pancreatic
juice
◦ Nucleosidases and phosphatases in brush border
ABSORPTION OF:
◦ Monosaccharides
◦ All dietary carbohydrates digested are absorbed
◦ Only indigestible cellulose and fibers left in feces
◦ Absorbed by facilitated diffusion or active transport into
blood
◦ Amino acids, dipetides and tripeptides
◦ Most absorbed as amino acids via active transport into
blood
◦ ½ of absorbed amino acids come from proteins in digestive
juice and dead mucosal cells
LIPIDS
◦ All dietary lipids absorbed by simple diffusion
◦ Short-chain fatty acids go into blood for transport
◦ Long-chain fatty acids and monoglycerides
◦ Large and hydrophobic
◦ Bile salts form micelles to ferry them to absorptive cell surface
◦ Reform into triglycerides forming chylomicrons
◦ Leave cell by exocytosis
◦ Enter lacteals to eventually enter blood with protein coat of
chylomicron keeping them suspended and separate
ABSORPTION OF:
◦ Electrolytes
◦ From GI secretions or food
◦ Sodium ions (Na+) reclaimed by active
transport
◦ Other ions also absorbed by active transport
◦ Vitamins
◦ Fat-soluble vitamins A, D, E, and K absorbed
by simple diffusion and transported with lipids
in micelles
◦ Most water-soluble vitamins also absorbed by
simple diffusion
◦ Water
◦ 9.3L comes from ingestion (2.3L) and GI
secretions (7.0L)
◦ Most absorbed in small intestine, some in
large intestine
◦ Only 100ml excreted in feces
◦ All water absorption by osmosis
LARGE INTESTINE
•Overall function to complete absorption, produce
certain vitamins, and form and expel feces
•4 major regions – cecum, colon, rectum, and
anal canal
•Ileocecal sphincter between small and large
intestine
•Colon divided into ascending, transverse, descending
and sigmoid
•Opening of anal canal (anus) guarded by internal
anal sphincter of smooth muscle and external anal
sphincter of skeletal muscle
LARGE INTESTINE
Mucosa – mostly absorptive and goblet cells
◦ No circular folds or villi
◦ Does have microvilli
Submucosa
Muscularis
◦ Longitudinal muscle modified to form teniae coli
◦ Forms haustra – pouches
Serosa
DIGESTION IN THE LARGE
INTESTINE
Mechanical digestion
◦ Haustral churning
◦ Peristalsis
◦ Mass peristalsis – drives contents of colon
toward rectum
Chemical digestion
◦ Final stage of digestion through bacterial action
◦ Ferment carbohydrates, produce some B
vitamins and vitamin K
◦ Mucus but no enzymes secreted
Remaining water absorbed along with ions
and some vitamins
PHASES OF DIGESTION
Cephalic phase
◦ Smell, sight, thought or initial taste of food
activates neural centers – prepares mouth and
stomach for food to be eaten
Gastric phase
◦ Neural and hormonal mechanisms promote
gastric secretion and motility
Intestinal phase
◦ Begins when food enter small intestine
◦ Slows exit of chyme from stomach
◦ Stimulates flow of bile and pancreatic juice