Overview

I. Introduction

II. General Principles of Gastrointestinal Function

III. Propulsion and Mixing of Food in the Alimentary Tract

IV. Secretory Functions of the Alimentary Tract

V. Digestion and Absorption in the Gastrointestinal Tract

VI. Physiology of Gastrointestinal Disorders

 Actions of Digestive (GI) Tract
• Ingestion • Digestion
– Occurs when material – Chemical breakdown of
enters via the mouth food into small organic
• Mechanical Processing compounds for absorption
– Crushing / Shearing • Absorption
– makes material easier to – Movement of organic
move through the tract substrates, electrolytes,
• Secretion vitamins & water across
digestive epithelium
– Release of water acids,
buffers, enzymes & salts by • Excretion
epithelium of GI tract and – Removal of waste products
glandular organs from body fluids
 V. Digestion and Absorption in the G.I Tract

• Digestion begins in the

mouth and continues as
food travels through the
small intestine

• Most absorption occurs in

the small intestine
 V. Digestion and Absorption in the G.I Tract
• Major foods
– Carbohydrates
– Fats
– Proteins

• Cannot be absorbed in their natural forms through the GI mucosa

• Discusses
– Processes by which carbohydrates, fats, and proteins are digested
into small enough compounds for absorption
– Mechanisms by which the digestive end products, water, electrolytes,
and other substances, are absorbed
V. Digestion and Absorption in the G.I Tract
1. DIGESTION OF THE VARIOUS FOODS BY
HYDROLYSIS

2. BASIC PRINCIPLES OF GASTROINTESTINAL

ABSORPTION

3. ABSORPTION IN THE SMALL INTESTINE

4. ABSORPTION IN THE LARGE INTESTINE:

FORMATION OF FECES
V. Digestion and Absorption in the G.I Tract
1. DIGESTION OF THE VARIOUS FOODS BY
HYDROLYSIS

2. BASIC PRINCIPLES OF GASTROINTESTINAL

ABSORPTION

3. ABSORPTION IN THE SMALL INTESTINE

4. ABSORPTION IN THE LARGE INTESTINE:

FORMATION OF FECES
 I. DIGESTION OF CARBOHYDRATES

Carbohydrate Foods of the Diet

• Sucrose
• Lactose
• Starches
• Other carbohydrates ingested to a slight extent
• Amylose,
• Glycogen,
• Alcohol,
• Lactic acid,
• Pyruvic acid,
• Pectins
• Dextrins
• Minor quantities of carbohydrate derivatives in meats
• Cellulose
• Enzymes capable of hydrolyzing cellulose are not secreted in the human
digestive tract
 1. Hydrolysis of Carbohydrates

• Carbohydrates of the diet

– large polysaccharides or disaccharides, which are
combinations of monosaccharides
 I. DIGESTION OF CARBOHYDRATES

Digestion of Carbohydrates Begins in the

Mouth
• Ptyalin (an α-amylase)
• This enzyme hydrolyzes starch into the
disaccharide maltose and other small
polymers of glucose that contain three
to nine glucose molecules
• Food remains in the mouth only a short
time
• Activity of the salivary amylase is
blocked by acid of the gastric secretions
• Before food and its accompanying saliva
become completely mixed with the
gastric secretions, as much as 30 to 40
percent of the starches will have been
hydrolyzed, mainly to form maltose
 I. DIGESTION OF CARBOHYDRATES IN THE SMALL INTESTIN

Digestion by Pancreatic Amylase

• α-amylase

• Within 15 to 30 minutes after the

chyme empties from the stomach into
the duodenum and mixes with
pancreatic juice, virtually all the
carbohydrates will have become
digested

• Carbohydrates are almost totally

converted into maltose and/or other
small glucose polymers before passing
beyond the duodenum or upper
jejunum
DIGESTION OF CARBOHYDRATES IN THE SMALL INTESTIN

Hydrolysis of Disaccharides and Small

Glucose Polymers Into Monosaccharides by
Intestinal Epithelial Enzymes
• Lactase, sucrase, maltase, and α-
dextrinase
• These enzymes are located in the
enterocytes covering the intestinal
microvilli brush border
• Lactose splits into a molecule of galactose
and a molecule of glucose
• Sucrose splits into a molecule of fructose
and a molecule of glucose
• Maltose and other small glucose
polymers all split into multiple molecules
of glucose
• Final products of carbohydrate digestion
are all monosaccharides
 II. DIGESTION OF PROTEINS

Proteins of the Diet

• Dietary proteins are chemically long chains of amino acids

bound together by peptide linkages
• At each linkage
– hydroxyl ion has been removed from one amino acid
– hydrogen ion has been removed from the succeeding
one

• The characteristics of each protein are determined by

– types of amino acids in the protein molecule
– sequential arrangements of these amino acids
 Hydrolysis of Proteins
• Successive amino acids in the protein chain
– bound together: condensation
– digestion occurs by the reverse effect: hydrolysis

• Proteolytic enzymes return hydrogen and hydroxyl ions from water

molecules to the protein molecules to split them into their constituent
amino acids

• Chemistry of digestion is simple

• Difference lies in the types of enzymes required to promote the

hydrolysis reactions for each type of food

• All the digestive enzymes are proteins

 II. DIGESTION OF PROTEINS

Digestion of Proteins in the Stomach

• Pepsin: peptic enzyme of the stomach

• Gastric glands secrete a large quantity of

hydrochloric acid

• Pepsin: digest the protein collagen

• Collagen is a major constituent of the

intercellular connective tissue of meats

• Pepsin: convert the protein to

– proteoses, peptones, and a few
polypeptides

• This splitting of proteins occurs as a result of

hydrolysis at the peptide linkages between
amino acids
 II. DIGESTION OF PROTEINS

Most Protein Digestion Results From

Actions of Pancreatic Proteolytic Enzymes
• Protein digestion occurs in the upper
small intestine, in the duodenum and
jejunum, under the influence of
proteolytic enzymes from pancreatic
secretion

• Trypsin, chymotrypsin,
carboxypolypeptidase, and elastase

• Only a small percentage of the proteins

are digested all the way to their
constituent amino acids by the
pancreatic juices. Most remain as
dipeptides and tripeptides
 II. DIGESTION OF PROTEINS
Digestion of Peptides by Peptidases in the Enterocytes That Line the Small
Intestinal Villi.
• The last digestive stage of the proteins in the intestinal lumen is achieved
by the enterocytes that line the villi of the small intestine, mainly in the
duodenum and jejunum
• Aminopolypeptidase and several dipeptidases
• Inside the cytosol of the enterocyte are multiple other peptidases that are
specific for the remaining types of linkages between amino acids
• More than 99 % of the final protein digestive products that are absorbed
are
– individual amino acids
– with only rare absorption of peptides
 III. DIGESTION OF LIPIDS

Fats of the Diet

• Neutral fats, also known as
triglycerides, each molecule of which
is composed of a glycerol nucleus and
three fatty acid side chains
• Neutral fat is a major constituent in
food of animal origin but much less so
in food of plant origin
• Small quantities of phospholipids,
cholesterol, and cholesterol esters are
also present in the usual diet.
– The phospholipids and cholesterol
esters contain fatty acid
– Cholesterol is a sterol compound
that contains no fatty acid
 Hydrolysis of Fats

• Entire fat portion of the diet

– Triglycerides (neutral fats), which are combinations of three fatty acid
molecules condensed with a single glycerol molecule
– During condensation, three molecules of water are removed

• Hydrolysis (digestion) of the triglycerides consists of the reverse process:

– the fat-digesting enzymes return three molecules of water to the
triglyceride molecule and thereby split the fatty acid molecules away
from the glycerol
 III. DIGESTION OF FATS

Digestion of Fats Occurs Mainly in the Small Intestine

• A small amount of triglycerides is digested in the stomach by lingual lipase

secreted by lingual glands in the mouth and swallowed with the saliva

• This amount of digestion is less than 10 percent and is generally

unimportant

• All fat digestion occurs in the small intestine

 III. DIGESTION OF FATS

The First Step in Fat Digestion Is Emulsification by Bile Acids and Lecithin
• Physically break the fat globules into small sizes
• This process is called emulsification of the fat, and it begins by
agitation in the stomach to mix the fat with the products of stomach
digestion
• Most of the emulsification then occurs in the duodenum under the
influence of bile, the secretion from the liver that does not contain any
digestive enzyme.
• Bile does contain a large quantity of bile salts, as well as the
phospholipid lecithin
• Lipase enzymes are water-soluble compounds and can attack the fat
globules only on their surfaces
 III. DIGESTION OF FATS

Triglycerides Are Digested by Pancreatic Lipase

• Enzyme for digestion of the triglycerides

– pancreatic lipase
– Present in pancreatic juice
– enough to digest within 1 minute all triglycerides that it can reach
• The enterocytes of the small intestine contain
– lipase
– enteric lipase
– but it is usually not needed
 III. DIGESTION OF FATS

Bile Salts Form Micelles That Accelerate Fat Digestion

• Hydrolysis of triglycerides is a highly reversible process
• Bile salts play additional important role of removing monoglycerides and free fatty
acids from vicinity of digesting fat globules almost as rapidly as these end products
of digestion are formed
• This process occurs in the following way:
– When bile salts are of a high enough concentration in water, they have the
propensity to form micelles
– These micelles develop because each bile salt molecule is composed of a sterol
nucleus that is highly fat-soluble and a polar group that is highly water-soluble.
– The bile salt micelles also act as a transport medium to carry the monoglycerides
and free fatty acids
– The monoglycerides and free fatty acids are absorbed into the blood but the bile
salts are released back into the chyme to be used again and again for this
“ferrying” process
 III. DIGESTION OF FATS

Digestion of Cholesterol Esters and Phospholipids

• Most cholesterol in the diet
– is in the form of cholesterol esters
– which are combinations of free cholesterol and one molecule of fatty acid
– Phospholipids also contain fatty acid within their molecules
• Both the cholesterol esters and the phospholipids are hydrolyzed by two
other lipases in the pancreatic secretion that free the fatty acids
– the enzyme cholesterol ester hydrolase to hydrolyze the cholesterol ester
– phospholipase A2 to hydrolyze the phospholipid
• The bile salt micelles play the same role in “ferrying” free cholesterol and
phospholipid molecule digestates that they play in ferrying monoglycerides
and free fatty acids
• No cholesterol is absorbed without this function of the micelles
V. Digestion and Absorption in the G.I
Tract
1. DIGESTION OF THE VARIOUS FOODS BY
HYDROLYSIS

2. BASIC PRINCIPLES OF GASTROINTESTINAL

ABSORPTION

3. ABSORPTION IN THE SMALL INTESTINE

4. ABSORPTION IN THE LARGE INTESTINE:

FORMATION OF FECES
 ANATOMICAL BASIS OF ABSORPTION

• The total quantity of fluid that must be absorbed each day by the
intestines is equal
– to the ingested fluid (about 1.5 liters)
– plus that secreted in the various gastrointestinal secretions (about 7
liters)

• All but about 1.5 liters of this fluid is absorbed in the small intestine,
leaving only 1.5 liters to pass through the ileocecal valve into the colon
each day

• The stomach is a poor absorptive area of the gastrointestinal tract

– few highly lipid-soluble substances (alcohol)
– some drugs (aspirin) can be absorbed in small quantities
• Increase the Mucosal
Absorptive Area by Nearly
1000-Fold
• Folds of Kerckring
• Villi
• Microvilli
 V. Digestion and Absorption in the G.I
Tract
1. DIGESTION OF THE VARIOUS FOODS BY HYDROLYSIS

2. BASIC PRINCIPLES OF GASTROINTESTINAL

ABSORPTION

3. ABSORPTION IN THE SMALL INTESTINE

4. ABSORPTION IN THE LARGE INTESTINE:

FORMATION OF FECES
3. ABSORPTION IN THE SMALL INTESTINE
• Absorption from the small intestine each day
– several hundred grams of carbohydrates
– 100 or more grams of fat
– 50 to 100 grams of amino acids
– 50 to 100 grams of ions
– 7 to 8 liters of water
• Absorptive capacity of the normal small intestine
– several kilograms of carbohydrates
– 500 grams of fat
– 500 to 700 grams of proteins
– 20 or more liters of water
• Large intestine can absorb
– still more water and ions
– few nutrients
 C.1 Carbohydrates Are Mainly Absorbed as Monosaccharides

• Monosaccharides

• Glucose

• Galactose: from milk

• Fructose: from cane sugar

• Monosaccharides are absorbed by a secondary active transport process

 Glucose Is Transported by a Sodium Co-Transport Mechanism

• Glucose absorption occurs in a

co-transport mode with active
transport of sodium

• Initial active transport of sodium

through the basolateral
membranes of the intestinal
epithelial cells that provides the
eventual force for moving glucose
through the membranes as well
 Absorption of Other Monosaccharides

• Galactose

• Fructose is transported by facilitated diffusion all the way through the

intestinal epithelium and is not coupled with sodium transport
– Much of the fructose, upon entering the cell, becomes
phosphorylated
– It is then converted to glucose
– finally transported in the form of glucose the rest of the way into the
blood
- Most nutrients are absorbed by transepithelial transport

- Secondary active transport is the process by which glucose and

galactose (co-transported w/sodium using the same transport
protein) enter the luminal side of GI epithelial cells

- Fructose enters the epithelial cells on its own transporter via

facilitated diffusion
Once inside the epithelial cells, all monosaccharides exit the
basolateral side of the cells on the same type of transport
molecule via facilitated diffusion
The sugars are absorbed in the capillaries
and carried to the liver.
 C.2. Absorption of Proteins as Dipeptides, Tripeptides, or
Amino Acids

• The energy for most of this transport

is supplied by a sodium co-transport
mechanism in the same way that
sodium co-transport of glucose occurs
• Co-transport (or secondary active
transport) of the amino acids and
peptides
• A few amino acids are transported by
special membrane transport proteins
in the same way that fructose is
transported, by facilitated diffusion
• At least five types of transport
proteins for amino acids and peptides
have been found in the luminal
membranes of intestinal epithelial
cells
 C.3. Absorption of Fats

• Monoglycerides and free fatty acids: dissolved in the

central lipid portions of bile micelles
• Micelles are soluble in chyme
• Monoglycerides and free fatty acids are carried to
the surfaces of the microvilli of the intestinal cell
brush border and then penetrate into the recesses
among the moving, agitating microvilli
– monoglycerides and fatty acids diffuse
immediately out of the micelles and into the
interior of the epithelial cells
– this process leaves the bile micelles still in the
chyme
• Micelles perform a “ferrying” function that is highly
important for fat absorption
• After entering the epithelial cell, the fatty acids and
monoglycerides are taken up by the cell’s smooth
endoplasmic reticulum; here, they are mainly used
to form new triglycerides that are subsequently
released in the form of chylomicrons through the
base of the epithelial cell, to flow upward through
the thoracic lymph duct and empty into the
circulating blood
 Direct Absorption of Fatty Acids Into the Portal Blood

• Small quantities of short- and medium-chain fatty acids are absorbed

directly into the portal blood

• Short-chain fatty acids are more water soluble and mostly are not
reconverted into triglycerides by the endoplasmic reticulum.

• This phenomenon allows direct diffusion of these short chain fatty acids
from the intestinal epithelial cells directly into the capillary blood of the
intestinal villi
V. Digestion and Absorption in the G.I Tract
1. DIGESTION OF THE VARIOUS FOODS BY HYDROLYSIS

2. BASIC PRINCIPLES OF GASTROINTESTINAL ABSORPTION

3. ABSORPTION IN THE SMALL INTESTINE

4. ABSORPTION IN THE LARGE INTESTINE: FORMATION OF

FECES
 4. ABSORPTION IN THE LARGE INTESTINE:
FORMATION OF FECES
• 1500 ml of chyme normally pass through the ileocecal valve into the large
intestine each day

• Less than 100 ml of fluid: excreted in the feces

• 1 to 5 mEq each of sodium and chloride ions: lost in the feces

• Proximal one half of the colon: absorbing colon

• Distal colon: storage colon

 4. ABSORPTION IN THE LARGE INTESTINE:
FORMATION OF FECES

A. Absorption and Secretion of Electrolytes and Water

B. Maximum Absorption Capacity of the Large Intestine

C. Composition of the Feces

D. Bacterial Action in the Colon

 4. ABSORPTION IN THE LARGE INTESTINE:
FORMATION OF FECES

A. Absorption and Secretion of Electrolytes and Water

B. Maximum Absorption Capacity of the Large Intestine

C. Composition of the Feces

D. Bacterial Action in the Colon

 A. Absorption and Secretion of Electrolytes and Water

• Mucosa of the large intestine has a high capability for active absorption of
sodium, and the electrical potential gradient created by sodium
absorption causes chloride absorption as well

• Mucosa of the large intestine secretes bicarbonate ions while it

simultaneously absorbs an equal number of chloride ions in an exchange
transport process
– bicarbonate helps neutralize the acidic end products of bacterial
action

• Absorption of sodium and chloride ions creates an osmotic gradient across

the large intestinal mucosa, which in turn causes absorption of water
 4. ABSORPTION IN THE LARGE INTESTINE:
FORMATION OF FECES

A. Absorption and Secretion of Electrolytes and Water

B. Maximum Absorption Capacity of the Large Intestine

C. Composition of the Feces

D. Bacterial Action in the Colon

 B. Maximum Absorption Capacity of the Large Intestine

• Large intestine: absorb 5 to 8 liters of fluid and electrolytes each day

• Excess appears in the feces as diarrhea when

– total quantity entering the large intestine through the ileocecal valve
– by way of large intestine secretion exceeds this amount

• Toxins from cholera or certain other bacterial infections often cause the
crypts in the terminal ileum and large intestine to secrete 10 or more liters
of fluid each day
– leading to severe and sometimes lethal diarrhea
 4. ABSORPTION IN THE LARGE INTESTINE:
FORMATION OF FECES

A. Absorption and Secretion of Electrolytes and Water

B. Maximum Absorption Capacity of the Large Intestine

C. Composition of the Feces

D. Bacterial Action in the Colon

 C. Composition of the Feces

• Feces
– three-fourths water
– one-fourth solid matter
• 30 percent dead bacteria
• 10 to 20 percent fat
• 10 to 20 percent inorganic matter
• 2 to 3 percent protein
• 30 percent undigested roughage from the food and dried constituents of digestive
juices
• Brown color
– stercobilin
– urobilin
• Odor
– products of bacterial action
• Odoriferous products
– indole, skatole, mercaptans, and hydrogen sulfide
 4. ABSORPTION IN THE LARGE INTESTINE:
FORMATION OF FECES

A. Absorption and Secretion of Electrolytes and Water

B. Maximum Absorption Capacity of the Large Intestine

C. Composition of the Feces

D. Bacterial Action in the Colon

 D. Bacterial Action in the Colon

• Colon bacilli: absorbing colon.

– digesting small amounts of cellulose
• Other substances formed as a result of bacterial activity are
– vitamin K
– vitamin B12
– Thiamine
– Riboflavin
– various gases that contribute to flatus in the colon
• carbon dioxide, hydrogen gas, and methane
• Bacteria-formed vitamin K is important
– amount of this vitamin in the daily ingested foods is insufficient