Gastrointestinal System

Chapter 23

GI: Overview: Organ systems

Gastrointestinal (GI) tract [Alimentary canal] a

continuous muscular digestive tube
Digests:

Absorbs:

breaks food into smaller fragments

digested material is moved through mucosa into the blood

Eliminates:

unabsorbed & secreted wastes.

Organ systems

Includes:

Mouth, pharynx &

esophagus
Stomach
Small intestine
Large intestine

Accessory digestive
organs: teeth, tongue,
gall bladder, salivary
glands, liver &
pancreas
Figure 23.1

Processes
Ingestion
Propulsion
Mechanical digestion
Chemical digestion
Absorption
Defecation

Processes

Ingestion: obtaining food

Propulsion: moves food along the GI tract by
peristalsis (wave-like muscular contraction)
Mechanical digestion :

chewing & mixing with saliva

mixing in stomach
segmentation (local constriction in intestine to mix food
& digestive juices)

Processes

Chemical digestion: breaks down food to

molecular fragments (monomers) (Hydrolysis).

Begins in the mouth with saliva & continues into the

small intestine.

Absorption: movement of nutrients across the

mucosal membrane into blood/lymph
Defecation: eliminates unused/indigestible &
secreted substances from the body

Functional Considerations :

Substances in the GI tract lumen are outside of

the body.
Multiple sensors & receptors line the GI tract to
monitor contents & respond to conditions.
Controls: intrinsic (local control) & extrinsic (CNS)

Peritoneum : serous
membrane
Visceral peritoneum: covers the external surfaces of

most digestive organs

Parietal Peritoneum: lines the body wall
Peritoneal Space: potential space containing fluid
that separates the visceral & parietal peritoneum

Figure 23.5a

Peritoneum

Mesentery: double layer of peritoneum fused together

that extends to the organs from the posterior body
wall.

Provides support for the organs

Provides support for vessels & nerves supplying the organs

Figure 23.5a

Peritoneum

Retroperitoneal organs

Organs that adhere to the posterior abdominal wall &

lose their peritoneum by resorption
Parts of the large & small intestine & most of the
pancreas; (also kidneys)

Figure 23.5b

GI blood supply

Blood supply: about 25% of cardiac output

Arterial: Abdominal aorta celiac trunk
Celiac trunk Hepatic, splenic & gastric branches
which serve the liver, spleen & stomach
Celiac trunk superior & inferior mesenteric
branches serve small & large intestine

Histology

GI tract wall has 4 layers:

Mucosa
Submucosa
Muscularis Externa
Serosa or Adventitia

Histology of the Alimentary

Canal

Figure 23.6

Histology

Mucosa: The epithelial membrane that lines the GI

tract from mouth anus.

Secretes mucous, digestive enzymes & hormones

Absorbs nutrients
Protects from disease & from the GI contents

Histology

Mucosa; 3 layers:

Epidermis
Lamina propria (loose ct : contain capillaries & some
elements of MALT)
Muscularis mucosa

Histology

Submucosa: moderately dense CT with blood,

nerve, lymph vessels & lymphoid follicles; rich in
elastic fibers
Muscularis externa: smooth muscle

Responsible for peristalsis &

segmentation
Circular layer
Longitudinal layer
Sphincters: in some areas
the circular layer thickens;
act as valves

Histology

Serosa of intraperitoneal organs = visceral

peritoneum
Esophagus has an outer covering of fibrous
connective tissue = adventitia
Retroperitoneal organs: visceral serosa on the
surface facing the peritoneal cavity & adventitia
on the surface facing the body wall.

Nerves

Intrinsic: (Local): Short reflex

Submucosal nerve plexus:
regulates glands & mucosal muscle
Myenteric plexus: controls GI wall & GI motility
Extrinsic: (CNS): Long reflex
Parasympathetic NS: enhances gut motility &
secretion
SNS: inhibits gut motility & secretion

Nerves
Figure 23.4

Intrinsic: (Local): Short reflex

Submucosal nerve plexus: regulates glands & mucosal muscle

Myenteric plexus: controls GI wall & GI motility

Extrinsic: (CNS): Long reflex

Parasympathetic NS: enhances gut motility & secretion

SNS: inhibits gut motility & secretion

Functional Anatomy: Mouth

Mouth: lips, palate, &

tongue
Mouth cavity = Buccal
cavity

Functional Anatomy: Mouth

Lips: extend from inferior margin of the nose to

the superior margin of the chin. Red area = red
margin, is poorly keratinized & lacks sweat or
sebaceous glands.
Palate:
Hard palate: rigid surface against which food is
forced in chewing
Soft palate: muscular structure that rises &
blocks off the nasopharynx during swallowing

Functional Anatomy: Mouth

Tongue: muscular tentacle composed of

interlaced muscle fibers that grips & repositions
food, mixes food with saliva & compresses food to
form a food bolus, prior to swallowing.

Functional Anatomy: Mouth

Filiform papillae: rough surface

Fungiform papillae: house taste buds
Circumvallate papillae: house taste buds,
Foliate papillae: posterolateral; taste buds

Functional Anatomy: Mouth

Salivary Glands: intrinsic & extrinsic

Intrinsic glands: scattered throughout the buccal
cavity mucosa
Extrinsic glands: supply most of the saliva; outside
buccal cavity & supply secretions via ducts:
Parotid
Submandibular
Sublingual

Functional Anatomy: Mouth

Composition of saliva:

97-99.5% H2O
Electrolytes:
pH 6.75-7.0
Amylase: (digestive enzyme)
Proteins: mucin, lysozyme, & IgA

Protection from microbes by saliva:

IgA: immunglobulins in secretions

Lysozyme: bacteriostatic (inhibits bacterial growth)
Cyanide
Defensins: local antibiotic activity & when activated
promote chemotaxis by WBCs
Normal flora: convert salivary components to nitrates
then to NO. NO is toxic & bacteriocidal

Functional Anatomy: Mouth

Control of Salivation:
Continuous baseline secretory activity

With food ingestion, salivation increases dramatically

Parasympathetic NS: chemoreceptors & pressoreceptors
stimulate salivatory nuclei to increase salivation

Functional
Anatomy: Mouth,
Pharynx
Figure 23.07
Figure 23.11

Teeth:
Primary: 2I 1C 2M x 2 = 20
2I 1C 2M
Permanent: 2I 1C 2PM 3M x 2 = 32
2I 1C 2PM 3M
Structures

Crown: exposed above gingiva (gum)

Root: anchored by periodontal ligament to the bone by a
fibrous joint (gomphosis)

Functional Anatomy: Throat &

Esophagus

Pharynx: oropharynx & laryngopharynx;

muscular wall propels food to the esophagus
Esophagus:
Muscular 25cm tube from laryngopharynx to
stomach
Passes through the diaphragm at the
esophageal hiatus
Gastroesophageal (cardiac) sphincter: A
physiologic sphincter that helps keep
esophagus closed when empty

Functional Anatomy:
Esophagus

Esophagus (continued)

Wall has all 4 GI tract tunics:

Epithelial layer changes at the junction with
the stomach from stratified squamous
epithelium to simple columnar epithelium

Esophageal mucous glands lubricate food bolus

Muscularis externa
Superior 1/3 of muscularis externa is skeletal muscle
Middle 1/3 is mixed skeletal & smooth
Lower 1/3 is smooth muscle

Adventitia: external covering

Digestive Processes: Mouth,

Pharynx & Esophagus

Ingestion
Mechanical digestion: chewing
Chemical digestion: mixing food with saliva
Propulsion: swallowing & initiating peristalsis

Functional Anatomy:
Cardiac region: narrow, receives food bolus
Stomach
Fundus: bulge that extends supero-laterally to the cardia,
reaches the diaphragm

Body: mid-portion
Pyloric antrum : funnel shaped portion narrows to form
the;
Pyloric canal
Pylorous
Pyloric sphincter
small intestine
Rugae

longitudinal mucosal
folds
volume about 4L

Figure 23.14a

Rugae

Microscopic Anatomy :
Stomach

Stomach: has the 4 tunics of the GI tract.

Epithelium: Simple columnar epithelium
(goblet cells-mucous);
Muscularis externa has an additional oblique
layer of muscle (allows another dimension of
contraction).

Microscopic
Anatomy :
Stomach

Gastric glands secrete

gastric juices
Figure 23.15

Microscopic
Anatomy :
Stomach

Mucous neck cells: in

the duct portion

Figure 23.15

Microscopic
Anatomy :
Stomach

Gastric glands secrete

gastric juices

Mucous neck cells: in

the duct portion
Parietal cells: mid
portion secrete HCl &
intrinsic factor for B12
absorption

Figure 23.15

Microscopic
Anatomy :
Stomach

Gastric glands secrete

gastric juices

Mucous neck cells: in

the duct portion
Parietal cells: mid
portion of glands
secrete HCl & intrinsic
factor
Chief cells: base of
gland; secretes
pepsinogen a precursor
molecule to pepsin (an
enzyme that digests
protein)

Figure 23.15

Microscopic
Anatomy : Stomach

Enteroendocrine cells:
secrete multiple
hormonal products;

Gastrin, histamine,
endorphins, serotonin,
cholecystokinin, &
somatostatin, which
influence several
digestive system
organs
Figure 23.15

Microscopic Anatomy :
Stomach

Mucosal barrier: protects the stomach from its own

secretions
Viscous mucous overlies a thick coating of HCO3rich mucous
Tight junctions between epithelial cell
PM of glandular cells are impermeable to HCl
Epithelium is replaced every 3-6 days

Digestive Processes
(Stomach)

Acts as a holding vessel for ingested food

Participates in mechanical & chemical digestion

Propulsion: Delivers its product (chyme) to the small
intestine

Digestive Processes
(Stomach)

Protein digestion: HCl denatures protein

HCl activates pepsinogen to pepsin
Pepsin breaks peptide bonds of proteins
Rennin: an enzyme that breaks down casein
(milk protein) secreted in infants
Intrinsic factor: required for Vit. B12 absorption
(needed to mature RBC);

Absence of B12 results in pernicious anemia

Regulation of gastric secretion

(3 phases)
Cephalic Phase
Gastric Phase
Intestinal Phase

Cephalic phase: Stimulation

Cephalic phase: CNS response to presentation of

food; enhances gastric gland secretion

Cephalic phase: Inhibition

Loss of appetite; satiety / depression

Gastric phase: Stimulation

Gastric phase: food entering stomach;

Stretch
Change in pH (increase)
Peptides

All cause increased gastric gland secretion

Gastric phase: Stimulation

Stretch: reflex arc causes increased Acetylcholine

release which then causes increased gastric gland
secretions

Increased pH / polypeptides / caffeine

All enhance Gastrin secretion by enteroendocrine G cells

Gastric phase: Stimulation

3 chemicals: cause enhanced HCl secretion

through 2nd messenger systems
Gastrin
Acetylcholine
Histamine

Gastric phase: Inhibition

pH <2.0 inhibits Gastrin secretion

SNS inhibits Gastrin (G cell) activity

Intestinal phase:
Stimulation

Excitatory: As chyme enters the duodenum the

mucosa secretes enteric gastrin which stimulates
secretion by gastric glands

Intestinal phase: Inhibition

Inhibitory: As more chyme fills the small

intestine, the enterogastric reflex is triggered
Inhibits CNS stimulation
Inhibits local reflexes
Controls gastric emptying
Activates sympathetic fibers that tighten the
pyloric sphincter

Regulation of Gastric Activity

Figure 23.16

Small Intestine: Gross

Anatomy

6-7m long: from pyloric sphincter to the

ileocecal valve
3 subdivisions:

Duodenum
Jejunum
Ileum

Small Intestine:
Gross Anatomy

Fig 23.20

Duodenum :

Curves around the pancreatic head (~25cm long)

Contains the hepatopancreatic ampulla : formed
by the merger of the bile duct & the pancreatic
duct.
Hepatopancreatic sphincter controls admission of
bile & pancreatic enzymes to the duodenum
Duodenum is retroperitoneal

Small Intestine; Regulatory

Function

Duodenenal regulation of gastric emptying:

Feedback mechanisms monitor the contents being
delivered from the stomach
High fat content
Low pH (high acidity)
Hypertonicity (high osmolality)
All result in decreased stomach emptying.

Regulation of Gastric
Emptying

Figure 23.19

Small
Intestine:
Jejunum: extends from duodenum
Gross Anatomy

to ileum (~2.5m long)

Ileum: from jejunum to ileocecal
valve (~3.6m long)

Figure 23.1

Small Intestine: Gross

Anatomy

Jejunum & Ileum function in absorption;

Intraperitoneal
Suspended from mesentery whose veins &
lymph vessels carry nutrients away from small
intestine

Small Intestine:
Microanatomy

Plicae circularis:
mucosal folds
cause chyme to
spiral slowly
through the lumen

Microvilli: PM
projections
forming brush
border; Hold
enzymes that
complete protein &
carbohydrate
digestion

Villi

Villi: velvety mucosa of absorptive

epithelium containing capillaries &
lymph lacteals
Figure 23.21

Small intestine Wall

Cell types:

Mostly absorptive cells

Goblet (mucous) cells increase in number as
the small intestine progresses
Enteroendocrine cells
T-Lymphocytes

Small intestine Wall

Intestinal crypts with cells that secrete intestinal

juice & contain Paneth cells that secrete
protective lysozyme (antibacterial)
Peyers Patches: lymphoid follicle in submucosa

Small intestine Wall

Brunners glands (duodenum) secrete HCO3- rich

mucous to increase the pH of chyme
Villus epithelium is replaced every 3-6 days
Intestinal Juice : isotonic with blood plasma,
slightly alkaline, low enzyme content

Liver & Gall Bladder

Liver produces bile (fat emulsifier) that is stored

in & concentrated by the gall bladder. (metabolic
role of the liver; Ch. 24)

Liver: Gross Anatomy

Largest gland
4 Lobes
Falciform ligament

mesentery
supports liver
from diaphragm &
anterior body wall
separates R & L
lobes

Round ligament
fibrous remnant of
umbilical vein

Fig 23.23

Liver: Gross
Anatomy

Blood supply

hepatic artery & hepatic

portal vein

Bile

drains from biliary ducts to

common hepatic duct
which fuses with cystic
duct from gallbladder to
form the bile duct
Fig 23.23

Liver: Microscopic Anatomy

Liver lobule: hexagonal (Fig 23.24)

Central vein: drains the lobule

Hepatocytes form plates that radiate from the
central vein

Microanatomy of the Liver

Figure 23.24c, d

Liver: Anatomy

Portal triad at each corner of

the hexagonal system.
Consists of branches of:

Hepatic Artery delivers O2

Hepatic portal vein delivers
nutrients from small intestine
Bile duct receives bile from
the bile canaliculi that lie
between layers of hepatocytes
Figure 23.24c, d

Liver: Anatomy

Liver (cont)
Liver sinusoids Large
leaky capillaries conduct
blood from the artery &
portal vein to the central
vein
Hepatic macrophages
Kupffer cells lie in
sinusoid walls
Central veins flow into
hepatic veins then to the
inferior vena cava

Figure 23.24c, d

Liver & Gall Bladder

Composition of bile: Alkaline solution: Bile salts,

bile pigments, cholesterol, fats & phospholipids
Bile salts & phospholipids participate in fat
absorption

Liver & Gall Bladder

Bile salts are conserved by enterohepatic

circulation
Reabsorbed in the ileum
Return to Liver in hepatic portal blood
Re-secreted by the Liver
Bile pigments & bilirubin break down to urobilin
then stercobilin

Gall Bladder

Gall Bladder = a muscular pouch that stores bile & expels bile
when needed via the cystic duct & the bile duct.

Figure 23.20

Regulation of
Bile
Release

Cholecystokinin (CCK) & secretin

released by the small intestine in
response to increased fats in
chyme

CCK:

Stimulates both Gall bladder &

pancreatic secretion
Relaxes hepatopancreatic sphincter

Secretin: stimulates bile secretion

Figure 23.25

Pancreas: Gross Anatomy

Head encircled by duodenum

Tail abuts the spleen
Mostly retroperitoneal

Pancreatic Acini

Large numbers of Acinar cells in

clusters around ducts; exocrine
(Acini)
Acinar cells: Secrete
pancreatic digestive enzymes
Endocrine cell clusters form the
pancreatic islets that produce
insulin & glucagon

Pancreatic Juice

Pancreatic Juice: Alkaline, watery, contains

enzymes & electrolytes

Pancreatic Juice

Proteolytic enzymes are released as inactive

forms then are activated in the duodenum
Trypsinogen Trypsin by the brush border
enzyme enterokinase
Trypsin activates precursors to form
carboxypeptidase & chymotrypsin
Amylase, lipase, & nuclease are released in their
active forms

Regulation of
pancreatic
Neural via PSNS
secretion
Hormonal: Intestinal Hormones

CCK: released in response to fats &

protein. Stimulates pancreatic
secretion of enzymes
Secretin: released in response to HCl.
Stimulates pancreatic duct cells to
release HCO3-

Figure 23.28

Digestive Processes : Small

Intestine

Optimal digestion requires adequate motility &

control of chemical composition

Digestive Processes : Small

Intestine

pH: acidic chyme must be buffered to allow

proper enzyme activity
Osmolality: chyme is hypertonic & would pull H2O
out of circulation; thus chyme is released in small
amounts
Liver & pancreatic function are required for
appropriate delivery of bile salts & enzymes to
the small intestine

Digestive Processes : Small

Intestine

Segmentation: moves intestinal contents back &

forth to mix
Duodenal rhythm for segmentation is greater
than the rhythm in the ileum.
Contents move toward the ileum.

Digestive Processes : Small

Intestine

After most digestion has occurred,

Peristalsis begins sweeping from duodenum distally

Occurs in series with each peristaltic wave, originating

more distally (migrating mobility complex)

Ileocecal valve (sphincter) is relaxed by neural

(gastroileal reflex) impulses from the stomach &
hormonal (gastrin) secretion by the stomach

Large
Intestine:
Ileocecal valve to anus (~1.5m)
Gross Anatomy

Teniae coli: 3 ribbons of

longitudinal smooth muscle
Haustra: pocket-like segments
of large intestine
Epiploic appendages: fat filled
pouches of visceral peritoneum

Figure 23.29a

Large
Intestine:
Cecum: blind pouch (below ileocecal valve)
Gross Anatomy

Appendix: attached to cecum (lymphoid)

Colon: ascending, transverse, descending, sigmoid

Figure 23.29a

Transverse colon & sigmoid colon are intraperitoneal;

anchored by mesentery. The rest of the colon is
retroperitoneal

Rectum
Anal canal

Large Intestine: Microscopic

Anatomy

All 4 layers present

Mucosa: simple columnar epithelium until anal
canal (stratified squamous)

No folds or villi. No significant enzyme secretions

Crypts: invaginations of mucosa contain large numbers

of goblet cells that secrete mucous for protection &
lubrication

Large Intestine: Microscopic

Anatomy

Bacterial flora

Ferment indigestible CHO: produces about 500ml of gas

per day
Synthesize B complex vitamins & most vitamin K

Large Intestine: Digestive

Processes

Propulsion:

Haustra contractions: stretch stimulate haustra to

contract moving (& mixing) contents to next haustra
Mass peristalsis: long, slow contractile waves moving
contents toward rectum (3-4 per day)
Gastrocolic reflex: food intake causes mass peristalsis

Large Intestine: Digestive

Processes

H2O reabsorption & vitamin absorption

Defecation

Empty rectum receives waste, causing stretch

Stretch initiates reflex contraction of the rectum &
relaxation of both anal sphincters
Voluntary control of the external anal sphincter can
postpone defecation
If suppressed the contraction stops & is reinitiated later
With defecation rectal muscle contractions are aided by
increased abdominal pressure (valsalva maneuver)

Structure of the Anal Canal

Figure 23.29b

Figure 23.32

Chemical Digestion of Specific

Food Groups

Chemical Digestion: Mechanism

Catabolic process: break down of food molecules to

monomeric form that can be absorbed
Enzymes break molecules by hydrolysis (Adding H2O
into a molecular bond)

Chemical Digestion:
Carbohydrates

Carbohydrates (CHO): complex sugars are broken

down to simple sugars (monomers)
Simple sugars (monosaccharides): glucose,
fructose, & galactose can be absorbed
Disaccharides (not absorbed): sucrose,
maltose, & lactose are hydrolyzed by sucrase,
maltase, & lactase (brush border enzymes)
into monosaccharides

Chemical Digestion:
Carbohydrates

Polysaccharides: broken down to smaller &

smaller oligosaccharides

Salivary amylase: breaks starch into 2-8 linked

monosaccharide
Salivary amylase is denatured by HCl in the stomach

Chemical Digestion:
Carbohydrates

Polysaccharides (cont)

Pancreatic amylase: continues breakdown (mostly to

maltose)
Brush border enzymes act on oligosaccharides of more than
3 simple sugars (brush border)
Sucrose, maltose & lactose are broken down by specific
brush border enzymes (sucrase, maltase, & lactase)
Monosaccharides are absorbed.

Chemical Digestion:
Proteins

Proteins: broken down to amino acid monomers.

Begins in the stomach.

Pepsinogen is activated to pepsin by HCL

Pepsin: cleaves peptide bonds associated with tyrosine &
phenylalanine forming polypeptides (+ a few amino acids).
Pepsin is inactivated by increased pH in the duodenum
Trypsin & chymotrypsin: pancreatic enzymes that further
breakdown polypeptides.

Chemical Digestion:
Proteins

Proteins (cont):

Carboxypeptidase (pancreatic & brush border

enzyme):

Splits off single amino acid from the end of

polypeptide chain that contains the carboxyl group

Aminopeptidase & dipeptidase (brush border

enzymes) release final amino acid monomers

Figure 23.34

Figure 23.34

Chemical
Digestion:
Lipids: require emulsification to disperse
Lipids
fats into microdroplets which enhances
enzyme activity

Bile salts: surround fat droplets & keep them

in suspension in the aqueous digestive juices
Pancreatic lipase: cleaves off two fatty acid
chains from triglyceride molecules

Yields a monoglyceride & 2 free fatty acids

Figure 23.35

Chemical Digestion:
Nucleic acids

Nucleic acids: small amounts occur in the diet

Pancreatic nucleases: Hydrolyze nucleic acids to

nucleotide monomers
Nucleosidases & phosphatases (brush border) break
down nucleotides

Absorption: Small Intestine

Most nutrients are absorbed from chyme prior to the

ileum (ileum primarily reabsorbs bile salts)
Most nutrients cross the mucosa by active transport.

Some products of lipid digestion are absorbed by diffusion.

CHO, amino acids & nucleic acid remnants are actively
transported into mucosal cells & then enter capillary blood

Absorption: Small Intestine

(Fats)

Monoglycerides & free fatty acids are associated with

bile salts & lecithin (a phospholipid) to form micelles

Micelles diffuse between microvilli

The lipid substances leave the micelles & diffuse across the
PM of microvilli
Inside the intestinal epithelial cell, the components are
reassembled into triglycerides

Absorption: Small Intestine

(Fats)

Monoglycerides (cont)

Triglycerides are then packaged with cholesterol &

phospholipids into chylomicrons
Chylomicrons are exocytosed & diffuse to lymphatic lacteals
to eventually be placed into blood by the lymphatic system
Chylomicrons in the blood are hydrolyzed by lipoprotein lipase
to free fatty acids & glycerol prior to tissue absorption
Fig. 23.36

Fatty Acid Absorption

Figure 23.36

Absorption: Small Intestine

Vitamins

Some Vit. K & B complex vitamins are absorbed in the

large intestine
Dietary vitamins are absorbed in the small intestine
Fat soluble vitamins (A, D, E, K) dissolve in dietary fats
& are absorbed after being incorporated into micelles

Absorption: Small Intestine

Electrolytes: most ions are actively absorbed

throughout small intestine
Na+ is coupled to absorption of glucose & amino acids
(cotransport)
Cl- actively transported into cells; exchange for HCO3-

Absorption: Small Intestine

K diffuses into the cells

Iron is transported into cells & bound to ferritin
Ca2+ absorption regulated by blood Ca2+ levels &
Vit D

( Vit D is a required cofactor for Ca2+ absorption)

Absorption: Small Intestine

Water moves freely in both directions across the

mucosa

Active transport of solutes create an osmotic gradient &

H2O follows
H2O movement changes solute concentrations & effects
absorption of substances that move by diffusion

Absorption: Small Intestine

Malabsorption: can result from

Disruption of secretion
Mucosal damage
Reduction of absorptive surface area