YL5: 08.

07 Digestion and Absorption

01/15/2019 Gastrointestinal System and Nutrition
10:00-12:00 Leticia Ibañez-Guzman, MD, MSc

TABLE OF CONTENTS  Modifications of small intestine: Acts to increase its

surface area (and as a result, the absorption rate as well) by
I. INTRODUCTION ............................................................................... 1 as much as 600x
A. DIGESTION ............................................................................. 1  Plicae Circulares
B. ABSORPTION ......................................................................... 1  Permanent crescentic folds of the mucous
C. HYDROLYSIS ......................................................................... 1 membrane
II. CARBOHYDRATES ......................................................................... 2  Found in the lower part of the duodenum and the
A. DIETARY CARBOHYDRATES ................................................ 2 jejunum
B. DIGESTION ............................................................................. 2  Increases surface area by 3x
C. ABSORPTION ......................................................................... 2  Villi
III. PROTEINS ...................................................................................... 3
 Finger-like projections covering the luminal
A. DIGESTION ............................................................................. 3
B. ABSORPTION ......................................................................... 3 surface of the small intestine
C. PROTEIN ASSIMILATION ....................................................... 4  Increases surface area by 10x
IV. LIPIDS ............................................................................................ 4  Microvilli
A. GENERAL PROCESS ............................................................. 4  Minute cylindrical protrusions covering the surface
B. DIGESTION ............................................................................. 4 of an enterocyte
C. ABSORPTION ......................................................................... 4  Increases surface area by 20x
V. SODIUM AND WATER .................................................................... 4
A. ABSORPTION OF WATER ...................................................... 4 General Mechanism of Absorption of Macromolecules
B. SODIUM ABSORPTION .......................................................... 5
C. ABSORPTION IN THE GALLBLADDER .................................. 5 Carbohydrates
D. ABSORPTION IN THE SMALL INTESTINE ............................. 5  Can only be absorbed as monosaccharide
E. ABSORPTION IN THE COLON ............................................... 6
VI. VITAMIN AND NUTRIENT ABSORPTION....................................... 6
 Monosaccharides (e.g. glucose) do not undergo digestion, only
A. VITAMINS ............................................................................... 6 absorption
B. NUTRIENTS ............................................................................ 6  Disaccharides and other polysaccharides are digested outside the
QUICK REVIEW ................................................................................... 7 enterocyte into their corresponding monosaccharide compositions
SUMMARY OF TERMS ............................................................... 7 and absorbed through membrane digestion
REVIEW QUESTIONS ................................................................. 8
REFERENCES..................................................................................... 8 Proteins
REQUIRED .................................................................................. 8  Digested outside the enterocyte as amino acids and can be
SUGGESTED .............................................................................. 8 absorbed as such
APPENDIX ........................................................................................... 9
 Small peptides (di- and tri- peptides) are acted on by peptidases
FREEDOM SPACE .............................................................................. 9
in the enterocytes and digested into amino acids, which are
absorbed in the basolateral membrane
I. INTRODUCTION Triglycerides
A. DIGESTION  Digested outside the enterocyte into glycerol and fatty acids
 Chemical and mechanical breakdown of nutrients into small  Because they are fat soluble, they diffuse separately into the cell
metabolizable molecules wherein they reform into triglycerides and are absorbed
 Chemical digestion occurs mainly in the small intestine  Larger fatty acids are absorbed in the lymphatics
 Mechanical digestion occurs mainly in the mouth (chewing),  Smaller fatty acids are absorbed into the circulatory system
stomach (churning), and small intestine (segmentation)
 2 Types
C. HYDROLYSIS
 Luminal Digestion
 Basic process of digestion that involves the addition of water to
 Involves enzymes produced by the stomach, saliva,
break down a large molecule to make it smaller in the presence of
and pancreas
the appropriate digestive enzyme
 Occurs in the lumen of the digestive tract for the initial
 CHO + H2O → Monosaccharides
hydrolysis of large particles into smaller ones
 Triglycerides + H2O → Fatty Acids + Glycerol
 Membrane or Brush Border Digestion
 Performed by enzymes synthesized within the wall of  Proteins + H2O → Amino Acids
the enterocyte at the small intestinal brush border
 Important in generating simple, absorbable sugars
 Prepares the final step in the digestion of carbohydrates
and proteins before their basic components are
absorbed

B. ABSORPTION
 Transfer of molecules across the gastrointestinal mucosa into the
blood or lymphatic circulation
 Mucosa: Responsible for absorption, secretion, and
immunity
 Blood: Carbohydrates and Proteins
 Lymph: Fat
 Net passage of substances from gut lumen to interstitial fluid
 Dependent on:
 Available Surface Area
 Smaller the surface area = lower the absorption rate
 Flux of Molecules
 Size: Smaller molecules are absorbed easier
 Solubility: Lipid-soluble molecules are easier to absorb
 Presence of a special carrier
 Presence of electrochemical gradients
 Occurs mainly in the small intestine Figure 1. Components of Carbohydrates, Lipids, and Proteins
 The gut, when extended, can cover a doubles tennis court (Brisendine, 2013)

YL5: 08.07 Group 16: Balonan, Bondoc, Calanoc, Fernando, Guerrero, Melevo, Vergara, Viernes 1 of 9
 II. CARBOHYDRATES
A. DIETARY CARBOHYDRATES
 Humans intake 250-800g of dietary CHO per day
 Comprises 50-60% of human diet

Table 1. Composition of Dietary Carbohydrates

Class Examples Made of
Starch
Polysaccharides
Cellulose Glucose
(40-60%)
Glycogen
Sucrose Glucose-Fructose, Figure 2. Carbohydrate breakdown into monosaccharides
Disaccharides
Lactose Glucose-Galactose
(30-40%)
Maltose Glucose-Glucose
Glucose
Monosaccharides
Fructose
(5-10%)
Galactose

Monosaccharides
 Comprises 5-10% of dietary carbohydrates
 Absorbable form
 Examples are glucose, fructose, and galactose

Disaccharides
 Comprises 30%-40% of dietary carbohydrates
 Sucrose – Glucose + Fructose (Cane sugar or beet sugar)
 Lactose – Glucose + Galactose (Milk sugar)
 Maltose – Glucose + Glucose
Figure 3. Breakdown by amylase
Polysaccharides
 Comprises 40%-60% of dietary carbohydrates C. ABSORPTION
 Most common form  Apical membrane has different carriers than the basolateral
 Digested or broken down into smaller subunits membrane
(monosaccharides)  Carbohydrates are absorbed as monosaccharides
 Starch  Monosaccharides are not equally absorbed
 Polymeric carbohydrate produced by plants  Ranked according to decreasing ease of absorbability:
 Made up of two molecules o Galactose
 Amylose – straight chain polysaccharide o Glucose
 Amylopectin – branched chain polysaccharide o Fructose
 Cellulose  Its carrier protein, GLUT5, is only few in
 Cannot be digested by humans since we lack the required number
digestive enzyme  Digestion is not compromised but absorption
 Bacteria in the gut digest cellulose and those undigested is not as effective
become fiber in the gut and is then released in feces o Mannose
 Fiber helps us move our bowels, prevents absorption of o Xylose
toxin, and promotes growth of good bacteria o Arabinose

B. DIGESTION
 The most basic unit is absorbed (e.g. monosaccharides)
 Ptyalin = salivary amylase
 Mainly secreted by the parotid gland
 Hydrolyzes starch into the maltose and other small polymers
of glucose
 Important in neonates because they produce less salivary
amylase
 Starch undergoes luminal digestion (goes to lumen) via ptyalin
and pancreatic amylase
 Sugars like lactose, sucrose, and maltose undergo membrane
digestion
 Brush border enzymes
 Enzymes on the apical membrane of the villi that complete
digestion
 Different sugars are often digested by different enzymes
 Transport proteins located near these digestive enzymes
facilitate absorption of glucose monomers (e.g limiting
dextrinase, glycoseamylase, sucrase, lactase, maltase) Figure 4. Luminal and Membrane Digestion (ASMPH 2021, 2017)
 Amylase
 Can hydrolyze alpha-1,4 linkages, but cannot hydrolyze Types of Transport
alpha-1,6 linkages
 Begins digestion but cannot completely reduce starch and Passive Diffusion
glycogen to glucose monomers  Movement of molecules without the input of cellular energy and
 Reduces starch and glycogen to maltose and limit dextrins instead, is driven by entropy
(short-branched polysaccharide)  Lipid soluble molecules
 Further digestion requires additional enzymes

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 Facilitated Diffusion  Peptide bonds holding the polypeptides continue to be
 Movement of molecules across a cell membrane via special hydrolyzed and result to peptides
transport protein without utilizing energy  Enzymes such as peptidase continue to break down
 GLUT2 (Glucose transporter 2) polypeptides and peptides into amino acids
 Found in the basolateral membrane
 Where glucose and galactose exit the cell
 GLUT5 (Glucose transporter 5)
 Found in the apical membrane
 Transporter that uptakes fructose without a sodium co-
transport mechanism

Primary Active Transport

 Transport of molecules across a membrane by directly using
metabolic energy
 Na -K ATP Pump
+ +

 Also known as the Sodium Potassium Pump

 Found on the basolateral side
 3 Na+ out, 2 K+ in
Figure 6. Digestion of proteins
 Since Na+ is ejected outside, it wants to enter and can
thus enter easily with glucose, galactose, and amino
3 Phases of Enzymatically-mediated Digestion
acids after a meal
 Gastric Lumen – Digestion by pepsin, an enzyme secreted by
Secondary Active Transport gastric chief cells
 Also known as Coupled Transport or Co-Transport  Intestinal Lumen – Digestion by proteases in pancreatic juice
 Brush Border – Mature enterocytes express a variety of
 Relies on electrochemical potential difference created by the
peptidases on their brush borders
action of primary active transport
 Includes aminopeptidases and carboxypeptidases
 SGLT1 (Sodium/Glucose Transporter 1)
 Symporter that takes up glucose and galactose across  Generate products suitable for uptake across the apical
its gradient along with Na+ membrane
 Phlorizin is a competitive inhibitor of SGLT1 because it 
competes with D-glucose for binding to the carrier; this B. ABSORPTION
reduces renal glucose transport, lowering the amount of  Proteins are absorbed as:
glucose in the blood  Amino acids via sodium dependent carrier proteins
 Luminal plasma membrane of the absorptive cell bears
at least four sodium-dependent acid transporters
o Carrier system for neutral amino acids
o Carrier system for basic amino acids
o Carrier system for acidic amino acids
o Carrier system for proline (glycine and imino acid)
 Digested amino acids are carried across the mucosal
cell membrane from the intestinal lumen to the
cytoplasm of the cell by one of the above carrier
systems
 Transporters bind amino acids only after binding
sodium
o Transporter undergoes a conformational change
that dumps sodium and the amino acid into the
cytoplasm → reorientation back to the original
form
 Small polypeptides via PepT1
 Hydrogen-dependent, but sodium-independent
 Primary transporter for protein uptake
 Takes up proteins together with H+
Figure 5. Absorption of monosaccharides in the small intestine  Absorption of Peptides
(Koeppen and Stanton, 2010)  There is virtually no absorption of peptides longer than four
amino acids
III. PROTEINS  Peptides that enter the enterocytes are hydrolyzed by
 Two sources of intestinal protein: peptidases into amino acids
 Endogenous  Dipeptidases break down dipeptides (consisting of 2
  30-40g/day AAs)
 Proteins produced by the body  Tripeptidases break down tripeptides (consisting of 3
 o e.g. secretory proteins and desquamated cells AAs)
 Exogenous  Once inside the enterocyte, bulk of absorbed dipeptide and
 74-100 g/day tripeptide are digested into amino acids by cytoplasmic
 Dietary protein requirement is 0.5-0.7 g per kg of body peptidases and exported from the cell into blood
weight  Other transporters:
 Dietary fat varies widely  In brush border
   Sodium/Hydrogen exchanger: Na+/H+ antiporter
 PepT1: H - peptide symporter
+
A. DIGESTION 
 Digestion of protein always starts in the stomach  In Basolateral membrane
 Protein digestion does not occur in the mouth   Na+-K+ Pump: ATP mediated antiporter of Na+ and K+
 Protein digestion begins when:  Where sodium goes, water follows
 Acid in stomach activates pepsinogen into pepsin  Na+ is expelled to prevent the cell from bursting
 When pepsin acts on the protein, it breaks the protein
down into polypeptides
 These polypeptides move to the small intestine and are
acted upon by additional enzymes
 In the small intestines, trypsin, chymotrypsin,
carboxypolypeptidase, and proelastase break down the
polypeptides

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 B. DIGESTION
 Bile is needed to form emulsified fat
 Bile acts as a detergent surrounding the fat to form
smaller molecules for easier absorption
 Lipid digestion begins in the stomach
 Chief cells release gastric lipase
 Low lipid assimilation takes place due to acidic pH
 Acidic pH leads to the protonation of the free fatty acids
released by gastric lipase
 Small intestine
 Where majority of lipolysis takes place
 There is little to no breakdown of cholesterol esters or esters
of fat-soluble vitamins in this area

Figure 7. Dipeptide and tripeptide absorption (Koeppen and Stanton,

2010)
Figure 9. Digestion of lipids
NICE TO KNOW
 Absorption of intact proteins occurs only in a few C. ABSORPTION
circumstances:  In the presence of bile and phospholipids, fatty acids and
 Very few proteins get through soluble and membrane- monoglycerides form micelles
bound proteases  Micelles act as ferries and are not absorbed directly
 Normal enterocytes do not have transporters to carry  Micelles are then broken down and absorbed as fatty acids and
protein across plasma membrane and cannot pass monoglycerides in enterocytes
through tight junctions  Fatty acids are reformed in the smooth endoplasmic
 However, the ability to absorb intact protein is present for reticulum and processed in the Golgi apparatus to form
neonates (but is eventually lost) lipoproteins prior to distribution via lymphatics
 Allows newborn to acquire passive immunity by absorbing  If the fatty acids are small or medium sized, they are
immunoglobulins in colostral milk directly absorbed into the blood vessels instead of the
lymphatic vessels
 Long chain fatty acids are absorbed in the lymphatic
C. PROTEIN ASSIMILATION vessel
 Note: This portion of the lecture was skipped by Dra. Guzman
 Essential amino acids are amino acids that cannot be synthesized V. SODIUM AND WATER
by the body so we acquire them through our diet
A. ABSORPTION OF WATER
 Essential: His, Ile, Leu, Met, Phe, Thr, Trp, Val, Lys
 The intestines are presented with 9L of fluid a day (Berne and
 Conditionally Non-Essential: Arg, Asn, Gln, Gly, Pro, Ser,
Levy, 2010)
Tyr
 Only 2L is passed to the colon
 Non-Essential: Ala, Asp, Cys, Glu
 100-200mL is excreted in stool
IV. LIPIDS  The rest is reabsorbed
A. GENERAL PROCESS
 Triglyceride: Predominant form of lipid in the human diet
 When fat becomes a monoglyceride, it will diffuse into the cell
where it will reform together with fatty acids
 Lipase and Colipase
 Converts triglycerides into fatty acids and
monoglycerides
 Colipase allows lipase to remain attached with dietary lipid
(triglyceride) even in the presence of bile acids
 Phospholipase A2
 Converts phospholipids into fatty acids and lysolecithin
 Cholesterol Esterase
 Converts cholesterol esters into fatty acids and
cholesterol
 Important pathway for fat-soluble vitamins

Figure 8. General process of lipid breakdown

Figure 10. Fluid Balance in the Gut

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 Two pathways for water absorption D. ABSORPTION IN THE SMALL INTESTINE
 Paracellular: Through the tight junctions between apical 
+
Jejunum: Major site for Na absorption in the small intestine
borders of the epithelial cells
 Transcellular: Through the cells themselves; most common
pathway
 Water follows electrolytes such as Na+ and K+
 Elevated concentration of ions creates a large osmotic
gradient, allowing for the osmotic movement of water
 Transporters
 Remember: Water follows sodium
 Na-K pumps
 Located in the basolateral membrane
 Primary active transporter
 Secondary active transporter
 Entry of Na+ with glucose or amino acid
 The energy source comes from the primary active
transporter
 Aquaporins
 Water channels
 Transports water transcellularly

Remember:
Absorption is greater than secretion in the intestine;
however, with diarrhea, secretion is greater than absorption +
Figure 12. Absorption of Na in the jejunum
B. SODIUM ABSORPTION  Ileum: Same transport mechanisms as the jejunum plus a Cl-
 Occurs at the proximal small intestine mostly via secondary HCO3 exchange mechanism
active transport (together with glucose, galactose, and/or amino
acid)

+ + -
As it goes down, Na is exchanged for H with Cl to bicarbonate
 More prominent in the distal portion of the small intestine

+ + +
Na -K pump brings out Na
 Located in the basolateral membrane
 Contribute to the concentration gradient of the salts

C. ABSORPTION IN THE GALLBLADDER

 The gallbladder can concentrate bile through absorption of water
into capillaries via a sodium gradient
 Na -K pumps are found in the basolateral membrane
+ +

 They release Na in between cells, allowing water to follow

+

into the capillaries which would concentrate the bile

Figure 13. Absorption in the ileum


+ +
Na -H Exchanger
 Creates a gradient
 NaCl absorption allows osmotic movement of water
 Na can be absorbed with nutrients, Cl- or HCO3-
+

 Na+ can be absorbed through the following mechanisms:

 Passive diffusion
 Secondary active transport with sugar (Na -Glu transporter)
+

 Isoneutrally with Cl
-

 In exchange with H (Na+-H+ exchanger)

+

 Postprandial Period
 Absorption is promoted in the small intestine predominantly
via osmotic effects of nutrient absorption
 In the absence of nutrients (i.e. between meals), fluid
absorption occurs via couple uptake of Na+ and Cl-
Figure 11. Mechanism accounting for concentration of bile during  Mediated by cooperative interaction of NHE-3 Na+-H+
storage in the gallbladder antiporter and Cl-HCO3- antiporter

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 Figure 14. Sodium absorption in the small intestine

E. ABSORPTION IN THE COLON

 Colonic epithelium: Major role is to absorb or secrete sodium
Figure 16. Mechanism of uptake of SCFA in a colonocyte
and water (rather than nutrients)

Water VI. VITAMIN AND NUTRIENT ABSORPTION

 Passively driven by absorption of electrolytes and solutes A. VITAMINS
 Also driven by 2 cellular processes: Fat-soluble Vitamins
 Na+ absorption in the colon  A, D, E, and K
 Absorption of short-chain fatty acids  Becomes part of micelles formed by bile salts absorbed in the
proximal small intestine
Sodium  Absorbed by passive diffusion

+
Absorption of Na is predominantly localized to the distal part of
the colon Water-soluble Vitamins
 Special Epithelial Na+ Channels (ENaC)  C (Ascorbic Acid), B1 (Thiamine), B2 (Riboflavin), B3 (Niacin), B5
(Pantothenic Acid), B6 (Pyridoxine), B7 (Biotin), B9 (Folate), and
 Reabsorbs Na+ in the colon in order to absorb water
B12 (Cobalamin)
 Sensitive to aldosterone which is secreted when
 Absorbed by facilitated transport or Na dependent co-
+
dehydrated
transporters in the proximal small intestine
 Increased aldosterone levels will lead to increased
reabsorption of sodium and consequently, water
Vitamin B12 (Cobalamin) Absorption
retention
 Vitamin B12 is different; it requires intrinsic factors from gastric
parietal cells (in the stomach)
 The intrinsic factor-B12 complex binds to an ileal receptor
 Absorbed in the ileum via Na independent carrier
+

 B12 is stored in the liver

 Special because it undergoes active absorption
 Rate limiting step: number of ileal receptors
 See Appendix for Figure 19. Digestion, absorption, and transport
of cobalamin

B. NUTRIENTS

Figure 15. Sodium absorption in the colon

Short-chain Fatty Acids

 Mechanism of short-chain fatty acid (SCFA) uptake by
colonocytes:
 Action of colonic bacteria that produces SCFA such as
acetate, propionate, and butyrate
 Butyrate: Used by colonocytes as source of energy
and prevents malignancy or colon cancer
 Sodium-monocarboxylate transporters (SMCT1s)
 Facilitates absorption of short chain fatty acids
(SCFA) in the presence of sodium
 SCFA is metabolized for energy by colonocytes

Figure 17. Site of nutrient absorption (ASMPH 2022, 2018)

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 Carbohydrates, proteins, and lipids are absorbed in the  General macromolecules absorption mechanisms
duodenum, then jejunum and ileum  Carbohydrates: Absorbed as monosaccharides
 Absorption capability is the highest in the duodenum  Disaccharides: Broken down into monosaccharide subunits
 However, most are absorbed in the jejunum because the and absorbed via membrane digestion
duodenum is short  Proteins: Absorbed as individual amino acids
 Calcium, iron, and vitamin B9 are mostly absorbed in the  Small peptides are acted on by peptidases and
duodenum digested as amino acids
 Calcium is also absorbed in the jejunum and ileum  Triglycerides: Digested outside the cell as glycerol and fatty
 Bile acids are mostly absorbed in the ileum acids
 Vitamin B12 is absorbed in the ileum  Hydrolysis: Process of digestion involving the addition of water
to break down a compound to smaller molecules
Doc may ask:  Dietary Carbohydrates
 250-800 mg/day; 50-60% of human diet
What is best absorbed in the small intestine proximally?  Monosaccharides (5-10%)
 Disaccharides (30-40%)
Answer: Everything except Bile Acids and Vitamin B12  Polysaccharides (40-60%)
 Starch: Luminal digestion via pancreatic amylase
Calcium Absorption  Cellulose: Humans do not digest cellulose, bacteria in
 Calcium is absorbed via a transcellular active transport system the gut digests it
and a paracellular passive process  Digestion of Carbohydrates
 Better absorbed by the body with the presence of vitamin D  Monosaccharides are the most basic units absorbed
 Other vitamins that may help in absorption are vitamins C, E,  Ptyalin: Salivary amylase, hydrolyzes starch into
and K smaller polymers of glucose
 Starch: Luminal digestion via pancreatic amylase
Iron Metabolism
 Brush border enzymes:
 Mainly occurs in the duodenum and jejunum  On apical membrane to complete digestion
 Absorbed either as heme or free iron  Transport proteins located near digestive enzymes to

2+ 3+
Ferrous iron (Fe ) is better absorbed than ferric iron (Fe ) easily facilitate absorption of glucose monomers
 However, food mainly comes as ferric → converted into  Amylase
ferrous → then absorbed through transporters  Can hydrolyze alpha 1,4 links but cannot hydrolyze
 If there is not much iron, there are transport proteins: alpha 1,6 links; cannot reduce starch and glycogen to
ferroportin and hephaestin glucose monomers
 These transmembrane proteins also convert ferrous  Can reduce starch and glycogen to maltose and limit
into ferric dextrins
 Then, combines with transferrin to go into the blood  Absorption of Carbohydrates
cells and converts back into ferrous  Types of Transport
 Excess iron is stored as ferritin (storage form of iron)  Passive Diffusion: Movement of molecules without
 Cells die every 3-5 days and ferritin goes with the dying cell input of cellular energy, and instead, is driven by
 This lowers iron levels in the body entropy
 Increased absorption by:  Facilitated Diffusion: Movement of molecules across
 Ascorbic Acids a cell membrane via special transport proteins without
 Acetate chemical energy
 Decreased absorption by: o GLUT2: In basolateral membrane
 Tannin o GLUT5: in apical membrane; uptakes fructose
 Phytates, wheat, and other cereal  Primary Active Transport: Transport of molecules
 Low levels of Fe are transferred to blood across a membrane by directly using metabolic energy
o Na-K ATP Pump
 Secondary Active Transport: Relies on the
electrochemical potential difference created by the
action of primary active transport
o Co-transport
o SGLT1: Symporter that takes up glucose and
galactose
 Ease of Absorption (from greatest to least):
 Galactose > Glucose > Fructose > Mannose > Xylose >
Arabinose
 Proteins
 Endogenous: 30-40 g/day
 Proteins produced by the body
 Exogenous: 74-100 g/day
 Dietary proteins
 Digestion of Proteins
 Starts in the stomach
Figure 18. Iron transport and metabolism (ASMPH 2022, 2018)  Acid activates pepsinogen to pepsin
 Pepsin acts on small peptides
QUICK REVIEW  Proteins can be hydrolyzed to long peptides due to the
SUMMARY OF TERMS acidic pH in the gastric lumen
 Digestion: Chemical and mechanical breakdown of food mainly  Enzymes continue to break down polypeptides and
in the small intestine peptides into amino acids
 Luminal digestion: Done by enzymes in salivary, gastric,  Absorption of Proteins
and pancreatic secretions  Absorbed as amino acids (sodium dependent carrier
 Membrane digestion: Performed by enzymes synthesized proteins) and small polypeptides (PepT1)
in enterocytes at the small intestinal border  Other transporters:
 Absorption: Net transfer of molecules across the GI mucosa into o Brush border
the blood circulation that depends on flux of molecules o Sodium/hydrogen exchanger
o PepT1
 Blood: Carbohydrates and protein
o Basolateral membrane: Na+ - K
 Lymph: Fat
 Protein Assimilation: Essential amino acids cannot be
 Occurs in the small intestine
synthesized so they are taken from our diet

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 Lipids 3. Which of the following is not a factor of the flux of a molecule
 Triglyceride: Predominant form of lipid in human diet a) Presence of special carrier
 Lipase and Colipase convert TG into FA and b) Solubility
monoglycerides c) Size
 Phospholipase A2 converts phospholipids into FA and d) Presence of electrochemical gradient
lysolecithin e) Thermodynamic favorability
 Cholesterol Esterase converts cholesterol esters into FA
and cholesterol 4. Which of the following is false
 Digestion of Lipids a) Bile is needed to emulsify fat in the duodenum
 Bile is needed to form emulsified fat b) Chief cells release pepsin
 Begins in the stomach where chief cells release gastric c) The small intestine is where most of lipolysis takes place
lipase d) Acidic pH results in the protonation of free Fas
 Majority of lipolysis takes place in the small intestine
 Absorption of Lipids 5. Where is Vitamin B12 absorbed?
 Absorption > Secretion a) Stomach
 In diarrhea, secretion < absorption b) Duodenum
c) Jejenum
 Water Absorption
d) Ileum
 2 Pathways for Water Absorption
 Paracellular: Through the tight junctions between the
6. Among the following macronutrients which begins digestion in the
apical borders of the epithelial cells
mouth?
 Transcellular: Through the cells themselves
a) Carbohydrates
o Most common
b) Proteins
 Transporters: Na-K pumps, secondary active transporter,
c) Lipids
aquaporins
 Water follows sodium! 7. What is the predominant form of lipids in the body?
 Sodium Absorption a) Triglycerides
 Occurs at proximal small intestine mostly via secondary b) Monoglycerides
active transport c) Phospholipids
 More prominent when distal d) Cholesterol
 Na-K pump brings out Na+
 Located in basolateral membrane 8. Where are triglycerides formed?
 Absorption in the Gallbladder a) Smooth ER
 Gallbladder can concentrate bile through the absorption of b) Rough ER
water via sodium gradient c) Golgi body
 Na-K pumps located in basolateral membrane d) Centrosome
 Release Na+. between cells
 Absorption in the Small Intestine 9. What transporter uptakes fructose?
 Na-H Exchanger a) GLUT2
 Na+ can be absorbed via passive diffusion, secondary active b) GLUT5
transport with sugar, isoneutrally with Cl-, in exchange with c) SGLT1
H+ d) PepT1
 Postprandial period
 Absorption is promoted in the small intestine 10. Which of the following is true?
predominantly via osmotic effects of nutrient a) Iron is absorbed as ferrous and converted to ferric
absorption b) Iron is absorbed as either heme or free iron
 Absorption in the Colon c) Iron absorption is increased by tannins and phytates
 Major role is to absorb or secrete sodium and water d) Iron absorption mainly occurs in the ileum
 Water passively driven by absorption of electrolytes and
Answers
solutes
1B, 2C, 3E, 4B, 5D, 6A, 7A, 8A, 9B, 10B
 Sodium: Special epithelial Na+ channels
 Vitamin Absorption
REFERENCES
 Fat soluble (ADEK), Water Soluble (C/Ascorbic Acid,
B1/Thiamine, B2/Riboflavin, B3/Niacin, B5/Pantothenic Acid,
REQUIRED
B6/Pyridoxine, B7/Biotin, B9/Folate, B12/Cobalamin) (1) Leticia Ibañez-Guzman. 15 January 2019. Digestion and
Absorption [Lecture slides].
 Nutrient Absorption
(2) ASMPH 2022. 2018. Digestion and Absorption [Trans].
 Calcium, iron and Vitamin B12 - ileum
(3) ASMPH 2021. 2017. Digestion and Absorption [Trans].
 Carbohydrates, protein and lipids - duodenum, then jejenum
and ileum
SUGGESTED
 Iron metabolism
(1) Moore, K.L, Agur, M.R, Dalley, A.F. Clinically Oriented Anatomy.
 Increased absorption with ascorbic acids and acetate th
7 ed. 2014
 Decreased absorption witth tannin and phytates (2) Rodwell, V.W, Kennelly P.J, Bender D.A, Botham KM, Weil Pa.
th
Harper’s Illustrated Biochemistry 30 ed. McGraw-Hill. 2015
REVIEW QUESTIONS (3)
th
Mescher, A.L. Junqueira’s Basic Histology Text and Atlas, 14 ed.
1. Which of the following does not undergo digestion and only McGraw-Hill Education. 2016
absorption?
a) Sucrose
b) Galactose
c) Lactose
d) Maltose
e) Starch

2. Which of the following is a water soluble vitamin

a) Vitamin K
b) Vitamin A
c) Vitamin B
d) Vitamin D
e) Vitamin E

YL5: 08.07 Gastrointestinal System and Nutrition: Digestion and Absorption 8 of 9

 APPENDIX

Figure 19. Digestion, absorption and transport of cobalamin

FREEDOM SPACE

YL5: 08.07 Group 16: Balonan, Bondoc, Calanoc, Fernando, Guerrero, Melevo, Vergara, Viernes 9 of 9