DIGESTION

Chapter 1
BLOOD SUPPLY TO THE GIT & LIVER

From Ingestion to
Excretion
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 INTRODUCTION
• The primary function of digestive system is;
Breaking down the complex food/drug particle into smaller and simple
ones
Absorption into blood stream for nutrition/effect of drug

• The digestive system of the human body is the sum of:

Gastrointestinal tract (GIT; also called alimentary canal)
Accessory organs (tongue, liver, pancreas, etc.).
• Alimentary canal is the long tube through which the food that we eat is
passed.
• It begins at the mouth (buccal or oral cavity), passes through the pharynx,
oesophagus or food pipe, stomach, small intestines, large intestines, rectum
and finally ends at the anus.
• The food particles gradually get digested as they travel through various
compartments of the alimentary canal.
• Accessory organs are organs which participate in the digestion process but are
not actually a part of GIT.
• They stimulate the digestion by releasing certain enzymes that help in breaking
down the food.
 HISTOLOGY/LAYERS OF ALIMENTARY CANAL
• Alimentary canal starts from the mouth and ends at the anus.
• It is comprised of the following muscle layers: (Starting from the lumen and moving
outwards)
1.MUCOSA
• The mucosa is referred to as a mucous membrane, because mucus production is a
characteristic feature of gut epithelium. The membrane consists of :

 Epithelium: which is in direct contact with ingested food, the epithelial cells
have goblet cells, which secrete mucus and fluid into the lumen, and
enteroendocrine cells, which secrete hormones into the interstitial spaces
between cells
Lamina Propria: a layer of connective tissue analogous/parallel to the
dermis which serves an immune function by housing clusters of
lymphocytes.
Muscularis Mucosa: In addition, the mucosa has a thin, smooth muscle
layer, called the muscularis mucosa which keep the mucosal surface and
underlying glands in a constant state of gentle agitation to expel contents
into the lumen
2.SUBMUCOSA
• It lies immediately beneath the mucosa. A broad layer of dense connective
tissue, it connects the mucosa to the muscularis.
• It includes blood and lymphatic vessels (which transport absorbed nutrients),
and submucosal glands that release digestive secretions.
3.MUSCULARIS AKA MUSCULARIS EXTERNA.
• The muscularis in the small intestine is made up of a double layer of smooth
muscle: an inner circular layer and an outer longitudinal layer.
• The contractions of these layers promote mechanical digestion, expose more of
the food to digestive chemicals, and move the food along the canal. In mouth,
pharynx, anterior part of the esophagus, and external anal sphincter, the
muscularis is made up of skeletal muscle, which gives you voluntary control
over swallowing and defecation.
• The stomach is equipped for its churning function by the addition of a third
layer, the oblique muscle.
4.SEROSA
• it consists of a layer of visceral peritoneum overlying a layer of loose
connective tissue. It serves to hold the alimentary canal in place near the
ventral surface of the vertebral column.
 GI ORGANS
The GIT can be divided into:
 Alimentary canal
organs
 Mouth
 Pharynx
 Esophagus
 Stomach
 Small intestine
 Large intestine

 Accessory organs
(for secreting
enzymes)
 Salivary glands
 Liver
 Gall bladder
 Pancreas
 1.MOUTH
• Aka the oral cavity.
• Mouth begins mechanical and, to some extent, chemical digestion.
• Mouth moistens food so that it can be swallowed.
• You can chew and breath simultaneously because of the arched shape roof of
the mouth i.e., palate.
• The roof of the mouth is called the palate. The region of the palate closest
to the front of the mouth, the hard palate, is reinforced with bone. Toward
the back of the mouth is the soft palate, which consists only of muscle and
prevents food from entering the nose during swallowing.
• A fleshy bead of tissue called the uvula drops down from the center of the
posterior edge of the soft palate.
• Function of uvula?????
• When you swallow, the soft palate and uvula move upward, helping to keep
foods and liquid from entering the nasal cavity. Unfortunately, it can also
contribute to the sound produced by snoring.
• The tongue is positioned over the floor of the oral cavity. The tongue is
composed of intrinsic and extrinsic skeletal muscles.
• The intrinsic muscles (those within the tongue) allow you to change the size
and shape of your tongue, as well as to stick it out, if you wish. It facilitates
both swallowing and speech.
• Function of extrinsic muscles in tongue???
• The teeth, or dentes are organs similar to bones that you use to tear, grind,
and otherwise mechanically break down food.
• Types of teeth:
Incisors (8 teeth) – The front four teeth on both the upper and lower jaws.
These are flat and sharp, used for cutting food.
Canines (4 teeth) – Pointed teeth next to the incisors. These help tear food,
especially meat.
Premolars (8 teeth) – Located behind the canines, premolars have a flat
surface with ridges for crushing and grinding food.
Molars (12 teeth, including wisdom teeth) – The back teeth with a large, flat
surface used for grinding and chewing food. This includes the wisdom teeth,
which are the last to come in, usually in the late teens or early twenties.
Wisdom teeth are often removed due to space issues or dental complications.
Out of the 12 molars, 4 are
wisdom teeth (third
molars).There are:

2 wisdom teeth on the

upper jaw (1 on the left, 1
on the right)

2 wisdom teeth on the

lower jaw (1 on the left, 1
on the right)
 2.PHARYNX
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• It is the passageway commonly called the throat, is shared by the respiratory
and digestive systems.
• When we swallow, food is pushed from the mouth, through the pharynx
• When a person begins to swallow, the tongue pushes the bolus of softened and
moistened food into the pharynx .
• Once food is in the pharynx, it is too late to change one's mind about
swallowing.
• Sensory receptors in the wall of the pharynx detect the presence of food and
stimulate the involuntary swallowing reflex.
• It has three subdivisions.
• Nasopharynx (the most superior), is involved only in breathing and
speech.
• Oropharynx used for both breathing and digestion
• Laryngopharynx are used for both breathing and digestion
• Usually during swallowing, the soft palate and uvula rise reflexively to close off
the entrance to the nasopharynx.
• At the same time, the larynx is pulled superiorly and the cartilaginous
epiglottis, covering the glottis (the opening to the larynx); this process
effectively blocks access to the trachea and bronchi.
• When the food “goes down the wrong way,” it goes into the trachea.
• When food enters the trachea, the reaction is to cough, which usually forces
the food up and out of the trachea, and back into the pharynx.
 3.ESOPHAGUS
• It connects the pharynx to the stomach.
• It is approximately 25.4 cm (10 in) in length, located posterior to the trachea,
and remains in a collapsed form when not engaged in swallowing.
• Sphincters are muscles that surround tubes and serve as valves, closing the
tube when the sphincters contract and opening it when they relax.
• The upper esophageal sphincter and the lower esophageal sphincter.
• Upper esophageal sphincter, when relaxed/open, allows the bolus to move
from the pharynx to the esophagus through peristaltic movements.
• Lower esophageal sphincter, when relaxed/open allows the bolus to move from
the esophagus into the stomach and prevents chyme from entering the
esophagus through peristaltic movements.
• When the lower esophageal sphincter does not completely close, the
stomach’s contents can reflux (that is, back up into the esophagus), causing
heartburn or gastro-esophageal reflux disease (GERD).
• In the esophagus, small intestine, and large intestine, the peristalsis (wave of
muscle contraction) is produced by the two layers of muscle in the
muscularis.
Circular muscles – when they contract the tube constricts or narrow
Longitudinal muscles – when the contract, the tube shortens in length
 4.STOMACH
• The stomach is a muscular sac that is designed to carry out storing food and
regulating the release of food to the small intestine, liquefying food, and
carrying out the chemical digestion, including the continued digestion of
carbohydrates and the initial digestion of proteins and triglycerides.
• The empty stomach is only about the size of your fist, but can stretch to hold
as much as 4 liters of food and fluid, or more than 75 times its empty volume,
and then return to its resting size when empty.
• The mucosa of the stomach is exposed to the highly corrosive acidity of gastric
juice. Gastric enzymes that can digest protein can also digest the stomach itself.
• The stomach is protected from self-digestion by the mucosal barrier. This
barrier has several components.

First, the stomach wall is covered by a thick coating of bicarbonate-rich

mucus. This mucus forms a physical barrier, and its bicarbonate ions
neutralize acid.
Second, the epithelial cells of the stomach’s mucosa meet at tight
junctions, which block gastric juice from penetrating the underlying tissue
layers.
Finally, the surface epithelium of the stomach is completely replaced every
3 to 6 days if it gets damaged by the acid secretion.
• There are four main regions in the stomach:
• Cardia - is the point where the esophagus connects to the stomach and
through which food passes into the stomach
• Fundus - located inferior to the diaphragm, above and to the left of the cardia,
is the dome-shaped fundus.
• Body - below the fundus is the body, the main part of the stomach
• Pylorus - the funnel-shaped pylorus connects the stomach to the duodenum
(small intestine).
• The wider end of the funnel, the pyloric antrum, connects to the body of the
stomach. The narrower end is called the pyloric canal, which connects to the
duodenum. The smooth muscle pyloric sphincter is located at this latter point
of connection and controls stomach emptying.
• In the absence of food, the stomach deflates inward, and its mucosa and
submucosa fall into a large fold called a rugae,
• The layers of stomach walls comprised of serosa (outermost wall), muscularis,
sub mucosa, mucosa (innermost wall). We will talk about cells present in the
mucosal layer as follows:

Parietal cells that secrete HCL into the gastric lumen.

Enterochromaffin cells which release histamine and help parietal cells in
secreting HCL.
G cells which release gastrin and help parietal cells in secreting HCL.
D cells which release somatostatin that inhibits the HCL secretion.
Mucosal cells which release mucous that prevents the stomach lining from
being digested by the HCL and also inhibits the HCL secretion.
Chief cells which release pepsinogen for protein digestion
Mechanical Digestion In Stomach
• Within a few moments after food enters your stomach, mixing waves begin to
occur at intervals of approximately 20 seconds.
• A mixing wave is a unique type of peristalsis that mixes and softens the food
with gastric juices to create chyme.
• The initial mixing waves are relatively gentle, but these are followed by more
intense waves, starting at the body of the stomach and increasing in force as
they reach the pylorus.
• The pylorus, which holds around 30 mL (1 fluid ounce) of chyme, acts as a filter,
permitting only liquids and small food particles to pass through the mostly, but
not fully, closed pyloric sphincter.
• In a process called gastric emptying, rhythmic mixing waves force about 30
mL of chyme at a time through the pyloric sphincter and into the duodenum.
• Release of a greater amount of chyme at one time would overwhelm the
capacity of the small intestine to handle it.
• The rest of the chyme is pushed back into the body of the stomach, where it
continues mixing. This process is repeated when the next mixing waves force
more chyme into the duodenum.
• Gastric emptying is regulated by both the stomach and the duodenum. The
presence of chyme in the duodenum activates receptors that inhibit gastric
secretion. This prevents additional chyme from being released by the stomach
before the duodenum is ready to process it.
Chemical Digestion In Stomach
• While the food is in the fundus, the digestive activities of salivary amylase
continue until the food begins mixing with the acidic chyme.
• Ultimately, mixing waves incorporate this food with the chyme, the acidity of
which inactivates salivary amylase and activates lingual lipase.
• Lingual lipase then begins breaking down triglycerides into free fatty acids,
and mono- and diglycerides.
• The breakdown of protein begins in the stomach through the actions of HCl
and the enzyme pepsin.
• During infancy, gastric glands also produce rennin, an enzyme that helps
digest milk protein.
• Its numerous digestive functions notwithstanding, there is only one stomach function
necessary to life: the production of intrinsic factor/protein by parietal cells w/c aid in
Vit B 12 absorption .
• The intestinal absorption of vitamin B12, which is necessary for both the production
of mature red blood cells and normal neurological functioning, cannot occur without
intrinsic factor.
• People who undergo total gastrectomy (stomach removal)—for life-threatening
stomach cancer, for example—can survive with minimal digestive dysfunction if they
receive vitamin B12 injections.
• The contents of the stomach are completely emptied into the duodenum within 2 to 4
hours after you eat a meal. Different types of food take different amounts of time to
process. Foods heavy in carbohydrates empty fastest, followed by high-protein foods.
• Meals with a high triglyceride content remain in the stomach the longest. Since
enzymes in the small intestine digest fats slowly, food can stay in the stomach for 6
hours or longer when the duodenum is processing fatty chyme. However, note that
this is still a fraction of the 24 to 72 hours that full digestion typically takes from start
to finish.
 5.SMALL INTESTINE
• The next region of the digestive tract, the small intestine, has two major
functions: chemical digestion and absorption
• It has 3 regions the duodenum, the jejunum, and the ileum
• Chyme from the stomach enters the duodenum, the first region of the small
intestine, in squirts, so that only a small amount enters the small intestine at
one time.
• Digestive juices also enter the duodenum from the pancreas and liver.
• However, most chemical digestion and absorption occur in the jejunum and
the ileum.
• Within the small intestine, a battery of enzymes completes the chemical
digestion of virtually all the carbohydrates, proteins, fats, and nucleic acids in
food.
• Although both the small intestine and the pancreas contribute enzymes, most
of the digestion that occurs in the small intestine is actually performed by
pancreatic enzymes
• Fats present a special digestive challenge because they are insoluble in water.
This poses a problem for digestion because lipase that chemically breaks
down fats, is soluble in water and not in fats.
• As a result, lipase can work only at the surface of a fat globule.
• Large fat globules have less combined surface area than do smaller droplets, so
their digestion by lipase proceeds more slowly.
• Bile, a mixture of water, ions, cholesterol, bile pigments, and bile salts, plays
an important role in the mechanical digestion of fats, which assists lipase in
chemically digesting fats.
• The bile salts emulsify fats; that is, they keep fats separated into small
droplets that disperse in liquid.
• This separation exposes a larger combined surface area to lipase, making the
chemical digestion and absorption of fats faster and more complete.
• Bile is produced by the liver, is stored in the gallbladder, and acts in the small
intestine.
Histology
• The wall of the small intestine is composed of the same four layers typically
present in the alimentary system.
• Structural modifications in small intestine are:
Circular Fold/Pilca Circulare
• Human small intestine mucosa contains permanent circular folds called plicae
• The entire lining of the small intestine is pleated, into circular folds.
• These circular folds increase the surface area for absorption and cause chyme
to flow through the small intestine in a spiral pattern.
• The spiral flow helps mix the chyme with digestive enzymes and increases its
contact with the absorptive surfaces.
Villi
• The villi give the lining a velvety appearance and, like the pile on a bath towel,
increase the absorptive surface.
• Indeed, the villi increase the surface area of the small intestine tenfold.
• Each villus contains a capillary bed composed of one arteriole and one
venule, as well as a lymphatic capillary called a lacteal.
• The breakdown products of carbohydrates and proteins (sugars and amino
acids) can enter the bloodstream directly, but most lipid breakdown products
are absorbed by the lacteals and transported to the bloodstream via the
lymphatic system.
Microvilli
• It is much smaller (1 µm) than villi that increase the surface area of the small
intestine by another 20 times.
• The microvilli form a fuzzy surface, known as a brush border.
• Fixed to the surface of the microvilli membranes are enzymes that finish
digesting carbohydrates and proteins.
Lactose Intolerance
• It is a condition characterized by indigestion caused by dairy products. It
occurs when the absorptive cells of the small intestine do not produce enough
lactase, the enzyme that digests the milk sugar lactose.
• In people with lactose intolerance, the lactose in chyme is not digested.
• Bacteria in the large intestine ferment (the chemical breakdown of a
substance by bacteria, yeasts, or other microorganisms, typically involving
effervescence and the giving off of heat.) the undigested lactose, a process
that produces gas.
• In addition to gas, symptoms include abdominal cramps, bloating, and
diarrhea.
• Symptom severity ranges from mild discomfort to severe pain; however,
symptoms resolve once the lactose is eliminated in feces.
 6.LARGE INTESTINE
• It is the terminal part of the alimentary canal.
• It runs from the appendix to the anus.
• It frames the small intestine on three sides.
• Despite it being about one-half as long as the small intestine, it is called large
because it is more than twice the diameter of the small intestine, about 3
inches.
• Large intestine is subdivided into four main regions:
• Cecum: It receives the contents of the ileum, and continues the absorption of
water and salts. The appendix is a winding tube that attaches to the cecum
which has immunologic function, this organ is generally considered vestigial. In
diarrheal illness, the appendix may serve as a bacterial reservoir to repopulate
the enteric bacteria for those surviving the initial phases of the illness.
• Colon: The cecum blends seamlessly with the colon w/c is divided into
ascending, transverse, descending and sigmoid colon.(diagram).
• Rectum: Food residue leaving the sigmoid colon enters the rectum in the pelvis.
The rectum has rectal valves which help separate the feces from gas to prevent
the simultaneous passage of feces and gas. As food enters the rectum it is
stretched which creates an urge to defecate.
• Anus: If one needs to defecate the food enters the anal canal.
• The anal canal includes two sphincters.
• The internal anal sphincter is made of smooth muscle, and its contractions are
involuntary.
• The external anal sphincter is made of skeletal muscle, which is under
voluntary control. Except when defecating, both usually remain closed.
• The primary function of the large intestine is to finish absorption of nutrients
and water, synthesize certain vitamins, form feces, and eliminate feces from
the body.
• Large intestine helps absorb water up to 300 ml. This water absorption dries
out the feces. If food moves too quickly then water wont be able to be
absorbed by the large intestine –diarrhea.
• While lack of fiber in diet or by holding the feces for long time , too much water
is absorbed from the large intestine – hard stools
• There are trillions of bacteria live within the large intestine and are referred to
as the bacterial flora.
• They facilitate chemical digestion and absorption, and some synthesize certain
vitamins, mainly B7, B5, and vitamin K.
• Histology: the wall of the large intestine has far more intestinal glands, which
contain a vast population of enterocytes and goblet cells.
• These goblet cells secrete mucus that eases the movement of feces and
protects the intestine from the effects of the acids and gases produced by
enteric bacteria.
• The enterocytes absorb water and salts as well as vitamins produced by your
intestinal bacteria.
 ACCESSORY ORGANS
1.LIVER
• The liver is a roughly triangular, reddish-brown accessory organ of the digestive system
located to the right of the stomach. It produces bile, which helps in the digestion of fat
in the small intestine. The bile is stored and recycled in the gallbladder. It is a small,
pear-shaped organ which is located just next to the liver.
2.PANCREAS
• Pancreatic juice drains from the pancreas into the pancreatic duct, which fuses with
the common bile duct from the liver just before entering the duodenum of the small
intestine.

• In addition to enzymes, pancreatic juice contains water and ions, including

bicarbonate ions that are important in neutralizing the acid in chyme when it
emerges from the stomach. Neutralization is essential for optimal enzyme activity in
the small intestine.
 3.GALLBLADDER
• After the bile is produced by the liver, bile is stored, modified, and
concentrated in gallbladder.
• When chyme enters the small intestine, a hormone causes the gallbladder to
contract and squirting the bile through the common bile duct into the
duodenum of the small intestine.
4.SALIVARY GLANDS
• Salivary glands are housed within the mucous membranes of the mouth and
tongue.
• These minor exocrine glands are constantly secreting saliva even while you
sleep.
• An average of 1 to 1.5 liters of saliva is secreted each day.
• Usually just enough saliva is present to moisten the mouth and teeth.
• Secretion increases when you eat, because saliva is essential to moisten food
and initiate the chemical breakdown of carbohydrates.
• Small amounts of saliva are also secreted by the labial glands in the lips.
• In addition, the buccal glands in the cheeks, palatal glands in the palate, and
lingual glands in the tongue help ensure that all areas of the mouth are
supplied with adequate saliva.
COMMON BILE DUCT
Major Salivary Glands
• Submandibular Glands: which are in the floor of the mouth, secrete saliva into
the mouth through the submandibular ducts. They have cells similar to those
of the parotid glands, as well as mucus-secreting cells. Therefore, saliva
secreted by the submandibular glands also contains amylase but in a liquid
thickened with mucus.
• Sublingual Glands: which lie below the tongue, use the lesser sublingual ducts
to secrete saliva into the oral cavity. They contain mostly mucous cells, and
they secrete the thickest saliva with the least amount of salivary amylase.
• Parotid Glands: lie between the skin and the masseter muscle, near the ears.
They secrete saliva into the mouth through the parotid duct, which is located
near the second upper molar tooth. They secrete a watery solution that
contains salivary amylase.
 ENZYME SITE OF PRODUCTION SITE OF ACTION SUBSTRATE AND PRODUCTS

Carbohydrate Digestion
Polysaccharides into shorter
Salivary amylase Mouth Salivary glands Mouth
molecules

Polysaccharides into
Amylase Pancreas Small intestine
disaccharides

Maltase Small intestine Small intestine Maltose into glucose units

Sucrose into glucose and

Sucrase Small intestine Small intestine
fructose

Lactose into glucose and

Lactase Small intestine Small intestine
galactose
Protein Digestion
Proteins into protein
Pepsin Stomach Stomach
fragments (polypeptides)
Proteins and polypeptides
Trypsin Pancreas Small intestine
into smaller fragments
Proteins and polypeptides
Chymotrypsin Pancreas Small intestine
into smaller fragments
Polypeptides into amino
Carboxypeptidase Pancreas Small intestine
acids
Lipid Digestion
Triglycerides (fats) into fatty
Lipase Pancreas Small intestine
acids and glycerol
 PROCESS OF DIGESTION
• The process of digestion begins from the mouth and ends in the small intestine
– the large intestines’ main function is to absorb the remaining water from the
undigested food and enable bacterial fermentation of materials that can no
longer be digested.
• The digestion process takes place in the following steps:
Ingestion ⇒Mixing and Movement ⇒ Secretion ⇒ Digestion ⇒Absorption ⇒Excretion

INGESTION
• The very first step involves mastication (chewing).
• The salivary glands, along with the tongue, helps to moisten and lubricate food,
before being pushed down into the food pipe.
MIXING AND MOVEMENT
• It involves the process of lubricating and manipulating food and pushing it
down the food through the food pipe (using peristalsis), and into the stomach.
SECRETION
• The stomach, small intestine, liver, and pancreas secrete enzymes and acids to
aid the process of digestion.
• It functions by breaking down food particles into simple components and easily
absorbable components.
DIGESTION
• The process of converting complex food particles into simpler substances in the
presence of enzymes and acids secreted by different digestive organs.
ABSORPTION
• This process begins in the small intestine where most of the nutrients and
minerals are absorbed.
• The excess water in the indigestible matter is absorbed by the large intestines.
EXCRETION
• The process of removing indigestible substances and waste by-products from
the body through the process of defecation.
 REGULATION OF GI FUNCTON
• It occurs by neural control and hormonal control
1.NEURAL CONTROL OF DIGESTION
• The neural control of digestion involves two main systems:
• the enteric nervous system (ENS), which is often called the "gut's brain”
• the autonomic nervous system (ANS), which regulates involuntary functions
A.ENTERIC NERVOUS SYSTEM
• The ENS is a network of neurons located in the walls of the digestive tract, from
the esophagus to the intestines.
• It controls local functions like:
Movement of food (peristalsis): Coordinated muscle contractions push food
through the digestive system.
 Secretion of digestive enzymes: It helps glands in the stomach, intestines,
and pancreas release enzymes to break down food.
Blood flow regulation to the digestive organs.
• The ENS can work independently but also communicates with the brain and
spinal cord.
B.AUTONOMIC NERVOUS SYSTEM (ANS)
• The ANS has two branches that regulate digestion:
i.PARASYMPATHETIC NERVOUS SYSTEM
• AKA ("rest and digest")
• This part helps activate digestion when the body is relaxed.
• It increases activities like:
Stimulating saliva production.
Increasing the release of digestive juices in the stomach and intestines.
Promoting peristalsis (smooth muscle contractions).
• Main nerve: The vagus nerve sends signals from the brain to the digestive
organs.
ii.SYMPATHETIC NERVOUS SYSTEM
• AKA ("fight or flight")
• This part slows down digestion when the body is stressed or in danger.
• It reduces blood flow to the digestive tract and slows peristalsis and digestive
secretions
 2. HORMONAL CONTROL
• Hormonal control of digestion involves several hormones that regulate the
processes of digestion, including the release of digestive enzymes, bile, and
gastric juices, as well as the movement of food through the digestive tract.
• These hormones are produced by cells in the stomach, small intestine, and
pancreas.
Gastrin stimulates acid production in the stomach for food digestion.
Secretin helps neutralize stomach acid and slows down stomach emptying.
Cholecystokinin (CCK) promotes bile and enzyme release for fat and protein
digestion.
Gastric Inhibitory Peptide (GIP) slows gastric activity and promotes insulin
release.
Motilin ensures that undigested food is cleared during fasting periods.
• Together, these hormones coordinate the different stages of digestion, ensuring
food is digested, absorbed, and moved through the digestive tract efficiently.
The End