Chapter 25 The Digestive System

General anatomy & digestive processes Mouth through esophagus Stomach Liver, gallbladder & pancreas Small intestine Chemical digestion & absorption Large intestine

Subdivisions of the Digestive System

Digestive tract (GI tract)
30 foot long tube extending from mouth to anus

Accessory organs
teeth, tongue, liver, gallbladder, pancreas, salivary glands

Relationship to the Peritoneum

Only duodenum, pancreas & parts of large intestine are (2o) retroperitoneal (have peritoneum only on their anterior side; become r-p during embryogenesis) Dorsal mesentery suspends GI tract & forms serosa (visceral peritoneum) of stomach & intestines Ventral mesentery forms lesser & greater omentum
lacy layer of connective tissue contains lymph nodes, lymphatic vessels and blood vessels

Lesser & Greater Omentum

Lesser attaches stomach to liver Greater covers small intestines like an apron

Mesentery and Mesocolon

Mesentery of small intestines holds many blood vessels Mesocolon anchors the colon to the back body wall

Digestive Functions & Processes

Functions
ingestion = intake of food digestion = breakdown of molecules absorption = uptake of nutrients into blood or lymph defecation = elimination of undigested material

Processes
motility = muscular contractions that break up food, mix it with enzymes & move it along secretion = digestive enzymes & hormones membrane transport = absorption of nutrients

Stages of Digestion
Mechanical digestion is physical breakdown of food into smaller particles
teeth & churning action of stomach & intestines

Chemical digestion is series of hydrolysis reactions that break macromolecules into their monomers
enzymes from saliva, stomach, pancreas & intestines results
polysaccharides into monosaccharides proteins into amino acids fats into glycerol and fatty acids

The Mouth or Oral Cavity

Features of the Oral Cavity

Cheeks and lips keep food between teeth for chewing, are essential for speech & suckling in infants
vestibule is space between teeth & cheeks cutaneous area versus red or vermilion area

Tongue is sensitive, muscular manipulator of food

papillae & taste buds on dorsal surface lingual glands secrete saliva, tonsils in root

Hard & soft palate

allow breathing & chewing at same time glossopalatine & pharyngopalatine arches

Permanent & Baby Teeth

Baby teeth (20) by 2 years; Adult (32) between 6 and 25 Occlusal surfaces and cusp numbers differ

Tooth Structure
Periodontal ligament is modified periosteum
anchors into alveolus

Cementum & dentin are living tissue Enamel is noncellular secretion formed during development Root canal leads into pulp cavity
nerves & blood vessels

Gingiva or gums

Mastication or Chewing
Breaks food into smaller pieces to be swallowed
mixes more easily with digestive enzymes

Contact of food with sensory receptors triggers chewing reflex

tongue, buccinator & orbicularis oris manipulate food masseter & temporalis elevate the teeth to crush food medial & lateral pterygoids swing teeth in side-to-side grinding action of molars

Saliva
Functions of saliva
moisten, begin starch & fat digestion, cleanse teeth, inhibit bacteria, bind food together into bolus

Hypotonic solutions of 99.5% water and solutes:

amylase = begins starch digestion lingual lipase = digests fat after reaches the stomach mucus = aids in swallowing lysozyme = enzyme that kills bacteria Ig A = inhibits bacterial growth electrolytes = Na+, K+, Cl-, phosphate & bicarbonate

pH of 6.8 to 7.0

Antibody review (see notes)

IgA : mucosal linings, saliva, tears, breast milk; prevents pathogen adherence to epithelial tissue IgD: functions as an antigen receptor on nave B cells; activates mast cells and basophils IgE ; involved in allergy; causes mast cell/basophil degranulation and release of histamine and heparin; protects against parasitic worms IgG: secondary immune response; the only one that can cross the placenta IgM: primary immune response; good complement activator; receptor on B cells

Salivary Glands

Small intrinsic glands found under mucous membrane of mouth, lips, cheeks and tongue -- secrete at constant rate 3 pairs extrinsic glands connected to oral cavity by ducts
parotid, submandibular and sublingual

Histology of Salivary Glands

Compound tubuloacinar glands Mucous cells secrete mucins Serous cells secrete thin fluid rich in amylase (starch to
maltose)

Mixed acinus is possible

Salivation
Total of 1 to 1.5 L of saliva per day Cells filter water from blood & add other substances Food stimulates receptors that signal salivatory nuclei in the medulla & pons
cranial nerves VII and IX supply salivary glands to produce thin saliva sympathetic fibers stimulate mucus secretion
dry mouth when scared

Higher brain centers stimulate salivatory nuclei so sight, smell & thought of food cause salivation

The Esophagus
Straight muscular tube 25-30 cm long
nonkeratinized stratified (multilayer) squamous (thin cell) epithelium esophageal glands in submucosa skeletal muscle in upper part & smooth in bottom

Extends from pharynx to cardiac stomach passing through esophageal hiatus in the diaphragm
inferior pharyngeal constrictor excludes air from it

Enteric nervous
submucosal & myenteric plexuses control motility & secretion in response to stimuli to the mucosa

Lower esophageal sphincter closes orifice to reflux

Tissue Layers of the GI Tract

Mucosa
epithelium lamina propria muscularis mucosae

Submucosa (glands, vessels, nerve plexus) Muscularis externa

inner circular layer Myenteric nerve plexus outer longitudinal layer

Adventitia or serosa (inferior to diaphragm)

areolar tissue or mesothelium

Anatomy of Esophagus

Structure of small intestine

Swallowing/deglutition

Swallowing or Deglutition
Series of muscular contractions coordinated by swallowing center in medulla & pons
motor signals from cranial nerves V, VII, IX and XII

Buccal phase (voluntary)

tongue collects food & pushes it back into oropharynx

Pharyngeal-esophageal phase
soft palate rises & blocks nasopharynx infrahyoid muscles lift larynx & epiglottis is folded back pharyngeal constrictors push bolus down esophagus
liquids in 2 seconds -- food bolus may take 8 seconds lower esophageal sphincter relaxes

X ray of Swallowing in Esophagus

Introduction to the Stomach

Mechanically breaks up food particles, liquifies the food & begins chemical digestion of protein & fat
resulting soupy mixture is called chyme

Stomach does not absorb any significant amount of nutrients

does absorb aspirin & some lipid-soluble drugs

Innervation by parasympathetic fibers from vagus & sympathetic fibers from the celiac plexus All blood drained from stomach is filtered through the liver before returning to heart

Gross Anatomy of the Stomach

Muscular sac with a typical volume of 1 to 1.5 L
J - shaped organ with lesser & greater curvatures regional differences
cardiac region just inside cardiac orifice fundus is domed portion superior to esophageal opening body is main portion of organ pyloric region is narrow inferior end
antrum & pyloric canal

Pylorus is opening to duodenum

thick ring of smooth muscle forms a sphincter

Gross Anatomy of Stomach

Notice: bulge of fundus, narrowing of pyloric region, thickness of pyloric sphincter and greater & lesser curvatures

Unique Features of Stomach Wall

Mucosa
simple columnar glandular epithelium (ideal for absorption) lamina propria is filled with tubular glands (gastric pits)

Muscularis externa has 3 layers

outer longitudinal, middle circular & inner oblique layers

Parenchyma vs stroma
Parenchyma is the functional part of an organ and is usually of ectodermal/endodermal origin Ex: the secretory acini of an excretory gland

Stroma is the structural/supporting part of an organ and is composed of connective tissue, which is always of mesodermal origin. Ex: the septa and capsules of an excretory gland

Cells of the Gastric Glands

Mucous (neck) cells secrete mucus Regenerative cells divide rapidly to produce new cells that migrate upwards towards surface Parietal/oxyntic cells secrete HCl acid & intrinsic factor (glycoprotein required for B12 uptake Chief/zymogenic cells secrete rennin & lipase in infancy & pepsinogen throughout life Enteroendocrine cells secrete hormones & paracrine messengers (histamine/gastrin)

Gastric Pit and Gastric Gland

Gastric Secretions

2 to 3 L of gastric juice per day (water, HCl & pepsin) Parietal cells contains carbonic anhydrase (CAH)
CO2 + H2O H2CO3 HCO3- + H+ H+ produced is pumped out of parietal cell by H+/K+ ATPase (antiporter that uses energy of ATP to pump out H+ & in K+) HCO3- in parietal cells is exchanged for Cl- in the blood
pumped out to join H+ forming HCl acid in the stomach lumen bicarbonate increase in blood causes alkaline tide (blood pH increase)
CAH

Functions of Hydrochloric Acid

Activates enzymes pepsin & lingual lipase Breaks up connective tissues & plant cell walls
liquifying food to form chyme

Converts ingested ferric ions (Fe+3) to ferrous ions (Fe+2) that can be absorbed & utilized for hemoglobin synthesis Destroys ingested bacteria & pathogens

Gastric Enzymes & Intrinsic Factor

Intrinsic factor (a glycoprotein)
secreted by parietal cells (less with aging) essential for absorption of B12 by small intestine necessary for RBC production (pernicious anemia)

Pepsin --- chief cell function in protein digestion

secreted as inactive zymogen called pepsinogen under HCl, converted to active form, pepsin which then helps form more by digesting the pepsinogen (autocatalytic)

Lipase & rennin enzymes also from chief cells

lipase digests butterfat of milk in infant rennin curdles milk by coagulating its proteins

Production & Action of Pepsin

Gastric Motility
Swallowing center signals stomach to relax Arriving food stretches the stomach activating a receptive-relaxation response
resists stretching briefly, but relaxes to hold more food

Rhythm of peristalsis controlled by pacemaker cells in longitudinal muscle layer

gentle ripple of contraction every 20 seconds churns & mixes food with gastric juice stronger as reaches pyloric region squirting out 3 mL
duodenum neutralizes acids and digests nutrients little at time

typical meal is emptied from stomach in 4 hours

Vomiting
Induced by excessive stretching of stomach, psychological stimuli or chemical irritants (bacterial toxins) Emetic center in medulla causes lower esophageal sphincter to relax as diaphragm & abdominal muscles contract
contents forced up the esophagus may even expel contents of small intestine

Regulation of Gastric Secretion

Regulation of Gastric Function (Phases 1-2)

Cephalic phase
vagus nerve (parasymp.) stimulates gastric secretion & motility just with sight, smell, taste or thought of food

Gastric phase
activated by presence of food or semidigested protein
stretch activates medulla obl. myenteric & vagovagal reflexes

secretion is stimulated by ACh, histamine & gastrin

receptors for each substance on parietal cells & chief cells ACh from parasympathetic fibers, histamine from gastric enteroendocrine cells and gastrin from G cells (a type of enteroendocrine cells) (stimulate parietal cells to secrete and chief cells to secrete pepsinogen)

Regulation of Gastric Function (Phase 3)

Intestinal phase
duodenum regulates gastric activity through hormones & nervous reflexes gastric activity increases if duodenum is stretched or amino acids in chyme cause gastrin release

Enterogastric reflex = duodenum inhibiting stomach Chyme (pH <2) stimulates duodenal cells to release secretin, cholecystokinin (CCK) & gastric inhibitory peptide
all 3 suppress gastric secretion & motility

Positive Feedback Control of Gastric Secretion

Gross Anatomy of Liver

3 lb. organ located inferior to the diaphragm 4 lobes -- right, left, quadrate & caudate
falciform ligament separates left and right round ligament is remnant of umbilical vein

Gallbladder adheres to ventral surface between right and quadrate lobes

Inferior Surface of Liver

Microscopic Anatomy of Liver

Tiny cylinders called hepatic lobules (2mm by 1mm) Central vein surrounded by sheets of hepatocyte cells separated by sinusoids lined with fenestrated epithelium Blood filtered by hepatocytes on way to central vein
nutrients, toxins, bile pigments, drugs, bacteria & debris filtered

Histology of Liver -- Hepatic Triad

3 structures found in corner between lobules

hepatic portal vein brings nutrient rich, but O2 poor blood from the abdominal viscera; hepatic artery delivers oxygenated blood to the liver. bile duct collects bile (synthesized by the liver) from the bile canaliculi between sheets of hepatocytes, which are eventually secreted into the common hepatic duct

Ducts of Gallbladder, Liver & Pancreas

Ducts of Gallbladder, Liver & Pancreas

Bile passes from bile canaliculi between cells to bile ductules to right & left hepatic ducts Right & left ducts join outside the liver to form common hepatic duct Cystic duct from gallbladder joins to form common bile duct Duct of pancreas and common bile duct combine to form hepatopancreatic ampulla (ampulla of Vater) emptying into the duodenum at the major duodenal papilla
sphincter of Oddi (hepatopancreatic sphincter) regulates release of bile & pancreatic juice

The Gallbladder ( ) and Bile

Sac on underside of liver -- 10 cm long 500 to 1000 mL bile are secreted daily from liver Gallbladder stores & concentrates bile
bile backs up into gallbladder from a filled bile duct between meals, bile is concentrated by factor of 20

Yellow-green fluid containing minerals, bile acids, cholesterol, bile pigments & phospholipids
bilirubin pigment from hemoglobin breakdown
intestinal bacteria convert to urobilinogen = brown color

bile acid (salts) emulsify fats & aid in their digestion

enterohepatic circulation is recycling of bile salts from ileum

Gross Anatomy of Pancreas

Retroperitoneal gland posterior to stomach
head, body and tail

Endocrine and exocrine gland

secretes insulin & glucagon into the blood secretes 1500 mL pancreatic juice into duodenum
water, enzymes, zymogens, and sodium bicarbonate
zymogens are inactive until converted by other enzymes other pancreatic enzymes are activated by exposure to bile and ions in the intestine

Pancreatic duct runs length of gland to open at sphincter of Oddi (hepatopancreatic sphincter)
accessory duct opens independently on duodenum

Pancreatic Acinar Cells

Zymogens = proteases
trypsinogen chymotrypsinogen procarboxypeptidase

Other enzymes
amylase digests starch lipase digests fats ribonuclease and deoxyribonuclease digest RNA and DNA

Activation of Zymogens

Trypsinogen converted to trypsin by enterokinase in intestinal epithelium Trypsin converts other 2 as well as digests dietary protein

Hormonal Control of Secretion

Cholecystokinin (CCK) released from duodenum in response to arrival of acid and fat
causes contraction of gallbladder, secretion of pancreatic enzymes, relaxation of hepatopancreatic sphincter

Secretin released from duodenum in response to acidic chyme

stimulates all ducts to secrete sodium bicarbonate

Gastrin from stomach & duodenum weakly stimulates gallbladder contraction & pancreatic enzyme secretion (in addition to HCl)

Small Intestine

Nearly all chemical digestion and nutrient absorption occurs in the small intestine

Gross Anatomy of Small Intestine

Duodenum curves around head of pancreas (10 in.)
retroperitoneal along with pancreas receives stomach contents, pancreatic juice & bile neutralizes stomach acids, emulsifies fats, pepsin inactivated by pH increase, pancreatic enzymes

Jejunum is next 8 ft. (in upper abdomen)

covered with serosa and suspended by mesentery

Ileum is last 12 ft. (in lower abdomen)

covered with serosa and suspended by mesentery ends at ileocecal junction with large intestine

Large Surface Area of Small Intestine

Plicae circularis or circular folds up to 10 mm tall
involve only mucosa and submucosa chyme flows in spiral path causing more contact

Villi are fingerlike projections 1 mm tall

contain blood vessels & lymphatics (lacteal)
nutrient absorption

Microvilli 1 micron tall

brush border on cells brush border enzymes for final stages of digestion

Intestinal Crypts
Pores opening between villi lead to intestinal crypts
absorptive cells, goblet cells & at base, rapidly dividing cells
life span of 3-6 days as migrate up to surface & get sloughed off & digested

paneth cells with unknown function

Brunners glands in submucosa secrete bicarbonate mucus Peyer patches are populations of lymphocytes to fight pathogens Secrete 1-2 L of intestinal juice/day
water & mucus, pH 7.4-7.8

Cells/structures of the small intestine

Lacteals: lipid absorption, chylomicron transport Plicae circularis: circular folds of the small intest.
Goblet cells: mucus ( = glucoproteins) secretion for protection and lubrication Paneth cells: involved in innate immuty; secrete lysozymes and PLP A2 bacterial membrane destruction M cells: found in Peyer patches ( = lymphoid nodules/follicles of the small intestine; serve as sampling stations

Intestinal Motility
Mixes chyme with intestinal juice, bile & pancreatic juice Churns chyme to increase contact with mucosa for absorption & digestion Types of GI motility:
peristaltic waves begin in duodenum but each one moves further down
push chyme along for 2 hours property of enteric nervous system (serotonin motility) suppressed by refilling of stomach

segmentation
random ringlike constrictions mix & churn contents retards movement of contents to allow digestion and absortpion)

Mass action contraction (only in colon): simultaneous contraction of smooth muscle that moves material Distention of stomach causes gastroileal reflex (relaxing of valve & filling of cecum) and gastrocolic reflex (contractions of the rectum)

Segmentation in the Small Intestine

Purpose of segmentation is to mix & churn not to move material along as in peristalsis

Peristalsis
Gradual movement of contents towards the colon Migrating motor complex controls waves of contraction
second wave begins distal to where first wave began

Cecum

Carbohydrate Digestion in Small Intestine

Salivary amylase stops working in acidic stomach(if 4.5)

50% of dietary starch digested before it reaches small intestine

Pancreatic amylase completes first step in 10 minutes Brush border enzymes act upon oligosaccharides, maltose, sucrose, lactose & fructose
lactose indigestible after age 4 in most humans (lack of lactase)

Carbohydrate Absorption

Liver

Sodium-glucose transport proteins (SGLT) in membrane help absorb glucose & galactose Fructose absorbed by facilitated diffusion then converted to glucose inside the cell

Protein Digestion & Absorption

Pepsin has optimal pH of 1.5 to 3.5 -- inactivated when passes into duodenum & mixes with alkaline pancreatic juice (pH 8)

Protein Digestion & Absorption

Pancreatic enzymes take over protein digestion by hydrolyzing polypeptides into shorter oligopeptides

Protein Digestion & Absorption

Brush border enzymes finish the task producing amino acids that are absorbed into the intestinal epithelial cells
amino acid cotransporters move into epithelial cells & facilitated diffusion moves amino acids out into the blood stream

Infants absorb proteins by pinocytosis (maternal IgA)

Fat Digestion & Absorption

Bile acids are steroid acids Lecithin is a generic name for a group of various FAs

Fat Digestion & Absorption

Fat Digestion & Absorption

Nucleic Acids, Vitamins, and Minerals

Nucleases hydrolyze DNA & RNA to nucleotides
nucleosidases & phosphatases of the brush border split them into phosphate ions, ribose or deoxyribose sugar & nitrogenous bases

Vitamins are absorbed unchanged

D, E, K & A with other lipids -- B complex & C by simple diffusion and B12 if bound to intrinsic factor

Minerals are absorbed all along small intestine

Na+ cotransported with sugars & amino acids Cl- exchanged for bicarbonate reversing stomach Iron & calcium absorbed as needed

Water Balance
Digestive tract receives about 9 L of water/day
.7 L in food, 1.6 L in drink, 6.7 L in secretions 8 L is absorbed by the small intestine & .8 L by the large intestine

Water is absorbed by osmosis following the absorption of salts & organic nutrients Diarrhea occurs when too little water is absorbed
feces pass through too quickly if irritated feces contains high concentrations of a solute (lactose)

Anatomy of Large Intestine

Gross Anatomy of Large Intestine

5 feet long and 2.5 inches in diameter in cadaver Begins as cecum & appendix in lower right corner Ascending, transverse and descending colon frame the small intestine Sigmoid colon is S-shaped portion leading down into pelvis Rectum is straight portion ending as anus

Microscopic Anatomy
Mucosa is simple columnar epithelium
anal canal is stratified squamous epithelium

No circular folds or villi to increase surface area Intestinal crypts (glands sunken into lamina propria) produce mucus only Muscularis externa
longitudinal muscle fibers form teniae coli producing haustra (pouches)

Transverse & sigmoid have a serosa, the rest is retroperitoneal

epiploic appendages are suspended fatty sacs

Bacterial Flora & Intestinal Gas

Bacterial flora populate large intestine
ferment cellulose & other undigested carbohydrates synthesize vitamins B and K

Flatus (gas)
average person produces 500 mL per day most is swallowed air but it can contain methane, hydrogen sulfide, indole & skatole that produce the odor

Absorption and Motility

Transit time is 12 to 24 hours
reabsorbs water and electrolytes

Feces consist of water & solids (bacteria, mucus, undigested fiber, fat & sloughed epithelial cells) Haustral contractions occur every 30 minutes
distension of a haustrum stimulates it to contract

Mass movements occur 1 to 3 times a day

triggered by gastrocolic and duodenocolic reflexes
filling of the stomach & duodenum stimulates motility moves residue for several centimeters with each contraction

Anatomy of Anal Canal

Anal canal is 3 cm total length Anal columns are longitudinal ridges separated by mucus-secreting anal sinuses Hemorrhoids are permanently distended veins

Defecation
Stretching of the rectum stimulates defecation
intrinsic defecation reflex via the myenteric plexus
causes muscularis to contract & internal sphincter to relax
relatively weak contractions

defecation occurs only if external anal sphincter is voluntarily relaxed

parasympathetic defecation reflex involves spinal cord

stretching of rectum sends sensory signals to spinal cord splanchnic nerves return signals intensifying peristalsis

Abdominal contractions increase abdominal pressure as levator ani lifts anal canal upwards
feces will fall away

Neural Control of Defecation

1. Filling of the rectum 2. Reflex contraction of rectum & relaxation of internal anal sphincter 3. Voluntary relaxation of external sphincter