CnA1Lk 23 - DIGLS1IVL SS1LM 1

Chapter 23 - 1he D|gest|ve System

A81 1: CvL8vlLW Cl 1PL ulCLS1lvL S?S1LM
1wo groups of organs
o AllmenLary canal (gasLrolnLesLlnal or Cl LracL)
ulgesLs and absorbs food
MouLh, pharynx, esophagus, sLomach, small lnLesLlne, and large lnLesLlne
Accessory dlgesLlve organs
1eeLh, Longue, gallbladder
ulgesLlve glands
Sallvary glands
Llver
ancreas
D|gest|ve rocesses
1he Cl LracL ls a dlsassembly" llne
nuLrlenLs become more avallable Lo Lhe body ln each sLep
Slx essenLlal acLlvlLles
1. lngesLlon - Laklng food lnLo Lhe dlgesLlve LracL
2. ropulslon - swallowlng and perlsLalsls
er|sta|s|s - waves of conLracLlon and relaxaLlon of muscles ln Lhe organ walls
3. Mechanlcal dlgesLlon - chewlng, mlxlng, and churnlng foods
4. Chemlcal dlgesLlon - caLabollc breakdown of food
3. AbsorpLlon - movemenL of nuLrlenLs from Lhe Cl LracL Lo Lhe blood or lymph
6. uefecaLlon - ellmlnaLlon of lndlgesLlble solld wasLes
8as|c Iunct|ona| Concepts
GI tract regu|atory mechan|sms
1. MechanorecepLors and chemorecepLors
8espond Lo sLreLch, changes ln osmolarlLy and pP, and presence of subsLraLe and end producLs
of dlgesLlon
lnlLlaLe reflexes LhaL
AcLlvaLe or lnhlblL dlgesLlve glands
SLlmulaLe smooLh muscle Lo mlx and move lumen conLenLs
2. lnLrlnslc and exLrlnslc conLrols
LnLerlc nerve plexuses (guL braln) lnlLlaLe shorL reflexes ln response Lo sLlmull ln Lhe Cl LracL
Long reflexes ln response Lo sLlmull lnslde or ouLslde Lhe Cl LracL lnvolve CnS cenLers and
auLonomlc nerves
Pormones from cells ln Lhe sLomach and small lnLesLlne sLlmulaLe LargeL cells ln Lhe same or
dlfferenL organs


2 CnA1Lk 23 - DIGLS1IVL SS1LM

D|gest|ve System Crgans: ke|at|onsh|ps
er|toneum and er|tonea| Cav|ty
erlLoneum - serous membrane of Lhe abdomlnal cavlLy
vlsceral perlLoneum - covers exLernal surface of mosL dlgesLlve organs
arleLal perlLoneum - llnes Lhe body wall
erlLoneal cavlLy
8eLween Lhe Lwo perlLoneums
lluld lubrlcaLes moblle organs allowlng Lhem Lo sllde across one anoLher
MesenLery - double layer of perlLoneum
8ouLes for blood vessels, lymphaLlcs, and nerves
Polds organs ln place and sLores faL
8eLroperlLoneal organs - ouLslde, posLerlor Lo Lhe perlLoneum
lnLraperlLoneal (perlLoneal) organs - surrounded by Lhe perlLoneum
8|ood Supp|y: Sp|anchn|c C|rcu|at|on
ArLerles and Lhe organs Lhey serve lnclude:
PepaLlc, splenlc, and lefL gasLrlc
lnferlor and superlor mesenLerlc: small and large lnLesLlnes
PepaLlc porLal clrculaLlon
uralns nuLrlenL-rlch venous blood from dlgesLlve organs
uellvers lL Lo Lhe llver for meLabollc processlng and sLorage
n|sto|ogy of the A||mentary Cana|
lrom esophagus Lo Lhe anal canal, Lhe walls of Lhe Cl LracLs have Lhe same four baslc layers (Lunlcs):
Mucosa
Submucosa
Muscularls exLerna
Serosa
Lach Lunlc has a predomlnanL Llssue Lype and speclflc dlgesLlve funcLlon
Mucosa
MolsL eplLhellal layer LhaL llnes Lhe lumen of Lhe allmenLary canal
lLs' Lhree ma[or funcLlons are:
SecreLlon of mucus, dlgesLlve enzymes and hormones
AbsorbLlon of Lhe end producLs of dlgesLlon
roLecLlon agalnsL lnfecLlous dlsease
1hree sublayers: eplLhellum, lamlna proprla, and muscularls mucosae
Lp|the||um
ConslsLs of slmple columnar eplLhellum and mucus-secreLlng gobleL cells
1he mucus secreLlons
roLecLs dlgesLlve organs from enzymes (prevenLs dlgesLlng Lhemselves)
Lases food along Lhe passage
May secreLe enzymes and hormones (e.g., ln sLomach and small lnLesLlne)
Lam|na ropr|a
Loose areolar and reLlcular connecLlve Llssue
Caplllarles for nourlshmenL and absorpLlon
Lymphold folllcles (parL of MAL1), lmporLanL ln defense agalnsL bacLerla

CnA1Lk 23 - DIGLS1IVL SS1LM 3

Muscu|ar|s mucosae
SmooLh muscle LhaL produces local movemenLs of mucosa
Cther Sub|ayers
Submucosa
uense connecLlve Llssue conLalnlng elasLlc flbers
8lood and lymphaLlc vessels, lymphold folllcles, and submucosal nerve plexus
Muscularls exLerna
8esponslble for segmenLaLlon and perlsLalsls
lnner clrcular and ouLer longlLudlnal layers
MyenLerlc nerve plexus
SphlncLers ln some reglons
Serosa
Serosa - vlsceral perlLoneum
8eplaced by Lhe flbrous advenLlLla ln Lhe esophagus
8eLroperlLoneal organs have boLh an advenLlLla and serosa

Lnter|c Nervous System
lnLrlnslc nerve supply of Lhe allmenLary canal
Submucosal nerve plexus
8egulaLes glands and smooLh muscle ln Lhe mucosa
MyenLerlc nerve plexus
ConLrols Cl LracL moLlllLy
Llnked Lo Lhe CnS vla afferenL vlsceral flbers
Long AnS flbers synapse wlLh enLerlc plexuses
SympaLheLlc lmpulses lnhlblL secreLlon and moLlllLy
arasympaLheLlc lmpulses sLlmulaLe



A81 2: lunC1lCnAL AnA1CM? Cl 1PL ulCLS1lvL S?S1LM
1he Mouth and Assoc|ated Crgans
Mouth
Cral (buccal) cavlLy
8ounded by llps, cheeks, palaLe, and Longue
Cral orlflce ls Lhe anLerlor openlng
Llned wlLh sLraLlfled squamous eplLhellum

L|ps and Cheeks
ConLaln orblcularls orls and bucclnaLor muscles
vesLlbule: recess lnLernal Lo llps and cheeks, exLernal Lo LeeLh and gums
Cral cavlLy proper lles wlLhln Lhe LeeLh and gums
Lablal frenulum: medlan aLLachmenL of each llp Lo Lhe gum

4 CnA1Lk 23 - DIGLS1IVL SS1LM

a|ate
Pard palaLe: palaLlne bones and palaLlne processes of Lhe maxlllae
SllghLly corrugaLed Lo help creaLe frlcLlon agalnsL Lhe Longue
SofL palaLe: fold formed mosLly of skeleLal muscle
Closes off Lhe nasopharynx durlng swallowlng
uvula pro[ecLs downward from lLs free edge
1ongue
luncLlons lnclude
8eposlLlonlng and mlxlng food durlng chewlng
lormaLlon of Lhe bolus
lnlLlaLlon of swallowlng, speech, and LasLe
lnLrlnslc muscles change Lhe shape of Lhe Longue
LxLrlnslc muscles alLer Lhe Longue's poslLlon
Llngual frenulum: aLLachmenL Lo Lhe floor of Lhe mouLh
Surface bears paplllae
llllform-whlLlsh, glve Lhe Longue roughness and provlde frlcLlon
lunglform-reddlsh, scaLLered over Lhe Longue
ClrcumvallaLe (vallaLe)-v-shaped row ln back of Longue
1hese Lhree house LasLe buds
lollaLe-on Lhe laLeral aspecLs of Lhe posLerlor Longue
1ermlnal sulcus marks Lhe dlvlslon beLween
8ody: anLerlor 2/3 resldlng ln Lhe oral cavlLy
8ooL: posLerlor Lhlrd resldlng ln Lhe oropharynx
Sa||vary G|ands
LxLrlnslc sallvary glands (paroLld, submandlbular, and subllngual)
lnLrlnslc (buccal) sallvary glands are scaLLered ln Lhe oral mucosa
SecreLlon (sallva)
Cleanses Lhe mouLh
MolsLens and dlssolves food chemlcals
Alds ln bolus formaLlon
ConLalns enzymes LhaL begln Lhe breakdown of sLarch
aroLld gland
AnLerlor Lo Lhe ear exLernal Lo Lhe masseLer muscle
aroLld ducL opens lnLo Lhe vesLlbule nexL Lo second upper molar
Submandlbular gland
Medlal Lo Lhe body of Lhe mandlble
uucL opens aL Lhe base of Lhe llngual frenulum
Subllngual gland
AnLerlor Lo Lhe submandlbular gland under Lhe Longue
Cpens vla 10-12 ducLs lnLo Lhe floor of Lhe mouLh
Compos|t|on of Sa||va
SecreLed by serous and mucous cells
97-99.3 waLer, sllghLly acldlc soluLlon conLalnlng
LlecLrolyLes-na
+
, k
+
, Cl
-
, C
4
2-
, PCC
3
-

Sallvary amylase and llngual llpase
Mucln
MeLabollc wasLes-urea and urlc acld
Lysozyme, lgA, defenslns, and a cyanlde compound proLecL agalnsL mlcroorganlsms
CnA1Lk 23 - DIGLS1IVL SS1LM S

Contro| of Sa||vat|on
lnLrlnslc glands conLlnuously keep Lhe mouLh molsL
LxLrlnslc sallvary glands produce secreLlons when
lngesLed food sLlmulaLes chemorecepLors and mechanorecepLors ln Lhe mouLh
SallvaLory nuclel ln Lhe braln sLem send lmpulses along parasympaLheLlc flbers ln cranlal
nerves vll and lx
SLrong sympaLheLlc sLlmulaLlon lnhlblLs sallvaLlon and resulLs ln dry mouLh (xerosLomla)
1eeth
rlmary and permanenL denLlLlons are formed by age 21
20 declduous LeeLh erupL (6-24 monLhs of age)
8ooLs are resorbed, LeeLh fall ouL (6-12 years of age) as permanenL LeeLh develop
32 permanenL LeeLh
All excepL Lhlrd molars erupL by Lhe end of adolescence
C|ass|f|cat|on of 1eeth
lnclsors
Chlsel shaped for cuLLlng
Canlnes
langllke LeeLh LhaL Lear or plerce
remolars (blcusplds) and molars
Pave broad crowns wlLh rounded cusps for grlndlng or crushlng
Denta| Iormu|as
A shorLhand way of lndlcaLlng Lhe number and relaLlve poslLlon of LeeLh
8aLlo of upper Lo lower LeeLh for one-half of Lhe mouLh
rlmary: 2l,1C, 2M
ermanenL: 2l,1C, 2M, 3M
1ooth Structure
Crown: Lhe exposed parL above Lhe glnglva (gum)
Covered by enamel-Lhe hardesL subsLance ln Lhe body (calclum salLs and hydroxyapaLlLe
crysLals)
8ooL: porLlon embedded ln Lhe [awbone
ConnecLed Lo crown by neck
CemenLum: calclfled connecLlve Llssue
Covers rooL and aLLaches lL Lo Lhe perlodonLal llgamenL
erlodonLal llgamenL
lorms flbrous [olnL called a gomphosls
Clnglval sulcus: groove where glnglva borders Lhe LooLh
uenLln: bonellke maLerlal under enamel
MalnLalned by odonLoblasLs of pulp cavlLy
ulp cavlLy: cavlLy surrounded by denLln
ulp: connecLlve Llssue, blood vessels, and nerves
8ooL canal: exLends from pulp cavlLy Lo Lhe aplcal foramen of Lhe rooL
1ooth and Gum D|sease
uenLal carles (cavlLles): gradual demlnerallzaLlon of enamel and denLln
uenLal plaque (sugar, bacLerla, and debrls) adheres Lo LeeLh
Acld from bacLerla dlssolves calclum salLs
roLeolyLlc enzymes dlgesL organlc maLLer
revenLlon: dally flosslng and brushlng
6 CnA1Lk 23 - DIGLS1IVL SS1LM

ClnglvlLls
laque calclfles Lo form calculus (LarLar)
Calculus dlsrupLs Lhe seal beLween Lhe glnglvae and Lhe LeeLh
Anaeroblc bacLerla lnfecL gums
lnfecLlon reverslble lf calculus removed
erlodonLlLls
lmmune cells aLLack lnLruders and body Llssues
uesLroy perlodonLal llgamenL
AcLlvaLe osLeoclasLs
Consequences
osslble LooLh loss, promoLlon of aLherosclerosls and cloL formaLlon ln coronary and
cerebral arLerles
1he harynx
Cropharynx and laryngopharynx
Allow passage of food, flulds, and alr
SLraLlfled squamous eplLhellum llnlng
SkeleLal muscle layers: lnner longlLudlnal, ouLer pharyngeal consLrlcLors
1he Lsophagus
llaL muscular Lube from laryngopharynx Lo sLomach
lerces dlaphragm aL esophageal hlaLus
!olns sLomach aL Lhe cardlac orlflce
Lsophageal mucosa conLalns sLraLlfled squamous eplLhellum
Changes Lo slmple columnar aL Lhe sLomach
Lsophageal glands ln submucosa secreLe mucus Lo ald ln bolus movemenL
Muscularls: skeleLal superlorly, smooLh lnferlorly
AdvenLlLla lnsLead of serosa
D|gest|ve rocesses: Mouth to Lsophagus
lngesLlon
Mechanlcal dlgesLlon
MasLlcaLlon ls parLly volunLary, parLly reflexlve
Chemlcal dlgesLlon (sallvary amylase and llngual llpase)
ropulslon
uegluLlLlon (swallowlng)
Deg|ut|t|on
lnvolves Lhe Longue, sofL palaLe, pharynx, esophagus, and 22 muscle groups
8uccal phase
volunLary conLracLlon of Lhe Longue
haryngeal-esophageal phase
lnvolunLary
ConLrol cenLer ln Lhe medulla and lower pons



CnA1Lk 23 - DIGLS1IVL SS1LM 7

1he Stomach
Gross Anatomy
Cardlac reglon (cardla)
Surrounds Lhe cardlac orlflce
lundus
uome-shaped reglon beneaLh Lhe dlaphragm
8ody
MldporLlon
ylorlc reglon: anLrum, pylorlc canal, and pylorus
ylorus ls conLlnuous wlLh Lhe duodenum Lhrough Lhe pylorlc valve (sphlncLer)
CreaLer curvaLure
Convex laLeral surface
Lesser curvaLure
Concave medlal surface

Lesser omenLum
lrom Lhe llver Lo Lhe lesser curvaLure
CreaLer omenLum
urapes from greaLer curvaLure
AnLerlor Lo Lhe small lnLesLlne
AnS nerve supply
SympaLheLlc vla splanchnlc nerves and cellac plexus
arasympaLheLlc vla vagus nerve
8lood supply
Cellac Lrunk
velns of Lhe hepaLlc porLal sysLem
Stomach: M|croscop|c Anatomy
lour Lunlcs
Muscularls and mucosa are modlfled
Muscularls exLerna
1hree layers of smooLh muscle
lnner obllque layer allows sLomach Lo churn, mlx, move, and physlcally break down
food
Mucosa
Slmple columnar eplLhellum composed of mucous cells
Layer of mucus Lraps blcarbonaLe-rlch fluld beneaLh lL
CasLrlc plLs lead lnLo gasLrlc glands
Gastr|c G|ands
Cell Lypes
Mucous neck cells (secreLe Lhln, acldlc mucus)
arleLal cells
Chlef cells
LnLeroendocrlne cells

8 CnA1Lk 23 - DIGLS1IVL SS1LM

Gastr|c G|and Secret|ons
Clands ln Lhe fundus and body produce mosL of Lhe gasLrlc [ulce
arleLal cell secreLlons
PCl
pP 1.3-3.3 denaLures proLeln ln food, acLlvaLes pepsln, and kllls many bacLerla
lnLrlnslc facLor
ClycoproLeln requlred for absorpLlon of vlLamln 8
12
ln small lnLesLlne
Chlef cell secreLlons
lnacLlve enzyme pepslnogen
AcLlvaLed Lo pepsln by PCl and by pepsln lLself (a poslLlve feedback mechanlsm)
LnLeroendocrlne cells
SecreLe chemlcal messengers lnLo Lhe lamlna proprla
aracrlnes
SeroLonln and hlsLamlne
Pormones
SomaLosLaLln and gasLrln
Mucosal 8arrler
Layer of blcarbonaLe-rlch mucus
1lghL [uncLlons beLween eplLhellal cells
uamaged eplLhellal cells are qulckly replaced by dlvlslon of sLem cells
nomeostat|c Imba|ance
CasLrlLls: lnflammaLlon caused by anyLhlng LhaL breaches Lhe mucosal barrler
epLlc or gasLrlc ulcers: eroslon of Lhe sLomach wall
MosL are caused by nellcoboctet pylotl bacLerla
D|gest|ve rocesses |n the Stomach
hyslcal dlgesLlon
uenaLuraLlon of proLelns
LnzymaLlc dlgesLlon of proLelns by pepsln (and rennln ln lnfanLs)
SecreLes lnLrlnslc facLor requlred for absorpLlon of vlLamln 8
12

Lack of lnLrlnslc facLor pernlclous anemla
uellvers chyme Lo Lhe small lnLesLlne
kegu|at|on of Gastr|c Secret|on
neural and hormonal mechanlsms
SLlmulaLory and lnhlblLory evenLs occur ln Lhree phases:
Cephallc (reflex) phase: few mlnuLes prlor Lo food enLry
CasLrlc phase: 3-4 hours afLer food enLers Lhe sLomach
lnLesLlnal phase: brlef sLlmulaLory effecL as parLlally dlgesLed food enLers Lhe duodenum,
followed by lnhlblLory effecLs (enLerogasLrlc reflex and enLerogasLrones)
kegu|at|on and Mechan|sm of nC| Secret|on
1hree chemlcals (ACh, hlsLamlne, and gasLrln) sLlmulaLe parleLal cells Lhrough second-messenger
sysLems
All Lhree are necessary for maxlmum PCl secreLlon
AnLlhlsLamlnes block P
2
recepLors and decrease PCl release
CnA1Lk 23 - DIGLS1IVL SS1LM 9

kesponse of the Stomach to I||||ng
SLreLches Lo accommodaLe lncomlng food
8eflex-medlaLed recepLlve relaxaLlon
CoordlnaLed by Lhe swallowlng cenLer of Lhe braln sLem
CasLrlc accommodaLlon
lasLlclLy (sLress-relaxaLlon response) of smooLh muscle
Gastr|c Contract||e Act|v|ty
erlsLalLlc waves move Loward Lhe pylorus aL Lhe raLe of 3 per mlnuLe
8aslc elecLrlcal rhyLhm (8L8) lnlLlaLed by pacemaker cells (cells of Ca[al)
ulsLenslon and gasLrln lncrease force of conLracLlon
MosL vlgorous near Lhe pylorus
Chyme ls elLher
uellvered ln ~ 3 ml spurLs Lo Lhe duodenum, or
lorced backward lnLo Lhe sLomach
kegu|at|on of Gastr|c Lmpty|ng
As chyme enLers Lhe duodenum
8ecepLors respond Lo sLreLch and chemlcal slgnals
LnLerogasLrlc reflex and enLerogasLrones lnhlblL gasLrlc secreLlon and duodenal fllllng
CarbohydraLe-rlch chyme moves qulckly Lhrough Lhe duodenum
laLLy chyme remalns ln Lhe duodenum 6 hours or more
1he Sma|| Intest|ne and Assoc|ated Structures
Gross Anatomy
Ma[or organ of dlgesLlon and absorpLlon
2-4 m long, from pylorlc sphlncLer Lo lleocecal valve
Subdlvlslons
uuodenum (reLroperlLoneal)
!e[unum (aLLached posLerlorly by mesenLery)
lleum (aLLached posLerlorly by mesenLery)
uuodenum
1he blle ducL and maln pancreaLlc ducL
!oln aL Lhe hepaLopancreaLlc ampulla
LnLer Lhe duodenum aL Lhe ma[or duodenal papllla
Are conLrolled by Lhe hepaLopancreaLlc sphlncLer
SLrucLural ModlflcaLlons
lncrease surface area of proxlmal parL for nuLrlenL absorpLlon
Clrcular folds (pllcae clrculares)
vllll
Mlcrovllll
Clrcular folds
ermanenL (~1 cm deep)
lorce chyme Lo slowly splral Lhrough lumen
vllll
MoLlle flngerllke exLenslons (~1 mm hlgh) of Lhe mucosa
vlllus eplLhellum
Slmple columnar absorpLlve cells (enLerocyLes)
CobleL cells

10 CnA1Lk 23 - DIGLS1IVL SS1LM

Mlcrovllll
ro[ecLlons (brush border) of absorpLlve cells
8ear brush border enzymes
lnLesLlnal CrypLs
lnLesLlnal crypL eplLhellum
SecreLory cells LhaL produce lnLesLlnal [ulce
LnLeroendocrlne cells
lnLraeplLhellal lymphocyLes (lLLs)
8elease cyLoklnes LhaL klll lnfecLed cells
aneLh cells
SecreLe anLlmlcroblal agenLs (defenslns and lysozyme)
SLem cells
Submucosa
eyer's paLches proLecL dlsLal parL agalnsL bacLerla
uuodenal (8runner's) glands of Lhe duodenum secreLe alkallne mucus
lnLesLlnal !ulce
SecreLed ln response Lo dlsLenslon or lrrlLaLlon of Lhe mucosa
SllghLly alkallne and lsoLonlc wlLh blood plasma
Largely waLer, enzyme-poor, buL conLalns mucus
laclllLaLes LransporL and absorpLlon of nuLrlenLs
L|ver
LargesL gland ln Lhe body
lour lobes-rlghL, lefL, caudaLe, and quadraLe
lalclform llgamenL
SeparaLes Lhe (larger) rlghL and (smaller) lefL lobes
Suspends llver from Lhe dlaphragm and anLerlor abdomlnal wall
8ound llgamenL (llgamenLum Leres)
8emnanL of feLal umblllcal veln along free edge of falclform llgamenL
L|ver: Assoc|ated Structures
Lesser omenLum anchors llver Lo sLomach
PepaLlc arLery and veln aL Lhe porLa hepaLls
8lle ducLs
Common hepaLlc ducL leaves Lhe llver
CysLlc ducL connecLs Lo gallbladder
8lle ducL formed by Lhe unlon of Lhe above Lwo ducLs
L|ver: M|croscop|c Anatomy
Llver lobules
Pexagonal sLrucLural and funcLlonal unlLs
lllLer and process nuLrlenL-rlch blood
Composed of plaLes of hepaLocyLes (llver cells)
LonglLudlnal cenLral veln
orLal Lrlad aL each corner of lobule
8lle ducL recelves blle from blle canallcull
orLal arLerlole ls a branch of Lhe hepaLlc arLery
PepaLlc venule ls a branch of Lhe hepaLlc porLal veln
Llver slnusolds are leaky caplllarles beLween hepaLlc plaLes
kupffer cells (hepaLlc macrophages) ln llver slnusolds
CnA1Lk 23 - DIGLS1IVL SS1LM 11

PepaLocyLe funcLlons
rocess bloodborne nuLrlenLs
SLore faL-soluble vlLamlns
erform deLoxlflcaLlon
roduce ~900 ml blle per day
8||e
?ellow-green, alkallne soluLlon conLalnlng
8lle salLs: cholesLerol derlvaLlves LhaL funcLlon ln faL emulslflcaLlon and absorpLlon
8lllrubln: plgmenL formed from heme
CholesLerol, neuLral faLs, phosphollplds, and elecLrolyLes
LnLerohepaLlc clrculaLlon
8ecycles blle salLs
8lle salLs duodenum reabsorbed from lleum hepaLlc porLal blood llver secreLed lnLo blle
1he Ga||b|adder
1hln-walled muscular sac on Lhe venLral surface of Lhe llver
SLores and concenLraLes blle by absorblng lLs waLer and lons
8eleases blle vla Lhe cysLlc ducL, whlch flows lnLo Lhe blle ducL
ancreas
LocaLlon
MosLly reLroperlLoneal, deep Lo Lhe greaLer curvaLure of Lhe sLomach
Pead ls enclrcled by Lhe duodenum, Lall abuLs Lhe spleen
Lndocrlne funcLlon
ancreaLlc lsleLs secreLe lnsulln and glucagon
Lxocrlne funcLlon
Aclnl (clusLers of secreLory cells) secreLe pancreaLlc [ulce
Zymogen granules of secreLory cells conLaln dlgesLlve enzymes
ancreat|c Iu|ce
WaLery alkallne soluLlon (pP 8) neuLrallzes chyme
LlecLrolyLes (prlmarlly PCC
3
-
)
Lnzymes
Amylase, llpases, nucleases are secreLed ln acLlve form buL requlre lons or blle for opLlmal
acLlvlLy
roLeases secreLed ln lnacLlve form
roLease acLlvaLlon ln duodenum
1rypslnogen ls acLlvaLed Lo Lrypsln by brush border enzyme enLeropepLldase
rocarboxypepLldase and chymoLrypslnogen are acLlvaLed by Lrypsln
kegu|at|on of 8||e Secret|on
8lle secreLlon ls sLlmulaLed by
8lle salLs ln enLerohepaLlc clrculaLlon
SecreLln from lnLesLlnal cells exposed Lo PCl and faLLy chyme
Callbladder conLracLlon ls sLlmulaLed by
CholecysLoklnln (CCk) from lnLesLlnal cells exposed Lo proLelns and faL ln chyme
vagal sLlmulaLlon (mlnor sLlmulus)
Ckk also causes Lhe hepaLopancreaLlc sphlncLer Lo relax
12 CnA1Lk 23 - DIGLS1IVL SS1LM

kegu|at|on of ancreat|c Secret|on
CCk lnduces Lhe secreLlon of enzyme-rlch pancreaLlc [ulce by aclnl
SecreLln causes secreLlon of blcarbonaLe-rlch pancreaLlc [ulce by ducL cells
vagal sLlmulaLlon also causes release of pancreaLlc [ulce (mlnor sLlmulus)
D|gest|on |n the Sma|| Intest|ne
Chyme from sLomach conLalns
arLlally dlgesLed carbohydraLes and proLelns
undlgesLed faLs
8equlremenLs for ulgesLlon and AbsorpLlon ln Lhe Small lnLesLlne
Slow dellvery of hyperLonlc chyme
uellvery of blle, enzymes, and blcarbonaLe from Lhe llver and pancreas
Mlxlng
Mot|||ty of the Sma|| Intest|ne
SegmenLaLlon
lnlLlaLed by lnLrlnslc pacemaker cells
Mlxes and moves conLenLs slowly and sLeadlly Loward Lhe lleocecal valve
lnLenslLy ls alLered by long and shorL reflexes
Wanes ln Lhe laLe lnLesLlnal (fasLlng) phase
erlsLalsls
lnlLlaLed by moLllln ln Lhe laLe lnLesLlnal phase
Lach wave sLarLs dlsLal Lo Lhe prevlous (Lhe mlgraLlng moLlllLy complex)
Meal remnanLs, bacLerla, and debrls are moved Lo Lhe large lnLesLlne
Local enLerlc neurons coordlnaLe lnLesLlnal moLlllLy
Chollnerglc sensory neurons may acLlvaLe Lhe myenLerlc plexus
Causes conLracLlon of Lhe clrcular muscle proxlmally and of longlLudlnal muscle dlsLally
lorces chyme along Lhe LracL
lleocecal sphlncLer relaxes and admlLs chyme lnLo Lhe large lnLesLlne when
CasLrolleal reflex enhances Lhe force of segmenLaLlon ln Lhe lleum
CasLrln lncreases Lhe moLlllLy of Lhe lleum
lleocecal valve flaps close when chyme exerLs backward pressure
1he Large Intest|ne
unlque feaLures
1enlae coll
1hree bands of longlLudlnal smooLh muscle ln Lhe muscularls
PausLra
ockeLllke sacs caused by Lhe Lone of Lhe Lenlae coll
Lplplolc appendages
laL-fllled pouches of vlsceral perlLoneum
8eglons
Cecum (pouch wlLh aLLached vermlform appendlx)
Colon
8ecLum
Anal canal
Co|on
Ascendlng colon and descendlng colon are reLroperlLoneal
1ransverse colon and slgmold colon are anchored vla mesocolons (mesenLerles)

CnA1Lk 23 - DIGLS1IVL SS1LM 13

kectum and Anus
8ecLum
1hree recLal valves sLop feces from belng passed wlLh gas
Anal canal
1he lasL segmenL of Lhe large lnLesLlne
SphlncLers
lnLernal anal sphlncLer-smooLh muscle
LxLernal anal sphlncLer-skeleLal muscle
Large Intest|ne: M|croscop|c Anatomy
Mucosa of slmple columnar eplLhellum excepL ln Lhe anal canal (sLraLlfled squamous)
AbundanL deep crypLs wlLh gobleL cells
Superflclal venous plexuses of Lhe anal canal form hemorrholds lf lnflamed
8acter|a| I|ora
LnLer from Lhe small lnLesLlne or anus
Colonlze Lhe colon
lermenL lndlgesLlble carbohydraLes
8elease lrrlLaLlng aclds and gases
SynLheslze 8 complex vlLamlns and vlLamln k
Iunct|ons of the Large Intest|ne
vlLamlns, waLer, and elecLrolyLes are reclalmed
Ma[or funcLlon ls propulslon of feces Loward Lhe anus
Colon ls noL essenLlal for llfe
Mot|||ty of the Large Intest|ne
PausLral conLracLlons
Slow segmenLlng movemenLs
PausLra sequenLlally conLracL ln response Lo dlsLenslon
CasLrocollc reflex
lnlLlaLed by presence of food ln Lhe sLomach
AcLlvaLes Lhree Lo four slow powerful perlsLalLlc waves per day ln Lhe colon (mass movemenLs)
Defecat|on
Mass movemenLs force feces lnLo recLum
ulsLenslon lnlLlaLes splnal defecaLlon reflex
arasympaLheLlc slgnals
SLlmulaLe conLracLlon of Lhe slgmold colon and recLum
8elax Lhe lnLernal anal sphlncLer
Consclous conLrol allows relaxaLlon of exLernal anal sphlncLer

A81 3 - P?SlCLCC? Cl CPLMlCAL ulCLS1lCn Anu A8SC81lCn
Chem|ca| D|gest|on
CaLabollc
LnzymaLlc
Pydrolysls
Chemlcal ulgesLlon and AbsorpLlon of CarbohydraLes
ulgesLlve enzymes
Sallvary amylase, pancreaLlc amylase, and brush border enzymes (dexLrlnase, glucoamylase,
lacLase, malLase, and sucrase)

14 CnA1Lk 23 - DIGLS1IVL SS1LM

Absorpt|on
Secondary acLlve LransporL (coLransporL) wlLh na
+

laclllLaLed dlffuslon of some monosaccharldes
LnLer Lhe caplllary beds ln Lhe vllll
1ransporLed Lo Lhe llver vla Lhe hepaLlc porLal veln
Absorpt|on of rote|ns
Lnzymes: pepsln ln Lhe sLomach
ancreaLlc proLeases
1rypsln, chymoLrypsln, and carboxypepLldase
8rush border enzymes
AmlnopepLldases, carboxypepLldases, and dlpepLldases
AbsorpLlon of amlno aclds ls coupled Lo acLlve LransporL of na
+

Absorpt|on of L|p|ds (Iats)
re-LreaLmenL-emulslflcaLlon by blle salLs
Lnzymes-pancreaLlc llpase
AbsorpLlon of glycerol and shorL chaln faLLy aclds
Absorbed lnLo Lhe caplllary blood ln vllll
1ransporLed vla Lhe hepaLlc porLal veln
Absorpt|on of Iatty Ac|ds
AbsorpLlon of monoglycerldes and faLLy aclds
ClusLer wlLh blle salLs and leclLhln Lo form mlcelles
8eleased by mlcelles Lo dlffuse lnLo eplLhellal cells
Comblne wlLh proLelns Lo form chylomlcrons
LnLer lacLeals and are LransporLed Lo sysLemlc clrculaLlon
Absorpt|on of Nuc|e|c Ac|ds
Lnzymes
ancreaLlc rlbonuclease and deoxyrlbonuclease
AbsorpLlon
AcLlve LransporL
1ransporLed Lo llver vla hepaLlc porLal veln
V|tam|n Absorpt|on
ln small lnLesLlne
laL-soluble vlLamlns (A, u, L, and k) are carrled by mlcelles and Lhen dlffuse lnLo absorpLlve cells
WaLer-soluble vlLamlns (vlLamln C and 8 vlLamlns) are absorbed by dlffuslon or by passlve or
acLlve LransporLers.
vlLamln 8
12
blnds wlLh lnLrlnslc facLor, and ls absorbed by endocyLosls
ln large lnLesLlne
vlLamln k and 8 vlLamlns from bacLerlal meLabollsm are absorbed
L|ectro|yte Absorpt|on
MosLly along Lhe lengLh of small lnLesLlne
lron and calclum are absorbed ln duodenum
na
+
ls coupled wlLh absorpLlon of glucose and amlno aclds
lonlc lron ls sLored ln mucosal cells wlLh ferrlLln
k
+
dlffuses ln response Lo osmoLlc gradlenLs
Ca
2+
absorpLlon ls regulaLed by vlLamln u and paraLhyrold hormone (1P)

CnA1Lk 23 - DIGLS1IVL SS1LM 1S

Water Absorpt|on
93 ls absorbed ln Lhe small lnLesLlne by osmosls
neL osmosls occurs whenever a concenLraLlon gradlenL ls esLabllshed by acLlve LransporL of soluLes
WaLer upLake ls coupled wlLh soluLe upLake
MalabsorpLlon of nuLrlenLs
Causes
AnyLhlng LhaL lnLerferes wlLh dellvery of blle or pancreaLlc [ulce
uamaged lnLesLlnal mucosa (e.g., bacLerlal lnfecLlon)
Ma|absorpt|on of Nutr|ents
CluLen-senslLlve enLeropaLhy (cellac dlsease)
CluLen damages Lhe lnLesLlnal vllll and brush border
1reaLed by ellmlnaLlng gluLen from Lhe dleL (all gralns buL rlce and corn)
Deve|opmenta| Aspects of the D|gest|ve System
Ieta| L|fe
ln Lhe Lhlrd week
Lndoderm has folded and foreguL and hlndguL have formed
MldguL ls open and conLlnuous wlLh Lhe yolk sac
MouLh and anal openlngs are nearly formed
ln Lhe elghLh week
Accessory organs are buddlng from endoderm
leLal nuLrlLlon ls vla Lhe placenLa, buL Lhe Cl LracL ls sLlmulaLed Lo maLure by amnloLlc fluld
swallowed ln uLero
Newborn
1he newborn's rooLlng reflex helps Lhe lnfanL flnd Lhe nlpple, Lhe sucklng reflex alds ln
swallowlng
Ger|atr|c
uurlng old age
Cl LracL acLlvlLy decllnes, absorpLlon ls less efflclenL, and perlsLalsls ls slowed
ulverLlculosls, fecal lnconLlnence, and cancer of Lhe Cl LracL
Cancer
SLomach and colon cancers rarely have early slgns or sympLoms
MeLasLaslzed colon cancers frequenLly cause secondary llver cancer
revenLlon
8egular denLal and medlcal examlnaLlon
pp. o,
oqq