Physiology A GASTROINTESTINAL PHYSIOLOGY (DR. VILA AND DR.

BARBON)

Gastrointestinal Physiology 1
I. Flow of food intake
You take in food  Cross Sectional Cut of the Digestive System
↓
You have your MASTICATORS
 Teeth
 Muscle of mastication
 Tongue
You also have your GLANDS
↓
It will have to be propelled towards the pharynx
↓
Esophagus
↓
Stomach
↓
Small intestine
↓
Large Intestine
a. Mucosa
↓
- This is important in physiology because you
Rectum (Where undigested food particles will have to be collected)
have there different cells that will secrete
II. Review of Digestive System
enzymes or substances needed for digestion
- Also important is MUSCULARIS MUCOSA
because there will be small contractions of
your gastrointestinal tract in between meals
b. Submucosa
- Also important because you have there
intrinsic nervous system called MEISSNER’S
PLEXUS
- Mesisner’s Plexus or Submucosal Plexus
1. Innervate muscularis mucosa and cells
found in the mucosa.
2. Mechanism:

 Basically this is your tract

 You also have your ACCESORY DIGESTIVE ORGANS
a. Liver 3. Connected to the MYENTERIC PLEXUS.
b. Gall Bladder Meaning if you innervate or stimulate
c. Pancreas Meissner’s, you also stimulate
d. Salivary Glands Myenteric Plexus and vice versa
- First the food will be moving AWAY from the c. Tunica Muscularis
oral cavity that’s why we have the term - Myenteric Plexus or Auerbach’s Plexus
ABORAL. “Ab” means away and “oral” means 1. Found in between layers of TUNICA
mouth so away from the oral cavity and MUSCULARIS or MUSCULARIS EXTERNA
eventually it will reach the rectum - Mechanism:

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SECRETIONS
2. Myenteric or Auerbach’s Plexus
 Generally, it causes MOVEMENT
or CONTRACTION of Tunica
Muscularis.
 Basically, almost all tunica
muscularic of the GI tract are
made up of SMOOTH MUSCLES
except:
i. Upper 2/3 of the
Esophagus
d. Serosa or Adventitia
 the Upper third of
III. General Functions of Gastrointestinal System
the esophagus is
 Major Functions:
PURELY SKELETAL
a. Motor
 The middle third of
- You have to move the food aborally
the esophagus is
b. Secretion
made up of MIXED
- You have to secrete enzymes so that you will
SMOOTH MUSCLE
be able to digest the food particles
and SKELETAL
c. Digestion
MUSCLE. This
d. Absorption
skeletal muscle is
- After digestion, you have to absorb it
INVOLUNTARY.
 Minor Functions:
ii. Lower half of the anal
a. Plays part of the immune system. There are so many
canal which is made up of
Lymphocytes for mucosal associated lymphatic
SKELETAL MUSCLE. This is
tissue specifically GUT associated lymphatic tissue.
VOLUNTARY that will form
- Probiotics
part of the external anal
1. Needed for development of immune
sphincters.
system especially for kids
 Smooth muscles in general are
IV. Regulation
INVOLUNTARY
 Neural Control
 For MOTOR activities
a. Intrinsic.
 The receptor associated is
- Under this we have:
MECHNORECEPTORS
1. Meissner’s or Submucosal Plexus
 Stimulated by STRETCH or
 Innervates the cells of the
INTESTINAL DISTENTION
Mucosa
- That’s why kahit mawala ang Sympathetic and
 For SECRETORY activities
Parasympathetic Stimulation, gumagalaw ang
 The receptor associated is
GI Tract.
CHEMORECEPTORS
- Just like the heart, even without sympathetic
 Stimulated by CHEMICAL
and parasympathetic stimulation, heart will
IRRITATION of the intestinal
continuously contract because it has its own
mucosa.
intrinsic innervation which is the conduction
 Mechanism:
system of the heart
Food particles should come in
- Mechanism (In General):
contact with the lining epithelium
Once you eat
↓
↓
Irritate the lining epithelium
Stretch Motor
↓
↓
Activate Meissner’s Plexus
Activation of Meissner’s Plexus
↓
↓
Reactivate cells in the mucosa
You will activities of your GI Tract
↓
↓

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Secretions  Amphetamine is used for

↓ diarrhea because it is
Digestion SYMPATOMIMETIC
↓  Atropine is a PARASYMATOLYTIC
And if the cells are intact it will cause Absorption drug meaning it lyses the effect of
b. Extrinsic your parasympathetic. It
- Under this we have: competes with muscarinic
1. Sympathetic Stimulation receptors in the GIT. What
 INHIBITORY except for the happen?
sphincters If Atropine binds with Muscarinic
 Neurotransmitter involved is receptors in the GIT
NOREPINEPHRINE. Take note that ↓
sympathetic nervous system lang Displaces Acetylcholine
ang pinaguusapan natin so ↓
norepinephrine lang. Pag Inhibit Parasympathetic
Adrenals, may kasamang Predominates Sympathetic
epinephrine. So dito since ↓
sympathetic lang ang Stops defecation
pinaguusapan, Norepinephrine  Before, Dipehnoxylate + Atropine
lang!!!!. Example, Adrenal are the contents of your Lomotil
Medulla, meron Epinephrine and but now it is not being used
Norepinephrine. Pag Sympathetic, anymore because it is addictive.
neuronal lang tayo so  When someone is having
norepinephrine lang (paulit ulit na diarrhea, we do not inhibit them
ah) from having diarrhea. We only
 In the sphincters this is usually give them drugs if needed like
STIMULATORY so that food will having a peristaltic rush in an
not go out from the GI tract. Kaya important event.
nga diba may constipation.  Peristaltic Rush = NAGTATAE
 A sympatomimetic drug is  A common drug is LOPERAMIDE
SALBUTAMOL. This is a usual drug  Normally, we do not inhibit
for asthma. So if you give this to a diarrhea because it means that
patient, make sure you told him someone has taken in some
that one of the side effects of the TOXINS. We need to let them
drug is CONSTIPATION. defecate to release the toxins but
2. Parasympathetic Stimulation make sure you HYDRATE the
 STIMULATORY except sphincters patient or replace the fluid and let
 Neurotransmitter involved in them eat. Avoid highly colored
ACETYLCHOLINE foods and too much oily foods.
 In the sphincters this are usually  Nowadays, we do not anymore
INHIBITORY. use BRAT diet.
 If there is parasympathetic i. B – Banana
predominance, you will have  This is a source of
diarrhea. POTASSIUM
 Before we have a drug called ii. R – Rice
ATROPINE DIPHENOXYLATE  A source of
(Lomotil). GLUCOSE
 DIphenoxylate is one of the iii. A – Apple
derivatives or one that will give  This is okay kasi
rise to your AMPHETAMINE. ang POTASSIUM
nasa balat
iv. T – Tea

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 This is just for fluid  Distal 1/3 of the

replacement but transverse colon
this is not advisable  Descending Colon
anymore because  Rectum
this is a DIURETIC 2. Thoraco-lumbar
 A good one to drink if you have  Sympathetic Nervous System
diarrhea is ORESOL and i. Also innervates the GI
PEDIALYTE. If you do not want tract
Oresol, you can drink Gatorade. ii. Look at the picture above
- Roots of Parasympathetic and Sympathetic (left). It has a SHORT
Trunk PREGANGLIONIC and
LONG POSTGANGLIONIC
iii. Synapse is located at the
PARAVERTEBRAL AREA
(Para means beside so it
is beside the vertebra).
iv. The paravertebral ganglia
are the following (Refer
to the drawing of
sympathetic):
 Celiac Ganglion
 Superior
Mesenteric
Ganglion
 Inferior
Mesenteric
Ganglion
 Parasympathetic Nervous System
v. Look at the picture above
(right), it has LONG
PREGANGLIONIC but
1. Carniosacral Nerve SHORT
 It means, Cranial Nerves and POSTGANGLIONIC
Sacral Nerves that innervates vi. The POSTGANGLIONIC
your gastrointestinal tract. neurons are found within
 Cranial Nerve 10 (Vagus) the GI Tract and are
i. Innervates GI tract up to located near the organ it
the proximal 2/3 of the innervates or within the
transverse colon organ it innervates. One
ii. Innervates: of the examples of
 Esophagus “within the organ it
 Stomach innervates” is the GI
 Duodenum tract.
 Small intestines (in c. Cephalic Phase
general) - Highly dependent on extrinsic neurons
 Ascending Colon - Yung iniisip mo palang, nagsasalivate kana and
 Proximal 2/3 of gumagalaw ang GI.
Transverse Colon - Kaya pag iniisip mo ang food, naglalaway ka or
 Sacral Nerves or Pelvic Sacral or nagmemake ng sounds ang stomach mo
Pelvic Splanchnic Nerves (S2-S4)
i. Innervates:

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 Hormonal Control b. After a meal (Postprandial)

a. Under this, we have: - Immediately after a meal, there is increase GI
- Paracrine activities due to stretch
1. You have studied na merong sinisecrete  In between meals, you have GI activities. Kung kagabi
sa gastrointestinal tract like in the kumain ka or nagmidnight snack ka. Tapos kinabukasan di
stomach, may sinisecrete jan na kapa nagbreakfast, ang GI tract gumagalaw padin. Sino
nagcause ng stimulation ng ibang cells. nagpapagalaw?  the SMOOTH MUSCLES of the GI tract
2. Example: which is the Tunica Muscularis.
STOMACH:  Why is it moving? Because of PACESETTING POTENTIAL or
Acid BASIC ELECTRICAL RHYTHM or Slow waves.
↓ a. It will almost bring your smooth muscle near
Inhibit or Stimulate G-Cells threshold
↓ b. So it will bring your tunica muscularis near the
↑ or ↓ Gastrin Secretion threshold
c. Para lang siyang KONTING WAVE
SMALL INTESTINES: d. Once it reaches the threshold potential, action
I Cells potential will occur which is known as the SPIKE
↓ POTENTIAL
Secretes Cholecystokinin e. No muscle tension built because it did not reach the
↓ threshold. So this is just a local potential
Stimulation of S Cells  Spike Potential
↓ a. Action potential in the smooth muscle of the GIT
Secretes Secretin b. Mechanism:
- Endocrine If smooth muscle reaches spike potential
1. You have cells or hormones coming ↓
from the pancreas that will either Smooth muscle will now strongly contract
stimulate or inhibit your GI functioning ↓
b. Gastrointestinal Hormones that regulate ↓ size of the lumen of the GI Tract
gastrointestinal tract ↓
- Gastrin You can now move the food aborally
- Secretin c. What will cause spike potential?
- CCK-PZ (cholecystokinin-Pancreozymin) - Parasympathetic Stimulation which causes
- Somatostatin excitatory effect on your GI tract.
- Motilin - Neurotransmitter involve is ACETYLCHOLINE
- Gastric Inhibitory Polypeptide d. At rest
- Vasoactive Intestinal Polypeptide - Paminsan minsan lang ang spike potential
e. Stimulation:
V. Electrical Activities of the Gastrointestinal Tract - Stretch
1. When you eat, your GI tract will move.
2. If it did not move, meaning you do not
have myenteric plexus
 If in the esophagus  ACHALASIA
 If in the Large Intestines (Colon)
 AGANGLIONIC MEGACOLON or
HIRSCHSPRUNGS DISEASE
- Acetylcholine
- Parasympathetic
f. Inhibition  effect is HYPERPOLARIZATION
- Noradrenaline or Norepinephrine
 In the GI tract, movement of the smooth muscles occurs by - Sympathetic
pulse except: g. Since it reaches the threshold, you have MUSCLE
a. During a meal ACTIVITY

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h. 1 or more spike potential = 1 Muscle contraction or d. It means that you have to remove first the food in
Mechanical Response the small intestines so that food from the stomach
 Local Potential of Smooth Muscles will move to that area.
a. A certain activity of smooth muscle that doesn’t When you remove food from the small intestines
reach the threshold. ↓
b. This is only a local potential due to slow influx of Food from the stomach will go to the duodenum
calcium causes SLOW MOTILITY of the GI tract ↓
c. Secondary to interstitial cells of CAJAL Stomach will decrease in size
d. Interstitial Cells of Cajal ↓
- They innervate your smooth muscle HUNGER
- Causes the opening of L-Type of Calcium e. As long as your stomach is bloated or as long as
- Mechanism: there is still food in the small intestines, you will not
Interstitial cells of CAJAL feel hungry because your appetite regulation is
↓ MULTIFACTORIAL
Synapse with plenty of the smooth muscle f. When you are excited or depressed, normally you do
↓ not eat.
Innervate smooth muscle  Functional Movements of the Gastrointestinal Tract
↓ a. Peristalsis
Facilitate slow entry of calcium inside the smooth - Movement of food particles aborally
muscle - What muscle moves your food aborally? 
↓ OUTER LONGITUDINAL
Sarcoplasmic reticulum releases more calcium - It means movement of food particles going to
↓ the rectum and anal canal
Calcium binds with myosin (ang myosin sa smooth b. Segmenting Contractions
muscle ay KALAT KALAT) - Breaking down food particles or mechanical
↓ digestion
Causes a little activity or movement because only - Hahati-hatiin niya ang food bolus (mechanical
little amount of calcium stimulated the sarcoplasmic digestion) to prepare the food for digestion
reticulum. May portion na nagcocontract at may and absorption
portion na di nagcocontract or what we call LATHE - It somehow mixes your food particles.
or LATCHING dahil kalat kalat ang myosin. - What muscle is responsible for mixing and
e. Lathe or Latche System breaking down of food  INNER CIRCULAR
- If there is latching, one portions is contracting c. Tonic Contractions
and another portion is relaxed - This is simply digestion and absorption
- That’s why the description of the contraction
of smooth muscles in the GI tract is like a
CRUMPLED PAPER APPEARANCE wherein
merong lukot na lukot at yung iba parang di
lukot.

VI. Motor Activities of the Stomach

 Migrating Motor Complex (MMC)
a. Motor activity of the stomach to your intestines in
between meals to clear these particular parts of the
tract with food particles left.
b. So this is a motor activity of the stomach up to the
distal ileum (small intestines).
c. This is done to prepare you for another meal
because if there are still food particles left in the
stomach and small intestines, food cannot move
forward from the stomach.

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 Law of the Intestines or Myenteric Reflex - Meaning, as you go towards the ileum, motor
a. 2 Segments of the Intestines: activity is DECREASING. Why?
- Proximal 1. For ABSORPTION
1. Its end is not hypertrophied 2. You need food to be absorbed.
- Distal 3. That’s why if you use diet pills, it
1. Muscle is hypertrophied facilitates motility of the GI tract
2. Kaya pag surgery, kapag pinagdikit mo especially in the small intestines so that
ang parehong distal  NO MOVEMENT less time for absorption.
b. Mechanism of Law of the Intestines or Myenteric 4. If you use KANCURA, which is a tea use
Reflex for dieting, it increases your rectal
pressure. It destroys the mucosal
epithelium of your small and large
intestines. Repair is weak in these areas
so this is not good.
5. A good one you use for diet is the one
that delays the absorption of food
particle without destroying your
mucosal epithelium.
6. The best to delay absorption of
carbohydrates is a diabetic drug named
ACARBOSE. It has a side effect which is
frequent farting.
 You should take this 30 minutes
to 1 hour after a meal because if
you take this before a meal, you
will experience weakness.
 Effect is 1-2 months
7. METFORMIN which is also an anti-
diabetic drug is also used every night to
lose weight. Oral hypoglycemic agents
are used for obese with high blood
sugar and the side effect is they lose
weight.
8. Remember that if you want to lose
weight, do not remove all or a lot of
your fats because the effect is you will
feel hungry frequently. For those who
undergone liposuction, they will
eventually gain weight again. Why?
 Immediately you decrease the
fat content and the effect is they
will crave for food. Because in
between meals, their source of
food is their fats but since they
removed a lot of fats, they will
 Motor Activity of Duodenum and Jejunum feel hungry and eventually
a. Duodenum becomes fat.
- Motor activity is greater than jejunum  So for those who will undergo
especially on the FIRST part of the duodenum liposuction, control the diet first
b. Jejunum before the procedure.
- Motor activity is LESSER

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 Hormones Affecting GI Motor Activities  This will have to make use of an

EXCITATORY INHIBITORY association neuron which is MAIN
SENSORY NUCLEUS
Substance P VIP
 Then you have to masticate now
CCK (Small and Large and muscle of mastication is
CCK (Stomach)
Intestines)
innervated by CN V specifically
Motilin (for Motility the MANDIBULAR DIVISION. So
especially in between Somatostatin you have there your MOTOR
meals)
NUCLEUS OF CN V  which will
Nitric Oxide innervate muscles of
Enkephalins MASTICATION (Masseter,
Secretin Temporalis etc.)
 If you masticate, you need joint
 Other Gastrointestinal Movements coordination which is detected by
a. Mastication MESENCEPHALIC NUCLEUS OF CN
- Voluntary V. (2 kasi ang sensory nucleus ng
- Eventually it becomes a reflex CN V, one is Trigeminal Ganglion
- Example, you chew bubble gum, initially and the other one is
you’re just chewing it voluntarily but Mesencephalic)
eventually you will not notice that you’re  We have 2 Association Neurons or
chewing it involuntarily. So that’s an example Interneuron of CN V
that it is voluntary at first and eventually it will i. Main Sensory Nucleus
become a reflex. ii. Nucleus of Spinal Tract
- Force of Mastication:  This one is
1. Incisors activated for pain
 55 dynes b. Swallowing
2. Molars - Initially VOLUNTARY but eventually becomes
 200 dynes a REFLEX (mostly)
 That explains why your strongest - 3 Phases of Swallowing
muscle is MASSETER. (Not the 1. Buccal or Oral Phase
tongue)  Voluntary
- Mastication Reflex  You need TONGUE muscle which
is innervated by CN XII
 Aside from the tongue, you also
need a muscle to push the food
towards the pharyngeal area. So
you need some of your facial
muscle to help move the food
bolus to the pharyngeal area
which is innervated by CN VII
 Somehow you also need you
teeth because before you swallow
the food, your need to break it
down to smaller pieces first which
is innervated by CN V
1. First you have something in your mouth 2. Pharyngeal Phase
 Initiate mastication  Involuntary
2. You need to have sensory innervation  Once food raches the pharynx,
which is your TRIGEMINAL NERVE you use CN IX and X
(Gasserian Ganglion).  Nucleus of Tractus Solitarius
i. All of the innervations
mentioned will

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innervate this nucleus of Movement of the food towards the stomach

tractus solitaries - Primary Peristalsis
ii. A sensory association 1. Involuntary contraction of the smooth
neuron muscle of the esophagus
iii. Formed by Cranial 2. Just to move the food towards the
Nerves: stomach
 VII - Secondary Peristalsis
 IX 1. Sometimes, you feel that there’s
 X something left in your esophagus after
3. Esophageal Phase eating. In order for you to remove this,
 Involuntary you need secondary peristalsis
 When you already feel that you 2. STRONGER contraction than primary
are swallowing, your intrinsic peristalsis because it has to move the
muscles of the esophagus and the food left in your esophagus.
pharynx will now contract and 3. If it has the same strength with primary
innervated by NUCLEUS peristalsis, it cannot move the food
AMBIGUUS because the food left is smaller so you
- To summarize: need a stronger contraction
So your mouth, pharynx and esophagus will 4. Sometimes, you just have to eat
sense that you are swallowing anything to move the food.
↓ 5. Sometimes, you can feel that there’s a
It will be transmitted to the center pain in your chest and often
↓ misinterpreted it are heart burn but NO!
Going to the Nucleus of Tractus Solitarius It is just your secondary peristalsis.
which has communication with Nucleus Ambiguus - Upper and Lower Esophageal Sphincter
↓ 1. Usually governed by OSMOTIC
Innervates Intrinsic Muscles of Pharynx and PRESSURE.
Esophagus  ↑ Osmotic Pressure  They can
↓ open the upper or lower
SWALLOW esophageal sphincters
↓  So it’s either vomiting or food will
Esophagus will contract and relax go to the duodenum
↓ 2. These sphincters are not anatomic,
Food will go to the stomach these are PHYSIOLOGIC meaning their
- Mechanism of Swallowing (Deglutition) Reflex: circular muscle just hypertrophied that
Initially you chew your food why they are present by actually, they
↓ are not real sphincters.
Tongue will move the bolus towards the  Stomach
posterior portion of the oral cavity a. Usually has lower pressure especially in the lower
↓ esophageal sphincter.
Contraction of soft palate When pressure is higher in esophagus than the
↓ stomach
Closes the common opening of the nose and ↓
oral cavity Open lower esophageal sphincter
↓ ↓
Closing of the laryngeal inlet by the Stomach relaxes (Stomach is the first one to relax
contraction and movement of the epiglottis before the opening of the lower esophageal
backward sphincter)
↓ b. Pyloric Pressure
Intrinsic muscle of the pharynx and esophagus When food in the stomach increases
will contract ↓
↓ ↑ Pyloric Pressure

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↓  So that they will be able to push

Food particles will move DISTALWARDS the food bolus towards the
c. Regurgitation of Food duodenum
When you eat a lot  It will increase the pressure in the
↓ antral area to open the pyloric
Food will be stored first in the Upper stomach sphincter (also a physiologic
↓ sphincter not a anatomic
If too many food is stored sphincter) and push the bolus
↓ towards the duodenum
↑ Pressure in the Upper stomach - Mechanism of Mixing:
↓ Push food bolus towards the pylorus
Lower esophageal sphincter will become loose ↓
↓ Pylorus will contract
Regurgitation of food ↓
Food bolus will go back the antrum of the
- In patients with GASTROESOPHAGEAL REFLUX stomach
DISEASE (GERD) ↓
1. We usually advice SMALL FREQUENT Push again towards the pylorus (parang
FEEDINGS because if too many, lower nguyain mo tapos luwa then nguyain ulit.)
esophageal sphincter will open and
there will be acid reflux. - Percent (%) Emptied in a Particular Number of
2. They often misinterpreted it as Hours
heartburn but the truth is, they only 1. Glucose is fast to empty
have GERD  So mabilis kang magutom, mabilis
3. MILK usually relaxes the sphincters ka rin tataba
that’s why it is not advised to drink with 2. Protein is slow to empty
these patients.  Example is Caucasian Diet
4. MAALOX is a treatment for GERD and it which is a high protein diet.
looks like milk and minty in taste Matagal silang nagugutom at
d. Upper Stomach (Upper 1/3) mabagal silang tumaba
- For storage - Feeding or Hunger Center
- Commonly when it receives the food bolus, it 1. Found in the LATERAL NUCLEUS of
has to relax or what we call RECEPTIVE Hypothalamus
RELAXATION or PLASTICITY of the stomach Excitatory Inhibitory
- Plasticity in the stomach is different from Dopamine Leptin
plasticity in the nervous system. GABA Calcitonin
1. Plasticity in the stomach is relaxation so CRH (Corticotropine Releasing
NPY
Hormones from Hypothalamus)
you can receive the food
GAL Serotonin
2. Plasticity in the brain, if you usually use
Nor-Epinephrine
it, interpretation will widen. Say for Endogenous Opiod Peptides
example if you usually use your hand, (Dynorphins)
the representation of your brain for Ghrelin (Parietal Cells)
your hand is wide. Orexins (+by hypoglycemia)
e. Lower 2/3 of the Stomach Cold Temperature
- Portion of the stomach that will have MOTOR 2. But remember, even you inhibit the
ACTIVITIES hunger center, it doesn’t mean that you
- This is for: will not get hungry anymore.
1. Mixing Contractions 3. Appetite is multifactorial.
 Because they will have to mix the Hypothalamus is only one of them that
food bolus with the enzymes for will regulate appetite. You still have Gall
partial digestion Bladder, fats in the body, physical and
2. Propulsive Contractions

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emotional states that will regulate

appeptite
4. If you’re fat, you have so many Leptin
and this should inhibit the hunger
center. Even if fat people have Leptin
they stiil eat. Why?  If the
DISTENTION of their stomach is not
satisfied, they will eat. You are used to
distend your stomach when eating so by
the law of plasticity, you should eat
always the same amount of food.
However, you can train your stomach
for 1 month on to what extent you want
it to distend.
- Satiety Center
1. Found in the VENTRO-MEDIAL Nucleus
of the hypothalamus
Excitatory Inhibitory
CRH Gastrin
GLP-1 GABA
Melanin Stimulating Hormone
(MSH)
CART
CCK
Leptin (Adipose Cells)
Gastric Distention
Hyperglycemia
Hypertonic Diet
Warm Temperature

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Gastrointestinal Physiology 2
I. Regulation of Food Intake  External Factors that will regulate feeding
a. Emotions
- Supposedly, when you are depressed or
excited, you are not stimulated to eat. That
the physiologic response of the body
b. Food Characteristics
- If your food is rough, you are not stimulated
to eat
- If you are eating soft or slimy, you are often
stimulated to eat
c. Lifestyle and Behaviors
- It depends on your culture
d. Environmental Cues
- When the weather is hot, usually you are not
stimulated to eat
- If cold, you are stimulated to eat. Example
during Christmas, kain ka ng kain.
 This picture will tell you that food intake or appetite
- But it really depends on the SIGHT. If you see
regulation is MULTIFACTORIAL
food, the more feeling that you want to eat.
 As you can see here, there are Hormones that will regulate
 Review of Stomach and Small Intetines
the feeding:
a. Upper Stomach
a. CCK, Apo-A-IV, Glucagon-like Peptide 1 (GLP1) and
- For storage
Vagus Nerve.
b. Lower Stomach
When any of these enzymes is secreted
- For mixing and regulation of emptying of the
↓
stomach.
Inhibit the Center
- The one responsible for mixing of food in our
↓
stomach is the TUNICA MUSCULARIS. When it
You will not be eating
contracts, there will be mixing of food.
b. CCK2 receptors (not shown in the picture)
- On the DISTAL 2/3 of the stomach, the
- Before it is called CCK-B Receptors
pressure builds up due to increase amount of
- Mechanism:
food going to that area and also due to the
When CCK or Gastrin binds to your CCK-2
mixing action.
receptors
- Eventually, the pressure will continuously
↓
increase and that will open the PYLORIC
Inhibit you from eating
SPHINCTER.
c. Ghrelin
- Once the pyloric sphincter opens, there will be
- Increases appetite
SQUIRTING of chyme towards the duodenum
d. Cortisol
- The frequency of motor acticity in the distal
- Increases appetite
potion of the stomach is 3 every minute
- An example is Steroid.
- Transit time
1. Ang effect nito kakain ka ng kakain
1. The time that the food will be staying
2. The effect of this drug is BUFFALO
in that particular segment of the GI
HUMP meaning the fats will be
tract)
distributed in the center and no fats in
2. Transit time of food in the stomach is
the extremities.
4-6 hours.
3. Parang baboy. Ang taba nasa gitna,
3. Kaya nga karaniwan pag nagalmusal ka
yung mga extermities naman maliliit.
ng 6am, and susunod mong kain ay
12nn kasi usually and stomach natin ay
may food pa or distended pa so it will

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 Physiology A GASTROINTESTINAL PHYSIOLOGY (DR. VILA AND DR. BARBON)

signal the hypothalamus na wag ka 2. Facilitated Transit Time (Faster)

muna kumain. ↓pH less than 5 (Acidic)
4. But it is not applicable all the time ↓
because appetite is MULTIFACTORIAL You immediately cause gastric
diba? So maraming factors na emptying
pwedeng magincrease ng appetite mo. ↓
And kapag konti lang naman kinain mo, Facilitated (or mabilis siyang
hindi naman yan matutunaw within 6 lumalabas sa stomach)
hours so it really depends. c. Type of food
5. ↓ Transit Time  it means the there - Malamang pag solid ang food, matagal yan
is a fast movement of GI Tract lumabas kasi kailangan yan idigest
6. ↑ Transit Time  it means you - Pag liquid, mabilis yan aalis sa stomach.
prolong the stay of food in that d. Consistency
particular segment of the GI Tract or e. Temperature
you decrease the motility of the GI - If temperature is warm
Tract. Warm Temp
c. Small Intestines ↓
- The frequency of motor activity is between 9- ↓ Gastric Emptying
13 ↓
- The most proximal portion which is the Your stomach is distended for a longer period
duodenum has the most frequent motility ↓
- Kaya nga pag Migrating Motor Complex, ↓ Appetite
pinaka marami sa DUODENUM kesa sa - If cold
Jejunum and Ileum. Cold Temp
- As you go towards the distal portion, the ↓
motility DECREASES so the frequency ↑ Gastric emptying
decreases ↓
 Factor Affecting Gastric Emptying ↑ Appetite
a. Tonicity f. Volume
- The optimal tonicity of the stomach should be - If volume is high
around 200 mOsm/L ↑ Volume of food
- So dapat 200 mOsm/L ang tonicity ng pagkain ↓
niyo sa stomach with your enzymes. There will be distention of the stomach
- If the tonicity is 200 mOsm/L  it is just ↓
PHYSIOLOGIC GASTRIC EMPTYING Stimulate Myenteric plexus
- If ↓ or ↑ than 200 mOsm/L  gastric ↓
emptying is FACILITATED meaning it will Stomach will contract
become faster ↓
- In other words if it is HYPERTONIC  Mabilis Facilitate or faster emptying of food
- If you have HYPOTONIC  Mabilis din - If volume is low
- Pero sino mas mabilis lumabas?  ↓ Volume of food
HYPOTONIC. ↓
b. Acidity Stomach will not be distended
- pH  5 ↓
- If ↑ or ↓ than 5 there will be: Myenteric plexus is not stimulated because
1. Derangement (Delay) stomach is not that stretched
↑pH greater than 5(Alkaline) ↓
↓ Stomach will not contract
You prolong the stay of food in the ↓
stomach Delayed emptying of food
↓
Gastric emptying is delayed

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 Enteric Movements  Lowest frequency of motility in

nd
a. Basically, motility in small intestines is in the 2 the ILEUM because it is the
phase of contraction which are: most distal part of the small
- Segmentation intestines. the frequency is
1. Mechanical breaking down and 2. Large Intestines (Colon)
somehow mixing of food in the small
intestine
2. Pag hinati-hati na ang food, somehow
nagmimix narin
3. In this phase, you also mix the food with
your ENZYMES to break them down to
absorbable materials
- Tonic Contraction
1. You let the digested food stay in that
particular segment of the small
intestines so that there will be more
time for ABSORPTION
2. So kailangan natin magabsorb sa small
intestines. So the most important
function of small intestine is TO
ABSORB THE DIGESTED FOOD
 Highest frequency of motility in
PARTICLES that’s why we need tonic
the ASCENDING COLON. And as
contractions
it goes to the descending colon,
b. Frequency of Segmentation Contraction
it decreases.
- We said a while ago that as the food moves
c. Peristalsis
towards the DISTAL PORTION, the frequency
- ABORAL movement of food particles
of motility in the small intestine decreases
- Less in SMALL INTESTINES
1. Small Intestines
- Peristaltic Rush = DIARRHEA
 Colonic Movements
a. Most of the movement in the colon is
SEGMENTATION CONTRACTION
- In the colon, segmentation contraction is
called HAUSTRATION
b. Peristalsis
- In the colon is called MASS MOVEMENTS
- So that there will be bulk movement of your
undigested food particles and delivered in the
rectum
- Facilitated by proximal and distal connections
of the GI tract
1. If proximal to distal  FACILITATORY
2. If distal to proximal  INHIBITORY
c. Tonic Contractions
- You also see some tonic contractions in the
colon kasi konti lang naman talga ang
 Highest frequency of motility is ABSORPTIVE PROCESS na nangyayari sa colon
in the DUODENUM because it - Colon Absorbs:
is the most proximal part of the 1. Water
intestines. The frequency is 13 2. Some electrolytes
in the duodenum. - Colon doesn’t absorb nutrients

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d. Rectal Distention
- Gastrocolic 2. Motor
When you eat  Functions to innervate the
↓ particular part of the lower GI
Eventually food will go to the stomach Tract
↓ b. Mechanism of Defecation Reflex
Facilitate motility of colon going to the rectum
↓
RECTAL DISTENTION
↓
Urge to defecate
- Kaya nga bago ka maligo sa umaga to prepare
yourself to go to work or class, make sure
nakakain kana para if ever there is an urge to
defecate, isahan na sa CR yun. Kesa naman
nakabihis kana tsaka kapa lang kakain tapos
pwede ka pang magkaroon ng rectal
distension and eventually magurge to
defecate ka nun. Toxic lang.
e. Rectal Pressure
- If 18 mmHg  you have an URGE TO
DEFECATE.
- If 55 mmHg or more  it is already a REFLEX
When the rectum is distended
ACTION. Di na yun mapipigilan kasi
↓
INVOLUTNARY na siya
Rectum will be stretched
 Movement of Impulse
↓
a. Stimulatory or Facilitatory Movements
Send impulse to your Spinal Nerve (S2, S3 and S4 which is
- Basta ito, papuntang DISTAL (Paabante_
PARASYMPATHETIC)
- Examples:
↓
1. Gastro-Colic
Sensory Impulse will go to the spinal cord
2. Oro-Gastric
↓
b. Inhibitory Movements
Sensory Neuron (Dorsal Root Ganglion) will immediately synapse
- Going to PROXIMAL (PABALIK)
with your Motor Neuron (Found in the Anterior Horn)
- Example:
↓
1. Colo-Gastric
Motor Neuron will send impulses to Myenteric Plexus innervating
2. Entero-Gastric
the Tunica Muscularis
 Small intestine is sending an
↓
impulse to your stomach to stop
Tunica Muscularis of the rectum will contract
moving
↓
 This is happening if there is still
Inhibit Internal Anal Sphincter which is a smooth muscle
food in the small intestines. it
↓
send signals to your stomach so
Excretion of collected undigested food particle or what we call FECES
that food will not yet go there.
c. For children
 Defecation Reflex
- They don’t have control of their external anal
a. Spinal Nerves
sphincter
- Composed of:
- Since they cannot control it, their external
1. S2
anal sphincter will relax so feces will go out
2. S3
- Once toilet trained, they now have the control
3. S4
to their external anal sphincter with the same
- Functions are:
spinal nerves especially the dorsal ramus kasi
1. Sensory
 It functions to carry SENSATION

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yung ventral ramus yung pagiging II. Secretion

parasympathetic  Secretory Activities of the GI
d. For Adults a. This is primary regulated by INTRINSIC NERVOUS
- Our control of defecation is from the SYSTEM which is through your Meissner’s or
PRIMARY MOTOR AREA Submucosal plexus. Except of course to the
1. Yung sinend na impulse ng rectal secretory activities of the SALIVARY GLANDS
distention sa spinal cord ay magsesend b. SALIVARY GLANDS do not contain Meissne’s Plexus
din ng fiber tracks sa cerebrum so that  Like in motor activity, secretory activities can also be
the cerebrum can analyze that you have regulated by:
the urge to defecate. a. Neural
2. The cerebrum will also control your - Extrinsic.
body from defecating anywhere. 1. Sympathetic
Example if you are in class and you have 2. Parasympathetic
the urge to defecate, usually you can - Intrinsic
still control it and do not defecate inside 1. Meissner’s Plexus only because we are
the classroom. That is because of your talking about secretory activities
cerebrum. It can control your EXTERNAL b. Hormonal
ANAL SPHINCTERS. - There are hormones that will regulate the
3. If you are already in a proper place like secretions of your glands and cells of the GI
comfort room, it will inhibit your Tract
external anal sphincter so you can now  Salivary Glands
defecate.
4. We already know that within 18 mmHg,
we have the urge to defecate and when
it reached 55 mmHg, it is already a
reflex so we cannot control it anymore
 Transit Time in the Small Intestine and Colon
a. The transit time of food going towards the cecum
(first part of the large intestine) , the fastest is 4
hours.
- Diba yung transit time sa stomach, 4-6 hours?
- If it reaches the cecum within 4 hours, it only
means that you have fast motility of the
stomach and small intestines
b. All undigested food particles can reach the colon
(the fastest) within 8-9 hours
c. 25% of Food residue (mga natirang pagkain) in the
colon can stay in the rectum for 72 hours.
- If you are not eating or if you are on a diet, do a. Salivary Glands are the following:
not expect to defecate everyday kasi hindi - Submandibular Gland
naman madidistend ang rectum mo dahil 1. GREATEST contribution if the
konti ang kinakain mo. production of saliva
- To those people who are dieting, do not 2. 70% of the saliva comes from this gland
consider them constipated if they did not 3. MIXED PREDOMINANTLY SEROUS
defecate within 3 days. Gland
- If still they did not defecate for 4 days, that’s - Parotid Gland
the time you consider them constipated. You 1. 20% of saliva comes from this gland
can now aply your intervention or administer 2. A PURELY SEROUS gland
drugs if needed for them to defecate. - Sublingual Gland
- If the patient is on a dextrose or IV Fluid, do 1. Only 5% of saliva comes from this gland
not expect him to defecate because the 2. MIXED PREDOMNANTLY MUCUS Gland
patient doesn’t have food intake

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 Salivary Gland Activity when it comes to Neural Control may hydrogen ions sa saliva mo
a. Salivary glands are innervated by CRANIAL NERVES it becomes SLIGHTLY ACIDIC.
- Most of the salivary glands are innervated by Hydrogen ions represents your
CN VII (Facial) except for the Parotid Gland acid
- Parotid gland is innervated by CN IX 2. For increased activity, saliva becomes
(Glossopharyngeal) ISOTONIC and ALKALINE
- So CNVII and CN IX are PARASYMPATHETIC  There’s NO TIME FOR
- Parasympathetic Roots are CARNIO-SACRAL REABSORPTION so whatever the
which is composed of following cranial nerves: content of your plasma is also
1. III the content of your saliva that’s
2. VII why it is ISOTONIC.
3. IX  Anu ba ang pH ng plasma? 7.35-
4. X 7.45. Normal pH is 7 so slightly
- Parasympathetic Effect increased ang ph kaya siya
1. An increase in parasympathetic SLIGHTLY ALKALINE. Also you
stimulation can increase production of are not reabsorbing you
saliva and it is more WATERY bicarbonate so mas lalo talga
2. This is happening if you are RELAXED siyang magiging alkaline.
3. NO TIME for reabsorption  Flow of Saliva
b. Salivary gland has minimal SYMPATHETIC regulation ↑ Flow of Saliva
- Sympathetic Effect ↓
1. An increase in sympathetic effect also ↓ Time for reabsorption
INCREASES production of saliva but they ↓
are more VISCOUS ↑ Content of K, CL HCO3 and Na in saliva
2. This is happening if you are feeling  Reabsorption of Electrolytes
NERVOUS. ↑ Time for reabsorption
3. Since this is viscous, makikita mo ang ↓
saliva sa gilid ng bibig na namumuo or ↑ Absorption of NaCl
namumuti. ↓
4. Less LUMINOUS and More ORGANIC Since NaCl is reabsorbed, this will leave K, Hydrogen Ions and
CONTENTS because you have time for Bicarbonate in your fluid
reabsorption of fluid and electrolytes in  Acinar and Ductal Cells
the salivary ducts a. In the lumen of acinar cells, you can secrete your K,
c. Sympathetic and Parasympathetic Effect NaCl and Bicarbonate.
- Sympathetic and Parasympathetic Stimulation a. In the lumen of ductal cells, you can reabsorb K,
are both STIMULATORY to salivary gland NaCl and Bicarbonate. In the ducts you reabsorb
secretion electrolyte. Ang irereabsorb mo yung itatapon ng
- NO INHIBITORY in Salivary Glands acinar cells.
- Activities of Autonomic Nervous System - Your ducts in saliva are affected by
1. In a Normal Activity of autonomic ALDOSTERONE.
nervous system, saliva is HYPOTONIC  Neural Control of Saliva
and SLIGHTLY ACIDIC. Why? a. Conditioned Reflex
 In a normal activity of your - Yung nakita mo, naamoy, naisip or narinig,
autonomic nervous system, lahat ito ay conditioned reflex.
there will be time for - You need PRIOR SENTITIZATION. Example,
reabsorption of electrolytes, nung bata tayo, pinaalam satin yung amoy ng
leaving your saliva or fluid to bawang so pag naaalala mo yung ngayun,
have fewer electrolytes kaya nagsasalivate ka.
nagiging HYPOTONIC. - That’s why it is called CONDITIONED REFLEX
 Pag nagreabsorb siya ng sodium because we have been educated about foods
magtatapon siya ng potassium at when we were still a child so whenever we
hydrogen ions sa saliva. Dahil think of it, we SALIVATE

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 Physiology A GASTROINTESTINAL PHYSIOLOGY (DR. VILA AND DR. BARBON)

- Whenever you see, think, smell or hear Pyloric Area Mucous Cells Mucus, Pepsinogen
something about a food you like, you are
SALIVATING - There are different cells found on the different
b. Unconditioned Reflex areas of the Stomach.
- NO PRIOR SENSITIZATION. Kahit maglagay ka - What is the characteristic cell of the stomach?
ng kahit anung bagay sa bibig mo kahit bato  PARIETAL CELLS
pa yan, magsasalivate ka. 1. The gastric pits in the stomach will
 Importance of Saliva form the gastric glands in the mucosa
a. For Digestion 2. The cells that will line the gastric pits
- Your saliva contains your SALIVARY AMYLASE. are the cells that will make up your
1. Enzyme that will digest carbohydrates gastric glands and the most numerous
b. For Lubrication is the PARIETAL CELLS.
- Saliva can facilitate swallowing 3. Secretes
- It’s hard to swallow without saliva  Hydrochloric Acid
c. For Defense against Invading Microorganism  Intrinsic Factor
(Protection) i. For the absorption of
- Saliva contains: Vitamin B12
1. Lysozymes ii. The receptor for intrinsic
2. Immunoglobulins factor is in the TERMINAL
3. Lactoferins ILEUM so vitamin B12
will be absorbed there
 Esophagus  Ghrelin
a. Secretion i. Stimulate your HUNGER
- His only secretion is MUCUS to facilitate the CENTER
flow of food bolus from the oral cavity to the - Chief Cells
stomach 1. Found on the BASE
b. Mainly a CONDUIT 2. Secrete:
- Daanan lang siya ng food  PEPSINOGEN
- Abnormal: i. To be activated or
1. Odynophagia converted to Pepsin
 Painful swallowing  Gastric Lipases
 When you have Odynophagia, - Enteroendocrine Cells
automatic you have Dysphagia 1. Now it is called Diffused
 Pag masakit lumunok, mahirap Neuroendocrine Cells
umunok 2. Old name is Amine Presucrsor Uptake
2. Dysphagia Derivative (APUD)
 Difficulty swallowing 3. Older name is Enterochromaffin Cells
 It is not necessarily that if you 4. Example:
have dysphagia, you have  Delta Cells that secrete
odynophagia SOMATOSTATIN
 G Cells that secrete GASTRIN
 Stomach  Alpha Cells the secrete
a. Gastric Cells and Secretory Products GLUCAGON
Area Cells Secretory Products - Enterochromaffin 2 Cells (EC2 Cells)
Acid and Intrinsic 1. This is now called Mo Cells
Parietal Cells
Factor  Produces MOTILIN
Chief Cells Pepsinogen - D1 Cells
Fundic Area
Mucous Cells Mucus, Pepsinogen 1. Produces Vasoactive Intestinal Peptide
Histamine,
ECL Cells
Serotonin
Mucus Cells Mucus
Antral Area
G Cells Gastrin

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 Physiology A GASTROINTESTINAL PHYSIOLOGY (DR. VILA AND DR. BARBON)

 Formation of Hydrochloric Acid (HCL)  This is NICE TO KNOW magform pa ng carbonic acid at
only so do not focus on this magdissociate pa para makakuha ng H
Ions?  It has to be PROTONATED so
that it is a more effective Hydrochloric
Acid to effectively degrade or cleave
peptide bonds.
 Surface Mucus Cells

a. Inside the parietal cells, we have Water and Carbon

Dioxide.

a. Secretes MUCUS LAYER or PROSTAGLANDIN LAYER

b. Misoprostol (Cytotec)
- It is a COATING AGENT.
- Protects the stomach from HCL so that it will
not come in contact with the lining epithelium
and not be destroyed.
c. Why does stomach normally do not have ulceration
although there is HCL?
- Because of the PROSTAGLANDIN COATING or
MUCUS COATING.
1. It will try to neutralize the acid so that it
will not come in contact with your
gastric cells
2. Hindi dahil mahilig ka sa softdrinks, kaya
ka nagkaulcer. Kahit softdrinks ka ng
softdrinks, kung intact ang mucus
b. Hydrochloric Acid (HCL) coating mo sa stomach, hindi ka
- Formed in the LUMEN magkakaulcer
- Not formed inside the parietal cells 3. Pag may ulcer kana at nagsoftdrinks
- Once formed inside the parietal cells, these kapa, yun ang masama. Mas lalo niyang
cells will be destroyed pinalalaki ang ulceration mo
c. H Ions 4. Milk can further increase secretion of
- Needs to be pumped acid. So this is not advisable for those
- Comes from H2O people with ulcer.
1. Water still have to form Carbonic Acid d. Gastric Ulceration
and dissociates to form H Ion and - Is not secondary to too much acid
Bicarbonate 1. What disease is secondary to ↑ acid
2. Bat di pa kunin diretso and H Ions sa  DUODENAL ULCER. Why? We don’t
H2O sa umpisa palang? Bakit kailangan have mucus coating in our duodenum.
pag magcombine sa carbon dioxide at

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2. Pathophysiology of Duodenal Ulcer

When you facilitate movement of Here you have Pepsinogen secreted from the Chief Cells
acidic chyme from the stomach or you ↓
increase or decrease the gastric HCl will activate Pepsinogen to Pepsin
emptying ↓
↓ Pepsin will auto-catalyze pepsinogen to become pepsin
Acidic Chyme will go directly to the
duodenum  Parietal Cells
↓
↓ Time to neutralize the acidic chime
in the duodenum
↓
↑ Acid in the duodenum
↓
DUODENAL ULCER
- It is secondary to the BREAKDOWN OF
MUCUS COATING.
- When does the mucus coating or
prostaglandin coat does breaks down?
1. Every 7 days it is being replaced
- Non-steroidal Anti-Inflammatory Drugs
(NSAIDs)
1. Example is Ponstan, Dolfenal etc.
2. Common drug for Elderly due to
arthritis and Female due to a. Proton Pump
menstruation. They usually take NSAIDs - In the drawing, yung nasa gitna na may
to relieve the pain. “ATPase”, that’s the PROTON PUMP
3. This drug destroys the mucus coating - Purpose of this is to pump Hydrogen Ion
that lead to ulceration - Diba kanina sa HCl production, meron tayong
4. One manifestation is MELENA due to H ion na galling sa dissociation for carbonic
ulceration. acid? Panu lalabas yung H Ion?  through our
HYDROGEN-POTASSIUM ATPase PUMP or
 Activation of Pepsinogen to Pepsin PROTON PUMP
- Receptors in Parietal Cells:
1. Histamine 2 Receptor (H2)
 That’s why we give H2
ANTAGONIST. These are drugs
ending in “-tidine”
i. Ranitidine
ii. Cemetidine
 Mechanism of H2 Antagonist:
No H2 receptor
↓
No stimulatory protein
↓
No cAMP
↓
Protein kinase will not be
activated
↓
Inhibition of Proton Pump
↓

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H Ions will not go out No HCl

↓ ↓
No production of Hydrochloric No Activation of Pepsinogen to Pepsin
Acid (HCl) ↓
 Before, they give Antihistamine, No Proteolysis or No breaking Down of
but they found out that it is not Proteins
that effective because it binds 2. Also HCl is our PROTECTION in the
with H1 receptors not on the H2 stomach that’s why microbes cannot
receptors : live in our stomach because it is acidic
2. Acetylcholine Receptor except for UREASE that produces H
 Action of Acetylcholine Pylori which is a causative agent for
Acetylcholine Ulcer.
↓ H. Pylori
When it binds to Muscarinic 3 ↓
receptors It destroys mucus coating
↓ ↓
↑ Ca and IP3 HCl come in contact with the epithelium
↓ of the stomach
There will be Protein Kinase ↓
↓ ULCERATION
Proton pump will be activated - Management of gastric ulcer is just 2 weeks.
↓ We don’t manage it for life. So 2 weeks, then
H Ion will go out rest then another 2 weeks then rest again.
↓ Meaning there is rest periods in treating
There is production of HCl gastric ulcer.
 Atropine
i. Not just ANTIMOTILITY  Gastrin Secretion
but also a. Mechanism:
ANTISECRETORY Pepsinogen
ii. Effect is no HCl ↓
3. G Receptors Converted to Pepsin through your acid
 Nowadays, we don’t have G ↓
receptors anymore. It is now Cleave Protein
called CCK-2 Receptors ↓
 This is where GASTRIN will be ↑ Oligopeptides (Protein Fragment)
binding ↓
 There is NO DRUG yet to inhibit ↑ Gastrin secretion from the G Cells
G Receptors or CCK-2 Receptors ↓
4. Prostaglandin Analog Further stimulate Vagus Nerve to innervate stomach
 INHIBITORY to the proton pump ↓
 It coats the stomach and inhibits Further ↑ HCl Production in the stomach
the proton pump b. High Protein Diet
 That’s why nowadays, to decrease - Can increase secretion of GASTRIN from the G
HCL production, we give H2 Cells
antagonists or Proton Pump - Can further increase HCl production in the
- The best drug for ulcer is PROTON PUMP stomach. Di ka nga mabilis magutom pero
INHIBITORS such as those ending in ‘-prazole”: puro ka acid so maku sure intact ang stomach
1. Omeprazole mucus mo kasi kung hindi, ulcer ang abot mo.
- If you are treating ulcer, we don’t want HCl - The pH can go as low as 2 if yu have high
but it doesn’t mean we don’t want it forever. protein diet
1. Remember that HCl is needed for
activation of Pepsinogen.

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 Secretion of HCl  Neural Control of Gastric Activity

a. Excitatory
- Usually regulated by PARASYMPATHETIC (GRP
and Ach)
- Intrinsic Reflex
b. Inhibitory
- Inhibitory is SYMPATHETIC through
Norepinephrine and Enterogastric.
- Pag may laman pa yung intestine, hindi
gaanong magsesecrete ang stomach
- Pag may laman na ang proximal stomach,
magsesecrete na yung distal stomach para
mas maidigest niya na ang food nang maalis
na sa stomach.

 Hormonal Control of Gastric Activity

a. Usually regulated by PARASYMPATHETIC which is
Excitatory
- If it stimulates secretion, it is called
a. Vagus Nerve:
SECRETAGOGUE such as:
1. Gastrin
2. Histamine
3. Epinephrine (Adrenal)
4. Bombesin (Gastrin Releasing Peptide)
from the Vagus Nerve
b. SYMPATHETIC is Inhibitory
- If it inhibits secretion, it is called
ENTEROGASTRONES
1. Somatostatin
2. Secretin
b. Histamine 3. GIP
Histamine 4. VIP
↓ 5. Glucagon
Binds to H2 Receptors in the Parietal Cells 6. Calcitonin
↓ 7. Acid
Secrete further HCL
c. G Cells
G Cells
↓
Secrete Gastrin
↓
Goes into the circulation
↓
Stimulate ECL Cells
↓
Secrete Histamine
↓
Histamine binds to H2 Receptors
↓
Secrete further HCl

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 Physiology A GASTROINTESTINAL PHYSIOLOGY (DR. VILA AND DR. BARBON)

 Phases of Gastric Acid Secretion 2. if it inhibits the sphincter of Oddi, it will

facilitate the flow of bile

 Effects of Secretin
a. Almost all are STIMULATORY (expect for bolded
sentences below)
- Excitatory stimuli – acid, peptides, amino acids
- Effects:
- Stimulates pancreatic secretion of watery alkaline
juice (ductal cells)
- Stimulates Brunner’s glands
- Stimulates chief cells
- Stimulates water and bicarbonate secretion
(liver)…increasing rate of bile flow
- Augments action of CCK-PZ
- Inhibits parietal cell
1. So that acid in the duodenum is not too
a. Cephalic Phase much
- When you think about food 2. Remember that Secretin secretes
- This includes the CONDITIONED REFLEXES Bicarbonate to neutralize acid
b. Gastric Phase - Inhibits gastric and enteric motor activity
- When the food goes to the stomach 1. Para hindi agad pumunta ang acid sa
- Stimulated by: duodenum to prevent duodenal ulcer
1. Antral Distention
2. Protein Content  Effects of Cholecyctokinin-Pancreozymin (CCK-PZ)
- Remember that acid can also inhibit the effect a. Almost all are STIMULATORY (Except for the bolded
of gastrin, para di na gaanong magsecrete ng sentence below)
HCl - Excitatory stimuli – fats, peptides
c. Intestinal Phase - Effects:
- When the food goes to the intestine - Stimulates gallblader contraction
- Stimulated by: - Stimulates pancreatic enzyme secretion
1. Intestinal Gastrin - (acinar cells)
2. Absorbed Amino Acids - Augments the action of Secretin
- Stimulates chief cells
 Physiologic Effects of Gastrin - Stimulates enteropeptidase
a. Gastric Effects (almost all are STIMULATORY) - Stimulates pyloric sphincter
- Increases gastric secretion - Stimulates enteric & colonic motor activity
- Increases gastric motor activity - Trophic action on the pancreas
- Increases gastric blood flow - Inhibits the sphincter of Oddi
- Trophic action on the gastric mucosa 1. To facilitate flow of bile
b. Extra Gastric Effects: 2. To facilitate flow of pancreatic secretions
- Increases water and electrolyte secretion of
the liver, pancreas and small intestine  Functions of the Liver
- Increases pancreatic enzyme secretion a. Formation & secretion of bile (500 ml/day)
- Stimulates lower esophageal sphincter, b. Protein, carbohydrate and lipid metabolism
enteric, colonic and gallbladder contraction c. Ketone body and urea formation
- Inhibits pyloric sphincter and sphincter of d. Metabolism of vitamins and GAGs
Oddi e. Detoxification and hormone inactivation
1. if it inhibits pyloric sphincter, the food f. Synthesis of plasma proteins
from the stomach goes directly into the g. Immunity (Kupffer cells)
duodenum h. Excretion of bilirubin, cholesterol, alkaline
phosphatase

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 Processes in the Liver  If there is uneven composition of

a. In the liver, you break down your cholesterol to form water and bile salts
BILE. 3. Nucleation factors that favors formation of
- 95% of bile goes to ENTEROHEPTIC CIRCULATION. stones in supersaturated bile
Para hindi secrete ng secrete ng bile ang liver,  Nucleation factors are inherent in our
irerecirculate mo siya. body. We cannot modify it so wala
- Bile Salts talga tayong magagawa jan.
1. Recirculate 6-8x per day  Enteric Secretion
2. In the terminal ileum, 90-95% of the bile a. Mucus
salts is reabsorbed - From the Goblet Cells and Brunner’s Gland
3. In the colon, 2-3% of bile salts is reabsorbed b. Immunoglobulins
4. 3% left in the feces para may kulay ang - From the Peyer’s Patches or Lymphatic Nodules
feces c. Water and Electrolytes
- Function of bile - From the Crypts of Lieberkuhn
1. EMULSIFICATION OF FATS d. Digestive Enzymes
 Emulsify means you insert - From the enterocytes
hydrophilic shells to make it e. Hormones
susceptible to enzymes which are - Yung mga I Cells, J Cells etc.
LIPASES
 The fats need to become MICELLES so  Hormones being secreted by the Intestines and Their Location
that lipase can act on them. Kasi pag
buo ang fats, lipase cannot degrade Hormone Cell Location
the core of the lipid so you cannot Gastrin G, G1 Ga, D, J, I
Glucagon A Ga, D, J, I
effectively digest them.
Secretin S D, J, I
- Composition of Bile in the Liver
CK-PZ I D, J, I
Composition Percentage (%) GIP K D, J, I
Water 97% Motilin EC2 G, D, J, I, C
Inorganic Salts 0.70% VIP D1 (H) G, D, J, I, C
Bile Salts 0.70% Somatostatin D G, D, J, I, C
Bile Pigments 0.20% GRP Vagal Endings G, D, J, I, C
Fatty Acids 0.15% Ga – Gastric or Stomach
Lecithin 0.10%
D – Duodenum
Fat 0.10%
J – Jejunum
Cholesterol 0.06%
Alkaline Phosphatase I – Ileum
C – Colon
- Comparison of Human Hepatic Duct Bile and
Gallbladder Bile  Colonic Secretions
Hepatic Duct Cystic Duct a. Mucus
% of Solids 2-4 10 - 12 - From the Goblet Cells
Amount of Bile Salts 10 - 20 50 - 200 b. Immunoglobulins
pH 7.8 - 8.6 7.0 – 7.4 - From Colonic Lymphatic Nodules
+ -
1. We can see in this table that Gall bladder c. Water ad Eletrolytes (K and HCO3 )
will really be able to concentrate bile. - Colon only secretes a little amount of water and
2. Look at the percent of solids, mas marami electrolytes
sa cystic duct. Galling yan sa gallbladder as - Majority of Water is absorbed in the Small
compared to the liver, mas konti ang Intestines (7.2 L)
percentage. - In the colon, the amount of water absorbed is 1.3
L
- Factors in the formation of Gallstones - If you are dehydrated, you need to reabsorb more
1. Bile stasis water and that commonly happens in the colon
 Pag matagal na sa gallbladder ang bile
2. Supersaturation of bile with cholesterol

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- Most of the needed water reabsorption beyond

physiologic limits will have to be reabsorbed in
the colon
- Within physiologic limits, most volume of water is
reabsorbed in the small intestines.

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Gastrointestinal Physiology 3 and 4

I. Digestion
 BREAKDOWN of nutritive agents into smaller and absorbable b. Absorption
units - This is also present in the mouth that’s why we
 What is the major reaction? have SUBLINGUAL ADMINISTRATION of drugs.
a. Hydrolysis 1. We can absorb drugs sublingually but it has
- So all enzymes are capable of hydrolyzing with to be in absorbable form
their respective substrate 2. Most of the food we eat are not in their
 Digestion in different organs of GIT absorbable form
a. Mouth 3. We can only absorb food in the mouth if
- Initial digestion of CARBOHYDRATES takes place they are already:
here  Monosaccharide
- What are the sources of carbohydrates?  Fatty Acids
1. Starch (Diet) 4. We cannot absorb complex carbohydrates
2. Glycogen (in the Muscle) or lipids
b. Stomach  Esophagus
- Initial digestion of PROTEINS takes place a. Digestion is still PRESENT here
c. Small Intestine - Whatever food coming from the mouth will enter
- Where all of them (food) are completely digested the esophagus
 Cannot be digested by GI Tract - Food that comes from the mouth still have ALPHA
a. Fibers AMYLASE so digestion is still happening in the
- Provides normal activity of GI Tract esophagus but enzyme doesn’t come from this
- Found in FRUITS and Vegetable organ
- It keeps the smooth muscle of the GIT active - But if you separate the esophagus from the
- It maintains stretch on the smooth muscle so it is mouth, no digestion will occur because no
stimulated to contract enzyme is synthesized from the esophagus
- If you are not eating food rich in fiber, you are b. Absorption
prone to GI abnormalities - NO ABSORPTION
- The transit time of the food in the esophagus is
II. Absorption very short (LESS THAN A SECOND)
 TRANSPORT of digestive products from the GIT to the blood or - Yung nilunok mo, didiretso nay yan sa stomach
lymphatics - Esophagus is only a passageway of food going to
 Transport can be: the stomach
a. Active - Lining of Esophagus:
b. Passive 1. More of a SEROSA than mucosa so wala
talagang absorption
III. Digestion and Absorption in the Different Organs of the  Stomach
Gastrointestinal Tract a. Digestion
 Mouth - Initially when the food enters the stomach,
a. Digestion is by the following enzymes STARCH is digested still due to the activity of
- ALPHA AMYLASE AMYLASE that comes from the mouth that passed
1. Mostly active in the mouth through the esophagus
2. It cannot digest completely the - But later on, the food mix with secretory agents of
carbohydrates of starch and glycogen the stomach so the activity of amylase will
3. It can just make them DISACCHARIDES and decrease. What will be active now?  PEPSIN
you cannot absorb this. - Pepsin
4. Disaccharidases are only found in the small 1. Source: CHIEF CELLS
intestines 2. Mechanism:
- Lipase Chief Cells
1. Not that active in the mouth ↓
Release Pepsinogen

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 Physiology A GASTROINTESTINAL PHYSIOLOGY (DR. VILA AND DR. BARBON)

↓ Gives you sufficient time for digestion and

Pepsinogen comes in contact with absorption
Hydrochloric Acid c. To finalize digestion, the enzymes needed for
↓ completion of digestion is found in the small intestines
Will be converted to its active form PEPSIN such as
↓ - Disaccharidases
Pepsin can auto-activate Pepsinogen - Proteases
3. When the stomach is acidic, the only one - Cholesterol Esterases
that is active is PEPSIN - Phospholipases
b. Absorption d. Absorption:
- Present but MINIMAL - MOST ABSORPTION takes place in the small
- The lining of the stomach is not designed for intestines particularly in the PROXIMAL PART
absorption. It is designed for PROTECTION of the which is the DUODENUM and JEJUNUM
stomach from the corrosive effect of Hydrochloric e. Has special transport processes not present in other
Acid parts of the GIT
 Small Intestine - Transporters or Carriers for Carbohydrates
a. This is where final products of digestion are formed in
greatest quantities. Why?
- Because enzymes from the PANCREAS are
brought here such as:
1. Amylase
 When released, they are already
active
2. Lipase
 Also when released, they are already
active
 What is needed for maximum activity
of lipase?  BILE SALTS
3. Liver Proteolytic Enzymes
 When these enzymes are released,
they are not yet active.
 What will activate them?  1. Sodium-Glucose Transporter (SGLT)
ENTEROPEPTIDASE  Carrier of:
 Effect of Enteropeptidase is seen in i. Sodium
TRYPSINOGEN ii. Glucose or Galactose
 Mechanism of Enteropeptidase.  Sabay sila nattransport
Enteropeptidase  This is a SYMPORT or Secondary
↓ Active Transport
Will act on Trypsinogen 2. GLUT 2
↓  Facilitated Transport (Passive but
Trypsinogen will be converted to with carrier)
active form TRYPSIN  Carrier of glucose to the BLOOD
↓ specifically in the PORTAL VEIN
Trypsin will activate other INACTIVE 3. GLUT 5
proteolytic enzymes  Carrier of FRUCTOSE to the
b. Contents are moving very slowly enterocyte via facilitated diffusion
- So the contents stay longer in the small intestine.
What is the significance?
↓ Movement
↓
Longer Transit Time
↓

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 If there is a problem with these carriers, you will not have transport 4. Diseases:
even though you have disaccharidases  Hartnup Disease
 All of these carriers in our intestines are not affected by INSULIN. You i. You cannot absorb NEUTRAL
only need insulin in your SKELETAL MUSCLE or CARDIAC MUSCLE amino acids
1. What glucose transporter is affected by insulin? ii. No carrier or transporter for
 GLUT4 neutral amino acids
 No GLUT 4 in the Small Intestines. iii. You can still transport other
proteins
- Transport or Carriers of Proteins  Cystinuria
1. It depends upon its Isomer if: i. No transporter for basic
 Dextrorotatory amino acids
i. D-amino Acid ii. No transport of Cysteine
ii. Passive transport except for  Problem in Intestinal Mucosa
D Methionine (this is actively i. You cannot absorb ALL
absorbed together with amino acids
Levorotatory) ii. But this is very rare
 Levorotatory iii. The problem is not in the
i. Active transport carriers
ii. Usually Co-transport with 5. Absorption of Proteins
either:
 Sodium
 Hydrogen
iii. There are different transport
system for actively
transported peptides:
 For neutral amino
acids
 For basic amino acids
like arginine, lysine,
ornithine, cysteine
 For proline,
hydroxyproline,
betaine, sarcomine
and N-dimethylglycine
 For dicarboxylic amino
acids
 For dipeptides and
tripeptides
2. The difference between proteins and Digest it first by Pepsin
carbohydrates: ↓
 In Carbohydrates, you can only Pancreatic enzymes will work
absorb MONOSACCARIDES ↓
 In Proteins, aside from Amino Acids, Proteins will be cleaved into smaller
you can also absorb DIPEPTIDES, peptides so there will be Dipeptides,
TRIPEPTIDES and even Tripeptides, Tetrapeptides Amino Acids
TETRAPEPTIDES. ↓
3. That’s why you can have FOOD ALLERGY You can now absorb these substances. But
because the allergens can be absorbed. to facilitate absorption, small intestine will
ALLERGENS can be tripeptide or be producing PROTEASES or PEPTIDASES to
tetrapeptide. Kung amino acids lang further cleave it to Amino Acids for easier
maabsorb natin, wala tayong food allergy. absorption

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↓ 6. Mechanism of Absorption of Fatty Acids

Amino Acids will be transported to the
blood. Majority via Facilitated Diffusion but
sometimes by active transport usually co-
transported with Hydrogen or Na
↓
Will be brought to the PORTAL
CIRCULATION
↓
Brought to the Liver
- Absorption of Fats (ALL are PASSIVE TRANSPORT)
1. Lipase
 This is a water soluble enzyme
 Since fats are not water-soluble, it
needs to become water-soluble first
by the bile salts before lipase can
digest it.
2. Co-Lipase
 Enhances the hydrolytic effect of
pancreatic lipase on the fats once
they are emulsified
3. Bile Salts
 For emulsification of fats
 Why do fats need to be emulsified?
 If you did not emulsify you fats,
your lipase cannot digest it.
 Emulsification means you render a
water-insoluble agent to a water-
soluble agent. Yung isang bagay na
ayaw humalo sa tubig, hahayaan
mong humalo sa tubig pag
naemulsify. So pag naemulsify,
hahalo yang fats sa tubig.
 What is the other term for
emulsification?  SAPONIFICATION
or MICELAR SOLUBILIZATION OF
FATS
 If bile salts were recycled, it is called
INTER-HEPATIC CIRCULATION OF
BILE SALTS. Galing siya sa small
interstine, babalik ng liver.
4. Short Chain Fatty Acids
 Has less than 10 carbon atoms
 < 10 Carbon Atoms  Brought to the
BLOOD
5. Long Chain Fatty Acids
 > 10 Carbon Atoms
 > 10 Carbon Atoms  Brought to the
LYMPHATIC CIRCULATION

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 Clathrin  Potassium
i. Agent needed by i. Can be passive or active
chylomicrons to form  Bicarbonate
vacuole so that it can be i. Can be active or passive
transported by exocytosis ii. Active absorption is by
- Absorption of Vitamins passive transport.
1. Active Transport (Most of them are Vitamin iii. Bicarbonate is not absorbed
B Complexes) as Bicarbonate. How?
 Thiamine Bicarbonate has to go with
 Riboflavin Hydrogen to become
 Biotin ↓
 Cyanocobalamin Carbonic Acid
 Pantothenic Acid ↓
 Gastric Intrinsic Factor Will go to the Lumen
i. Produced by PARIETAL ↓
CELLS Converted to:
2. Passive Transport (Fat-Soluble Vitamins) –  CO2
Basta associated with fats  PASSIVE  H2O
TRANSPORT ↓
 A Can now be absorbed by
 D simple diffusion
 E f. Has the biggest surface area in the GIT
 K - Kaya malakas siya magabsorb
- Absorption of Electrolytes - They have small diameter but surface area is
1. Can also be Active or Passive greater
2. Other electrolytes need hormones: - Its surface is really design for ABSORPTION.
 Calcium
i. Needs Vitamin D and
Parathyroid Hormone (PTH)
 Sodium
i. Can be active or passive
ii. Passive transport needs
MINERALOCORTICOID
(ALDOSTERONE)
iii. Can be transported by 4
membrane processes:
 Can be transported
together with Glucose
and Amino Acids
 Na-H Exchanger which
is an electroneutral 1. Plica Circulares (Valvulae Conniventes or
pump. They are both Valves of Kerckring)
Cation so the exchange  Folds in the small intestine
is equal that’s why it is  With the presence of this mucosal
electroneutral. folds, it increase the surface are by
Transport is 1:1. additional 3x
 Na-K Pump which is an  In every mucosal fold, you have tiny
electrogenic pump. projections called  VILLI
Unequal transport.  In every fold, you have hundreds of
 Passive Transport by villi
using Aldosterone

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2. Villi h. Why does the small intestines free from bacteria?

 With the presence of villi, it increases - The acidity of the stomach is transported to the
the surface area by additional 10x small intestine that keeps them free from bacteria
 In every Villus you have tiny small - Another reason is the BILE SALTS which are
projections  MICROVILLI BACTERIOSTATIC. Most of the bile salts are
3. Microvilli transported back to the liver but there’s a very
 Increases surface area by 20X little amount that can go to the large intestines.
- So in total, you have increase in surface area of  Large Intestine
about 600X a. Digestion is NOT OBSERVED
- So kahit maliit siya, eh siya naman ang may - Why? Because you don’t have ENZYMES  No
presence niyang mga plica circulares, villi and hydrolysis
microvilli, siya ang may pinakamalaking surface - But there is BREAKDOWN OF FOODS. Yung mga
area. hindi mo natunaw, ibbreakdown sa large
- Lahat ng pwedeng maabsorb, naaabsorb netong intestine.
mga plica circulares, villi and microvilli - Eh diba walang enzymes? Sinu magbbreak down?
g. Disaccharidases  BACTERIA. What process? FERMENTATION
which produces gas
- What bacteria mostly live in the large intestines?
1. Lactobacilli
b. In the DISTAL COLON (Recto-Sigmoid), absorption is the
colon is mostly happening.
- Absorption or water is mostly happening in the
PROXIMAL COLON
- Distal colon contains the FECES
- What is mostly absorbed?  byproducts of
BACTERIAL ACTIVITY and some WATER and
ELECTROLYTES
- What vitamin is absorbed by the colon due to
fermentation of bacteria?  VITAMIN K  that’s
why bacteria in the large intestine are considered
friendly bacteria.
- Synthesized in the small intestines which can c. Secretion
digest Disaccahrides. - Mostly happening from the ILEUM to the COLON
- Examples are: - Secretion in the colon is greater than absorption
1. Maltase because secretion is happening in throughout the
2. Sucrase colon from PROXIMAL to DISTAL
+ -
3. Lactase - K and HCO3 are normally secreted into the
- These will form MONOSACCHARIDES which can be lumen
absorbed. - Potassium
- What can be observed in a person if they don’t 1. When this reaches the Colon, this is not
have disaccharidases? only absorbed but also can be secreted.
1. Osmotic Diarrhea. Why osmotic diarrhea? 2. Why is there secretion of potassium in the
 Because your GIT have osmotically colon?  That helps in the LUBRICATING
active agents that will attract water. EFFECT OF THE MUCUS.
 You cannot absorb water. 3. When you have SEVERE diarrhea, it is
 So when you defecate, disaccharides described as mucoid, it means it has a lot
and water will be excreted of mucus. We are afraid of Hypokalemia
 Common in children and black due to loss of mucus which is rich in
people. They don’t have lactase so potassium. But if simple diarrhea, it okay.
they will develop lactose intolerance Do not be afraid of hypokalemia

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- Bicarbonate 3. SALIVARY GLANDS, this is an exocrine

1. Alkaline gland. You have the ability to control
2. When you have severe diarrhea, you production of its secretions.
secrete a lot of bicarbonate  - Total water reabsorbed is 8800 ml
METABOLIC ACIDOSIS 1. Most absorption of water is in the
3. This is absorbed via CARBON DIOXIDE JEJUNUM followed by ILEUM
4. Secreted via Chloride-Bicarbonate 2. Least reabsorption is in the COLON
Exchange 3. Yung sobrang naabsorbed, nadadala sa
 Electroneutral (1:1) kidneys for excretion in the urine
 Minsan masasabay to with Na-H - So dapat lahat ng nilabas mo, bawiin mo.
Exchange. Parehas naman sila
electroneutral.
- Secretion in the colon is enhanced by:
1. Aldosterone
2. Cyclic AMP
d. Daily Water Turnover (ml) in the GIT

- What is the normal amount of water in the fecal

matter  200 ml if your bowel movement is
regular.
1. What is the regular bowel movement?
 The most is 3x a day
 The least is once every 3 days
 Regular bowel movement is once a
day
 So the range of normal is 3x a day to
once every 3 days
 If once a week, that is constipation
- Total water entering our GIT is 9000 ml
1. Most of the water that entering the GIT is
not coming from the outside, it’s from our
own secretions.
2. STOMACH secretes water the most. Why?
To neutralize the acid or to dilute the acid
for protection.

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