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    This document provides an overview of the gastrointestinal system, including its gross anatomy, histology, nerve supply, and functions. Key points include: - The gastrointestinal tract and accessory organs work together to digest food, absorb nutrients, and excrete waste. - Propulsive and mixing movements help break down and transport food through the alimentary canal. - Accessory organs like the liver, pancreas and salivary glands secrete enzymes and hormones to further digest nutrients. - The small intestine absorbs most nutrients with help from pancreatic enzymes and bile, while the large intestine absorbs water before waste is excreted. - Motility throughout the GI tract is regulated by nerves and

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    This document provides an overview of the gastrointestinal system, including its gross anatomy, histology, nerve supply, and functions. Key points include: - The gastrointestinal tract and accessory organs work together to digest food, absorb nutrients, and excrete waste. - Propulsive and mixing movements help break down and transport food through the alimentary canal. - Accessory organs like the liver, pancreas and salivary glands secrete enzymes and hormones to further digest nutrients. - The small intestine absorbs most nutrients with help from pancreatic enzymes and bile, while the large intestine absorbs water before waste is excreted. - Motility throughout the GI tract is regulated by nerves and

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    This document provides an overview of the gastrointestinal system, including its gross anatomy, histology, nerve supply, and functions. Key points include: - The gastrointestinal tract and accessory organs work together to digest food, absorb nutrients, and excrete waste. - Propulsive and mixing movements help break down and transport food through the alimentary canal. - Accessory organs like the liver, pancreas and salivary glands secrete enzymes and hormones to further digest nutrients. - The small intestine absorbs most nutrients with help from pancreatic enzymes and bile, while the large intestine absorbs water before waste is excreted. - Motility throughout the GI tract is regulated by nerves and

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    46 views73 pages

    Git PDF

    Uploaded by

    Nica RT
    This document provides an overview of the gastrointestinal system, including its gross anatomy, histology, nerve supply, and functions. Key points include: - The gastrointestinal tract and accessory organs work together to digest food, absorb nutrients, and excrete waste. - Propulsive and mixing movements help break down and transport food through the alimentary canal. - Accessory organs like the liver, pancreas and salivary glands secrete enzymes and hormones to further digest nutrients. - The small intestine absorbs most nutrients with help from pancreatic enzymes and bile, while the large intestine absorbs water before waste is excreted. - Motility throughout the GI tract is regulated by nerves and

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    GASTROINTESTINAL

    SYSTEM

    CARINA C. GOMEZ, M.D. F.P.S.P.


    Our Lady of Fatima University
    Department of Physiology
    FUNCTION
    ■ provides the body with
    a continual supply of
    nutrients, water,
    minerals, vitamins and
    electrolytes.
    ■ excretory function
    ■ endocrine function
    ■ protective function
    ■ storage function
    Functional Anatomy

    GROSS ANATOMY

    Gastrointestinal Tract
    (Alimentary Tract)

    Accessory Organs
    (Glandular Organs)
    Gastrointestinal tract Accessory organs
    Upper esophageal sphincter

    Lower esophageal sphincter

    Pyloric sphincter

    Ileocecal valve
    Internal anal sphincter
    External anal sphicter
    Skeletal muscles
    Mouth

    Upper 1/3 of esphagus

    Middle 1/3 of esophagus

    External anal sphincter


    Enterocytes

    Tight junctions Columnar


    squamous
    Nerve Plexuses

    Meissner’s plexus
    Submucous plexus

    Myenteric plexus
    Aerbach plexus
    Innervation of the GIT
    ■ Intrinsic Innervation (Enteric nervous system)
    ■ 100 M afferent. Interneuron and efferent neurons
    ■ little brain of the gut (displaced part of CNS)
    ■ Myenteric or Auerbach plexus
    ■ Meissners or Submucous plexus
    ■ Extrinsic Innervation (autonomic nervous system) – via ENS
    ■ afferent. Interneuron and efferent neurons
    ■ Parasympathetic nervous system
    ■ Sympathetic nervous system
    Hirschsprung’s Disease (Megacolon)
    ■ congenital disorder of enteric nervous
    system.
    ■ characterized by failure to pass meconium at
    birth or severe chronic constipation in infancy.
    ■ typical features are absence of myenteric and
    submucosal neurons in the distal colon and
    rectum.
    ELECTRICAL ACTIVITY OF
    SMOOTH MUSCLES
    RMP: 50 mV – 60 mV
    45 mV – 60 mV (Ganong)
    40 mV – 70 mV (Berne and Levy)

    Types of Electrical Waves


    a) slow waves (BER)
    b) spike potential
    Regulation of GIT activity
    ■ Endocrine Regulation Open type
    Close type

    (Hormonal Control)

    ■ Neurocrine Regulation
    (Neural Control)

    ■ Paracrine Regulation
    Endocrine Regulation
    ■ Gastrointestinal hormones (EEC)
    ■ Gastrin (G cells)
    ■ Secretin (S cells)
    ■ CCK (I cells)
    ■ Somatostatin (D cells)
    ■ Motilin (Mo cells)
    ■ Gastric Inhibitory Polypeptide (K cells)
    ■ Vasoactive Intestinal Poypeptide
    Paracrine Control
    ■ Histamine (ECL cells)
    ■ Secretin
    ■ Cholecystokinin
    ■ Serotonin (enteric neurons, mast cells and
    enterochromaffin cells)
    Gastrointestinal Activity
    ■ Major physiological processes
    ■ MOTOR ACTIVITY
    ■ SECRETORY ACTIVITY

    ■ DIGESTIVE ACTIVITY

    ■ ABSORPTIVE ACTIVITY

    ■ transport of the absorbed nutrients by blood


    ■ controlled by nervous and hormonal System
    MOTOR FUNCTION
    ■ Two types of movement

    ■ Propulsive Movement

    ■ Mixing Movement
    Propulsive Movement
    ■ Peristaltic Movement (Basic
    propulsive movement)
    ■ observe from the esophagus
    to the anus
    ■ initiated by stretching the gut
    wall
    ■ requires intact myenteric
    plexus
    ■ analward flow of GI contents
    Mixing Movement

    Segmentation
    contraction
    Ingestion of Food
    Mouth
    ■ Mastication (Chewing)
    ■ a voluntary as well as a reflex behavior
    ■ important for mechanical digestion of all food
    ■ no. of chews (optimum) - 20 – 25

    Force = 55 dynes (incisors) - cutting action


    = 200 dynes (molars) - grinding action
    Muscles - CN V
    SALIVARY SECRETION (mouth)
    ■ Salivary glands
    ■ parotid glands
    ■ submandibular glands
    ■ sublingual glands
    ■ Buccal and minor salivary
    glands
    ■ 1-1.5 liters of saliva
    produced daily
    Composition of saliva
    ■ saliva is 99.5 % water and 0.5 % solutes
    ■ hypotonic fluid
    ■ pH ~ 7 (slightly acidic at rest)
    ■ solutes
    ■ Na, K, Cl, HCO3
    ■ Mucin, salivary amylase, secretory IgA,
    lingual lipase
    Functions of saliva
    ■ for lubrication
    ■ facilitate swallowing
    ■ facilitate speaking
    ■ for digestion
    ■ starches and fats
    ■ oral hygiene
    ■ keep mouth epithelium constantly wet
    ■ control growth of pathogenic bacteria
    ■ IgA, lysozyme and lactoferrin
    ■ neutralize the acid secreted by the bacteria
    Mouth, Pharynx and Esophagus
    ■ Deglutition (Swallowing)
    ■ propulsion of food into the stomach
    ■ Regulated by CN V, VII, IX, X & XII
    ■ Afferent fibers – CN V, IX and X
    ■ Centers – tractus solitarius & nucleus ambiguus
    ■ Efferent fibers – CN V, VII and XII
    ■ Partly voluntary, mostly reflex
    Stages of swallowing
    ■ Oral stage
    ■ Pharangeal stage
    ■ Esophageal stage

    ■ No. of swallows/day – 600


    ■ eating – 200
    ■ awake w/o food – 350
    ■ sleeping - 50
    ESOPHAGEAL SECRETION
    ■ Mucus Glands
    ■ located in the mucosa and

    submucosa
    ■ secrete mucus which

    lubricates esophagus for


    smooth passage of the
    bolus
    Stomach
    ■ Receptive relaxation

    ■ Mixing and grinding

    ■ Gastric emptying
    Weak Constrictor/Mixing Waves
    (mid stomach / BER)

    ↑ intensity (spike potential)


    (antrum)

    retropulsion
    (pylorus)

    CHYME
    Gastric Secretion
    Gastric Glands
    Secretion of HCl by Parietal cell
    Gastric Mucosal Barrier
    Cephalic and Gastric Phases
    Controlling Acid Secretion
    Small Intestine
    ■ ¾ of the length of the gut
    Doudenum – 5% Jejunum – 40% Ileum – 55%

    Types of movement
    ■ Segmentation contraction

    ■ Peristaltic movement
    ↑ proximal portion → ↓ distal portion

    Frequency is determined by BER

    Velocity – 0.5 – 2 cm/sec, Transit time – 3 -5 hrs


    Intestinal villus
    Pancreatic secretion
    Pancreatic cells
    ■ Acinar cells – synthesize, store, and
    secrete digestive enzymes
    ■ Ductal cells – secrete HCO3-, Na+, K+,
    Cl- ; contain carbonic anhydrase
    ■ Islet cells – secrete insulin, glucagon,
    somatostatin, and pancreatic polypeptide
    Pancreatic enzymes
    ■ digest fat, proteins, carbohydrates
    ■ proteolytic enzymes are secreted in inactive
    forms (zymogens) and then activated in the
    duodenum by other enzymes
    ■ nonproteolytic enzymes, eg amylase, lipase,
    colipase secreted in active forms
    Secretion of bile
    ■ one of the primary functions of the liver
    ■ hepatic function most important to the
    digestive tract.
    ■ secretes approximately 600-1000 ml/day
    BILE
    ■ produced by hepatocytes
    ■ stored and concentrated in the
    gallbladder
    ■ its secretion (primary secretion) is
    primarily stimulated by CCK.
    ■ modification of primary secretion is
    primarily stimulated by secretin
    Composition of bile
    bile acids --------------------- 65 %
    phospholipids --------------------- 20 %
    (lecithin)
    proteins ---------------------- 5%
    cholesterol --------------------- 4 %
    bile pigments --------------------- 0.30 %
    (bilirubin)
    Bile Acids
    CHOLIC ACID
    (50%)

    DEOXYCHOLIC ACID

    CHOLESTEROL hydroxylation
    (liver)
    LITHOCHOLIC ACID
    CHENODEOXYCHOLIC ACID
    (30%)

    PRIMARY BILE ACIDS SECONDARY BILE ACIDS


    conjugation
    BILE ACIDS GLYCINE AND TAURINE
    Enterohepatic Circulation of Bile Acids

    BILE ACID POOL = 2.5 - 3.5 gm


    CHOLESTEROL BILE SALTS

    2%

    Bile Salts Recirculation


    CCK (6-8X/day)
    Bile salts
    (5%)

    reabsorbed

    Bile salts
    (95%)

    feces ↑ bile salts → ↑ rate of bile secretion


    secretin → ↑ rate of bile secretion
    Functions of bile
    ■ helps in fat digestion (emulsifying and
    detergent functions of bile acids)
    ■ aid in the absorption of fatty acids,
    monoglycerides, cholesterol and lipids
    (ferrying function of bile acids).
    ■ means for excretion of several substances
    ■ bilirubin
    ■ cholesterol
    Migrating Motor Complexes

    Modified Motor Activity
    ■ occurs in fasted state (intermeal period)
    ■ cyclical contraction pattern (stomach – distal ileum)
    ■ strong antral contraction with relaxed pyloric sphincter
    ■ migrates down entire bowel
    ■ “interdigestive housekeeper” → MOTILIN
    ■ Ileocecal valve
    ■ prevents the backflow of fecal material from the
    colon into the small intestine

    ■ Ileocecal sphincter
    ■ responsible for the slow emptying of ileal
    contents into the cecum.
    Large Intestine
    ■ receives 500 ml – 1500 ml / day
    ■ Functions
    ■ absorption of H2O and electrolytes (proximal
    portion)
    ■ storage of fecal material (distal portion)
    Two Types of Colonic Movement
    ■ Haustrations

    ■ Mass Movement
    Haustrations
    ■ mixing movement
    ■ same as segmentation
    cecum

    transverse colon
    Mass Movement
    ■ propulsive movement
    ■ modified peristaltic movement
    ■ usually occurs 1 to 3x a day
    ■ facilitated by gastrocolic and duodenocolic
    reflexes ( transverse colon → sigmoid colon)
    Large Intestine
    ■ rectum is empty of feces (most of the time)
    Internal Anal
    Sphincter Tone
    (70 – 80%) – at rest
    (+) Sympathetic
    (-) Parasympathetic

    External Anal
    Sphincter Tone
    (20 – 30%) – at rest
    (+) Pudendal Nerve
    Defecation
    ■ expulsion of indigestible residues from the body.
    ■ requires coordinated action of the smooth and skeletal
    muscle layers in the rectum and anus.
    ■ components of feces
    ■ remnants of dead bacteria

    ■ dead or dying epeithelial cells

    ■ biliary metabolites

    ■ small amount of water

    ■ little amount of nutrients


    DEFECATION REFLEX

    Taken from: Classes.midlandstech.com


    Taken from: Review of Medical Physiology. 12th Edition
    Motility of Rectum and Anal Sphincters in Response to Rectal Filling and Defecation

    Taken from. Berne and Levy: Medical Physiology. 6th Edition


    EFFECT OF STRAINING
    (Sitting or Squatting Position)

    ANAL SAMPLING MECHANISM


    (SOLID, Liquid or Gas)

    Taken from: Review of Medical Physiology. 24th Edition


    HOW TO DELAY DEFECATION

    PUBORECTALIS MUSCLE
    EXTERNAL ANAL SPHINCTER
    SENSORY NERVE ENDINGS (ANAL CANAL)

    Taken from: Review of Medical Physiology. 24th Edition


    GASTROCOLIC REFLEX AND
    ORTHOCOLIC REFLEX

    Taken from: Review of Medical Physiology. 24th Edition


    Fecal Incontinence
    ■ develops due to the following conditions
    ■ trauma

    ■ surgical or obstetric injuries

    ■ prolapse of the rectum

    ■ neuropathic diseases (Diabetes Mellitus)


    Large Intestinal Secretion

    Bacteria in large intestine


    produce some B vitamins
    and vitamin K
    Large Intestinal Secretion
    ■ Mucus Secretion
    ■ parasympathetic stimulation
    ■ local stimulation
    ■ Function: lubricate colonic contents as they pass
    through; hold fecal material together; protect
    against bacterial activity and acid formed in
    feces
    ■ Water and Electrolytes (K+, HCO3-)
    Digestion & Absorption

    LIPID
    DIGESTION
    AND
    ABSORPTION

    10/20/15 Silverthorn, 1998


    LIPID DIGESTION AND ABSORPTION
    10/20/15
    Absorption of vitamins
    Fat-soluble vitamins (ADEK)
    ➢ become part of micelles formed by bile salts
    absorbed in proximal intestines.
    THANK YOU FOR LISTENING

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