GASTROINTESTINAL

PHYSIOLOGY

Dr. Muhammad Imran

Lecture No. 13 MBBS, M.Phil. CMT, Ph.D. Scholar
Assistant Professor Physiology, NMU
Chapter 66
Topics outline
1. Basic principles of absorption
2. Absorption in small intestine
3. Absorption in large intestine
Lecture # 13 Topics
➢ Basic principles of absorption
➢ Absorption in small intestine
• Carbohydrates, Fats & Proteins
• Ions & Water
• Vitamins
Basic Principles of
Gastrointestinal
Absorption
Quantity of fluid that must be absorbed
➢ The total quantity of fluid that must be absorbed each day by
the intestines is equal to the ingested fluid (about 1.5 liters)
plus that secreted in the various gas-trointestinal secretions
(about 7 liters).
➢ This comes to a total of 8 to 9 liters. All but about 1.5 liters
of this is absorbed in the small intestine, leaving only 1.5 liters
to pass through the ileocecal valve into the colon each day.
Absorption in stomach
➢ The stomach is a poor absorptive area of the gas-
trointestinal tract because it lacks the typical villus type of
absorptive membrane, and also because the junctions
between the epithelial cells are tight junctions.
➢ Only a few highly lipid-soluble substances, such as alcohol
and some drugs like aspirin, can be absorbed in small
quantities.
Absorption in small intestine
Intestinal modification to increase surface area for absorption
The small intestines are highly folded increasing the surface
area available for absorption.
Three special modifications greatly increase the surface area of the
small intestines:
• Valvulae conniventes (Folds of Kerckring)
• Villi
• Microvilli
• Valvulae conniventes (Folds of Kerckring)
Intestinal folds of mucosa increasing surface area around 3-fold.
especially well developed in the duodenum and jejunum, where they
often protrude up to 8 millimeters into the lumen
• Villi
Lining the intestinal mucosa are microscopic finger-like projections
called villi. Villi have a lining of enterocytes. These project about 1
millimeter from the surface of the mucosa.The presence of villi on the
mucosal surface enhances the total absorptive area another 10-fold.
• Microvilli
Microvilli are minute hair-like structures that are found on the surface of
enterocytes lining the villi, making brush border like appearance. Finally,
each intestinal epithelial cell on each villus is characterized by a brush
border, consisting of as many as 1000 microvilli 1 micrometer in length and
0.1 micrometer in diameter protruding into the intestinal chyme; This
increases the surface area exposed to the intestinal materials at least
another 20-fold
Thus, the combination of the folds of Kerckring,
the villi, and the microvilli increases the total
absorptive area of the mucosa perhaps 1000-fold,
making a tremendous total area of 250 or more
square meters for the entire small intestine—
about the surface area of a tennis court.
 Absorption of fats

As a result of fat digestion

➢ Fat-soluble vitamins,
➢ Monoglycerides,
➢ Glycerol,
➢ Cholesterol,
➢ Monoglycerides
➢ Need to enter the circulatory system,
where they can be used by cells around the
body.
 Absorption of fats
Fats are digested to form monoglycerides & fatty acids

Formation of micelles

Both monoglycerides & fatty acids becomes dissolved in the

central lipid portion of bile micelles

Micelles transport them to the surface of the intestinal cell brush border

Monoglyceride & fatty acids diffuse into the interior of the epithelial cells
because the lipids are also soluble in the epithelia cell membrane
(this ferrying function of micelles cause 97% of fat absorption)

Bile micelles are left behind to help absorb monoglycerides in

fatty acids again & again
New tri-glycerides are formed from the fatty acids and monoglycerides
inside the smooth endoplasmic reticulum of epithelial cells

New tri-glycerides are released in the form of chylomicrons through

the base of the epithelial cells

Chylomicrons flow into the lymphatics via lacteal then

into circulation through thoracic duct
 Absorption of short chain fatty acids
Small quantitates of short and medium chain fatty acids are water soluble
(Butter Fat)

Are absorbed directly into the portal blood by diffusion

(Not converted into tri-glycerides)
(Not absorbed by way of the lymphatics)

➢ The bloodstream can directly absorb short- and medium-

chain fatty acids and glycerol once these lipids have
entered the intestinal cells,
➢ But larger lipids such as monoglycerides, cholesterol, and
fat-soluble vitamins require more assistance by forming
chylomicrons to absorb and transfer into the bloodstream
The chylomicrons
➢ The chylomicrons are lipoproteins—large structures
made up of triglyceride and cholesterol in the core and
phospholipids in the outer membrane interspersed with
the proteins.
➢ Since they are covered by this outer membrane, they can
move in the body’s aqueous environment of blood and
lymph
➢ From the small intestine, chylomicrons travel into the
lymphatic system before reaching the bloodstream
➢ Dietary fats, after absorption, appear in the circulation as
a chylomicron.
➢ Their main function is to transport lipid molecules
through water molecules into the bloodstream.
 Absorption of
Carbohydrates &
different Ions
 Starches Potato (Polysaccharides)

Mouth (20-40%)
Ptyalin (Alpha-Amylase) Saliva-Parotid Gland
Common Carbohydrates
Amylose, Glycogen, Alcohol, Lactic Stomach
Acid, Pyruvic Acid, Pectin's, Dextrin's No digestive enzymes
& Carbohydrates derivatives in meats
Small intestine (50-80%)
Pancreatic Amylase (Stronger than Salivary amylase) 15-30 min
(Duodenum & Upper Jejunum)

Maltose & 3-9 Glucose Polymers (Disaccharides)

Intestine-enterocytes

Sucrose Sugarcane Maltase & Alpha Dextrinase Lactose Milk

(Disaccharides) (Disaccharides)
Intestine-enterocytes Intestine-enterocytes
Sucrase Lactase
Glucose + Glucose (80%)
Fructose + Glucose (10%) Galactose + Glucose (10%)
Absorption of different Carbohydrates
➢ All the carbohydrates in the food are absorbed in the form of
monosaccharides;
➢ Only a small fraction is absorbed as disaccharides
➢ Almost none as larger carbohydrate compounds are
absorbed.
➢ The most abundant of the absorbed monosaccharides is
glucose, usually accounting for more than 80 percent of
carbohydrate calories absorbed.
➢ The reason for this is that glucose is the final digestion
product of our most abundant carbohydrate food, the
starches.
➢ The remaining 20 percent of absorbed monosaccharides is
composed almost entirely of galactose and fructose, the
galactose derived from milk and the fructose as one of the
monosaccharides digested from cane sugar.
Transportation mechanisms
➢ All the monosaccharides (glucose) are absorbed by a
Sodium Co-Transport Mechanism.
➢ Galactose (Monosaccharide) is transported by almost
exactly the same mechanism as glucose.
• First stage, is active transport of sodium ions through the Na/K pump of basolateral
membrane form cell into the blood, thereby depleting sodium inside the epithelial cells.
• Second stage, low sodium inside the cells causes sodium from the intestinal lumen to
move to the cell interiors by combining with a special transport protein present in
microvillus membrane thus dragging glucose along with it (a process of secondary
active transport).

➢ Fructose (Monosaccharide) is transported by facilitated

diffusion.
Absorption of Carbohydrates, proteins & different Ions
Absorption of Carbohydrates, proteins & different Ions

Sodium plays a Vital role in absorption (Sodium is the Hero)

➢ Twenty to 30 grams of sodium are secreted in the intestinal
secretions each day. In addition, the average person eats 5 to
8 grams of sodium each day.
➢ Therefore, to prevent net loss of sodium into the feces, the
intestines must absorb 25 to 35 grams of sodium each day if
not absorbed, sodium will drag water from cell into lumen
causing diarrhea thus depleting sodium form body.
➢ Normally, however, less than 0.5 percent of the intestinal
sodium is lost in the feces each day because it is rapidly
absorbed through the intestinal mucosa.
➢ Sodium also plays an important role in helping to absorb
sugars and amino acids.
Absorption of Carbohydrates, proteins & different Ions

Type of transports
1. Active transport of sodium from cell to ECF by sodium
potassium ATPase pump in basolateral border.
2. Secondary active transport of sodium from lumen into cell
causing
• Sodium glucose co-transport
• Sodium Amino acid co-transport
3. Sodium hydrogen exchanger to maintain neutrality
4. Water reabsorption by Osmosis in the direction of sodium
movement
• Paracellular
• Transcellular
Absorption of Carbohydrates, proteins & different Ions

5. Absorption of chloride take part maximum in the upper

part of small intestine
• ATPase pump while throwing 3 Na in ECF cause positive
electrical gradient, moving chloride Ion from cell into
ECF through diffusion.
• Chloride Bicarbonate exchanger on luminal border to
maintain neutrality.
• The Bicarbonate that is moving into small intestine in
exchange of chloride will neutralize the acid being
produced by Bactria in large intestine.
• This Bicarbonate will combine with hydrogen Ion which
is present in lumen due to Sodium Hydrogen exchanger
forming carbonic acid and eventually Co2 & H2o. This
Co2 is expelled through lungs after absorption into
blood maintain PH and water moves to large intestine.
Absorption of Carbohydrates, proteins & different Ions

Applied Physiology
• Role of aldosterone in diarrhea
• Diarrhea in cholera
• Absorption of calcium in small intestine
• Absorption of iron in small intestine
Dietary Maximum absorption in duodenum & some
Iron amount is absorbed in proximal jejunum

Folic Maximum absorption in Jejunum & some

Acid amount is absorbed in duodenum

Vitamin
Maximum absorption in Ileum
B12
 Fructose
Transported by facilitated diffusion in to the cell

On entering the cell fructose is converted to glucose after

phosphorylation

Finally transported in the form of glucose form cell into the blood

Overall rate of transport is only about one half

that of glucose or fructose because of no active transport
Glucose absorption occurs in the small intestine by active transport via the SGLT-1
transporter (sodium glucose co-transporter).
Galactose, fructose and some glucose absorption is completed by the Glut5 transporter
by facilitated diffusion.
Absorption of
Proteins
Absorption of different Proteins
Most proteins, after digestion, are absorbed through the luminal
membranes of the intestinal epithelial cells in the form of
➢ Dipeptides,
➢ Tripeptides,
➢ Free amino acids.

Transport mechanism
➢ Sodium Co-transport mechanism (Secondary Active Transport)
➢ Via special membrane transport proteins (By Facilitated Diffusion)
Summary of absorption of
nutrients in small intestine
 Absorption in
The Large Intestine
The Large Intestine Has 3 Primary Functions:
➢ Absorbing water and electrolytes,
➢ Producing and absorbing vitamins,
➢ Forming and propelling feces toward the rectum for
elimination.
➢ Water balance regulated—large amounts of water absorbed
bacterial action on undigested food
➢ bacteria form moderate amounts of B complex and Vitamin K
gas formation –
➢ 1-3 pints/day, pass it through rectum (FLATULENCE) 14 times
a day, bacteria produce the gas
 Absorption In
The Large Intestine

Chyme entering large intestine =1500 ml

After absorption water left in feces =100 ml
After absorption ions left in feces 1-5 mEq/L
Maximal ability of large intestine to absorb fluids = 5-8 L
(Greater than that fluid appears in diarrhea)

Proximal Colon - Absorbing Colon

Distal Colon - Storage Colon

Absorption of the sodium causes chloride absorption as well.

Tight junctions between the epithelial cells prevent back-diffusion of ions
(better Na' absorption than small intestine)
Osmotic gradient pulls water

Mucosa of the large intestine secretes bicarbonate ions while it simultaneously

absorbs, an equal number of chloride ions
(Neutralize the acid end products of bacterial action in the large intestine)
 Bacterial Action In
The Colon

Digesting small
amounts of cellulose
Formation of carbon
dioxide, hydrogen &
methene gases
(flatus formation)
Proximal colon-Absorbing colon

Formation of Vitamin K,
vitamin B12, thiamine, riboflavin

Daily ingested vit-K insufficient

to maintain adequate blood coagulation
Short Chain Fatty acids
➢ SCFAs are a subset of fatty acids that are produced by
the gut microbiota during the fermentation of partially
and nondigestible polysaccharides.
➢ The highest levels of SCFAs are found in the proximal
colon, where they are used locally by enterocytes or
transported across the gut epithelium into the
bloodstream.
➢ Acetate, propionate, and butyrate are three major
SCFAs.
➢ The SCFAs have many health benefits, such as anti-
inflammatory, immunoregulatory, anti-obesity, anti-
diabetes, anticancer, cardiovascular protective,
hepatoprotective, and neuroprotective activities.
 Composition Of The Feces

3 / 4th - Water
1 / 4th - Solid matter

30% dead bacteria, 10-20% fat, 10-20% inorganic matter, 2-3 protein,
30% undigested roughage & dried digestive juices,
The brown color of feces is caused by stercobilin & urobilin

Odor
Products of bacterial action (colonic bacterial flora & type of food eaten)
odoriferous products include indole, skatole, mercaptans,
and hydrogen sulfide