Digestive System

The digestive system is a system of body which breakdown food into forms that can be
absorbed and used by body cells. It also absorbs water, vitamins, and minerals, and eliminates
wastes from the body. It breakdowns the larger molecules present in food into molecules that are
small enough to enter body cells by a process known as digestion. The organs which are
involved in the breakdown of food are collectively called the digestive system. The digestive

system is a tubular system which extends from the mouth to the anus.
The digestive system can be divided into two parts:
1. The gastrointestinal (GI) tract, or alimentary canal (alimentary = nourishment), is a
continuous tube that extends from the mouth to the anus. Organs of the gastrointestinal tract
include the mouth, most of the pharynx, esophagus, stomach, small intestine, and large
intestine.

2. The accessory digestive organs are the organs which assist in digestion of food. These
include the teeth, tongue, salivary glands, liver, gallbladder, and pancreas. Teeth aid in the
physical breakdown of food, and the tongue assists in chewing and swallowing. The other
accessory digestive organs never come into direct contact with food but they produce
secretions which aid in the chemical breakdown of food.

Functions of digestive system:

1. Ingestion: This process involves taking foods and liquids into the mouth (eating).
2. Secretion: Cells within the walls of the GI tract and accessory digestive organs secrete about 7
liters of water, acid, buffers, and enzymes into the tract which help in digestion of food.

3. Mixing and propulsion: Alternating contractions and relaxations of smooth muscle in the
walls of the GI tract mix food and secretions and propel them toward the anus. This capability of
the GI tract to mix and move material along its length is called motility.

4. Digestion: Digestion is of two types- Mechanical and Chemical digestion. In mechanical

digestion the teeth cut and grind food into smaller pieces. Then smooth muscles of the stomach
and small intestine break it into further small pieces and mix it thoroughly with digestive
enzymes. In chemical digestion the large carbohydrate, lipid, protein, and nucleic acid molecules
in food are split into smaller molecules by hydrolysis and digestive enzymes. Vitamins, ions,
cholesterol and water can be absorbed without chemical digestion.

5. Absorption: The entrance of ingested and secreted fluids, ions, and the products of digestion
into the epithelial cells lining the lumen of the GI tract is called absorption. The absorbed
substances pass into blood or lymph and circulate to cells throughout the body.

6. Defecation: Wastes, indigestible substances, bacteria, cells sloughed from the lining of the GI
tract, and digested materials that were not absorbed in their journey through the digestive tract
leave the body through the anus in a process called defecation. The eliminated material is termed
feces.
Layers of GI Tract:
The wall of the GI tract has four layers tissues. These four layers (from deep to superficial) are

the mucosa, submucosa, muscularis, and serosa.

Layers of GIT
1. Mucosa: It is the inner lining of the GI tract. It is subdivided into 3 layers called Epithelium,
Lamina propria and muscularis mucosae.

The epithelium may be simple or stratified which plays role in protection,

secretion and absorption. Epithelial cells also secrete mucus and fluid into the lumen of
the tract.

The lamina propria (lamina = thin) is areolar connective tissue containing

many blood and lymphatic vessels, which transfers the absorbed nutrients to the other
tissues of the body. The lamina propria also contains the mucosa-associated lymphatic
tissue (MALT) which contains immune system cells that protect against disease.

Muscularis musosae is a thin layer of smooth muscle fibers which increases the
surface area of the stomach and small intestine by many folds to enhance
digestion and absorption.

2. Submucosa: The submucosa consists of areolar connective tissue that binds the mucosa to
the muscularis. It contains many blood and lymphatic vessels that receive absorbed food
 molecules. It also contains an extensive network of neurons known as the submucosal plexus

or plexus of Meissner (apart of ENS).

3. Muscularis: Muscularis contains both skeletal muscles and smooth muscles. Skeletal
muscles help in voluntary swallowing and defecation. Involuntary contractions of the smooth
muscle help break down food, mix it with digestive secretions, and propel it along the tract.
The bundle of neurons present in this layeri is called myenteric plexus.

4. Serosa: It is a protective and connective tissue which forms the outer layer of the GI tract
which are suspended in the abdominopelvic cavity.

Peritonium:
It is the largest serous membrane. The peritoneum is divided into the parietal peritoneum, which
lines the wall of the abdominopelvic cavity, and the visceral peritoneum, which covers some of

the organs in the cavity and is their serosa.

Parts of digestive system:

1. Mouth:

Mouth is also called Oral cavity or Buccal cavity. It is formed by cheeks, hard
palate, soft palate and tongue.

Cheeks form lateral walls of mouth and are covered by skin from outside and
mucous membrane from inside.

Hard palate forms anterior portion of roof of mouth. Hard palate is made up of
palatine and maxillae bones covered with mucous membrane. Hard palate forms bony
partition between oral and nasal cavity.

Soft palate forms posterior portion of roof of mouth. It forms partition between
oropharynx and nasopharynx. Soft palate is also covered with mucous membrane.

Uvula is small muscular process hanging from soft palate. It prevents entrance of
swallowed food and liquid into nasal cavity.
2. Salivary glands:
A salivary gland is a gland that releases a secretion called saliva into the oral cavity. Saliva is
secreted to keep the mucous membranes of the mouth and pharynx moist and to cleanse the
mouth and teeth. When food enters the mouth, secretion of saliva increases, and it lubricates,
dissolves and begins the chemical breakdown of the food. There are 3 pairs of major salivary

glands which secrete saliva:

The parotid glands: (par = near; ot = ear) are located near ears. These secretes
saliva into the oral cavity via a parotid duct that open into the vestibule opposite the
second maxillary (upper) molar tooth.

The submandibular glands: (sub = below, mandible = lower jaw bone) are found
in the floor of the mouth, below lower jaw. Their ducts open into the oral cavity lateral
to the lingual frenulum.

The sublingual glands: (sub = below, lingual = tongue) are beneath the tongue and
superior to the submandibular glands. Their ducts open into the floor of the mouth.
Several minor glands are also present in cheeks, palates, tongue and lips etc. which produce

small amount of saliva. Process of secretion of saliva is called salivation.

Composition and functions of saliva:
Chemically saliva consists of 99.5% water and 0.5% of solutes. Solutes include ions
such as chloride ions, sodium, potassium, bicarbonate and phosphate ions.

It also contains various organic substances like urea, uric acid, mucus,
immunoglobin A, bacteriolytic enzyme lysozyme and salivary amylase.
Water dissolves food and helps to produce taste of food to initiate digestion.
Chloride ions in saliva activate salivary amylase which is an enzyme that starts
breakdown of starch.

Phosphate and bicarbonate ions buffer acidic food so that saliva is only slightly acidic
(6.35- 6.85)
Mucus lubricates and moistens food for easy swallowing.
IgA prevents microbes to enter or attach epithelial cells whereas lysozyme destroys
harmful bacteria.

3. Tongue:
Tongue is an accessory digestive organ composed of skeletal muscle covered with mucous

membrane. It helps to taste the food, swallow food and to speak. Tongue and its associated
muscles form floor of tongue. Tongue is divided into 2 symmetrical lateral parts by a median

septum that extends its whole length. Tongue consists of two types of muscles:

The extrinsic muscles move the tongue from side to side and in and out to
maneuver food for chewing, shape the food into a rounded mass, and force the food to the
back of the mouth for swallowing. They also form the floor of the mouth and hold the tongue
in position.

The intrinsic muscles alter the shape and size of the tongue for speech and
swallowing.

A fold of mucous membrane in midline of undersurface of tongue called lingual frenulum is

attached to floor of mouth and controls posterior movement of tongue.

The upper surface and lateral surfaces of the tongue are covered with papillae. Many papillae
contain taste buds, the receptors for gustation (taste). Some papillae lack taste buds, but they
contain receptors for touch and increase friction between the tongue and food, making it easier

for the tongue to move food in the oral cavity.

Lingual glands are also present which secretes mucus and fluid containing an enzyme lingual

lipase which breakdowns the triglycerides.

4. Teeth:

Teeth or dentes are the accessory digestive organs which cut, tear and pulverize
the solid food to reduce it into smaller particles which makes it easy to swallow and digest.
Teeth are
located in aveolar processes of mandible and maxillae.
 Aveolar processes are covered with gingivae (gums) that extend into each socket.
Sockets are lined by periodontal ligaments made of dense firbrous connective tissue with
anchors teeth

into socket.

A tooth has three parts: crown, root, and neck. The crown is the visible portion
above the level of the gums. Roots are the portion embedded in the socket. The neck is the
constricted junction of the crown and root near the gum line.

Internally, dentin forms the majority of the tooth. Dentin gives the tooth its basic
shape and rigidity. It is harder than bone because of its higher content of calcium salts.

The dentin of the crown is covered by enamel, which consists primarily of calcium
phosphate and calcium carbonate. Enamel is also harder than bone because of its even higher
content of calcium salts (about 95% of dry weight). In fact, enamel is the hardest substance
in the body. It serves to protect the tooth from the wear and tear of chewing. It also protects
against acids that can easily dissolve dentin.

The dentin of the root is covered by cementum, another bone like substance, which
attaches the root to the periodontal ligament.

The dentin of a tooth encloses a space which is called pulp cavity. This pulp cavity
contains blood vessels, nerves, and lymphatic vessels. Narrow extensions of the pulp
cavity, called root canals, run through the root of the tooth. Each root canal has an opening
at its base, the apical foramen, through which blood vessels, lymphatic vessels, and
nerves extend. The
 blood vessels bring nourishment, the lymphatic vessels offer protection, and the nerves

provide sensation.

Mechanical and Chemical digestion in the mouth:

Mechanical digestion: Mechanical digestion starts with mechanical breakdown of

food by teeth by chewing or mastication. After chewing and mixing with saliva, food is
converted into soft, flexible and easily swallowed mass called bolus (lump). Small food
molecules are dissolved in saliva and water after which they are reacted upon by enzymes.

Chemical digestion: It is done by 2 enzymes:

a. Salivary amylase: It is secreted by salivary glands. It causes breakdown of starch into
simple units of monosaccharides and bisaccharides. Food contains mono, bi and
polysaccharides but only monosaccharides are absorbed. So it starts breakdown of

polysaccharides into smaller until it is inactivated by acid present in stomach.

b. Lingual lipase: It is secreted by glands in tongue and results in breakdown of
triglycerides into diglycerides and fatty acids. It is activated in acidic environment of

stomach. So it is inactive in mouth and starts working after swallowing of food.

5. Pharynx:
Pharynx is funnel shaped tube, covered with mucous and composed of skeletal muscle. It is

present in region which extends from internal naresto esophagus. It is divided into 3 parts:
Nasopharynx: helps in respiration; Oropharnyx and laryngopharynx: it helps in respiration as

well as swallowing of food.

6. Esophagus:
It is a collapsible muscular tube (25 cm long) which starts from inferior end of laryngopharynx
and it ends at superior portion of stomach. It lies posterior to trachea and anterior to vertebral

column. Its main function is to transfer the bolus from mouth to stomach.

At each end of the esophagus a sphincter is present. The upper esophageal sphincter (UES)
consists of skeletal muscle and the lower esophageal sphincter (LES) consists of smooth muscle.
The upper esophageal sphincter regulates the movement of food from the pharynx into the
esophagus and the lower esophageal sphincter regulates the movement of food from the

esophagus into the stomach.

The movement of food from the mouth into the stomach is achieved by the act of swallowing, or
deglutition. Deglutition is facilitated by the secretion of saliva and mucus and involves the
mouth, pharynx, and esophagus. Swallowing occurs in three stages: (1) the voluntary stage, in
which the bolus is passed into the oropharynx; (2) the pharyngeal stage, the involuntary passage
of the bolus through the pharynx into the esophagus; and (3) the esophageal stage, the
involuntary passage of the bolus through the esophagus into the stomach. During esophageal
phase, peristalsis (stalsis = constriction), a progression of coordinated contractions and
relaxations of the circular and longitudinal layers of the muscularis, pushes the bolus toward

stomach
Physiology of the Esophagus: The esophagus secretes mucus and transports food into the

stomach. It does not produce digestive enzymes, and it does not carry on absorption.

7. Stomach:
Stomach is a ‘J’ shaped enlargement of GI Tract which lies directly inferior to diaphragm. It
connect esophagus to duodenum (first part of small intestine). Stomach serves as mixing
chamber and holding reservoir for food. When food is ingested, stomach pushes a small quantity
of food into duodenum periodically. As the size of stomach can vary, it can store large amount of
food. In stomach, semisolid bolus is converted into liquid, digestion of starch continues,

digestion of triglycerides and protein starts and absorption of several substances takes place.

Anatomy of stomach: The stomach has four main regions: the cardia, fundus, body and pylorus.

The cardia surrounds the superior opening of the stomach.

The fundus is the rounded portion superior and left to the cardia.
The body is inferior to the fundus and is the large central portion of the stomach.
The pylorus is the region of the stomach that connects to the duodenum. (pyl = gate; orus =
guard). Pylorus has two parts, the pyloric antrum which connects to the body of the stomach,

and the pyloric canal, which leads into the duodenum.

When the stomach is empty, the mucosa lies in large folds, called rugae (wrinkles) that can be
seen with the unaided eye. The pylorus communicates with the duodenum of the small intestine
via a smooth muscle sphincter called the pyloric sphincter. The concave medial border of the
stomach is called the lesser curvature, and the convex lateral border is called the greater

curvature.
Histology of stomach: The stomach wall is composed of 4 basic layers:
Mucosa: Mucosa contains several glands called gastric glands. The gastric glands contain three
types of exocrine gland cells and one type of endocrine cells that secrete their products into the

stomach and bloodstream respectively.

a. Mucous neck cells: These cells secrete mucus.
b. Chief cells: The chief cells secrete pepsinogen and gastric lipase.
c. Parietal cells: Parietal cells produce intrinsic factor (needed for absorption of vitamin B12)

and hydrochloric acid.

The secretions of the mucous, parietal & chief cells collectively form gastric juice (2–3 Lt/day).

d. G cell: These are endocrine cells which are located mainly in the mucous of pyloric antrum
and secretes the hormone gastrin into the bloodstream

Submucosa: is made up of areolar connective tissue.

Muscularis: is composed of 3 layers of smooth layers; oblique muscles, circular muscles and

longitudinal muscles.
Serosa: forms outermost layer of stomach.
Mechanical and chemical digestion in stomach:
When food enters the stomach, gentle peristalitic waves pass over the stomach every
15-25 second which is called mixing waves. These waves mix the food with gastric
juice and convert it into a soupy liquid called chyme.

As digestion proceeds more vigorous mixing wave start at body of stomach and
intensify as they reach pylorus. At pylorus, each wave periodically pushes little amount of
chyme into small intestine thorough pyloric sphincter. This process is called gastric
emptying.

Starch is digested by salivary amylase when food is in fundus. When food moves
into body, mixing of chyme with gastric juices starts. The salivary amylase is inactivated
and lingual lipase is activated. This stops digestion of starch and starts digestion of
triglycerides into diglycerides and fatty acids.

Parietal cell present in walls of stomach start secretion of a strong acid HCl,
which kills microbes and denature proteins. HCl also stimulate secretion of hormones
which further increases flow of bile and pancreatic juices.

Enzymatic digestion of proteins also begins in the stomach. The chief cells in
stomach secrete proteolytic (protein-digesting) enzyme in the stomach called pepsin.
Pepsin breaks peptide bonds to breaking down a large protein chain smaller peptide
fragments. Pepsin is most effective in the very acidic environment of the stomach (pH 2); it
becomes inactive at a higher pH.

What keeps pepsin from digesting the protein in stomach cells along with the food?
First, pepsin is secreted in an inactive form called pepsinogen; in this form, it cannot digest
the proteins in the chief cells that produce it. Pepsinogen is not converted into active pepsin
until it comes in contact with hydrochloric acid secreted by parietal cells or active pepsin
molecules. Second, the stomach epithelial cells are protected from gastric juices by a 1–3 mm
thick layer of alkaline mucus secreted by surface mucous cells and mucous neck cells.

Another enzyme of the stomach is gastric lipase, which splits the short-chain
triglycerides in fat molecules.

Only a small amount of nutrients are absorbed in the stomach e.g. water, ions, and
short- chain fatty acids, as well as certain drugs (especially aspirin) and alcohol.
Mechanism of HCl secretion by parietal cells: Parietal cells secrete H+ and Cl- separately into
stomach lumen but net effect is secretion of HCl. Proton pumps actively transport H+ into lumen
and bring K+ ion back into cell. At same time Cl- and K+ diffuse out into lumen through Cl- and
K+ channels in apical membrane. Carbonic anhydrase enzyme present in parietal cell produces
carbonic acid from CO2 and H2O. H2CO3 dissociates into H+ and HCO3-. H+ moves into
lumen by H+/K+ ATPase pump and HCO3- moves into bloodstream. HCl secretion in parietal

cells can be stimulated by Gastrin, Acetylcholine and Hisatmaine.

8. Pancreas:
Pancreas (Pan = all, creas = flesh) is a retroperitoneal (behind peritoneum) gland, which lies
posterior to greater curvature of stomach. It is 12- 15cm long and 2-3cm thick. Anatomically it is

divided into 3 parts:

Head: It is expanded portion and lies near to curve of duodenum
Body: It is central part and is left and superior to head.
 Tail: It is last tapering portion of pancreas.
Pancreas has two ducts that open into duodenum and these ducts carry pancreatic juices into

duodenum:
Pancreatic duct: It is larger in size. It combines with common bile duct from liver
and forms hepatopancreatic ampulla which opens into duodenum.
Accessory duct: It is smaller and also opens into duodenum.
Histology of Pancreas:
Pancreas are made up of small clusters of glandular epithelial cells known as acini. 99% of acini
are exocrine cells which secrete mixture of fluid and digestive enzymes called pancreatic juice.
1% of acini are endocrine cells which are called Pancreatic Islets or Islet of Langerhans. These

pancreatic islets secrete 4 types of hormone:

Glucagon: It increases blood sugar level.

Insulin: It decreases blood sugar level.

Somatostatin: It maintains Gluacagon and Insulin level in body.

Pancreatic polypeptide: It controls somatostatin secretion.

Composition and functions of pancreatic juice:
Pancreatic juice is a clear, colorless liquid is consisting of water, salts, sodium
bicarbonate and several enzymes. Each day 1200- 1500 ml pancreatic juice is produced.

Sodium bicarbonate makes pancreatic juice slight alkaline (7.1-8.2) and stops
action of pepsin from stomach and creates pH for action of digestive enzyme in small
intestine.
Enzymes secreted in pancreatic juices are:
o Pancreatic amylase: It is starch digesting enzyme.
o Trypsin, Chymotrypsin, Carboxypeptidase, Elastase: These are protein digesting
enzymes.
o Pancreatic lipase: This is major triglyceride digesting enzyme.
o Ribonuclease and deoxyribonuclease: Nucleic acid digesting enzyme.

9. Liver and Gall bladder:

Liver is the 2nd largest organ in body, located inferior to diaphragm. Gallbladder is pear
shaped

sac located inferiorly and posteriorly to liver.

Anatomy: Liver is divided into 2 lobes; Right lobe (larger) and left lobe (smaller). Right and left

lobes are separated by falciform ligament.

Gall bladder has 3 portions. The inferior broad portion is called fundus, the middle portion is

called body and the upper taper portion is called neck.

Histology of liver and Gall bladder:
Liver: is made up of lobes. Lobes are made up of lobules (small functional units). Lobules are
further made up of specialized cells called hepatocytes (hepato = liver, cytes = cells). Lobules
contain highly permeable capillaries which supply blood to hepatocytes. These capillaries

contain stellate reticuloendothelial cells also called Kupffer cells. These Kupffer cells act as
phagocytes and destroy worn out RBC, WBC, bacteria and other foreign materials.
Hepatocytes secret bile into bile canaliculi. Bile canaliculi carry bile into bile ductules which
transfers it into left hepatic duct or right hepatic duct. These left and right hepatic ducts combines
to form common hepatic duct which further combines with cystic duct (from gall bladder) to

form common bile duct.

Gall bladder: is made up of simple epithelial cells. Contraction of smooth muscles ejects the
content of gallbladder into cystic duct. Functions of gallbladder are to store and concentrate the

bile until required in duodenum. Concentration is done by the absorption of water and ions.
Role and composition of bile: Each day, hepatocytes secrete about 1 lt of bile, a yellow,
brownish, or olive-green liquid. It has a pH of 7.6–8.6 and consists mostly of water, bile salts,

cholesterol, a phospholipid called lecithin, bile pigments, and several ions.

Bile salts (sodium and potassium salts of bile acid) play role in emulsification.
Emulsification is process of breakdown of large lipids into small lipid gloubules. These
small gloubules are easily digested by pancreatic lipase.

Bile salts also play important role in absorption of lipids.

Functions of liver:
Carbohydrate metabolism: Liver maintains normal blood glucose level. When
blood glucose level is low, it starts breakdown of glycogen (storage form of glucose) to
glucose. It also converts lactic acid and amino acid into glucose. It can also convert
fructose, galactose and other sugars into glucose. When blood sugar level rises, it converts
glucose into glycogen and triglycerides for storage.

Lipid metabolism: Hepatocytes store some triglycerides; break down fatty acids to
generate ATP; synthesize lipoproteins, which transport fatty acids, triglycerides, and
cholesterol to and from body cells; synthesize cholesterol; and use cholesterol to make bile
salts.

Protein metabolism: Hepatocytes remove amino group (NH2) from amino acids
so that amino acids can be used for ATP production or can be converted into carbohydrates
or fats. The harmful free amino group (NH2) is converted into urea which can be
excreted out of body in urine.

Processing of drugs and hormones: The liver can detoxify substances such as
alcohol and excrete drugs such as penicillin, erythromycin, and sulfonamides into bile.
It can also chemically alter or excrete thyroid hormones and steroid hormones such as
estrogens and aldosterone.

Excretion of billirubin: Bilirubin, derived from the heme of aged red blood
cells, is absorbed by the liver from the blood and secreted into bile. Most of the bilirubin
in bile is metabolized in the small intestine by bacteria and eliminated in feces.

Synthesis of bile salts: Bile salts are used in the small intestine for the
emulsification and absorption of lipids.
 Storage: In addition to glycogen, the liver is a prime storage site for certain
vitamins (A, B12,D, E, and K) and minerals (iron and copper).

Phagocytosis: The stellate reticuloendothelial (Kupffer) cells of the liver

phagocytize aged red blood cells, white blood cells, and some bacteria.

Activation of vitamin D: Liver along with skin and kidneys participate in

synthesizing the active form of vitamin D.

10.Small Intestine:
Small intestine starts from pyloric sphincter of stomach, coils through central and inferior part of
abdominal cavity and ends at large intestine. It has major role in digestion and absorption of

nutrients.

Anatomy: It has 3 major parts:

a. Duodenum: This is first part of small intestine. It starts from pyloric sphincter, extends up to
25 cm and merges into jejunum.
b. Jejunum: It is middle part and extends up to ileum.
c. Ileum: It is last part of small intestine and ends at ileocecal junction of large intestine.
Histology: Small intestine is composed of same basic 4 layers:
Muscosa: The mucosa of small intestine contains many types of cells:
Absorptive cells: These cells digest and absorb nutrients.
Goblet cells: These cells secrete mucus.
Paneth cells: These secrete bactericidal enzyme lyzozyme. Lyzoyme play
role in phagocytosis.

Endocrine cells: These cells secrete hormones into blood stream. These
include: S cells: secrete secretin
CCK cells: secrete cholecystokinin or CCK
K cells: secrete Glucose dependent insulinotropic peptide or GIP
Mucosa of small intestine also contain some special structural feature which
facilitates

digestion and absorption:

a. Circular folds: These are folds of mucosa and submucosa. These folds increase surface

area and cause the chime to move spiral than straight as it passes through small intestine.

b. Villi: These are fingerlike projections of mucosa which vastly increases surface area for

absorption and digestion. (20-40 sq. mm.)

c. Microvilli: These are projections from free membrane of absorptive cells. These are too
small to see individually under microscope. Instead they form a fuzzy line called brush
border. This brush border also contains several enzymes called brush border enzyme that

have digestive function.

Submucosa: The submucosa of the duodenum contains duodenal which secrete an alkaline

mucus that helps neutralize gastric acid in the chyme.

Muscularis: The muscularis of the small intestine consists of two layers of smooth muscle i.e.

the outer longitudinal and inner circular muscles.

Serosa: The serosa (or visceral peritoneum) completely surrounds the small intestine.

Role of intestinal juice and brush border enzyme:

About 1-2 lt of intestinal juice (pH 7.6) is secreted everyday which contained water and mucous.
Intestinal juice mixes with pancreatic juices and provides the liquid medium for absorption of

substance from chime into small intestine.

Brush border enzymes secreted from absorptive cells in small intestine contain following types

of enzymes:
Four carbohydrate-digesting enzymes called α-dextrinase, maltase,sucrase and lactase

Two Protein-digesting enzymes called peptidases (aminopeptidase and dipeptidase)

Two types of nucleotide-digesting enzymes, nucleosidases and phosphatases.
Mechanical and chemical digestion in small intestine:
Mechanical Digestion: Two types of movements occur in small intestine which result in

mechanical digestion:
Segmentation: These are localized mixing contractions that occur in portions
of small intestine distended with large volume of chime. Segmentation helps in mixing and
absorption of chyme, but it does not push chyme forward.

Migrating motality complex (MMC): This is a type of peristaltic movement which

occurs when volume of chyme in distended portion of small intestine decreases. This
pushes the chyme forward.

Chyme remains in small intestine for 3-5 hours.

Chemical digestion: Chyme entering the small intestine contains partially digested
carbohydrates, proteins, and lipids by the enzymes in mouth and stomach. The completion of the
digestion of carbohydrates, proteins, and lipids occurs in small intestine and it is a collective

effort of pancreatic juice, bile, and intestinal juice.

Digestion of carbohydrates: Starches are broken into maltose, maltriose and α-
dextrin units by pancreatic amylase. Following brush border enzymes act on these and
convert it even smaller units.
o α-Dextrinase acts on α-dextrin to produce glucose.
o Maltase splits maltose and maltriose into 2-3 units of glucose.
o Lactase digests lactose into a glucose and galactose.
o Sucrase breaks sucrose into molecule of glucose and fructose.
o Cellulose (a polysaccharide) is not digested by amylase enzymes and hence it is called
roughage.

Digestion of proteins: Trypsin, chymotrypsin, carboxypeptidase and elastase

convert proteins into peptide units. These peptides are converted into small amino acids
by two enzymes aminopeptidase and Dipeptidase which break amino acids into single
amino acids.

Digestion of lipids: Most of triglycerides in food are broken into long chain or
short chain fatty acids and monoglycerides by pancreatic lipase. Long chain fatty acids
are emulsified into short chain fatty acid by bile salts in small intestine.

Digestion of nucleic acids: Pancreatic juice contains two nucleases (nucleic acid
digesting enzymes) ribonuclease (digests RNA) and deoxyribonuclease (digests
DNA) into
 nucleotides. These nucleotides are further digested by brush-border enzymes called

nucleosidases and phosphatases intopentoses, phosphates, and nitrogenous bases.

Absorption in small intestine: All chemical and mechanical phases of digestion convert large
molecule into smaller one which can be easily absorbed. For example Carbohydrates are
converted into monnosacchride i.e. glucose, fructose and galactose. Proteins are converted into
single amino acids, dipeptides and tripeptides. Triglycerides are converted into fatty acids,

glycerol and monoglycerides.

Passage of these digested nutrients from GIT into blood or lymph is called absorption. Nutrients
move from lumen into absorptive cells and then pass to blood or lymph capillaries or lacteals in
villi. Lacteals are network of blood and lymph capillaries which absorb fat. This absorbed fat
gives them milky appearance and hence they are called lacteals (lact = milky). 90% of all
absorption of nutrients occurs in small intestine. Absorption is done by diffusion, fascilitated

diffusion, osmosis and active transport.

Absorption of monosaccharides: All carbohydrates are absorbed as
monosaccharides. Fructose is absorbed by fascilitated diffusion; glucose and galactose
are absorbed by secondary active transport into absorptive cells. Monosacchrides move out
of absorptive cells via facilitated diffusion.

Absortion of amino acids, dipeptides and tripeptides: Most of proteins are

absorbed as amino acid via active transport. Dipeptides and tripeptides which enter
absorptive cells are broken into to single amino acid. Amino acids move out of absorptive
cells via diffusion.

Absorption of lipids: All dietary lipids are absorbed by simple diffusion.

Triglycerides are broken into monoglycerides and fatty acids (long chain and short chain).
Short chain fatty acids are absorbed easily. Long chain fatty acids and monoglycerides are
absorbed with the help of bile salts. Bile salts form tiny spheres called micelles which
carry fatty acids and monoglycerides to the absorptive cells for absorption. Micelles also
help to solubilize and absorb other large hydrophobic molecules such as Vit. A, D, E, K and
cholesterol.

Absorption of electrolytes: Electrolytes absorbed in small intestine come from

ingested food, liquids and from gastrointestinal sescretions. Most of the electrolytes
including Na+ , Ca2+ , negatively charged ions like bicarbonate, chloride, iodide, nitrate,
other electrolytes
like iron, potassium, magnesium and phosphate etc. are absorbed by active or passive

transport.
Absorption of vitamins: Fat soluble vitamins like Vit. A, D, E, K are absorbed by
simple diffusion by micelle formation. Water soluble vitamins Vit. B and C are also
absorbed by simple diffusion. Vit B12 combines with intrinsic factor produced by
stomach and and is absorbed in ileum via active transport.

Absorption of water: All water absorption in the GI tract occurs via osmosis.
Because water can move across the intestinal mucosa in both directions, the absorption of
water from the small intestine depends on the absorption of electrolytes and nutrients to
maintain an osmotic balance with the blood.
11.Large Intestine:
The large intestine is the terminal portion of the GI tract. The overall functions of the large
intestine are the completion of absorption, the production of certain vitamins, the formation of

feces and the expulsion of feces from the body.

Anatomy of large intestine: Large intestine is about 1.5 m long and extends from ileum to anus.
The joining of small and large intestine occurs at ileocecal sphincter which controls movement of
material from small intestine to large intestine. Large intestine consists of 4 major regions

cecum, colon, rectum and anal canal.

Cecum is a small pouch like organ which is present next to ileocecal sphincter. Attached to

cecum is a coiled and twisted tube called appendix or vermiform appendix.

Colon is a long tube which is present next to cecum. The open end of cecum attaches with colon.
Colon is divided into 4 portions i.e. ascending colon, transverse colon, descending colon and

sigmoid colon.
Rectum is approximately last 20 cm of GI tract. Terminal 2-3 cm of rectum is called anal canal.
Opening of anal canal to exterior is called anus which is guarded by internal sphincter of smooth

muscles and external sphincter of skeletal muscles.

Histology of large intestine: Walls of large intestine consists of same basic 4 layers:
Mucosa: Mucosa mainly consists of absorptive and goblet cells. The absorptive cells function in
water absorption and the goblet cells secrete mucus that lubricates the passage of the colonic

contents. Villi and circular folds are absent in large intestine.

Submucosa: Submucosa is similar to that of rest of GIT.
Muscularis: Muscularis consists of circular and longitudinal muscles. Tonic contraction of

circular muscles divide colon into series of pouches called huastra.

Serosa: consist of visceral peritoneum.

Mechanical digestion in large intestine: As food passes through ileocecal sphincter, it fills the
cecum and accumulates in ascending colon. The haustral churning occurs in colon. In this
process, huastra remain relaxed and becomes distended when filled up. After a certain point, the
walls contract and squeeze the content into next haustrum. Peristalsis occurs at slow rate. A final
movement i.e. mass peristalsis which is a strong peristaltic wave, starts from middle
of transverse colon and drives the colonic contents into rectum (3-4 times a day).
Chemical digestion in large intestine: Chemical digestion in large intestine is done by bacteria

and no enzyme is secreted.

Bacteria ferments any remaining carbohydrate and releases hydrogen, CO2 and methane gas. If
excessive, these gases cause flatulence.

Bacteria also convert remaining protein to amino acids and amino acids into simple
substances like indole, hydrogen sulphide which are further converted to less toxic
substances by liver.

Bacteria also decompose bilirubin to simple pigment like stercobilin which gives brown color to
fecal material.
Certain vitamins like Vitamin B and K are produced by bacteria which are absorbed in colon.

Absorption and feces formation in large intestine: Chyme remains for 3– 10 hours in large
intestine and it becomes solid or semisolid because of water absorption and then it is called
feces. Chemically, feces consist of water, inorganic salts, sloughed-off epithelial cells from the
mucosa of the gastrointestinal tract, bacteria, products of bacterial decomposition, unabsorbed

digested materials, and indigestible parts of food.

Although 90% of all water absorption occurs in the small intestine, the large intestine absorbs
enough to make it an important organ in maintaining the body’s water balance. The large

intestine also absorbs ions, including sodium and chloride, and some vitamins.

Phases of Digestion:
Digestive activities occur in three overlapping phases: the cephalic phase, the gastric phase, and

the intestinal phase.

Cephalic phase: During this phase, smell, sight, thought or initial taste of food activates neural
centers in different parts of brain. The brain parts stimulate salivary glands and gastric glands to
secrete saliva and gastric juices respectively. This phase of digestion prepare mouth and stomach

for food that is about to be eaten.

Gastric phase: Once food reaches the stomach, the gastric phase of digestion begins. Neural and
hormonal mechanisms regulate the gastric phase of digestion to promote gastric secretion and

gastric motility.
 Neural regulation: Food of any kind distends the stomach and stimulates stretch
receptors in its walls. Chemoreceptors in the stomach monitor the pH of the stomach
chime. When the stomach walls are distended by food or pH increases because proteins
have entered the stomach the stretch receptors and chemoreceptors are activated. This
activation propagates nerve impulses which cause peristalsis and stimulation of flow of
gastric juice from gastric glands. The peristaltic waves mix the food with gastric juice; and
cause gastric emptying into the duodenum. The pH of the stomach chyme decreases
(becomes more acidic) and the distension of the stomach walls decreases to normal.

Hormonal regulation: Gastric secretion during the gastric phase is also regulated
by the hormone gastrin. Gastrin is released from the G cells when chyme distends stomach,
partially digested proteins, caffeine, high pH of chime etc. Gastrin stimulates gastric glands
to secrete gastric juice. It closes lower esophageal sphincter so that acid can nto reflux back
and opens pyloric sphincter so that chime can move ahead. Gastrin secretion stops when pH
falls below 2.

Intestinal phase: The intestinal phase of digestion begins once food enters the small intestine.
Intestinal phase have inhibitory effects that slow the exit of chyme from the stomach. This
prevents the duodenum from being overloaded with more chyme than it can handle. In addition
intestinal phase promote the continued digestion of foods that have reached the small intestine.
These activities of the intestinal phase of digestion are regulated by neural and hormonal

mechanisms.
Neural regulation: Distension of the duodenum by chyme causes the enterogastric
reflex. Stretch receptors in the duodenal wall send nerve impulses to inhibit gastric
motility. The contraction of the pyloric sphincter increases which decreases gastric emptying.

Hormonal regulation: The hormonal regulation is done by two hormones:

cholecystokinin and secretin. Cholecystokinin (CCK) is secreted by the CCK cells which
stimulate secretion of pancreatic juice, contraction of gallbladder and relaxation of
the sphincter of the hepatopancreatic ampulla (sphincter of Oddi), to increases digestion.
CCK also slows gastric emptying by promoting contraction of the pyloric sphincter,
produces satiety (a feeling of fullness) and enhances the effects of secretin.

Acidic chyme entering the duodenum stimulates the release of secretin from the
S cells which stimulates the flow of pancreatic juice rich in bicarbonate ions to buffer
the acidic
 chyme. Secretin also enhances the effects of CCK. Overall, secretin causes buffering of acid

in chyme that reaches the duodenum and slows production of acid in the stomach.

Disorders of digestive system:

Gastroesophageal reflux disease (GERD): If the lower esophageal sphincter fails to close
adequately after food has entered the stomach, the stomach contents can reflux (backup) into the
inferior portion of the esophagus. This condition is known as gastroesophageal reflux disease
(GERD). Hydrochloric acid (HCl) from the stomach contents can irritate the esophageal wall,
resulting in a burning sensation that is called heartburn. Drinking alcohol and smoking can cause
the sphincter to relax, worsening the problem. The symptoms of GERD often can be controlled
by avoiding foods that strongly stimulate stomach acid secretion (coffee, chocolate, tomatoes,

fatty foods, orange juice, peppermint, spearmint, and onions).

Vomiting: Vomiting or emesis is the forcible expulsion of the contents of the upper GI tract
(stomach and sometimes duodenum) through the mouth. The strongest stimuli for vomiting are
irritation and distension of the stomach; other stimuli include unpleasant sights, general
anesthesia, dizziness, and certain drugs such as morphine and derivatives of digitalis. Vomiting
involves squeezing the stomach between the diaphragm and abdominal muscles and expelling
the contents through open esophageal sphincters. Prolonged vomiting, especially in infants and
elderly people, can be serious because the loss of acidic gastric juice can lead to alkalosis (higher

than normal blood pH), dehydration, and damage to the esophagus and teeth.
Jaundice: Jaundice is a yellowish coloration of the sclerae (whites of the eyes), skin, and
mucous membranes due to a buildup of a yellow compound called bilirubin. After bilirubin is
formed from the breakdown of the heme pigment in aged red blood cells, it is transported to the
liver, where it is processed and eventually excreted into bile. The three main categories of
jaundice are (1) prehepatic jaundice, due to excess production of bilirubin; (2) hepatic jaundice,
due to congenital liver disease, cirrhosis of the liver, or hepatitis; and (3) extrahepatic jaundice,

due to blockage of bile drainage by gallstones or cancer of the bowel or the pancreas.
Gallstone: If bile contains either insufficient bile salts or lecithin or excessive cholesterol, the
cholesterol may crystallize to form gallstones. As they grow in size and number, gallstones may

cause minimal, intermittent, or complete obstruction to the flow of bile from the gallbladder into
the duodenum. Treatment consists of using gallstone-dissolving drugs, lithotripsy (shock-wave

therapy), or surgery.
Peptic Ulcer Disease (PUD): Ulcers that develop in areas of the GI tract exposed to acidic
gastric juice are called peptic ulcers. The most common complication of peptic ulcers is
bleeding, which can lead to anemia if enough blood is lost. In acute cases, peptic ulcers can lead
to shock and death. Three distinct causes of PUD are recognized: (1) the bacterium Helicobacter
pylori; (2) nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin; and (3)
hypersecretion of HCl, as occurs in Zollinger–Ellison syndrome, a gastrin-producing tumor,
usually of the pancreas. Helicobacter pylori (previously named Campylobacter pylori) is the
most frequent cause of PUD. The bacterium produces an enzyme called urease, which splitsurea
into ammonia and carbon dioxide. While shielding the bacterium from the acidity of the
stomach, the ammonia also damages the protective mucous layer of the stomach and the
underlying gastric cells. H. pylori also produces catalase, an enzyme that may protect the
microbe from phagocytosis by neutrophils, plus several adhesion proteins that allow the
bacterium to attach itself to gastric cells. Several therapeutic approaches are helpful in the
treatment of PUD. Cigarette smoke, alcohol, caffeine, and NSAIDs should be avoided because
they can impair mucosal defensive mechanisms, which increase mucosal susceptibility to the

damaging effects of HCl.

Hepatitis: Hepatitis is an inflammation of the liver that can be caused by viruses, drugs, and
chemicals, including alcohol. Clinically, several types of viral hepatitis are recognized.
Hepatitis A (infectious hepatitis) is caused by the hepatitis A virus and is spread via fecal
contamination of objects such as food, clothing, toys, and eating utensils (fecal–oral route). It is
characterized by loss of appetite, malaise, nausea, diarrhea, fever, and chills. This type of

hepatitis does not cause lasting liver damage. Most people recover in 4 to 6 weeks.
Hepatitis B is caused by the hepatitis B virus and is spread primarily by sexual contact and
contaminated syringes and transfusion equipment. It can also be spread via saliva and tears.
Hepatitis B virus can be present for years or even a lifetime, and it can produce cirrhosis and

possibly cancer of the liver.

Hepatitis C, caused by the hepatitis C virus, is clinically similar to hepatitis B. Hepatitis C can

cause cirrhosis and possibly liver cancer.

Hepatitis D is caused by the hepatitis D virus. It is transmitted like hepatitis B and in fact a

person must have been co-infected with hepatitis B before contracting hepatitis D.
Hepatitis E is caused by the hepatitis E virus and is spread like hepatitis A. Although it does not
cause chronic liver disease, hepatitis E virus has a very high mortality rate among pregnant

women.