The Digestive System

Vocabulary Headings Important Info

Overview of GI tract Functions

Mouth: bite, chew, swallow Pharynx and Esophagus: transport Stomach: mechanical disruption; absorption of water & alcohol Small Intestine: chemical & mechanical digestion & absorption Large Intestine: absorb electrolytes & vitamins (B and K) Rectum & Anus: defecation

Layers of the GI Tract

1. Mucosal Layer secretes enzymes & absorbs nutrients 2. Submucosal Layer containing BV, glands & lymphatic tissue 3. Muscularis Layer Skeletal:control over swallowing and defecation Smooth: mixes, crushes & propels food along by peristalsis 4. Serosa Layer Covers all organs and walls of cavities not open to outside of body Secretes slippery fluid

Peritoneum
Peritoneum

visceral layer covers organs parietal layer lines the walls of body cavity

Peritoneal Cavity
potential space containing a bit of serous fluid

Salivary Glands

Parotid below your ear and over the masseter Submandibular is under lower edge of mandible Sublingual is deep to the tongue in floor of mouth All have ducts that empty into the oral cavity

 Wet food for easier swallowing Dissolves food for tasting Protects mouth from infection with its rinsing action: 1 to 1 qt/day Bicarbonate ions buffer acidic foods Bulimia---vomiting hurts the enamel on your teeth Salivary Amylase (enzyme): Starts chemical digestion of starch Lysozyme (enzyme): helps destroy bacteria

Composition and Functions of Saliva

Mumps
Myxovirus that attacks the parotid gland Symptoms inflammation and enlargement of the parotid fever, malaise & sour throat (especially swallowing sour foods) swelling on one or both sides Sterility rarely possible in males with testicular involvement (only one side involved) Vaccine available since 1967

Structure and Function of the Tongue

Muscle of tongue is attached to hyoid, mandible, hard palate and styloid process Papillae are the bumps:
taste buds are protected by being on the sides of papillae

Tooth Structure & Composition

Crown Neck Roots Pulp cavity

Enamel hardest substance in body calcium phosphate or carbonate Dentin calcified connective tissue Cementum bone-like periodontal ligament penetrates it

Dentition
Primary/baby teeth
20 teeth that start erupting @ 6months 1 new pair of teeth per month

Permanent teeth
32 teeth erupt b/t 6 & 12 years of age

differing structures indicate function

incisors for biting Canines/cuspids for tearing premolars & molars for crushing/grinding food

Primary and Secondary Dentition

Digestion in the Mouth

Mechanical Digestion
(Mastication/Chewing) breaks into pieces mixes with saliva forming: Bolus

Chemical Digestion
Amylase

Lingual Lipase

begins starch digestion at: pH of 6.5 or 7.0 found in mouth when bolus & enzyme hit pH 2.5 gastric juices hydrolysis ceases
secreted by glands in tongue begins breakdown of triglycerides into fatty acids and glycerol

Pharynx
Funnel-shaped tube extending from internal nares to the esophagus (posteriorly) and larynx (anteriorly) Skeletal muscle lined by mucous membrane Deglutition/swallowing is facilitated by saliva and mucus 1. starts when bolus is pushed into the oropharynx 2. sensory nerves send signals to deglutition center in brainstem 3. soft palate is lifted to close nasopharynx 4. larynx is lifted as epiglottis is bent to cover glottis

Esophagus
Collapsed muscular tube In front of vertebrae Posterior to trachea Posterior to the heart Pierces the diaphragm at hiatus
hiatal hernia or diaphragmatic hernia

Physiology of the Esophagus - Swallowing

Voluntary Phase: tongue pushes food to back of oral cavity Involuntary Phase: pharyngeal stage breathing stops & airways are closed soft palate & uvula are lifted to close off nasopharynx vocal cords close epiglottis is bent over airway as larynx is lifted

Swallowing
Upper sphincter relaxes when larynx is lifted Peristalsis pushes food down
circular fibers behind bolus longitudinal fibers in front of bolus shorten the distance of travel

Travel time:
4-8 seconds for solids 1 sec for liquids

Lower sphincter relaxes as food approaches

 If lower sphincter fails to open

Gastroesophageal Reflex Disease

distension of esophagus feels like chest pain or heart attack stomach acids enter esophagus & cause heartburn (GERD) for a weak sphincter---don't eat a large meal & lay down in front of TV smoking & alcohol make sphincter relax worsening situation coffee, chocolate, tomatoes, fatty foods, onions & mint take Tagamet HB or Pepcid AC 60 minutes before eating neutralize existing stomach acids with Tums

If lower sphincter fails to close

Control symptoms by avoiding

Anatomy of Stomach
Parts of stomach
Cardia Fundus Body Pylorus: starts to narrow as approaches Pyloric Sphincter

Empties as small squirts of chyme leave the stomach through the pyloric valve

 Abnormalities of the pyloric sphincter in infants Pylorospasm

muscle fibers of sphincter fail to relax trapping food in the stomach vomiting occurs to relieve pressure

Pylorospasm and Pyloric Stenosis

Pyloric Stenosis
narrowing of sphincter indicated by projectile vomiting must be corrected surgically

Histology of the Stomach

Mucosa & Gastric Glands

Hydrochloric acid converts pepsinogen from chief cell to pepsin Intrinsic factor absorption of vitamin B12 for RBC production Gastrin hormone (g cell) get it out of here release more gastric juice increase gastric motility relax pyloric sphincter constrict esophageal sphincter preventing entry

Muscularis
Three layers of smooth muscle: Outer Longitudinal Circular Inner Oblique Permits greater churning & mixing of food with gastric juice

Physiology of Digestion Mechanical vs. Chemical

Gentle mixing waves every 15 to 25 seconds mixes bolus with 2 quarts/day of gastric juice to turn it into chyme (a thin liquid) More vigorous waves travel from body of stomach to pyloric region Intense waves near pylorus opens & squirts out 1-2 teaspoons full w/each wave Protein digestion begins
HCl denatures protein molecules HCl transforms Pepsinogen into Pepsin breaks peptide bonds b/t certain a.a.

Fat digestion continues

gastric lipase splits the triglycerides in milk fat

most effective at pH 5 to 6 (infant stomach)

HCl kills microbes in food Mucous cells protect stomach walls from being digested w/13 mm thick layer of mucous

Stomach Getting Ready

Cephalic Phase =

Cerebral Cortex:
sight, smell, taste & thought stimulate PNS

Vagus Nerve:
increases stomach muscle and glandular activity

Gastric Phase =
Nervous control keeps stomach active
stretch receptors & chemoreceptors provide info vigorous peristalsis and glandular secretions continue chyme is released into duodenum

Stomach Working

Endocrine influences over stomach activity

distention & presence of caffeine or protein cause G cells secretion of gastrin into bloodstream gastrin hormone increases stomach glandular secretion gastrin hormone increases stomach churning and sphincter relaxation

Intestinal Phase = Stomach Emptying

Stretch receptors in duodenum slow stomach activity & increase intestinal activity Distension, fatty acids or sugar signals medulla Hormonal influences
SNS slow stomach activity secretin hormone decreases stomach secretions

Cholecystokinin (CCK)

Gastric Inhibitory Peptide (GIP) decreases

decreases stomach emptying

stomach secretions, motility & emptying

Absorption of Nutrients by the Stomach

Water especially if it is cold Electrolytes Some drugs (especially aspirin) & alcohol Fat content in the stomach slows the passage of alcohol to the intestine where absorption is more rapid Gastric mucosal cells contain alcohol dehydrogenase that converts some alcohol to acetaldehyde Females have less total body fluid that same size male so end up w/higher blood alcohol levels with same intake of alcohol
more of this enzyme found in males than females

Digestive Hormones
Gastrin Gastric inhibitory peptide--GIP Secretin
stomach & pancreas pancreas, liver & stomach stomach, gastric & ileocecal sphincters

Cholecystokinin--CCK
pancreas, gallbladder, sphincter of Oddi, & stomach

 When chyme enters the duodenum, proteins & carbohydrates are only partly digested, & fat digestion needs to be carried out Enzymes aid in digestive breakdown & absorption of chyme
_____________________________________________________________
Bile Salts (Liver & Gallbladder) Fat Fat Droplets
Bile is a thick digestive fluid secreted by the liver and stored in gallbladder. Facilitates digestion by emulsifying fats into fatty acids, which can be absorbed by the digestive tract

Digestive Enzymes

Pancreatic & Salivary Amylase (Pancreas & Mouth Starch + H2O Maltose

Trypsin & Pepsin (Pancreas)

Protein + H2O Peptides Lipase (Pancreas) Fat Droplets + H2O Glycerol + Fatty Acids Peptidases (Intestinal Juice) Peptides + H2O Amino Acids Maltase (Intestinal Juice)

Maltose + H2O Glucose

Vomiting (Emesis): Reverse Peristalsis

1. 2. 3.

A deep breath is taken, the glottis is closed, and the larynx is raised to open the upper esophageal sphincter. Soft Palate is elevated to close of external nares Diaphragm contracts down to create a negative pressure in the thorax, which facilitates opening of the esophagus and esophageal sphincter Simultaneously with the downward movement of the diaphragm, the abdominal muscles contract elevating inner gastric pressure. With the pylorus closed and the esophagus open the exit route is clear

Anatomy of the Pancreas

5" long by 1" thick Head close to curve in C-shaped duodenum Main duct joins common bile duct from liver Sphincter of Oddi on major duodenal papilla Bile and pancreatic secretions enter the digestive system through this point Opens 4" below pyloric sphincter

Composition and Functions of Pancreatic Juice

1.5 Quarts/day pH 7.1 to 8.2 Contains water, enzymes & sodium bicarbonate Digestive enzymes

pancreatic amylase, pancreatic lipase, proteases Ribonuclease to digest nucleic acids deoxyribonuclease

Pancreatitis
Pancreatitis: inflammation of the pancreas occurring with the mumps Acute Pancreatitis: associated with heavy alcohol intake or biliary tract obstruction
result is patient secretes trypsin in pancreas & starts to digest themselves

Regulation of Pancreatic Secretions

Secretin
acidity in intestine causes increased sodium bicarbonate release fatty acids & sugar causes increased insulin release fats and proteins cause increased digestive enzyme release

GIP

CCK

Anatomy of the Liver and Gallbladder

Liver
weighs 3 lbs. below diaphragm right lobe larger gallbladder on right lobe size causes right kidney to be lower than left

Gallbladder
fundus, body & neck The gallbladder stores about 50 ml of bile

Liver FunctionsCarbohydrate Metabolism Turn proteins glucose Turn triglycerides glucose Turn excess glucose glycogen & store in the liver Turn glycogen back glucose as needed

Liver Functions: Lipid Metabolism

Synthesize cholesterol Synthesize lipoproteins
HDL
(high-density lipoprotein)

helps move cholesterol back to liver for removal from bloodstream (GOOD)

LDL

(low-density lipoprotein)

helps cholesterol stick to artery walls (BAD)

Breaks down some fatty acids

 Deamination = removes NH2 (amine group) from amino acids so can use what is left as energy source Converts resulting toxic ammonia (NH3) into urea for excretion by the kidney Synthesizes plasma proteins utilized in clotting mechanism and immune system Convert one amino acid into another

Liver Functions: Protein Metabolism

Other Liver Functions

Detoxifies blood by removing or altering drugs & hormones (thyroid & estrogen) Removes the waste product: Bilirubin Releases bile salts help digestion by emulsification Stores fat soluble vitamins: A, B12, D, E, K Stores iron and copper Phagocytizes worn out blood cells & bacteria Activates Vitamin D: the skin can also do this with 1 hr of sunlight a week

Bile Production
1 quart of bile/day is secreted by the liver Components
yellow-green in color & pH 7.6 to 8.6
water & cholesterol Bile Salts = Na & K salts of bile acids Bile Pigments (bilirubin) from hemoglobin molecule Globin = a reuseable protein Heme = broken down into iron and bilirubin

Pathway of Bile Secretion

Bile capillaries Hepatic ducts connect to form common hepatic duct Cystic duct from gallbladder & common hepatic duct join to form common bile duct Common bile duct & pancreatic duct empty into duodenum

Regulation of Bile Secretion

Blood Supply to the Liver

Hepatic Portal Vein
nutrient rich blood from stomach, spleen & intestines

Hepatic artery branch off the aorta

Anatomy of the Small Intestine

20 feet long: 1 inch in diameter Large surface area for majority of absorption 3 parts
Duodenum: 10 inches Jejunum: 8 feet Ileum: 12 feet ends at Ileocecal Valve

 Plica Circularis

Villi

permanent inch tall folds that contain part of submucosal layer not found in lower ileum cannot stretch out like stomach 1 Millimeter tall Contains vascular capillaries and lacteals (lymphatic capillaries)

Small Intestine

Microvilli

Absorption and digestion Digestive enzymes found at cell surface on microvilli Digestion occurs at cell surfaces

Small Intestine: Regions and Structures

Mechanical Digestion in Small Intestine

Weak peristalsis in comparison to the stomach:
chyme remains for 3 to 5 hours

Segmentation:
local mixing of chyme with intestinal juices sloshing back & forth

Digestion of Carbohydrates
Mouth: salivary amylase Esophagus & stomach: nothing happens Duodenum: pancreatic amylase Brush Border Enzymes (maltase, sucrase & lactose) act on disaccharides
produces monosaccharides-fructose, glucose & galactose lactose intolerance (no enzyme; bacteria ferment sugar)--gas & diarrhea

Digestion of Nucleic Acids

Pancreatic juice contains 2 nucleases
ribonuclease which digests RNA deoxyribonuclease which digests DNA

Nucleotides produced are further digested by brush border enzymes Absorbed by active transport

Digestion of Proteins
Stomach
HCl denatures or unfolds proteins pepsin turns proteins into peptides

Digestion of Lipids
Mouth: lingual lipase

Small intestine
emulsification by bile Pancreatic Lipase: splits into fatty acids & monoglyceride No enzymes in brush border

Pancreas
digestive enzymes: split peptide bonds b/t different amino acids brush border enzymes: split off amino acid at amino end of molecule or split dipeptide

Absorption in Small Intestine

Absorption of Monosaccharides
Absorption into epithelial cell glucose & galactose: sodium symporter(active transport) Fructose: facilitated diffusion Movement out of epithelial cell into bloodstream by facilitated diffusion

Absorption of Amino Acids & Dipeptides

Absorption into epithelial cell active transport w/Na+ or H+ ions

Movement out of epithelial cell into blood diffusion

Absorption of Lipids
Small fatty acids enter cells & then blood by simple diffusion Larger lipids exist only within micelles (bile salts coating) Lipids enter cells by simple diffusion leaving bile salts behind in gut Bile salts reabsorbed into blood & reformed into bile in the liver

 Sources of electrolytes GI secretions & ingested foods and liquids Enter epithelial cells by diffusion & secondary active transport sodium & potassium move = Na+/K+ pumps (active transport) chloride, iodide and nitrate = passively follow iron, magnesium & phosphate ions = active transport Intestinal Ca+ absorption requires vitamin D & parathyroid hormone

Absorption of Electrolytes

 Fat-Soluble Vitamins

Absorption of Vitamins

A, D, E, K travel in micelles & are absorbed by simple diffusion

Water-Soluble Vitamins
Vitamin B complex, Ca absorbed by diffusion

B12 combines with intrinsic factor before it is transported into the cells
receptor mediated endocytosis

Absorption of Water
9 liters of fluid dumped into GI tract each day Small intestine reabsorbs 8 liters Large intestine reabsorbs 90% of that last liter Absorption is by osmosis through cell walls into vascular capillaries inside villi

5 feet long by 2 inches in diameter Ascending & descending colon are retroperitoneal Cecum & appendix Rectum = last 8 inches of GI tract anterior to the sacrum & coccyx Anal canal = last 1 inch of GI tract
internal sphincter----smooth muscle & involuntary external sphincter----skeletal muscle & voluntary control

Anatomy of Large Intestine

Appendicitis
Inflammation of the appendix due to blockage of the lumen by chyme, foreign body, carcinoma, stenosis, or kinking Symptoms
high fever, elevated WBC count, neutrophil count above 75% referred pain, anorexia, nausea and vomiting pain localizes in right lower quadrant

Infection may progress to gangrene and perforation within 24 to 36 hours

Mechanical Digestion in Large Intestine

Smooth muscle: mechanical digestion Peristaltic Waves 3 to 12 contractions/minute

Haustral Churning: relaxed pouches filled from below by muscular contractions (elevator) Gastroileal Reflex when stomach is full, gastrin hormone relaxes ileocecal sphincter so small intestine will empty and make room Gastrocolic Reflex when stomach fills, a strong peristaltic wave moves contents of transverse colon into rectum

Chemical Digestion in Large Intestine

No enzymes are secreted only mucous Bacterial Fermentation
undigested carbohydrates into carbon dioxide & methane gas undigested proteins into simpler substances (indoles)----odor turn bilirubin into simpler substances that produce color

Bacteria produce vitamin K and B in colon

Absorption & Feces Formation in Large Intestine

Some electrolytes: After 3 to 10 hours, 90% of H2O has been removed from chyme Feces are semisolid by time reaches transverse colon Feces = dead epithelial cells, undigested food such as cellulose, bacteria (live & dead)
Na+ and Cl-

Defecation
Gastrocolic reflex moves feces into rectum Stretch receptors signal sacral spinal cord Parasympathetic nerves contract muscles of rectum & relax internal anal sphincter External sphincter is voluntarily controlled

 Diarrhea

Defecation Problems

Constipation

chyme passes too quickly through intestine H20 not reabsorbed decreased intestinal motility too much water is reabsorbed Remedy = fiber, exercise and water

 Insoluble Fiber

Dietary Fiber

Soluble Fiber

Woody parts of plants (wheat bran, veggie skins) speeds up transit time & reduces colon cancer gel-like consistency beans, oats, citrus white parts, apples lowers blood cholesterol by preventing reabsorption of bile salts so liver has to use cholesterol to make more

 Changes that occur: decreased secretory mechanisms & motility loss of strength & tone of muscular tissue changes in neurosensory feedback diminished response to pain & internal stimuli Symptoms: sores, loss of taste, peridontal disease, difficulty swallowing, hernia, gastritis, ulcers, malabsorption, jaundice, cirrhosis, pancreatitis, hemorrhoids and constipation Colon or rectum is common

Aging and the Digestive System

Nutrient:

Substance used by the body for growth, maintenance, and repair

 Carbohydrates Most are derived from plants Exceptions: lactose from milk and small amounts of glycogens from meats Lipids Saturated fats from animal products Unsaturated fats from nuts, seeds, and vegetable oils Cholesterol from egg yolk, meats, and milk products Proteins Complete proteins contain all essential amino acids Most are from animal products Legumes and beans also have proteins, but are incomplete Vitamins Most vitamins are used as cofactors and act with enzymes Found in all major food groups Minerals Play many roles in the body Most mineral-rich foods are vegetables, legumes, milk, & some meats

Categories of Nutrients

Catabolism Substance is broken down to simpler products Energy is released

The sum of all chemical reactions necessary to maintain life

Metabolism

Anabolism Larger molecules are built from smaller ones Energy Required

The amount of energy expended while at rest, (meaning that the digestive system is inactive, which requires about twelve hours of fasting in humans). Release of

Basal Metabolic Rate (B.M.R.)

Wt (kg) = wt (lbs) / 2.2lbs/kg
Age BMR Equation

energy in this state is sufficient only for vital organ function

(how many cal you need)

Males

0-3 3-10 10-18

(60.9 x wt) - 54 (22.7 x wt) + 495 (17.5 x wt) + 651

18-30
30-60 >60

(15.3 x wt) + 679

(11.6 x wt) + 879 (13.5 x wt) + 487 (61.0 x wt) - 51

Females

0-3

3-10
10-18 18-30 30-60

(22.5 x wt) + 499

(12.2 x wt) + 746 (14.7 x wt) + 496 (8.7 x wt) + 829

>60

(10.5 x wt) + 596

Body Mass Index (B.M.I.)

1. Convert your weight in pounds to kilograms by dividing by 2.2
161lbs / 2.2kg = 73.18kg 55 = 65

2. Convert your height in feet to inches (1 foot = 12 inches).

3. Convert your height to meters: multiply your height in inches by 2.54. Then divide by 100 4. Multiply your height (in meters) by itself. 5. Divide your weight in kilograms (step 1) by your height squared (step 4)
1.651 x 1.651 = 2.725801 65 x 2.54 = 165.1m 165.1m/100 = 1.651

73.18kg/2.725801m2 = B.M.I. of 26.85 (Mrs. Warren is OverweightYikes!see ya at LA Fitness)

BMI Categories
Underweight: Less than 18.5
Normal Weight: 18.5 - 24.9 Overweight: 25 - 29.9

Obese: 30 or higher