NS 1150 Revision Packet

Digestive system overview

GI Tract – a hollow tube that runs from the mouth to the anus
GI motility – mixing and propulsion of material, caused by muscular contractions in GI tract
Segmentation – muscular movement in small intestine which moves food back and forth
Peristalsis – waves of muscular contractions which move material forward
Enteric endocrine system: hormones secreted by the mucosal (innermost) lining of GI tract
which regulates GI motility and secretion
Sympathetic system – ‘fight or flight’, if one part is on then all parts are turned on
Parasympathetic – ‘rest or digest, different parts can be on and off

Digestion
Phases
Cephalic phase: preparation phase of digestion. Thought, smell and sight of food stimulate CNS
which wakes up the digestive system and stimulate GI motility and secretions
– Ghrelin: hormone that stimulates hunger
Gastric phase: arrival of food in stomach. Increase in release of digestive secretions and motility
Intestinal Phase: arrival of chime in small intestine, decrease in secretion of gastric juices

The Oral Cavity and Esophagus

Mastication: chewing
– Breaks down particles into smaller pieces, which creases surface area, and is needed for
assimilation and enzyme activation
Saliva: secreted from salivary glands and stimulated by presence of food. Contains water, mucus,
enzymes (lipase breaks down triglycerides and amylase breaks down starch) and antibacterial
agents
Epiglottis: flap of tissue which covers trachea while swallowing
**Food hitting touch receptors at back of mouth triggers entire GI tract
Gastroesophageal Sphincter: muscle in btw esophagus and stomach which regulates flow of food
(i.e. prevents food from reentering eso. from stomach). Usually remains contracted, however
after swallowing, loosens up so food can pass through.
– Can be voluntarily controlled by belchers, beer pourers, sword swallowers, purgers.
Consequences of purging include esophageal lesions, tooth decay, cardiac irregularities.

The Stomach
** gastric pertains to the stomach
Gastrin: hormone which stimulates production and release of gastric juice (HCl acid, enzymes,
water, intrinsic factor)
Parietal cells: exocrine cells within the mucosa that secrets HCl acid, gastric lipase, and intrinsic
factor (needed for absorption of B12 vitamin)
Chief cells: exocrine cells which produces pepsin (protein enzyme)
proenzyme: an inactive precise of an enzyme e.g. pepsinogen -> pepsin by HCl acid
protease: enzyme that cleaves peptide bonds through hydrolysis
**Heartburn (GERD): Gastro. Sphincter weakening allows gastric juices to go up into the
esophagus. Can be treated with acid buffers (bicarbonate), acid blockers, avoiding foods and
drugs which promote gastrin release and sleeping vertically.
Gastric Inhibitory Peptide: compound with insulin like properties
Gastric Emptying: determined by volume, osmotic pressure, acidity, viscosity
**Fat remains in stomach longer than other nutrients.
Pyloric Sphincter: regulates flow of food from stomach into duodenum (first part of small intest.)
** Dietary Fiber: Indigestible carbohydrates.
Stomach ulcers: occur when mucus does not protect stomach lining properly
– Caused by: rapid eating, stress, and bacteria
– Treatment: Antibiotics

Dumping Syndrome: When undigested foot in stomach gets dumped into small intestine too
quickly causing abdominal cramps and nausea
The Small Intestine
3 regions: duodenum, jejunum, ileum
Lining of the intestine: mucosa villi (dissacharidases located)  enterocytes  microvilli
Protein Digestion:
– Amino acids and smaller polypeptides moving into small intestine stimulate production
of secretin.
– Secretin: hormone which signals pancreas to release bicarbonate into the duodenum,
neutralizing acidity of chyme and inactivating pepsin.
– Presence of amino acids in small intest. stimulates release of CCK
– CCK: hormone which stimulates release of pancreatic juice (enzymes and bicarbonate),
bile from gallbladder, and closing of pyloric sphincter.

Triglyceride Digestion:
1) Lingual lipase (lipase cleaves fatty acids off glycerol molecules)
2) Gastric lipase
3) Presence of fatty acids in duodenal stimulates CCK secretion
4) Bile (emulsification of fat into micelles [small fat molecules covered in bile])
** bile contains cholesterol
5) Pancreatic lipase
6) Fatty acids and monoglycerides reassembled into triglycerides in intestinal
epithelial cells
7) Triglycerides + cholesterol synthesized into chylomicrons (lipoprotein)
8) Chylomicron transported up lacteal into lymphatic system in neck
9) Goes into blood circulation
10) Lipoprotein lipase in capillaries breaks down chylomicrons, releasing fatty acids
into blood
Nutrient Absorption: most nutrients are absorbed along the brush border of small intest. Once
absorbed, they either go to the blood or lymphatic circulatory systems.
Basolateral membrane: cell membrane that faces away from the lumen which nutrients need to
pass to reach capillaries
Bioavailability: Extent to which a nutrient is absorbed
Hepatic Portal Circulation: water soluble nutrients (carbohydrates, proteins, minerals, some
vitamins) are absorbed into capillaries & are transferred directly to liver. Nutrients taken up by
liver can be stored, released into blood or detoxified.
**insoluble nutrients (long chain lipids i.e. fatty acids) cannot enter blood capillaries and instead,
are synthesized into chylomicrons (lipoprotein), absorbed by lacteal and taken to thoracic duct in
neck region (lymphatic system).

Large Intestine
4 regions: cecum, colon, retum, anal canal
Ileocecal sphincter: regulates flow of food from small intestine to large intest.
Absorption of water and ions, which are then circulated into body through blood
Microflora: bacteria in large intes. which breaks down undigested food residue and produces
vitamin K and B12.
Defecation: elimination of feces from body
Diarrhea: food passes through too fast and not enough water is reabsorbed into the body.
– Treatments: replenish water and electrolytes (Na+ and K+) from water, soups, fruit
juices, veggies
Constipation: too much water is reabsorbed.
– Causes: lack of fiber, exercise, irritable bowel syndrome, ignoring the “urge”, lack of
water
– Treatments: consumption of fiber, exercises, laxatives
**Soluble fibers dissolve in liquid and helps to slow down gastric emptying (increases viscosity),
control healthy BSL (slower glucose absorption into body) & cholesterol lvls (absorbs bile which
reduces cholesterol in body and lowers colon cancer), reduce duodenal ulcers, & diabetes.
Insoluble fibers cannot dissolve in liquid and helps prevent blockages in the GI tract (swells in
the tract after water absorption) and regulate pH balance in intestines
Examples of soluble fiber: fruit, carrots, beans, peas
Examples of insoluble fiber: dark leafy vegetables, seeds, nuts, grains
Other diseases due to lack of fiber in diet: Diverticula (little pouches on colon) & hemorrhoids
(swollen blood vessels at anal opening)
Cytokines: proteins that are secreted by cells of the immune system which carry
signals locally between cells, and thus have an effect on other cells

Carbohydrates & Glucose

Glucose is a source of energy for muscles and neural tissue. Easily transfers energy and can be
used w/o oxygen.
Monosaccharides: Glucose, Fructose, Galactose
Disaccharides: Lactose (Glu+Ga;), Maltose (Glu+Glu), Sucrose (Glu+Fru)
Oligosaccharides: carbohydrate made of 3-10 monosaccharides
Polysaccharide: Starch, Glycogen, Fiber
Glycogen: Stores of glucose in the liver and skeletal muscles. The body turns to glycogen during
periods of limited glucose availability.
Process of starch digestion:
Starch --- salivary amylase -- dextrins --- pancreatic amylase -- maltose ---
maltase -- glucose
After breakdown to glucose molecules, it is transported to the liver where the liver decides how
to use it. It can be used for: energy, stored as glycogen or fat, dumped into blood.
Glycemic Index: Measure of how different foods affect magnitude and duration of the rise in
BSL after a meal
Role of Pancreas: Important in regulation of BSL (resting BSL is 80mg/100dl). Inside the islets
of Langerhans, alpha cells produce glucagon and beta cells produce insulin.
– Insulin lowers BSL by increasing 1) uptake of glucose into tissues such as muscle and
adipose and 2) formation of glycogen in liver.
– Glucagon increases BSL by stimulating breakdown of glycogen in liver
**Delta cells produce somatostatin, hormone which regulates BSL stability and insulin
production
Response to high BSL:
– Glucose enters cells via glucose transporters.
– Tissue which require insulin in order to uptake glucose are insulin sensitive. Those which
do not are insulin insensitive.
– When there is an excessive amount of glucose, it is stored as glycogen in muscles and fat
in adipose.
– Glycogenesis: formation of glycogen
– Insulin inhibits gluconeogenesis
Response to low BSL:
– Hypoglycemia: abnormally low BSL
○ Fasting hypoglycemia: occurs after strenuous exercise or extended period btw
meals
○ Reactive hypoglycemia: occurs with 4hrs after meal due to oversecretion of
insulin
– Glycogenolysis: breakdown of glycogen to glucose
 – Liver glycogen is used to regulate BSL while muscle glycogen is used to fuel physical
activity as it is used by muscle themselves.
– Glucagon only works on liver glycogen. Muscle glycogenolysis is stimulated by hormone
epinephrine, which is released in response to stress/danger.
– Gluconeogenesis: synthesis of glucose from noncarbohydrate sources such as amino
acids (occurs in liver)
○ Adrenal gland releases glucocorticoids which breaks muscle into amino acids
– Ketones: organic compound used for energy source during starvation, low carb diets
– Ketogenesis: production of ketones from fatty acids when there is an absence of glucose

– Symptoms of hypoglycemia: tenseness, sweating, cold hand and feet, inability to

concentrate
– Treatment: ketogenic diet (low carb, high protein, high fat)

Diabetes: Medical condition characterized by lack of insulin or impaired insulin utilization that
results in hyperglycemia
– Type 1 Juvenile Onset: Lack of insulin production from beta cells. Person requires insulin
injections daily. Usually begins in childhood and has rapid onset of symptoms
– Type 2 Adult Onset: Tissue develop insulin resistance. Usually occurs in obese people.
Can be managed by diet, weight loss and exercise. Slow onset of symptoms.
– Gestational: diabetes characterized by insulin resistance in pregnant women. Hormones
released by placenta block insulin. Occurs late in pregnancy and babies have higher risk
of obesity
– Secondary: diabetes that results from other diseases, medical conditions or medication
– Pre-diabetes: blood glucose lvls are higher than normal but not high enough for diagnosis
of type 2 diabetes

– Symptoms: Glucose in urine, increased thirst, weight loss (type 1), weight gain (type 2),
dehydration, coma
– Effects: Depresses circulation (higher risk of heart attack, stroke, limb loss, high blood
pressure), clouded vision due to retina damage, loss of sensation due to impairment of
chemicals in neurons, impairment of protein reabsorption in kidney
– Treatments: smaller frequent meals, foods with low glycemic index, lose weight, exercise
B Vitamins
Thiamin (Vitamin B1):
– Purpose: Synthesis of DNA, RNA, NADPH, and nerve function
– Sources: pork, peas, fish, legumes, whole grain, soy milk
– Deficiency: Beriberi.
○ Dry beriberi: severe muscle wasting, leg cramps, tenderness, neuropathy
○ Wet beriberi: rapid heart rate, enlarged heart, edema (swelling due to excessive
water content in body)
○ Causes: alcoholism, raw shellfish

Riboflavin (vitamin B2):

– Purpose: energy metabolism, synthesis of other vitamins, nerve function, protection of
lipids
– Sources: Liver, meat, dairy
– Deficiency: ariboflavinosis
Niacin (vitamin B3):
– Purpose: ETC, synthesis of fatty acids and protein, metabolism of vitamin C, glucose
homeostasis
– Sources: meat, mushrooms, legumes, whole grains
– Deficiency: pellagra (very rare since nearly all foods have niacin)
○ Dermatitis, dementia, diarrhea, death
Pantothenic Acid (Vitamin B5):
– Purpose: coenzyme A synthesis, hemoglobin synthesis, phospholipid synthesis
– Sources: meats, dairy products, mushrooms, sunflower seeds
– Deficiency: “Burning Feet Syndrome”
○ Fatigue, weakness, nausea