I.

Overview of function and structure of

Chapter 24: Digestive System
GIT (alimentary canal and accessory organs)
A. Ingestion
Describe the functions of the GIT B. Secretion
C. Mix and move
D. Digestion
1. physical- break big pieces into small pieces
2. chemical-change complex molecule structure into
simple (smaller)
E. Absorption of nutrients from alimentary canal into
body
F. Defecation of waste

Fig. 24.01

Describe the general histology of the

layers of the GIT.

II. Structure (layers) of all hollow GI organs

A. Mucosa (mucous membrane)
B. Submucosa
C. Muscularis
D. Serosa (visceral peritoneum)

Enteric Nervous System

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 Describe the subdivisions and folds of
Which GIT function(s) require the mucosa? the peritoneum.
III. Peritoneum
A. Visceral
A. Ingestion B. Parietal
B. Secretion 1. “retroperitoneal” location
C. Peritoneal cavity
C. Mix and move 1. Ascites
D. Absorption D. Peritoneal folds (protection and
locating intestines)
E. B and D 1. Greater omentum
2. Lesser omentum
3. Mesentery
4. Mesocolon
5. Falciform ligament

Is the aorta retroperitoneal? A. yes B. no

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 These are major objectives
5. Follow food through the GIT and describe
the physical and chemical changes in each
organ.
6. Describe anatomy, histology, function and
control of motility and secretion of each
GIT organ.
7. List the various enzymes responsible for
chemical digestion, their source and action.

B. Salivary glands
1. Parotid, submandibular and
sublingual glands and ducts 3. Salivation
2. Saliva contents
a. Parasympathetic control
a. 99.5% water
b. Ions (bicarbonate, phosphate sodium and b. Stimulated by special senses
chloride) (smell, sight, taste, sound)
c. Salivary amylase to begin chemical c. Depressed by sympathetic ANS
digestion of starch (amylose)
(dry mouth)
d. Mucus
e. IgA (secretory antibodies for protection)

C. Tongue (Lingua)
1. Skeletal muscle
a. Extrinsic connect tongue to other muscles in
the pharyngeal area to maneuver food
b. Intrinsic muscles (within tongue) change it’s
shape
2. Lingual frenulum
3. Papillae
a. Sensory receptors for taste and touch
4. Lingual glands secrete water, mucous
and lingual lipase

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 Chemical digestion of what
molecules begins in the mouth?

A. Proteins and lipids

B. Lipids and polysaccharides
C. Polysaccharides and nucleic acids
D. Polysaccharides and proteins
E. Lipids, nucleic acids, proteins and
polysaccharies

Explain adult and deciduous

dental formulas.

Primary (deciduous): I-3, PM-0, M-2

Secondary (adult): I-3, PM-2, M-3

Your last molars are normally

I-2, K9-1, PM-0, M-2
numbered
This looks like the normal dental formula for A. 1, 16, 17, & 32
A. A geriatric person B. 1, 2, 3 & 4
B. A person that has had their last molars C. 8, 9, 24 & 25
(“wisdom teeth” ) removed. D. A, J, K, & T
C. A young child E. E, F, O & P
D. Secondary teeth
E. C and D

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 Deglutition and Swallow reflex The swallow reflex does NOT
include
A. Elevation of soft palate
B. Elevation of the base of the tongue
C. Epiglottis moves inferiorly
D. Closure of upper esophageal sphincter
E. All of these are included in the reflex

Fig. 24.09

F. Esophagus
1. Modified serosa is called “adventia”
2. upper esophageal sphincter
(cricopharyngeus muscle)
3. esophageal stage of swallowing
(begins peristalsis)
4. Lower esophageal sphincter (old name:
“cardiac sphincter”)

Fig. 24.10

Peristalsis
G. Stomach

1. Regions all contain rugae when empty

a. Cardia
b. Fundus
c. Body
i. Greater and lesser curvatures
d. Pylorus and pyloric sphincter

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Fig. 24.11

Fig. 24.12a

2. Histology of stomach epithelium

a. Gastric pits
b. Gastric exocrine glands produce “gastric juice”
i. Mucous neck cells produce mucous
ii. Chief cells produce pepsinogen and lipase
iii. Parietal cells produce HCl and intrinsic
factor (for B12 absorption)
c. Gastric endocrine gland cell
i. G cells secret hormone gastrin to help
control gastric activity

3. Digestion in stomach iii. HCl inactivates salivary amylase and

a. Physical digestion by churning CHYME (food
mixed with gastric juices and saliva), mostly in
pylorus as fundus is mainly storage
i. Parietal cells secret H+ and Cl- to make HCl
in lumen
ii. Carbonic anhydrase also make carbonic acid
from water and CO2, which dissociates. H+
stay ion stomach and bicarb is absorbed into
blood, slightly increasing blood pH.
activates lingual lipase, denatures proteins in
food, kills bacteria, activates pepsinogen to
pepsin (proteolytic enzyme)
iv. Mucosa protected by alkaline mucous
v. Gastric lipase is added
vi. Limited absorption: water, ions, short chain
FAs, aspirin and alcohol
vii. Each mixing wave force a few ml of chyme
through pyloric sphincter

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Fig. 24.12b Fig. 24.12c

Fig. 24.13 Fig. 24.14

4. Regulation of Gastric
Activity

a. Cephalic phase
stimulated by
exteroreceptors (smell,
sight, taste) before food
enters stomach

b. Gastric Phase stimulated

as food enters stomach
The cephalic phase of gastric (stretching and
activity is initiated by chemoreceptors)
1. Digested proteins buffers
H+ to increase pH,
A. Neural hormones stimulating PSNS to secrete
B. Upper nervous system motor activity ACh which stimulates
production of GASTRIN
C. The gastroenteric reflex (endocrine) to stimulate
D. A typical spinal reflex production of gastric juices
keeping pH about 2 and
E. All of these are involved increase motility
2. Gastroenteric reflex
speeds intestinal motility to
make room for new digesta.

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 So receptors responsible for
A stimulus of the gastric phase is initiating the gastric phase are
located in the
A. Increasing pH of stomach contents A. Brain
B. Increased protein contents in the stomach B. Spinal cord
C. Increased volume of the stomach C. Stomach
D. Increased buffer activity in the stomach D. Small intestine
E. All of these are gastric phase stimulants E. All of these

c) Intestinal phase, as
food enters small The intestinal phase of gastric
intestine, neural and activity is
hormonal feed back
inhibits gastric
activity A. Inhibitory by neural activity
Food entering Sm. Int. B. Excitatory by neural activity
stimulate secretion of C. Excitatory by hormonal action
hormones:
Secretin decreases D. All of these
gastric secretion E. Only B and C
Cholecystokinen
(CCK) slows stomach
emptying

Ok, now you know the intestinal

5. Gastric emptying (neural and
phase is INHIBATORY, but
hormonal)
what is inhibited?
a) Emptying stimulated by filling (distension) and
A. CCK inhibits gastric motility some chemicals (small polypeptides, alcohol,
caffeine) which stimulate PSNS and gastrin
B. Secretin inhibits gastric secretion activitiy.
C. Gastrin inhibits all gastric activity b) Enterogastric reflex slows emptying of
D. All of these are true stomach to assure small intestine is not
overloaded. Distension of duodenum depresses
E. Only A and B
PSANS, increase CCK and stimulate SANS

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 Which gastric phase does Which gastric phases(s) does
this feedback loop this diagram describe?
represent? A. Cephalic
A. Cephalic B. Gastric
B. Gastric C. Intestinal
C. Intestinal D. A and B
D. Neural E. B and C
E. All except D

List the function and secretions of the liver

and pancreas.

Differentiate endocrine and exocrine

pancreatic functions.

Fig. 24.17b

2. Histology and secretions of pancreas

a. Acini (exocrine portion) secret digestive
enzymes and bicarb in pancreatic juice Review of
i. Sodium Bicarbonate to neutralize acid bile and
chyme
ii. Starch enzyme: Pancreatic amylase pancreatic
iii. Proteases: Trypsin, chymotrypsin, juice flow
carboxypeptidase and elastase (inactive
forms). Proteases are not activated until (“plumbing”)
reaching lumen of duodenum and are activated
by brush boarder enzyme, enterokinase
iv. Triglyceride enzyme: pancreatic lipase
v. Nucleic Acid enzymes: ribonuclease and
deoxyribonuclease

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 Enteroendocrine hormones (CCK
and secretin) are
A. Inhibitory for the stomach
B. Excitatory for the pancreas
C. Excitatory for the stomach
D. A and B
E. B and C

Endocrine Pancreas Endocrine Pancreas

• Alpha Cells • Beta Cells
– Secrete glucagon – Secrete insulin
– Glucagon stimulates liver to convert glycogen – Insulin causes rapid uptake of glucose by all
to glucose somatic cells
– Stimulated by low blood glucose and SANS – Stimulated by low blood glucose and PSANS
– Insulin causes liver to convert blood glucose
into stored glycogen

Increased absorption of glucose

A. Stimulates secretion of insulin
B. Stimulates secretion of glucagon
C. Stimulates secretion of gastrin
D. Stimulates secretion of glycogen
E. All of these

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 Increased insulin secretion means
Secretion of glucagon:
A. Speeds systemic cell absorption of glucose A. There is increased blood glucose
B. Speeds conversion of glucose to glycogen B. Systemic cells will increase transport of
C. Increases blood glucose levels glucose
D. Increases glucose absorption from the gut C. The liver will convert glucose to glycogen
E. All of these D. Blood glucose will decrease
E. All of these

2. Liver histology
a. Hexagonal lobules
i. Hepatocytes (functional liver cells)
ii. Central vein
iii. Sinusoids
iv. Stellate reticuloendothelial cells (VanKupffer
cells or macrophages)- phagocytes to remove old
RBCs
v. Bile Canaliculi all combine to form common
hepatic duct which joins cystic duct to make
common bile duct for temporary bile storage in gall
bladder

3. Hepatic Blood supply

a. Hepatic artery (oxygenated blood)
b. Hepatic portal vein
c. Portal triads at corners of lobules (A, V and
bile duct)
d. Central vein (branches of hepatic veins) to
inferior vena cava

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 4. Regulation of bile secretion

a. PSNS increases bile secretion by

hepatocytes
b. CCK causes contraction of gall bladder
c. Secretin stimulates bicarbonate release
by hepatocytes into bile

5. Hepatic functions Which of these would not be a

a. Carbohydrate metabolism
b. Lipid metabolism liver function?
c. Protein metabolism
– deaminating amino acids to use as carbohydrate, A. Increasing pH of intestinal contents
detoxification of NH3 to urea
B. Secretion of glucagon
– synthesis of alpha and beta globulins, albumin, prothrombin
and fibrinogen C. Conversion of heme to bilirubin
d. Excretion of bilirubin (from heme) as bile pigment D. Hydrolysis of glycogen
e. Synthesis of bile salts to emulsify lipids
f. Storage of glycogen, some vitamins and some minerals E. Neither A or B are liver funtions
g. Phagocytosis
h. Activation of Vitamin D

J. Small Intestine
1. Anatomy
a. Begins at pyloric sphincter
Explain digestion and absorption of the four b. Duodenum is the first 25 cm
bio-macromolecules (carbohydrates, c. Jejunum is the middle one meter
proteins, lipids and nucleic acids) plus d. Ileum is the last 2 m
water, electrolytes and vitamins. e. Ends at ileocecal sphincter
f. Surface area for absorption is increased by
i. Circular folds
ii. Villi
iii.Microvilli (brush boarder on histology
sections)

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 2. Histology

a. Villi increase surface area and each contains

areolar CT (lamina propria) with an arteriole,
venule with capillary bed and a lacteal (lymph
capillary). Capillaries and lacteals absorb
nutrients passing through columnar epithelium.

b. Epithelium is simple columnar cells including

i. Mainly absorptive cells with microvilli that secrete

brush-border enzymes
ii. Goblet cells for mucus secretion
iii. 3 kinds of Enteroendocrine cells found in intestinal
glands
. S cells (make secretin)
. CCK cells
. K cells make glucose–dependent insulinotropic
peptide-stimulates insulin production when glucose is
present
iv. Paneth cells (secrete lysozyme for defense against
bacteria) and act as phagocytes

Which of these are enteroendocrine hormones?

A. CCK
B. Gastrin
C. Insulin
D. Pancreatic amylase
E. All of these

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3. Intestinal juice and brush-boarder enzymes
5. Chemical digestion in small
a. Liquid media for absorption of digested intestine
nutrients through mucosa
a. Carbohydrate digestion
b. Most macromolecules have been hydrolyzed by
b. Polypeptide digestion
salivary, stomach and pancreatic enzymes
c. Lipid digestion
c. Remaining disaccharides, dipeptides and
nucleosides are further chemically digested to i. Bile
monomers by brush-border enzymes d. Nucleic Acid Digestion
i. Nucleosidase removes base
ii. Phosphatase removes phosphate

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6. Regulation of motility and secretion
a. PSANS enteric reflex stimulated by
i. Presence of chyme
ii. Small intestine filling (distension)
b. SANS reduces motility and secretion
c. Migrating Motility Complex (MMC)
increased by reduction of nutrient content in
chyme (minimum of 4 hours from ingestion
to Lg. Int.)
b. Amino acids and small polypeptides (Di
and Tri) enter capillaries by active
transport
Lipid absorption continued
iii. In epithelial cells, FAs, glycerol are
recombined to make triglycerides. These
combine with phopholipids and cholesterol,
which are coated with transport proteins to
make cylomicrons that enter lacteals
iv. In blood, lipoprotein lipase hydrolyzes
triglycerides in chylomicrons to FAs and
glycerol and are absorbed by hepatocytes and
adipocytes, converted to triglycerides and
stored in adipose tissue
7. Absorption: means all nutrients must pass
through intestinal epithelium to reach capillaries
or lacteals
a. Monosaccharides (from polysaccharides
and simple sugars)
i. Facilitated diffusion of fructose
ii. Secondary active transport of glucose and
galactose, couples active transport of 2 Na+
and one monosaccharide (symporter) from gut.
iii. Facilitated transport moves
monosaccharides from cytoplasm into capillary
blood
c. Lipids
i. Simple diffusion of short chain FAs (10-12 Cs) into
epithelium and then into capillaries (not many)
ii. Long chains and monoglycerides are coated with
bile salts to make micells, which transport them into
epithelium, leaving bile in gut.
Bile is resorbed in ileum and returned to liver for
recycling (enterohepatic circulaiton)
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 Fig. 22.01

Fig. 22.03

d. Vitamin absorption
i. Fat soluble (ADEK) via micells
ii. Water soluble (Bs and C) by simple
diffusion

e. Water absorption by osmosis

Nutrients molecules absorbed via

Chylomicrons are
capillaries do not include
A. Dipeptides A. Found in the small intestine
B. Short chain FAs B. Surrounded by bile salts
C. Monoglycerides C. Are not the same as LDLs and HDLs
D. Monosaccharides D. Filled with triglycerides
E. None of these are absorbed via capillaries E. Not found in the lymphatics

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 Micells Daily fluid
volumes
A. Are surrounded with bile salts
(ingested,
B. Have hydrophobic centers
secreted,
C. Transport large FAs to intestinal
absorbed and
epithelium
D. Have a polar shell
excreted by GIT)
E. All of these

K. Large Intestine
1. Anatomy 2. Large Colon Histology
a. Ileocecal valve
b. Cecum with appendix
c. Colon a. Epithelium- goblet and absorptive cells
i Ascending to right colic flexure for water absorption
ii. Transverse to left colic flexure
iii. Descending b. Three longitudinal bands (teniae coli)
iv. Sigmoid colon
d. Rectum
i. Anal canal
ii. Anus and sphincter
Internal anal sphincter (smooth muscle)
External anal sphincter (skeletal muscle)

3. Digestion in colon
a. Mechanical
i. Gastroileal and gastrocolic reflexes
ii. Haustral churning
iii. Peristalsis
b. Chemical by bacterial action
i. Remaining nutrients metabolized by
bacteria to CO2, CH4 and H gases.
(flatulence)
ii. Bilirubin to stercobilin by bacteria
iii. Bacterial production of B and K vitamins

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 The gastrocolic reflex speeds
emptying of
A. colon
B. stomach
C. ileum
D. All of these
E. None of these

• 4. Absorption of water from chyme produces

feces (3-10 hours in Lg. Int.)
a. 90% of water in chyme removed in
small intestine, last 8-9% by lg. Int.) plus
ions and some vitamins.

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11. Who does the defecation reflex differ in infants and
adults? 12. Recognize the various
pathologic conditions of the GIT.
5. Defecation reflex
A. Dental caries and periodontal disease
a. Receptors for rectal distension
B. Peritonitis
b. Sensory impulse to sacral spinal cord
C. Mumps
c. Motor impulse and parasympathetic back for
D. Peptic ulcers
contraction of sigmoid colon, rectum and relaxation of
internal anal sphincter E. Hiatal hernia
d. Infants will defecate, “toilet training” F. GastroEsophageal Reflux Disease (GERD)
teaches control of voluntary external anal sphincter. G. pyloric stenosis
This relaxes at “the appropriate time” H. vomiting (emesis, reverse peristalsis)

I. Jaundice (prehepatic, hepatic, post hepatic and Jaundice is always a

neonatal)
J. Hepatitis (A, B and C)
A. Specific liver disease
K. Gall stones
L. Lactose intolerance B. Sign of liver disease
M. Diverticulitis (weakened muscularis) C. Symptom of liver disease
N. IBS D. All of these
O. Appendicitis
E. None of these
P. Occult blood
Q. Colorectal cancer and polyps
R. Diarrhea and constipation

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