Chapter 19

Taking the Indigestion out of the Digestive System

Next time you sit down to enjoy a burger and fries (or tofu and salad) think of the miracle of
digestion. Your food is chewed up, swallowed and embarks on a journey through a long and
winding tube to become part of your body. You really are what you eat.

The digestive system can be thought of as a long tube beginning at the mouth and ending at the
anus. The length of the tube ranges from 15-23 feet long. The tube is called the alimentary
canal. The canal has the same number of layers but different tissue characteristics throughout
(Fig. 19.1).

Here are the basic processes of digestion:

1. Breakdown of food chemically and mechanically.

2. Absorption of microscopic constituents of food.
Different parts of the tube are designed for different functions. It is a good idea to keep this in
mind when learning the digestive system.

Big Picture: Digestive system

Mouth—designed for breaking down food and beginning digestion of carbohydrates.

Stomach—designed for chemical digestion of proteins and some fats and very little
absorption.

Duodenum (small intestine)—designed for lots of digestion and some absorption.

Jejunum and Ileum (small intestine)—designed for finishing up digestion and lots of
absorption.

Colon (large intestine)—designed for almost no digestion or absorption. Mostly removing

water and moving what’s left through.

Those are the differences so here is one similarity. The “tube” has four layers throughout. From
inside to out these are:

Mucosa—inner mucous membrane.

Submucosa—deep to the mucosa. Contains blood and lymphatic vessels.
Smooth Muscle (two layers)—one layer runs lengthwise while the other encircles the tube.
Serosa—outer serous membrane that secretes a slimy, serous fluid.
Fig. 19.1. Digestive system.

Journey through the “Tube”

Let’s begin our journey through the digestive tube by starting with the mouth. The mouth
contains the oral cavity which of course contains the teeth and tongue. There are three sets of
salivary glands on each side of the head that secrete saliva into the mouth. Saliva helps to get
the food ready for digestion and contains an important enzyme that begins carbohydrate
digestion. This enzyme is aptly named salivary amylase. This is why you can dissolve lollipops in
your mouth. Lollipops are sugar (carbs) and salivary amylase breaks down carbs.

Here are the three salivary glands (Fig. 19.2):

Parotids—located just in front of and below your ear. They secrete mucous and salivary
amylase and connect to the mouth via ducts called Stensen ducts.
Sublinguals—these are under your tongue and secrete mucous.
Submandibulars—these are under your jaw and secrete enzymes and mucous.

Fig. 19.2. Salivary glands.

The mouth also contains the teeth which are the hardest structures in the body (Fig. 19.3). You
begin cutting your teeth as a baby and finish as a young adult with the wisdom teeth. There are
20 primary (baby) teeth and 32 secondary teeth (Fig. 19.4).
Fig. 19.3. Tooth.

Fig. 19.4. Teeth.

The mouth connects with the pharynx (Fig. 19.5). The pharynx is a shared passageway for the
respiratory and digestive systems. Every time you put food in your mouth your brain and mouth
work together to chew the food and roll it up into what is known as a bolus. The bolus is then
pushed to the back of the mouth where it enters the pharynx for swallowing.

Fig. 19.5. Pharynx.

The Esophagus
The pharynx connects with the esophagus (Fig. 19.6). The esophagus is a muscular tube
extending from the pharynx to the stomach. It lies behind the trachea.

The esophagus has two circular sphincter muscles. The upper esophageal sphincter keeps the
esophagus closed during breathing to keep air from moving into the digestive tract. The lower
esophageal sphincter (cardiac sphincter) is located at the inferior end of the esophagus where it
pierces the diaphragm at the esophageal hiatus. The lower esophageal sphincter remains
closed until swallowing occurs. In some cases the diaphragm is weakened near the hiatus and
the sphincter enlarges. This is known as a hiatal hernia and can allow contents of the stomach
to enter the esophagus and cause gastric reflux.

Fig. 19.6. Esophagus.

The esophagus empties into the stomach which is a curved pouch-like organ (Fig. 19.7). There
are four major divisions of the stomach. These include the cardiac region, body, fundus and
pylorus. The cardiac region is the superior portion just after the esophagus. The fundus is an
upward bulge that is located on the left side. The body is the central portion and the pylorus
the inferior portion.

The outer portion of the stomach contains concave and convex curves. The concave curve is
called the lesser curvature while the convex curve is the greater curvature.
The stomach contains two sphincters (circular muscles) at each opening. The lower esophageal
(cardiac) sphincter allows substances to enter while the pyloric sphincter allows substances to
exit.

Inside of the stomach are tube-like openings called gastric pits. Secretions from deeper gastric
glands flow through the pits to the inside of the stomach. There are also a good deal of mucous
secreting cells that secrete an alkaline mucous to help to protect the lining. If you were to look
inside of the stomach you would see that it was lined with folds. These folds are called rugae.
The rugae increase the surface area and help in mixing the contents of the stomach.

There are a number of different kinds of cells on the inside of the stomach. Here is an overview:

Parietal cells --secrete hydrochloric acid and intrinsic factor.

Chief cells-- secrete a precursor enzyme called pepsinogen. Pepsinogen combines with
hydrochloric acid to become an active form known as pepsin. Pepsin digests proteins.
Mucous secreting cells—secrete, you guessed it, mucous.
Endocrine cells--secrete hormones that help to control digestion. An example is intrinsic factor
that combines with vitamin B12 to help in absorption.

The combination of all of the stomach secretions is known as gastric juice. Food enters the
stomach and combines with gastric juice to form a pasty substance called chyme. Chyme then
leaves the stomach by way of the pyloric sphincter and enters the duodenum.

So, food goes in and chyme comes out.

Fig. 19.7. Stomach.

Small Intestine
After the stomach, food enters the small intestine. The small intestine consists of three parts.
The proximal section is the duodenum which is followed by the jejunum and ileum (Fig. 19.8).

The small intestine is built for absorption with a large surface area. The inside of the small
intestine consists of circular folds called plica circulares. The plicae also contain numerous
finger-like projections known as villi. The villi contain blood vessels and a lymphatic system
tubule called a lacteal. The intestines are lined with cilia containing epithelium. The epithelial
membrane resembles a brush and is sometimes referred to as a brush border. Cells lining the
intestines secrete enzymes and mucous. The membrane also contains intestinal crypts (crypts
of Lieberkuhn) that undergo rapid mitosis. The crypts help the intestinal membrane to renew
itself. Old cells are pushed out of the villi and are replaced by new cells.

Fig. 19.8. Intestines.

Large Intestine
The last large section of the tube is the large intestine or colon (Fig. 19.8). The large intestine
begins at a pouch called the cecum. The junction between the ileum and cecum occurs at a
smooth muscle sphincter in the cecum known as the ileocecal valve or sphincter.

The large intestine continues as the ascending colon which makes a turn at the liver called the
hepatic flexure. It then continues as the transverse colon which makes a turn at the spleen
called the splenic flexure. It then continues inferiorly as the descending colon until it makes an
“S” shape called the sigmoid colon which connects to the rectum and anus.

The large intestine contains numerous mucous secreting glands. Along the outside of the colon
are bands of smooth muscles called taenia coli that run longitudinally. There are also rings of
smooth muscle that divide the colon into pouch-like structures called haustra.

By the time material has reached the large intestine, digestion and absorption are primarily
complete. The colon secretes mucous that holds feces together. There are also resident
bacteria known as intestinal flora. The bacteria help to break down undigested substances.

Substances move through the small intestine by slow peristaltic movements. In the large
intestine substances move in what are called mass movements. Mass movements are
stimulated by parasympathetic impulses, stretch of the colon walls and impulses from the
enteric nervous system. The mass movements move large sections of the colon (up to 20 cm)
resulting in the movement of feces toward the rectum.

Water and electrolytes are absorbed in the large intestine with the resulting material called
feces. When feces enter the rectum it triggers the defecation reflex. Distention of the rectum
sends sensory impulses to the conus medullaris of the spinal cord. The resultant motor
impulses produce peristaltic contractions in the colon and cause the internal anal sphincter
muscle to relax. Impulses also travel to the cerebrum where the urge to defecate is sensed. This
allows for voluntary control of the external anal sphincter (this is a good thing). Relaxation of
the external anal sphincter results in defecation.

Defecation can be produced voluntarily by holding the breath and bearing down. This increases
the intrabdominal pressure and moves feces toward the rectum triggering the defecation
reflex.

So that brings us to “the end” of our journey through the tube.

The Liver
We need to mention a couple of organs associated with the digestive system. These are the
liver and pancreas. The liver is located in the right upper quadrant of the abdominal cavity close
to the diaphragm (Fig. 19.9). The liver consists of four lobes including right, left, quadrate, and
caudate lobes. The right and left lobes are separated by the falciform ligament (Fig. 19.11).

The liver performs many functions and is considered a vital organ. Its functions include
detoxifying the blood, producing bile, metabolism of carbohydrates, fats and proteins, storing
iron, blood and vitamins, recycling red blood cells and producing plasma proteins.

Since we are covering the digestive system we need to elaborate a bit more on bile. Bile is a
yellowish-green substance secreted by the liver and stored in the gallbladder. Bile contains bile
salts that are formed from cholesterol. Bile works to break down fat by emulsification and
eliminates products from the breakdown of red blood cells.

Bile works something like soap on a greasy pan. Let’s say that I just cooked a good ole country
breakfast complete with some fatty bacon (yum). When I proceed to clean up the pan I squirt a
few drops of dish soap on the pan with some water and low and behold, the grease just breaks
up! The same kind of thing happens with bile. It breaks some of the bonds holding the fat
molecules together so the enzymes can get in there and do their digestive work.
Bile is made in the liver and stored in the gallbladder. The gallbladder is about 3-4 inches long.
In some cases bile can precipitate and form gallstones. The gallbladder can become inflamed in
a condition known as cholecystitis.

Fig. 19.9. Liver.

Fig. 19.10. Pancreas and gallbladder.

Fig. 19.11. Lobes of the liver.

The Pancreas
The pancreas has a dual endocrine and exocrine role (Fig. 19.10). We investigated the
endocrine role in the endocrine system chapter. The exocrine portion consists of glands that
secrete substances into ducts. The smaller ducts merge with the larger pancreatic duct. The
pancreatic duct merges with the common bile duct at an area in the duodenum known as the
hepatopancreatic ampulla. The hepatopancreatic ampulla is encircled by smooth muscle
forming the hepatopancreatic sphincter.

The exocrine glands secrete digestive enzymes (we’ll cover these later). The endocrine cells are
called alpha and beta cells. The alpha cells secrete glucagon and the beta cells secrete insulin.

The pancreas consists of a body, head and a tail (just like your pet dog except the tail can’t
wag). It is located in the curve of the duodenum.
Here is a chart that summarizes the enzymes:
Enzyme What it Digests Where it's Secreted
Salivary Amylase Carbohydrates Salivary Glands
Pepsin Proteins Stomach
Gastric Lipase Fats Stomach
Pancreatic Amylase Carbohydrates Pancreas
Pancreatic Lipase Fats Pancreas
Trypsin Proteins Pancreas
Chymotrypsin Proteins Pancreas
Carboxypepsidase Proteins Pancreas
Intestinal Lipase Fats Small Intestine
Maltase Carbohydrates Small Intestine
Nucleases Proteins Small Intestine
Sucrase Carbohydrates Small Intestine

Feedback Systems
There are a few feedback systems that we need to cover. These help to control the secretions
of the digestive system.

Phases of Gastric Secretions

Big Picture: three phases of gastric secretions

1. Thinking about food.

2. Eating food.
3. Food exits stomach.
There are three phases of gastric secretions. Let’s say that I am going to one of those delicious
all you can eat buffets (I used to go to these in my student days). I am driving to the buffet and
thinking about all of the delicious (and cheap) food. My stomach begins to gurgle with
excitement. This is the first stage of digestion called the cephalic stage. Just thinking about, or
smelling food can cause my stomach to begin to secrete digestive juice (Fig. 19.12).

The next phase occurs when I have filled a plate (or two) of food and begin eating it. The food
slides down my esophagus and into my stomach kicking off what is called the gastric phase of
digestion. Since digestion is under parasympathetic control my parasympathetic nervous
system kicks in (Fig. 19.13).

The last phase occurs when food leaves my stomach and moves into my duodenum. Here the
gastric secretions are inhibited (Fig. 19.14).
Fig. 19.12. The cephalic phase of gastric secretion. Thoughts and smells cause the
parasympathetic nervous system to send impulses by way of the vagus nerve to the stomach
causing the release of the hormone gastrin. Gastrin is picked up by the stomach and stimulates
gastric secretions.
Fig. 19.13. The gastric phase of gastric secretion. Distention of the stomach and the presence of
amino acids causes the parasympathetic nervous system to stimulate gastric secretions.
Fig. 19.14. Intestinal phase of gastric secretion. Chyme moves into the duodenum causing the
release of CCK, gastic inhibitory polypeptide and secretin that inhibit gastric secretions.

Once food in the form of chyme hits the duodenum it needs to be more fully digested. That’s
where more enzymes from the pancreas and bile from the gallbladder come into the picture.
When that greasy bacon I just ate makes its way to the duodenum it responds by secreting a
hormone called:

Cholecystokinin (CCK)

CCK is picked up by the gallbladder causing it to release bile. Bile helps to break some of the
bonds of the greasy bacon fat so that the enzymes can more fully digest it.
Movement of chyme into the duodenum also stimulates the release of another hormone called:

Secretin

Secretin inhibits stomach secretion and causes the pancreas to secrete its digestive stuff (see
chart). Secretin also causes the pancreas to secrete good ole bicarbonate ions which help to
make the chyme more alkaline. Digestive enzymes work better in alkaline conditions (Fig.
19.15).
Fig. 19.15. Pancreatic secretions are regulated by the release of secretin by the duodenum.
Secretin causes the release of bicarbonate ions that help to neutralize acidic chyme.

How Digested Substances Move into the Blood

Big Picture: Absorption

Carbs and proteins are absorbed directly into the blood while fats move into lymph.
At this point everything is pretty much broken down into small constituents of carbohydrates,
fats and proteins. These molecules now need to be absorbed so they can be used by the body.

The key to learning about absorption is to understand that carbohydrates and proteins move
from the small intestine into the blood in a similar way while fats move from the small intestine
to the blood by way of the lymphatic system.

The big picture with regard to carbohydrate and protein transport is that they both move via
transport proteins (remember symporters in the kidney section) and diffusion directly into
capillaries in the intestine.

Fats diffuse into the intestinal cells and then are reassembled into triglycerides. The
triglycerides are then packaged into small packages called chylomicrons. The chylomicrons
move into the lymphatic system by way of small tublular structures located in the intestinal villi
(fingerlike projections). The chylomicrons are eventually delivered to the circulatory system
(Figs. 19.16, 19.17).

The liver converts lipids by combining them with proteins to form lipoproteins. Lipoproteins are
named for the amount of protein and lipid within them. Very low density lipoproteins (VLDL)
contain about 92% lipid and 8% protein. Low density lipoproteins (LDL) contain about 75% lipid
and 25% protein. High density lipoproteins (HDL) contain about 55% lipid and 45% protein.

Fig. 19.16. Absorption of glucose (Glu), sodium and amino acids (AA) in the intestinal wall.
Transport proteins use the sodium gradient to symport glucose and amino acids into the cells.
Sodium is removed by active transport while glucose and amino acids are passively transported
into the blood capillaries.
Fig. 19.17. Lipid molecules diffuse into epithelial cells lining the lumen of the small intestine.
Once inside lipids are repackaged by smooth endoplasmic reticulum into chylomicrons.
Chylomicrons diffuse out the cells and into the lacteals which are part of the lymphatic system.
Image Credits

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