Text Book of Anatomy & Physiology for Nurses and Midwives…….

CHAPTER-03

CHAPTER –3
Digestive system
Structure and functions of:
 Tongue, teeth, saliva gland
and pharynx
 Esophagus
 Stomach
 Small and large intestine
 Pancreas and spleen
 Liver , Gall bladder and
Digestive system

biliary tract/tree
 Mastication, digestion,
absorption, and elimination

SL No. Topic Name Page

1. Digestive system 193

2. Different Parts of Gastrointestinal Tract or 199
Alimentary Canal

3. Tongue 200
4. Tooth 201

5. Salivary gland 203

6. Saliva 204
7. Pharynx 208
8. Esophagus 210
9. Stomach 211

10. Stomach bed 216

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11. Intestine 217

12. Small intestine 217

13. Large intestine 218

14. Jejunum and Ileum 222

15. Peristalsis 223

16. Movement of Intestine 224

17. Defecation reflex 225

18. Gastric Secretion 227

19. Gastric emptying 229

20. Alkaline tide 231

21. Digestive Juices 233

22. Succus entericus 234

23. Pancreas 236
24. Pancreatic juice 238

25. Spleen 240

26. Liver 242

27. Liver function tests 246

28. Gallbladder 247
29. Biliary tract, (biliary tree or biliary system) 249
30. Bile 250

31. Bile salt 253

32. Gastrointestinal Hormone 255

33. Mastication, Digestion, Absorption & Elimination 258

34. Carbohydrate 259

35. Protein 264
36. Amino Acid 267
37. Fat 269
38. Vermiform Appendix 273

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Digestive system

The food we eat contains a variety of nutrients, which are used for building new body tissues and
repairing damaged tissues. However, most of the food we eat consists of molecules that are too large to be
used by body cells. Therefore, food must be broken down into molecules that are small enough to enter
body cells a process known as digestion. Collectively, the organs that perform these functions are known
as the digestive system

Oesophagus

Liver
Stomach
Gallbladder
Pancreas

Duodenum

Large intestine
Small intestine

Appendix
Anal canal

Figure 3.1 Digestive system

There are two groups of organs compose the digestive system:

 The gastrointestinal tract or alimentary canal and
 The accessory digestive organs.
The gastrointestinal (GI) tract or alimentary canal is a continuous tube that extends from the mouth to
the anus. The GI tract contains food from the time it is eaten until it is digested and absorbed or
eliminated from the body. Organs of the gastrointestinal tract include the mouth, pharynx, esophagus,
stomach, small intestine, and large intestine. The length of the GI tract is about 5–7 meters (16.5–23 ft) in
a living person. It is longer in a cadaver (about 7–9 meters or 23–29.5 ft) because the muscles along the
wall of the GI tract organs are in a state of tonus (sustained contraction).

The teeth, tongue, salivary glands, liver, gallbladder, and pancreas serve as accessory digestive
organs.
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. The secretions that they
produce or store flow into the GI tract through ducts and aid in the chemical breakdown of food.

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Definition of Digestive System:

The complex system concerned with receiving, breaking down and absorption of food materials is known
as digestive system.
Or,
The digestive system is the collective name used to describe the alimentary canal, some accessory organs
and a variety of digestive processes which take place at different levels in the canal to prepare food eaten
in the diet for absorption.
Parts of the Digestive System:

 Alimentary tract: Extends from mouth to anus.

 Mouth or buccal cavity with tongue and teeth.
 Oropharynx.
 Esophagus.
 Stomach.
 Small intestine:
 Duodenum
 Jejunum
 Ileum

Figure 3.2 Different parts digestive system

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 Digestive glands:
 Salivary glands: Parotid, submandibular &
sublingual.
 Pancreas.
 Liver.
 Gall bladder.
 Other digestive glands in the wall of the digestive tract.

Gastrointestinal tract (GIT):

 Extends from stomach to anus.

Draw and Label Different Parts Digestive System

Figure 3.3 Different parts digestive system

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Functions of the digestive tract

 Ingestion of food.
 Movement of food.
 Digestion of food.
 Secretion of various digestive juices.
 Absorption of end products of digestion, H2O, vitamins and minerals.
 Excretion of heavy metals, toxins, bile pigments etc.
 Regulation of water balance.
 Regulation of acid-base balance.
 Regulation of blood glucose level.
 Helps in erythropoiesis.

Another Answer:

1. Ingestion. This process involves taking foods and liquids into the mouth (eating).
2. Secretion. Each day, cells within the walls of the GI tract and accessory organs secrete a total of
about 7 liters of water, acid, buffers, and enzymes into the lumen of the tract.
3. Mixing and propulsion. Alternating contraction and relaxation of smooth muscle in the walls of the
GI tract mix food and secretions and propel them toward the anus. The ability of the GI tract to mix
and move material along its length is termed motility.
4. Digestion. Mechanical and chemical processes break down ingested food into small molecules.
 In mechanical digestion the teeth cut and grind food before it is swallowed, and then
smooth muscles of the stomach and small intestine churn the food. As a result, food
molecules become dissolved and thoroughly mixed with digestive enzymes.
 In chemical digestion the large carbohydrate, lipid, protein, and nucleic acid molecules in
food are broken down into smaller molecules by digestive enzymes.
5. Absorption. The entrance of ingested and secreted fluids, ions, and the small molecules that are
products of digestion into the epithelial cells lining the lumen of the GI tract is called absorption. The
absorbed substances pass into interstitial fluid and then into blood or lymph and circulate to cells
throughout the body.
6. Defecation. Wastes, indigestible substances, bacteria, cells shed from the lining of the GI tract, and
digested materials that were not absorbed leave the body through the anus in a process called
defecation. The eliminated material is termed feces (stool).

Histology of gut:

Cross section of the intestinal wall, including the following layers from outer surface inward:
 The serosa,
 Muscle layers:
 A longitudinal muscle layer,
 A circular muscle layer,
 The submucosa,
 The mucosa.
(Ref- Guyton & Hall / 14th / 797)

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Name The Digestive Glands:

Three major glands play an important role in the digestion. These are as follows:
1. Salivary gland.
2. Liver.
3. Pancreas
A. Salivary gland
Salivary glands consist of the following three pairs.
 Parotid glands
 Submandibular glands
 Sublingual glands
B. Liver
The liver is connected to the two following large blood vessels.
 Hepatic vein – It is used to carry the blood, which is rich in oxygen.
 Portal vein – It is used to carry the blood, which is rich in digested nutrients.
C. Pancreas
Pancreas consists of two portions as follows:

 Endocrine portion
 Exocrine portion

The digestive system views of the abdomen and pelvis

The relationship of the parts of the peritoneum (greater omentum and mesentery) to each other and to
organs of the digestive system is shown.
The peritoneum is the largest serous membrane in the body.
In 1906, the greater omentum was described as the "abdominal policeman" by the surgeon James
Rutherford Morrison. This is due to its immunological function, whereby omental tissue seems to
"surveil" the abdomen for infection and cover areas of infection when found - walling it off with
immunologically active tissue.

Figure 3.4 Anterior view of abdomen & pelvic to show digestive organs

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Different Parts of Digestive System with Their Functions Shortly

Oral cavity Salivary glands

Secretion of
Mechanical processing,
moistening, mixing with lubricating fluid
containing enzymes
salivary secretions.
that break down
carbohydrate

Liver Pharynx
Secretion of bile, Pharyngeal muscles
storage of nutrients, propel materials into
many other vital the oesophagus.
functions.
Oesophagus
Transport of materials
Gallbladder to the stomach.
Storage and
concentration of bile.
Stomach
Chemical break down
of materials via acid
Small intestine and enzymes.
Enzymatic digestion Mechanical processing
and absorption of through muscular
water, organic contractions.
substrates, vitamins
etc

Pancreas
Large intestine Exocrine cells secrete
Dehydration and buffers and digestive
compaction of enzyme.
indigestible materials Endocrine cells secrete
in preparation for hormones.
elimination.

Figure 3.5 Different parts of digestive system with their functions

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Different Parts of Gastrointestinal Tract or Alimentary Canal

Gastrointestinal tract also known as alimentary canal is basically a muscular tube extending from mouth
to the anus and compromises following parts:-

1. Mouth:- Mouth is loosely used term to denote the external opening and for the cavity it leads to. The
cavity containing anterior two-third of tongue and teeth is the mouth cavity or oral cavity or buccal
cavity.
a) Tongue :- Tongue in the digestive system, plays two important roles:
 Tells the taste of food and
 Helps in chewing and swallowing of food.
b) Teeth:- Teeth are accessory organ of digestion which help in crush grind and chewing the food.
2. Pharynx:- When food is swallowed, it passes from the mouth into the pharynx , a funnel-shaped tube
that is composed of skeletal muscle and lined by mucous membrane. It extends from the internal
nares to the esophagus posteriorly and the larynx anteriorly
3. Oesophagus:- The oesophagus is a muscular tube lined with stratified squamous epithelium that lies
posterior to the trachea. It begins at the end of the laryngopharynx, passes through the mediastinum
and diaphragm, and connects to the superior aspect of the stomach. It transports food to the stomach
and secretes mucus. At each end of the esophagus, the muscularis forms two sphincters—the upper
esophageal sphincter (UES) , which consists of skeletal muscle, and the lower esophageal sphincter
(LES), which consists of smooth muscle.
4. Stomach :- Stomach is a J-shaped hallow muscular bag connected to the oesophagus at its upper end
and to the duodenum at the lower end. The stomach is the most elastic part of the GI tract and can
accommodate a large quantity of food, up to about 6.4 liters (6 qt).
5. Small intestine:- The small intestine averages 2.5 cm (1 in.) in diameter; its length is about 3 m
(10ft) in a living person and about 6.5 m (21 ft) in a cadaver due to the loss of smooth muscle tone
after death.
It is a long tubular structure which can be divided into three parts :-

 Duodenum:- is the first part of small intestine. It is “C” shaped and measures about 25 cm in
length.
 Jejunum:- is the middle part of the small intestine, is about 2 meters long and
 Ileum: is the last part of small intestine, is about 3 meters long.
6. The large intestine:- is averages about 6.5 cm (2.5 in.) in diameter and about 1.5 m (5 ft) in length.
It extends from the ileum to the anus and is attached to the posterior abdominal wall by its mesentery.
The large intestine has four principal regions:
 Caecum,
 Colon,
 Rectum, and
 Anal canal

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Tongue

Definition of Tongue:

Tongue is a strong muscle that is anchored to the floor of the mouth. The tongue is covered by the lingual
membrane, which has special areas to detect different types of tastes.

External Feature:

1. A tongue has a root, a tip & a body.

2. Tongue has two parts:
 Oral part
 Pharyngeal part
3. The tongue is covered by three types of papillae:
 Vallate papillae
 Fungiform papillae
 Filiform papillae.
4. The tongue made up of two types of muscle ;
 Intrinsic & Extrinsic.

Structure of Tongue

The human tongue is about 3.3 inches in men and 3.1 inches in women. It is located in the oral cavity.
The tongue is divided into three parts:
 Tip
 Body
 Base

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The tongue is embryologically divided into the anterior and posterior part. The anterior part is known as
the oral or presulcal part that includes the root attached to the floor of the oral cavity. While the posterior
part is known as pharyngeal or postsulcal part that includes the base forming the ventral wall of
oropharynx.
The tongue is made up of three elements:
 Epithelium
 Muscles
 Glands

Functions of the tongue:

 The tongue's main physiological functions are:
 Tasting (gustatory sensation)
 Chewing (aiding in mastication)
 Speech formation
 Sound formation
 It comprises of various individual muscles that help in positioning it while there is activity involved
of chewing or speaking.
 The upper 'skin' surface of it has the taste buds. There are approximately 2,000 to 8,000 taste buds
found on an average human tongue. Papillae (small nipple-like projections) surface, which is easily
noticeable, is covered by the taste buds.
Blood supply:

 Lingual artery,
 Tonsillar artery& pharyngeal artery.
 Venous drainage: mainly by deep by lingual vein.

Nerve supply:

 Motor- mainly by hypoglossal,

 Sensory- glossopharyngeal, lingual & corda tympany.
Principal functions: Helps in mastication & speech.

Teeth

Definition of Teeth:

Tooth is one of the structures within the mouth that allow for biting and chewing.
Or
Tooth (plural teeth) is a small, calcified, whitish structure found in the jaws (or mouths) of which is helps
in breakdown of food and speaking.

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Figure 3.6 Structures of the mouth (oral cavity)

External Features

Externally each tooth consists of

 A root: It is buried in the jaw.

 A neck: The neck is encircled by the gum.
 A crown: The crown projects beyond the gum.

Classification

There are two types of teeth in human

1. The deciduous teeth: Appears at child hood. Ten in each of the upper and lower dental arches.
2. The permanent teeth: Sixteen in each dental arch. The teeth are-
 Two incisors
 One canine
 Two premolars
 Three molars (The last molar appears usually appears lately and known as wisdom
teeth).

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Functions:

 Food needs to be broken down and chewed before entering the digestive system so that our body
can easily absorb nutrients from them.
 Teeth can help us pronounce accurately.
 Teeth can help us look better by giving us a good profile.
 Deciduous teeth can reserve spaces for permanent teeth. Once the permanent teeth start to erupt, the
deciduous teeth will fall out and give room for permanent teeth.

Figure 3.7 Sagittal section of a mandibular (lower) molar tooth

Salivary Gland

Definition of Salivary Gland:

Salivary gland is a gland in the mouth that produces saliva.

Or,
The salivary glands are accessory digestive glands that produce a secretion called saliva.

Names of Salivary Glands:

There are three pairs of large salivary glands:

1. Parotid glands: It secretes purely serous of fluid.
2. Submandibular gland: It secretes both serous and mucous type of fluid.

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3. Sub lingual gland: It secretes both serous and mucous type of fluid.

Figure 3.8 The salivary glands

Functions of Salivary Glands:

 Moistening dry foods to aid swallowing.

 Providing a medium for dissolved and suspended food materials that chemically stimulate taste
buds.
 Buffering of the contents of the oral cavity through its high concentration of bicarbonate ion.
 Digestion of carbohydrates by the digestion enzyme alpha-amylase.
 Controlling the bacteria flora because of the presence of the antibacterial enzyme lysozyme.

Saliva

Definition of Saliva:

Saliva is a viscous, colorless & opalescent fluid which is secreted by the salivary glands.

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 Sources of saliva: 3 pairs of salivary glands –

 Parotid.
 Submandibular &
 Sublingual.
 Amount: About 1 Liter/day (800 – 1500 ml/day).
 Composition of saliva:
 Water: 99.5%
 Organic substances:
 Digestive enzymes.
- Salivary amylase (ptyalin)
- Lingual lipase.
 Mucin.
 Lysozyme.
 Immunoglobulin-A. (IgA).
 Blood group antigen.
 Electrolytes:
 Cations: K+, Na+
 Anions: HCO3-, Cl- etc.

Functions of saliva:
 Mechanical function:
 Facilitates swallowing.
 Helps in speech.
 Keeps the mouth moist.
 Protect the oral mucosa.
 Acts as a lubricant.
 Digestive function: Ptyalin initiates boiled starch (CHO) digestion.
 Anti- bacterial function: IgA acts as the 1st line defense against bacteria.
 Excretory function: It excretes urea, some heavy metals (e.g. Pb, As, Bi) etc.
 Buffering function: Saliva contains HCO3- which acts as a buffer.
 Saliva helps in taste by dissolving food stuffs & also helps in water balance.

(Ref: Guyton and Hall 14th /819+ Lectures of RMC)

Remember
Gland Histologic type Secretion % of total
saliva
Parotid Serous Watery 20
Submandibular Mixed Moderately viscus 70
Sublingual Mucous Viscous 05

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Daily secretion & pH of different juices:

Saliva Gastric juice Pancreatic Small Brunner's Liver bile Gall

juice intestinal gland bladder
juice secretion bile

pH 6.0 – 7.0 1 – 3.5 8.0 – 8.3 7.5 – 8.0 8.0 – 8.9 7.8 – 8.6 7.0 – 7.4

Daily 800 - 1500 1200 - 2500 800 - 1500 1800 200 600 - 1200
secretion
(ml/day)

Functions of saliva for oral Hygiene:

Saliva helps to maintain oral hygiene by several ways -
 Saliva helps to wash away the pathogenic bacteria and food particles that loaded in mouth.
 It contains several factors like thiocyanate ions & lysozyme which -
 Attack & Kills the bacteria.
 Digests food particle.
 It often contain significant amounts of protein antibodies (Ig-A) that destroy oral bacteria, including
those that cause dental caries.
(Ref: Guyton and Hall/ 12th /775)
Salivary Digestion:

Saliva contains following enzymes and help in digestion.

Ptyalin (salivary -amylase):

Ptyalin
Boiled starch Erythrodextin & Maltose Isomaltose & Maltose.

Lingual lipase:
lingual lipase
Fat Fatty acids & triglycerides.

Protective functions of saliva:

 Dilutes hot and irritant food, thus prevents injury to the mucosa.
 Washes down the food debris, thereby prevent bacterial growth.
 Bacteriolytic function: Saliva dissolves the cell wall of many bacteria and kills them.

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Regulation of salivary secretion:

A. Neural regulation:
 Para-sympathetic nerve: stimulation of parasympathetic nerve causes  secretion of watery
saliva with a relatively low organic material.
 Sympathetic nerve: Stimulation of sympathetic nerve causes  secretion of thick mucus saliva
with high organic constituents.

B. Reflex, drugs and others:

 Saliva secretion is increased by –
 Conditioned reflexes e.g. sight, smell, sound and thought of food.
 Un-conditioned reflex e.g. food in the mouth. Food in the mouth   vagal afferent at
the gastric end of the esophagus  signals go to the salivary centre   secretion of
saliva.
 Nausea.
 Drugs e.g. Acetylcholine.
 Saliva secretion is decreased by –
 Sleep.
 Fear.
 Dehydration.
 Drugs e.g. Atropin.
(Ref: Guyton and Hall/ 14th / 820)

Changing of composition of saliva with flow rate:

1. During high flow rate: During maximal salivation, the rate of production of saliva increases to
about 20 folds and the flow of saliva is so rapid that the ductal reconditioning of saliva is
considerably reduced. It has –
 High Na+ & Cl- concentration.
 Low K+ & HCO3- concentration.
2. During low flow rate: This represents the composition of resting condition. Here, the rate of
production is normal and the transport processes of the ducts are normally performed. It has -
 Low Na+ & Cl- concentration.
 High K+ & HCO3- concentration.
(Ref: Guyton and Hall 14th 775p)
Aptyalism:
Complete cessation of salivary secretion is called Aptyalism or Xerostemia. In this case, speech is
troublesome, chewing is difficult and incidence of dental caries is common.
Causes:
 Congenital hypoplasia.
 Absence of salivary glands.
 Temporary cessation occurs in Anxiety, Worry, Fear, and Shock etc.

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Hyposalivation/ Xerostomia:
Reduced salivation (less than normal) is called Hyposalivation.
Causes:
 Deep X-ray radiation given to salivary glands.
 Surgical intervention

Hypersalivation/ Sialorrhea:
Excessive salivation (more than normal) is called Hypersalivation. It is also known as Ptyalism or
Sialorrhea.
Causes:
 Excessive production:
 Mouth ulcers
 Oral infections
 Rabies
 Gastroesophageal reflux disease
 Pregnancy
 Excessive starch intake
 Pancreatitis
 Liver disease
 Drugs: Clozapine, pilocarpine, potassium chlorate, resperidone, rabeprazole
 Toxins: Mercury, copper, organophosphorus compounds (OPC), arsenic
 Decreased clearance:
 Infections: Tonsillitis, retrophareangeal abscess, peritonsillar abscess, epiglottitis,
mumps.
 Radiation therapy.
 Neurologic disorders: Myasthenia gravis, Parkinson’s disease, bulbar paralysis,
bilateral facial

Pharynx

The pharynx, usually called the throat, is part of the respiratory system and digestive system. It carries air,
food and fluid down from the nose and mouth.
Or,
The pharynx is a wide fibromuscular tube, situated behind the nose, the mouth and the larynx.

Parts of the pharynx

The pharynx anatomy includes:
 Nasopharynx: The top part of the throat connects to the nasal cavities (nose) and lets air pass
through.
 Oropharynx: The middle part of the throat connects to the oral cavity (mouth). It allows air, food
and fluid to pass through.

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 Laryngopharynx (or hypopharynx): The bottom part of the throat is near the larynx (or voice
box). It regulates the passage of air to the lungs and food and fluid to the esophagus.

The pharynx also contains:

 Tonsils: There are three sets of tonsils. They are located at the back of the throat and base of the
tongue. Tonsils are the body’s first defense against infection.
 Auditory (eustachian) tubes: These two tubes connect the ears to the throat. They equalize
pressure and help drain fluid.

Figure 3.8 Parts of Pharynx

Boundaries of pharynx:

 Superiorly: Base of the skull.

 Inferiorly: It is continuous with the esophagus at the level of the sixth cervical vertebra.
 Posteriorly: Prevertebral fascia.
 Anteriorly: It communicates with the nasal cavity, oral cavity and the larynx. Thus the anterior
wall of the pharynx is incomplete.

Structure of the pharynx:

The wall of the pharynx is composed of following layers from within to outwards-
 Mucosa
 Sub-mucosa
 Pharyngobasilar fascia
 Muscular coat

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 Buccopharyngeal fascia

Functions of pharynx:

 Carries air to the respiratory system.

 Delivers food and liquid to the digestive system.
 Pushes food into the esophagus so it’s not breathed in.
 Equalizes pressure in the ears and drains fluid from the ears.

Esophagus

This is the narrow muscular tube forming food passages. The esophagus begins in the neck at the lower
part of the cricoid cartilage as a continuation of the pharynx. It ends in the stomach at the level of the
vertebra T10.
Or,
The esophagus is a muscular tube connecting the throat (pharynx) with the stomach. The esophagus is
about 8 inches long, and is lined by moist pink tissue called mucosa.
 This Total length is about 25 cm (10 inch)
 It has 3 parts-
 Cervical part - 4 cm (11/2 inch)
 Thoracic part - 20 cm (8 inch)
 Abdominal part- 1.25 cm (54 inch)
 Breadth is about 2 cm (3/4 inch)
 The esophagus has four constrictions:
 At its commencement in the neck
 Where it is crossed by the arch of aorta in the thorax
 Where it is crossed by the left principal bronchus in the thorax
 At the esophageal opening of the diaphragm in the abdomen

 Clinical importance of the constrictions:

 During introducing a Ryle’s tube location of the constrictions should be kept in mind
to prevent injury to the esophagus.
 Structure of the esophagus:
The esophagus has four layers (inwards to outwards):
 The mucosa is lined by non-keratinized stratified squamous epithelium
 The sub-mucosa
 The muscular layer
 The adventitia

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Stomach

Definition of Stomach:

The stomach is a muscular, hollow organ in the gastrointestinal tract of humans which act as reservoir of
food.
Or
Stomach is a muscular bag like organ forming the widest and most distensible part of the digestive tract.
It acts as a temporary reservoir of food.

1. Shape: J Shaped
2. Length: 25 cm
3. Capacity:
At birth 30-50 ml

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At puberty 1000 ml

At adult 1500-2000 ml (1.5-2 lit)

4. Location/ Situation: It is situated in the upper abdomen. It lies in the epigastric, left hypochondriac,
and umbilical regions.

Features

1. Two Orifices: Cardiac, Pyloric

2. Two Curvatures: Lesser Curvature, Greater Curvatures
3. Two Surface : Anterior , Posterior

Parts of Stomach

Cardiac part:  Fundus

 Body

Pyloric part  Pyloric antrum

 Pyloric canal
 Pylorus

Functions of Stomach:
 Mechanical function:
 Acts as reservoir of food.
 Helps in proper mixing of food.
 Digestive function: e.g.-Partial digestion of protein.
 Secretory function:
 Secretion of digestive juice.
 Secretion of hormones.
 Absorptive function: e.g.- water, alcohol etc.

In another way
It may be answered as –
Functions of stomach:
A) Motor functions:
 Storage of large quantities of food material until emptying to the duodenum.
 Mixing of the food with gastric juices until it forms a semi-fluid mixture called chyme.
 Slow emptying of food materials to the small intestine at a rate suitable for proper digestion
& absorption by the small intestine.
B) Secretory functions:

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 Peptic/ chief cells secrete pepsinogen.

 Parietal/ oxyntic cells secrete HCl, Intrinsic factor of Castle.
 Mucous neck cells secrete mucous.
 'G' cells secrete gastrin.
(Ref-Guyton & Hall / 14th / 810-821)

The cells present in main gastric glands

Cells Secretion

Peptic (chief) cell Pepsinogen

Parietal (oxyntic) cell HCl, Intrinsic factor of Castle.

Mucus neck cell Mucin

G cells Gastrin.

Blood Supply of Stomach:

A. Artery supply of stomach:
 Left gastric artery.
 Right gastric artery.
 Left gastroepiploic artery.
 Right gastroepiploic artery.
 5-7 short gastric artery.
 Posterior gastric artery.
B. Venous drainage of stomach:
 Right gastric vein.
 Left gastric vein.
 Right gastro-epiploic vein.
 Left gastro-epiploic vein.
 Short gastric vein.
 Prepyloric vein.

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Figure 3.9 Blood Supply of Stomach

C. Nerve supply:
 Sympathetic nerve: T6-T9 segments of spinal cord.
 Parasympathetic nerve: Vagus nerve

Layers of Stomach

There are four layers of stomach wall, from the inside to out, are...
1. The mucosa,
2. Submucosa,
3. Muscularis, and Mucosa
4. Serosa.

Submucosa
Muccularis

Serosa

Figure 3.10 Layer of stomach wall

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Draw and label stomach

Figure 3.11: The stomach

Structure of the stomach:

The stomach has four layers (inwards to outwards):
 Mucosa: is lined by simple columnar epithelium.
 Submucosa
 Muscularis externa: Consists of three layers:
 Inner oblique layer
 Middle circular layer
 Outer longitudinal layer
 Serosa

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Figure 3.12 Structure of Stomach.

Write short note on – Stomach Bed

Definition of Stomach Bed:

The stomach bed refers to the structures upon which the stomach rests in mammals. These include the
Pancreas, Spleen, Left Kidney, Left Suprarenal gland, Transverse colon and its mesocolon, and the
diaphragm.

Figure 3.13 Structure forming stomach bed

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Motor Functions of Stomach:

 Storage of large quantities of food until the food can be processed in the duodenum.
 Mixing of this food with gastric secretions until it forms a semi fluid mixture called chyme.
 Slow emptying of the food from the stomach in to the small intestine at a rate suitable for proper
digestion and absorption.

Intestine

Definition of Intestine:

Intestine is the long, tube like organ in the abdomen that completes the process of digestion. It consists of
the small and large intestines.

Write short note on small intestine

Definition of Small Intestine:

Small intestine is the part of the digestive tract that extends from the stomach to the large intestine.

 Duodenum
 Jejunum.
Parts of Small
 Ileum.
Intestine:

 Outer: Serous layer.

 Middle: Muscle layer.
Structures of small
 Inner: Sub-mucous layer.
intestine:
 Inner most: Mucous layer.
 Helps in onward movement of its contents by peristalsis.
 Secretion of intestinal juice which takes part in digestion.
Functions of small
 Completion of chemical digestion of carbohydrates, protein and fats.
intestine:
 Protection against infection by microorganism.

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 Absorption of nutrients.
 Secretion of the local hormones cholecystokinin and secretion.

Figure 3.14 Different parts of small intestine

Write short note- Large intestine

Definition of Large Intestine:

The large intestine, also known as the large bowel or colon, is the last part of the gastrointestinal tract and
of the digestive system in vertebrates.

Parts of Large Intestine:

 Caecum.
 Ascending colon.
 Transverse colon.
 Descending colon.
 Sigmoid colon.
 Rectum.
 Anal canal.

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Figure 3.15 Different parts of large intestine

Functions of large intestine

 Absorption of water and electrolytes (Na+, Cl- etc) from the chyme.
 Storage of fecal matter until it can be expelled.
 Secretion of mucus, which lubricate the stool.
 Large intestine has a rich bacterial flora. These bacteria synthesize Vit-K, Vit-B complex & folic
acid.
(Ref: Guyton & Hall 14th /770p.)
Another Answer
Functions of large intestine:
 Absorptive: It absorbs 80% water, electrolytes, some glucose, certain drugs and alcohol.
 Secretory: It secrets mucin and inorganic substances like chlorides and bicarbonates.
 Excretory: Excretes heavy metals like mercury, lead, bismuth and arsenic through feces.
 Synthetic: Bacterial flora in the large intestine synthesizes vitamin-K, vitamin-Bl2 and folic acid.
 Digestive: Bacteria in the large intestine digest some cellulose and produce some gases e.g. CO2,
H2, CH4.

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 Propulsive: Its mass peristalsis is essential for defecation.

 Formation of faeces: After the absorption of nutrients, water and other substances, the unwanted
substances in the large intestine form feces. This is excreted out.

Rectum

Anal canal

Internal anal sphincter

(Involuntary)

External anal sphincter

(Voluntary)

Anus

Figure 3.16 Frontal section of Rectum and Anal canal

Functions of small intestine

 Mechanical functions:- The mixing and propulsive movement of the small intestine help in through
mixing of chyme with the digestive juices (pancreatic juice, bile juice and succus entericus) and
propel it towards the large intestine.
 Digestive functions:- Completion of chemical digestion of carbohydrates, protein and fats.
 Absorptive functions:- The end products of carbohydrates, protein and fats are absorbed through
portal system or through the lymph.
 Hormonal function:- The small intestine secretes certain hormones as enterogastrone, secretine and
cholecystokinin(CCK).
 Protective function:- The mucus secreted into the succus entericus protects the intestine wall from
the gastric acid chyme.
 Hydrolytic function:- The succus entericus provides necessary water which help to digest various
food particles.

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Difference between Large Intestine and Small Intestine:

Basis for comparison Small Intestine Large Intestine

1. Size Small intestine measures Large intestine measures around 1.5 m in

around 4.5 - 7.0 m in size. size.
It is narrow in width of around It has width of around 4 - 6 cm in
3.5 - 4.5 cm. diameter.
2. Parts It has three parts, which are It has four parts, which are colon, rectum,
duodenum, jejunum and ileum. caecum and anal canal.
3. Length Longer Shorter
4. Presence of Villi Villi are present. Villi are absent.
5. Peyers Patches Peyers Patches are present. Peyers patches are absent.
6. Muscle bands It forms the layer of It is reduced to three types of muscles
continuous bands of muscles bands called as taeniae coli.
around it.
7. Taeniae Coli Taenia coli is absent from the Taenia Coli are present.
surface of small intestine.
8. Motility It shows small movements in Large intestine is fixed or show very little
the abdominal cavity. mobility.
9. Hastura Absent Present

10. Epiploic Epipolic apppedages is absent Epipolic appendages are present.

appendages in small intestine.
11. Role in digestion Digestion is complicated. No role in digestion.
12. Hormones Numerous hormones are No hormones are secreted.
Secreted secreted.
13. Activity It absorb the nutrients from the It takes part in absorption of water and
digested food. electrolytes and in production of
vitamins.

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Difference between Jejunum and Ileum:

Traits Jejunum Ileum

Position: More to the left and above Right and below.

Length Shorter Longer

Appearance Redder and wider. Paler and narrower

Feel: Thicker Thinner

Lumen Wider Narrower

Aggrated lymphatic Fewer and smaller in the More and larger

follicles: jejunum.

Mesenteric fat : Less fat in the mesentery of the Such areas are absent from the
jejunum near the gut, so that mesentery of the terminal ileum.
translucent ‘windows' are
visible when the mesentery is
held against the light.

Arterial arcades Arteries form a greater number Form fewer arcades- Receives
of arcades than do the ileal shorter terminal branches from
arteries. . tertiary or quaternary arcades

Movements of the GIT:

A. Movement of stomach:
 Mixing movement (In full stomach).
 Propulsive movement (In full stomach).
 Hunger contraction (In empty stomach).

B. Movement of small intestine:

 Peristalsis: propulsive contraction.
 Segmentation: mixing contraction.

C. Movement of large intestine:

 Haustration: mixing movement.

 Mass movement: propulsive movement.

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Another Answer
Movements of alimentary tract / GIT:
 Movement of mouth: Mastication/chewing.
 Movement of pharynx & oesophagus: Deglutition /swallowing.
 Movements of stomach:
 Mixing movement - Mixing.
 Propulsive movement - Peristalsis.
 Movements of small intestine:
 Mixing contractions (Segmentation contractions).
 Propulsive movement - Peristalsis.
 Pendular or swaying movement.
 Movements of large intestine:
 Mixing movement - Haustration.
 Propulsive movement - Mass movement.
 Anti-peristaltic movement.

Q. Write a short note on ‘Peristalsis’

Peristalsis:
Peristalsis is a reflex response that initiate when the gut wall is stretched by the content of the lumen and
it occurs in all parts of the gastrointestinal tract.
Or,
The anal ward movement of the contents of the gut is known as propulsive movement or peristalsis.
Or,
The basic propulsive movement of GIT is peristalsis.
 Velocity: 2 - 25 cm/second.

Stimulus for peristalsis:

 Distension (usual).
 Myenteric plexus.

Steps:
Distension of the gut wall.

 Myenteric plexus

Contraction above the point of distension & relaxation below

Contraction moves towards the distended part & pushing the contents to anal ward direction (Peristalsis)

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Figure 3.17: Peristalsis

Purpose of peristalsis:
 Propulsion of food-chyme from oral to aboral direction.
 Helps in mixing food particles with digestive enzymes.
Peristalses occur in:
 GIT.
 Bile duct.
 Ducts of the glands.
 Ureters.
 Other smooth muscle tubes of the body.
Characteristic of peristalsis:

 Peristalsis is induced reflexly by distension of gut wall.

 Peristalsis moves in the aboral direction.
 It is a propulsive movement.

Movement of Intestine
 Movements of small intestine:
 Mixing contractions (Segmentation contractions).
 Propulsive movement - Peristalsis.
 Pendular or swaying movement.
 Movements of large intestine:
 Mixing movement - Haustration.
 Propulsive movement - Mass movement.
 Anti-peristaltic movement.

(Ref- Guyton & Hall / 14th / 807 - 814 + Chakrabarti, Ghosh & Sahana / 2nd / 438-440)

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Physiological effects of GIT movement:

 Propulsive movements, which cause food to move forward along the tract at an appropriate rate for
digestion and absorption.
 Mixing movements, which keep the intestinal contents thoroughly mixed at all times.

Q. Write short note on: Mass peristalsis.

Mass movement: It is a modified type of peristalsis in the colon which is initiated by the gastrocolic and
duodenocolic reflexes.

Mechanism:
A constrictive ring occurs at the distended point in the colon.

20 cm or more of the colon distal
to the constriction contract occur as a unit.

Forcing the fecal material in this segment down to the colon.

Complete disappearance of haustration.

Mass contraction lasts for 30 sec.

Relaxation then occurs during the next 2-3 min, before another one.

 Frequency: Few times (l-3)/day.

 Purpose / importance:
 It serves to empty the contents of the proximal colon into the more distal part and
finally into rectum.
 It helps in desiring to defecation.
(Ref- Guyton & Hall / 14th / 815)

Defecation Reflex
Defecation reflex
Defecation is initiated by defecation reflexes & this reflex is initiated when the rectum is distended with
feces.
The urge to defecate first occurs when rectal pressure increases to about 18 mm Hg.
Or
The reflex mechanism that causes defecation is called defecation reflex.

Mechanism/ Types:
There are two types of defecation reflexes:

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1. Intrinsic reflexes.
2. Parasympathetic defecation reflex.

Intrinsic reflexes:
It is mediated by local enteric nervous system. When the feces enter the rectum, distension of the rectal
wall initiates afferent signals that spread through the myenteric plexus to initiate peristaltic waves in the
descending colon, Sigmoid colon & rectum forcing feces toward the anus.
As the peristaltic wave approaches to the anus, the internal anal sphincter is relaxed, defecation will
occur.
Parasympathetic defecation reflex:
It involves the sacral segment of the spinal cord. When the nerve endings in the rectum are stimulated,
signals are transmitted into the spinal cord. These signals reflexly back from spinal cord to the descending
colon, sigmoid colon, rectum & anus by way of parasympathetic nerve fibres in the pelvic nerves.
The parasympathetic signals greatly intensify the peristaltic wave as well as relaxing the internal anal
sphincter. Thus the intrinsic defecation reflex is converted from a weak movement into a powerful
process of defecation.

Figure 3.18: Defecation reflex.

(Ref: Guyton & Hall 14th /815-16)

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Gastric Secretion

Composition of Gastric Juice:

A. Water : 99.5%
B. Solids : 0.5%
a) Organic constituent:
1. Pepsinogen.
2. Gastric lipase & amylase.
3. Mucin.
4. Intrinsic factor of Castle.
b) Electrolytes (inorganic constituent):
1. Hydrochloric acid (HCl).
2. Cation: Na+, K+, H+ etc.
3. Anion: Cl-, SO4-- etc.

Important constituent of gastric juice:

 Hydrochloric acid (HCl).
 Pepsinogen.
 Intrinsic factor of Castle.
 Hormone. e.g.- gastrin.
 Electrolytes: Na+, K+, H+, Cl-, HCO3- etc.
[N.B. Gastric juice contain about 99.5% water.]
(Ref: Ganong 25th/431p)
Functions of the Gastric Juices:
 Functions of gastric HCl:
 Destroy bacteria & other pathogens coming with the food particles.
 Converts inactive pepsinogen into active pepsin.
HCl
Pepsinogen Pepsin
(Inactive) (Active)
 Helps in protein digestion along with pepsin.
 Helps in HCO3- rich pancreatic secretion.
 Helps in iron absorption.
 Stimulates the flow of bile.
 Functions of gastric enzymes:
 Pepsin helps in protein digestion.
 Gastric lipase helps in fat digestion.
 Functions of Intrinsic factor of castle: It is essential for the absorption of vitamin B12.

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 Functions of mucin/ mucous:

 It protects the gastric mucosa from the action of HCl.
 It lubricates the gastric mucosa and thereby prevents contact of irritant substances to gastric
mucosa.
(Ref: Guyton and Hall 14th 777-79+Lecture of RMC)
Another Answer
Functions of gastric juices;
 Digestive function:
 Digestion of protein:
 Pepsin acts on the protein to break it down up to the stage of peptone.
 Rennin acts on milk protein caseinogen to coagulate it into insoluble casein,
which is then digested by other proteolytic enzymes present in the small
intestine. It is present only in stomach of children.
 Digestion of fat: Gastric lipase digests fat to some extent.
 Antiseptic function: Many bacteria pass into the stomach with food materials. They are killed by
gastric HCl.
 Functions of HCl of gastric juice: HCl performs digestive & protective functions.
 Hemopoietic function: The intrinsic factor of Castle of gastric juice helps absorption of vitamin
B12 (extrinsic factor) which is essential for maturation of RBC.
 Lubricating function: Mucin of gastric juice lubricates any irritant, which might have gained entry
into the stomach.
 Protective function: Mucin is responsible for protecting the gastric mucosa from the aggressive
action of HCl. Thus stomach is not self-digested.
 Acid-base balance: It is responsible for the alkaline tide of blood, during secretion of HC1.
 Excretory function: Some heavy metals (e.g. Bismuth, lead etc.), toxins, opium and other
alkaloids are excreted through the gastric juice.
(Ref- Chakrabarti, Ghosh & Sahana / 2nd / 396)

Mechanism of secretion of HCl in stomach:

 Water inside the parietal cell becomes dissociated into H+ and OH- in the cell cytoplasm. The H+ is
then actively secreted into the canaliculus in exchange for K+, an active exchange process that is
catalyzed by H+-K+ ATPase. Potassium ions transported into the cell by the Na+-K+ ATPase pump on
the basolateral (extracellular) side of the membrane tend to leak into the lumen but are recycled back
into the cell by the H+-K+ ATPase. The basolateral Na+-K+ ATPase creates low intracellular Na+,
which contributes to Na+ reabsorption from the lumen of the canaliculus. Thus, most of the K + and
Na+ in the canaliculus is reabsorbed into the cell cytoplasm, and hydrogen ions take their place in the
canaliculus.
 The pumping of H+ out of the cell by the H+-K+ ATPase permits OH- to accumulate and form HCO3-
from CO2, either formed during metabolism in the cell or entering the cell from the blood. This
reaction is catalyzed by carbonic anhydrase. The HCO3 is then transported across the basolateral
membrane into the extracellular fluid in exchange for chloride ions, which enter the cell and are
secreted through chloride channels into the canaliculus, giving a strong solution of hydrochloric acid

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in the canaliculus. The hydrochloric acid is then secreted outward through the open end of the
canaliculus into the lumen of the gland.
 Water passes into the canaliculus by osmosis because of extra ions secreted into the canaliculus.
Thus, the final secretion from the canaliculus contains water, hydrochloric acid at a concentration of
about 150 to 160 mEq/L, potassium chloride at a concentration of 15 mEq/L, and a small amount of
sodium chloride.

Figure 3.19: Postulated mechanism for secretion of hydrochloric acid .

Q. Write short note on: Gastric emptying.

Regulations of gastric emptying:
Signals from both stomach and duodenum control emptying of the chyme into the duodenum at a rate no
greater than the chyme can be digested and absorbed in the small intestine.

Gastric factors that promote emptying:

 Gastric food volume: Increased food volume  gastric emptying.
 Gastrin Increases gastric motility  gastric emptying.

Powerful duodenal factors that inhibit emptying:

The duodenal factors work when too much chyme is already in the small intestine, or the chyme is
excessively acidic, contains too much unprocessed protein or fat, is hypotonic or hypertonic or is
irritating.
 Enterogastric reflex: When food enters into duodenum multiple nervous reflexes are
initiated from duodenum go back to the stomach decreases emptying.
 Hormonal factors:

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 Fat in intestine Fat extracts several hormones from intestinal epithelium

hormones go to stomach  emptying.
 CCK-PZ gastric motility  emptying.
 Secretin  gastric motility emptying.
In this way, the rate of stomach emptying is limited to that amount of chyme that the small intestine can
process.
(Ref- Guyton & Hall / 14th /811)
Agents that inhibit gastric HCl secretion:

1. Histamin-2 (H2) receptor blockers inhibit gastric secretion. They are -

a. Ranitidine (most commonly use).
b. Cimetidine.
c. Nizatidine.
d. Famotidine.
e. Roxatidine.
2. Proton pump (H+- K+ pump) inhibitor. e.g. Omeprazol, Pantoprazole, Rabiprazole.
3. Antimuscarinic drugs. e.g. Pirenzepine, Dicyclomine.

Importance of H2 receptors in clinical medicine:

H2 blocker are the drugs that act on the H2 receptor and prevent histamine to combine with the histamine-
2 receptor and decrease HCl secretion.

Mechanism:
H2 blockers
(Ranitidine, nizatidine, famotidine, roxitidine etc)

Block Histamine-2 (H2) receptor

Histamine cannot act on its receptor on parietal cells.

 Acid secretion

Healing of peptic ulcer.

Receptors present on the parietal cell:

 M3 muscarinic receptor.
 Gastrin receptor.
 H2 receptor (Histamin-2).

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Factors stimulate gastric HCl secretion:

A. Hormonal factors.
i. Acetylcholine.
ii. Gastrin.
iii. Histamin.
B. Neural factors: e.g. - stimulation of vagus nerve.
C. Emotional factors. e.g. – Anxiety, Excitement.
D. Others: smoking, genetic factors etc.

Alkaline Tide

Alkaline tide / post prandial alkaline tide:

After meal, HCl secretion by parietal cell is increased. For every H+ secretion from parietal cell HCO3-
enters into blood.
Thus, after meal H+ secretion HCO3- secretion into blood HCO3- excretion in the urine
Urine becomes alkaline postprandial alkaline tide.

Regulation of gastric juice secretion:

Gastric juice secretion occurs at cephalic phase, gastric phase and intestinal phases, which are regulated
by-
 Neural mechanism &
 Humoral mechanism.
Cephalic phase (neural):
It takes place before food enters into stomach.
Food in mouth, and sight, smell, taste, thought of food

Signals arise in cerebral cortex or in appetite centers of amygdala or hypothalamus

Signals go to dorsal nucleus of vagus

Signals come to stomach via vagus nerve

Release of acetylcholine (Ach)

Ach causes HC1, pepsinogen & mucous secretion (20% of gastric secretion)

Gastric Phase:
It takes place when food enters the stomach.
 Neural mechanism:

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
Food in stomach local vasovagal and enteric reflexes Release of acetylcholine (ACh)
ACh causes secretion of HC1, pepsinogen & mucus.
 Humoral mechanism:
 Food in stomach Release of gastrin gastrin causes direct stimulation of gastrin receptor
on parietal cells Causes HCl secretion. Gastrin also causes release of histamine from
enterochromaffin cells Histamine acts on H2 receptor on parietal cell Causes HCI
secretion.

Intestinal phase:
 Neural: Food in duodenum Reverse enterogastric reflex  gastric secretion.
 Humoral: Food in duodenum Release of secretin, VIP, GIP  gastric secretion.
 Other influences:
 Emotions: anger, hostility secretion. But, Fear, depression  secretion
 Hypoglycemia  secretion.
 Alcohol & caffeine secretion.

Factors affecting gastric secretion:

 Emotion:
 Pleasant surroundings, elated mood increase gastric secretion.
 Unpleasant surroundings, fear, anger, hostility, worries, grief, shock decrease gastric
secretion.
 Food: Palatable foods stimulate gastric secretion; while disagreeable foods depress it.
 Drink: Pre-lunch drinks (alcoholic) stimulate gastric secretion.
 Alkalis:
 In large doses - increases secretion.
 In small doses - decreases secretion.
 Acids: HC1 (1%) decreases secretion when directly put inside the stomach.
 Bitters: Unless the bitters contain alcohol, they have hardly any effect on gastric secretion.
 Drugs: Drugs like histamine, caffeine, insulin stimulate gastric secretion.
 Tobacco smoking: Stimulates gastric secretion.
 Vitamins: Deficiency of vitamin B12 & vitamin-B respectively cause achylia gastrica and
achlorhydria.
 Electrolytes: Changed blood calcium level depresses gastric secretion.
 Hormones:
 Parathormone, ACTH, steroids, insulin and gastrin stimulate gastric secretion.
 Serotonin & enterogastrone decrease gastric secretion.

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Digestive Juices

Digestive juice:
The juices which are secreted from the glands of digestive tract and help in the digestion of food are
called digestive juices.

Name of juices Daily secretion PH

1. Saliva 1000 ml. 6.0 – 7.0
2. Gastric juice 1500ml. 1.0 – 3.5
3. Pancreatic juice 1000ml. 8.0 – 8.3
4. Bile 1000ml. 7.8
5. Small intestinal juice 1800 ml. 7.5 – 8.0
6. Brunner's gland secretion 200 ml. 8.0 – 8.9
7. Large intestinal juice 200 ml. 7.5 – 8.0

Composition of digestive juices:

Digestive juice Water Solid Organic Inorganic

 Enzymes: Ptyalin (Salivary α-  Cation: Na+
amylase), Lingual lipase, ,K+, Ca2+
Saliva 99.5% 0.5% Lysozyme.  Anion: CI-,
 Mucin
HCO3-
 Secretory IgA
 Cells: Yeast cell, bacteria,
protozoa.

 Enzymes: Pepsin, Gastric lipase,  Cation: Na+

Rennin. ,K+, Mg2+, H+
Gastric juice 99.5% 0.5%  Intrinsic factor of Castle.
 Anion: CI-,
 Mucus.
PO43-
 HC1
SO42-

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 Carbohydrate splitting enzymes:  Cation: Na+

 Pancreatic amylase ,K , Ca2 , Mg2+
+ +

 Proteolytic enzymes: Trypsin,  Anion: HCO3-

 Chymotrypsin,
C1-, SO42-
Pancreatic juice 98.5% 1.5%  Carboxypolypeptidase,
Elastase.
 Lipolytic enzymes: Pancreatic
lipase, Cholesterol esterase,
PhospholipaseA2, colipase.
 Nuclease:
 RNAase
 DNAase.

 Carbohydrate splitting enzymes:  Cation: Na+,

 Sucrase, Maltase, Lactase, K+, Ca2+, Mg2+
Isomaitase, α- Dextrinase,  Anion: HCO3-
Succus entericus 98.5% 1.5% Trehalase.
C1-, SO42-
 Proteolytic enzymes:
 Enteropeptidase,
 Aminopeptidase,
 Carboxypeptidase,
 Endopeptidase,
Dipeptidases.
 Lipolytic enzymes: Intestinal
lipase
 Nuclease: RNAase, DNAase.
Bile  Activator
Bile salt. enzyme: Enterokinase.  Cation: Na+,
 Liver bile 97.5% 2 - 4%  Bilirubin. K+, Ca2+,
 Gall bladder 92% 10-12%  Cholesterol.  Anion: HCO3-
bile  Fatty acid.
C1-,
 Lecithin.

Succus Entericus

Succus entericus also called intestinal juice is a fluid that is secreted in small quantity in the small
intestine. The secretions of the brush border cells of the mucosa along with the secretions of the goblet
cells constitute this intestinal juice.
Composition of Succus Entericus:
A. Water: 98.5%
B. Solid: 1.5%
 Organic:

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 Proteolytic enzymes:
- Aminopeptidase (mainly).
- Dipeptidase.
- Nuclease.
 Amylolytic enzyme:
- Sucrase.
- Maltase.
- Lactase.
- Isomaltase.
 Fat splitting enzyme:
- Intestinal lipase.
 Activator enzyme:
- Enterokinase.
 Inorganic:
 Cation: Na+, K+
 Anion: HCO3-

Functions of succus entericus:

 Protective function: By its mucus.
 Hydrolytic action: Due to its abundant water content -
 It helps in the transport of food particles, ready for enzyme action or absorption.
 It provides the ready supply of water needed for hydrolysis of food particles.
 It dissolves many substances, so supplies a readymade vehicle for emulsification of fat.
 Enzyme activation: Due to enterokinase, it activates inactive trypsinogen into active trypsin.
 Digestive function:
 Protein: Proteolytic enzymes complete the digestion of protein and liberate amino
acids. Nucleoproteins are completely broken down in the intestine.
 Carbohydrate: Dipeptidases (mainly maltase, lactase, sucrose) act on the
disaccharides (maltose, lactose, sucrose) to liberate monosaccharides.
 Fat: Lipolytic enzymes help in splitting fat.
 Absorptive function: It is particularly an effective vehicle in promoting absorption.
 Water absorption: Normally, the amount of secretion is absorbed almost wholly, leaving a small
residue to be absorbed by large intestine.

Classification of Digestive Enzymes:

 Carbohydrate splitting enzymes:

 Ptyalin (salivary α -amylase)
 Pancreatic amylase
 Sucrase, Maltase, Lactase.
 α-Dextrinase
 Isomaitase

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 Trehalase.
 Proteolytic enzymes;
 Pepsin
 Trypsin, Chymotrypsin, Carboxypolypeptidase, Elastase.
 Aminopeptidase, Dipeptidases, Tripeptidases, Enteropeptidase.
 Fat splitting enzymes:
 Lingual lipase
 Gastric lipase
 Pancreatic lipase, Phospholipase A2, cholesterol esterase, co-lipase.
 Enteric lipase
 Lecithinase.
 Acid lipase.
 Nuclease:
 DNAase
 RNAase
 Other enzymes:
 Carbonic anhydrase, phosphatase, lysozymes.
 Gastric rennin.
 Enterokinase.

Q. Write short note on: Gastrointestinal reflex.

The gastrointestinal reflexes are given below:

 Reflexes that are integrated entirely within the enteric nervous system. It includes reflexes
that control GIT secretion, peristalsis, mixing contraction, local inhibitory effects etc.
 Reflexes from the gut to the prevertebral sympathetic ganglia and then back to the Gut. It
includes Gastrocolic reflex, enterogastric reflex, colonoileal reflex.
 Reflex from the gut to the spinal cord or brain stem and then back to the gut, such as, the
defecation reflex.

Pancreas

Definition of Pancreas:

Pancreas is a spongy, tube-shaped organ that is about 6 inches long and is located in the back of the
abdomen, behind the stomach which helps in digestion and metabolism.

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Figure 3.19: Pancreas

Feature of Pancreas:

1. Length: 15-30 cm long

2. Width: 2.5-3.8 cm long
3. Parts: four parts:
The pancreas anatomy includes:

 Head: The wider part of the pancreas that sits in the curve of duodenum.
 Neck: The short part of the pancreas extending from the head.
 Body: The middle part of the pancreas between the head and neck, which extends
upward.
 Tail: The thinnest part of the pancreas, located near spleen.
4. Ducts :
 Main pancreatic duct
 Accessory pancreatic duct
5. Histology: Exocrine part is serous grand & made up of tubular acini. Endocrine part is made up
of islets of Langerhans. Exocrine part is composed of following cells-
 α1-pancreatic gastrin, serotonin

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 α 2- glucagon,
 ß – insulin

Function of Pancreas:

Exocrine function  Digestive action: Due to the presence of high concentration of different
enzymes, pancreatic juice digests all three types of food- proteins,
carbohydrates and fats.
 Neutralizing action: Pancreatic juice contains large quantities of
bicarbonate which plays an important role in neutralizing the acid chyme
emptied by the stomach into the duodenum.
Endocrine  Glucagon: Increase blood glucose level
functions  Insulin: Metabolism of glucose & fat.

Pancreatic Juice

Composition of pancreatic juice

Water: 98% Solid: 2%

Organic Inorganic

a) Carbohydrate splitting enzyme: i. Cation: Na+, K+, Ca++, Mg++

etc.
 Pancreatic -amylase. ii. Anion: HCO3-, SO42-, HPO42-
, Cl- etc.
b) Proteolytic enzymes:
 Trypsin.
 Chymotrypsin.
 Carboxypolypeptidase.
 Elastases.
 Nucleases.
c) Lipolytic enzyme:
 Pancreatic lipase.
 Cholesterol esterase.
 Phospholipase A.
 Co-lipase.

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Functions of Pancreatic Juice

 Protein digestion: The enteropeptidase converts the trypsinogen and chymotrypsinogen into the
active proteolytic enzymes trypsin and chymotrypsin, which convert the polypeptides into tripeptides,
dipeptides and amino acids.
 Digestion of carbohydrates: Pancreatic amylase helps in the conversion of digestible
polysaccharides - starch - by salivary amylase to disaccharides.
 Digestion of fats: Bile salts help lipase in the conversion of fats into Acids Fatty acids and glycerol.

Mechanism of pancreatic juice secretion:

 Neural mechanism: Pancreatic secretion occur in three phases -

 Cephalic phase.
 Gastric phase.
 Intestinal phase.
Cephalic phase:
Sight, smell, thought or taste of the food and the greater appetite  Stimulates afferent nerve 
Signal go to the brain  Acetylcholine release by vagal nerve endings in the pancreas  Secretion
occur.
Gastric phase:
Foods enter into the stomach  Stimulates the long vasovagal reflexs, enteric reflex & the gastrin
mechanism  Secretion occur.
Intestinal phase:
Chyme enters the intestine  Stimulates secretin & cholecystokinin   Pancreatic enzyme
secretion.

 Hormonal mechanism:
It is the most important and basic mechanism for pancreatic juice secretion. 3 hormones are
involved
 Acetylcholine.
 Cholecystokinin &
 Secretin.
 Acetylcholine & Cholecystokinin stimulate the acinar cells of the pancreas  causes
production of large amount of enzyme rich pancreatic juice but contain small amount of water
& electrolytes.
 Secretin also stimulates the acinar cells of the pancreas  causes production of large quantities
of HCO3- & water rich pancreatic secretion but low in enzymes.

(Ref- Guyton & Hall / 13th / 826)

Another Answer

Regulations of pancreatic juice secretion:

 Pancreatic juice secretion is primarily under hormonal control. Neural mechanism also plays
some role.

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Neural mechanism:
It occurs in 2 phases -
 Cephalic phase: It takes place before food enters into stomach:
Food in mouth and sight, smell, taste, thought of foodSignals arise in cerebral cortex or in
appetite centers of amygdala or hypothalamus Signals go to dorsal nucleus of vagus Signals
come to pancreas via vagus nerve Release of acetylcholine (Ach), which acts on acinar cells of
pancreas  Release of pancreatic juice (about 20%) rich in enzyme but poor in HCO3- (Ecbolic
type).
 Gastric phase: Food in stomach Local vagovagal reflex & local enteric reflex  Release of
acetylcholine (Ach) Ach acts on acinar cells of pancreas Release Of pancreatic juice (about
5- 10%) rich in enzyme but poor in HCO3- (Ecbolic type).

Hormonal mechanism:
It is the most important mechanism for secretion of pancreatic juice. It occurs in intestinal phase by two
local hormones:
 Secretin: Acidic chyme in duodenum  Release of secretin by duodenal mucosa  Secretin
goes to pancreas (via blood)  Acts on pancreatic duct  Release of pancreatic juice rich in
HCO3- but poor in enzyme (Hydrelatic type).
 CCK-PZ: Fat and protein in duodenum  Release of CCK-PZ by duodenal mucosa  CCK-
PZ goes to pancreas (via blood) Acts on pancreatic acini  Release of pancreatic juice rich in
enzyme, poor in HCO3- (Ecbolic type).

Name the Enzymes of Pancreas.

Classification of pancreatic hydrolases / pancreatic enzymes:
 Carbohydrate splitting enzymes:
 Pancreatic amylase.
 Proteolytic enzymes:
 Endopeptidase - Trypsin, Chymotrypsin
 Exopeptidase - Carboxypolypeptidase.
 Lipoplytic enzymes:
 Pancreatic lipase
 Cholesterol esterase
 Phospholipase A2
 Co-lipase.
 Nuclease:
 RNAase
 DNAase.
(Ref- Guyton & Hall / 14th / 825)

Spleen

Definition of Spleen:

The spleen is an organ found in virtually all vertebrates. Similar in structure to a large lymph node, it acts
primarily as a blood filter.

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Feature of Spleen

1. Length 12 Cm

2. Weight 120-150 gm.

3. Thickness 3-3.5 cm

4. Surface  Diaphragmatic
 Visceral
5. Border:  Superior border.
 Inferior border.
 Intermediate border.
6. End:  Anterior end.
 Posterior end.

Figure 3.20: Spleen

Functions of the Spleen

 Spleen participates in the primary immune response to invading bacteria, viruses, parasites or
foreign particles.
 Spleen is a strong defense against blood-borne pathogens.
 Spleen acts like a filter for the blood.
 It removes cellular residues, particulate matter, senescent RBCs and other abnormal cells from
the bloodstream.
 Spleen synthesizes antibodies, macrophages and activated lymphocytes in its white pulp.

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Liver

Definition of Liver:

The liver, the largest gland in the body and consists of both exocrine and endocrine part.
Or,
The liver is an organ only found in vertebrates. In humans, it is located in the upper right quadrant of the
abdomen, below the diaphragm.
The liver has a wide range of functions, including -
 Detoxification of various metabolites,
 protein synthesis, and
 The production of biochemicals necessary for digestion

Location: It is wedge shaped & occupies most of the right hypochondric and epigastric region of the
abdominal cavity

Figure 3.21 Antero-Superior surface of Liver showing right and left lobe.

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Right lobe Falciform ligament Left lobe of liver

of liver

Right Hepatic
duct Round
ligament Common bile duct
Left Hepatic Pancreatic
duct duct
Hepatopancreatic
Cystic duct
ampulla
Pancreas
Common
Hepatic duct Sphincter of the
Hepatopancreatic
Gallbladder ampulla
Jejunum
Duodenum

Common duct to duodenum

Or
Hepatopancreatic ampulla

Figure 3.22 Relation of the pancreas to the liver, gallbladder and duodenum

Features of Liver:

Weight  In adult male: 1.4 to 1.8 kg.

 In adult female: 1.2 to 1.4 kg.
 At birth : 150 gm

Shape  Wedge shaped.

 Anterior surface.
 Posterior surface.
Surface  Superior surface.
 Inferior surface.
 Right lateral surface.

Lobe The liver presents anatomically two lobes-

 Right lobe: Two small lobes caudate and quadrate
lobes are also related to the right lobe.
 Left lobe

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Position of the liver is  Hepatic veins opening into the inferior vena cava.
maintained by  Intra abdominal pressure.
 Ligaments of the liver.
 Surrounding viscera.
Borders of the liver:  Liver has an inferior sharp border and other borders are
ill defined.
Ligaments of liver:  Peritonial folds or false ligaments:
 Falciform ligament.
 Coronary ligament.
 Right Triangular ligament.
 Left Triangular ligament.
 Lesser omentum.
 True ligaments:
 Ligamentum teres hepatis.
 Ligamentum venosum.

Anatomical points of the  Groove for inferior vena cava lies posteriorly and is
liver: directed vertically downwards.
 Fossa for gall bladder lies in the inferior surface.
 Right lobe is larger than the left lobe.
 Anterior superior surface is convex and directed
upwards and forwards.

Posterior surface of liver  The bare area

presents following  Groove for inferior vena cava
features from right to left  Caudate lobe
-  Fissure for ligamentum venosum
 Groove for oesophagus

Relations of inferior  Gastric impression

surface of the liver from  Fissure for ligamentum teres
left to right-  Gall bladder
 Duodenal impression
 Right colic flexure
 Right kidney
 Right suprarenal gland.
Relations of the right The right lateral surface is related to the right lateral chest
lateral surface of the wall which extends from 7th to 12th ribs and intercostal
liver : spaces. It is divided into three parts
 Upper l/3rd: closely related to the diaphragm which
separate liver from right lung and pleura
 Middle l/3rd: closely related to the diaphragm which

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separate the liver from right pleura and right

costodiaphragmatic pleural recess.
 Lower l/3rd: closely related to the diaphragm which
separate liver from right lateral chest wall

Structure entering the  Left & right branches of hepatic artery.

liver through porta  Right & left division of portal vein.
hepatis:  Hepatic plexus of nerve.

Structure leaving the  Right & left hepatic duct.

liver through porta  Lymphatic's from the liver.
hepatis:
Nutrition of liver: It gets nutrition from two sources:
 Portal vein provides 66% to 75% nutrition
 Hepatic artery provides 25% to 33% nutrition

Functions of liver:

1. Synthetic function:
a. Synthesis of Plasma proteins e.g. albumin, Ig etc.
b. Synthesis of Clotting factors -
 Prothrombin
 Fibrinogen.
 Factor V, VIII & X.
c. Synthesis of Many enzymes -
 SGPT.
 SGOT.
 Alkaline phosphatase.
 Synthesis of urea, cholesterol.
2. Metabolic function:
 Liver is the main organ for metabolism of Protein, Carbohydrate, Fat, Fat soluble
vitamins (Vit-A, D, E & K) as well as Water-soluble vitamins (Vit-B complex & C).
3. Detoxication: e.g.- Ammonia, Morphine, Barbiturate etc.
4. Storage function: Glucose, Iron, some vitamins (A, D, K, B12) etc.
5. Hormone inactivation: e.g.-
 Insulin.
 Glucagon.
 Testosterone.
 Thyroxine. etc.
6. Bile secretion.
7. Anti-bacterial function: Reticuloendothelial cell (Kuffer cell).

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8. Hemopoietic function: In intrauterine life, liver is the main organ for production of RBC. But in
adult, liver is the main organ for destruction of RBC.
(Ref: Ganong 26th/507-509+Lecture of SBMC)

Liver Function Tests

Liver function tests:
Liver function tests (LFTs or LFs) are groups of laboratory assays designed to give information about the
state of a patient's liver.
The liver function tests are
 Tests for excretory function:
 In blood:
 Serum bilirubin concentration [0.3-1 mg/dl or 3-17 µmol/L]
 Conjugated & unconjugated bilirubin
 In urine - Urinary bilirubin, urobilinogen
 Enzyme concentration:
 Evidence of hepatocellular damage (as in hepatitis):
 Serum ALT / SGPT [10-40 U/L]
 Serum AST/ SGOT [ 10-35 U/L]
 Evidence of cholestasis (as in obstructive jaundice):
 Alkaline phosphatase (ALP) [40-125 U/L]
 Gamma-glutamyl transferase [Male: 10-55 U/L, Female: 5-35 U/L]

 Test for synthetic function:

 Serum albumin [35-50 gm/L]
 Albumin / globulin ratio [Normal- 1.7: 1; Range (1.3 - 4.1): 1]
 Prothrombin time [Normal: 12-16 sec]. It assesses the liver function test for production
of factor-II.
 Serum total protein concentration [Normal: 60 - 80 gm/L]
 Serum albumin & globulin level

 Test for detoxification function:

 NH3 concentration in blood.

 Other biochemical tests:

 Serum electrolytes (Hyponatraemia may occur in severe liver disease)
 Blood urea level
 Serum ferritin level (Haemochromatosis)
 Serum & urinary copper (Wilson’s disease)
 Serum ceruloplasmin (Wilson’s disease)
 Tumour marker (for hepatocellular carcinoma):
 α-fetoprotein (AFP)
 Viral markers: Different viral markers for different types of viral hepatitis.

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 Immunological tests (for autoimmune liver disease):

 Anti-mitochondrial antibody
 Anti-smooth muscle antibody
 Antinuclear antibody (ANA)

Clinically important liver function tests with their importance:

Important liver function test Importance

Serum bilirubin Increased in different types of jaundice.

ALT / SGPT Rises in hepatitis.

AST / SGOT High levels are seen in hepatic necrosis, myocardial infarction,
muscle injury and congestive cardiac failure.

Plasma albumin A valuable guide to the severity of chronic liver disease.

Prothrombin time Because of its short half-life, it is a sensitive indicator of both

acute and chronic liver disease.

Alkaline phosphatase (ALP) Serum ALP is raised in cholestasis (obstruction to bile flow) from
any cause, whether intrahepatic or extrahepatic disease.

Gall Bladder

Definition of Gall Bladder:

The gallbladder is a small pouch that sits just under the liver. The gallbladder stores bile produced by the
liver.
Or,
Gall bladder is a pear shaped reservoir of bile situated in the inferior surface of the right lobe of the liver.
It is 7 to 10 cm long and 3 cm broad at its widest part. Its capacity is 30 to 50 ml.
Location: Right hypochondriac. Just below the tip of the 9th coastal cartilage.

Feature
 Length : 7-10 cm long
 Width : 3 cm
 Capacity- 30-50 ml
Parts
 Fundus:

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 Body,
 Neck

Figure 3.23 Gall bladder

Functions of Gall bladder:

 In the gallbladder, the bile is concentrated by absorption of water.

 Acidification of the bile.
 It helps in the intermittent flow of bile.
 It excretes cholesterol to some extent.
 It secretes mucus, which is the main source of mucin of bile.
 It equalizes the pressure in the biliary system by its contracting power.

(Ref- Ganong / 26th / 513 + Chakrabarti, Ghosh & Sahana / 2nd / 422)

Blood supply of the gall bladder:

 Artery supply: Cystic artery which is a branch of the right hepatic artery.
 Venous drainage: Cystic vein which drains into the portal vein.
 Lymphatic drainage:
 Lymph drains into the cystic lymph nodes, hepatic nodes and coeliac lymph nodes.
 Nerve Supply:
 Sympathetic nerve supply: From coeliac plexus.
 Parasympathetic nerve supply: From both vagus nerves.

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Factors that favor gall bladder emptying:

 Presence of fatty food in duodenum.

 Cholecystokinin: By far the most potent stimulus for causing the gallbladder contractions is the
hormone cholecystokinin.
 Acetylcholine: Gallbladder is stimulated less strongly by acetylcholine-secreting nerve fibers
from both the vagi and the intestinal enteric nervous system.
(Ref- Guyton & Hall / 13th / 829)

Common Bile Duct/ Biliary Tract/ Tree

Definition of Biliary Tree:

The biliary tract, (biliary tree or biliary system) refers to the liver, gall bladder and bile ducts, and how
they work together to make, store and secrete bile. Bile consists of water, electrolytes, bile acids,
cholesterol, phospholipids and conjugated bilirubin

Parts of the biliary apparatus:

Figure 3.24: Parts of extra hepatic biliary apparatus.

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 Intrahepatic part:
 Bile canaliculi.
 Canal of Hering.
 Bile ductules.
 Right & left hepatic duct.
 Extra hepatic part
 Right & left hepatic duct
 Common hepatic duct
 Gall bladder
 Cystic duct
 Common bile duct

Biliary Secretion

Bile:
Bile is made up of bile salts, bile pigments, and other substances dissolved in an alkaline electrolyte
solution.
Or
Bile is the secretory product of liver made up of bile salts, bile pigments and other substances dissolved in
an alkaline solution.
Criteria:
 Site of formation: Hepatocyte of the liver.
 Site of storage: Gall bladder.
 Daily secretion: 600-1200ml/day.
 Colour: Yellowish green. (Due to bilirubin & biliverdin)
 Composition of bile:
 Bile pigments:
 Bilirubin.
 Bliverdin.
 Bile salts:
 Na+-K+ glycocholate.
 Na+-K+ tarurocholate.
 Lecithin & cholesterol.
 Electrolytes e.g. Na+, K+, HCO3¯ etc.
 Taste of bile: Bitter.
 PH of bile: Liver bile : 7.8 - 8.6
 Gall bladder bile : 7.0 - 7.4
(Ref: Guyton & Hall/ 14th/784p)
Justification of bile as a digestive juice:

Though bile has no enzymes, bile is a digestive juice because -

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 It helps in the digestion & absorption of fat by-

 Emulsification of fat (by lowering surface tension)
 Activation of pancreatic lipase
 Formation of micelles (which facilitates fat absorption)
 It also helps in the absorption of fat soluble vitamins (vitamin A, D, E & K).
(Ref- Ganong / 26th / 463)
Formation of bile:
Bile is made up of -
 Bile salt
 Bile pigment and
 Other substance dissolved in an alkaline electrolyte solution.

Synthesis of bile salt:

 Precursor: cholesterol
 Site: Hepatocyte.
Bile salt are sodium & potassium salts of bile acids, conjugated to glycine or taurine. These bile acids are
cholic acid & cherodeoxycholic acid, both are synthesized from cholesterol.

Conjugation
 Cholesterol Cholic acid Taurocholic acid or Glycocholic acid.
 Taurocholic acid + Na or K+
+
Na or K-taurocholate
 Glycocholic acid + Na+ or K+ Na or K-glycocholate.

Synthesis of bile pigments:

Site:
Reticulo-endothelial system (i.e. liver, spleen & bone marrow).
Bile pigments are bilirubin & biliverdin. These are the breakdown products of haemoglobin.
 Destruction of RBC  Haemoglobin
 Haemoglobin  Heam + Globin
 Heam  Iron + Biliverdin (bile pigment)
 Biliverdin  Bilirubin.
oxidize

Thus bile salts, bile pigments and others substance are dissolved in a alkaline solution within the liver
and form bile.

Functions of bile:
Digestive function:
Bile helps in the digestion of fat by emulsification of fat by bile salts. Advantages of emulsification
include:
 surface tension

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  surface area
 Activation of lipase
Absorptive function:
Bile salts form micelle, which helps in absorption of fat and fat soluble vitamins. Bile salts also help in
absorption of iron, calcium etc.
Laxative function:

 Peristalsis and thereby helps in defecation.

Excretory function:
Certain substances are excreted through bile, such as -
 Heavy metals, Cu, Hg, Zn.
 Certain drugs,
 Bile pigments- bilirubin etc.
 Cholesterol.
 Toxin, bacteria.
Neutralizing action:
Maintains alkaline medium in the intestine by neutralizing gastric HCl by its HCO3.

Composition of bile:

Liver bile Gallbladder bile

A. Water: 97.5 gm/dl. 92 gm/dl.

B. Organic:

 Bile salt 1.1 gm/dl 6 gm/dl

 Bilirubin 0.04 gm/dl 0.30 mg/dl

 Cholesterol 0.10 gm/dl 0.3 to 0.90 gm/dl

 Fatty acids 0.12 gm/dl 0.3 to 1.20 gm/dl

 Lecithin 0.04 gm/dl .0.30 gm/dl

C. Electrolytes:
 Cations: Na+, K+, Ca++etc.
 Anion: Cl-, HCO3-etc.
(Ref: Guyton & Hall 14th/784p.)
pH of Bile:
 Liver bile: 7.8-8.6
 Gall bladder bile: 7.0-7.4
 Daily secretion: 1,000 ml/day

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Regulation of bile secretion:

Nervous regulation:

 Sympathetic nerve: inhibits bile secretion.

 Parasympathetic nerve: stimulates bile secretion.
Hormonal regulation:

 Cholecystokinin (CCK): increase bile secretion by contraction of gall bladder.

 Secretin: increase bile secretion by stimulating of the vagus nerve.

Q. Write short note on: Bile salt.

Name of bile salts:
 Na-taurocholate
 K-taurocholate
 Na-glycocholate
 K-glycocholate
Synthesis of bile salt:
Bile salt is synthesized from cholesterol. The cholesterol is first converted to cholic acid and
chenodeoxycholic acid. These acids in turn combine mainly with glycine and to a lesser extent with
taurine to from glyco-and tauro-conjugated bile acids. The salts of these acids (mainly Na- salt) are
secreted in the bile.
 Glycine + Cholic acid Glycocholic acid.
Glycocholic acid + Na Na-glycocholate.
 Taurine + Cholic acid Taurocholic acid.
Taurocholic acid + Na Na-taurocholate.

Functions of bile salt:

 Digestive function: Bile salts emulsify the large fat particles into many minute particles that can
be attacked by pancreatic lipase.
 Absorptive function: By forming micelles, they, help in absorption of the end products fat
digestion as well as fat-soluble vitamins.
 Laxative function:  peristalsis and thereby helps in defecation.
 Bile salts keep the cholesterol in soluble from & thus prevent gall stone formation.
 The faecal excretion of bile salts is the only route for the removal of cholesterol from the body.
 Antiseptic action: Prevents the growth of certain bacteria in the intestine.
Bile Acids:
 Primary bile acids:
 Cholic acid, taurocholic acid & glycocolic acid
 Chenodeoxycholic acid
 Secondary bile acids:

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 Deoxy cholic acid produced from cholic acid

 Lithocholic acid produced from chenodeoxycholic acid.

Bile pigments:
 Bilirubin
 Biliverdin.

Difference between Liver and Gall Bladder Bile are as Follows:

Traits Liver bile Gall bladder bile

1. Concentration Dilute Concentrated

2. Reaction Slightly alkaline Slightly acidic

3. Mucin Absent Present

4. pH 7.6 – 8.6 6.8 – 7.8

5. Specific gravity 1.01 1.04

6. Composition see above chart see above chart

Enterohepatic Circulation of Bile Salt:

Bile salts are reabsorbed from the small intestine, returned to the liver via portal circulation and re-
excreted in the bile. This cyclical circulation of bile or bile salts are known as enterohepatic circulation.
Or,
Recirculation of bile salts from the liver to the small intestine and back again is called enterohepatic
circulation.

Pathway of circulation:

 After secretion from the gallbladder bile salt enter into the duodenum via common bile duct, then
reaches terminal ileum.
 About 94% of the bile salts are reabsorbed in small intestine by diffusion in the early portions of the
small intestine and active transport in the distal ileum.
 Then the bile salts enter the portal blood and pass to the liver.
 On reaching the liver, these salts are absorbed almost totally through the venous sinusoids into the
hepatic cells and then re-secreted into the bile.

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Fig 3.25: Enterohepatic Circulation.

Importance of enterohepatic circulation:

Due to limited synthesis of bile salts by the liver, the enterohepatic circulation provides adequate bile salts
in the intestine for digestion and absorption of fat. Because, when the enterohepatic circulation is
interrupted, the liver cannot increase the rate of bile salt production enough to compensate the loss.

Gastrointestinal Hormone

Local hormones of GIT:

These are the biologically active polypeptides that are secreted by nerve cells & gland cells in the mucosa
act in the paracrine fashion but they also enter the circulation

The gastrointestinal hormones are -

 Gastrin.
 Secretin.
 Cholecystokinin-Pancreozymin (CCK-PZ).
 Gastric inhibitory peptide (GIP).
 Vaso-active intestinal peptide (VIP).

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Other hormones are:

 Motilin.
 Glucagon.
 Somatostatin.
 Substance-P.
(Ref-Guyton & Hall/ 14th/757-59p.)
Another Answer

According to structural & functional similarity, many of the hormones fall into one of two families -

Gastrin family:
 Gastrin
 Cholecystokinin (CCK)

Secretin family:
 Secretin
 Glucagon
 Glicentin (GL1)
 Vaso-active intestinal polypeptide (VIP)
 Gastric inhibitory polypeptide (GIP)
Others:
 Motilin
 Neurotensin
 Substance P
 Gastrin releasing polypetide (GRP)
 Somatostatin
 Bombesin
 Guanylin
 Serotonin.
 Enkephalin
 Villikinin
 Enterocrinin
 Enterogastrone
 THR& ACTH
 Pancreatic polypeptide.
Functions of Local hormones of GIT:

Name Functions

Gastrin  Stimulate the secretion of gastric HCl, pepsinogen & intrinsic factor.
 Enhances gastric motility.
 Causes the contraction of gall bladder.

CCK  Stimulate enzyme rich pancreatic secretion.

 Contraction of gall bladder
 Decrease intestinal motility.

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Somatostatin  Inhibits the secretion of both insulin & glucagons.

 Inhibits gastric secretion.
 Reduce motility of GIT.

Secretin  Stimulate HCO3- rich pancreatic secretion.

 Gastrin secretion.
 Contraction of pyloric sphincter.
GIP  Gastrin secretion.
  Gastric motility.

VIP  Gastric secretion & motility.

  Serous secretion from pancreas.

(Ref: Guyton and Hall/ 14th 758)

Source, cause of secretion & site of action of local hormones of GIT:

Hormone Source Cause of secretion Site of action

 Luminal:  Stomach,
 Peptides & amino acids.  Lower
 Distention esophageal
 Neural: sphincter,
  vagal discharge via  Small intestine,
Gastrin G cells of the antrum, GRP  Gall bladder.
 Blood-borne:
duodenum, and jejunum  Calcium
 Epinephrine.
 Presence of acidic chyme in  Pancreatic
duodenum. ductal cells.
Secretin S cells of duodenum,  Fat.
jejunum & ileum  Products of protein digestion in
the duodenum.

Mucosa of upper small  Presence of fatty food, protein  Gall bladder,

& acid in duodenum.  Pancreas
intestine
Cholecystokinin (I cells of the duodenum,
- Pancreozymin jejunum, and ileum)
(CCK-PZ)
/CCK

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Gastrin

Gastrin is a local hormone of the GIT.

Source:
 'G' cells of stomach (lateral walls of the glands in the antral portion of the gastric mucosa)
 'TG' cells of - Stomach & small intestine.
Factors stimulate gastrin secretion:

A)  Gastric secretion:
 Peptides & amaino acids.
 Increased vagal discharge.
 Calcium.
 Epinephrine.
B)  Gastrin secretion:
 Somatostatin.
 Secretin.
 Glucagon.
 Calcitonin.
 GIP,VIP.

Fig: Actions of Gastrin.

Functions:
 Stimulate the secretion of gastric HCl, pepsinogen & intrinsic factor.
 Enhances the gastric motility.
 Causes the contraction of gall bladder.

Mastication, Digestion, Absorption & Elimination

Mastication:
Mastication is the mechanical grinding of food into smaller pieces by teeth; it is essentially a technical
word for “chewing”.

Digestion:
Digestion may be defined as a physiological process by which complex food particles are broken down
into simple forms, suitable for absorption and subsequent utilization.

Absorption:

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Absorption may be defined as a process by which the end products or digestion and water, electrolytes &
vitamins pass through the intestinal epithelium to enter the lymph or blood stream.

Elimination

Elimination is the process of expelling or removing, especially of waste products from the body.

Metabolism:
Metabolism is the whole range of biochemical processes that occur within a living organism. Metabolism
consists of anabolism (the buildup of substances) and catabolism (the breakdown of substances).
The term metabolism is commonly used to refer specifically to the breakdown of food and its
transformation into energy.

Carbohydrate

Definition of Carbohydrate:
Carbohydrates are organic compounds composed of carbon, hydrogen and oxygen, with the later elements
in the ratio of 2:1. The general formula is CnH2nOn. They are viewed as hydrated carbon atoms.
Or
Carbohydrates are simple sugar, which consist of hydrogen, oxygen and carbon. Main sources of energy
are provided through the carbohydrate.

Classification of Carbohydrate:

1. Monosaccharide:  Monosaccharide’s are simple form of carbohydrates e.g.,

glucose or dextrose, fructose or levulose and galactose.
2. Disaccharides:  Disaccharides are the complex sugar. Important disaccharides
are sucrose, maltose and lactose.
3. Polysaccharides:  Common polysaccharides are starch, dextrin, glycogen, pectin
and cellulose.

Sources of Carbohydrates:
There are three main sources of carbohydrates.

Source Found in
1. Starches  Cereals,
 Millets,

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 Roots,
 Tubers,
 Plant stems
2. Sugars  Monosaccharide’s (glucose, fructose and galactose)
 Disaccharides (sucrose, lactose and maltose).
3. Cellulose  Fruits, cereals and vegetables

Carbohydrate is found in –
 Cereals such as wheat, rice millets, raggi, bajra and rnaize
 Roots and tubers such as tapioca, potato, sweet potato, coloccasia and yam.
 Fruits such as banana, apple, grapes and dried fruits
 Sugar, jaggary and honey.
 Pulses and vegetables contain small quantity of carbohydrates.

Daily requirement of carbohydrate:

 It should be 50-70% of total energy intake. The daily requirement of carbohydrates for an adult
is 400-600 gm.
Functions of Carbohydrate:
 Carbohydrates Provide main source of energy
 Help the body to use protein and fat efficiently.
 Supply fiber that helps in the formation of the bulk for better digestion.
 Can convert itself into fat.
 Essential for the synthesis of certain nonessential amino acids.
 Carbohydrates remove poisonous substances from the liver.
 Lactose helps in the absorption of calcium.
 Carbohydrate provides taste and flavor to the diet.
 Cellulose and indigestible polysaccharides prevent constipation.
 Carbohydrates help in retention of water in the colon.
 Carbohydrates help in mobility of the intestines.
 Carbohydrate helps in formation of nucleic acid and matrix of connective tissues.
 Carbohydrates help the growth of desirable bacteria in the small intestines.

Results of absence of dietary carbohydrates:

Carbohydrate has two types disease condition. Such as:

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 Obesity.
 Diabetes.
1. Excess consumption of  Sweet form of carbohydrate may lead
carbohydrates: to irritation of gastro intestinal mucosa
and increases formation of gas.
 Increase the incidence of dental caries.
 Depress appetite.
2. Deficiency of carbohydrates:  Below five years age causes marasmus.

Digestion and Absorption of Carbohydrate

Stage of carbohydrate digestion:

In mouth:
Salivary -amylase (ptyalin) hydrolyzes starch into a disaccharide maltose and oligosaccharide
maltotriose.
Ptyalin
Carbohydrate Maltose + Maltotriose
(Boiled)
In stomach:
In the acid media, the function of ptyalin is lost and for this, no digestion of carbohydrate take place.
However, HCl hydrolyzes some sucrose only.
HCl
Sucrose Glucose + Fructose

In the duodenum:
The acidity of the chyme is neutralized by the help of duodenal gland secretion which facilitates the
action of Pancreatic -amylase.
Pancreatic -amylase
Starch/Carbohydrate Maltose, Maltotriose, -limit dextrin etc.

In the small intestine:

The carbohydrate splitting enzymes of small intestine digest the carbohydrates as follows –

Maltase
Maltose Maltotriose + Glucose.

Maltase
Maltotriose Glucose

Sucrase

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Sucrose Glucose + Fructose.

Lactase
Lactose Glucose + Galactose.

-limit dextrinase
-limit dextrin Glucose

(Ref: Guyton & Hall/ 14th /834)

Absorption of end product of carbohydrate:
 Glucose: By secondary active transport (Na-co-transport)
 Galactose: By Na-Cotransport.
 Fructose: By facilitated diffusion.
 Site of absorption: Luminal brush border of duodenum & upper Jejunum

Mechanism:
Carbohydrates are absorbed as glucose (80%), fructose, galactose and a few pentose.

End product of Transport from lumen to enterocyte Transport from enterocytes to blood
CHO digestion Process Carrier protein Process Carrier protein
+
1. Glucose Secondary active Na - Facilitated GLUT-2
2. Galactose transport glucose/galactose diffusion
co-transport
(SGLT)
3. Fructose Facilitated GLUT-5 Facilitated GLUT-2
diffusion diffusion
4. Pentose Simple diffusion Simple diffusion

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End products of CHO, Protein & Fat:

Name End product

 Glucose (80%)
1. Carbohydrate  Fructose (10%)
 Galactose (10%)
 Fatty acid
2. Fat
 Monoglycerides
3. Protein  Amino acids

Carbohydrate splitting enzyme

Carbohydrate splitting enzymes are the enzymes, which causes breakdown of the carbohydrate molecule
& help in digestion.
These enzymes are:
 In salivary secretion: Salivary -amylase (Ptyalin)
 In gastric juice: Gastric amylase.
 In pancreatic juice: Pancreatic amylase.
 In intestinal juice:
 Lactase.
 Sucrase.
 -Dextrinase.

Lactose Intolerance
Lactose intolerance:
Lactose intolerance is an inability to digest and absorb lactose (the sugar in milk) that results in
gastrointestinal symptoms when milk or products containing milk are drunk or eaten.
Intestinal lactase activity is high at birth and low in childhood & adulthood.
Causes:
 Reduced or absent activity of the enzyme lactase.
 A congenital absence (absence from birth) of lactase due to a mutation in the gene that is
responsible for producing lactase.
 Secondary causes: Some diseases e.g. celiac sprue cause destruction of the lining of the small
intestine along with the lactase.
Types:
 Primary lactose intolerance: In this case, lactase deficiency is racially determined and jejunal
morphology is normal.
 Secondary lactose intolerance: In this case, lactase deficiency is due to disorders that damage
the jejunal mucosa, e.g. coeliac disease, viral gastroenteritis etc.

Feature: Malabsorption of milk & milk products leads to -

 Primarily, abdominal pain, diarrhea, flatulence (passing gas), and

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 Less commonly, abdominal bloating, abdominal distention, and nausea.

Treatment:
 Dietary changes
 Lactase enzyme containing tablet intake
 Adaptation
 Calcium and vitamin D supplements

Protein

Definition of Protein:

Protein are complex organic nitrogenous compounds composed of carbon (C), hydrogen (H), oxygen (O),
nitrogen (N), sulphur (S) in varying amounts. Some proteins also contain phosphorous and iron and
occasionally other elements.
Classification of Protein:

1. First class protein or high biological When protein contains all the essential amino acids
value of protein/biological complete in amounts corresponding to human needs it is said
proteins: to be high biological value.
 Animal sources: Milk, meat eggs, fishes etc.
are in this group.
It is also called first class protein or biologically
complete protein.
2. Second class protein or low biological When one or more of the essential amino acids are
value of protein or biologically in lacking, the protein is said to be low biological
complete protein: value.
 Vegetables sources: Pulses, cereals, beans,
nuts etc. are in this group.
It is also called second-class protein or biologically
incomplete protein.

Sources of Protein:
1. Animal sources: Meat, fish, milk, milk products (such as butter, ghee, cheese, yougurt), poultry
birds, sausages etc.
2. Plant or vegetable sources: Pulse, oil seeds cakes etc. nuts, groundnuts, legumes, dhals, cashew
nut, beans.

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Daily protein requirement in different age:

Age Requirement
Children 35-60gm
Adolescence 70-80gm
Adult male 70-80gm
Adult female 60-70gm
Pregnant woman 90 gm
Lactating mother 100 gm

Functions of Protein:
1. Protein helps growth and development and repair of the body and body cell.
2. Takes part in defense mechanism of the body.
3. Synthesis of certain substance like antibodies, plasma proteins, hemoglobin, enzymes, hormones
and coagulation factors.
4. Maintenance of osmotic pressure.
5. Helps in metabolic processes with enzymes.

Effects of Protein Deficiency:

 Still birth.
1. During pregnancy:  Premature babies.
 Specific deficiency in the baby. e.g. anaemia.
 Kwashiorkor.
2. Infancy and early  Marasmus.
childhood. :  Mental retardation.
 Stunted growth and development.
 Loss of weight
 Under weight
 Poor musculature.
3. Adults:  Anemia
 Increased susceptibility to infections
 General lethargy.
 Delay in wound healing
 Cirrhosis of liver
 Edema and ascites.

(Ref by: K. Park/26th/648)

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Protein Digestion:

In the Mouth:
 No digestion takes place.

In the Stomach:
 Pepsinogen is activated into pepsin by HCl and initiates protein digestion.

Proteoses.
Pepsin
Protein Peptones.

Polypeptides.

In the small Intestine:

 In the intestinal lumen: Most protein digestion occurs in the lumen of duodenum and jejunum
by the proteolytic enzymes of pancreas.

Trypsin, Chymotripsin
Proteoses Polypeptides
Peptones
Carboxypeptidase
Polypeptides Aminoacids. (End product of protein
digestion)
Elastase
Elastin Dipeptide, Polypeptides.

 In the brush border of the enterocyte: The brush border of enterocytes consists of hundreds of
microvilli and the membrane of the microvilli contain peptidases (aminopolypeptidase &
dipeptidase) that breakdown polypeptides.
Amainopolypeptidase, dipeptidase
Polypeptide Dipeptide, Tripeptide, & Amino acids.
 In the cytosol of the enterocyte: Finally, inside the cytosol of the enterocyte, the di & tripeptides
are converted in aminoacids and then the aminoacids enter into the blood.
Intracellular peptidases
Dipeptides & Tripeptides Aminoacids

Absorption of protein:
 Most of the proteins after digestion are absorbed through the intestinal epithelial cells in the form
of dipeptides, tripeptides and a few free aminoacids.
 Site: Brush border of the intestinal epithelium (Duodenum and upper jejunum).

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 Process of absorption: By Secondary active transport or Co-transport.

Mechanism:

 Amino acids & Na+ first bind to the common carrier in the brush border of the luminal cell of the
intestine.
 Amino acid is carried into the cell as Na+ moves down its concentration gradient.

Amino acid
Amino acid binding site

Amino acid

Fig 3.26: Transport of Amino acid.

 The Na+ then pumped out of the cell into the intercellular space by active transport.
 The aminoacid is transported into the intercellular space by facilitated diffusion and then into the
capillary.
(Ref- Guyton & Hall / 14th / 834+ Ganong / 25th / 479)
Nice To Know

Definition Amino acids:

Proteins are made up of simpler substances which are the building blocks of protein called amino acids.
Or,
Proteins are made by joining together a hundred or more much smaller things called amino acids.

Classification of Amino Acids:

Amino acids are classified into two groups – essential (indispensable) and non-essential (dispensable).
Essential amino acids: -
These are the amino acids, which cannot be synthesized in the body in sufficient quantity. And therefore,
the dietary proteins must supply them.
These are:
 Leucine
 Isoleucin

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 Lysine
 Methionine
 Phenylalanine
 Threonine
 Valine
 Tryptophan

Non-essential amino acids:

It can be synthesized by the body and they need not be supplied through diet.
These are –
1. Alanine. 8. Glutamine.
2. Arginine. 9. Glycine.
3. Asparagine. 10. Histidine.
4. Aspartic acid. 11. Hydroxyproline.
5. Cysteine. 12. Proline.
6. Cystine. 13. Serine.
7. Glutamic acid. 14. Tyrosine.

Essential amino acid requirements in adult:

Amino acid FAO/WHO/UNU 2007

mg/kg /day Each gram protein contains
Histidine 10 15 mg
Isoleucine 20 30 mg
Leucine 39 59 mg
Lysine 30 45 mg
Methionine. 10 16 mg
Cysteine 4 6 mg
Methionine + Cysteine 15 22 mg
Threonine 15 23 mg
Phenylalanine + Tyrosine 25 38 mg
Tryptophan 4 6 mg
Valine 26 39 mg
Total EAA 184 277 mg
Total protein 0.66g/kg/day
Safe level of protein 0.83g/kg/day
(Mean+1.96xSD)

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Fig 3.27: Structure of amino acids

Fat

Lipids more commonly known as fats and oil, are integral part of our food. They are insoluble in water
but soluble in organic solvents. They occur in both plant and animals. Lipids are a concentrated source of
energy.

Classification of Fatty Acids

Fatty acids can be classified into Saturated Fatty Acids (SFA) & Unsaturated Fatty Acids (UFA)

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1. Saturated Fatty Acids  Saturated fatty acids are those that are unable to absorb more
hydrogen. They are usually stiff and hard fats. Eg. Ghee,
Butter.

2. Unsaturated fatty acids  Unsaturated fatty acids have one or more double bond in their
molecule and are thus not saturated with hydrogen. They are
liquid at room temperature. Eg. Sunflower oil.

Sources of Fat:

Animal fat containing mainly saturated fatty acid and glycerol.

E.g. –
 Milk and milk product,
1. Animal fat:  Eggs meat,
 Fish,
 Cord liver oil.
 Halibut liver oil,
 Sea fish etc.
2. Sea fish:  Salmon fish.
 Trout.
 Mackerel.
It containing mainly unsaturated fatty acids and glycerol.
E.g. –
3. Vegetable sources:  Seeds of grounds,
 Mustard oil,
 Sesame,
 Coconut oil,
 Pum oil, dulta, corn oil, coconut oil.

Functions:

 They are the concentrated fuel reserve of the body

 Lipids are the constituents of cell membrane structure and regulate the
membrane permeability.
 They are essential for the digestion, absorption and utilization of fat soluble
1. Major vitamins like Vitamin A, D, E and K.
functions:  Lipids are important as cellular metabolic regulators (Steroid hormones and

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prostaglandin).
 Lipids protect the internal organs serving as insulating materials.
 As compounds of the mitochondria membranes, lipids (phospholipids)
participate in electron transport chain.
 Fat imparts palatability to the diet and slows stomach emptying time, thus
giving a feeling of fullness. This delay of onset of hunger is called ‘satiety
value’ of fats.
 The calories in fat spare the proteins from being oxidized for energy.
 Fat deposited in the adipose tissue serve as reserve source of energy during
starvation. It acts as an insulator conserving the body heat.

 It makes the food palatable and stimulates secretion of digestive juices and
thereby helps in digestion.
 It stimulates the secretion of the hormone enterogastrone and thereby reduces
2. Other appetite.
functions:  It stimulates the secretion of bile and so it acts as a cholegogue.
 Cholesterol is a component of hormones of ovary, testes and adrenal cortex.
 Phospholipids help in the formation of cell membrane'
 Gives support to the viscera.
 Gives protection from cold-acts as cushion and insulator.
 Maintains the decency of the body and beautify the body configuration.

Effects of Fat Deficiency:

1. Dryness of the skin.
2. Swelling of the foot and leg.
3. Eczema of the children.
4. Toad skin or phrenoderma.
5. Indigestion.
6. Constipation.
7. Acidosis.
8. Coma e.g. Diabetic coma.
9. Gall bladder, urinary bladder (stone).

Digestion of fat
Dietary fat:
 Neutral fat (also known as triglycerides) {most abundant}.
 Phospholipids.
 Cholesterol ester. Small quantities.
 Cholesterol.
[N.B: Neutral fat is a major constituent in food of animal origin but much, much less in food of plant
origin.]

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Stages of fat digestion:

In the Mouth:
No digestion of fat takes place.

In the Stomach:
A small amount (<10%) of fat (triglycerides) is digested in the stomach by lingual lipase that is secreted
by lingual glands (Ebner’s gland on the dorsal surface of the tongue) in the mouth and swallowed with
saliva. Gastric lipase is of little importance in fat digestion but it is important in pancreatic insufficiency.
In the Intestine:

Most of the fat digestion begins in the duodenum. At first, bile salts and lecithin emulsify the fat globules
into small particle. Then pancreatic lipase hydrolyzes the 1- and 3-bonds of the triglycerides and produces
free fatty acids and 2-monoglycerides.
(Bile + agitation)
 Fat Emulsified fat.

Pancreatic lipase
 Triacylglycerol Free fatty acids & 2-
monoglycerides.

Cholesterol esterase
 Cholesterol ester Cholesterol + Fatty acids.

Phospholipase A2
 Phospholipid Fatty acids +
Lysophospholipids.

Intestinal lipase
 1-monoacylglycerol Glycerol + Fatty acids.

(Ref: Guyton & Hall/ 13th /835 & Ganong 25th /481)

Absorption of fat (Fatty acid):

Fat are digested to from monoglycerides and free fatty acid.
 Short chain fatty acid: Fatty acid containing less than 10-20 carbon atoms, absorbed directly by
portal blood and transported as free fatty acid.
 Long chain fatty acid: Fatty acid containing more than 10-20 carbon atoms, absorbed in the
form of chylomicron

Site of absorption:
 Mainly in jejunum.

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Steps:
 Fatty acid & monoglycerids dissolved in the central hydrophobic portion of micell (which form
by lipid & bile salt). Micells then go to the brush border of intestinal epithelium where they enter
into the intestinal mucosal cell (enterocytes) by passive diffusion.
 Esterification of F.A to form triacylglycerol in the mucosal cell.
 The triglycerides and cholesterol esters are coated with a layer of protein, cholesterol and
phospholipid to form chylomicrons.
 Exocytosis of chylomicron to extra cellular space.
 Then enter into the lacteals and then via thoracic duct it goes into the systemic circulation.

Vermiform Appendix

Definition of Vermiform Appendix:

The appendix or vermiform appendix is a blind-ended tube connected to the cecum, from which
it develops in the embryo.
 Length: The length varies from 2 to 20cm.
 Diameter: About 5mm

Various Positions of Vermiform Appendix:

Retrocaecal: Appendix lies behind the caecum or colon.

Pelvic: Appendix descends into the pelvis.

Subcaecal: Appendix lies below the caecum

Pre-ileal: Appendix lies in front of ileum.

Post-ileal: Appendix lies behind the ileum.

Paracolic: Appendix passes upwards and to the right.

Promontoric: Appendix passes horizontally to the left.

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Figure 3.28: Various Positions of Vermiform Appendix

Blood Supply:
 Artery supply: By appendicular artery branches of lower division of ileocolic artery.
 Venous Drainage: Veins corresponds to the arteries and drains into superior mesenteric
artery.

Nerve Supply:
 Sympathetic nerve: From T9-T10 segment.
 Parasympathetic nerve: From vagus.

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