DIGESTIVE PHYSIOLOGY

All living organism, energy is available in the form of food. Food comprises
various metabolites. The major components of food is carbohydrate, protein, lipids,
vitamins and minerals.
These components are cannot utilize by cell directly. So, these are metabolized
by digestive organs and converted into energy. Digestive system which
helps in digestion of food by that, food been metabolized and converted into
energy for living. The process of conversion of complex food substance to
simple absorpable form is called digestion.
Physiological structure of digestion system
Digestive system otherwise called alimentary canal. It starts from mouth and ends
in anus. The both terminal part is opens outside. These canal is helpful for
digestion of food. Some other structure which are helpful for digestion
process are called accessory organs of digestion.
So, digestive system comprises two divisions,
 Primary digestive organs
 Accessory digestive organs.
Primary digestive organs
The primary digestive organs, are the part of alimentary canal such as,
 Mouth
 Pharynx
 Esophagus
 Stomach
 Small intestine
 Large intestine
 Rectum
 Anal canal.
Accessory digestive organs
These organs are also helpful for digestion in digestive tract
 Liver
 Extra hepatic biliary apparatus
  Pancreas
Structure of gastro-intestinal tract
This gastro intestinal tract is lumen which surrounded by wall. The whole length of
gastrointestinal tract is formed by four layers such as,
 Mucous layer
 Submucous layer
 Muscular layer
 Serous layer
(Inner to outer)
Mucous gland
The whole length of alimentary canal is formed by mucosa. The inner surface of
gastro intestinal wall is entirely formed by mucosa. In mucosa, the lower
alimentary canal has various glands and modification are seen.
 This layer forms irregular folds called rugae in stomach.
 Small intestine has finger like projection called micro villi seen in small
intestine.
Submucosa layer
Below the mucosa layer, there is a submucosa layer is seen. This submucosa layer
is entirely formed by loose connective tissue. The blood supply, nerve supply and
lymphatic of gastro intestinal tract is seen in this layer.
Muscular layer
Muscular layer is formed by smooth muscle. These are arranged into three layer
such as,
 Outer longitudinal layer
 Middle circular layer
 Inner oblique layer
But in intestinal part, it is modified in to
 Outer longitudinal layer
 Inner circular layer.
Serous layer
 Serous layer or serous membrane is the outer covering of gastro intestinal tract.
It is made up of epithelial cells and connective tissues.
Nerve supply to gastro intestinal tract
All the secretion and movement of gastro intestinal tract is carried out by a
specialized nerve control called enteric nervous system. Enteric nervous system
has two plexus namely,
 Auerbauch plexus
 Meissner plexus
Auerbach plexus
This is present between the muscular layers. This accelerates the movement of
gastro intestinal tract. This fibers secretes the excitatory neuro transmitter called
acetylcholine which facilities the secretion off gastro intestinal juice. Some fibers
secretes the inhibitory neurotransmitter which inhibits the secretion of gastro
intestinal juice. This fibers also helps in movement of gastro intestinal tract.
Meissner plexus
Meissner plexus present between the muscular coat and mucosal layer. This fibers
regulates the secretion of gastro intestinal tract.
Autonomic nervous system
The overall control of gastro intestinal tract including enteric nervous system is
carried out by autonomic nervous system. It consist of sympathetic and
parasympathetic fibers.
Sympathetic supply
Sympathetic supply is by T5 to L1 segments of spinal cord. Sympathetic
stimulation causes reduce or inhibitory effect seen all over digestive tract
especially it reduced mobility of digestion and secretion.
Parasympathetic supply
Parasympathetic flow is by three divisions, upper division is carried out by
glossopharyngeal and facial nerve supplies mouth, salivary glands. Middle division
is carried out by vagus nerve supplies esophagus to intestine. Distal part of
intestine, rectum and anal canal is carried out by sacral segments of spinal cord.
The parasympathetic stimulation is causes increase or enhance the activity off
digestive functions.
Digestive structures and digestive glands
Oral cavity and mouth
The oral cavity is the anterior opening off alimentary canal. This is seen in inferior
part of face. The oral cavity is formed by following structures,
 Vestibule of mouth
 Lips
 Oral cavity proper
 Gums
 Teeth
 Palate
 Salivary glands
 Tongue
Mouth
Mouth is seen in inferior part of face. Inside the mouth has oral cavity. The
opening of mouth is guarded by lips. In between the lips and teeth is called
vestibule of mouth helps in grain food in proper form.
Boundaries
 Roof is formed by soft palate, hard palate and upper rows of teeth.
 Floor is formed by tongue and lower rows of teeth.
 Anteriorly formed by vestibule of mouth.
 Posteriorly formed by oro-pharyngeal isthmus
 Laterally formed by buccal cavity.
Buccal cavity
Buccal cavity externally called check. These are formed by five layers,
 Skin
 Buccal pad of fat
 Buccinators muscle
 Bucco-pharyngeal membrane
 Buccal mucosa
Functions of mouth
 Mouth helps to grain food in proper form.
Mouth has tongue, teeth, salivary secretion which helps to grain the food
particles into smaller pieces and convert into bolus form by the help of
saliva.
 Helps in speech
Salivary secretion of mouth helps to lubricates and moisture the oral cavity
which helps in articulation off speech.
 Helps to chewing and convert food particles into bolus
By the helps of teeth the complex food particle is convert into smaller
particle called bolus.
 Helps in appreciate taste
Tongue has various taste buds which helps to appreciation of taste with the
help of saliva.
 Helps in facial expressions
Around the face there is various muscles surrounded helps in facial
expression like laughing, crying, weeping, talking etc.
Teeth
Teeth is the hardest part of our body which present over the alveolar socket of
maxilla (upper) and mandible (lower). There are 32 teeth in adults which
comprises into four types such as,
 Incisor -2
 Canine -1
 Premolar – 2
 Molar – 3
Functions
 Teeth helps in articulation and speech
 This helps in grain the macro food particles into smaller particles which able
to swallow.
Salivary glands
The salivary glands is a exocrine glands which has ductile system. It secretes saliva
which helpful for lubrication of mouth and chewing of food. It partially diagest
food and convert into bolus with the help of teeth and tongue. There are three
major salivary glands such as,
 Parotid glands
 Submandibular glands
 Sublingual glands
Some minor salivary glands are also present around the mouth such as,
 Labile glands
 Lingual glands
 Buccal glands
Based upon the secretions, the salivary glands is divided into three categories,
1. Serous glands
Serous glands secretes watery saliva. The parotid gland is comes under this
category.
2. Mucous glands
Mucus gland secretes mucus saliva. The lingual gland, buccal gland are
comes under this.
3. Mixed glands
These glands secretes both watery and mucus saliva. The sublingual glands
and submandibular glands are comes under this category.
Parotid gland
Parotid gland is largest salivary gland secretes serous saliva. This gland entirely
madeup of serous cells. This gland present in anterio-inferior part of external ear.
The duct arises from parotid gland is opens into vestibule of mouth, just opposite
to the upper second molar teeth. The duct is called as parotid duct which is 4cm in
length. The parotid duct otherwise called as stenson’s duct.
Submandibular salivary gland
This is second largest salivary gland present in submandibular region which is
present in floor of mouth. It secretes both mucus and serous saliva. The
submandibular salivary gland duct opens in deep lingual sulcus, near to frenulum
of tongue. This duct otherwise called as wharton’s duct.
Sublingual salivary gland
This is small salivary gland, when compare with other two major salivary glands.
This is present in sublingual fossa of mandible. This gland secretes the mucus and
serous saliva. The duct arises from sublingual salivary gland is called duct of
rinivus which opens into the floor of mouth.
Oro-pharynx
The oro-pharynx is seen behind the oral cavity which form the posterior part of
oral cavity. Superiorly connected with naso-pahrynx and inferiorly by two opening
called inlet of larynx and opening of esophagus.
Wall
Oro-pharynx is formed by four walls such as,
 Mucus wall
 Submucus wall
 Muscular wall
 Serous wall
Functions
 Oro-pharynx is common pathway for food and air.
 Oro-pharynx muscles helps in swallowing and proper entry of food particles
into esophagus.
 Oro-pharynx also conducts the respiratory air from naso-pharynx to laryngo-
pharynx.
Improper functioning of pharyngeal muscles leads to chocking.
Stomach and esophagus
Esophagus is extends from pharynx to stomach. It is musculo-tubular structure.
Otherwise called as food pipe. It conducts bolus (food mixed with saliva) from
pharynx to stomach. There is no secretion of digestive juices and no digestion
takes place in esophagus.
Stomach
Stomach is present in left hypochondriac region of abdomen. This is the muscular
bag liked structure which is temporary reservoir of food. This is J shaped gland
which has capacity to expand. It holds food upto 1.5 litres but it able to expand for
four liters.
The stomach has four parts such as,
 Cardiac part
 Fundus
 Body
 Pyloric part
Cardiac part is the continouation of esophagus and pyloric part opens into
duodenum ( a part of small intestine).
Cardiac part
Cardiac part is formed by cardiac sphincture which guarded the opening of
stomach.
Pyloric part
The pyloric part has pyloric canal which is narrow in nature. This opens into
duodenum guarded by sphincture called pyloric sphincture.
Body
Body is largest part where the food digestion takes place.
Physiological structure of stomach
Stomach wall is formed by four layers such as ,
 Mucus layer
 Submucus layer
 Muscular layer
 Serous layer
The external layer called serous layer covered by peritoneum called omentum.
There are two omenum namely, greater omentum and lesser omentum. The inner
wall of stomach is lined by mucosal layer which has longitudinal mucosal folds
called gastric rugae. Inside the gastric rugae, gastric pits are seen. The gastric pits
has gastric glands which secretes gastric juices which contains HCL, pepsin, renin,
lipase etc.
Gastric glands
Gastric glands are located in gastric pits of rugae. Majorly gastric glands are
divided into three types such as,
 1. Fundic glands
Fundic glands located in fundus of stomach. These glands are long and
straight. This gland has three parts such as, Body, neck and isthmus.
Cells of fundic glands
 Chief cells
 Parietal cells or oxyntic cells
 Mucus neck cells
 Enterochromaffin cells
2. Pyloric glands
Pyloric glands is located in pyloric canal which has following cells,
 Entero chromaffin cells
 Entero chromaffin like cells
 G cells
3. Cardiac glands
Cardiac glands located in cardiac part of stomach which has following cells,
 Chief cells
 Entero chromaffin cells
 Entero chromaffin like cells
Functions of stomach
 Reservoiur of food
The major function of stomach is reservoiur of food for three to four hours.
It holds the capacity of 1-1.5 liter in empty stomach.
 Digestive function
Stomach has gastric glands which secretes gastric juice which is highly
acidic in nature. It mixed with food and forms chyme. The chyme is helpful
in digestion. The major part of protein digestion is takes place in stomach.
 Protective function
The mechanical loading of food is protected by mucus layer of stomach.
Mucus layer synthesis mucin which helps to prevent damaging of mucus
layer in stomach while loading food in stomach.
 Erythropoitic function
Stomach mucus layer synthesis the intrinsic factor of castle which is helpful
for theabsorption of vitamin B12 from intestine. Vitamin B12 is necessary
for the maturation of RBC.
Small intestine
Small intestine is the middle part of gastro intestinal tract, extending from pyloric
sphincture of stomach to ileocecal valve in cecum. The distal part of small intestine
attached with cecum of large intestine. It is smaller in diameter which compared to
large intestine. The maximum part of digestion and absorption is takes place in
small intestine.
Small intestine distinguished into three regions,
 Duodenum ( C shaped, first part)
 Jejunum ( middle, long portion)
 Ilieum (distal, highly coiled part)
Pyloric sphincture in stomach guarded the opening of stomach and small intestine.
The wall of small intestine has four layers such as, mucosal, submucosal, muscular
and serous wall.
The mucosal layer, there is specialized modification is seen. The mucosa has folds
called vili and micro villi which increase the surface area of small intestine. The
absorption of nutrition takes place in this part. There is intestinal glands or crypts
of leiberkuhn have epithelial cells which secretes mucus. Paneth cells and
argentaffin cells which secretes digestive hormones and enzymes. The digestive
juice in small intestine is called succus entericus. There is lymphoid tissue present
in patches throughout the small intestine called peyer’s patches.
Functions of small intestine
 Digestive function
Small intestine secretes the digestive juice called succus entericus. In
associated with succus entericus, the pancreatic juice and bile which helps in
digestion of food especially lipids, protein and carbohydrates. Mixing
movements of small intestine helps in the through mixing and digestion of
food.
 Hemopoietic function
Vitamin B12 absorption is takes place in small intestine under the influence
of intrinsic factor of castle. Vitamin B12 is essential for the maturation of
RBC.
 Hormonal function
A large number of hormones are secreted by small intestine include secretin,
CCK, enterogastrones, vasoactive peptide, gastrointestinal peptide etc.
which helpful for the regulation of enzymes secretion.
  Mucus secretion
The brunners glands and globlet cells present in small intestine which
secretes mucus. This mucus helpful for protection of small intestinal wall
during movements.
 Absorption function
Presence of villi and microvilli in small intestinal mucosa increases the
surface area of mucosa. This facilitates the absorption of digestive food
substance in intestine. Carbohydrates, protein, fats, minerals and vitamin
absorption are takes place in small intestine.
Large intestine
Large intestine is the distal part of digestive tract. It consist of following parts
namely,
 Cecum
 Vermiform appendix
 Ascending colon
 Transverse colon
 Descending colon
 Sigmoidal colon
The rectum and anal canal are seen in most distal part of digestive tract.
Functions
 Absorptive function
Most of nutrients and digestive substance is absorbed in small intestine. The
remaining part of digestive substance such as water, electrolytes, dietary
fibers are absorbed in large intestine.
 Formation of eliminatory substance
Indigestive substance for excretion is formed followed by absorption of all
essential substance is seen in large intestine. The indigestive substance is for
excretion is called fecus. Fecus is excreted out by rectum and anal canal.
 Excretion function
Large intestine eliminates the digestive waste products, toxins, metals etc
through the fecal form.
 Erythropoietic function
Vitamin B12 absorption takes place in large intestine helps in erythropoietic
function.
DIGESTIVE JUICES
Saliva
Saliva is secreted by salivary glands. There are two types of saliva
 Mucus saliva
 Watery saliva
Composition of saliva
Properties of saliva
 Parotid gland secretes 25% of saliva, submaxillary gland secretes 70% of
saliva and sublingual glands secretes 5% of saliva.
 The average daily salivary secretion is 1 to 1.5 liters/day.
 Saliva is acidic in nature. The pH is about 6.35 to 6.85.
 Specific gravity is 1.002 to 1.012.
 Saliva is hypotonic in nature.
Functions of saliva
 Mechanical function
Saliva mix with the food materials which helps in chewing of food
(mastication), mix with food and form bolus.
 Lubrication of mouth
Salivary secretion in mouth helps to keep the mouth in moisture form and
helps in lubrication of mouth.
 Helps in taste sensation and speech
Chemical sensation of taste is carried out by saliva. While saliva is mixing
with food substance cause the activation of taste buds gives taste
appreciation.
By maintaining the moisture cause the smooth articulation of mouth while
speech.
 Digestive function
The major salivary enzymes such as salivary amylase, maltase and lipase.
Salivary amylase
Salivary amylase otherwise called as ptyalin which plays major role in
carbohydrate digestion. The cooked starch present in food digestion. The
cooked starch present in food digestion in mouth while chewing.
Maltase
 The digestive starch has maltose is converted into glucose with the help of
maltase enzymes.
Lipase
Lipase in saliva is lipid digestive enzymes. It helps in partial digestion of
triglycerides and fats.
 Protective function
Saliva has large number of lysosomes which helps in protection against the
bacteria. It helps to maintain defense function of mouth.
Regulation of salivary secretion
The saliva secretes spontaneously in mouth without any stimulus. The average
secretion is 1ml/ min. there is small mount of mucin is present in normal salivary
secretion. The overall regulation (stimulation and inhibition ) of salivary secretion
is regulated by higher centers present in CNS.
The salivary gland has supplied by autonomic nervous system. Both sympathetic
and parasympathetic fibers are supplied.
Sympathetic fibers
Sympathetic supply of salivary gland is arises from the T1 and T2 segments of
spinal cord.
Functions:
Sympathetic stimulation causes the activate the secretion of saliva. The saliva us
thick and mucus rich in nature.
Parasympathetic fibers
Parasympathetic supply of sublingual and submandibular glands arises from the
facial and trigeminal nerve arises from the superior salivary nucleus in pons.
The parotid gland receives the parasympathetic from glossopharyngeal nerve arises
from the inferior salivary nucleus in pons.
Functions:
Parasympathetic stimulation causes the secretion of watery saliva.
Reflex action in salivary secretions:
Reflex action causes the stimulation of salivary secretions.
  Conditional reflex
This reflex is seen only had previous experience. It is acquired one. Site,
smell, taste of food which had previous experience cause the salivary
secretion.
 Unconditional reflex
It is inborn reflex which present since birth. there is no previous experience
is required. By birth itself the reflex is present.
Applied physiology
Xerostomia
Xerostomia otherwise called as dry mouth. It is caused by hyposalivation.
Etiology:
 Chronic kidney disease
 Radio and chemotherapy
 Drugs, smoking and uses of narcotics
 Paralysis.
Hyposalivation
Reduced or amount of salivary secretion is decreased causes hyposalivation.
Etiology
 Anxiety and anticipation
 Fear
 Dehydration
 Hemorrhage
Hypersalivation
Increased or excessive secretion of saliva cause hypersalivation. It also called
ptyalism, sialism.
Etiology
 Parotid tumor
 Dental caries
 Cerebro vascular accident
 Vomiting, nausea
Mumps
Mumps is causes by virus called paramyxovirus. It is commonly seen in children
causes edema, puffiness in buccal cavity, fever, weakness are seen.
Sjogren syndrome
It is an autoimmune disorder which autoimmune cells are destroy the exocrine
glands of human body.
Features
 Dry mouth/ hyposalivation
 Dryness of eyes
 Dryness of skin, mucous membrane etc.
GASTRIC JUICE
Gastric juice is secreted from the various gastric glands present in stomach.
Properties of gastric juice
 Volume: 1.2 to 1.5 liter/ day
 Reaction: due to high concentration of HCl highly acidic in nature and pH is
about 1.2.
 Specific gravity: 1.002 to 1.004.
Composition of gastric juice
Gastric juice is the mixture is 99% of water and 1% of solids. Solids has various
mixtures of organic and inorganic components.
Functions of gastric juice
Stomach stores food for 3 to 4 hours. The bolus mixes thoroughly with the acidic
gastric juice of stomach by the movement of muscular wall and is called chyme.
 Digestive function
Gastric juice has the proenzymes pepsinogen. On exposure to HCl gets
converted into active enzymes pepsin. Pepsin is the proteolytic enzymes in
gastric juice.
Pepsin converted the proteins into protease and peptones. The protease and
peptones are the partially digested proteins.
 The gastric juice has gastric lipase which is lipolytic enzymes. This
hydrolyzes the fatty acids. It is weak lipolytic enzymes.
 Hemopoietic function
The parietal cells of gastric glands synthesis “intrinsic factor of castle”
which plays major role in erythropoiesis.
 Protective function
The mucin and bicarbonates present in gastric juice play an important role in
lubrication and protection of mucosal epithelium from excoriation by the
high concentrated HCl.
Phases of gastric secretion
There are three phases in gastric secreti0ons
 Cephalic phase
 Gastric phase
 Intestinal phase
Cephalic phase
The gastric juice secretion stimulation is arises from the head region is called
cephalic phase. This phase is entirely based on nervous mechanisms. The gastric
juice secretion during cephalic phase is called appetite juice. This phase occurs
during the absence of food in stomach. The quantity of gastric juice is less but rich
in HCL.
Gastric phase
This phase occurs after the entry of food in stomach. The mechanical loading of
food in stomach causes,
 Distension of stomach causes the vagovagal reflex and secretes gastric juice.
 Distension of pyloric canal which causes the release of gastrin from G cells.
Secretion of HCL, lowers the pH.
Intestinal phase
Presence of food in duodenum causes the intestinal phase. It caused due to the
effect of gastrin released from duodenum.
Mechanism of secretion of gastric juice
Hydrochloric acid is secreted from parietal cells. Inside the parietal cells, there is
intra cellular canaliculi are present. These canaliculi opens into lumen of gastric
glands. The whole mechanism is carried out by energy obtained in oxidation of
glucose.
Carbon dioxide is derived from metabolic activities of parietal cells. The carbon
dioxide is combines with water to form carbonic acids in the presence of carbonic
anhydrase enzymes. This enzymes present only parietal cells. The carbonic acids is
highly unstable and immediate split into bicarbonate and hydrogen ion.
These hydrogen ion pumped into canaliculus of parietal cells. In associated with
hydrogen ion, the chloride ion is also pumped into canaliculi immediately.
The chloride is from sodium chloride present in the blood. Now, the hydrogen and
chloride ion is combines and form the hydrochloric acid.
Regulation of HCl secretion
The HCl secretion regulated by,
 Neuronal control
 Humoral control
Neuronal control
The neuronal control is carried out by the vagal nerve stimulation. Vagus nerve
causes the direct stimulation of secretion of gastric juice.
Gastrin is the hormone necessary fore the secretion of HCL from parietal cells.
Release of gastric releasing peptide which enhances the gastrin secretion. By that,
the HCl secretion also increases. The neurotransmitter acetylcholine and
somatostatin are released from the vagus nerve which act on the parietal cells and
G cells.
Humoral control
Gastrin is the hormones secreted from the pyloric glands and enter into parietal
cells through blood route. Due to stimulation of parietal cells by gastrin, the acid
gastrin juice is increases.
Applied physiology
Gastritis
Gastritis otherwise called as stress ulcer. Gastritis is the term used to mention an
inflammation of gastric mucosa. Gastritis may be two types
 Acute gastritis
 Chronic gastritis
Acute gastritis
Inflammation of superficial layer of gastric mucosa and mostly activated by
polymorphs neutrophils.
Etiology
 Infection of helicobacter pylori
 Alcohol consumption and smoking
 Life style modifications like intake of junk food, delay in food habits, error
in diets, etc.
 Erosion during Ryle’s tube insertion
 Radiation therapy
Chronic gastritis
Inflammation involved into deeper layer of gastric mucosa. It is carried out by the
lymphocytic infiltration. It damage the gastric glands and cause reduction ion
secretion of gastric juice.
Etiology
 Infection of helicobacter pylori
 Prolonged life style modification
 Autoimmune diseases
 Use of non-steriodal anti inflammatory drugs
Features
 Nausea, vomiting
 Abdominal pain especially at epigastric region
 Heart burn and eructation
 Fullness of abdomen and distension of abdomen
 Anorexia (loss of appetite)
Peptic ulcer disease
Inflammation, erosion and bleeding of gastric or duodenal mucosa is termed as
peptic ulcer disease. The excess secretion of gastric acids causes the peptic ulcer
disease. It may two types,
 Gastric ulcer
 Duodenal ulcer
Gastric ulcer
The erosion of gastric mucosa especially at the lesser curvature of stomach seen
over the pyloric region of stomach.
Features
 Pain in epigastric region especially after food.
 Hematemesis (vomiting of blood)
 Heart burn
 Hard eructation
 Anorexia
Duodenal ulcer
Inflammation of duodenal mucosa especially in the first and second part of
duodenum.
Features
 Abdominal pain at umblical region especially after food.
 Melena (blood in stool)
 After food, the pain is ameliorates
 Loss of weight
 Anorexia.
Zollinger-ellison syndrome
The tumor in pancreas produces excess secretion of gastrin. This causes the excess
quantity of acids in stomach by over stimulation of parietal cells. This condition is
called zollinger-ellison syndrome.
Etiology
 Tumor in pancreas
Features
  Abdominal pain
 Diarrhea
 Anorexia
 Hematemesis
Succus entericus
Small intestine secretes the digestive juice called succus entericus
Composition of succus entericus
Succus entericus has 99.5% of water and 0.5% of solids.
Properties of succus entericus
 Volume: 1.8 liter/day
 Alkaline in medium and pH is about 8.3 due to presence of bicarbonate ion
concentration.
Secretion of succus entericus
The intestinal mucosal epithelium has globlet cells which secretes mucus. The
secretion of the crypts of lieberkuhn along with the globlet cells secretes succus
entericus.
The succus entericus contains variety of enzymes like enterokinase, dipeptidases,
maltase, lactase, sucrose, nucleotidases, lipases etc.
The mucus along with the bicarbonates from pancreas protects the intestinal
mucosa from acid (acid chyme) as well as provide an alkaline medium for efficient
enzymatic activities.
Functions of succus entericus
 Digestive function
Proteins, proteoses and peptons (partially digested proteins in stomach) in
the chyme reaching the small intestine are acted upon the proteolytic
enzymes of pancreatic juice.
So, pancreatic juice digest the protein, carbohydrate and lipids and form the
further digestion.
This digestion is followed by the enzymes in succus entericus act on the
digestion and form end products which is converted into simple absorbable
forms.
 So, succus entericus shows the final steps in digestion occurs very close to
the mucosal cells if intestine.
Dipeptides…………………>dipeptidases amino acids
Maltose ………………….> maltase glucose+glucose
Lactose …………………..> lactase glucose+ galactose
Sucrose……………………..> sucrase glucose+fructose
Nucleotides ……………..> nucleotidases nucleosides ………>nucleosidase
sugar + nitrogenous base
Di and monoglycerides ………….>lipases fatty acids +glycerol
 Activation of pancreatic enzymes
The enterokinase enzymes present in succus entericus activates the inactive
trypsinogen into active trypsin which leads to activation of all pancreatic
enzymes.
 Protective function
Mucus present in succus entericus and high concentration of bicarbonate ion
cause increase intestinal pH level and maintain alkaline medium. Tis
products the intestinal mucosa from acid chyme.
 Hemopoietic function
The synthesis of intrinsic factor of castle shows important role in
erythropoiesis.
 Absorptive function
The breakdown of all biomacromolecules into simple absorptive molecules
takes place in duodenal region of small intestine. These simple substances
formed are absorpted in jejunum and ileum of small intestine.
The villi and microvilli present in mucosal layer of small intestine helps in
absorption.
The undigested and unabsorbed substances are passed on to the large
intestine.
Absorption of digestive end products
Absorption is the process in which the digestive end products from intestinal villi
into blood or lmph.
Absorption takes place in active, passive or facilitated transport mechanisms.
The glucose and amino acids are absorped with the passive diffucsion an
dfacilaited transport. The fatty aicds and glycerol are absorpted into lymph vessels
called lacteals. Fat are formed into small droplets called micelles and form fat
globules with the help of proteins called chylomicrons. Chylomicrons transported
into lacteals and then goes to blood stream.
Applied physiology
 Celiac disease
It is an autoimmune disorder where, there is damage of mucosa and
microvilli. It leads to impairment in absorption of digestive end products.
Etiology
This is mainly causes by protein called gluten. Gluten seen in wheat, oats, barley
etc. this gluten causes sensitive and damage the mucosa and microvilli of intestine.
It also called gluten sensitive enteropathy.
Features
 Diarrhea
 Steatorrhoea
 Abdominal pain
 Weight loss
 Emaciation
Tropical sprue
It is causes the malabsorption those who visiting tropical countries.
Features
 Indigestion
 Anorexia
 Abdominal pain
 Diarrhea
Malabsorption syndrome
The failure to absorb the digestive end products into blood stream or lymph
through villi.
Etiology
 Tropical sprue
 Celiac disease
 Crohn’s disease
Large intestine juice
Large intestine secretes juice called large intestine juice. It also has high
concentration of bicarbonate ion. This contains 99.5% of water and 0.5% of solids.
It maintain the alkaline medium in large intestine.
Functions of large intestinal juice
 Absorptive function
No significant digestion takes place in large intestine. It absorb water, some
minerals, and drugs
 Lubricative function
Secretion of mucus in large intestine juice which helps in adhering waste
particles together and form lubrication it for an easy passage.
 Neutralization function
High concentration of bicarbonate ion in the large intestine juice which
neutralizing the acids and maintain the alkaline medium.
Applied physiology
 Diarrhea
Frequent, loose and profuse discharge of fecus in liquid form called diarrhea.
It is mainly due to increased movement of intestine.
Etiology
 Infection by [Link], salmonella typhi, shigella, entameoba histolytica etc,
 Excess intake of antibiotics, drug induced diarrhea
 Life style modification causes irritable bowel syndrome, inflammation of
intestine etc.
Complications
 Dehydration
 Metabolic acidosis
 Abdominal cramps
 Bloating of abdomen
Constipation
Difficult and excess straining to pass fecus and leads to discomfort called
constipation. It is mainly due to lack of movements in colon. Fecus is hard, large
and dry in nature.
Etiology
 Lack of dietary fibers,
 Reduced intake of enough liquids
 Irregular bowel habits
 Antibiotics
PANCREAS
Pancreas is the dual functioning organ having both digestive and endocrine
functions. Digestive functions shows the exocrine activities. Endocrine function
shows the synthesis of hormones namely insulin, glucogon and somatostatin. The
digestive functions shows the exocrine activities by synthesis of enzymes
(digestive enzymes) called pancreatic juice.
Physiological structure of pancreas
Pancreas is present in umblical region of abdominal cavity. It present transversely
and extends from the C shaped concavity of duodenum to spleen. Anatomically, it
has four parts such as, head, neck, body and tail. The head part is present in the C
shaped concavity of duodenum and tail part extend to the spleen.
Head, neck and body parts functioning as digestive function and tail part shows the
endocrine functions.
The exocrine part is made up of acini like structures and has ductile system. The
synthesis of enzymes takes place in acini and secretion of pancreas are passing
through major and minor pancreatic duct begins from the tail of pancreas and
passes through body, neck and head. Then it drains into duodenum through major
duodenal papillae. Minor and accessory pancreatic duct usually drains from
uncinated process and drain into major pancreatic duct. Occasionally, this may
directly drains into minor duodenal papillae of duodenum.
Composition of pancreatic juice
Pancreatic juice contain 99.5% of water and 0.5% of solids. The solids has various
organic and inorganic substances. The concentration of bicarbonate level is very
high which helps to maintain alkaline medium in intestine.
Significance of high concentration of bicarbonate ion in pancreatic juice
The high level of bicarbonate ion helps to neutralize the acids chyme into alkaline
at duodenum. It makes the protection to the intestine mucosa from acids.
The high concentration of bicarbonate ion helps the alkalinity in pancreatic juice
helpful for activation of all inactive pancreatic proenzymes.
Functions of pancreatic juice
Pancreatic juice has variety of enzymes like trypsinogen, chymotrypsinogen,
procarboxypeptidases, pancreatic amylase, pancreatic lipase and nuclease. The
pancreatic enzymes are high proteolytic and lipolytic in nature.
Digestion of protein by pancreatic juice
The main enzymes present in pancreatic juice is trypsin and chymotrypsin. These
enzymes are proteolytic enzymes. Some other enzymes such as
carboxypeptidases, nuclease, elastase and collagenase.
Trypsin
Trypsin is major proteolytic enzymes present in pancreatic juice. It is secreted from
inactive proenzymes called trypsinogen. The trypsinogen is converted into active
trypsin by the action of enterokinase enzymes from the succus entericus in small
intestine.
Succus entericus (enterokinase) enzymes is necessary for the activation of
trysinogen. This activation occurs only on duodenal mucosa. Once, the trypsin
activation formed in pancreas or in ductile system of pancreas, then it leads to
catalytic activity.
Chymotrypsin
Chymotrypsin is secreted from the inactive proenzymes called chymotrypsinogen
which converted in to active trypsin by the enzyme trypsin.
In associated with the trypsin and chymotrypsin, there are several other enzymes
called carboxypeptidase, nuclease, elastase, collagenase which are proteolytic in
action.
Carboxypeptidase
There are two types of carboxypeptidase such as carboxypeptidase A and
carboxypeptidase B. this secreted from the inactive carboxypeptidase which is
activated by trypsin.
Carboxypeptidases……………..> trypsin carboxypeptidase A and B
Protein, peptones, proteoses …………….> trypsin, chymotrypsin and
carboxypeptidase…… dipeptides.
Nuclease
There are two nuclease such as ribonuclease and deoxyribonuclease. This enzymes
plays important role in digestion of nucleic acids.
Elastase
This is from the inactive proenzymes called proelastase activated by trypsin. It
digest the elastic fibers.
Digestion of lipids
Pancreatic lipase: it is most virulent lipolytic enzymes which converts fats into
diglycerides and monoglycerides. This is activated by bile. Bile and colipase are
responsible for the activation of pancreatic lipase.
Cholesterol ester hydrolase, phospholipase A, phospholipase B are helpful in
digestion of fats.
Phospholipase A and phospholipase B are responsible for digestion of
phospholipids namely lecithin and cephalin and convert them into
lysophospholipids and further it convert into lysolecithin and lysocephalin.
Colipase
It is from the inactive procolipase activated by trypsin. It enhances the activation of
pancreatic lipase in digestion of fats.
Carbohydrate digestion
Pancreatic enzymes are weak in digestion of carbohydrates. Carbohydrates in
chyme are hydrolysed by pancreatic amylase into disaccharides.
Polysaccharides ………….> pancreatic amylase …..disaccharides
Neutralizing action
In acid, the gastric juice is highly acid in nature. By that, the chyme is highly acidic
while digestion takes place in stomach. So, when this acid chyme enters into
intestine (duodenum) from stomach. It supposed to damage the intestinal mucosa.
Due to presence of large quantity of bicarbonate in pancreatic juice which nullify
the acid chyme and convert into alkalinity. So, pancreatic enzymes shows the
protective function of intestinal mucosa.
Regulation of pancreatic juice secretion
The secretion and release of pancreatic juice from pancreas is regulated under the
two mechanisms such as neuronal control and hormonal control
Phases of pancreatic secretion
Pancreatic juice is secreted by three phases namely,
 Cephalic phase
 Gastric phase
 Intestinal phase
Cephalic phase
Cephalic phase is entirely comes under the neuronal mechanism. Stimulation of
vagus nerve initiated the cephalic pahse. This phase is regulated neuronal control
by reflex mechanism. This phase is seen before or during the intake of food.
Two types reflex seen such as,
 Conditional reflex
 Unconditional reflex
Conditional reflex
It is an inborn reflex when the food is keep in mouth, automatically the pancreatic
juice is secreted from the pancreas in associated with the salivary and gastric juice
secretion. This mechanism is carried out by vagus nerve.
Unconditional reflex
It is acquired reflex. There must be previous experience is neccessory for this
reflex. The sight, smell, taste or hearing the name of food, this reflex is activate.
This cause the secretion of pancreatic juice in associated with the salivary and
gastric secretion.
Gastric phase
This phase started, when the food enters into stomach mucosa. This phase is
rtegulated by hormonal mechanism. When the bolus is enters into stomach, the
hormones called gastrin is secreted. By that, effect of gastrin, the pancreatic juice
is secreted. So, this process is carried out by hormones called gastrin.
Intestinal phase
This phase started, when the chyme is enters into duodenum. This phase is carried
out by hormonal control.
When chyme enters into intestine, the secretin and cholecystokinin are hormones
secreted from duodenal mucosa cause release of pancreatic juice.
Applied physiology
Pancreatitis
Inflammation of exocrine part of pancreatic parenchyma is called pancreatitis. It
may be two types
 Acute pancreatitis
 Chronic pancreatitis
Acute pancreatitis
It is more severe and intense painful in nature. It sudden onset and rapid in
progress.
Etiology
 High intake of alcohol
 Recurrent gall stone
 Obstructive jaundice
Features
 Abdominal pain extends upto back
 Nausea
 Vomiting
 Fever
 Shock
 Coma
Chronic pancreatitis
Due to recurrent attack if acute pancreatitis may results in chronic pancreatitis.
Etiology
  Hereditary cause
 Intake of alcohol
 Obstructed gall stone
 Cystic fibrosis
Features
 Indigestion which is severe due to damage of pancreatic cells.
 Protein digestion is highly deficient.
 Complete destruction of pancreatic cells and ducts leads to necrosis.
 Severe abdominal pain
 Nausea and vomiting
 Weight loss and emaciation.
LIVER AND GALL BLADDER
Liver is second largest gland of the body weighing about 1200 to 1500 kg in
adults. It is located in right side of abdominal cavity just below the diaphragm.
Functional anatomy of liver
It is largest metabolic organ in human which has two lobes such as,
 Right lobe
 Left lobe
Inside both lobes, there is a several lobes called hepatic lobules. Hepatic lobules
are the structural and functional unit of liver containing hepatic cells or
hepatocytes. There are more or less 50,000 to 1,00,000 lobules in liver. Every
lobules has cells called hepatic cells or hepatocytes.
The hepatocytes are arranged in the form of cords. Each lobules is covered by thin
connective tissue sheath called glisson’s capsule.
Hepatocytes
Hepatocytes or hepatic cells which arranged in columns and forms hepatic plates.
Each hepatic plate has two columns of hepatic cells and in between the two column
of each plates has bile canaliculus. In between two hepatic plates there is a space
called sinusoids. Sinusoids is lined by blood vessels. Hepatocytes has special
macrophages called kupffers cells.
Portal traids
Each hepatic lobules has portal triads. The portal triads has,
 Branch of hepatic artery
 Branch of portal vein
 Bile duct
The hepatic artery and portal vein open into sinusoids. Sinusoids drains blood into
hepatic vein.
Bile is synthesis by hepatic cells and drains into bile canaliculus. From bile
canaliculus, the bile enters into right and left hepatic duct and goes out of liver.

Extra hepatic biliary apparatus

Biliary apparatus is formed by the group of ducts and gall bladder. The right and
left hepatic duct are formed in the region of porta hepatis in liver. The porta hepatis
is seen in the inferior surface of liver. This emerges out from the liver along with
the portal vein and hepatic artery. The right and left hepatic duct unites and forms
the common hepatic duct. The common hepatic duct runs downwards and end by
connecting with cystic duct. The cystic duct is arises from the gall bladder and
connect with common hepatic duct. The cystic duct and common hepatic duct
united and form common bile duct. The common bile duct runs downwards and
backwards, then united with pancreatic duct and forms hepato-pancreatic duct.
This hepato pancreatic duct gets opened into duodenal papillae called ampulla of
vater. The sphincture present at the opening called sphincture of oddi.
Blood supply of liver
Liver is supplied by,
 Portal vein: 80% of blood is supplied by portal vein. The liver is major
metabolic organs. By that portal vein has bring metabolites from intestine to
liver. It is formed by the union of superior mesenteric vein in intestine and
splenic vein in spleen. So, portal vein blood has enormous amount of
metabolities such as monosaccharides, amino acids, bile salts, bilirubin etc.
this circulation is called hepato portal circulation.
 Hepatic artery: the remaining 20% of blood supply is by hepatic artery
which gives oxygen supply to hepatocytes. The blood from portal vein and
hepatic artery is mix in the sinusoids of liver.
  Hepatic vein: the blood from sinusoids is drains into central vein. All central
vein is collected as hepatic vein and later drains into inferior vena cava.
Functions of liver
Liver is largest metabolic gland and doing various functions in human body. It is
one of the vital organ in human.
 Metabolic function
It is largest metabolic organ. The digestive end products comes to liver
through the portal vein. The conversion of digestive end products into
assimilatory products called metabolic reactions. Liver has various
metabolic reaction such as carbohydrates, protein, fats, vitamins, mineral
etc.
 Synthesis function
Liver synthesis glucose by gluconeogenesis, synthesis various proteins
especially plasma proteins, synthesis red blood cells during embryonic
period, synthesis hormones binding proteins, synthesis vitamin A, synthesis
anticoagulant (heparin) and various clotting factors etc.

Liver synthesis bile salts, bile acids, bile pigments, fatty acids. Bile is
necessary for the digestion of fats. Through bile the, the bilirubin is excreted
out.
 Storage function
Liver is largest storage organs. It stores reserve proteins, iron products,
mineral, glycogen, amino acids etc.
 Increasing basal metabolic reactions
Due to excessive metabolism take place in liver, the organ is responsible for
increase metabolic reactions. By that, liver is responsible for increasing heat
production in body.
 Hemopoietic function
During embryonic period, liver is functioning as hemopoietic organ. It
synthesis RBC. Liver stores vitamin B12 which is necessary for the
maturation of red blood cells.
 Reticulo endothelial function
Liver is one of the organ comes under the reticulo endothelial system. This
is participate in defense mechanism of human body. Liver is a;lso hel;ful in
destruction of red blood cells.
 Kupffers cells is the phagocytic cells present in liver, helpful for excretion of
microbes, toxins etc.
GALL BLADDER
Gall bladder is the small sac like structure seen in the cystic fossa of liver. Gall
bladder is oval in shape present in inferior part of liver.
Physiological structure of gall bladder
Bile synthesis in liver but it store and secreted from gall bladder. Gall bladder hold
upto 20 to 40 ml of bile.
The duct arises from the gall bladder called cystic duct which unite with common
hepatic duct and forms the common bile duct. The mucosal fold present in cystic
duct is called valves of heister.
Functions of gall bladder
 Storage function
Bile is synthesis in liver and store into gall bladder. During storage the bile
is modified into their quantity and quality such as,
1. Increase the concentration of bile
2. Decrease the pH of bile
3. Decrease the volume of bile
4. Increase the content of mucin.
 Secretion of mucin
Gall bladder secreted mucin in bile. It helpful for lubrication and movement
of chyme in intestine.
 Maintain pressure in biliary ducts
The pressure in biliary ducts is regulated by gall bladder by altering the
concentration and quantity of bile.
Properties of bile
The average amount of bile synthesis is about 800 to 1000 ml per day. The bile is
highly alkaline in nature and pH is about 8 to 8.5. it maintain specific gravity 1.010
to 1.011. bile is greenish yellow in colour.
Composition of bile
Bile contain 98% of water and 2% of solids. Solids have various organic and
inorganic sunstances.
Synthesis of bile
Bile is synthesis in liver. Hepatocytes are synthesis bile which has large quantity of
bile acids, bile salts, bile pigments, cholesterol and lecithin. From hepatocytes, the
bile is released into bile canaliculi. From bile canaliculi forms into right and left
hepatic duct and goes to gall bladder for storage.
Storage of bile
Bile is store in gall bladder and released into bile duct whenever necessary. During
the storage of bile in gall bladder, it undergoes various changes.
Bile salts
There are four bile salts such as sodium glycocholate, potassium glycocholate,
sodium taurocholate and potassium taurocholate. These bile salts are formed from
the primary bile acids such as cholic acid and chemodeoxycholic acid. These bile
acids are the raw products for bile salts, which secreted by hepatic cells.
After formation of cholic acid and chemodeoxycholic acid, it enter into intestine
during secretion of bile. In intestine, these bile acids converted into secondary bile
acids such as deoxycholic acid and lithocholic acids respectively under the
influence of bacterial action in intestine.
The deoxycholic acid and lithocholic acid enters into liver through portal vein and
conjugated with glycine and taurine. After conjugated, it forms glycocholic acid
and taurocholic acid. These bile acids react with sodium and potassium and forms,
 Sodium glycocholate
 Potassium glycocholate
 Sodium taurocholate
 Potassium taurocholate.
Bile pigments
Bile pigments are the excretory products of bile. Commonly two bile pigments
such as,
 Bilirubin
 Biliverdin
Formation of bile pigments
Bile pigments are formed from the destroy of red blood cells. When the senile
RBC enters into reticuloendothelial blood vessels especially splenic vessels, the
cells gets destructed. During destruction the pigment hemoglobin from RBC is
released out. The hemoglobin is break into heme and globin. Heme is further split
into iron and biliverdin. Biliverdin is reduced into bilirubin. Bilirubin is released
into reticuloendothelial cells.
Bilirubin is transported into blood by albumin. In blood, bilirubin is circulating
called unconjugated bilirubin. Then it uptake by liver cells and conjugated with
glycyronic acid called conjugated bilirubin.
These bilirubin is excreted out by intestine as urobilinogen and stereobilinogen
forms.
Normal level of bilirubin in plasma is 1.5 mg/dl. If it is exceed more than 1.5mg/dl,
then it called subclinical jaundice. If it is more than 2mg/dl, then it is called
jaundice.
Functions of bile
1. Digestive function
Bile is responsible for the digestion of fats in intestine. Bile has bile salts
which helps to reduce the surface tension of fats and enhance the fats
digestion. Fats are insoluble in water due to increased surface tension. But
after bile salts reduce the surface tension. Bile also helps in emulsification of
fats. Bile broke the fats into minute droplets and forms milky like fluid is
called emulsion. This process is called emulsification. After emulsification,
the fat can easily digest by lipolytic enzymes.
2. Absorptive function
Digested fat do not absorb from intestine directly. The digested fats combine
with bile salts and form small micelles. Then it easily absorb from intestine.
3. Choleretic action
Bile salts are responsible for stimulation of bile secretion from liver. This
process is called choleretic action.
4. Cholagogue action
The contraction of gall bladder and followed by release of bile from gall
bladder whenever necessary. This process is called cholagogue action.
5. Laxative action
Due to presence of mucin in bile, it helpful for lubrication during movement
of intestine and laxative action during defecation.
Applied physiology
1. Jaundice
The yellowish discoloration of skin, mucus membrane and deeper tissue are
indication of jaundice.
The increased level of plasma bilirubin level above 2 mg/dl is leads to
jaundice.
Etiological classification
 Hemolytic jaundice
 Hepatocelluar injury
 Obstructive jaundice
Hemolytic jaundice
Excess hemolysis leads to jaundice. The excessive destruction of RBC leads to
increase bilirubin level. It occurs in following conditions such as,
 Chronic kidney disease
 Splenomegaly
 Burns
 Plasmodium infestations
 Sickle cell anemia
 Thalassemia
 Autoimmune disease like pernicious anemia
 Malignancy conditions.
Hepatocellular injury
The damage of liver function due to injury in hepatocytes and liver parenchyma
especially in hepatitis, alcoholic liver disease and cirrhosis of liver.
Obstructive jaundice
If any obstruction in bile duct or block the hepatobiliary ducts leads to obstructive
jaundice. Due to obstruction, the bile pigments are not excreted out. This is
commonly seen in cholelithiasis and malignancy conditions.
Cirrhosis of liver
Damage of liver parenchyma or hepatic cells leads to dysfunction of liver. It also
called end stage liver disease.
Etiology
  Alcoholic liver disease
 Hepatitis
 Infections
 Hepatomegaly
 Fatty liver
Features
 Abdominal pain
 Fever
 Nausea and vomiting
 Portal hypertension
 Ascities and distension of abdomen
 Drowsiness
 Anemia
 Weight loss and emaciation
 Hepatic coma
MOVEMENTS OF GASTROINTESTINAL TRACT
Mastication
Mastication otherwise called chewing. This is first mechanical action seen in
mouth in the process of ingestion of food.
In this process, the food particles are break or split into small particles. The food
particles undergoes torn and cut into minute particles, then convert into ball like
structure called bolus. Bolus is the form of chewed food substance makes flexible
to swallowing.
The mastication process is mechanical process, carried out by teeth, tongue, saliva
and movements of muscles of mastication. The process is entirely voluntary in
nature.
Regulation
Mastication is mechanical and reflex in action. Whenever the food present in
mouth, the process is start. The center for mastication located in medulla and
cerebral cortex. The trigeminal nerve helpful for mastication.
Muscles of mastication
 Massester muscle
  Temporal muscle
 Pterygoid muscle
 Buccinator muscle
Movements of oral cavity
 When food present in mouth cause the inhibition of mastication muscle
contraction leads to opening of mouth or depression of mouth.
 Opening followed by contraction of muscles, leads to closure of mouth
 Rotational movements of jaw.
 Forwards projection and backwards projection of jaw.
DEGLUTITION (SWALLOWING)
Deglutition is a reflex response controlled by vagus and its centre is located in the
medulla oblongata.
Stages of deglutition are:
1. Oral stage ( voluntary stage) – bolus is rolled from mouth to pharynx
2. Pharyngeal stage - food moves from pharynx to oesophagus
3. Oesophageal stage – food moves from oesophagus to stomach.

ORAL STAGE
When food is ready for swallowing, bolus formed is put over the dorsum of the
tongue. Tongue is pressed against the palate and is moved backward, moving the
bolus from mouth to pharynx.

PHARYNGEAL STAGE
When bolus moves from mouth to the pharynx, receptors present around the
openings of pharynx are stimulated. Impulses from these areas pass to the brain
stem deglutition centre to initiate series of muscular contractions in the following
sequence:
➢ Soft palate moves upwards and closes posterior nasal openings to prevent the
entry of food in to the nose.
➢ Palatopharyngeal folds on either side of the pharynx approximate to make a slit
like opening for food, allowing only properly masticated food to pass through.
➢ Vocal cords of larynx strongly approximate. Larynx is pulled upward and
anteriorly by neck muscles. Epiglottis swings backwards to close laryngeal
opening. All this prevents entry of food into the trachea.
➢ Upward movements of larynx enlarge the opening of oesophagus. Pharyngo -
easophageal sphincter relaxes.
➢ At the same time, entire muscular wall of the pharynx contracts from superior to
inferior part, originating a fast peristaltic wave which also continuous in
oesophagus. This wave pushes the food from pharynx to oesophagus.

All the factors mentioned above act together so that, bolus moves easily into the
esophagus. The whole process takes place within 1 to 2 seconds and this process is
purely involuntary.

OESOPHAGEAL STAGE
Oesophageal stage conducts food from oesophagus to stomach by movements as
follows:

1. PRIMARY PERISTALSIS:
It is simply a continuation of peristaltic wave initiated in pharynx. It takes 8-10
seconds to carry food to the stomach. But in upright posture food passes in the
stomach earlier because of gravity.

2. SECONDARY PERISTALSIS:
If primary peristaltic wave fails to carry all the food to the stomach, secondary
peristaltic wave is initiated in oesophagus due to distension of oesophagus with
food. These waves continue till all the food entered is emptied into the stomach.

DEGLUTITION REFLEX
Though the beginning of swallowing is a voluntary act, later it becomes
involuntary and is carried out by a reflex action called deglutition reflex. It occurs
during the pharyngeal and esophageal stages.

Stimulus
When the bolus enters the oropharyngeal region, the receptors present in this
region are stimulated.

Afferent Fibers
Afferent impulses from the oropharyngeal receptors pass via the glossopharyngeal
nerve fibers to the deglutition center.

Center
Deglutition center is at the floor of the fourth ventricle in medulla oblongata of
brain. Efferent Fibers Impulses from deglutition center travel through
glossopharyngeal and vagus nerves (parasympathetic motor fibers) and reach soft
palate, pharynx and esophagus. The glossopharyngeal nerve is concerned with
pharyngeal stage of swallowing. The vagus nerve is concerned with esophageal
stage.

Response
The reflex causes upward movement of soft palate, to close nasopharynx and
upward movement of larynx, to close respiratory passage so that bolus enters the
esophagus. Now the peristalsis occurs in esophagus, pushing the bolus into
stomach. „

MOVEMENTS OF STOMACH
Hunger Contractions
The contractions which occur when the stomach is empty or near empty are called
hunger contractions. They begin 3hours after a meal. The duration of contraction is
about 20 seconds.
There are 3 types of contractions:
1. Type I: Where the tone is low and there is interval between contractions. The
interval between contractions is about 3 to 4 seconds. s. Tone of the muscles does
not increase between contractions. Pressure produced by these contractions is
about 5 cm of H2 O.
2. Type II: The tone is high; amplitude is large with no intervening pause. But the
pause between the contractions is decreased. Pressure produced by these
contractions is 10 to 15 cm of H2 O.
3. Type III: Tone is very high, duration is long and there is incomplete tetanus.
These contractions last for 1 to 5 minutes. The pressure produced by these
contractions increases to 10 to 20 cm of H2 O.

When the stomach is empty, the type I contractions occur first, followed by type II
contractions. If food intake is still postponed, then type III contractions appear and
as soon as food is consumed, hunger contractions disappear.

It is a reflex initiated by the process of swallowing and begins even before the food
enters the stomach. This prepares the stomach to receive the food and enables it to
accommodate large volume ( receptive relaxation) without much increase in the
intra gastric pressure( accommodation of stomach).

GASTRIC PERISTALSIS (Mixing & Propulsive movements)

Peristaltic movements of the stomach help to mix the food thoroughly with the
gastric juice and macerate the food which is softened by the digestive juices.
The peristaltic wave begins in the middle of the stomach as a week ring of
contraction and passes downwards towards the pyloric sphincter, becoming more
powerful and rapid. Finally, it ends with the constriction of pyloric sphincter. Some
of the waves disappear before reaching the sphincter.
Each peristaltic wave takes about one minute to travel from the point of origin to
the point of ending. This type of peristaltic contraction is called digestive
peristalsis because it is responsible for the grinding of food particles and mixing
them with gastric juice for digestive activities.

GASTRIC EMPTYING

Gastric emptying is the process by which the chyme from stomach is emptied into
intestine. Food that is swallowed enters the stomach and remains there for about 3
hours. During this period, digestion takes place. Partly digested food in stomach
becomes the chyme.

Functions:
➢ Regulates and limit the flow into the duodenum.
➢ Increases the effectiveness of antral mixing and churning by closing as the
wave passes over it.
➢ Prevents reflux of duodenal contents into the stomach as the sphincter remains
constricted slightly longer than the duodenum. It takes 3-5hours for the stomach to
empty a mixed meal.
Enterogastric Reflex
Enterogastric reflex is the reflex that inhibits gastric emptying. It is elicited by the
presence of chyme in the duodenum, which prevents further emptying of stomach.
TYPES OF MOVEMENTS OF SMALL INTESTINE
Movements of small intestine are of four types:
1. Mixing movements:
i. Segmentation movements
ii. Pendular movements.
2. Propulsive movements:
i. Peristaltic movements
ii. Peristaltic rush.
3. Peristalsis in fasting – migrating motor complex
4. Movements of villi
MIXING MOVEMENTS
Mixing movements of small intestine are responsible for proper mixing of chyme
with digestive juices such as pancreatic juice, bile and intestinal juice. The mixing
movements of small intestine are segmentation contractions and pendular
movements.
1. Segmentation movements.
Segmentation contractions are the movements of small intestine, which occur
regularly or irregularly, but in a rhythmic fashion. The contractions occur at
regularly spaced intervals along a section of intestine. The segment of the intestine
involved in each contraction is about 1 to 5 cm long. The segments of intestine in
between the contracted segments are relaxed. These alternate segments of
contraction and relaxation give appearance of rings, resembling the chain of
sausages. After sometime, the contracted segments are relaxed and the relaxed
segments are contracted. Therefore, the segmentation contractions chop the chyme
many times. This helps in mixing of chyme with digestive juices.

2. Pendular movement
It is the sweeping movement of small intestine, resembling the movements of
pendulum of clock. Small portions of intestine (loops) sweep forward and
backward or upward and downward. It is a type of mixing movement, noticed only
by close observation. It helps in mixing of chyme with digestive juices. „
PROPULSIVE MOVEMENTS
Propulsive movements are the movements of small intestine which push the chyme
in the aboral direction through intestine.
i. Peristaltic Movements
Peristalsis is a wave of contraction preceded by wave of relaxation. Peristaltic
wave can be initiated in any part of the small intestine it moves aboral direction at
a rate of 0.5 -2cm /min, but it is weak and dies out after travelling onlyn3-5 cm,
very rarely up to 10cm. so net movement of chyme in aboral direction is slow
( 1cm/ min).

Peristaltic movement propel the chyme in aboral direction. As chyme enters the
intestine, it spreads along the entire length of the intestine due to peristaltic waves
for proper digestion and absorption.
Peristaltic waves in small intestine increase to a great extent immediately after a
meal. This is because of gastroenteric reflex, which is initiated by the distention of
stomach. Impulses for this reflex are transmitted from stomach along the wall of
the intestine via myenteric plexus.

ii. Peristaltic rush:

Intense irritation of intestinal mucosa causes very powerful and rapid peristalsis
called peristaltic rush. It is partially initiated by extrinsic nervous reflex and partly
by myenteric reflex. Powerful peristaltic contractions travel long distances in small
intestine within minutes.
Peristaltic rush sweeps the contents of intestine into the colon. Thus, it relieves the
small intestine off either irritants or excessive distention.
3. PERISTALSIS IN FASTING – MIGRATING MOTOR COMPLEX (MMC)

Migrating motor complex is a type of peristaltic contraction, which occurs in

stomach and small intestine during the periods of fasting for several hours. It is
also called migrating myoelectric complex.
It is different from the regular peristalsis because, a large portion of stomach or
intestine is involved in the contraction. The contraction extends to about 20 to 30
cm of stomach or intestine. This type of movement occurs once in every 1½ to 2
hours. It starts as a moderately active peristalsis in the body of stomach and runs
through the entire length of small intestine.

Significance of MMC: Migrating motor complex sweeps the excess digestive

secretions into the colon and prevents the accumulation of the secretions in
stomach and intestine. It also sweeps the residual indigested materials into colon.
4. MOVEMENTS OF VILLI

Intestinal villi also show movements simultaneously along with intestinal

movements, because of the extension of smooth muscle fibers of the intestinal wall
into the villi.
Movements of villi are shortening and elongation, which occur alternatively and
help in emptying lymph from the central lacteal into the lymphatic system. The
surface area of villi is increased during elongation. This helps absorption of
digested food particles from the lumen of intestine.
Movements of villi are caused by local nervous reflexes, which are initiated by the
presence of chyme in small intestine. Villikinin increase the movement of
intestinal villi.

MOVEMENTS OF LARGE INTESTINE

Usually, the large intestine shows sluggish movements. Still, these movements are
important for mixing, propulsive and absorptive functions.
Movements of large intestine are of two types:
1. Mixing movements: Segmentation contractions
2. Propulsive movements: Mass peristalsis.

MIXING MOVEMENTS – SEGMENTATION CONTRACTIONS

Large circular constrictions, which appear in the colon, are called mixing
segmentation contractions. These contractions occur at regular distance in colon.
Length of the portion of colon involved in each contraction is nearly about 2.5 cm.
PROPULSIVE MOVEMENTS – MASS PERISTALSIS
Mass peristalsis or mass movement propels the feces from colon towards anus.
Usually, this movement occurs only a few times every day. Duration of mass
movement is about 10 minutes in the morning before or after breakfast. This is
because of the neurogenic factors like gastrocolic reflex.
DEFECATION

Voiding of feces is known as defecation. Usually the rectum is empty. Due to

mass movements, fecal matter enters the rectum causing its distension. Defecation
involves both voluntary and reflex activity.
The internal sphincter is supplied by the autonomic nervous system; the external
anal sphincter is supplied by the pudental nerve. The external anal sphincter is
under voluntary control.
 The entry of feces in to the rectum causes its distension
 The afferent signals are initiated in the myenteric plexus. It results in the
formation of peristaltic waves in the descending colons, sigmoid colon and
rectum.
 The movement of feces toward the anal canal relaxes the internal sphincter.
 Defecation occurs when the external anal sphincter is also relaxed.
 The contraction of the abdominal muscles helps in the process of defecation
If the circumstances are not favorable, defecation is inhibited by voluntary
contraction of the external anal sphincter and the rectum also relax. The reflex
disappears but reappears a few minutes later.
HORMONAL CONTROL OF DIGESTION
The activities of the gastro intestinal tract are under neural and hormonal control
for proper coordination of different parts. The sight, smell or presence of food in
mouth can stimulate the secretion of saliva. The gastric, pancreatic, intestinal
juices are also secreted simulteously under the stimulation of neuronal signal.
Themuscular activities of different part of alimentary tract can also moderated by
neural mechanisms, both local and through central nervous system. Hormonal
control of the secretion of digestive juices are carried out by the local hormones
produced by the gastric and intestinal mucosa. The role of some of the major gastro
intestinal hormones in digestion are given below
1. Gastrin
Gastrin is the hormones secreted by the gastrin mucosa in stomach. Gastrin
stimulate the gastric glands to secrete and release of gastric glands.
2. Enterogastrone
 Enterogastrone is also known as gastric inhibitory peptide. It is secreted by
the duodenal mucosa and action seen over the stomach. This hormone
inhibit the gastric secretion and slows the gastric contraction.
3. Secretin
Secretin is the hormone secreted in duodenum. After secretion of secretin it
act over the pancreas, liver and stomach. It helps to release bicarbonate ion
in the pancreatic juice. It increase the secretion of bile from liver. It decrease
the gastric secretion and motility. This hormone secreted only chyme enter
into intestinal mucosa.
4. Cholecystokinin
This hormone secreted by the small intestine and act over the gall bladder
and pancreas. It helps to contract the gall bladder and release bile into
intestine. It also stimulate the pancreas to secrete and release the pancreatic
juice into intestine.
5. Duocrinin
Duodrinin is secreted from the duodenum. It stimulate the brunner’s gland to
release the mucus and enzyme into intestinal mucosa.
6. Enterocrinin
It is secreted from the small intestine. It stimulate the crypts of liberkuhn to
release enzymes into intestinal juice.
7. Vasoactive peptide (VIP)
It secreted by small intestine. It dilates the peripheral blood vessel of
intestine and also inhibit the gastric secretion.
8. Somatostatin
It is the pancreatic hormone secreted by delta cells of pancreatic islets of
lanherhans. It inhibit the glucagon by alpha cell and insulin by beta cells. It
also inhibit the absorption of nutrients from the gastro intestinal tract.