GASTRO INTESTINAL FUNCTION

GLOSSARY
 absorption: phase of the digestive process that occurs
when small molecules, vitamins, and minerals pass through the
walls of the small and large intestine and into the bloodstream.
 amylase: an enzyme that aids in the digestion of starch.
 anus: last section of the gastrointestinal (GI) tract; outlet for
waste products from the GI system.
 chyme: mixture of food with saliva, salivary enzymes, and
gastri secretions that is produced as food passes through the
mouth,
esophagus, and stomach.
 digestion: phase of the digestive process that occurs when
digestive enzymes and secretions mix with ingested food and
when proteins, fats, and sugars are broken down into their
component smaller molecules.
 dyspepsia: indigestion; upper abdominal discomfort
associated with eating.
 elimination: phase of the digestive process that occurs
after digestion and absorption, when waste products are
evacuated from the body.
 esophagus: collapsible tube connecting the mouth to the
stomach, through which food passes as it is ingested
hydrochloric acid: acid secreted by the glands in the stomach;
mixes with chyme to break it down into absorbable molecules
and to aid in the destruction of bacteria.
 ingestion: phase of the digestive process that occurs when
food is taken into the GI tract via the mouth and esophagus.
 intrinsic factor: a gastric secretion that combines with
vitamin B12 so that the vitamin can be absorbed.
 large intestine: the portion of the GI tract into which
waste material from the small intestine passes as absorption
continues and elimination begins; consists of several parts—
ascending segment, transverse segment, descending segment,
sigmoid colon, and rectum; also known as the colon.
 lipase: an enzyme that aids in the digestion of fats pepsin: a
gastric enzyme that is important in protein digestion
small intestine: longest portion of the GI tract, consisting of
three parts —duodenum, jejunum, and ileum—through which
food mixed with all secretions and enzymes passes as it
continues to be digested and begins to be absorbed into the
bloodstream.
 Stomach: distensible pouch into which the food bolus
passes to be digested by gastric enzymes
trypsin: enzyme that aids in the digestion of protein

The digestive system is composed of the gastrointestinal (GI)

tract, or the alimentary canal, salivary glands, the liver, and the
exocrine pancreas. The principal functions of the gastrointestinal
tract are to digest and absorb ingested nutrients, and to excrete
waste products of digestion.

Anatomy of the Gastrointestinal System

The GI tract is a pathway 7 to 7.9 meters (23 to 26 feet)

in length that extends from the mouth to the esophagus,
stomach, small and large intestines, and rectum, to the
terminal structure, the anus .
The esophagus is located in the mediastinum, anterior
to the spine and posterior to the trachea and heart. This
hollow muscular tube, which is approximately 25 cm (10
inches) in length, passes through the diaphragm at an
opening called the diaphragmatic hiatus.
The remaining portion of the GI tract is located within
the peritoneal cavity. The stomach is situated in the left
upper portion of the abdomen under the left lobe of the
liver and the diaphragm, overlaying most of the
pancreas . A hollow muscular organ with a capacity of
approximately 1500 mL, the stomach stores food during
eating, secretes digestive fluids, and propels the
partially digested food, or chyme, into the small
intestine. The gastroesophageal junction is the inlet to
the stomach.
The stomach has four anatomic regions: the cardia
(entrance), fundus, body, and pylorus (outlet).
Circular smooth muscle in the wall of the pylorus forms
the pyloric sphincter and controls the opening between
the stomach and the small intestine.
The small intestine is the longest segment of the GI
tract, accounting for about two thirds of the total length.
It folds back and forth on itself, providing approximately
70 m (230 ft) of surface area for secretion and
absorption, the process by which nutrients enter the
bloodstream through the intestinal walls. It has three
sections: The most proximal section is the
duodenum, the middle section is the jejunum, and the
distal section is the ileum. The ileum terminates at the
ileocecal valve. This valve, or sphincter, controls the
flow of digested material from the ileum into the cecal
portion of the large intestine and prevents reflux of
bacteria into the small intestine. Attached to the cecum
is the vermiform appendix, an appendage that has little
or no physiologic function. Emptying into the duodenum
at the ampulla of Vater is the common bile duct, which
allows
for the passage of both bile and pancreatic secretions.
The large intestine consists of an ascending segment
on the right side of the abdomen, a transverse segment
that extends from right to left in the upper abdomen, and
a descending segment on the left side of the abdomen.
The sigmoid colon, the rectum, and
the anus complete the terminal portion of the large
intestine. A network of striated muscle that forms both
the internal and the external anal sphincters regulates
the anal outlet. The GI tract receives blood from arteries
that originate along the entire length of the thoracic and
abdominal aorta and veins that return blood from the
digestive organs and the spleen. This portal venous
system is composed of five large veins: the superior
mesenteric, inferior mesenteric, gastric, splenic, and
cystic veins, which eventually form the vena portae that
enters the liver. Once in the liver, the blood is distributed
throughout and collected into the hepatic veins that then
terminate in the inferior vena
cava. Of particular importance are the gastric artery and
the superior and inferior mesenteric arteries. Oxygen
and nutrients are supplied to the stomach by the gastric
artery and to the intestine by the mesenteric
arteries (see Fig. 43-2). Venous blood is returned from
the small intestine, cecum, and the ascending and
transverse portions of the colon by the superior
mesenteric vein, which corresponds with the distribution
of the branches of the superior mesenteric artery. Blood
flow to the GI tract is about 20% of the total cardiac
output and increases significantly after eating. Both the
sympathetic and parasympathetic portions of the
autonomic nervous system innervate the GI tract. In
general, sympathetic nerves exert an inhibitory effect on
the GI tract, decreasing gastric secretion and motility
and causing the sphincters and blood vessels to
constrict. Parasympathetic nerve stimulation causes
peristalsis and increases secretory activities. The
sphincters relax under the influence of parasympathetic
stimulation, except for the sphincter of the upper
esophagus and the external anal sphincter, which are
under voluntary
control (Grossman & Porth, 2014).

Function of the Digestive System

Major functions of the GI tract include:



 Breakdown of food particles into the molecular form for
digestion
 Absorption into the bloodstream of small nutrient
molecules produced by digestion
 Elimination of undigested unabsorbed foodstuffs and
other waste
products.

Chewing and Swallowing




  The process of digestion begins with the act of chewing,
in which food is broken down into small particles that can
be swallowed and mixed with digestive enzymes.
 Eating—or even the sight, smell, or taste of food—can
cause reflex salivation. Approximately 1.5 L of saliva is
secreted daily
from the parotid, the submaxillary, and the sublingual
glands.
 Ptyalin, or salivary amylase, is an enzyme that begins
the digestion of starches.
 Swallowing begins as a voluntary act that is regulated
by the swallowing center in the medulla oblongata of the
central nervous system (CNS).
 As a bolus of food is swallowed, the epiglottis moves to
cover the tracheal opening and prevent aspiration of food
into the lungs.
 Subsequently, the lower esophageal sphincter closes
tightly to prevent reflux of stomach
contents into the esophagus.

Gastric Function



 The stomach, which stores and mixes food with
secretions, secretes ahighly acidic fluid in response to the
presence or anticipated ingestion of food.
 This fluid, which can total 2.4 L/day, can have a pH as
low as 1 and derives its acidity from hydrochloric acid
(HCl) secreted by the glands of the stomach.
 The function of this gastric secretion is twofold:



 To break down food into more absorbable
components and
 To aid in the destruction of most ingested bacteria.

 Pepsin, an important enzyme for protein digestion, is the

end product of the conversion of pepsinogen from the
chief cells.
  Intrinsic factor, also secreted by the gastric mucosa,
combines with dietary vitamin B12 so that the vitamin can
be
absorbed in the ileum.

Small Intestine Function

The primary function of the small intestine is to break

down and absorb ingested nutrients while mixing and
moving the intestinal contents (consisting of gastric
juices and partly digested food) along the digestive tract
into the colon.

Colonic Function

One of the main functions of the colon is to remove

the water and other key nutrients from waste material
and recycle it. As the waste material exits the small
intestine through the ileocecal valve, it will move into
the cecum and then to the ascending colon where this
process of extraction starts.

Waste Products of Digestion

Feces consist of undigested foodstuffs, inorganic

materials, water, and bacteria. Fecal matter is about
75% fluid and 25% solid material (Grossman & Porth,
2014). The composition is relatively unaffected
by alterations in diet because a large portion of the fecal
mass is of nondietary origin, derived from the secretions
of the GI tract. The brown color of the feces results from
the breakdown of bile by the intestinal
bacteria. Chemicals formed by intestinal bacteria are
responsible in large part for the fecal odor. Gases
formed contain methane, hydrogen sulfide,
and ammonia, among others. The GI tract normally
contains approximately
150 mL of these gases, which are either absorbed into
the portal
circulation and detoxified by the liver or expelled from
the rectum as flatus.
Elimination of stool begins with distention of the rectum,
which initiates reflex contractions of the rectal
musculature and relaxes the normally closed internal
anal sphincter. The internal sphincter is controlled by the
autonomic nervous system; the external sphincter is
under the conscious control of the cerebral cortex.
During defecation, the external anal sphincter voluntarily
relaxes to allow colonic contents to be expelled.
Normally, the external anal sphincter is maintained in a
state of tonic contraction. Thus, defecation is seen to be
a spinal reflex (involving the parasympathetic nerve
fibers) that can be inhibited voluntarily by keeping the
external anal sphincter closed. Contracting the
abdominal muscles (straining) facilitates emptying of the
colon. The average frequency of defecation in humans
is once daily, but this varies among people.

Gerontologic Considerations
Although an increased prevalence of several common GI disorders
occurs in the older adult population, aging per se appears to have
minimal direct effect on most GI functions, in large part because of
the functional reserve of the GI tract. Normal physiologic changes
of the GI system that occur with aging are identified in Table 43-3.