THE DIGESTIVE SYSTEM

Food provides the raw materials or

nutrients that cells use to reproduce and to
build new tissue. The energy needed for cell
reproduction and tissue building is released
from food in the process of cell respiration.
In fact, a supply of nutrients from regular
food intake is so important that the body
can even store any excess for use later.
Those “extra 5 pounds” are often stored fat
in adipose tissue.

The food we eat, however, is not in a form

that our body cells can use. A turkey
sandwich, for example, consists of complex
proteins, fats, and carbohydrates. The
function of the digestive system is to change
these complex organic nutrient molecules
into simple organic and inorganic molecules
that can then be absorbed into the blood or
lymph to be transported to cells.

DIVISIONS OF THE DIGESTIVE SYSTEM:-

The two divisions of the digestive system

are the alimentary tube and the accessory
organs. The alimentary tube extends from
the mouth to the anus. It consists of the oral cavity, pharynx, esophagus, stomach, small intestine, and large intestine.
Digestion takes place within the oral cavity, stomach, and small intestine; most absorption of nutrients takes place in the
small intestine. Undigestible material, primarily cellulose, is eliminated by the large intestine (also called the colon).

The accessory organs of digestion are the teeth, tongue, salivary glands, liver, gallbladder, and pancreas. Digestion does
not take place within these organs, but each contributes something to the digestive process.

TYPES OF DIGESTION:-

The food we eat is broken down in two complementary processes: mechanical digestion and chemical digestion.
Mechanical digestion is the physical breaking up of food into smaller pieces. Chewing is an example of this. As food is
broken up, more of its surface area is exposed for the action of digestive enzymes.

The work of the digestive enzymes is the chemical digestion of broken-up food particles, in which complex chemical
molecules are changed into much simpler chemicals that the body can utilize. Such enzymes are specific with respect to
the fat, protein, or carbohydrate food molecules each can digest. For example, protein-digesting enzymes work only on
proteins, not on carbohydrates or fats. Each enzyme is produced by a particular digestive organ and functions at a specific
site. However, the enzyme’s site of action may or may not be its site of production.

END PRODUCTS OF DIGESTION: -

The three types of complex organic molecules found in food are carbohydrates, proteins, and fats. Each of these complex
molecules is digested to a much more simple substance that the body can then use. Carbohydrates, such as starches and
disaccharides, are digested to monosaccharides such as glucose, fructose, and galactose. Proteins are digested to amino
acids, and fats are digested to fatty acids and glycerol. Also part of food, and released during digestion, are vitamins,
minerals, and water.

ORAL CAVITY: Food enters the oral cavity (or buccal cavity) by way of the mouth. Within the oral cavity are the teeth and
tongue and the openings of the ducts of the salivary glands.
TEETH: The function of the teeth is, of course, chewing. This is the process that
mechanically breaks food into smaller pieces and mixes it with saliva. The crown
is visible above the gum (gingiva). The root is enclosed in a socket in the mandible
or maxillae. The periodontal membrane lines the socket and produces a bone-like
cement that anchors the tooth. The outermost layer of the crown is enamel,
which is made by cells called ameloblasts. Enamel provides a hard chewing
surface and is more resistant to decay than are other parts of the tooth. Within
the enamel is dentin, which is very similar to bone and is produced by cells called
odontoblasts. Dentin also forms the roots of a tooth. The innermost portion of a
tooth is the pulp cavity, which contains blood vessels and nerve endings of the
trigeminal nerve (5th cranial). Erosion of the enamel and dentin layers by bacterial
acids (dental caries or cavities) may result in bacterial invasion of the pulp cavity
and a very painful toothache.

TONGUE: The tongue is made of skeletal muscle that is innervated by the

hypoglossal nerves (12th cranial). On the upper surface of the tongue are small projections called papillae, many of which
contain taste buds. The sensory nerves for taste are also cranial nerves: the facial (7th) and glossopharyngeal (9th).
Chewing is efficient because of the action of the tongue in keeping the food between the teeth and mixing it with saliva.
Elevation of the tongue is the first step in swallowing. This is a voluntary action, in which the tongue contracts and meets
the resistance of the hard palate. The mass of food, called a bolus, is thus pushed backward toward the pharynx. The
remainder of swallowing is a reflex action.

SALIVARY GLANDS: The digestive secretion in the oral cavity is

saliva, produced by three pairs of salivary glands. The parotid
glands are just below and in front of the ears. The submandibular
(also called submaxillary) glands are at the posterior corners of the
mandible, and the sublingual glands are below the floor of the
mouth. Each gland has at least one duct that takes saliva to the oral
cavity.

Secretion of saliva is continuous, but the amount varies in different

situations. The presence of food (or anything else) in the mouth
increases saliva secretion. This is a parasympathetic response
mediated by the facial and glossopharyngeal nerves. The sight or
smell of food also increases secretion of saliva. Sympathetic
stimulation in stress situations decreases secretion, making the
mouth dry and swallowing difficult.

Saliva is mostly water, which is important to dissolve food for

tasting and to moisten food for swallowing. The digestive enzyme
in saliva is salivary amylase, which breaks down starch molecules to shorter chains of glucose molecules, or to maltose, a
disaccharide. Most of us, however, do not chew our food long enough for the action of salivary amylase to be truly
effective. As you will see, another amylase from the pancreas is also available to digest starch.

Saliva is made from blood plasma and thus contains many of the chemicals that are found in plasma.

PHARYNX: The oropharynx and laryngopharynx are food passageways connecting the oral cavity to the esophagus. No
digestion takes place in the pharynx. Its only related function is swallowing, the mechanical movement of food. When the
bolus of food is pushed backward by the tongue, the constrictor muscles of the pharynx contract as part of the swallowing
reflex. The reflex center for swallowing is in the medulla, which coordinates the many actions that take place: constriction
of the pharynx, cessation of breathing, elevation of the soft palate to block the nasopharynx, elevation of the larynx and
closure of the epiglottis, and peristalsis of the esophagus.

Talking or laughing while eating, however, may interfere with the reflex and cause food to go into the “wrong pipe,” the
larynx. When that happens, the cough reflex is usually effective in clearing the airway.
ESOPHAGUS: The esophagus is a muscular tube that takes food from the pharynx to the stomach; no digestion takes place
here. Peristalsis of the esophagus propels food in one direction and ensures that food gets to the stomach even if the
body is horizontal or upside down.

At the junction with the stomach, the lumen (cavity) of the esophagus is surrounded by the lower esophageal sphincter
(LES or cardiac sphincter), a circular smooth muscle. The LES relaxes to permit food to enter the stomach, then contracts
to prevent the backup of stomach contents. If the LES does not close completely, gastric juice may splash up into the
esophagus; this is a painful condition we call heartburn, or gastroesophageal reflux disease (GERD). The lining of the
esophagus cannot withstand the corrosive action of gastric acid and will be damaged, perhaps resulting in bleeding or
even perforation. Medications are available to treat this condition.

STRUCTURAL LAYERS OF THE ALIMENTARY TUBE:-

When viewed in cross-section, the alimentary tube has four layers:

the mucosa, submucosa, external muscle layer, and serosa. Each
layer has a specific structure, and its functions contribute to the
functioning of the organs of which it is a part.

MUCOSA: The mucosa, or lining, of the alimentary tube is made of

epithelial tissue, areolar connective tissue, and two thin layers of
smooth muscle. In the esophagus the epithelium is stratified
squamous epithelium; in the stomach and intestines it is simple
columnar epithelium. The epithelium secretes mucus, which
lubricates the passage of food, and also secretes the digestive
enzymes of the stomach and small intestine. Just below the
epithelium, within the areolar connective tissue, are lymph nodules
that contain lymphocytes to produce antibodies, and macrophages
to phagocytize bacteria or other foreign material that get through
the epithelium. The thin layers of smooth muscle create folds in the
mucosa, and ripples, so that all of the epithelial cells are in touch
with the contents of the organ. In the stomach and small intestine
this is important for absorption.

SUBMUCOSA: The submucosa is made of areolar connective tissue with many blood vessels and lymphatic vessels. Many
millions of nerve fibers are also present, part of what is called the enteric nervous system, or the “brain of the gut,” which
extends the entire length of the alimentary tube. The nerve networks in the submucosa are called Meissner’s plexus (or
submucosal plexus), and they innervate the mucosa to regulate secretions.

Parasympathetic impulses increase secretions, whereas sympathetic impulses decrease secretions. Sensory neurons are
also present to the smooth muscle (a stretched or cramping gut is painful), as are motor neurons to blood vessels, to
regulate vessel diameter and blood flow.

EXTERNAL MUSCLE LAYER: The external muscle layer typically contains two layers of smooth muscle: an inner, circular
layer and an outer, longitudinal layer. The stomach has three layers of smooth muscle, rather than two.

Contractions of this muscle layer help break up food and mix it with digestive juices. The one-way contractions of
peristalsis move the food toward the anus. Sympathetic impulses decrease contractions and peristalsis, whereas
parasympathetic impulses increase contractions and peristalsis, promoting normal digestion. The parasympathetic nerves
are the vagus (10th cranial) nerves;

SEROSA: Above the diaphragm, for the esophagus, the serosa, the outermost layer, is fibrous connective tissue. Below
the diaphragm, the serosa is the mesentery or visceral peritoneum, a serous membrane. Lining the abdominal cavity is
the parietal peritoneum, usually simply called the peritoneum. The peritoneum-mesentery is actually one continuous
membrane. The serous fluid between the peritoneum and mesentery prevents friction when the alimentary tube
contracts and the organs slide against one another.
STOMACH: The stomach is located in the
upper left quadrant of the abdominal
cavity, to the left of the liver and in front of
the spleen. Although part of the alimentary
tube, the stomach is not a tube, but rather
a sac that extends from the esophagus to
the small intestine.

Because it is a sac, the stomach is a

reservoir for food, so that digestion
proceeds gradually and we do not have to
eat constantly. Both mechanical and
chemical digestion take place in the
stomach.

The cardiac orifice is the opening of the

esophagus, and the fundus is the portion
above the level of this opening. The body
of the stomach is the large central portion,
bounded laterally by the greater curvature and medially by the lesser curvature. The pylorus is adjacent to the duodenum
of the small intestine, and the pyloric sphincter surrounds the junction of the two organs. The fundus and body are mainly
storage areas, whereas most digestion takes place in the pylorus.

When the stomach is empty, the mucosa appears wrinkled or folded. These folds are called rugae; they flatten out as the
stomach is filled and permit expansion of the lining without tearing it. The gastric pits are the glands of the stomach and
consist of several types of cells; their collective secretions are called gastric juice.

Mucous cells secrete mucus, which coats the stomach lining and helps prevent erosion by the gastric juice. Chief cells
secrete pepsinogen, an inactive form of the enzyme pepsin. Parietal cells produce hydrochloric acid (HCl); these cells have
enzymes called proton pumps, which secrete H+ ions into the stomach cavity. The H+ ions unite with Cl– ions that have
diffused from the parietal cells to form HCl in the lumen of the stomach.

HCl converts pepsinogen to pepsin, which then begins the digestion of proteins to polypeptides, and also gives gastric
juice its pH of 1 to 2. This very acidic pH is necessary for pepsin to function and also kills most microorganisms that enter
the stomach. The parietal cells also secrete intrinsic factor, which is necessary for the absorption of vitamin B12.
Enteroendocrine cells called G cells secrete the hormone gastrin.

Gastric juice is secreted in small amounts at the sight or smell of food. This is a parasympathetic response that ensures
that some gastric juice will be present in the stomach when food arrives. The presence of food in the stomach causes the
G cells to secrete gastrin, a hormone that stimulates the secretion of greater amounts of gastric juice.

The external muscle layer of the stomach consists of three layers of smooth muscle: circular, longitudinal, and oblique
layers. These three layers are innervated by the myenteric plexuses of the enteric nervous system. Stimulatory impulses
are carried from the CNS by the vagus nerves (10th cranial) and provide for very efficient mechanical digestion to change
food into a thick liquid called chyme. The pyloric sphincter is usually contracted when the stomach is churning food; it
relaxes at intervals to permit small amounts of chyme to pass into the duodenum. This sphincter then contracts again to
prevent the backup of intestinal contents into the stomach.

SMALL INTESTINE: The small intestine is about 1 inch (2.5 cm) in diameter and approximately 20 feet (6 m) long and
extends from the stomach to the cecum of the large intestine. The duodenum is the first 10 inches (25 cm) of the small
intestine. The common bile duct enters the duodenum at the ampulla of Vater (or hepatopancreatic ampulla). The
jejunum is about 8 feet long, and the ileum is about 11 feet in length.

Digestion is completed in the small intestine, and the end products of digestion are absorbed into the blood and lymph.
The mucosa has simple columnar epithelium that includes cells with microvilli and goblet cells that secrete mucus.

Enteroendocrine cells secrete the hormones of the small intestine. Lymph nodules called Peyer’s patches are especially
abundant in the ileum to destroy absorbed pathogens.
The external muscle layer has the typical circular and longitudinal smooth muscle layers that mix the chyme with digestive
secretions and propel the chyme toward the colon. Stimulatory impulses to the enteric nerves of these muscle layers are
carried by the vagus nerves. The waves of peristalsis, however, can take place without stimulation by the central nervous
system; the enteric nervous system can function independently and promote normal peristalsis.

There are three sources of digestive secretions that function within the small intestine: the liver, the pancreas, and the
small intestine itself.

LIVER: The liver consists of two large lobes, right

and left, and fills the upper right and center of the
abdominal cavity.

The structural unit of the liver is the liver lobule, a

roughly hexagonal column of liver cells
(hepatocytes). Between adjacent lobules are
branches of the hepatic artery and portal vein. The
capillaries of a lobule are sinusoids, large and very
permeable vessels between the rows of liver cells.
The sinusoids receive blood from both the hepatic
artery and portal vein, and it is with this mixture of
blood that the liver cells carry out their functions.

The hepatic artery brings oxygenated blood, and

the portal vein brings blood from the digestive
organs and spleen. Each lobule has a central vein.
The central veins of all the lobules unite to form the
hepatic veins, which take blood out of the liver to
the inferior vena cava.

The cells of the liver have many functions (which

are discussed in a later section), but their only
digestive function is the production of bile.

Bile enters the small bile ducts, called bile

canaliculi, on the liver cells, which unite to form
larger ducts and finally merge to form the hepatic
duct, which takes bile out of the liver. The hepatic
duct unites with the cystic duct of the gallbladder
to form the common bile duct, which takes bile to
the duodenum.

Bile is mostly water and has an excretory function

in that it carries bilirubin and excess cholesterol to the intestines for elimination in feces. The digestive function of bile is
accomplished by bile salts, which emulsify fats in the small intestine. Emulsification means that large fat globules are
broken into smaller globules. This is mechanical, not chemical, digestion; the fat is still fat but now has more surface area
to facilitate chemical digestion.

Production of bile is stimulated by the hormone secretin, which is produced by the duodenum when food enters the small
intestine.

GALLBLADDER: The gallbladder is a sac about 3 to 4 inches (7.5 to 10 cm) long located on the under surface of the right
lobe of the liver. Bile in the hepatic duct of the liver flows through the cystic duct into the gallbladder which stores bile
until it is needed in the small intestine. The gallbladder also concentrates bile by absorbing water.

When fatty foods enter the duodenum, the enteroendocrine cells of the duodenal mucosa secrete the hormone
cholecystokinin. This hormone stimulates contraction of the smooth muscle in the wall of the gallbladder, which forces
bile into the cystic duct, then into the common bile duct, and on into the duodenum.
PANCREAS: The pancreas is located in
the upper left abdominal quadrant
between the curve of the duodenum and
the spleen and is about 6 inches (15 cm)
in length. The exocrine glands of the
pancreas are called acini (singular:
acinus). They produce enzymes that are
involved in the digestion of all three
types of complex food molecules.

The pancreatic enzyme amylase digests

starch to maltose. You may recall that
this is the “backup” enzyme for salivary
amylase, though pancreatic amylase is
responsible for most digestion of starch.
Lipase converts emulsified fats to fatty
acids and glycerol. The emulsifying or fat-
separating action of bile salts increases
the surface area of fats so that lipase
works effectively. Trypsinogen is an inactive enzyme that is changed to active trypsin in the duodenum. Trypsin digests
polypeptides to shorter chains of amino acids.

The pancreatic enzyme juice is carried by small ducts that unite to form larger ducts, then finally the main pancreatic duct.
An accessory duct may also be present. The main pancreatic duct emerges from the medial side of the pancreas and joins
the common bile duct to the duodenum.

The pancreas also produces a bicarbonate juice (containing sodium bicarbonate), which is alkaline. Because the gastric
juice that enters the duodenum is very acidic, it must be neutralized to prevent damage to the duodenal mucosa. This
neutralizing is accomplished by the sodium bicarbonate in pancreatic juice, and the pH of the duodenal chyme is raised
to about 7.5.

Secretion of pancreatic juice is stimulated by the hormones secretin and cholecystokinin, which are produced by the
duodenal mucosa when chyme enters the small intestine. Secretin stimulates the production of bicarbonate juice by the
pancreas, and chole-cystokinin stimulates the secretion of the pancreatic enzymes.

COMPLETION OF DIGESTION AND ABSORPTION : -

SMALL INTESTINE: The secretion of the epithelium of the intestinal glands (or crypts of Lieberkühn) is stimulated by the
presence of food in the duodenum. The intestinal enzymes are the peptidases and sucrase, maltase, and lactase.
Peptidases complete the digestion of protein by breaking down short polypeptide chains to amino acids. Sucrase, maltase,
and lactase, respectively, digest the disaccharides sucrose, maltose, and lactose to monosaccharides.

The enteroendocrine cells of the intestinal glands secrete the hormones of the small intestine. Secretion is stimulated by
food entering the duodenum.

ABSORPTION: Most absorption of the end products of digestion takes place in the small intestine (although the stomach
does absorb water and alcohol). The process of absorption requires a large surface area, which is provided by several
structural modifications of the small intestine;

Plica circulares, or circular folds, are macroscopic folds of the mucosa and submucosa, somewhat like accordion pleats.
The mucosa is further folded into projections called villi, which give the inner surface of the intestine a velvet like
appearance. Each columnar cell (except the mucus-secreting goblet cells) of the villi also has microvilli on its free surface.
Microvilli are microscopic folds of the cell membrane, and are collectively called the brush border. All of these folds greatly
increase the surface area of the intestinal lining.

The absorption of nutrients takes place from the lumen of the intestine into the vessels within the villi. Within each villus
is a capillary network and a lacteal, which is a dead-end
lymph capillary. Water-soluble nutrients are absorbed
into the blood in the capillary networks.
Monosaccharides, amino acids, positive ions, and the
water-soluble vitamins (vitamin C and the B vitamins)
are absorbed by active transport. Negative ions may be
absorbed by either passive or active transport
mechanisms. Water is absorbed by osmosis following
the absorption of minerals, especially sodium.

Fat-soluble nutrients are absorbed into the lymph in

the lacteals of the villi. Bile salts are necessary for the
efficient absorption of fatty acids and the fat-soluble
vitamins (A, D, E, and K). Once absorbed, fatty acids are
recombined with glycerol to form triglycerides. These
triglycerides then form globules that include
cholesterol and protein; these lipid–protein complexes
are called chylomicrons. In the form of chylomicrons,
most absorbed fat is transported by the lymph and
eventually enters the blood in the left subclavian vein.

Blood from the capillary networks in the villi does not

return directly to the heart but first travels through the
portal vein to the liver. This pathway enables the liver
to regulate the blood levels of glucose and amino acids,
store certain vitamins, and remove potential poisons
from the blood.

LARGE INTESTINE: The large intestine, also called the colon, is approximately 2.5 inches (6.3 cm) in diameter and 5 feet
(1.5 m) in length. It extends from the ileum of the small intestine to the anus, the terminal opening.

The cecum is the first portion, and at its junction with the
ileum is the ileocecal valve, which is not a sphincter but serves
the same purpose. After undigested food (which is now
mostly cellulose) and water pass from the ileum into the
cecum, closure of the ileocecal valve prevents the backflow of
fecal material.

Attached to the cecum is the appendix, a small, dead-end

tube with abundant lymphatic tissue. The appendix seems to
be a vestigial organ, that is, one whose size and function seem
to be reduced. Although there is abundant lymphatic tissue in
the wall of the appendix.

Appendicitis refers to inflammation of the appendix, which

may occur if fecal material becomes impacted within it. This
usually necessitates an appendectomy, the surgical removal
of the appendix.

The remainder of the colon consists of the ascending,

transverse, and descending colon, which encircle the small
intestine; the sigmoid colon, which turns medially and
downward; the rectum; and the anal canal. The rectum is
about 6 inches long, and the anal canal is the last inch of the
colon that surrounds the anus. Clinically, however, the
terminal end of the colon is usually referred to as the rectum.
No digestion takes place in the colon. The only secretion of the colonic mucosa is mucus, which lubricates the passage of
fecal material. The longitudinal smooth muscle layer of the colon is in three bands called taeniae coli. The rest of the colon
is “gathered” to fit these bands. This gives the colon a puckered appearance; the puckers or pockets are called haustra,
which provide for more surface area within the colon.

The functions of the colon are the absorption of water, minerals, and vitamins and the elimination of undigestible
material.

About 80% of the water that enters the colon is absorbed (400 to 800 mL per day). Positive and negative ions are also
absorbed. The vitamins absorbed are those produced by the normal flora, the trillions of bacteria that live in the colon.
Everything absorbed by the colon circulates first to the liver by way of portal circulation. Yet another function of the
normal colon flora is to inhibit the growth of pathogens.

ELIMINATION OF FECES: Feces consist of cellulose and other undigestible material, dead and living bacteria, and water.
Elimination of feces is accomplished by the defecation reflex, a spinal cord reflex that may be controlled voluntarily.

The rectum is usually empty until peristalsis of the colon pushes feces into it. These waves of peristalsis tend to occur
after eating, especially when food enters the duodenum. The wall of the rectum is stretched by the entry of feces, and
this is the stimulus for the defecation reflex.

Stretch receptors in the smooth muscle layer of the rectum generate sensory impulses that travel to the sacral spinal cord.
The returning motor impulses cause the smooth muscle of the rectum to contract. Surrounding the anus is the internal
anal sphincter, which is made of smooth muscle. As part of the reflex, this sphincter relaxes, permitting defecation to take
place.

The external anal sphincter is made of skeletal muscle and surrounds the internal anal sphincter. If defecation must be
delayed, the external sphincter may be voluntarily contracted to close the anus. The awareness of the need to defecate
passes as the stretch receptors of the rectum adapt. These receptors will be stimulated again when the next wave of
peristalsis reaches the rectum.

OTHER FUNCTIONS OF THE LIVER: The liver is a remarkable organ, and only the brain is capable of a greater variety of
functions. The liver cells (hepatocytes) produce many enzymes that catalyse many different chemical reactions. These
reactions are the functions of the liver.

As blood flows through the sinusoids (capillaries) of the liver, materials are removed by the liver cells, and the products
of the liver cells are secreted into the blood. Because the liver has such varied effects on so many body systems, we will
use the categories below to summarize the liver functions.

1. Carbohydrate Metabolism: The liver regulates the blood glucose level. Excess glucose is converted to glycogen
(glycogenesis) when blood glucose is high; the hormones insulin and cortisol facilitate this process. During
hypoglycaemia or stress situations, glycogen is converted back to glucose (glycogenolysis) to raise the blood
glucose level. Epinephrine and glucagon are the hormones that facilitate this process. The liver also changes other
monosaccharides to glucose. Fructose and galactose, for example, are end products of the digestion of sucrose
and lactose. Because most cells, however, cannot readily use fructose and galactose as energy sources, they are
converted by the liver to glucose, which is easily used by cells.

2. Amino Acid Metabolism: The liver regulates blood levels of amino acids based on tissue needs for protein
synthesis. Of the 20 different amino acids needed for the production of human proteins, the liver is able to
synthesize 12, called the nonessential amino acids. The chemical process by which this is done is called
transamination, the transfer of an amino group (NH2) from an amino acid present in excess to a free carbon chain
that forms a complete, new amino acid molecule. The other 8 amino acids, which the liver cannot synthesize, are
called the essential amino acids. All 20 amino acids are required in order to make our body proteins.

Excess amino acids, those not needed right away for protein synthesis, cannot be stored. However, they do serve
another useful purpose. By the process of deamination, which also occurs in the liver, the NH2 group is removed
from an amino acid, and the remaining carbon chain may be converted to a simple carbohydrate molecule or to
fat. Thus, excess amino acids are utilized for energy production: either for immediate energy or for the potential
energy stored as fat in adipose tissue. The NH2 groups that were detached from the original amino acids are
 combined to form urea, a waste product that will be removed from the blood by the kidneys and excreted in
urine.

3. Lipid Metabolism: The liver forms lipoproteins, which as their name tells us, are molecules of lipids and proteins,
for the transport of fats in the blood to other tissues. The liver also synthesizes cholesterol and excretes excess
cholesterol into bile to be eliminated in feces.

Fatty acids are a potential source of energy, but in order to be used in cell respiration they must be broken down
to smaller molecules. In the process of beta-oxidation, the long carbon chains of fatty acids are split into two-
carbon molecules called acetyl groups, which are simple carbohydrates. These acetyl groups may be used by the
liver cells to produce ATP or may be combined to form ketones to be transported in the blood to other cells. These
other cells then use the ketones to produce ATP in cell respiration.

4. Synthesis of plasma proteins: The liver synthesizes many of the proteins that circulate in the blood. Albumin, the
most abundant plasma protein, helps maintain blood volume by pulling tissue fluid into capillaries. The clotting
factors are also produced by the liver. These, as you recall, include prothrombin, fibrinogen, and Factor 8, which
circulate in the blood until needed in the chemical clotting mechanism. The liver also synthesizes alpha and beta
globulins, which are proteins that serve as carriers for other molecules, such as fats, in the blood.

5. Formation of bilirubin: The liver contains fixed macrophages that phagocytize old red blood cells (RBCs). Bilirubin
is then formed from the heme portion of the haemoglobin. The liver also removes from the blood the bilirubin
formed in the spleen and red bone marrow and excretes it into bile to be eliminated in feces.

6. Phagocytosis by Kupffer cells: The fixed macrophages of the liver are called Kupffer cells (or stellate
reticuloendothelial cells). Besides destroying old RBCs, Kupffer cells phagocytize pathogens or other foreign
material that circulate through the liver. Many of the bacteria that get to the liver come from the colon. These
bacteria are part of the normal flora of the colon but would be very harmful elsewhere in the body. The bacteria
that enter the blood with the water absorbed by the colon are carried to the liver by way of portal circulation.
The Kupffer cells in the liver phagocytize and destroy these bacteria, removing them from the blood before the
blood returns to the heart.

7. Storage: The liver stores the fat-soluble vitamins A, D, E, and K, and the water-soluble vitamin B12. Up to a 6- to
12-month supply of vitamins A and D may be stored, and beef or chicken liver is an excellent dietary source of
these vitamins. Also stored by the liver are the minerals iron and copper. You already know that iron is needed
for haemoglobin and myoglobin and enables these proteins to bond to oxygen. Copper (as well as iron) is part of
some of the proteins needed for cell respiration, and is part of some of the enzymes necessary for haemoglobin
synthesis.

8. Detoxification: The liver is capable of synthesizing enzymes that will detoxify harmful substances, that is, change
them to less harmful ones. Alcohol, for example, is changed to acetate, which is a two carbon molecule (an acetyl
group) that can be used in cell respiration. Medications are all potentially toxic, but the liver produces enzymes
that break them down or change them. When given in a proper dosage, a medication exerts its therapeutic effect
but is then changed to less active substances that are usually excreted by the kidneys. An overdose of a drug
means that there is too much of it for the liver to detoxify in a given time, and the drug will remain in the body
with possibly harmful effects. This is why alcohol should never be consumed when taking medication. Such a
combination may cause the liver’s detoxification ability to be overworked and ineffective, with the result that
both the alcohol and the medication will remain toxic for a longer time.

Ammonia is a toxic substance produced by the bacteria in the colon. Because it is soluble in water, some ammonia
is absorbed into the blood, but it is carried first to the liver by portal circulation. The liver converts ammonia to
urea, a less toxic substance, before the ammonia can circulate and damage other organs, especially the brain. The
urea formed is excreted by the kidneys.
 THE PROCESS OF DIGESTION
ORGAN ENZYME/ OTHER SECRETION FUNCTION SITE OF ACTION
Salivary glands Amylase Converts starch to maltose Oral cavity
Stomach Pepsin Converts proteins to polypeptides Stomach
Changes pepsinogen to pepsin; maintains pH
Stomach HCI 1–2; destroys pathogens Stomach
Liver Bile salts Emulsify fats Small intestine
Pancreas Amylase Converts starch to maltose Small intestine
Pancreas Trypsin Converts polypeptides to peptides Small intestine
Pancreas Lipase Converts emulsified fats to fatty acids and glycerol Small intestine
Small intestine Peptidases Convert peptides to amino acids Small intestine
Small intestine Sucrase Converts sucrose to glucose and fructose Small intestine
Small intestine Maltase Converts maltose to glucose Small intestine
Small intestine Lactase Converts lactose to glucose and galactose Small intestine

REGULATION OF DIGESTIVE SECRETIONS

SECRETION NERVOUS REGULATION CHEMICAL REGULATION
Presence of food in mouth or sight of food;
parasympathetic impulses along 7th and
Saliva 9th cranial nerves None
Gastrin—produced by the G cells of
Sight or smell of food; parasympathetic the gastric mucosa when food is
Gastric juice impulses along 10th cranial nerves present in the stomach
Bile Secretin—produced by the enteroendocrine
Secretion by cells of the duodenum
the liver None when chyme enters
Cholecystokinin—produced by the
Bile Contraction of enteroendocrine cells of the duodenum
the gallbladder None when chyme enters
Enzyme pancreatic juice None Cholecystokinin—from the duodenum

Bicarbonate pancreatic juice None Secretin—from the duodenum

Presence of chyme in the duodenum;
parasympathetic impulses along 10th cranial
Intestinal juice nerves None