Physiology of

Digestion

Department of Physiology
School of Medicine
University of North Sumatra
Food
Nutrient
Non Nutrient
Assimilated
Eliminated
Digestive
system
Motility;
Movement of food through tract ,includes ingestion,
mastication (chewing food and mixing with saliva),
deglutition (swallowing) and peristalsis (rhythmic
contractions along GI tract that propel food)
muscular contraction.
Secretion;
Endocrine (secretion of hormones that regulate digestive
process)
Exocrine (secretion of water, enzymes, acid, bicarbonate,
into GI tract enzyme & other digestive juices.
Primary Functions of Digestive System
Activity necessary:
Digestion;
Hydrolysis reactions that break ingested polymers
(large molecules) into their smaller subunits
(monomers) breakdown of substances.
proteins into amino acids
fats into glycerol and free fatty acids
complex sugars into monosaccharides
Absorption;
Transfer of monomer subunits across wall of small
intestine into blood or lymph
transport modified nutrients.
Regulation;
There are two nerve nets (plexuses) in GI tract
that contain neurons and interneurons
sub mucosal (Meissner)
Myenteric (Auerbach)
Plexuses = brain of the gut
stimulated by stretch (bolus of food), chemicals,
and stomach content (local stimuli)
Activity of plexuses can be modified by central
nervous system and the autonomic nervous
system
Neural:
Neural regulation via autonomic nervous system
GI tract receives both sympathetic and
parasympathetic innervations
Parasympathetic via vagus nerve and spinal nerves
in sacral region (to lower portion of large intestine)
stimulates motility and secretion; favors digestion
Sympathetic
reduces motility and secretory activity and
stimulates sphincter contraction
Paracrine regulation
production of hormone-like molecules that are
produced in one cell and travel through
interstitial fluid (not bloodstream) to affect
activity of nearby cells
Hormone regulation
production of hormones that are released into
the bloodstream and carried to target tissues
within digestive system where they affect
digestive activity
Hormonal.
Salivary glands
(parotid, submaxillary, sublingual)
secrete saliva
lubricates and softens food; aids in
swallowing
contains amylase = enzyme that begins
breakdown of carbohydrates
Oropharynx
To convey food into the esophagus.
Important role in swallowing.
Cavity at back of mouth opening to
both esophagus (digestive tract)
and trachea (windpipe)

Voluntary raising of larynx to close
(epi)glottis and prevent food entry
into windpipe
Pharynx = throat
Esophagus.
Hollow muscular tube connecting pharynx and
stomach.
Bounded by sphincters.
Lined w/ stratified squamous epithelium.
Lower esophageal (gastroesophageal) sphincter ;
transtition from low pressure ( intrathoracic )
high pressure (intra-abdominal).
Dissorder o/t LES tone major cause esophageal
reflux heart burn.
stomach
Stomach:
Temporary stores ingested food. sphincters
prevent backward flow of materials into
esophagus and regulate release of stomach
contents into small intestine
Churn, mixes food with gastric juice.
Mechanical and chemical breakdown of ingested
material
Produces, mucus, HCl and pepsinogen.
HCl converts pepsinogen into pepsin.
Sterilization of stomach contents by acid
Pepsin digests proteins into peptide fragments.
Absorbs some water, alkohol, glucose.
Binds vit. B
12
allows abs. in ileum
Secretion/Digestion
Pepsinogen
HCl
Gastrin
Histamine
Stomach:
lower region of stomach
(antrum) secretes the
hormone gastrin.
Additional secretions:
histamine (ECL cell)
Somatostatin


Mucous cell, secrete mucous protects
mucosa from acid & pepsin.
Chief cells, secrete :
- Gastric lipase.
- Pepsinogen Pepsin
HCl
Prietal (oxyntic) cells, secrete :
- HCl .
- Intrinsic factor binds vit. B
12
Prietal (oxyntic) cells, secrete :
- HCl .
- Intrinsic factor binds vit. B
12
Pyloric gland Alkaline mucus.
Digestion in the stomach
CHO digestion is halted because acidic pH of the
stomach inactivates salivary amylase
Little fat digestion occurs in the stomach
Protein digestion begins in the stomach
Involves mechanical breakdown of proteins by the
churning actions of the stomach
Involves the chemical digestion of proteins by acid and
hormones
Gastric (stomach) acid = hydrochloric acid (HCl)
pepsin
Protein Digestion in the Stomach
Parietal cells
secrete acid (hydrochloric acid = HCL)
stimulated to produce acid by gastrin
Chief cells
secrete pepsinogen
Pepsinogen = inactive hormone
Pepsinogen converted to pepsin (active hormone) by
acidic pH of the stomach
Pepsin breaks large proteins down into smaller peptides
G cells
Secrete gastrin
Gastrin = hormone
target tissues = chief cells and parietal cells in stomach
stimulates gastric juice production
HCL from parietal cells
Pepsinogen from chief cells
Increases pH of stomach
Promotes conversion of pepsinogen to pepsin
Protein Digestion in the Stomach
It also activates gastroileal reflex which moves
chyme from ileum to colon
Parasympathetic stimulation releases gastrin
releasing peptide, which stimulates G cell release
of gastrin

Mucus cells - secretes mucus to protect against
acid and digestive enzymes


Absorption in the Stomach
Almost all products of digestion are
absorbed in the intestine
Notable exceptions
alcohol and aspirin can be absorbed directly
through stomach wall
due to their lipid solubility
absorption of aspirin through stomach wall
associated with bleeding, may be related to
peptic ulcers in people taking large dosages
Chyme
Food in stomach is liquified
mixed with stomach juices to form pasty liquid
material = chyme
Chyme = material passed from stomach to
small intestine
Small Intestine
Functions in digestion
CHO digestion resumes and is completed here
Protein digestion continues and completes here
Fat digestion is initiated and completed here
Also functions to absorb nutrients, fluids, and
electrolytes
Divisions (@ 12 feet long total length)
duodenum = upper portion (@ 1 foot long) closest to
stomach
jejunum = middle section
ileum = lower section closest to large intestine

Anatomy
3 segments (12 ft long, 22 ft in cadaver)
Duodenum
Jejunum
Ileum
Anatomy
Features that increase surface area
Circular folds (valvulae conniventes, kerckrings
folds, plicae circularis)
Project into lumen 3-10 mm
Prominent in duodenum and jejunum and disappear near
mid ileum
Responsible for feathery appearance on barium
radiographs
Villi
4-5 million in entire length
0.5-1.5 mm long
Account for velvet-like appearance
Anatomy
Microvilli
1.0 um long
Brush border
Anatomy
Structure of the villus
Lacteal
Anatomy
Goblet cells and absorptive cells
Anatomy
Brush border enzymes
Anatomy
Crypts of Lieberkuhn
Physiology
Two primary function
Digestion
Absorption of nutrients and water
Digestion
Mainly in duodenum small intestine and
pancreatic enzymes
Bicarbonate from pancreas neutralizes acids
Mucous protects from acids
Bile emulsifies fats

Hormones Important in Sm.
Intestine Digestive Activity
Secretin
Cholecyctokinin (CCK)
Enterokinase
Pancreatic enzymes
Lipase, Amylase, Peptidases, Trypsinogen, Trypsin
Physiology
Digestive enzymes
Salivary amylase
Pepsin
Pancreatic enzymes
Trypsin
Chymotrypsin
Carboxypeptidase
Nucleases
Pancreatic lipase
Pancreatic amylase
Intestinal enzymes
Peptidases
Disaccharidases
Lipase
Nucleotidases



physiology
Hormones
Cholycystokinin secretion stimulated by fat in
duodenum
Contraction of gall bladder
Pancreatic secretion of enzyme rich material
Secretin secretion stimulated by low pH in
duodenum
Secretion of bile from the liver
Pancreatic secretion of HCO
3
-
rich juice
Physiology
Absorption
Nutrients broken down into simple sugars, fatty
acids and amino acids
Principle sites of absorption
Duodenum: iron, calcium, vitamins, fats, sugars, amino
acids, vitamins
Jejunum: fat, sugar, amino acid (largely complete by mid
jejunum), vitamins
Ileum: vitamin B
12
and bile salts
Most bile salts are absorbed and recirculated to the liver
important in maintaining bile pool
Digestion
Most occurs by hydrolysis reactions -
reactions that add water to break chemical
bonds
Enzymes involved:
amylase - breaks complex sugars to
disaccharides
lipases - breaks down lipids
proteases - breaks down proteins
Hormonal Control of Intestinal
Secretion
S cells secrete secretin
secretin target tissue = pancreatic ducts and liver
induces release of water and HCO
3
-
from pancreatic duct
cells and secretion of HCO
3
-
into bile by liver

HCO
3
-
neutralizes acidic chyme
Stimuli for secretin secretion
acid (pH less than 4.5 stimulates secretion)
secretin = natures antacid
I cells secrete cholecystokinin (CCK)
CCK target tissues = pancreatic acinar cells and
gall bladder
induces secretion of digestive enzymes from
pancreatic acinar cells
induces contraction of gall bladder, which releases
bile into small intestine
Stimuli for CCK secretion
presence of protein and/or fat in chyme



Hormonal Control of Intestinal
Secretion (continued)
CCK and Appetite Control
CCK also thought to act on satiety center in
brain and inhibit appetite
Butabindid = drug that interfers with
enzyme responsible for CCK degradation
(breakdown)
keeps CCK in system longer
boosts appetite inhibition
used to treat obesity

Pancreatic Enzymes
Amylase - breaks CHO starch to maltose, maltriose,
and small branched structures
Lipase - breaks down triglycerides into fatty acids
and glycerol
Proteolytic enzymes break peptides down to amino
acids and dipeptide fragments
Trypsinogen
converted to trypsin by enzyme (enterokinase) located
along inner wall of small intestine
trypsin converts other pancreatic zymogens (inactive
forms) to their active forms within the small intestine
Pancreatic Enzymes (continued)
Most pancreatic enzymes are produced as
inactive molecules = zymogens
Are transported to small intestine in zymogen
form
Protects the pancreas from self digestion

CHO Digestion in Sm. Intestine
Pancreatic amylase secreted into duodenum in
response to secretin
Is active in the intestine because the acidic chyme
is neutralized by HCO
3
-
also secreted from
pancreas in response to secretin
Amylase converts complex CHOs to maltriose,
maltose, and short branched sugars
Small Intestine (continued)
Inner surface (epithelial layer) extensively
folded and covered with smaller folds (villi)
and even smaller folds (microvilli) increase
surface area for absorption to occur
Site of absorption of carbohydrates, lipids,
amino acids, calcium and iron in duodenum
and jejunum
Bile salts, Vit B
12
, water, and electrolytes
mainly in ileum
CHO Absorption in the Sm. Intestine
Enzymes in the brush border complete
breakdown of maltotriose, maltose, and branched
sugars, lactose and sucrose
Lactase converts lactose to glucose and galactose
Sucrase converts sucrose to glucose and fructose
Isomaltase converts branched sugars glucose,
maltose and unbranched short oligosaccharides
Maltase converts maltose to glucose
Epithelial cells that line the sm. Intestine absorb
monosaccharides by active or facilitated transport
Glucose and galactose are actively co-transported
with sodium using the same transporter and
Fructose is absorbed by passive facilitated transport
using a different transporter protein than that used
by glucose and galactose
Monosaccharides enter bloodstream and are
transported to liver and converted to glycogen or
sent to bloodstream for immediate, direct ultilization
or storage by cells
CHO Absorption in the Sm. Intestine
(continued)
Fat Digestion in Sm. Intestine
Limited fat digestion occurs prior to sm. Intestine
Some lipases in saliva and gastric secretions
Lipase = enzyme important in fat digestion
Secreted into sm. intestine from pancreas in response
to secretin
breaks down triglycerides to free fatty acids and
monoglycerides
Activity is dependent upon the amount of surface area
on which it can work
Phospholipase A
2
digests phospholipids
Bile is essential for proper fat digestion
Digestion and Absorption of Lipids in
Small Intestine
Fats stimulate I cell release of CCK
CCK triggers release of bile from gall
bladder
Bile emulsifies fats
breaks large fat globules into smaller globules
does not actually break bonds between glycerol
and fatty acids
Increases surface area available for pancreatic
lipase to act
Liver
Largest organ in body
Blood supply
hepatic artery delivers oxygenated blood
hepatic portal vein
products absorbed into capillaries in the intestines
do not directly enter general circulation
this blood is delivered first to the liver by the hepatic
portal vein, and then passed on to the general
circulation
liver has first crack at absorbed nutrients, except
lipids
Liver (continued)
Digestive functions
secretes bile - essential for digestion and absorption of fats
Function - overall is to filter and process nutrient-rich
blood, not just a digestive function
regulates carbohydrate metabolism through glycogen storage
and release
regulates many aspects of lipid metabolism, eg., cholesterol
synthesis and release of ketones
detoxifies blood
urea and bile synthesis

Non-digestive functions
circulatory functions; destroys aged or abnormal
blood cells and produces clotting factors
converts protein metabolites to urea for
elimination by kidneys
immune function (Kupffer cells)
functions as blood reservoir in regulation of blood
volume
Liver (continued)
Bile Synthesis
This is the main digestive function of the liver;
Approximately 1 liter per day is produced
bile salts are cholesterol derivatives and function
to emulsify fats
bile salts are recycled, not excreted
main bile pigment is bilirubin, derived from RBC
heme
bile is synthesized in the liver and stored in the
gallbladder
release is stimulated by cholecystokinin and
vagus nerve
Bile
Product of the liver cells
bile contains bile pigment, bile salts, phospholipids,
cholesterol, and inorganic ions
bile pigment = bilirubin = breakdown product of hemoglobin
bile salts = derivatives of cholesterol that are combined with
taurine or glycine, form micelles = lipid aggregates with non-
polar parts in central region and polar regions toward water
Essential for absorption of fat from the digestive
tract
Emulsifies fat; breaks large fat globules into smaller fat
droplets, provides greater surface area on which lipase
can act
Gall Bladder
Located on underside of liver
Bile produced in liver is carried to gall bladder,
concentrated, and stored until secretion into the
small intestine
Gall bladder contraction forces bile into small
intestine
Cholecystokinin = hormone released by I cells of
small intestine
stimulates release of digestive enzymes from pancreas and bile
from gall bladder
Micelles
Aggregates of bile salts, free fatty acids,
monglycerides, lysolecithin, and fat-soluble
vitamins
Arranged with non-polar regions to center, polar,
water-soluble portions to outside
makes lipids more water soluble in lumen of intestine
Micelle is transported to epithelial cells lining
small intestine

Importance of Micelle Formation
Intestinal epithelial layer is covered by an unstirred
water layer
Fats are nonpolar, and therefore insoluble in water
Micelles are structures whose outer borders are polar,
but whose inner segments are nonpolar
Outer polar portion can dissolve in the unstirred water layer
and be transported to epithelial cell surfaces
Nonpolar contents can then be removed from micelle and
absorbed individually, or in some cases the micelle itself
may be absorbed
Chylomicrons
Inside epithelial cells, triglycerides and
phospholipids are re-synthesized
Resynthesized triglycerides and phospholipids are
combined with cholesterol and protein inside the
cell to form chylomicrons
Chylomicrons are released into the lymphatic
system - NOT INTO HEPATIC PORTAL VEIN
liver does not get first crack at lipids
Protein Digestion in Sm. Intestine
Proteolytic enzymes are released (in inactive,
zymogen forms) from the pancreas in response to
secretin
Trypsinogen = inactive precursor that is
converted (by enterokinase) to trypsin in the brush
border of the small intestine
Trypsin converts other zymogens to their active
forms
Collectively, the proteolytic enzymes break
proteins and peptides into single amino acids, or
di- and tripeptides
Absorption of Amino Acids in Sm.
Intestine
Amino acids are absorbed by the epithelial cells of
the small intestine by active co-transport with
sodium
Di- and tripeptides are also absorbed by epithelial
cells of the small intestine and then broken down
into amino acids within the epithelial cells
Epithelial cells release amino acids into portal
blood, which is transported first to the liver, then
to rest of the body

Absorption of Intact Proteins
Does not occur to any considerable amount in adult
humans
Infants can absorb proteins through the intestinal
wall, therefore can obtain some immune protection
from antibodies found in colostrum
Colostrum contains components that promote
closure of the GI tract, which then makes the GI
tract impermeable to proteins
Intestinal Contractions and Motility
2 major types of
contractions occur in the
small intestine:
Peristalsis:
Slow movement.
Pressure at the pyloric end
of small intestine is greater
than at the distal end.
Segmentation:
Major contractile activity of
the small intestine.
Contraction of circular
smooth muscle.
Mix chyme.
Insert fig. 18.14
Brush border
enzymes
reassembly
Anatomy and Physiology
Anatomy
Anatomy and Physiology
Functions (converts chyme to feces)
Absorption of water and electrolytes (mainly on
right side)
Absorbs 800 ml water/day
Capacity 1500-2000 ml/day (when exceeded results in
diarrhea)
Sigmoid colon reservoir for dehydrated fecal
mass
~200 g feces/day
Water 80-90%
Food residue
Bacteria
Cells
Unabsorbed minerals
Anatomy and Physiology
Secretes mucus (no enzymes)
Bacteria produce vitamin K and several Bs
Flatus (NH
3
, CO
2
, H
2
, H
2
S, CH
4
)
CO
2
produced when fatty acids and HCl are neutralized
by bicarbonate
Bacterial fermentation of carbohydrates produces CO
2
,
H
2
, CH
4

~1000 ml expelled each day
Excess occurs with aerophagia and diets high in
indigestible carbohydrates
Rectum and anus sites of some of most common
disorders known to humans
Constipation
Hemorrhoids
Abscesses and fistulas
Colon and rectal cancer
Colon
1,5 1,8 m.
Various segment.
Columnar epithelium at the surface (few, short),
no villi, few folds (except in the distal rectum).
Goblet cells.
Endocrine cells.
Absortive cells.
Anatomi & Histology
Large Intestine
Larger diameter, shorter length (@ 4 feet)
than small intestine
separated from small intestine by ileocecal
valve
Collects food residue (indigestible) material
Site of final water reabsorption - causes
chyme to become solid (forms feces)
Stores feces until eliminated from body
Bacteria live in the colon and stimulate the
production of vitamin K and some of the B
complex vitamins
Mucus is produced but no enzymes are
secreted in the large intestine
Divisions
cecum = section nearest small intestine
(appendix attached in this region)
colon = major portion
ascending
transverse
descending
sigmoid (leads to rectum)
Large Intestine (continued)
Water Absorption in the Intestine
Majority ( 98%) of water that enters gut is
(re)absorbed
85% (re)absorbed in small intestine
13% in large intestine
Absorption of water is passive process
osmotic gradient created by active transport of
ions
water moves according to its gradient

Large Intestine
Large
Intestine
Colon: Function
Absorb H
2
O and electrolytes
Secretion of mucus
Formation, propulsion & storage of
unabsorbed material (feces)
Some digestion by bacteria
Mass Peristaltic Movements (2-3x day)
Moves through in 12-24 hours
DIGESTIVE ACTIVITIES OF
LARGE INTESTINE
STRUCTURE ACTIVITY RESULT
Mucosa Secretes
mucus
Lubricates colon &
protects mucosa
Absorbs water

Maintains water
balance; solidifies
feces; absorbs
vitamins & some ions

DIGESTIVE ACTIVITIES OF
LARGE INTESTINE
STRUCTURE ACTIVITY RESULT
Lumen Bacterial
activity
Breaks down
undigested
carbohydrates,
protein, & amino
acids into products
that can be expelled
in feces or absorbed
& detoxified by liver
Synthesizes certain B
vitamins & vitamin K
DIGESTIVE ACTIVITIES OF
LARGE INTESTINE
STRUCTURE ACTIVITY RESULT
Muscularis Haustral
churning
Contractions move
contents from haustrum
to haustrum
Peristalsis Contractions of circular
& longitudinal muscles
move contents along
length of colon
DIGESTIVE ACTIVITIES OF
LARGE INTESTINE
STRUCTURE ACTIVITY RESULT
Muscularis Mass
peristalsis
Forces contents into
sigmoid colon
Defecation
reflex
Eliminates feces by
contractions in sigmoid
colon & rectum
Large Intestine
Digestion and Absorption
Fermentation breaks down undigested complex
CHO and proteins
Produce lactate and short chain fatty acids used by
the colonocytes for energy
Bacteria produce absorbable vitamins like K
Gases are produced in the large intestine
Colon is responsible for absorbing most of the
water that enters it in the form of chyme
Colonocytes absorb NaCl
Secretion
& H
2
O
absorption
2000 ml 150 ml = ?
Ion &
Vitamin
absorption
Rectum
Figure 24.25
The
Defecation
Reflex
Defecation process
Reflex relaxation of internal sphincter
Valsalva maneouvre raising intraabdominal
pressure
Relaxation of puborectalis (anorectal
angle)
Voluntary relaxation of external sphincter

Defecation reflex
> 15 mm Hg
Continence mechanism
Rectum normally empty
Colonic movements distend rectum -
150 mls, 25 cm H2O which activate
defecation reflex
Voluntary inhibition (external sphincter)
movement of faecal material back into
colon