The Digestive System

• All living organisms require energy to

carry out the daily activities.
• The required energy is provided by food.
• The food is consists of complex organic
substances.
• The digestive system is responsible for
1- Ingestion of food 2- Digestion of food.
3- Absorption
4- Elimination of indigestible foodstuffs as
feces. Dr. Yaser Ashour
The Digestive
System
gland

Esophagus

Longitudinal Stomach
organization

Small Intestine

Large Intestine

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• The adult gastrointestinal
tract is about 5 meter
long.
• It starts by mouth and
ended by anus.
• It consists of:
- Mouth
- Pharynx
- Oesophagus
- Stomach
- Small intestine
- Large intestine (rectum
and anal canal)
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 Digestive Tract Anatomy
• 1- Oral cavity
• 2- Salivary glands
• 3- Esophagus
• 4- Stomach
– Fundus
– Body
– (rugae)
– Antrum
– pyloris

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 More Digestive Tract Anatomy

• 5- Small intestine
– Duodenum
– Jejunum
– Ileum
• 6- Pancreas
• 7- Liver
• 8- Large intestine
– Colon
– Rectum
• 9- Anus

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Gastrointestinal System

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 Digestive system functions

• 1- Ingestion
• 2- Digestion
• 3- Motility
• 4- Secretion
• 5- Absorption
• 5- Elimination
• 6- Self protection

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Functions representation of main regions of the gastrointestinal
tract

REGION: FUNCTION:
Oesophagus
- Transit

Stomach - storage, H+/peptic digestion

& intrinsic factor

duodenum - fat, protein, carbohydrate

Small intestine digestion & absorption
jejunum
- water and electrolyte transport
ileum - bile salt transport

Colon - Storage
Large intestine water and electrolyte transport
rectum & anus

- defecation
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Layers of GI Tract

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 The gut wall

Lumen

epithelium

Lamina propria MUCOSA 1

Muscularis mucosa

SUBMUCOSA ( blood vessels, lymph 2

vessels and Meissner`s plexus)

Circular muscle

MUSCULARIS
Myenteric plexus
PROPRIA 3

Longitudinal muscle

Mesothelium (SEROSA) 4
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Layers of GI Tract

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 GIT WALL
The wall of the gut is formed by four layers:-
1- The serous layer: all abdominal organs are
covered by a connective tissue called
peritoneum.
2- Muscle layer: it is consists of two layers outer
longitudinal and inner circular in between
these there are blood vessels and
Myenteric plexus (Auerbach`s).
3- Submucous layer: it consists of loose
connective tissue and it contains blood vessels
and nerve plexus (Meissner`s).
4- Mucous layer: it consists of surface epithelium
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 Innervation of the GI tract
Smooth muscle has inherent
rhythmicity
• Intensity, duration and frequency of
contraction modulated by
parasympathetic nervous system
• Ganglia present in wall
– Meissner’s plexus in submucosa
– Auerbach’s plexus in between
layers of the muscularis
(myenteric plexus).

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GIT
Innervations
• The GIT is innervated by an intrinsic nervous
and extrinsic nerves (sympathetic and
parasympathetic)
The intrinsic nervous system consists of:
1- The Meissner’s (submucosa).
2- The Auerbach’s plexus (myenteric).
The Meissner’s (submucosa), control the
secretory activity and the blood flow of the
gut. It also serves a sensory function.
The Auerbach’s plexus (myenteric), controls
the motility of the gut.
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GIT Innervations (cont.

The intrinsic nervous system has many

neurotransmitters (acetylcholine, norepinephrine,
vasoactive intestinal peptide, substance P and
somatostatin.
The extrinsic nerve supply:
The parasympathetic fibers to the gut, extending
from esophagus to the large intestine, pass via the
vagus nerve, which also supply pancreas and gall
bladder, the distal half of the large intestine
receives its parasympathetic through pelvic
nerve.
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GIT innervations (cont.
The parasympathetic stimulation
increase the motility of GIT wall,
relaxation of the sphincters and
increase of secretory activity of
the GIT.
The sympathetic fibers to the GIT:
Are supplied through the splanchnic
nerves.
Stimulation of the sympathetic nerves
causes inhibition of the motility,
contraction of the sphincters and
vasoconstriction in the GIT.

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 Intrinsic and extrinsic nerves of the digestive tract

e.g. secretory cell

e.g. Stretch & chemosensitive

neurons
Submucosal
plexus

INTRINSIC
NERVES
e.g. post-ganglionic non-
adrenergic or cholinergic fibres

Myenteric
plexus
Visceral
afferents
EXTRINSIC
NERVES
Parasympathetic
efferents

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 Regulation of GIT motility and secretion
The motility and secretion depend upon Reflex arc:
• The Receptors: present in the mucosa.
• The stimulus: is the distention of gut by the
luminal contents, acidity of the chyme,
osmolality of the chyme, peptides and fats.
• The effector organs: the smooth muscle wall and
exocrine glands.
• The aim of the reflex activities: is to maintain
conditions that are optimal for digestion and the
absorption of foodstuff.
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Regulation of GIT motility and secretion
Neural regulation
• The intrinsic nervous system regulate the
motility and secretory activity of GIT.
• Extrinsic innervations is involved in the
regulation of GIT motility and secretion in
response to changes in the environment
(emotions, taste, smell).
Hormonal regulation
• local hormones control and regulate GIT
motility and secretion.
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 GIT Hormones
• Released from small intestine epithelium in
response to acid and some of them secreted
from stomach wall.
• Synthesized in entero chromaffin like cells, which
has diffuse distribution.
Gut Hormone Families
• Gastrin family: Gastrin,
Cholecystokinin pancreozymin.
• Secretin family (Secretin, Glucagon, Vasoactive
intestinal polypeptide (VIP) and Gastric
inhibitory peptide (GIP).
• Other Candidate Hormones (Motilin, Somatostatin,
Substance P, Neurotensin, Gastrin-
releasingpeptide, Bulbogastrone, Urogastrone,
Villikinin, Calcitonin gene- related peptides,
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Endorphins)
 Physiological Roles of GIT Hormones
• Stimulate secretion of enzymes for digestion.
• Required to move material across cell
membranes.
• Stimulate secretion of acids and bases.
• Responsible for optimal pH for enzymes action.
• Stimulate smooth muscle contraction.
• Stimulate release of hormones from pancreatic
islets
• Provide satiety signals to the brain

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 Gastrin
Source: Antral mucosa of the stomach and G
cells of duodenal mucosa.
Released into: both lumen and into blood at
basal lamina.
Released in response to: food, Peptides,
amino acids, to a lesser extent, FFA’s
distension of stomach after food intake
• Release under autonomic nervous system
control.
Physiological Function of Gastrin
• Stimulate HCl and pepsinogen
secretion in the funds of the
stomach
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 Site targeted for stimulating release
• Histamine-releasing cells
• Acid-secreting parietal cells
• Indirect release of pepsinogen through
HCl release
Effect of Gastrin hormone release:
• Stimulates lower esophageal sphincter.
• Relaxation of pyloric sphincter.
• Stimulates release of pancreatic enzymes.
• Enhance motor activity of intestine.
• Stimulate pancreatic bicarbonate and
water secretion.
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 Cholecystokinin (CCK)
Release in response to the presence of food particularly lipids.
Site of release: T cells of duodenum and jejunum.
Response to stimulation:
• Gallbladder contractions.
• Pancreatic enzyme secretion.
• Emptying of gallbladder.
• Inhibits gastric emptying.
• Potentates Secretin-induced pancreatic bicarbonate secretion.
• Trophic actions on acinar cells of the pancreas.
• Relaxation of sphincter of Oddi by VIP release.
• Regulates bile flow.
• Inhibition of gastric emptying by inhibiting vago-vagal reflex by
vasoactive intestinal peptide.
• Acts as satiety hormone.
• Anorexia of aging may be related to increased levels of CCK.

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 Secretin
• Concentration greatest in duodenum
• Granular S cells between crypts and villi of
mucosa.
• HCl reaching mucosa stimulus for secretion.
• Stimulates pancreatic bicarbonate secretion.
• Potentiate CCK-stimulated pancreatic enzyme
secretion.
• Interact with CCK to stimulate bicarbonate
secretion

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Vasoactive Intestinal Peptide (VIP)
Physiological effects:
• Relaxes smooth muscles
• Antagonizes smooth muscle constrictor agents
• Inhibits histamine and pentagastrin-stimulated
gastric acid release
• Stimulates electrolyte and water secretion by
pancreas
• Stimulates bile secretion
• Stimulates
– Lipolysis
– Glycogenolysis
– Insulin secretion

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 Gastric Inhibitory Peptide (GIP)
• Localized to K cells of duodenum and jejunum
• Released by fat present in ingested meal.
Physiological effects:
• Inhibits gastric-acid secretion.
• Stimulates release of pancreatic water and electrolyte
secretion.
• Stimulates water and electrolyte release from Brunner’s
glands on intestinal mucosa.
• Adipose tissue.
• Activates lipoprotein lipase.
• Inhibits glucagon-induced lipolysis
• Potentiates effect of insulin on fatty acid incorporation
into triglycerides
• Increases glucose use in peripheral tissue (muscle)
• Increase volume or electrolyte composition of saliva and
intestinal secretions
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 Motilin
• peptide hormone
• Highest concentrations localized to
duodenum
• Stimulates gastric motor activity
• Regulates emptying of stomach

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 Movements of the GIT
• Digestion is a process by which complex
food material is broken down into simple
particles, and then absorbed.
• Digestion is of two types:-
– Mechanical (physical).
– Chemical.
• Mechanical digestion: is broken of food
into small particles.
• Chemical digestion: is the act of various
digestive enzymes on the complex food to
convert it into a simple form.
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 Movements of the GIT
There are three types of GIT movements:
• Neurogenic, Myogenic and passive movements
1- The neurogenic: are brought by nervous
control.
2- The Myogenic: are brought about by
smooth muscles which are independent of
nervous control.
3- The passive movements: are neither
neurogenic nor Myogenic in nature.
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 Movements of the GIT (con.
Purpose of gastrointestinal movements:
1- Converting the food into fine particles.
2- Mixing the food with juices.
3- Moving the food onward through the alimentary
canal.
4- Help in absorption of food.
5- Help in maintenance of alimentary tract in an
active and normal condition.
6- Help in excrete waste products from the food and
body itself, and eliminate the undigested and
unabsorbed food inDr.the form
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 Movements of the GIT (con.
Types of Gastrointestinal Movement:
• 1- Mastication.
• 2- Deglutition (swallowing).
• 3- Stomach movements.
• 4- Small intestine movements.
• 5- Large intestine movements.

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 Movements of the GIT (con.
• Mastication
– It is the preliminary stage of motor
function.
– It is the first mechanical process to
which food is subjected in the GI
tract.
– It is a process of crushing food under
the grinding action of the teeth.

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 Mastication is a reflex actìon:
Stimulus: The pressure of food in the mouth.
Receptors: The mechanical receptors in the oral
mucosa.
Afferent: 5th, 7th and 9th cranial nerves.
Center: Mastication center in the reticular
formation of the medulla.
Effector organs: The digastric and mylohyoid
muscles.
Response: Inhibition of the muscles of mastication,
which allows the lower jaw to drop, and
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opening of mouth.
• The drop initiates a stretch reflex of the jaw
muscles (the masseters, temporalis and
pterygoids, which are supplied by the fifth
cranial nerve).
• This leads to rebound contraction, which
automatically raises the jaw, causing the teeth
to close and exert their crushing effect.
• The rotatory movements of the molars are
carried out by the pterygoid muscles, which
make the jaws move sideways.

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• The tongue muscles (supplied by the
12th cranial nerve) move inside the
mouth.
• The muscles of the oropharynx
(supplied by the 9th cranial nerve)
and the cheek muscles (supplied by
the 7th cranial nerve) also move.

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 Purpose of mastication
– Help the swallowing processes.
– Help in food broken into small particles,
– With saliva it helps in formation of bolus.
– Helps in protection of mucous membrane
against damage.
– Facilitate digestion.
– Helps in the secretion of digestive juice.
– Stimulation of the taste buds.
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 Deglutition (swallowing)
• It is the process by which food is passed from the oral
cavity into the stomach.
• It starts after mastication is complete, that is, when the
food has been converted into a bolus.
Deglutition may be divided into:-
• Oral stage: A voluntary stage, which initiates the
swallowing process.
• Pharyngeal stage: A pharyngeal stage, which is
involuntary and constitutes the passage of food through
the pharynx into the esophagus.
• Esophageal stage: An esophageal stage, which is an
involuntary phase that promotes the passage of food
from the pharynx to the stomach.
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Deglutition (swallowing)

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 Oral stage (voluntary Stage)
• It started when the food in the mouth is ready to be
swallowed.
• This is done by the tongue pushing upwards and
backwards against the palate to move the food.
• This is a voluntary movement which humans can control
in normal swallowing.
• When the bolus is allowed to pass into the pharynx, the
nasopharynx is shut off to prevent the regurgitation of
food through the nose. At this point, respiration reflexly
stops (deglutition apnea).
• The nasopharynx is shut off by the upward movement of
the soft palate and the forward movement of the
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posterior pharyngeal wall.
Oral Phase

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 Pharyngeal stage
• The pharyngeal stage begins once the swallow
reflex has been activated at the end of the oral
stage.
• The events of this stage cannot be voluntarily
interrupted and will not take place if the reflex is
not activated by the swallowing receptor areas
around the opening of the pharynx, particularly the
tonsillar or faucial pillars, which are stimulated as
the bolus of food enters the posterior mouth and
pharynx.
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 Pharyngeal stage (cont.
• A person does not breathe during the pharyngeal
stage of swallowing.
• During the pharyngeal stage of swallowing it is
important to:
• Protect the airway during deglutition so that none
of the swallowed matter is ingested into the lungs.
• The whole sequence of events in this stage is
completed quickly so that breathing can be rapidly
resumed.
• The whole stage occurs in less than 2 seconds.
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 Pharyngeal stage (cont.
• The swallowing receptor areas pass impulses to the brain
stem to start a series of automatic pharyngeal muscle
contractions.
• Reflux of food into the nasal cavities is prevented by the
soft palate pulling upwards, by contracting the tensor
veli palatini, levator veli palatini and musculus uvulae.
• On either sides of the pharynx are pillars of fauces which
are pulled together, to form a saggital slit. This slit acts
as a gateway to the posterior pharynx, letting through
food which has been masticated enough to pass easily.
Larger objects usually can't pass.

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Pharyngeal Stage

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 Pharyngeal stage (cont.
• The vocal folds of the larynx are closed and the larynx is
pulled upward and anteriorly by the neck muscles.
• The epiglottis is attached to ligaments that prevent it
from moving upwards, thus causing it to swing backward
to cover the entrance to the larynx.
• These two actions prevent food passing into the trachea,
particularly the action of the vocal folds.
• If the vocal folds were removed or unable to close (i.e.
muscle defects) then strangulation could occur.
• However, if the epiglottis was to be removed then
swallowing could still occur.
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 Pharyngeal stage (cont.
• As the larynx moves upwards, it effectively
pulls up and enlarges the opening to the
esophagus.
• The upper oesophageal sphincter relaxes to
allow food to move easily down from the
posterior pharynx to the upper esophagus.
• This sphincter remains strongly contracted in
between swallows so as to prevent air from
going into the esophagus during respiration.

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Protection of air ways

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 Protection of air ways
• The glottis is lifted out of the main flow of food
when the larynx moves upwards, so that food
passes on either side of the epiglottis rather than
over its surface. This action can count as another
protective precaution to prevent the entry of food
into the trachea.
• At this stage the whole muscular wall of the
pharynx contracts as a rapid peristaltic wave,
beginning in the superior part of the pharynx and
spreading downwards. This wave then spreads
down into the esophagus, propelling food down
into this part of the digestive tract.

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 Esophageal Stage
This stage involves the esophagus which
functions to transport food from the
pharynx to the stomach via the relaxed
gastro-oesophageal (or cardiac) sphincter
at the entrance to the stomach.
In this stage the esophagus moves the food
by:-
1- primary peristalsis.
2- secondary peristalsis.

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 Primary peristalsis
• Continues the peristaltic wave that begins in the
pharynx and spreads down into the esophagus
during the pharyngeal stage mentioned earlier.
• The primary peristaltic wave passes from the
pharynx to the stomach in approximately 8-10
seconds.
• However, when a person is sitting upright, food
swallowed is transmitted to the lower end of the
esophagus in about 5-8 seconds.

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 Secondary peristalsis
• occurs to move any left food down from the
esophagus into the stomach, which the primary
peristaltic wave may have left behind.
• This second wave results from the distension
(stretching) of the esophagus by the food within
it.
• The esophagus is always closed flat except
during the passage of food.
• The secondary peristaltic waves continue until
all the food has moved down into the stomach.
• During this stage, the larynx descends and the
airway is reopened. The tongue moves forwards
and respiration resumes
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 Swallowing of fluids
The descriptions above apply to human adults
swallowing solid or semisolid food.
• There is a slight difference with the swallowing
of liquids.
• First suction is created as a seal is created
between the tongue and palate and
simultaneously the tongue is retracting.
• The posterior part of the tongue then
depresses from the palate and allows the
liquid to run into the pharynx.
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 Salivary glands
• Three major glands (paired)
– Parotid
– Submandibular
– Sublingual
• Secretion
– Parasympathetic stimuli
– Chemical stimuli
– Physical stimuli
– Psychological stimuli
• Numerous accessory glands in submucosa –
continuous secretion
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Salivary glands

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 Salivary glands
One and half liter of saliva is produced daily in normal
adult persons to start chemical digestion in the mouth,
when the food comes in contact with saliva.
• Saliva is secreted by:-
– Three pairs of salivary glands (parotid, Submaxillary and
sublingual.)
– Many buccal glands, which secrete mucous.
• The salivary gland is an exocrine gland; its secretion is
as follow:
– Parotid glands: secrete about 25% of saliva and it is serous
(thin and watery)
– Submaxillary glands: Secrete about 70 % of saliva and it is
mixed (serous and mucous).
– Sublingual glands: Secrete about 5% of saliva and it is
mucous (thick and viscid).
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 Salivary glands
• Saliva
– Mucus -Enzymes (amylase, lysozyme)
– Antibodies (IgA) - Inorganic ions
• Cells
– Serous and mucus secreting
• Serous cells
– Round central nuclei
– Zymogen granules
– Basophilic cytoplasm
• Mucus cells
– Clear staining mucigen granules
– Flattened eccentric nuclei
– Lightly stained cytoplasm
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 Salivary Gland Functions
1- Digestion of starch:
- salivary amylase/ptyalin acts on polysaccharides
and converts boiled starch into maltose.
- It acts best at a pH of 6.8.
- The digestion of carbohydrates begins in the
oral cavity, but the food remains in the oral cavity
for only a short time.
- Therefore, the action of amylase is short-lived,
continuing only until the food enters the stomach
and till the ph of gastric contents becomes too
acidic for amylase activity.

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 Salivary Gland Functions
2- Facilitation of swallowing:
By moistening and lubricating food bolus.
3- Facilitation of speech: by moistening
the mouth cavity, tongue and lips.
4- Regulation of water balance:
in cases of dehydration when secretion
is decreased giving the sensation of thirst.

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 Salivary Gland Functions
5- Immunity function: The immunoglobulin present in
saliva acts against bacteria in the mouth.
6- Cleaning: saliva washes ood remnants, which acts
as a good medium for bacteria.
7- Excretion: The salivary glands excrete heavy
metals, such as lead and mercury, and viruses
such as rabies and poliomyelitis.
8- Solvent: Saliva dissolves many food materials so
that taste buds in the tongue can be stimulated.
9- Dilution: of irritating substances and excessively
hot or cold food.

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 Regulation of salivary secretion

- The secretion of saliva is regulated basically by parasympathetic

innervations of the salivary glands.
-This brings about reflex secretion of saliva in response to tactile
stimuli, or stimuli which arise in the CNS itself.
- Parasympathetic stimulation causes vasodilatation, while
stimulation of glandular tissue gives rise to profuse, watery
secretion.
- Vasodilatation by the parasympathetic nerves is brought about
by the formation of bradykinin.
- Parasympathetic innervations of the salivary glands arises from
the superior and inferior salivary nuclei in the reticular formation
of the medulla.

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 Mechanism of salivary secretion
• Salivary secretion is a rapid process; therefore it occurs through
nervous mechanism only, through two pathways:-
• Conditioned reflex
• Unconditioned reflex
• Conditioned reflex:
• It is an acquired reflex which depends on presence of cerebral
cortex and pervious training. It produces salivary secretion in
empty mouth
• Stimulus: Seeing, hearing and smelling of food
• Receptors: In the organs of special senses.
• Afferent: Sensory nerves from organs of special senses (optic,
olfactory and auditory).
• Center: Cerebral cortex.
• Efferent: Chorda tympani, glossopharyngeal and sympathetic
nerve.
• Response: Salivary secretion.

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 Mechanism of salivary secretion
Unconditioned reflex:
• Is present since birth, do not need learning.
• It started on the presence of food in the mouth,
which stimulate taste receptors in the mouth.
• Stimulus: food, (chemical) or mechanical (e.g.
chewing gum) stimuli.
• Receptors: taste buds receptors.
• Afferent: Chorda tympani (anterior 2/3 of tongue)
and glossopharyngeal nerve (posterior 1/3 of
tongue).
• Center: Superior and inferior salivary nuclei.
• Efferent: Chorda, glossopharyngeal and sympathetic
nerves.
• Effectors organs: Salivary gland.
• Response: Salivary secretion.
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 Salivary secretion
• Clinical Importance
• - It is important to maintain oral asepsis in high
fever and coma, since the secretion of saliva
decreases.
• - Decreased salivary secretion can cause
dental caries, so the mouth has to be rinsed
after taking food.
• - Atropine is administered before general
anesthesia to decrease salivary secretion.
• - The rabies virus, caused by dog bite, and the
virus of poliomyelitis are transmitted through
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saliva.
 Vomiting
Vomiting:
It is the forceful expulsion of contents of the stomach and
often, the proximal small intestine.
• It is a manifestation of a large number of conditions,
many of which are not primary disorders of the
gastrointestinal tract. Regardless of cause, vomiting can
have serious consequences, including acid-base
derangements, volume and electrolyte depletion,
malnutrition and aspiration pneumonia.
The Act of Vomiting
• Vomiting is usually experienced as the finale in a series
of three events,
• Nausea is an unpleasant and difficult to describe psychic
experience in humans and probably animals.
Physiologically, nausea is typically associated with
decreased gastric motility and increased tone in the
small intestine. Additionally, there is often reverse
peristalsis in the proximal small intestine.
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 • Retching ("dry heaves") refers to spasmodic respiratory
movements conducted with a closed glottis. While this is
occurring, the antrum of the stomach contracts and the funds
and cardia relax.
• Emesis: is when gastric and often small intestinal contents are
propelled up to and out of the mouth. It results from a highly
coordinated series of events that could be described as the
following series of steps
Mechanism of vomiting
• 1-A deep breath is taken, the glottis is closed and the larynx is
raised to open the upper esophageal sphincter. Also, the soft
palate is elevated to close off the posterior nares.
• 2- The diaphragm is contracted sharply downward to create
negative pressure in the thorax, which facilitates opening of the
esophagus and distal esophageal sphincter.
• 3- Simultaneously with downward movement of the diaphragm,
the muscles of the abdominal walls are vigorously contracted,
squeezing the stomach and thus elevating intragastric
pressure. With the pylorus closed and the esophagus relatively
open, the route of exit is clear.
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