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FUNCTIONAL ANATOMY AND GENERAL PRINCIPLES OF  Chemical break down of food particles into
REGULATION IN THE GASTROINTESTINAL TRACT nutrient molecules / more absorbable
DR. W. ANTONIO / 5TH OF December, 2015 molecules
FINALS: QUIZ 3
RED= EMPHASIZED DURING THE LECTURE, 2. MOTILITY – moves and mixes food along GI tract
ITALIC, BLUE LETTERS= AUDIO, a. Peristalsis
GREEN- OT/BOOK  Reflexive contractions triggered by gut wall
distention
FUNCTIONAL ANATOMY  Presence of bolus Stimulation of distention
of lumen  proximal contraction (with
simultaneous relaxation)forward
movement of food along GI tract
 Propulsion by swallowing
b. Segmentation
 Simultaneous contractions of GI tract
 Does not result to forward propulsion of bolus,
but results to mixing and digestion of contents
of the intestine

3. SECRETION
 important for chemical digestion
 Enzymes and hormones for hydrolysis
 Water and electrolytes, protein, humoral agents for
immune function of GI
 Functions of mucous: digestive, protective and
facilitates movement of bolus

4. ABSORPTION
 Passage of nutrients from the GI tracts into the
circulation
 majority of absorption occurs in the small intestine
 GI tract is a hollow tube of major functional segments:
** The GI tract also serves as an important organ for excretion of
mouth, esophagus, stomach, small intestine (duodenum,
substances.
jejunum, ileum), large intestine (caecum, ascending
colon, transverse, descending colon), rectum, anus
OVERVIEW
 Accessory organs: tongue, teeth, salivary glands, liver,
 Mouth- carbohydrate digestion and minimal fat
gallbladder and pancreas; important for the functioning
digestion, motility, secretion of saliva- lingual lipase,
of GI tract
absorption, i.e. sublingual medication, alcohol, etc. but
 The GI tract represents the largest immune organ of the
not the nutrients
body.
 Esophagus- motility and secretion of mucus to facilitate
movement of food down to stomach
PHYSIOLOGIC PROCESSES OF GI FUNCTION
1. DIGESTION  Stomach- digestion: churning will further break down
a. Mechanical food- protein digestion by pepsin, motility, secretion,
absorption of lipid soluble substances such as alcohol
 Muscular movements of the digestive tract
and aspirin
 Physically breaks down food into smaller
 Small Intestine- digestion of carbohydrates, proteins
particles
and fats by pancreatic amylase, protease and lipase,
 Start at the mouth – chewing, churning
emulsification of non-water soluble fats by bile acids,
b. Chemical
motility, secretion, Majority of absorption
 Hydrolysis (main chemical process in
 Large Intestine/ Colon- No digestion in large intestine,
digestion of nutrients) reactions aided by
but with bacteria, polysaccharide can be digested to
enzymes
form short chain fatty acids, absorption of short chain
 Salivary amylase: for initial digestion of
fatty acids, secretion of mucus, motility
carbohydrates in the mouth

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GI SPHINCTERS
PHYSIOLOGY
4. Sphincter of Oddi
 Prevents back flow of food to bile or pancreatic tracts
 Closes the tract that comes from the gallbladder and the
pancreas
 GI exposed to external environment, may ingest
microorganisms
 S. Of Oddi prevents inflow of microorg into the biliary
tract
**Oral nutrition is better than parenteral nutrition (through
intravenous vessels) because parenteral nutrition is prone to
infection
**Use parenteral nutrition only if the gut is not functioning

5. Ileocecal valve
 Separates small intestine (chyme) from the cecum/large
intestine (fecal materials)
 Prevents back flow of fecal materials
1. Upper esophageal sphincter
6. Internal and external sphincters
 Closed during inhalation
 After swallowing, it closes to prevent back flow of food
BLOOD SUPPLY
from the esophagus; protects the inflow of air into the
 Celiac Artery
esophagus (too much air in GI is painful)
 Superior Mesenteric artery
2. Lower esophageal sphincter / Gastroesophageal sphincter  All nutrients absorbed in the Portal VeinLiver: where
nutrients are metabolized to energy
 Prevents regurgitation of food particles from the
stomach to the esophagus
LYMPHATIC DRAINAGE
 Ensures efficient digestion (massive contraction when
 Lipids and other lipid-soluble molecules are packaged
there is food; strong contractions may move food
into particles that are too large to enter the portal vein,
forward to duodenum or reflux back to the esophagus)
so instead they pass into the lymph vessels of the gut
 Closes after the bolus reaches the stomach
wall drain into larger lymph ductsthoracic duct
 Stomach – only organ resistant to acid; without the
systemic circulation
different sphincters, acid may reflux and injure other
organs
HISTOLOGY
 Failure of this sphincter to function may result to GERD
 Gastroesophageal Reflux Disease/GERD – back flow of
gastric contents into esophagus; injuring (erosive) the
esophagus (esophagitis) causing heartburn, acid
regurgitation
 Small amounts of acid can normally reflux, (when
swallowing, there is relaxation of LES which allows
small amounts of acid to reflux) it is a disease (GERD)
when it is already disturbing to the patient (persistent
pain, sore throat, asthma attacks, chronic coughing)
 **Achalasia- sphincter does not relax satisfactorily

3. Pylorus/ Pyloric ring

 Prevents forward movement of food that is in the
stomach
 Controls the flow of the chyme from stomach to small
intestine: ~2 mL per minute to allow adequate mixing
(bolus + gastric contents) which is pushed into the
duodenum)
 Rapid outflow: inefficient digestion

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4 Layers Of GI 4. SEROSA
1. MUCOSA – innermost layer; in contact with the food we eat  “Adventitia” of esophagus ** no serosa in esophagus
a. Epithelium  Outermost layer consisting of squamous epithelial cells
 Esophagus: squamous epithelium, non-  Part of mesentery that lines the surface of the
stratified abdominalwall and suspends the organs within
 Why squamous epithelium? It is the protective abdominal cavity
mechanism of the body because sometimes we Esophageal malignancy can easily spread/ progress because wala
swallow food without chewing it. It is protection siyang serosa.
from partially undigested food.
 Single cell layer lining of the GIT lumen GIT REGULATORY MECHANISMS
 stomach and small intestine: Simple columnar  for Stimulation of smooth muscle cells for contraction,
epithelium specialized cells for enzyme production, etc.
 where specialized cells are found
 Enterocytes- most abundant
 Absorptive cells
 Enteroendocrine cells- contain
secretory granules that release
regulatory peptides and amines
 surface area of epithelium is arranged into villi
and crypts

b. Lamina propria
 Loose CT (collagen and elastin fibrils)
 Glands, lymph vessels, nodules,
capillaries and nerve endings

c. Muscularis mucosae
 Folds in the stomach
 Thin innermost layer

2. SUBMUCOSA (SS)
1. Endocrine
 Loose CT (collagen and elastin fibrils)
 production of hormones portal circulation liver
 In some regions, glands are present
 Large nerve trunks, blood vessels and lymph vessels of systemic circulationtarget cell: distant cell
the intestinal wall that lie in this layer + one of the  enteroendocrine cell (EEC): sensing cell of GI
plexuses of the enteric nervous system = submucosal tractresponds
plexus aka Meissner’s plexus  to stimulus by secreting regulatory peptide or
hormone circulation target cell
3. MUSCULARIS EXTERNA (MM)  2 types of EECs:
 “Muscularis propria”  Open type-(common type) with apical membrane
 2 layers of smooth muscles: that is in contact with the lumen of GI tract and a
 Inner circular layer – contraction makes it basolateral membrane where secretion occurs
smaller  Closed type- no part of their membrane in contact
 Outer longitudinal layer – contraction makes it with the lumen, i.e., enterochromaffin-like (ECL)
shorter cell which secretes histamine
 Important for mixing and propulsion of luminal  hormones produced: secretin (first hormone identified)
 contents and gastrin (stimulated by activation of
 Myentenric nerve plexus aka Auerbach’s– in between parasympathetic outflow, stimulates gastric acid
the secretion, postprandial)
 circular and longitudinal layer of muscles
 Stomach has 3 muscle layers: 2. Paracrine
 Oblique muscle layer  located outside the gut wall
 Inner circular  Paracrines; stimulation of enteroendocrinesecretions
 Outer longitudinal can act locally

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 Histamine: paracrine mediator; stored and released by GUT STIMULI EVOKE DIGESTIVE RESPONSE VIA THE
ECL ENTERIC AND THE CENTRAL NERVOUS SYSTEMS
 cells located in gastric glands; stimulates production of
acid
 Serotonin: regulates smooth muscle function and water
 absorption

3. Neural
   The autonomic nervous system (ANS) of the GI tract **CNS has no direct action to effectors; it only modulates the
comprises both extrinsic and intrinsic nervous systems.
enteric nervous system.
Extrinsic innervation (parasympathetic and sympathetic
nervous systems)
 nerves that innervates the gut, with cell bodies located
outside the gut wall
a. Parasympathetic nervous system
   is usually excitatory on the functions of the GI tract.
 cell bodies located outside the GI tract in the CNS
(1) The vagus nerve innervates the esophagus, stomach, small
intestine, caecum, and ascending colon.
Its cell bodies are located in the brainstem specifically medulla
oblongata.
(2) The pelvic nerve innervates the transverse colon, descending
colon, and sigmoid colon.
Its cell bodies are located in the Sacral spinal cord.

b. Sympathetic nervous system

   is usually inhibitory on the functions of the GI tract but
stimulates contraction of sphincters
 Sensory and Secretory GI functions
 supplied by cell bodies in the spinal cord and fibers that
terminate in the prevertebral ganglia ( celiac, superior
and inferior mesenteric ganglia)
 It innervates, esophagus, stomach and small intestine

Intrinsic innervation (enteric nervous system)

 ‘Little Brain of the Gut’
 Cell bodies located in the GI wall
   coordinates and relays information from the
parasympathetic and sympathetic nervous systems to
the GI tract.
   controls most functions of the GI tract, especially
motility and secretion, even in the absence of extrinsic
innervation.

a. Myenteric plexus (Auerbach plexus)

-   primarily controls the motility of the GI smooth muscle.

b. Submucosal plexus (Meissner plexus)

-  primarily controls secretion and blood flow.
-   receives sensory information from chemoreceptors and
mechanoreceptors in the GI tract.

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