Gastrointestinal physiology

By: Zewdu Jima 1

 GI tract divided into:
1. Alimentary canal
Mouth, Pharynx,
Esophagus, Stomach
Small intestine,
Large intestine,
Rectum & Anus
- digests and absorbs food

2. Accessory digestive
organs.
Salivary glands,
Pancreas, Liver ,
Gallbladder
- produce and send
secretions that
facilitate chemical
breakdown of food
2
 Clinically speaking,

 “upper GI” refers to the

esophagus
and stomach, and

 “lower GI” refers to

the small intestine and
large intestine.

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• The major physiological processes that occur in the GI tract are:
 Ingestion-Taking of food into the GI tract by way of the mouth
 Mastication-Chewing of food in the mouth and mix it with saliva
(salivary action, a chemical process).
 Deglutition-Swallowing of food
 Peristalsis-Rhythmic, wavelike contractions that move food
through the GI tract
 Secretion-Includes both exocrine and endocrine secretions.
 Digestion-Breakdown of food particles into subunits
(mechanical and chemical processes).
 Absorption-Passage of food molecules through the mucous
membrane of the small intestine and into the circulatory or
lymphatic systems
 Defecation-Discharge of indigestible wastes, called feces, from the

GI tract
4
 GI Smooth Muscle Fibers

• In the longitudinal muscle layer, the bundles extend longitudinally

down the intestinal tract; in the circular muscle layer, they extend
around the gut.

• Therefore, each muscle layer functions as a syncytium;

that is, when an action potential is elicited anywhere within the
muscle mass, it generally travels in all directions in the muscle
 Electrical Activity of GI Smooth Muscle
• The smooth muscle of the GIT is excited by almost continual slow, intrinsic
electrical activity along the membranes of the muscle fibers

• proposed..... by pecialized cells, called the interstitial cells of

Cajal
- act as electrical pacemakers

- are coupled with smooth muscle cells via gap junctions

- produce inward (pacemaker) currents that may

generate slow wave activity

- usually do not by themselves cause muscle contraction,

- because do not cause Calcium to enter the smooth

muscle fibers
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10
 Spike Potentials

• true action potentials

• occur when the resting membrane potential of the GI smooth

muscle becomes more positive than about -40 mv

• the channels responsible for the action potentials;

- are calcium-sodium channels

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12
Factors that depolarize the membrane
—that is, make it more excitable—are
(1) stretching of the muscle
(2) stimulation by acetylcholine
(3) stimulation by parasympathetic nerves
(4) stimulation by GI hormones

Important factors that make the membrane

potential more negative—that is,
hyperpolarize the membrane and make the
muscle fibers less excitable—are
(1) NE/Epi
(2) stimulation of the sympathetic nerves

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 Regulation of the GI functions

• There are three principal control mechanisms involved in the

regulation of GI function:
- neural
- endocrine
- paracrine

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 1. Neural Regulation of GI Function

• The gut is innervated by two sets of nerves,

- the intrinsic and extrinsic nervous systems.

• The intrinsic nervous system,

- also referred to as the enteric nervous system
- has cell bodies that are contained within the wall of the gut
(submucosal and myenteric plexuses).

• The extrinsic nervous system

- is defined as nerves that innervate the gut, with cell bodies
located outside the gut wall
- these extrinsic nerves are part of the autonomic nervous
system (ANS).
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 Enteric Nervous System

• lies entirely in the wall of the gut, beginning in the esophagus and
extending all the way to the anus.
• can act independently and are therefore, called little brain

• important in controlling GI movements/motility and secretion.

• is composed mainly of two plexuses

- an outer plexus lying between the longitudinal and circular

muscle layers, called the myenteric plexus/Auerbach’s plexuses

- an inner plexus, that lies in the submucosa, called the

submucosal plexus/ Meissner’s plexus,.
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• The myenteric
plexus controls
- mainly the GI
movements

• The submucosal
plexus controls

- mainly GI secretion
and local blood
flow

17
• Note :
the extrinsic sympathetic
and parasympathetic fibers
that connect to both the
myenteric and submucosal
plexuses

• Although the enteric nervous

system can function on its own,
independently of extrinsic
nerves, stimulation by the
parasympathetic and
sympathetic systems can
greatly enhance or inhibit
GI functions

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The extrinsic nervous system

Parasympathetic Innervation

• Stimulation of parasympathetic nerves causes general

increase in activity of the entire enteric nervous system,
- in turn stimulates activity of most GI functions(increases
motility, secretion, relaxes GI sphincters)
• Secretes Ach
Sympathetic Innervation
• secretes nor-epinephrine and epinephrine
• In general, stimulation of the sympathetic nervous system
inhibits activity of the gastrointestinal tract(decreases
motility, secretion, constricts GI sphincters)
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 Functional Types of Movements in the GIT

• Two types of movements occur in the GIT:

(1) Propulsive Movements
- propel food forward along
the tract
- The basic propulsive
movement of the GIT is
peristalsis
- A contractile ring appears
around the gut and then
moves forward
- The usual stimulus for
intestinal peristalsis;
• distention
• chemical or physical irritation 21
• Direction
- Peristalsis, theoretically, can occur in either direction
from a stimulated point

- but it normally dies out rapidly in the orad direction while

continuing for a considerable distance toward the anus.

- During the act of vomiting, retro-peristalisis is occurs in the

small intestine.

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(2) Mixing Movements

• Mixing movements: mix food with digestive juices

Eg. Segmentation

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CHEWING

• Chewing has three major functions:

(1) it facilitates swallowing by reducing the size of ingested

particles

(2) it mixes food with saliva, which exposes the food to

digestive enzymes and lubricates it;

(3) it increases the surface area of ingested material and

thereby increases the rate at which it can be digested
SWALLOWING (DEGLUTITION)

• transports food from the pharynx to the stomach.

• initiated voluntarily, the n becomes under reflex control
(involuntarily)
• respiration is inhibited due t closure of the glottis and

• relaxation of the upper esophageal sphincter(UES), propel

the bolus into the esophagus

• relaxation of the lower esophageal sphincter(LES) allows

food to enter the stomach.

• The LES is a barrier to the reflux of the stomach contents

into the esophagus
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 The Stomach

• the stomach can be divided into two regions based on

patterns of motility:

1. the proximal region

- weak contraction
- accommodate an ingested meal(Reservoir)
- food is deposited in this part and may remain
relatively unmixed for up to an hour

2. the distal region

- strong contractions
- The contraction begins in the midregion of the
stomach and pushes contents toward the
duodenum
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28
• most of the distal contents
are forced back and forth

- between the contractions,

there is opening of the
pyloric sphincter then a
portion of the contents is
propelled into the
duodenum.

- but most is propelled back

into the body of the
stomach known as
‘‘retropulsion’’
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Migrating Motility Complex (MMC):

• Is a strong peristaltic wave that occurs in between meals and

lasts about 90 min

• called hunger contractions

• mild pain in the pit of the stomach, called hunger pangs

• The cause is the hormone “motilin” that increases during

fasting in the stomach.

• Motilin is suppressed by feeding/ Eating abolishes the migrating

motility complex.

• performs a housekeeping function by sweeping gastric acid

to the ileum to prevent bacterial overgrowth in the gut

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 Vomiting
• is the forceful expulsion of intestinal and gastric contents
through the mouth.

• is usually, but not necessarily, associated with the feeling of

nausea.

• A wave of reverse peristalsis begins in the distal small intestine

moving intestinal contents in orad diretion.

• A contraction of the antrum and continued reverse peristalsis

force the gastric contents through a relaxed lower esophageal
sphincter into the esophagus.

• then, the increased intrathoracic pressure forces the contents of

the esophagus past the upper esophageal sphincter and out of
the mouth. 31
• Vomiting is reflexively
controlled by the vomiting
center located in the medulla

• The vomiting center is activated

by afferent impulses triggered
by diverse stimuli from many
parts of the body.
- include tickling the back of
the throat
- distension of the stomach or
duodenum
- dizziness
- unequal vestibular stimulation
- pain from the urogenital system
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- other painful injuries
• Various chemicals stimulate vomiting by acting on either
central or peripheral receptors.

- by emetics in the blood or cerebrospinal fluid. .

• Chemically sensitive receptors also occur and primarily in the

GI tract.

• Stimulation of this zone also occurs during vomiting arising

from radiation or motion sickness

• In general, vomiting is a protective mechanism to rid

the body of noxious or toxic substances.

• Prolonged vomiting, however, can cause severe problems in

fluid and electrolyte balance
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Secretion of Saliva

- Daily secretion of saliva normally ranges between 800- 1500 ml

• Salivary Glands;
a. Parotid /25%:

- Secrete saliva that is rich in water , electrolytes and

ptyalin.

b. Submandibular /70%: and Sublingual/ ~5%

- both secrete saliva that is rich in mucin

d. many very small buccal glands

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Composition :
A. H2O (99.5%): facilitates taste and dissolution
B. Electrolytes ( 0.5%): Na+, Cl-, K+, HCO3-, etc
C. Mucin : for lubrication
D. Enzymes: ptyalin/α-amylase/salivary amylase,
lingual lipase
E. Lysozymes, thiocyanate, Glycoprotein's, albumin, globulin,
IgA, mucus, etc.- defense

- pH is almost neutral (pH =7)

Functions: - lubrication and moistening of the oral cavity

- chemical digestion / starch digestion
- dissolve and teste; role in water intake
- mixing
- bacterial attack
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- oral hygiene
 Nervous Regulation of Salivary Secretion
• salivary glands are controlled mainly by parasympathetic

• Sympathetic stimulation can also increase salivation a slight

amount

• Factors that cause salivation

- taste and tactile stimuli from the tongue and other areas
of the mouth and pharynx
- reflexes originating in the stomach and upper small intestine
- nervous signals arriving in the salivatory nuclei from
higher centers of the central nervous system

* Psychic stimulation, sight, hearing, Impulses from

the feeding centre in the hypothalamus 37
 Esophageal Secretion
• The esophageal secretions are entirely mucous in character and
principally provide lubrication for swallowing.

Gastric Secretion

• the stomach mucosa has,

- Two important types of tubular glands:

I. gastric glands
II. pyloric glands
- and mucus-secreting cells

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I. Secretions from the Gastric Glands

• composed of three types of cells:

(1) parietal(or oxyntic) cells, which secrete hydrochloric

acid and intrinsic factor.

(2) chief (peptic) cells, which secrete large quantities of

pepsinogen

(3) mucous neck cells, which secrete mainly mucus

(4) Enterochromaffin-like(ECL), cells release histamine

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41
Basic Mechanism of HCl Acid Secretion
• the parietal cells secrete an acid solution, which is almost
exactly isotonic with the body fluids.

• The pH of this acid is about 0.8

- extremely acidity.

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Steps in HCl secretion

1. H2CO3 formed as the result of metabolism breaks into H+

and HCO3- ion in parietal cells
CA
H2O + CO2 → H2CO3 →H+ +HCO3-

2. H+ is actively pumped into the lumen of the stomach by

H+ - K+ ATPase

3. Cl- ion passes into the ICF of parietal cells from ECF in
exchange to HCO3- ion

4. Cl- is actively pumped into the lumen of the canaliculus

(lumen of the stomach)
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5. In the lumen H combines with Cl to form HCl acid
+ -
44
• somatostatin
—inhibits HCl secretion.

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• Mucus production is stimulated by prostaglandins, which also
directly inhibit gastric acid secretion by parietal cells.

• Thus, alcohol, aspirin, and other drugs that inhibit prostaglandin

formation decrease mucus secretion and predispose to the
development of acid-peptic disease.
 Function of HCl in the stomach

1. Kills most of the bacteria's in food

2. Stimulates hunger, so important in appetite regulation

3. Activates the pro-enzyme Pepsinogen into its active pepsin

that denatures peptide bonds to produce amino acids.

4. Enhances motility of the stomach etc.

Absorption in the stomach

• No food or water is absorbed into the blood through the
stomach mucosa. However, two noteworthy nonnutrient
substances are absorbed directly by the stomach—ethyl
alcohol and aspirin.
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Clinical correlate

Heart burn

• This burning sensation is

caused by the reflux of
gastric acid into the
esophagus and the
resulting injury to the
esophageal mucosa
Helicobacter pylori (H. pylori)

• is a type of bacteria
• can enter your body and live in your digestive tract
• After many years, they can cause sores, called ulcers,in the
lining of your stomach
•  it attacks the lining of your stomach, which usually protects
you from the acid
• Once the bacteria have done enough damage, acid can get
through the lining, which leads to ulcers.
Secretion and Activation of Pepsinogen
• When pepsinogen (inactive) is first secreted, it has no digestive
activity.
• hydrochloric acid activated pepsinogen to form the active pepsin.
• pepsin is necessary for protein digestion in the stomach

Secretion of Intrinsic Factor

• The substance intrinsic factor, essential for absorption of vitamin
B12 in the ileum, is secreted by the parietal cells 51
II. Pyloric Glands—Secretion of Mucus and Gastrin

• they contain mostly mucous cells that are identical with the
mucous neck cells of the oxyntic glands.

• secrete large amount of thin mucus

- helps to lubricate food movement
- protect the stomach wall from digestion by the gastric
enzymes.

• also secrete the hormone gastrin(G-cells)

- a key role in controlling gastric secretion (stimulate
HCl secretion)

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III. Surface Mucous Cells

- secrete large quantities of mucous that coats the

stomach mucosa

- which provides a major shell of protection for the

stomach

- wall as well as contributing to lubrication of food

transport.

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Summary - Secretions in the stomach

Cells Secretions(gastric juice)

1. Parietal cells HCl + IF (intrinsic factor)

2. Chief cells Pepsinogen (stimulated by HCl)
3. Mucous cells: mucous
4. G-cells: Gastrin (at pyloric antrum)
5. D-cells Somatostatin
6. ECL-cells Histamine
7. Electrolytes
8. Water

* ECL-cells- enterochromaffin-like cells

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 Pancreatic Secretion

• Pancreatic juice is composed of digestive enzymes and

bicarbonate solution

• secreted by pancreatic acini- for fat, protein and carbohydrate

digestion

• The combined product then flows through a long pancreatic

duct that normally joins the hepatic duct immediately before it
empties into the duodenum

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56
Pancreatic Digestive Enzymes

• The pancreatic enzyme for digesting carbohydrates is pancreatic

amylase

• The main enzymes for fat digestion is pancreatic lipase

•the pancreatic enzymes for digesting proteins are:

- trypsin
- chymotrypsin
- carboxypolypeptidase.

• When first synthesized in the pancreatic cells, the proteolytic

digestive enzymes are in the inactive forms.

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• in small intestine, Trypsinogen is activated by an enzyme called
enterokinase

• then Trypsin activates trypsinogen,Chymotrypsinogen and

procarboxypolypeptidase.

• Secretion of Trypsin Inhibitor Prevents Digestion of the

Pancreas Itself.

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 Secretion of Bile by the Liver
• One of the many functions of the liver is to secrete bile
• normally between 600 and 1000 ml/day
• Bile is an alkaline fluid (pH 8)
• Bile serves two important functions:

 First, bile plays an important role in fat digestion and

absorption
- because bile acids in the bile

 emulsify the large fat particles of the food into many

minute particles/micelles

 aid in absorption of the digested fat end products

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 Second, bile serves as a means for excretion of several
important waste products from the blood.

 include especially bilirubin, an end product of

hemoglobin destruction

 excesses of cholesterol.

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Enterohepatic Circulation

Insert fig. 18.22

• Bile is secreted continually by the liver cells, but most of it is
normally stored in the gallbladder until needed in the
duodenum.

• The maximum volume that the gallbladder can hold is only 30 to

60 milliliters.

• The gallbladder bile is more highly concentrated.

• Water absorption is the major mechanism involved in

concentrating hepatic bile by the gallbladder

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• Generally, Bile contains the following major ingredients:

(1) bile salts (bile acids)

(2) lecithin (a phospholipid)
(3) bicarbonate ions and other salts
(4) cholesterol
- Bile is the primary excretory pathway for
cholesterol.
(5) bile pigments(bilirubin) and small amounts of other
metabolic end products
(6) Electrolytes (Na+, K+, Ca2+, Cl- ,etc
(7) H2O (~ 84%) also takes the higher share of bile

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65
Digestive Enzymes in the Small Intestinal Secretion
• The enterocytes of the mucosa do contain digestive enzymes

that digest specific food substances

• These enzymes are the following:

(1) several peptidases for splitting small peptides into

amino acids

(2) 3 enzymes—sucrase, maltase, and lactase

—for splitting disaccharides into monosaccharides, and

(3) small amounts of intestinal lipase for splitting neutral

fats into glycerol and fatty acids. 66
 Secretions of the Large Intestine
• Mucus Secretion
- The epithelial cells contain mainly of mucous cells
that secrete only mucus. (almost no enzymes)

- This mucus contains moderate amounts of bicarbonate

ions
• Mucus in the large intestine ;
- protects the intestinal wall against excoriation
- it provides an adherent medium for holding fecal matter
together.
- it protects the intestinal wall from the great amount of
bacterial activity that takes place inside the feces
- provides a barrier to keep acids formed in the feces from
attacking the intestinal wall.
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Digestion and absorption of Carbohydrates

68
Digestion and absorption of proteins

69
Digestion and absorption of fats

70
 Water Absorption
• The average intake of water (in beverages and foodstuffs) is
roughly 1.5 L per day.

• An additional 7 L of fluid are secreted into the GIT whereas

only about 0.1 L/day is eliminated in the feces.

• The digestive tract must therefore absorb a net volume of at

least 8.4 L of water/day.

• GI absorption of water occurs mainly in the jejunum and

ileum (95%), with smaller quantities being absorbed by the
colon
Function of the large intestine

1. Water absorption
2. Electrolyte absorption; mainly NaCl
3. Mucous & HCO3- Secretion
4. Absorption of vitamins and some drugs
5. Storage, transport, and evacuation of feces

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 Clinical correlates

The appendix
• appendix has no digestive function
and remains a rudimentary tissue
(from cecum).

• The special feature is the presence

of mass of lymphoid tissues;
therefore sometimes named as the
intestinal tonsil.

• Distention, spasm or inflammation

caused by bacteria causes pain
(appendicitis).

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Constipation:

• is a common disorder, particularly of the colon.

• Reduced intestinal motility is mainly responsible for

constipation.

• Reduced motility increases storage time that in turn increases

the degree of water absorption from the colon.

• Dried feces are less bulky and, therefore, less likely to initiate
movement.

• Increased fiber content (cellulose, raw vegetable) may

improved fecal bulk and thus can stimulate colon motility.
Diarrhea:

• is characterized by excessive and frequent discharge of watery

feces induced by increased intestinal motility.

• Some causes:
 Toxins acting on intestinal glands (e.g. cholera) cause
secretion of electrolytes (Na+, Cl-, HCO3) into the lumen;
water follows by osmosis.

 Nervous (psychogenic) origin: anxiety increases

parasympathetic activity to the lower bowls that increasing
motility; absorption time decreases leading to diarrhea.

 Enzyme deficiency in the intestine (e.g., some subjects lack

the enzyme lactase (milk sugar) that is a common cause of
diarrhea.
Peptic ulcers :

• Normally the stomach and intestinal walls are protected by

mucosa against the eroding actions of HCL.

• Excess acid secretion erodes the wall creating wounds (ulcers).

If this are deep enough can reach the vascular layer and cause
bleeding.

• Increased secretion of Gastrin and excessive activity of the

Vagus nerve as well as psycho-physiological factors stemming
from anxiety and stress are believed to be involved as
causatives.

• Bacteria” Helicobacter pylori” is found to be another cause of

Ulcer
…….end….