Option D.

2 Digestion

Exocrine glands produce and secrete substances via a duct onto an epithelial surface –
either:
■ The surface of the body (e.g. sweat glands, sebaceous glands)
■ The lumen of the digestive tract / gut (e.g. digestive glands)

Examples of digestive glands include:

■ Salivary glands – secrete saliva which contains amylase (breaks down starch)
■ Gastric glands – secretes gastric juices which includes hydrochloric acid and
proteases (breaks down protein)
■ Pancreatic glands – secretes pancreatic juices which include lipase, protease
and amylase
■ Intestinal glands – secretes intestinal juices via crypts of Lieberkuhn in the
intestinal wall

Exocrine glands are composed of a cluster of secretory cells which collectively form an
acinus (plural = acini)
■ The acini are surrounded by a basement membrane and are held together by
tight junctions between secretory cells
■ The secretory cells possess a highly developed ER and golgi network for
material secretion and are rich in mitochondria

Exocrine products are released (via secretory vesicles) into a duct, which connects to
an epithelial surface
■ These ducts may arise from a convergence of smaller ductules (each connected
to an acinus) in order to enhance secretion
The secretion of digestive juices is controlled by both nervous and hormonal
mechanisms
■ These mechanisms control both the volume of secretions produced and the
specific content (e.g. enzymes, acids, etc.)

Nervous Mechanism:
■ The sight and smell of food triggers an immediate response by which gastric
juice is secreted by the stomach pre-ingestion
■ When food enters the stomach it causes distension, which is detected by stretch
receptors in the stomach lining
■ Signals are sent to the brain, which triggers the release of digestive hormones to
achieve sustained gastric stimulation

Hormonal Mechanism:
■ Gastrin is secreted into the bloodstream from the gastric pits of the stomach and
stimulates the release of stomach acids
■ If stomach pH drops too low (becomes too acidic), gastrin secretion is inhibited
by gut hormones (secretin and somatostatin)
■ When digested food (chyme) passes into the small intestine, the duodenum also
releases digestive hormones:
■ Secretin and cholecystokinin (CCK) stimulate the pancreas and liver to
release digestive juices
■ Pancreatic juices contain bicarbonate ions which neutralise stomach
acids, while the liver produces bile to emulsify fats

Control of Gastric Secretions

The gastric glands that line the stomach wall secrete an acidic solution that creates a
low pH environment within the stomach
■ The normal pH of the stomach is roughly 1.5 – 2.0, which is the optimum pH for
hydrolysis reactions by stomach enzymes

The acid conditions in the stomach serve a number of functions:

■ Assists in the digestion of food (by dissolving chemical bonds within food
molecules)
■ Activates stomach proteases (e.g. pepsin is activated when pepsinogen is
proteolytically cleaved in acid conditions)
■ Prevents pathogenic infection (stomach acids destroy microorganisms in
ingested food)

The stomach wall is lined by a layer of mucus, which protects the stomach lining from
being damaged by the acid conditions
■ The pancreas releases bicarbonate ions into the duodenum which neutralises the
stomach pH (intestinal pH ~7.0 – 8.0)
■ Certain foods (e.g. antacids) may also neutralise stomach acids, impairing
digestion and increasing chances of infection

Acid Conditions in the Stomach

The low pH environment of the stomach is maintained by proton pumps in the parietal
cells of the gastric pits
■ These proton pumps secrete H+ ions (via active transport), which combine with
Cl– ions to form hydrochloric acid
■ Certain medications and disease conditions can increase the secretion of H+
ions, lowering the pH in the stomach

Proton pump inhibitors (PPIs) are drugs which irreversibly bind to the proton pumps and
prevent H+ ion secretion
■ This effectively raises the pH in the stomach to prevent gastric discomfort caused
by high acidity (e.g. acid reflux)
■ Individuals taking PPIs may have increased susceptibility to gastric infections
due to the reduction of acid secretion

Proton Pump Inhibitors (PPIs)

Once digested food has passed through the stomach, it enters the small intestine for
absorption into the blood
■ The small intestine also releases digestive enzymes to ensure the complete
hydrolysis of food molecules

The inner epithelial lining of the small intestine is highly folded into finger-like projections
called villi (singular: villus)
 ■ Many villi will protrude into the intestinal lumen, greatly increasing the available
surface area for material absorption
Features of Villi
Intestinal villi contain several structural features which facilitate the absorption of
digestive products:

■ Microvilli – Ruffling of epithelial membrane further increases surface area

■ Rich blood supply – Dense capillary network rapidly transports absorbed
products
■ Single layer epithelium – Minimises diffusion distance between lumen and
blood
■ Lacteals – Absorbs lipids from the intestine into the lymphatic system
■ Intestinal glands – Exocrine pits (crypts of Lieberkuhn) release digestive juices
■ Membrane proteins – Facilitates transport of digested materials into epithelial
cells

Mnemonic: MR SLIM

Features of Intestinal Villi

The human intestines function to complete the process of digestion and absorb digested
products into the bloodstream
 ■ The small intestine absorbs usable food substances (i.e. nutrients –
monosaccharides, amino acids, fatty acids, vitamins, etc.)
■ The large intestine absorbs water and dissolved minerals (i.e. ions) from the
indigestible food residues

Dietary Fibre
Dietary fibre, or roughage, is the indigestible portion of food derived principally from
plants and fungi (cellulose, chitin, etc.)
■ Humans lack the necessary enzymes to break down certain plant matter (e.g.
lack cellulase required to digest cellulose)
■ Certain herbivores (ruminants) possess helpful bacteria in the digestive tract that
can break down indigestible plant matter

The rate of transit of materials through the large intestine is positively correlated with
their fibre content:
■ Roughage provides bulk in the intestines to help keep materials moving through
the gut
■ Roughage also absorbs water, which keeps bowel movements soft and easy to
pass

There are several health benefits associated with diets rich in dietary fibre:
■ It reduces the frequency of constipation and lowers the risk of colon and rectal
cancer
■ It lowers blood cholesterol and regulates blood sugar levels (by slowing the rate
of absorption)
■ It aids in weight management (contributes few calories despite consisting of a
large volume of ingested material)
Egestion
Materials that are not absorbed by the small and large intestines are ultimately egested
from the body as faeces
■ A large portion of human faeces consists of dietary fibre, such as cellulose and
lignin
■ Also present in faeces are the remains of intestinal epithelial cells, bile pigments
and human flora (intestinal bacteria)

Summary of egested materials:

 ■ Bile pigments
■ Epithelial cells
■ Lignin
■ Cellulose
■ Human flora (bacteria)

Mnemonic: BELCH
Stomach ulcers are inflammed and damaged areas in the stomach wall, typically
caused by exposure to gastric acids
■ There is a strong positive correlation between Helicobacter pylori infection and
the development of stomach ulcers

Helicobacter pylori is a bacterium that can survive the acid conditions of the stomach by
penetrating the mucus lining
■ H. pylori anchors to the epithelial lining of the stomach, underneath the mucus
lining
■ An inflammatory immune response damages the epithelial cells of the stomach –
including the mucus-secreting goblet cells
■ This results in the degradation of the protective mucus lining, exposing the
stomach wall to gastric acids and causing ulcers
■ The prolonged presence of stomach ulcers may lead to the development of
stomach cancer over many years (20 – 30 years)
■ H. pylori infections can be treated by antibiotics (previously, stomach ulcers were
considered stress related and not treatable)

Stomach Ulcer Formation

Vibrio cholerae is a bacterial pathogen that infects the intestines and causes acute
diarrhoea and dehydration
■ The associated disease – cholera – can kill within hours unless treated with oral
rehydration therapies

V. cholerae releases a toxin that binds to ganglioside receptors on the surface of

intestinal epithelium cells
■ This toxin is internalised by endocytosis and triggers the production of cyclic
AMP (a second messenger) within the cell
■ Cyclic AMP (cAMP) activates specific ion channels within the cell membrane,
causing an efflux of ions from the cell
■ The build up of ions in the intestinal lumen draws water from cells and tissues via
osmosis – causing acute diarrhoea
■ As water is being removed from body tissues, dehydration will result if left
untreated
Mechanism of Action of Cholera Toxin
The digestive system contains numerous organs that contribute to the secretion of
digestive juices
■ These organs include the salivary glands, stomach, liver, pancreas and small
intestine
Organs Involved in Digestive Juice Production

Salivary Glands
■ Initiate chemical digestion while food is still being physically chewed within the
mouth
■ Secretes salivary amylase, which assists in the breakdown of glucose polymers
(e.g. starch)
Stomach
■ Produces stomach acids which aid in the chemical breakdown of food materials
■ Secretes proteases to function as the initial site of protein digestion
■ Stomach proteases typically require acid conditions for activation (e.g.
pepsinogen → pepsin)
Liver
■ Produces bile which is responsible for the emulsification of fats (separates fats
globules to enhance lipase activity)
■ Bile produced in the liver is commonly stored in the gall bladder until release
Pancreas
 ■ Secretes bicarbonate ions into the duodenum to neutralise stomach acids
(intestine pH is usually ~ 7 – 8)
■ Also secretes lipase (for fat digestion), amylase (for carbohydrate digestion) and
protease (for protein digestion)
■ Pancreatic proteases are activated by enzymes and not by acid conditions
(enterokinase converts trypsinogen to trypsin)
Small Intestine
■ Intestinal juices are secreted from pits called crypts of Leiberkuhn, located
between intestinal villi
■ Digestive enzymes in the small intestine are typically immobilised on the
epithelial membrane (e.g. maltase)
■ This prevents the enzymes from being removed from the body as part of the
normal digestive cycle
■ It also concentrates the digestive products at sites where membrane proteins are
present (to optimise absorption)

The stomach wall is lined with millions of gastric pits which release gastric juice into the
stomach lumen
■ Gastric juice is an acidic solution that functions to break down food into a creamy
paste called chyme

The gastric pits are lined by a number of different cell types which contribute to the
overall function of the stomach:
■ Goblet cells – secrete mucus to form a protective layer around the stomach lining
■ Parietal cells – secrete hydrochloric acid which is responsible for creating a low
pH environment in the stomach
■ G cells – secrete gastrin (stimulates
release of stomach acids to increase
stomach acidity)
■ D cells – secrete somatostatin
(inhibits release of stomach acids to
reduce stomach acidity)
■ Chief cells – secrete pepsinogen
(inactive protease precursor which is
activated by acidity to form active
pepsin)