Digestive System Notes

The digestive system is a system of body which breakdown food into forms that can be
absorbed and used by body cells. It also absorbs water, vitamins, and minerals, and eliminates
wastes from the body. It breakdowns the larger molecules present in food into molecules that are
small enough to enter body cells by a process known as digestion. The organs which are
involved in the breakdown of food are collectively called the digestive system. The digestive
system is a tubular system which extends from the mouth to the anus.

The digestive system

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The digestive system can be divided into two parts:
1. The gastrointestinal (GI) tract, or alimentary canal (alimentary = nourishment), is a
continuous tube that extends from the mouth to the anus. Organs of the gastrointestinal tract
include the mouth, most of the pharynx, esophagus, stomach, small intestine, and large
intestine.
2. The accessory digestive organs are the organs which assist in digestion of food. These
include the teeth, tongue, salivary glands, liver, gallbladder, and pancreas. Teeth aid in the
physical breakdown of food, and the tongue assists in chewing and swallowing. The other
accessory digestive organs never come into direct contact with food but they produce
secretions which aid in the chemical breakdown of food.

Functions of digestive system:

1. Ingestion: This process involves taking foods and liquids into the mouth (eating).
2. Secretion: Cells within the walls of the GI tract and accessory digestive organs secrete about 7
liters of water, acid, buffers, and enzymes into the tract which help in digestion of food.
3. Mixing and propulsion: Alternating contractions and relaxations of smooth muscle in the
walls of the GI tract mix food and secretions and propel them toward the anus. This capability of
the GI tract to mix and move material along its length is called motility.
4. Digestion: Digestion is of two types- Mechanical and Chemical digestion. In mechanical
digestion the teeth cut and grind food into smaller pieces. Then smooth muscles of the stomach
and small intestine break it into further small pieces and mix it thoroughly with digestive
enzymes. In chemical digestion the large carbohydrate, lipid, protein, and nucleic acid molecules
in food are split into smaller molecules by hydrolysis and digestive enzymes. Vitamins, ions,
cholesterol and water can be absorbed without chemical digestion.
5. Absorption: The entrance of ingested and secreted fluids, ions, and the products of digestion
into the epithelial cells lining the lumen of the GI tract is called absorption. The absorbed
substances pass into blood or lymph and circulate to cells throughout the body.
6. Defecation: Wastes, indigestible substances, bacteria, cells sloughed from the lining of the GI
tract, and digested materials that were not absorbed in their journey through the digestive tract
leave the body through the anus in a process called defecation. The eliminated material is termed
feces.

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Layers of GI Tract:
The wall of the GI tract has four layers tissues. These four layers (from deep to superficial) are
the mucosa, submucosa, muscularis, and serosa.

Layers of GIT
1. Mucosa: It is the inner lining of the GI tract. It is subdivided into 3 layers called Epithelium,
Lamina propria and muscularis mucosae.
 The epithelium may be simple or stratified which plays role in protection, secretion and
absorption. Epithelial cells also secrete mucus and fluid into the lumen of the tract.
 The lamina propria (lamina = thin) is areolar connective tissue containing many blood
and lymphatic vessels, which transfers the absorbed nutrients to the other tissues of the
body. The lamina propria also contains the mucosa-associated lymphatic tissue (MALT)
which contains immune system cells that protect against disease.
 Muscularis musosae is a thin layer of smooth muscle fibers which increases the surface
area of the stomach and small intestine by many folds to enhance digestion and
absorption.
2. Submucosa: The submucosa consists of areolar connective tissue that binds the mucosa to
the muscularis. It contains many blood and lymphatic vessels that receive absorbed food

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 molecules. It also contains an extensive network of neurons known as the submucosal plexus
or plexus of Meissner (a part of ENS).
3. Muscularis: Muscularis contains both skeletal muscles and smooth muscles. Skeletal
muscles help in voluntary swallowing and defecation. Involuntary contractions of the smooth
muscle help break down food, mix it with digestive secretions, and propel it along the tract.
The bundle of neurons present in this layeri is called myenteric plexus.
4. Serosa: It is a protective and connective tissue which forms the outer layer of the GI tract
which are suspended in the abdominopelvic cavity.

Peritonium:
It is the largest serous membrane. The peritoneum is divided into the parietal peritoneum, which
lines the wall of the abdominopelvic cavity, and the visceral peritoneum, which covers some of
the organs in the cavity and is their serosa.

Parts of digestive system:

1. Mouth:
 Mouth is also called Oral cavity or Buccal cavity. It is formed by cheeks, hard palate, soft
palate and tongue.
 Cheeks form lateral walls of mouth and are covered by skin from outside and mucous
membrane from inside.
 Hard palate forms anterior portion of roof of mouth. Hard palate is made up of palatine and
maxillae bones covered with mucous membrane. Hard palate forms bony partition between
oral and nasal cavity.
 Soft palate forms posterior portion of roof of mouth. It forms partition between oropharynx
and nasopharynx. Soft palate is also covered with mucous membrane.
 Uvula is small muscular process hanging from soft palate. It prevents entrance of swallowed
food and liquid into nasal cavity.

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2. Salivary glands:
A salivary gland is a gland that releases a secretion called saliva into the oral cavity. Saliva is
secreted to keep the mucous membranes of the mouth and pharynx moist and to cleanse the
mouth and teeth. When food enters the mouth, secretion of saliva increases, and it lubricates,
dissolves and begins the chemical breakdown of the food. There are 3 pairs of major salivary
glands which secrete saliva:
 The parotid glands: (par = near; ot = ear) are located near ears. These secretes saliva into
the oral cavity via a parotid duct that open into the vestibule opposite the second maxillary
(upper) molar tooth.
 The submandibular glands: (sub = below, mandible = lower jaw bone) are found in the
floor of the mouth, below lower jaw. Their ducts open into the oral cavity lateral to the
lingual frenulum.
 The sublingual glands: (sub = below, lingual = tongue) are beneath the tongue and superior
to the submandibular glands. Their ducts open into the floor of the mouth.
Several minor glands are also present in cheeks, palates, tongue and lips etc. which produce
small amount of saliva. Process of secretion of saliva is called salivation.

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Composition and functions of saliva:
 Chemically saliva consists of 99.5% water and 0.5% of solutes. Solutes include ions such as
chloride ions, sodium, potassium, bicarbonate and phosphate ions.
 It also contains various organic substances like urea, uric acid, mucus, immunoglobin A,
bacteriolytic enzyme lysozyme and salivary amylase.
 Water dissolves food and helps to produce taste of food to initiate digestion.
 Chloride ions in saliva activate salivary amylase which is an enzyme that starts breakdown of
starch.
 Phosphate and bicarbonate ions buffer acidic food so that saliva is only slightly acidic (6.35-
6.85)
 Mucus lubricates and moistens food for easy swallowing.
 IgA prevents microbes to enter or attach epithelial cells whereas lysozyme destroys harmful
bacteria.

3. Tongue:
Tongue is an accessory digestive organ composed of skeletal muscle covered with mucous
membrane. It helps to taste the food, swallow food and to speak. Tongue and its associated

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muscles form floor of tongue. Tongue is divided into 2 symmetrical lateral parts by a median
septum that extends its whole length. Tongue consists of two types of muscles:
 The extrinsic muscles move the tongue from side to side and in and out to maneuver food
for chewing, shape the food into a rounded mass, and force the food to the back of the mouth
for swallowing. They also form the floor of the mouth and hold the tongue in position.
 The intrinsic muscles alter the shape and size of the tongue for speech and swallowing.

A fold of mucous membrane in midline of undersurface of tongue called lingual frenulum is

attached to floor of mouth and controls posterior movement of tongue.
The upper surface and lateral surfaces of the tongue are covered with papillae. Many papillae
contain taste buds, the receptors for gustation (taste). Some papillae lack taste buds, but they
contain receptors for touch and increase friction between the tongue and food, making it easier
for the tongue to move food in the oral cavity.
Lingual glands are also present which secretes mucus and fluid containing an enzyme lingual
lipase which breakdowns the triglycerides.

4. Teeth:
 Teeth or dentes are the accessory digestive organs which cut, tear and pulverize the solid
food to reduce it into smaller particles which makes it easy to swallow and digest. Teeth are
located in aveolar processes of mandible and maxillae.

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 Aveolar processes are covered with gingivae (gums) that extend into each socket. Sockets are
lined by periodontal ligaments made of dense firbrous connective tissue with anchors teeth
into socket.

 A tooth has three parts: crown, root, and neck. The crown is the visible portion above the
level of the gums. Roots are the portion embedded in the socket. The neck is the constricted
junction of the crown and root near the gum line.
 Internally, dentin forms the majority of the tooth. Dentin gives the tooth its basic shape and
rigidity. It is harder than bone because of its higher content of calcium salts.
 The dentin of the crown is covered by enamel, which consists primarily of calcium phosphate
and calcium carbonate. Enamel is also harder than bone because of its even higher content of
calcium salts (about 95% of dry weight). In fact, enamel is the hardest substance in the body.
It serves to protect the tooth from the wear and tear of chewing. It also protects against acids
that can easily dissolve dentin.
 The dentin of the root is covered by cementum, another bone like substance, which attaches
the root to the periodontal ligament.
 The dentin of a tooth encloses a space which is called pulp cavity. This pulp cavity contains
blood vessels, nerves, and lymphatic vessels. Narrow extensions of the pulp cavity, called
root canals, run through the root of the tooth. Each root canal has an opening at its base, the
apical foramen, through which blood vessels, lymphatic vessels, and nerves extend. The

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 blood vessels bring nourishment, the lymphatic vessels offer protection, and the nerves
provide sensation.

Mechanical and Chemical digestion in the mouth:

 Mechanical digestion: Mechanical digestion starts with mechanical breakdown of food by
teeth by chewing or mastication. After chewing and mixing with saliva, food is converted
into soft, flexible and easily swallowed mass called bolus (lump). Small food molecules are
dissolved in saliva and water after which they are reacted upon by enzymes.
 Chemical digestion: It is done by 2 enzymes:
a. Salivary amylase: It is secreted by salivary glands. It causes breakdown of starch into
simple units of monosaccharides and bisaccharides. Food contains mono, bi and
polysaccharides but only monosaccharides are absorbed. So it starts breakdown of
polysaccharides into smaller until it is inactivated by acid present in stomach.
b. Lingual lipase: It is secreted by glands in tongue and results in breakdown of
triglycerides into diglycerides and fatty acids. It is activated in acidic environment of
stomach. So it is inactive in mouth and starts working after swallowing of food.

5. Pharynx:
Pharynx is funnel shaped tube, covered with mucous and composed of skeletal muscle. It is
present in region which extends from internal nares to esophagus. It is divided into 3 parts:
Nasopharynx: helps in respiration; Oropharnyx and laryngopharynx: it helps in respiration as
well as swallowing of food.

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6. Esophagus:
It is a collapsible muscular tube (25 cm long) which starts from inferior end of laryngopharynx
and it ends at superior portion of stomach. It lies posterior to trachea and anterior to vertebral
column. Its main function is to transfer the bolus from mouth to stomach.

At each end of the esophagus a sphincter is present. The upper esophageal sphincter (UES)
consists of skeletal muscle and the lower esophageal sphincter (LES) consists of smooth muscle.
The upper esophageal sphincter regulates the movement of food from the pharynx into the
esophagus and the lower esophageal sphincter regulates the movement of food from the
esophagus into the stomach.
The movement of food from the mouth into the stomach is achieved by the act of swallowing, or
deglutition. Deglutition is facilitated by the secretion of saliva and mucus and involves the
mouth, pharynx, and esophagus. Swallowing occurs in three stages: (1) the voluntary stage, in
which the bolus is passed into the oropharynx; (2) the pharyngeal stage, the involuntary passage
of the bolus through the pharynx into the esophagus; and (3) the esophageal stage, the
involuntary passage of the bolus through the esophagus into the stomach. During esophageal
phase, peristalsis (stalsis = constriction), a progression of coordinated contractions and
relaxations of the circular and longitudinal layers of the muscularis, pushes the bolus toward
stomach.

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Physiology of the Esophagus: The esophagus secretes mucus and transports food into the
stomach. It does not produce digestive enzymes, and it does not carry on absorption.

7. Stomach:
Stomach is a ‘J’ shaped enlargement of GI Tract which lies directly inferior to diaphragm. It
connect esophagus to duodenum (first part of small intestine). Stomach serves as mixing
chamber and holding reservoir for food. When food is ingested, stomach pushes a small quantity
of food into duodenum periodically. As the size of stomach can vary, it can store large amount of
food. In stomach, semisolid bolus is converted into liquid, digestion of starch continues,
digestion of triglycerides and protein starts and absorption of several substances takes place.

Anatomy of stomach: The stomach has four main regions: the cardia, fundus, body and pylorus.
The cardia surrounds the superior opening of the stomach.
The fundus is the rounded portion superior and left to the cardia.
The body is inferior to the fundus and is the large central portion of the stomach.
The pylorus is the region of the stomach that connects to the duodenum. (pyl = gate; orus =
guard). Pylorus has two parts, the pyloric antrum which connects to the body of the stomach,
and the pyloric canal, which leads into the duodenum.
When the stomach is empty, the mucosa lies in large folds, called rugae (wrinkles) that can be
seen with the unaided eye. The pylorus communicates with the duodenum of the small intestine
via a smooth muscle sphincter called the pyloric sphincter. The concave medial border of the
stomach is called the lesser curvature, and the convex lateral border is called the greater
curvature.

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Histology of stomach: The stomach wall is composed of 4 basic layers:
Mucosa: Mucosa contains several glands called gastric glands. The gastric glands contain three
types of exocrine gland cells and one type of endocrine cells that secrete their products into the
stomach and bloodstream respectively.
a. Mucous neck cells: These cells secrete mucus.
b. Chief cells: The chief cells secrete pepsinogen and gastric lipase.
c. Parietal cells: Parietal cells produce intrinsic factor (needed for absorption of vitamin B12)
and hydrochloric acid.

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The secretions of the mucous, parietal & chief cells collectively form gastric juice (2–3 Lt/day).
d. G cell: These are endocrine cells which are located mainly in the mucous of pyloric antrum
and secretes the hormone gastrin into the bloodstream
Submucosa: is made up of areolar connective tissue.
Muscularis: is composed of 3 layers of smooth layers; oblique muscles, circular muscles and
longitudinal muscles.
Serosa: forms outer most layer of stomach.

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Mechanical and chemical digestion in stomach:
 When food enters the stomach, gentle peristalitic waves pass over the stomach every 15-25
second which is called mixing waves. These waves mix the food with gastric juice and
convert it into a soupy liquid called chyme.
 As digestion proceeds more vigorous mixing wave start at body of stomach and intensify as
they reach pylorus. At pylorus, each wave periodically pushes little amount of chyme into
small intestine thorough pyloric sphincter. This process is called gastric emptying.
 Starch is digested by salivary amylase when food is in fundus. When food moves into body,
mixing of chyme with gastric juices starts. The salivary amylase is inactivated and lingual
lipase is activated. This stops digestion of starch and starts digestion of triglycerides into
diglycerides and fatty acids.
 Parietal cell present in walls of stomach start secretion of a strong acid HCl, which kills
microbes and denature proteins. HCl also stimulate secretion of hormones which further
increases flow of bile and pancreatic juices.
 Enzymatic digestion of proteins also begins in the stomach. The chief cells in stomach
secrete proteolytic (protein-digesting) enzyme in the stomach called pepsin. Pepsin breaks
peptide bonds to breaking down a large protein chain smaller peptide fragments. Pepsin is
most effective in the very acidic environment of the stomach (pH 2); it becomes inactive at a
higher pH.
 What keeps pepsin from digesting the protein in stomach cells along with the food?
First, pepsin is secreted in an inactive form called pepsinogen; in this form, it cannot digest
the proteins in the chief cells that produce it. Pepsinogen is not converted into active pepsin
until it comes in contact with hydrochloric acid secreted by parietal cells or active pepsin
molecules. Second, the stomach epithelial cells are protected from gastric juices by a 1–3 mm
thick layer of alkaline mucus secreted by surface mucous cells and mucous neck cells.
 Another enzyme of the stomach is gastric lipase, which splits the short-chain triglycerides in
fat molecules.
 Only a small amount of nutrients are absorbed in the stomach e.g. water, ions, and short-
chain fatty acids, as well as certain drugs (especially aspirin) and alcohol.

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Mechanism of HCl secretion by parietal cells: Parietal cells secrete H+ and Cl- separately into
stomach lumen but net effect is secretion of HCl. Proton pumps actively transport H+ into lumen
and bring K+ ion back into cell. At same time Cl- and K+ diffuse out into lumen through Cl- and
K+ channels in apical membrane. Carbonic anhydrase enzyme present in parietal cell produces
carbonic acid from CO2 and H2O. H2CO3 dissociates into H+ and HCO3-. H+ moves into
lumen by H+/K+ ATPase pump and HCO3- moves into bloodstream. HCl secretion in parietal
cells can be stimulated by Gastrin, Acetylcholine and Hisatmaine.

8. Pancreas:
Pancreas (Pan = all, creas = flesh) is a retroperitoneal (behind peritoneum) gland, which lies
posterior to greater curvature of stomach. It is 12-15cm long and 2-3cm thick. Anatomically it is
divided into 3 parts:
 Head: It is expanded portion and lies near to curve of duodenum
 Body: It is central part and is left and superior to head.

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 Tail: It is last tapering portion of pancreas.
Pancreas has two ducts that open into duodenum and these ducts carry pancreatic juices into
duodenum:
 Pancreatic duct: It is larger in size. It combines with common bile duct from liver and forms
hepatopancreatic ampulla which opens into duodenum.
 Accessory duct: It is smaller and also opens into duodenum.

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Histology of Pancreas:
Pancreas are made up of small clusters of glandular epithelial cells known as acini. 99% of acini
are exocrine cells which secrete mixture of fluid and digestive enzymes called pancreatic juice.
1% of acini are endocrine cells which are called Pancreatic Islets or Islet of Langerhans. These
pancreatic islets secrete 4 types of hormone:
Glucagon: It increases blood sugar level.
Insulin: It decreases blood sugar level.
Somatostatin: It maintains Gluacagon and Insulin level in body.
Pancreatic polypeptide: It controls somatostatin secretion.

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Composition and functions of pancreatic juice:
 Pancreatic juice is a clear, colorless liquid is consisting of water, salts, sodium bicarbonate
and several enzymes. Each day 1200-1500 ml pancreatic juice is produced.
 Sodium bicarbonate makes pancreatic juice slight alkaline (7.1-8.2) and stops action of
pepsin from stomach and creates pH for action of digestive enzyme in small intestine.
 Enzymes secreted in pancreatic juices are:
o Pancreatic amylase: It is starch digesting enzyme.
o Trypsin, Chymotrypsin, Carboxypeptidase, Elastase: These are protein digesting
enzymes.
o Pancreatic lipase: This is major triglyceride digesting enzyme.
o Ribonuclease and deoxyribonuclease: Nucleic acid digesting enzyme.

9. Liver and Gall bladder:

Liver is the 2nd largest organ in body, located inferior to diaphragm. Gall bladder is pear shaped
sac located inferiorly and posteriorly to liver.
Anatomy: Liver is divided into 2 lobes; Right lobe (larger) and left lobe (smaller). Right and left
lobes are separated by falciform ligament.
Gall bladder has 3 portions. The inferior broad portion is called fundus, the middle portion is
called body and the upper taper portion is called neck.

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Histology of liver and Gall bladder:
Liver: is made up of lobes. Lobes are made up of lobules (small functional units). Lobules are
further made up of specialized cells called hepatocytes (hepato = liver, cytes = cells). Lobules
contain highly permeable capillaries which supply blood to hepatocytes. These capillaries
contain stellate reticuloendothelial cells also called Kupffer cells. These Kupffer cells act as
phagocytes and destroy worn out RBC, WBC, bacteria and other foreign materials.
Hepatocytes secret bile into bile canaliculi. Bile canaliculi carry bile into bile ductules which
transfers it into left hepatic duct or right hepatic duct. These left and right hepatic ducts combines
to form common hepatic duct which further combines with cystic duct (from gall bladder) to
form common bile duct.

Gall bladder: is made up of simple epithelial cells. Contraction of smooth muscles ejects the
content of gall bladder into cystic duct. Functions of gall bladder are to store and concentrate the
bile until required in duodenum. Concentration is done by the absorption of water and ions.

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Role and composition of bile: Each day, hepatocytes secrete about 1 lt of bile, a yellow,
brownish, or olive-green liquid. It has a pH of 7.6–8.6 and consists mostly of water, bile salts,
cholesterol, a phospholipid called lecithin, bile pigments, and several ions.
 Bile salts (sodium and potassium salts of bile acid) play role in emulsification. Emulsification
is process of breakdown of large lipids into small lipid gloubules. These small gloubules are
easily digested by pancreatic lipase.
 Bile salts also play important role in absorption of lipids.

Functions of liver:
 Carbohydrate metabolism: Liver maintains normal blood glucose level. When blood
glucose level is low, it starts breakdown of glycogen (storage form of glucose) to glucose. It
also converts lactic acid and amino acid into glucose. It can also convert fructose, galactose
and other sugars into glucose. When blood sugar level rises, it converts glucose into glycogen
and triglycerides for storage.
 Lipid metabolism: Hepatocytes store some triglycerides; break down fatty acids to generate
ATP; synthesize lipoproteins, which transport fatty acids, triglycerides, and cholesterol to and
from body cells; synthesize cholesterol; and use cholesterol to make bile salts.
 Protein metabolism: Hepatocytes remove amino group (NH2) from amino acids so that
amino acids can be used for ATP production or can be converted into carbohydrates or fats.
The harmful free amino group (NH2) is converted into urea which can be excreted out of
body in urine.
 Processing of drugs and hormones: The liver can detoxify substances such as alcohol and
excrete drugs such as penicillin, erythromycin, and sulfonamides into bile. It can also
chemically alter or excrete thyroid hormones and steroid hormones such as estrogens and
aldosterone.
 Excretion of billirubin: Bilirubin, derived from the heme of aged red blood cells, is
absorbed by the liver from the blood and secreted into bile. Most of the bilirubin in bile is
metabolized in the small intestine by bacteria and eliminated in feces.
 Synthesis of bile salts: Bile salts are used in the small intestine for the emulsification and
absorption of lipids.

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 Storage: In addition to glycogen, the liver is a prime storage site for certain vitamins (A,
B12, D, E, and K) and minerals (iron and copper).
 Phagocytosis: The stellate reticuloendothelial (Kupffer) cells of the liver phagocytize aged
red blood cells, white blood cells, and some bacteria.
 Activation of vitamin D: Liver along with skin and kidneys participate in synthesizing the
active form of vitamin D.

10.Small Intestine:
Small intestine starts from pyloric sphincter of stomach, coils through central and inferior part of
abdominal cavity and ends at large intestine. It has major role in digestion and absorption of
nutrients.

Anatomy: It has 3 major parts:

a. Duodenum: This is first part of small intestine. It starts from pyloric sphincter, extends up to
25 cm and merges into jejunum.
b. Jejunum: It is middle part and extends up to ileum.
c. Ileum: It is last part of small intestine and ends at ileocecal junction of large intestine.

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Histology: Small intestine is composed of same basic 4 layers:

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Muscosa: The mucosa of small intestine contains many types of cells:
 Absorptive cells: These cells digest and absorb nutrients.
 Goblet cells: These cells secrete mucus.
 Paneth cells: These secrete bactericidal enzyme lyzozyme. Lyzoyme play role in
phagocytosis.
 Endocrine cells: These cells secrete hormones into blood stream. These include:
S cells: secrete secretin
CCK cells: secrete cholecystokinin or CCK
K cells: secrete Glucose dependent insulinotropic peptide or GIP
 Mucosa of small intestine also contain some special structural feature which facilitates
digestion and absorption:
a. Circular folds: These are folds of mucosa and submucosa. These folds increase surface
area and cause the chime to move spiral than straight as it passes through small intestine.

b. Villi: These are fingerlike projections of mucosa which vastly increases surface area for
absorption and digestion. (20-40 sq. mm.)
c. Microvilli: These are projections from free membrane of absorptive cells. These are too
small to see individually under microscope. Instead they form a fuzzy line called brush
border. This brush border also contains several enzymes called brush border enzyme that
have digestive function.

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Submucosa: The submucosa of the duodenum contains duodenal which secrete an alkaline
mucus that helps neutralize gastric acid in the chyme.
Muscularis: The muscularis of the small intestine consists of two layers of smooth muscle i.e.
the outer longitudinal and inner circular muscles.
Serosa: The serosa (or visceral peritoneum) completely surrounds the small intestine.

Role of intestinal juice and brush border enzyme:

About 1-2 lt of intestinal juice (pH 7.6) is secreted every day which contained water and mucous.
Intestinal juice mixes with pancreatic juices and provides the liquid medium for absorption of
substance from chime into small intestine.
Brush border enzymes secreted from absorptive cells in small intestine contain following types
of enzymes:
Four carbohydrate-digesting enzymes called α-dextrinase, maltase,sucrase and lactase
Two Protein-digesting enzymes called peptidases (aminopeptidase and dipeptidase)
Two types of nucleotide-digesting enzymes, nucleosidases and phosphatases.

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Mechanical and chemical digestion in small intestine:
Mechanical Digestion: Two types of movements occur in small intestine which result in
mechanical digestion:
 Segmentation: These are localized mixing contractions that occur in portions of small
intestine distended with large volume of chime. Segmentation helps in mixing and absorption
of chyme, but it does not push chyme forward.
 Migrating motality complex (MMC): This is a type of peristaltic movement which occurs
when volume of chyme in distended portion of small intestine decreases. This pushes the
chyme forward.
Chyme remains in small intestine for 3-5 hours.
Chemical digestion: Chyme entering the small intestine contains partially digested
carbohydrates, proteins, and lipids by the enzymes in mouth and stomach. The completion of the
digestion of carbohydrates, proteins, and lipids occurs in small intestine and it is a collective
effort of pancreatic juice, bile, and intestinal juice.
 Digestion of carbohydrates: Starches are broken into maltose, maltriose and α-dextrin units
by pancreatic amylase. Following brush border enzymes act on these and convert it even
smaller units.
o α-Dextrinase acts on α-dextrin to produce glucose.
o Maltase splits maltose and maltriose into 2-3 units of glucose.
o Lactase digests lactose into a glucose and galactose.
o Sucrase breaks sucrose into molecule of glucose and fructose.
o Cellulose (a polysaccharide) is not digested by amylase enzymes and hence it is called
roughage.
 Digestion of proteins: Trypsin, chymotrypsin, carboxypeptidase and elastase convert
proteins into peptide units. These peptides are converted into small amino acids by two
enzymes aminopeptidase and Dipeptidase which break amino acids into single amino acids.
 Digestion of lipids: Most of triglycerides in food are broken into long chain or short chain
fatty acids and monoglycerides by pancreatic lipase. Long chain fatty acids are emulsified
into short chain fatty acid by bile salts in small intestine.
 Digestion of nucleic acids: Pancreatic juice contains two nucleases (nucleic acid digesting
enzymes) ribonuclease (digests RNA) and deoxyribonuclease (digests DNA) into

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 nucleotides. These nucleotides are further digested by brush-border enzymes called
nucleosidases and phosphatases into pentoses, phosphates, and nitrogenous bases.

Absorption in small intestine: All chemical and mechanical phases of digestion convert large
molecule into smaller one which can be easily absorbed. For example Carbohydrates are
converted into monnosacchride i.e. glucose, fructose and galactose. Proteins are converted into
single amino acids, dipeptides and tripeptides. Triglycerides are converted into fatty acids,
glycerol and monoglycerides.
Passage of these digested nutrients from GIT into blood or lymph is called absorption. Nutrients
move from lumen into absorptive cells and then pass to blood or lymph capillaries or lacteals in
villi. Lacteals are network of blood and lymph capillaries which absorb fat. This absorbed fat
gives them milky appearance and hence they are called lacteals (lact = milky). 90% of all
absorption of nutrients occurs in small intestine. Absorption is done by diffusion, fascilitated
diffusion, osmosis and active transport.
 Absorption of monosaccharides: All carbohydrates are absorbed as monosaccharides.
Fructose is absorbed by fascilitated diffusion; glucose and galactose are absorbed by
secondary active transport into absorptive cells. Monosacchrides move out of absorptive cells
via facilitated diffusion.
 Absortion of amino acids, dipeptides and tripeptides: Most of proteins are absorbed as
amino acid via active transport. Dipeptides and tripeptides which enter absorptive cells are
broken into to single amino acid. Amino acids move out of absorptive cells via diffusion.
 Absorption of lipids: All dietary lipids are absorbed by simple diffusion. Triglycerides are
broken into monoglycerides and fatty acids (long chain and short chain). Short chain fatty
acids are absorbed easily. Long chain fatty acids and monoglycerides are absorbed with the
help of bile salts. Bile salts form tiny spheres called micelles which carry fatty acids and
monoglycerides to the absorptive cells for absorption. Micelles also help to solubilize and
absorb other large hydrophobic molecules such as Vit. A, D, E, K and cholesterol.
 Absorption of electrolytes: Electrolytes absorbed in small intestine come from ingested
food, liquids and from gastrointestinal sescretions. Most of the electrolytes including Na+ ,
Ca2+ , negatively charged ions like bicarbonate, chloride, iodide, nitrate, other electrolytes

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 like iron, potassium, magnesium and phosphate etc. are absorbed by active or passive
transport.
 Absorption of vitamins: Fat soluble vitamins like Vit. A, D, E, K are absorbed by simple
diffusion by micelle formation. Water soluble vitamins Vit. B and C are also absorbed by
simple diffusion. Vit B12 combines with intrinsic factor produced by stomach and and is
absorbed in ileum via active transport.
 Absorption of water: All water absorption in the GI tract occurs via osmosis. Because water
can move across the intestinal mucosa in both directions, the absorption of water from the
small intestine depends on the absorption of electrolytes and nutrients to maintain an osmotic
balance with the blood.

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11.Large Intestine:
The large intestine is the terminal portion of the GI tract. The overall functions of the large
intestine are the completion of absorption, the production of certain vitamins, the formation of
feces and the expulsion of feces from the body.
Anatomy of large intestine: Large intestine is about 1.5 m long and extends from ileum to anus.
The joining of small and large intestine occurs at ileocecal sphincter which controls movement of
material from small intestine to large intestine. Large intestine consists of 4 major regions
cecum, colon, rectum and anal canal.
Cecum is a small pouch like organ which is present next to ileocecal sphincter. Attached to
cecum is a coiled and twisted tube called appendix or vermiform appendix.
Colon is a long tube which is present next to cecum. The open end of cecum attaches with colon.
Colon is divided into 4 portions i.e. ascending colon, transverse colon, descending colon and
sigmoid colon.
Rectum is approximately last 20 cm of GI tract. Terminal 2-3 cm of rectum is called anal canal.
Opening of anal canal to exterior is called anus which is guarded by internal sphincter of smooth
muscles and external sphincter of skeletal muscles.

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Histology of large intestine: Walls of large intestine consists of same basic 4 layers:
Mucosa: Mucosa mainly consists of absorptive and goblet cells. The absorptive cells function in
water absorption and the goblet cells secrete mucus that lubricates the passage of the colonic
contents. Villi and circular folds are absent in large intestine.
Submucosa: Submucosa is similar to that of rest of GIT.
Muscularis: Muscularis consists of circular and longitudinal muscles. Tonic contraction of
circular muscles divide colon into series of pouches called huastra.
Serosa: consist of visceral peritoneum.

Mechanical digestion in large intestine: As food passes through ileocecal sphincter, it fills the
cecum and accumulates in ascending colon. The haustral churning occurs in colon. In this
process, huastra remain relaxed and becomes distended when filled up. After a certain point, the
walls contract and squeeze the content into next haustrum. Peristalsis occurs at slow rate. A final
movement i.e. mass peristalsis which is a strong peristaltic wave, starts from middle of
transverse colon and drives the colonic contents into rectum (3-4 times a day).

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Chemical digestion in large intestine: Chemical digestion in large intestine is done by bacteria
and no enzyme is secreted.
 Bacteria ferments any remaining carbohydrate and releases hydrogen, CO 2 and methane gas.
If excessive, these gases cause flatulence.
 Bacteria also convert remaining protein to amino acids and amino acids into simple
substances like indole, hydrogen sulphide which are further converted to less toxic
substances by liver.
 Bacteria also decompose bilirubin to simple pigment like stercobilin which gives brown color
to fecal material.
 Certain vitamins like Vitamin B and K are produced by bacteria which are absorbed in colon.

Absorption and feces formation in large intestine: Chyme remains for 3–10 hours in large
intestine and it becomes solid or semisolid because of water absorption and then it is called
feces. Chemically, feces consist of water, inorganic salts, sloughed-off epithelial cells from the
mucosa of the gastrointestinal tract, bacteria, products of bacterial decomposition, unabsorbed
digested materials, and indigestible parts of food.
Although 90% of all water absorption occurs in the small intestine, the large intestine absorbs
enough to make it an important organ in maintaining the body’s water balance. The large
intestine also absorbs ions, including sodium and chloride, and some vitamins.

Phases of Digestion:
Digestive activities occur in three overlapping phases: the cephalic phase, the gastric phase, and
the intestinal phase.
Cephalic phase: During this phase, smell, sight, thought or initial taste of food activates neural
centers in different parts of brain. The brain parts stimulate salivary glands and gastric glands to
secrete saliva and gastric juices respectively. This phase of digestion prepare mouth and stomach
for food that is about to be eaten.
Gastric phase: Once food reaches the stomach, the gastric phase of digestion begins. Neural and
hormonal mechanisms regulate the gastric phase of digestion to promote gastric secretion and
gastric motility.

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 Neural regulation: Food of any kind distends the stomach and stimulates stretch receptors in
its walls. Chemoreceptors in the stomach monitor the pH of the stomach chime. When the
stomach walls are distended by food or pH increases because proteins have entered the
stomach the stretch receptors and chemoreceptors are activated. This activation propagates
nerve impulses which cause peristalsis and stimulation of flow of gastric juice from gastric
glands. The peristaltic waves mix the food with gastric juice; and cause gastric emptying into
the duodenum. The pH of the stomach chyme decreases (becomes more acidic) and the
distension of the stomach walls decreases to normal.
 Hormonal regulation: Gastric secretion during the gastric phase is also regulated by the
hormone gastrin. Gastrin is released from the G cells when chyme distends stomach, partially
digested proteins, caffeine, high pH of chime etc. Gastrin stimulates gastric glands to secrete
gastric juice. It closes lower esophageal sphincter so that acid can nto reflux back and opens
pyloric sphincter so that chime can move ahead. Gastrin secretion stops when pH falls below
2.
Intestinal phase: The intestinal phase of digestion begins once food enters the small intestine.
Intestinal phase have inhibitory effects that slow the exit of chyme from the stomach. This
prevents the duodenum from being overloaded with more chyme than it can handle. In addition
intestinal phase promote the continued digestion of foods that have reached the small intestine.
These activities of the intestinal phase of digestion are regulated by neural and hormonal
mechanisms.
 Neural regulation: Distension of the duodenum by chyme causes the enterogastric reflex.
Stretch receptors in the duodenal wall send nerve impulses to inhibit gastric motility. The
contraction of the pyloric sphincter increases which decreases gastric emptying.
 Hormonal regulation: The hormonal regulation is done by two hormones: cholecystokinin
and secretin. Cholecystokinin (CCK) is secreted by the CCK cells which stimulate secretion
of pancreatic juice, contraction of gallbladder and relaxation of the sphincter of the
hepatopancreatic ampulla (sphincter of Oddi), to increases digestion. CCK also slows gastric
emptying by promoting contraction of the pyloric sphincter, produces satiety (a feeling of
fullness) and enhances the effects of secretin.
 Acidic chyme entering the duodenum stimulates the release of secretin from the S cells
which stimulates the flow of pancreatic juice rich in bicarbonate ions to buffer the acidic

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 chyme. Secretin also enhances the effects of CCK. Overall, secretin causes buffering of acid
in chyme that reaches the duodenum and slows production of acid in the stomach.

Disorders of digestive system:

Gastroesophageal reflux disease (GERD): If the lower esophageal sphincter fails to close
adequately after food has entered the stomach, the stomach contents can reflux (back up) into the
inferior portion of the esophagus. This condition is known as gastroesophageal reflux disease
(GERD). Hydrochloric acid (HCl) from the stomach contents can irritate the esophageal wall,
resulting in a burning sensation that is called heartburn. Drinking alcohol and smoking can cause
the sphincter to relax, worsening the problem. The symptoms of GERD often can be controlled
by avoiding foods that strongly stimulate stomach acid secretion (coffee, chocolate, tomatoes,
fatty foods, orange juice, peppermint, spearmint, and onions).
Vomiting: Vomiting or emesis is the forcible expulsion of the contents of the upper GI tract
(stomach and sometimes duodenum) through the mouth. The strongest stimuli for vomiting are
irritation and distension of the stomach; other stimuli include unpleasant sights, general
anesthesia, dizziness, and certain drugs such as morphine and derivatives of digitalis. Vomiting
involves squeezing the stomach between the diaphragm and abdominal muscles and expelling
the contents through open esophageal sphincters. Prolonged vomiting, especially in infants and
elderly people, can be serious because the loss of acidic gastric juice can lead to alkalosis (higher
than normal blood pH), dehydration, and damage to the esophagus and teeth.
Jaundice: Jaundice is a yellowish coloration of the sclerae (whites of the eyes), skin, and
mucous membranes due to a buildup of a yellow compound called bilirubin. After bilirubin is
formed from the breakdown of the heme pigment in aged red blood cells, it is transported to the
liver, where it is processed and eventually excreted into bile. The three main categories of
jaundice are (1) prehepatic jaundice, due to excess production of bilirubin; (2) hepatic jaundice,
due to congenital liver disease, cirrhosis of the liver, or hepatitis; and (3) extrahepatic jaundice,
due to blockage of bile drainage by gallstones or cancer of the bowel or the pancreas.
Gallstone: If bile contains either insufficient bile salts or lecithin or excessive cholesterol, the
cholesterol may crystallize to form gallstones. As they grow in size and number, gallstones may
cause minimal, intermittent, or complete obstruction to the flow of bile from the gallbladder into

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the duodenum. Treatment consists of using gallstone-dissolving drugs, lithotripsy (shock-wave
therapy), or surgery.
Peptic Ulcer Disease (PUD): Ulcers that develop in areas of the GI tract exposed to acidic
gastric juice are called peptic ulcers. The most common complication of peptic ulcers is
bleeding, which can lead to anemia if enough blood is lost. In acute cases, peptic ulcers can lead
to shock and death. Three distinct causes of PUD are recognized: (1) the bacterium Helicobacter
pylori; (2) nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin; and (3)
hypersecretion of HCl, as occurs in Zollinger–Ellison syndrome, a gastrin-producing tumor,
usually of the pancreas. Helicobacter pylori (previously named Campylobacter pylori) is the
most frequent cause of PUD. The bacterium produces an enzyme called urease, which splits urea
into ammonia and carbon dioxide. While shielding the bacterium from the acidity of the
stomach, the ammonia also damages the protective mucous layer of the stomach and the
underlying gastric cells. H. pylori also produces catalase, an enzyme that may protect the
microbe from phagocytosis by neutrophils, plus several adhesion proteins that allow the
bacterium to attach itself to gastric cells. Several therapeutic approaches are helpful in the
treatment of PUD. Cigarette smoke, alcohol, caffeine, and NSAIDs should be avoided because
they can impair mucosal defensive mechanisms, which increase mucosal susceptibility to the
damaging effects of HCl.

Hepatitis: Hepatitis is an inflammation of the liver that can be caused by viruses, drugs, and
chemicals, including alcohol. Clinically, several types of viral hepatitis are recognized.
Hepatitis A (infectious hepatitis) is caused by the hepatitis A virus and is spread via fecal
contamination of objects such as food, clothing, toys, and eating utensils (fecal–oral route). It is
characterized by loss of appetite, malaise, nausea, diarrhea, fever, and chills. This type of
hepatitis does not cause lasting liver damage. Most people recover in 4 to 6 weeks.
Hepatitis B is caused by the hepatitis B virus and is spread primarily by sexual contact and
contaminated syringes and transfusion equipment. It can also be spread via saliva and tears.
Hepatitis B virus can be present for years or even a lifetime, and it can produce cirrhosis and
possibly cancer of the liver.
Hepatitis C, caused by the hepatitis C virus, is clinically similar to hepatitis B. Hepatitis C can
cause cirrhosis and possibly liver cancer.

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Hepatitis D is caused by the hepatitis D virus. It is transmitted like hepatitis B and in fact a
person must have been co-infected with hepatitis B before contracting hepatitis D.
Hepatitis E is caused by the hepatitis E virus and is spread like hepatitis A. Although it does not
cause chronic liver disease, hepatitis E virus has a very high mortality rate among pregnant
women.

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