Physiology

GIT
Introduction
 Introduction
Parts of the digestive system functions of GIT
Digestion
:Alimentary canal
extends from mouth to anus .breakdown of food materials into small particles -
.mostly occurs in the proximal part of small intestine -
Associated glands Absorption
,salivary glands
, liver transfer of the contents of the gut from lumen into the -
pancreas .mucosa
Secretion ml / day 7500
Accessory organs
tongue, teeth transport of fluid, electrolytes, and peptides etc…) from -
and muscles of mastication .blood, to the lumen of the GIT
Secretions are usually isotonic with plasma except for -
.saliva which is hypotonic relative to plasma
Immune function
lymphocytes in the Peyer's patches of the intestine -
protect the body against microorganisms in the lumen of
. the gut
Endocrine function
release of somatostatin, intestinal glucagon, gastrin, -
secretin and CCK
 Introduction
Innervation of the digestive tract

voluntary Involuntary
Somatic nervous system
striated muscles of the mouth other musculature of the digestive tract

upper part of the oesophagus

extrinsic (sympathetic and parasympathetic) .1

intrinsic (enteric nerve plexus) .2

external anal sphincter

 Introduction
Innervation of the digestive tract

Intrinsic innervation of the gut Extrinsic innervation of the gut

) enteric nervous system( )sympathetic and parasympathetic(
control the motility and secretion of
alimentary canal modulate the enteric nervous system

submucosal (Meissner’s)
myenteric (Aurbach’s ) plexus
plexus
musculosa between circular & site
longitudinal muscle layers .in the submucosal layer

controlling the motility of GIT function controlling local secretion of GIT

mainly excitatory neurons to .1 Contain neurons of the sensory afferent .1
tonic & rhythmic contractions nerves which arise from the
some inhibitory neurons .2 mucosal layer
 Introduction
Innervation of the digestive tract

Intrinsic innervation of the gut Extrinsic innervation of the gut

) enteric nervous system( )sympathetic and parasympathetic(
control the motility and secretion of
alimentary canal modulate the enteric nervous system

parasympathetic supply sympathetic supply

generally excitatory to enteric - function generally inhibitory to enteric -
nervous system nervous system
)stimulates motility & secretion( )inhibits motility & secretion(
However, contains inhibitory - However, contains excitatory -
vagus fibers to stomach & vagus fibers to gastrointestinal
gastrointestinal sphincters sphincters
 Introduction
Sensory fibers arise from the luminal epithelium and wall of the gut to the enteric plexuses then to the, spinal
cord and brain stem
SALIVARY SECRETION
 introduction
Salivary glands are exocrine glands, with ducts opening into the oral cavity •
. The total volume of salivary secretion in human (1000 - 1500 ml/day ) •
Salivary glands

Parotid salivary glands submandibular salivary glands sublingual salivary glands

type Serous Mixed Mucous
percentage 25% 70% 5%

.,In addition, the buccal mucosa contains a large number of small glands which secrete mucus

Types of salivary secretion

Serous (watary)secretion Mucous (viscous )secretion
containing the a-amylase enzyme(ptyalin ) for starch digestion containing mucin ( glycoprotein) which renders the salivary
secretion viscous for protective and lubricating purposes
 The salivary secretion
The salivary secretion is a vital process

constituents of ECF

-amylase

(Isotonic) Cl- (passive)

Na+ (1ry active )
K+ (2ry active )
H+ (2ry active )
HCO3 - (active )

(slightly acidic + Hypotonic )

 The salivary secretion
The salivary secretion is a vital process
:  Mechanism , formed of 2 stages
: Frist stage in acinar cell❶
.Secrete primary secretion (Isotonic) contain : -amylase , constituents of ECF -
: second stage in duct system ❷
: under effects of aldosterone , Modify the primary secretion by -
+
reabsorption of Na+ actively in exchange with K+ & H
reabsorption of Cl- passively
.secretion of HCO3 - actively

 The Salivary secretion cannot be explained by a simple process of filtration because its composition not identical with the
. composition of the plasma
.  Salivary secretion is an active process
 the secretion coupled with vasodilatation
 The salivary secretion
Innervation of Salivary glands
. Salivary glands are supplied by the autonomic nervous system
 Salivary secretion is a complementary function (produce similar effects )between sympathetic and
.parasympathetic nervous systems
sympathetic nerve supply parasympathetic nerve supply
 small amounts of viscid saliva rich in organic Profuse secretion of watery saliva with relatively low content
constituents .of organic constituents and has some electrolytes
.in the submandibular and sublingual glands in the parotid and submandibular glands
glands of buccal mucosa +
: Action : Marked vasoconstriction  Action : Vasodilation
 Mechanism : release of noradrenaline  Mechanism : release of acetylcholine at the post
:  Effect . ganglionic nerve endings
reduction of the blood flow :  Effect
Increase blood flow up to 10 times -
Increase oxygen consumption up to 3 times -
 Mechanism : release of noradrenaline  Mechanism : release of acetylcholine at the post
. ganglionic nerve endings
 The salivary secretion
Innervation of Salivary glands
. Salivary glands are supplied by the autonomic nervous system
 Salivary secretion is a complementary function (produce similar effects )between sympathetic and
.parasympathetic nervous systems
sympathetic nerve supply parasympathetic nerve supply
parasympathetic sympathetic

acetylcholine noradrenaline
<

<
Vasodilation Marked vasoconstriction

blood flow up to 10 times reduction of the blood flow

 oxygen consumption up to 3 times

mucous acinus
Serous acinus

submandibular , sublingual + glands of buccal mucosa

parotid and submandibular glands

watery saliva with relatively low content of small amounts of viscid saliva rich in organic
organic constituents and has some electrolytes constituents
 The salivary secretion
Properties of salivary secretion
.The amount : 1 to 1.5 L/day .1
.Colourless , viscous fluid .2
pH: 6.6-7.1 (slightly acidic ) .3
hypotonic relative to the plasma .4

organic constituents (0,3%)

Water (99,5%) Inorganic constituents (0,2%)
Ptyalin (-amylase) .1 Composition of
.optimum pH : 6.9-7.1 -
It hydrolyses cooked starch only because raw starch -saliva NaCl and KCI: CI act as coenzymes for salivary .1
.amylase
-

.granules have a cellulose covering

The action of salivary amylase continues in stomach for - .Ca+2 are needed activate salivary amylase .2
about half an hour until gastric HCI lowers the pH of the Calcium salts as calcium bicarbonate & phosphate .3
.medium  saliva (alkaline) by loss of CO2 to atmosphere, -
Lysozyme: has antibacterial action because it destroys .2 precipitation of insoluble calcium salts on teeth occurs
polysaccharides covering of bacterial capsule .and forms with organic matter a crust known as tartar
lingual lipase .3 If calcium salts are precipitated in the duct system -
Albumin, globulins, mucin, and traces of urea, uric acid .4 .salivary calculi results
and lactic acid Potassium thiocyanate which is formed from .4
Epidermal growth factors .5 metabolism of proteins. It has bactericidal action
 The salivary secretion
Articulation (Speech) .1

H2O (water ) balance .10

A
buffering action .2
Heat regulation .11
B

H
Functions
of saliva C Cleaning action .3
Contain GH .9 G Cooling .4

F D Deglutition .5
Facilitate the stimulation of .8
Digestion .6
taste buds
E
Excretion .7
 The salivary secretion
Functions of saliva
:Articulation (Speech) .1
facilitates speech by moistening of the oral cavity -
.which includes soft palate, tongue and lips

Buffer : Has buffering action by its content of bicarbonates, phosphates, and mucin, to protect the buccal cavity from excessive .2
.acids or alkalis
:  Excessive alkalis lead to
precipitation of calcium salts around the teeth which forms with hard organic matter called tarter -
.bacteria flourish underneath the Tartar leading to chronic inflammation of the gums -
:  Excessive acids lead to
.Dissolves enamel and dentine of teeth after prolonged exposure -
: Cleaning .3
: Cleans the mouth by
a) Mechanical wash of the food residues and the shed epithelial cells which prevents putrefaction
b) Antibacterial action by lysozyme
c) The bactericidal effect of Potassium thiocyanate
d) saliva contains protein antibodies (Ig A ) that can destroy the bacteria in the oral cavity
: Cooling .4
Protects against irritating substances and neutralizes excessively cold or hot food -
 The salivary secretion
Functions of saliva
Deglutition (swallowing ) : Moistens food to facilitate its swallowing .5

.Digestion : digestion of starch by salivary amylase .6

.N.B: Digestion of starch is completed by pancreatic amylase

Excretion : this process is not very effective because these materials are swallowed again .7
 Excretes iodides and mercury which may produce inflammation of buccal mucosa (stomatitis) & poisoning a blue line formed
. at the margins of teeth and gums
 Urea is excreted in saliva in renal diseases
 some little glucose may be excreted in diabetes mellitus

Facilitate the stimulation of taste buds : helps taste sensation by dissolves some food materials .8

H2O (water ) balance : Has a role in water balance because dryness of the buccal and pharyngeal mucosa initiates the sensation .9
of thirst

.Heat regulation : Helps in body temperature regulation in animals with no sweat glands (e g. dogs) by evaporation of saliva .10
 The salivary secretion
Control of salivary secretion
.  salivary secretion is evoked by a nervous mechanism (why ???)
.Hormonal regulation would be too slow to meet with such a function which needs a rapid response -
. The nervous mechanism plays a role only in modification of salivary contents

Nervous regulation
Unconditioned reflexes Conditioned reflexes
)Inborn, do not depend on training( )acquired, depend on training(
SALIVARY SECRETION
SALIVARY SECRETION
The salivary secretion
reflex ‫قبل ما نبدأ الزم نعرف مكونات أي‬

re nt
Aff centre

SRACEER

re nt
e ffe
 The salivary secretion
Control of salivary secretion
Unconditioned reflexes (Inborn, do not depend on training)
Stimulus receptor

Pharyngeal
taste receptors in tongue Thermoreceptors (warm
 food, acids or alkalis ,  moving the tongue &
) salt, acid, sweet, bitter receptors ( and cold) and pain
stimulating the buccal inside the mouth during esophageal
receptors
mucosa mechanically or speech causes salivary receptors
chemically secretion
Affrent
 Impulses for taste sensation from the anterior 2/3 of the tongue are conducted by the chorda tympani branch of the
.facial nerve
 Impulses for taste sensation from posterior 1/3 of the tongue and pharynx are conducted by glossopharyngeal and
. vagus nerves
 Impulses from mechanical stimuli and common sensations (touch, pain, warm and cold) are conducted by the
.lingual nerve, palatine branch of the trigeminal nerve and pharyngeal branch of the vagus nerve
 The salivary secretion
Control of salivary secretion
Unconditioned reflexes (Inborn, do not depend on training)

Effector Efferent Centre

otic ganglion
< auriculotemporal ne
rve <
< lesser superf
<

icial
petrosal
submandibular ganglion
lingual nerve <
chorda tympani tympanic bra
n ch
Of glossopha
ryngeal
 The salivary secretion
Control of salivary secretion
Conditioned reflexes (acquired, depend on training)
Stimulus receptor Af
f er
 Stimulation of any sensory nerve endings in en
to
fs
the body (as optic, auditory, and olfactory nerves) en
se
org
in absence of food from buccal cavity an
s

Effector

<
Efferent
otic ganglion
< auriculotemporal ne
rve <
< lesser superf
<

icial
response petrosal

tympanic bra
n ch
Of glossopha
ryngeal

Centre
Physiology
GIT
The oesophagus and
Deglutition
 Introduction

Vagus

part
Upper
part
Lower
local myenteric plexus
 The oesophagus
Types of normal peristaltic contractions in the oesophagus contraction behind
 During eating and drinking both types of peristalsis occur and complement each other.
Primary peristaltic contractions Secondary peristaltic contractions
transfer function: transport bolus of food to Function clearing function :empties the oesophageal
the stomach from food , fluid residues & normal gastric
refluxate
relaxation in front
response to the act of swallowing & start stimulus distension of the body of oesophagus by
even before food reaches esophagus ingested bolus or gastro-oesophageal
refluxate.
start at the upper end of esophagus as beginning
continuation of pharyngeal peristalsis start proximal to the site of distension

contractions travel along whole length of Description repeated contractions proximal to the site of
esophagus from above downwards distension until the bolus is driven down into
- Velocity : 9 seconds (3cm/s). the stomach
- In upright position : 7 seconds (4cm/s)
Due to the effect of gravity
 The oesophagus
Bilateral vagotomy (removing part of the vagus nerve)

Bilateral vagotomy

abolishes the primary and secondary

waves in the upper half of the
oesophageal, but not in lower half

difficulty in swallowing until the bolus

passes through the upper part of the Vagus

part
oesophageal by the effect of gravity

‫الااازم تبقى‬ bolus ‫بالتالي الـ‬

Upper
small, soft and well lubricated

part
Lower
local myenteric plexus
 Deglutition (swallowing)
Speed of Deglutition
.In basal condition , the food travel along the whole length of the esophagus in 9 seconds (3cm/s)
Depends on

Consistency of food

Fluids Semisolids solids

faster than the Semisolids slower than fluids slower than semisolids
and solids
Position
Speed of Deglutition increase In the •
upright (erect) position
Fluids : 6 seconds(4,5 cm/s) .1
Bolus of food : 7 seconds(4 cm/s) .2
but they remain above the cardiac -
sphincter until peristaltic wave opens
this sphincter
 Deglutition (swallowing)
The reflexes of the involuntary phases are mediated by

Affrent
5th

9th tongue
12th
10th mylohyoid
deglutition center 5th
9th
10th
11th
 gastric glands

ACH
< ACH
<
c tl y
d i re
Vagus
ind
excites the secretion irec
t ly
< G-
< ce
ACH ll
GRP

blood
gastrin
 ganglia of the local nerve plexuses
Vagus )Auerbach's and Meissner's(

greater splanchnic nerve

coeliac ganglia <

<
< <
Parasympathetic Sympathetic
Motor to the muscles of wall Inhibitory to the muscles of wall
inhibitory to cardiac & pyloric sphincter motor to cardiac & pyloric sphincters
 rate of emptying of the stomach.  rate of evacuation of the stomach
A secretion rich in HCL and alkaline mucous secretion from the
pepsinogens. pyloric glands.
V.D. of the gastric blood vessels. V.C. of the gastric blood vessels.
Physiology
GIT
physiology of the stomach
Part 1 Part 2
• Function of stomach
• Constituents of Gastric secretion
• Innervation of stomach
• HCl formation
• Regulation of Gastric secretion

Part 3 Part 4
• Gastric motility • Stomach emptying
• vomiting
 Gastric secretion
Function of stomach

Secretory functions Motor functions

1. Secretes mucin : protect the mucosa.

2. Secretes digestive enzymes e.g. pepsin

which starts digestion of protein.

3. Secretes HCL which acidifies the gastric juice,

facilitating absorption of substances from the
upper intestine such as calcium and iron.
1. Stores large quantities of food until they can be
4. Releases intrinsic factor for vitamin B12 accommodated in the lower portion of GIT .
absorption from the intestine.
2. Mixes food with gastric secretions.
3. Regulates of the rate of evacuation of chyme
5. Releases hormones e.g. gastrin which
into the duodenum via the pyloric pump.
regulates gastric emptying. various
- prevent rapid passage of food into the small
intestine
 Gastric secretion
Innervation of the stomach
 Gastric secretion
Innervation of the stomach
Note : Some reflexes are also initiated from the stomach via the vagi as gastro-
ileal or the gastrocolic reflexes
 Gastric secretion
regulation of gastric secretion

❶Cephalic phase :

❷Gastric phase :

❸Intestinal phase :
 Gastric secretion
❶Cephalic phase :
 The gastric secretion
Control of Gastric secretion
Conditioned reflexes (acquired, depend on training)
Stimulus receptor Af
 not present in the buccal f er
en
, seeing, hearing to
cavity, but lie in any special fs
en
smelling, etc ..) of food se
sense organs org
an
s

gastric glands gastric glands

<
intrinsic nerve plexuses
ACH
<
<
ACH

Vagus
 The gastric secretion
Control of Gastric secretion
Unconditioned reflexes (Inborn, do not depend on training)
Stimulus receptor
The presence of food in the mouth reflexly -
stimulates gastric secretion even
if the swallowed food is not allowed to reach -
.the stomach (by sham feeding)
Pharyngeal Taste buds
&
esophageal
gastric glands gastric glands
receptors

intrinsic nerve plexuses salivary centers

< <
ACH
< <
<
ACH

Vagus
 Sham feeding (false feeding)
Aim:
It Proves the role of Unconditioned reflexes in gastric secretion.
Technique:
1. Conditioned reflexes are abolished, by preventing the animal from Seeing, Smelling or feeling
the preparation of the meal (or in decorticated animals)
2. Food is swallowed to fall from an esophageal fistula (Opening to the Outside) and so does not
enter the stomach.

Observation :
Gastric juice is collected from the empty Stomach.
This type of Secretion . is purely nervous in origin.
so Vagotomy or Cholinergic blockers as the
atropine block this unconditioned reflex and stop this type
Gastric phase :
Distention of the stomach as well as chemical stimulation of the gastric mucosa by the products of digestion initiate
1. Nervous mechanism :
(a) Vago-vagal reflexes
1. Action potentials are carried by the vagus nerves
to the medulla oblongata (greenarrow).
2. The medulla oblongata send efferent vagus nerves
that stimulate secretions directly and indirectly.(pink arrow).
neurotransmitter released from vagal fiber is
( bombesin = gastrin-releasing peptide “GRP”) not acetylcholine

(b) Local enteric reflex (submucosal nerve plexus)

3. Distention of the stomach also activates local reflexes (orange arrow).
S: stretch
R: gastric wall/mucosa
A : sensory fibers from receptor
C : submucosal plexus
E: postganglionic
R: stimulate gastric cells
2.Hormonal mechanism (Gastrin)
4. Gastrin is carried through the circulation back oxyntic glands and peptic cells
via their arterial blood supply. (purple arrow)
 The gastrin hormone
 Chemical nature :
polypeptide

 Site of release :
the antral part of the gastric mucosa (gastrin cells or G cells)
 Stimulus :
1. Distension of the stomach by food
2. Certain substances called secretagogues, such as vegetables digestive products of proteins, alcohol and caffeine.
3. Vagal stimulation
 Intestinal phase :
1. When the products of gastric digestion enter the duodenum, they initiate intestinal phase by :
Distension by food
Certain substances called secretagogues, such as vegetables extractives digestive products of proteins, alcohol and
caffeine.
Stimulatory action :
secretion of small amounts of gastric juice, probably partly because of small amounts of gastrin released by the duodenal
mucosa. This secretion accounts for about 10 percent of the acid response to a meal.

Inhibitory action :
1.Nervous mechanism
2. enterogastric reflex, transmitted through the
myenteric nervous system (will be discussed later )
, extrinsic sympathetic and vagus nerves, that inhibits stomach secretion

2.Hormonal mechanism
3. other hormones are secreted to inhibit gastric secretion and emptying
e,g. secretin, CCK, neurotensin, GIP
 Secretin hormone
- Site of secretion : secreted by the duodenal mucosa response to
- acidification of bulb
- Stimulus : evacuation of an acidic chyme before adequate mixing
- and buffering of the acid.

Cholecystokinin hormone
- Site of secretion : secreted by duodenal mucosa
- Stimulus : in response to contact with fat
Physiology
GIT
Constituents of Gastric
secretion
Gastric secretion
liters/day 3 Enzymes
Pepsin ❶
PH = 1 (highly acidic) :  Formation HCl
Pepsinogen pepsin
pepsin
Pepsinogen pepsin
)autoactivation(
 optimum pH : 2.0
. active in a highly acid medium -
Above pH of 5 : has little proteolytic activity -
Constituents of and soon becomes completely inactivate
 Function : protein digestion in stomach
gastric juice Pepsin converts proteins into acid metaproteins, -
proteoses, and peptones
) no amino acids are formed (
gastric lipase ❷
 Function : lipolytic enzyme
 optimum pH : 5
in infants : gastric secretion pH = 5.5  -
active
in adult : gastric secretion pH = 1  inactive -
Active in adult when the gastric contents are -
gelatinase ❸
.well buffered
 Gastric secretion
Mucin liters/day 3 Enzymes

:  Site of secretion PH = 1 (highly acidic) Pepsin ❶

pyloric glands, cardiac glands and .1 gastric lipase ❷
.mucous neck cells of gastric glands gelatinase ❸
Mucosa of stomach secretes large .2
quantities of a far more viscid and
alkaline mucus
:  Function
protection for the stomach wall .1 Enzymes (not in human)
lubrication of food transport .2 Constituents of Rennin ❶
neutralization of considerable .3  site : present in calves and many
. amounts of HCI gastric juice other young animals
:  Function
HCL milk caseinogen Rennin soluble casein
% 0.4 Ca+2
caseanate salt (milk clot)
Intrinsic factor
water
 Function : glycoprotein necessary for
minerals 99%
absorption of cyanocobalamin (vit. B12) from
.the ileum
Cations Anions .Thus , prevents pernicious anaemia -
Na+, K+ , Mg+2, Ca+2 -
Cl- , HPO4- SO4
‫‪Gastric secretion‬‬

‫‪ -‬هنتكلم بقى عن الـ ‪HCl‬‬

‫بالتفصيل الممل‬
‫‪ -‬بس معانا مش هيبقى ممل ان‬
‫شاء هللا‬
 Gastric secretion

Mechanism of secretion of HCl

Extracellular fluid Parietal cell Lumen of canaliculus

active
+
Na +
Na +
Na mEq/L 3
ATPase
+
K +
K 15mEq/L

ATPase
NaHCO3

Proton pump
+
H +
H 155mEq/L
1 H2O
-
OH

2 CO2 CO2 CA H2CO3

+
H
HCl

H2O HCO3
HCO3
active
3 -
Cl -
Cl -
Cl 173mEq/L

H2O Osmosis H2O

 Gastric secretion
Mechanism of secretion of HCl

Extracellular fluid

”postprandial alkaline tide"

after a meal
H+ are secreted for each 2
 gastric acid secretion molecule of O2 consumed
high blood HCO3 content
Blood coming from stomach has HCI secretion is directly
high pH (alkaline) proportional to the CO2
tension of blood
alkaline urine is excreted
hyperventilation
 blood CO2
 HCI formation
 Gastric secretion
Stimulation and function of HCl secretion
H2 blocker cimetidine atropine
histamine acetylcholine Gastrin
H
antral mucosa

H2 (Histamine) receptors M1 (Muscarinic cholinergic ) receptors Gastrin receptors

HCl secretion
Activation of Pepsinogen
Related to intestine
HCl
Pepsinogen pepsin : Acid chyme -
gives the optimum pH needed - Facilitates the absorption Stimulates release of secretin .1
for its action calcium and iron - hormone from the duodenum
thus initiates the entero-gastric -
Antibacterial action reflex which regulates the rate of
killing microorganisms so - hydrolysis emptying the stomach
prevents their entry in the hydrolysis of some food -
duodenum & biliary tract materials as disaccharides
Gastric motility
 Introduction

Electrical Activity of Gastrointestinal Smooth Muscle

Interstitial cell of Cajal

Slow waves (Basal electrical rhythm )

Frequency :
3 in stomach , 12 in duodenum, 8 in terminal ileum, 3 in
colon slow wave / min
Importance :
• The frequency of slow waves determine the rhythm of
smooth muscle membrane potential.

• Initiating peristalsis in stomach

Types of gastric motility

Receptive relaxation

Migrating motor complex

Types of gastric motility Tonic contractions

Hunger contractions Peristaltic movements

 1 Tonic contractions
Remember difference between Tonic and phasic contraction

• place : the fundus but to a lesser extent in the body.

• function : maintain a constant intragastric pressure.

• Severity : mild to moderate contractions

The severity of the tone is inversely related to the volume of the stomach contents.
 2 Receptive relaxation
• Mechanism : With food intake, there is a reflex relaxation of the fundus and
body of the stomach to receive the coming bolus of food .

• Function : storage of food

• Stimulus (This reflex is initiated by) :

1. Seeing, smelling, or tasting of food.

2. Distension of the esophagus by the bolus of food.
3. Distension of the stomach.
 3 Peristaltic movements

• place : starts at middle of stomach as weak ring of contraction that proceeds towards the pylori
antrum.
• Stimulus : Shortly after the intake of food .
 Mixing movements
Grinding movements
Propulsive movements
 4 Migrating motor complex
• Nature and place : peristaltic wave that begins within the esophagus and travels through
GIT .

• Function : remove Undigested substance from stomach during inter-digestive period

• Time : occurs every 60-90 min during inter-digestive period (fasting or between meal )

Note : The motilin hormone

Site of secretion : endocrine cells within epithelium of small intestine .

Function : increases strength of MMC

 5 Hunger contractions
Nature and cause :
They are exacerbated peristaltic waves caused by strong vagal stimulation
occur in the body of the stomach when it is empty .

 Mechanism of Hunger contractions

Feeding centers in
hypothalamus

Hypoglycemia
 5 Hunger contractions
They may fuse together tea contractions for 1-3 minutes forming hunger pains.
Hunger pains:
appear 12-24 hours after last meal, reach maximal intensity in 3 - 4 days then subside later
on.

Q: Bilateral vagotomy ??
abolishes hunger contractions , but sense of hunger still Occurs due to stimulation of feeding
center .

Note:
They play a little or no role in the control of appetite
Sum up gastric motility 

1. Tonic contractions
2. Hunger contractions
3. Receptive relaxation
4. Peristaltic movements , which act as :
• Mixing movements
• Propulsive movements
• Grinding movements
5. Migrating motor complex
Physiology
GIT
Emptying and Vomiting
 Emptying and Vomiting

? Mechanism of Stomach emptying

."Antral peristaltic waves provide a pumping action "pyloric pump -

1. promoted by antral peristalsis waves

2. prevented by resistance of the pylorus.

Fluids Semisolids solids

 Emptying and Vomiting

Regulation of stomach emptying ?

Gastric factors
VS duodenal factors

3- Autonomic stimulation
4- Type of food
5- Other factors
 Emptying and Vomiting

irritants Distension
acids secretagogues
 Emptying and Vomiting

va ga l re fl
ex
o
vag

local enteric reflex

prevertebral ganglia Sympathetic innervation

So
Ga mato
st r
ic statin
Va in h
s i bi
Ch oact t or
yp
o i
Se lec ve in
GIF

ep
cre yst te tid
tin oki stin e(
nin al GI
pe F)
pt i
de
(V
IP)
insulin
 Emptying and Vomiting
Gastric factors

Nervous hormonal
Distension food volume
Motility
Secretion

distention

Gastrin Circulation
Hormone
 Emptying and Vomiting

Vomiting

Motion sickness ??

Vestibular nucleus

Vomiting center
Chemoreceptor
trigger zone
 Emptying and Vomiting

Causes

Central Peripheral (Reflex vomiting)

1. irritation of mucosa of upper
Direct Indirect gastrointestinal tract.
e.g. posterior part of the tongue
increased intracranial pressure Occur by certain circulating chemicals
hypoxia and acidosis 2. Irritation by inflammatory
neoplastic growth or ulceration
Exogenous Endogenous  The gastrointestinal tract
tartar emetic blood urea  other abdominal organs
emetine  Extra-abdominal organs
morphine
3. Irritation of vestibular nuclei

Psychogenic vomiting
1. psychic troubles (without any organic diseases)
2. conditioned reflexes through visual, olfactory or gustatory stimuli: nauseating smells or sickening sight.
 Emptying and Vomiting

1 0 th
Anywhere in body and
1 2 th
according to cause of vomiting Phr - cr
e ni a ni
Spi c ne al n
nal rve e rv
ne r s es ,
ve s 9 ,7
,5

before vomiting
preceded by sense of nausea and profuse salivation

during vomiting
1. Contraction of diaphragm, anterior abdominal wall muscles , pelvic floor and pyloric portion of stomach
2. Relaxation of body and fundus of stomach, relaxation of esophageal sphincters.
 Emptying and Vomiting

The protective reflexes that prevent passage of vomitus in the respiratory

passages :
1. elevation of soft palate
2. closure glottis & raising of larynx .
3. Apnea

Q:
The vomitus may have from yellow to green color ?
Sometimes antiperistalsis may occur to drive duodenal contents into the stomach, and consequent
vomitus contains bile
Physiology
GIT
The Liver
 Function of The liver
Digestive function
Non-Digestive function
formation and secretion of bile (bile salt )
RBCs
o d Synthesis of plasma
 The liver is
l o
the largest B protein
gland of the
.body

 The
functional unit
Metabolic Detoxification
of the liver is function
the Hepatic
.lobule

Endocrine Excretion
function
Storage
 Function of The liver
Digestive function Non-Digestive function
formation and secretion of bile (bile salt )

Blood RBCs
Reservoir Filtration Production Destruction
ml of blood 350 - filter between blood of GIT & the The normal function of Destruction of aged
1L of blood can - blood in the rest of body by the .fetal liver RBCS by the activity of
be more added activity of Kupffer cells .Kupffer cells
Synthesis of plasma protein
For blood clotting Others
clotting factors :Fibrinogen , prothrombin ,acute phase proteins, albumin
Helps in blood clotting mechanism hormone binding proteins
The liver
 Function of The liver
Digestive function Non-Digestive function
formation and secretion of bile (bile salt )

Detoxification Excretion Storage Endocrine function

cytochrome P450 enzymes expressed in bile pigments iron and vitamins erythropoietin, somatomedins
hepatocytes
oxidation
hydroxylation
inactivates toxins, hormones & steroids Metabolic function
.carbohydrate, fat and protein metabolism

Glucose buffer function Cholesterol homeostasis

maintaining the stability of blood glucose levels in the synthesizing this molecule and also converting excess
postprandial period, removing excess glucose from the cholesterol to bile acids
blood
The liver
 Bile secretion

 Bile is secreted by the cells of the liver into the bile duct, which pours its secretion in
the duodenum.
 Bile is considered as a secretion & Excretion : “Why”

because it contains bile salts which serve many important

Secretion .functions in the body

.because it contains waste products as bile pigments

Excretion
 Bile secretion
 Differences between human hepatic duct bile and gall bladder bile:

Bile salts
 Cholesterol

Cholic acid Cysteine Systemic

Conjugation Circulation
Glycine Taurine
5%

Glycocholic acid Taurocholic acid

95% Portal
Circulation
Gall Bladder
During feeding
Terminal 90%
Duodenum
ileum
10%

Colon
Deoxycholic acid ”Lithocholic acid “insoluble

Absorbe Stool
 Function of bile salts
1 : Digestion of fat ‫يشجع طرفي المباراة‬

 Bile salts have no direct digestive effects, but help fat digestion by :
Emulsification of fat : decreases the surface tension of the particles and allows a good surface area to be exposed to the action of .1
.pancreatic lipase Emulsification
activate the pancreatic lipase enzyme .2 fat
Bile salts
2 : Absorption of fat
No Bile salts Steatorrhoea (fatty diarrhea ) No pancreatic lipase
Liver disease or Fat mostly Fat mostly pancreatic disease or
obstruction in biliary duct digested (FA) undigested obstruction in pancreatic duct
 The importance of absorption of fat

1) Bile salts have the ability to dissolve the insoluble fatty acids in water, thus the fatty acids formed are removed from
medium and new molecules of neutral fat are exposed to the action of pancreatic lipase.
2) Bile salts facilitate the absorption of fat-soluble vitamins (D, E, K) and carotenes.
3) Absorption of fatty acids also helps indirectly the absorption of calcium and iron by prevention of their precipitation in
an insoluble form.

3 Solvent Action
,bile salts prevent the precipitation of cholesterol and fatty acids by keeping them in solution -
. Thus , prevent gall stones formation
4 Choleretic function
.Bile salts are the best choleretics (stimulants for bile secretion by liver cells) -
Absorption of any amount of the secreted bile salts in the intestines mucosa, passes via the portal circulation to the liver, -
.leading to stimulation of bile secretion
5 Stimulation of peristalsis
.Bile salts stimulate the motility of the intestine and colon and prevent constipation -
6 Anti-putrefactive action
.Bile salts have no direct antiseptic effect, but they prevent putrefaction by absorption of fats -
.In their absence, undigested fat covers the protein particles and hinders their digestion -
.The undigested protein particles in the large intestine are attacked by bacteria leading to putrefaction -

Digestion of fat Absorption of fat

Choleretic
Solvent Action
Function
Anti-
Stimulation of
putrefactive
peristalsis
action
mechanism of bile salts secretion

Between the meals

the sphincter of Oddi is closed, bile flows and is stored in -
the gallbladder whose wall has concentrating power which
.enables it to store a large volume

When the food taken

the sphincter of Oddi relaxes, the gall bladder contracts & both -
diluted bile coming from the liver and concentrated bile coming
.from gall bladder are evacuated into the duodenum

After meals:(entero-hepatic circulation of bile salts)

 Normally about 95% of the bile salts are reabsorbed again from the terminal ileum by active transport
. mechanism. into the portal blood and re-secreted by the liver with bile
:  The remaining 5-10% of the bile salts enter the colon and are converted to 2ry bile salts
. deoxycholic acid : 100% absorbed from colon -
lithocholic acid : relatively insoluble and is mostly excreted in the stools -
1
Humoral
2 3 Blood Flow
Mechanis Nervous
m Factor
 Humoral
Mechanism
.Bile salts: They are the most powerful choleretics known .1
.Bile salts evacuated with bile from the liver to the intestine -
.After performing their function, 95% of them are absorbed from the terminal ileum by an active transport mechanism -
On reaching the liver they stimulate it to secrete bile, which is deficient in bile pigments -
.)entero- hepatic circulation of bile salts(
:Secretin .2
In addition to its stimulant effect on pancreatic secretion , it stimulates bile secretion by increasing its water & bicarbonate -
.“content, so it is called "hydrocholeretic

Nervous Factor
. Parasympathetic :carries mainly stimulatory secretory fibers, so its stimulation increases bile secretion
 sympathetic : exerts its effect on bile secretion through vasoconstriction which decreases the blood flow and in turn
.decreases bile secretion
Blood Flow
Increased portal blood during digestion increases bile secretion, but when the liver is markedly congested bile secretion stops
due to increase of the intrahepatic vascular pressure
 Storage of bile

Acidification of bile
Function of
gall bladder Secretion of white bile

Concentration of bile

Buffering of biliary pressure

Evacuation of bile when needed

 1 Storage of bile
.Bile flows into the duodenum only after ingestion of food -
In between the meals e sphincter of Oddi is closed, and bile flows back to the cystic duct to be stored -
.in the gall bladder

2 Acidification of bile
: Acidification is done by absorption of its NaHCO3 content to
.prevents the precipitation of insoluble calcium salts, and formation of gall stones .1
.bactericidal effect .2

3 Secretion of white bile

.Gall bladder and bile duct mucosa secrete mucoid like material which protects them from any irritant chemical products -
 4 Concentration of bile
.The total daily secretion of bile is 500 ml , while the maximum volume of gall bladder is only 40-70 ml -
 Mechanism of Concentration of bile : Bile can be concentrated up to 10 or 12 times
sodium ion actively absorbed by the gall bladder mucosa -
.Cl- , HCO3- absorbed passively and water absorbed by osmosis -
.The other bile constituents are concentrated -

5 Buffering of biliary pressure

???”  The gall bladder equalizes the pressure in the biliary system “ how
.By storing bile, it prevents any increase in pressure in biliary passages -
.This enables the liver to secrete because hepatic cells cannot secrete against high pressure -

6 Evacuation of bile when needed

.Hepatic cells secrete bile at a low pressure, about 7 cm H20
.The tonic contraction of sphincter of Oddi is equivalent to 30 cm H20 when it is closed (between meals)
 After ingestion of food there is partial relaxation of the sphincter with a tone of about 10 cm H20, synchronous with
.contraction of the gallbladder with a pressure equal to 20 cm H2O
.In this case the bile flows from gall bladder together with fresh bile coming from liver to the duodenum -
 Humoral factor .Cholecystokinin (CCK)
Factor
.This local hormone is secreted when fatty acids or amino acids reach the duodenum -
affecting gall It circulates in the blood and passes to the gall bladder via its blood supply and leads to -
bladder .contraction of the gall bladder wall and evacuation of its contents into the duodenum
evacuation
“Cholagouges
Nervous factor
” play a minor role in bile evacuation

Parasympathetic Sympathetic
- the gall bladder contracts, and bile is collected into the  inhibits the gall bladder wall,
bile ducts and flows into the duodenum by the aid of the  but contracts the sphincter.
relaxation phase of peristaltic wave travelling along it.

 The vagus nerve is motor to the wall of gall bladder and

inhibitory to the sphincter of Oddi.
Note ‫اخر‬
I. Cholagogues
. Gall bladder evacuants , e.g :- Cholecystokinin (CCK)
II. Choleretics
 Any factor which stimulates bile secretion, e.g :- Bile
salts , Secretin (hydrocholeretic) , vagus (A. Ch. )
Bile pigment and Jaundice
 Bile pigments (bilirubin & biliverdin)
 Liver execretion no digestive function.
 Major end-products of hemoglobin and myoglobin metabolism.
 Normal concentration : 0.2-0.8mg /100ml of plasma.
Formation of bile pigments
• RES
After that
 life span of RBCs=120 days their cell membrane rupture
globin aa
[Reservoir for erythropoiesis (recycled)]
1) macrophages attack hemoglobin fe
(Spleen,bone marrow,LNs,CT) heam biliverdin reduced bilirubin
• Plasma
2) bilirubin + plasma protein (mainly albumin) Haembilirubin (water insoluble) (unconjugated)
• Liver plasma

3) haembilirubin haem
Bilirubin ( conjugation)

 Bilirubin + 2 molecules of glucuronic acid Glucuronyl transferase cholebilirubin or bilirubin diglucuronide

(Water soluble) (conjugated)
 Cholebilirubin is execreted by an active process into the bile ducts to the intestine.
P.S Normally, a small amount of cholebilirubin leaks from the bile canaliculi to the general circulation,and is
excreted in urine. So the plasma contains ( heambilirubin & cholebilirubin).

Does not pass from the kidney because of its Is filtered through the kidney &passes in urine
large molecules & insolubility in water. but in very small amount.
Normal urine is considered free from both types of
pigment.
• Intestine

Cholebilirubin Intestinal bacteria stercobilinogen (water soluble).

reduction
 Fate of stercobilinogen

 2/3 of total amount feces stercobilinogen (1)

Ox
Colorless derivaties (2) 1/3

ida
tio
n
Stercobilin (3) brownish color of feces
2/3
 1/3 portal circulation liver, where some of it is re-excreted in bile
(enterohepatic circulation)

oxidation
 Small traces escapes to the general circulation urine (urobilinogen) (urobilin)

Is not responsible for normal color of urine

 Formation of bile pigments
[Reservoir for erythropoiesis (recycled)]

macrophages attack Hb, globin Fe+2

RBCs cell membrane hemoglobin amino acids
After 120 day (Spleen, bone marrow, LNs, CT)
rupture
haem biliverdin
reducetion

bilirubin
liver o n j u g a t ed bilirubin
in = u n c
i n d i re c t bilirub
ub in = umin
Cholebilirubin Haembilir r ri e r : a l b
Ca
Active reuptake
Direct = conjugated with glucuronic acid water soluble
excreted by an active transport Small amount
urobilinogen
Oxidation
intestine stercobilinogen Oxidation (2/3)
sterocobilin urobilin
1/3 responsible for the dark not responsible for the
brown color of stool normal color of urine
enterohepatic circulation of bile pigment
 Jaundice
(lcterus)

Def.
Yellowish tint or discoloration of the skin, sclera, mucous membrane and deep tissues.
Cause:
Increased serum billirubin above normal value (0.2-0.8mg/dl)
0.8-2 mg/dl is not detected clinically (subclinical)
> 2 mg/dl is detected clinically (clinical jaundace)
Hemolysis Haemolytic jaundice
(prehepatic)
Haembilirubin ++++ Water insoluble

cholebilirubin +++

Urine is free
stercobilin +++ (Acholuric jaundice)

Darker stool
 Obstructive jaundice
(post hepatic)
Haembilirubin
Water soluble

cholebilirubin +++

Intrahepatic or
extrahepatic obstruction
of bile ducts by: atresia,
stones in its lumen or
pressure from cancer of Dark brown urine
pancreas stercobilin absence (liquorice urine)

Clay stool
 Hepatocellular jaundice
(hepatic)
Haembilirubin ++++ Water soluble

cholebilirubin +++
1) damage or failure of the
hepatic cells.
2) mild obstruction of
intrahepatic bile canaliculi.

Dark brown urine

stercobilin Deficiency

Grayish stool
 Haemolytic jaundice Obstructive jaundice Hepatocellular jaundice
(prehepatic) (post hepatic) (hepatic)
causes Excessive hemolysis as Intrahepatic or extrahepatic 1) damage or failure of
hemolytic anemia obstruction of bile ducts by: the hepatic cells.
atresia, stones in its lumen 2) mild obstruction
or pressure from cancer of pancreas of intrahepatic bile canaliculi

Type of bilirubin Haembilirubin Cholebilirubin Haembilirubin&cholebilirubin

elevated (unconjugated) (conjugated) (both unconjugated &
conjugated)

Urine color Free Liquorice Dark brown

(Acholuric urine)

Stool color darker Clay grayish

Bile salt Absent Present present
Van den Bergh test Indirect positive Direct positive Biphasic
 Other bile constituents
a) Cholesterol:
 Is not related to dietary cholesterol.
 It is an excretory product.
 It is concentrated in the gall bladder.
 It forms mixed micelles with phosphatidyl-choline that enters the bile and bile salt.
 The ratio of bile acids : phosphatidyl-choline : cholesterol
10 : 3 : 1 ( Deviations from this ratio cause cholesterol leading to gall
stones)
 It is a precursor of bile salts (cholic acid), sex hormones and adrenal steroids.
 It helps the absorption of fats, it is a constituent of the cell membrane.

b) Fatty acids and lecithin:

 Play role in emulsification of fats and micelles formation.
 Pancreatic secretion
The main enzymes present in pancreatic secretion
proteolytic enzymes -1

pepsin
large peptides
Protein
enterokinase basic amino acids
trypsinogen trypsin
trypsin aromatic amino acids endopeptidase
Chymotrypsinogen chymotrypsin
trypsin aliphatic amino acids
Proelastase elastase

Small peptides
trypsin
Procarboxypeptidase carboxypeptidase exopeptidase

Small peptides + amino acid

Physiology
GIT
Exocrine pancreatic secretion
Introduction
 Pancreatic secretion
ml / day 1500 PH = 8.3 •
-
. Cations: Na+, K+ , Mg+2, Ca+2
 Anions: Cl- , HPO4- , HCO3- ,SO4
Amount )most alkaline juice in the body(
 Water bile and intestinal secretion are also -

t
en
 Albumin and globulin pH neutral or alkaline so these three secretions

nt
 Pancreatic enzymes neutralize gastric acids to PH 6-7
Pancreatic

Co
contains enzymes for digesting 3 major .1
secretion

im
 when acid chyme enters the duodenum , the

lus
.types of food: proteins, CHO and fats

po
contains large quantities of NaHCO3 2 . flow of juice is augmented

mu
rta
)fold that of plasma 5 ( . maximum level : 3 hours after meals -

Sti
nce
.greatly declines : when stomach is emptied -

Types
Enzymatic secretion Aquous secretion
small volume large volume Characters
poor in water and bicarbonate rich in water and bicarbonate
Rich in enzymes poor in enzymes
Acinar cell Duct cell Site
CCK - Secretin - Control
: Vagus - : Sympathatic -
 Pancreatic secretion
The main enzymes present in pancreatic secretion
proteolytic enzymes -1
Mechanism of activation function
trypsinogen optimum PH 8-9 trypsin activate trypsinogen and other proteolytic -1
enterokinase enzymes
trypsinogen trypsin
endopeptidase , hydrolyze peptides at site of basic -2
trypsin
trypsinogen trypsin amino acids (lysine and arginine)
)autoactivation(
Chymotrypsinogen trypsin endopeptidase , hydrolyses peptides at site of aromatic -
Chymotrypsinogen chymotrypsin
amino acids (phenylalanine, tyrosine, tryptophan)
Proelastase trypsin attacks the elastic fibers .1
Proelastase elastase
endopeptidase , hydrolyses peptides at site of aliphatic -2
amino acids (alanine, glycine, and serine)
procarboxypeptidase exopeptidase: cleaves the last amino acid from carboxyl .1
trypsin
Procarboxypeptidase carboxypeptidase
terminal end of protein and peptides
Ribonucleases and -------- Split the two types of nucleic acid: ribonucleic and .1
deoxyribonucleases
deoxyribonucleic acids
 Pancreatic secretion
The main enzymes present in pancreatic secretion
proteolytic enzymes -1
 Pancreatic secretion
The main enzymes present in pancreatic secretion

Secretion of trypsin inhibitor

Why ? activation of the proteolytic enzymes occurs

only in the intestine????

because the pancreatic acini that secrete the enzymes -

.secrete at the same time a trypsin inhibitor

The trypsin inhibitor is stored in the cytoplasm of the -

.glandular cells surrounding the zymogen granules
Function : prevents activation of trypsinogen in the pancreas, -
.thus protecting it from autodigestion
 Pancreatic secretion
The main enzymes present in pancreatic secretion
pancreatic amylase -2

most form of carbohydrates Cl

- oligosaccharides (maltose,
e.g. starches, glycogen malt triose and a-dextrins).
pancreatic amylase
(except cellulose)

Powerful action than salivary amylase, it can split the uncooked starch

lipolytic enzymes -3

Colipase +
Pancreatic lipase
Triacylglycerol free fatty acids + monoacylglycerols
Cholesterol esterase
Cholesterol ester free Cholesterol
Phospholipase
phospholipids fatty acids
 Pancreatic secretion
Regulation of pancreatic secretion
Pancreatic secretion is regulated by both nervous and hormonal, but hormonal is more important
 Amount of secretion according the time of meal

Secretion greatly
declined after c r e t i o n
stomach emptied L it tle s e in g
i n g f a s t
dur retio n s t ar t
Maximum Sec m i n ut e
t er f e w
secretion after af ac t i o n
r e f l ex
3 hours Secretion by
augmented when
acid chime enters
the duodenum
 Pancreatic secretion
Regulation of pancreatic secretion
Nervous regulation -1
:  Mechanism  Nervous type of secretion
occurs by both conditioned and ❶
Nervous signals from .unconditioned reflexes
the brain
small in amount, rich in enzymes but ❷
.deficient in alkali and water
Stimulate vagus nerve abolished by atropine ❸
endings to pancreas

Stimulate release of
acetylcholine

Stimulate cells to cause discharge

acinar from zymogen granules
 hormonal regulation -2
:  Stimulus of pancreatic secretion
.Evacuation of the gastric contents to duodenum .1

.Some local hormones evoke pancreatic secretion (mainly secretin, CCK and VIP) .2

-:It could be divided into*

Gastric phase via gastrin which increases pancreatic juice rich in enzymes .1

‫ال‬ ‫اتكلمنا عنها في‬

Stomach

.Intestinal phase via secretin, CCK and VIP .2

‫هنتكلم عنها دلوقتي‬

 Secretin
.polypeptide of 27 amino acids Structure
. S cells ( located in mucosa of the upper portion of the small intestine) secreted by
Stimulus
blood
pro-secretin entry of acid chyme to the duodenum secretin
(inactive form) (active form)
secretin
negative feedback

neutralizing the acid from the stomach

Regulation of pancreatic secretion
Secretin
Actions

❶ secrete aquous secretion

- large volume of alkaline pancreatic • stimulates bile secretion:
secretion rich in water and bicarbonate but (hydrocholeretic action )
poor in enzymes Why -  water and HCO3 content,
1. neutralizes the acidity thus acts as protective - but the output of bile salts, and bile
mechanism against duodenal ulceration pigments does not increase
2. provides suitable pH for action of pancreatic
enzymes which act optimally at pH about 8.
❷ augments CCK actions on the pancreas
❸ stimulates release of insulin but
inhibit release of glucagon

 gastric secretion .1
May cause contraction of the .2
.pyloric sphincter .intestinal movements
 Cholecystokinin (CCK)
.  I cells ( located in mucosa of the upper portion of the small intestine) secreted by
:  nerves in many parts of the body
.nerves in the distal ileum and colon.1
neurons in the brain ( cerebral cortex mainly ) .2
presence of digestive products or release of CCK bile and pancreaticStimulus
juice
proteins, and fats in small intestine enter the duodenum
positive feedbac
k catalyze the digestion of more protein and fat
However, the positive feedback is terminated when the products of digestion move on to the lower -
.portions of the gastrointestinal tract
 Cholecystokinin (CCK) Actions

❶ secrete enzymatic secretion

- small volume rich in enzymes but poor blocks gastric motility by competitive inhibition .1
in water and bicarbonate of gastrin hormone
❷augments action of secretin on .inhibits gastric emptying and secretion .2
pancreas . augments the contraction of pyloric sphincter, .3
❸CCK stimulates release of glucagon thus preventing the reflux of duodenal contents
and insulin. into the stomach

Helps evacuation of gall

related to production of
bladder, i.e. cholagogue
anxiety and analgesia
may be involved in the
.intestinal movements regulation of food intake
 hormonal regulation
secretin cholecystokinin
I cells
S cells Site of secretion in nerves in the distal ileum and colon
entry of acid chyme to the duodenum • presence of digestive products or proteins, •
stimulus and fats

Aquous secretion
type of Enzymatic secretion
secretion
negative feedback feedback positive feedback
augments CCK actions on the pancreas - . augments action of secretin on pancreas -
stimulates release of insulin - CCK stimulates release of glucagon & insulin -
inhibit release of glucagon -
.intestinal movements .intestinal movements
hydrocholeretic action Action evacuation of gall bladder, i.e. cholagogue
 gastric acid secretion .1 inhibits gastric motility , emptying and .1
.May cause contraction of pyloric sphincter .2 .secretion
augments the contraction of pyloric .2
sphincter, thus preventing the reflux of
duodenal contents into the stomach
Regulation of pancreatic secretion

Vasoactive intestinal peptide (VIP)

certain neurons and endocrine cells throughout the intestine ❶ secreted by
thus is not itself a hormone but a neurotransmitter or a co-transmitter -
. .brain and many autonomic nerves ❷
action

secrete aquous secretion

(weaker than secretin)  gastric HCI secretion and
stimulates intestinal secretion
motility
of electrolytes and water

relaxation of gastrointestinal smooth ❺

muscles, including : (Sphincters , dilation of
.peripheral blood vessels) potentiates action of acetylcholine
in salivary glands (Serous secretion)
Physiology
GIT
The SMALL INTESTINE
 In the living human, the distance Duodenum
between the pylorus and iliocecal valve Jejunum
. is about 280 cm

After death : it elongates to more Il

double its length (about 6 m)
. because of losing its tone

:The small intestine preforms both

Endocrine functions by Exocrine functions by

:secretion of hormones as secretion of
.Secretin  .Digestive enzymes
.CCK 
.VIP 
 Constituents of the intestinal secretion (succus entericus)

Digestive juice mucus

1 brunner’s glands
: Secreted from  Only in the first cm of -
intestinal glands duodenum
.)crypts of Lieberkuhn(
amount : 1 L / day Secrete alkaline 
mucus (why??)
PH : 7-7.5 (Slight alkaline)
:Stimulated by 
No digestive enzymes  Acidic chyme.1
.)only water and ions( Vagal stimulation .2
. Isotonic  Secretin hormone.3
Inhibition by : 
sympathetic
 Digestion in the small intestine
The final digestion in the intestine occur in three locations 

Brush border intracellular (cytoplasmic Luminal digestion

The intestinal digestion) Occur by 30 gm. of
digestion mainly Occur by the enzymes cellular enzymes and
proteins of desquamated
occur there by located in the cytoplasm of . intestinal cells
.digestive enzymes .intestinal mucosal cells The life span of-
intestinal mucosal cell is
Brush border .3-5 days
 Protein digestion
pepsin
Small peptides
Protein
Trypsin and chymotrypsin
carboxypeptidases
endopeptidases
some
tripeptides
Dipeptides
tripeptides
Dipeptides
Dipeptides
aminopeptidases
dipeptidases

Intracellular
peptidase Free amino acid
 Lipid digestion Nucleic acids digestion

Small amounts of intestinal lipase are Nucleases split nucleic acids to

secreted to splits neutral fats into pentose, purine, and
monoglycerides and fatty acids pyrimidine base
In the living human, the distance
between the pylorus and iliocecal valve
is about 280 cm .

After death : it elongates to more

double its length (about 6 m)
because of losing its tone .

The small intestine preforms both:

Endocrine functions by Exocrine functions by

secretion of hormones as: secretion of
 Secretin. Digestive enzymes.
 CCK.
 VIP.
 Constituents of the intestinal secretion (succus entericus)

Digestive juice mucus

 Digestive juice
Secreted from : intestinal glands
(crypts of Lieberkuhn).
amount : 1 L / day
PH : 7-7.5 (Slight alkaline)
No digestive enzymes
(only water and ions).
Isotonic .
 mucus
1
brunner’s glands
- Only in the first cm of duodenum

 Secrete alkaline mucus (why??)

Stimulated by:
1.Acidic chyme.
2. Vagal stimulation.
3.Secretin hormone.

Inhibition by : sympathetic.
 2
Goblet cells 3 Crypts of Lieberkuhn
Both are scattered all over the mucosal surface of
small intestine
 Stimulated by :  Controlled by :
food bolus ( mechanical local nerve plexuses.
and chemical).
Anxiety sympathetic

Inhibition secretion of mucus

brunner’s glands
 Digestion in the small intestine
 The final digestion in the intestine occur in three locations

1
Brush border The intestinal digestion mainly
occurs at this brush border

by

Digestive enzymes
 2 3

intracellular Luminal digestion

(cytoplasmic digestion) Occur by 30 gm. of cellular
Occur by the enzymes enzymes and proteins of
located in the cytoplasm of desquamated intestinal cells .
intestinal mucosal cells.  The life span of intestinal
mucosal cell is 3-5 days.
Protein digestion

In our body

Polypeptide chains
By intra
cellular
peptidases
Carbohydrate digestion
 Lipid digestion Nucleic acids digestion

Small amounts of intestinal lipase Nucleases split nucleic acids

are secreted to splits neutral fats to pentose, purine, and
into monoglycerides and fatty pyrimidine base
acids
Regulation of intestinal secretion
 Nerves control
A) Chemical and mechanical stimulation by: B) Vagal stimulation
food

Stimulates
secretion

Of mucus from
brunner’s gland only.
Stimulates
secretion

Initiates local enteric reflex (in submucosal plexus).

Physiology
GIT
The Large Intestine
And Defecation
 The Large Intestine

Proximal Distal Colon

Colon “Storage”
“Absorption”

Rectum + Anal
canal
“Defecation”
 Functions of large Intestine

3 Secretion 4 Storage

Action of
2 Absorption 5
bacteria flora

1 Digestion
6 Defecation
 Functions of large Intestine
1 Digestion
 The large intestine has No digestive functions in man.
 In herbivores, cellulose is hydrolyzed into glucose by the action of bacteria in the colon.

2 Absorption
1300 ml of water have been
1500 ml of fluid absorbed in the large intestine,
chyme pass daily 200 ml of fluid secrete especially in the caecum and
from the ileocecal in feces per day ascending colon. ”proximal
valve. colon”

The large intestine can absorb water, salts, glucose, and other crystal-loids, but with a much slower rate
than the small intestine.
 Functions of large Intestine
3 Secretion
 The only significant secretion in the large intestine is mucus
 its rate of secretion is regulated principally by direct stimulation of the goblet cells and by
local enteric reflex a the goblet cells in the crypts of Lieberkuhn.

NB Parasympathetic stimulation to the distal part of the large intestine causes marked
increase in mucus secretion

Functions of the mucus

1) It protects the wall against mechanical and chemical irritation.
2) It provides the binding medium for holding fecal matter together and lubricates the feces.
3) It neutralizes the acids produced by bacterial fermentation, due to its alkaline reaction.
4) It secretes large quantities of water and electrolytes in cases of bacterial infection, to dilute the
irritating factors and to cause rapid movement of the feces toward the anus.
 Functions of large Intestine
4 Action of bacteria flora
 In the large intestine, bacteria synthesize valuable substances as vitamin K, vitamin E complex,
and some amino acids.
 These substances are absorbed and supplement the dietary vitamins.

Prolonged use of antibiotics and intestinal antiseptics destroy the bacteria

leading to vitamin deficiency

5 Storage of feces
 Feces are stored in the pelvic colon till the time of defecation
 Functions of large Intestine
6 Defecation

Parasympathatic Sympathatic Somatic

supply supply supply
 Parasympathetic supply
 The vagi supply the proximal colon with motor fibers Vagus
Pelvic
 the pelvic visceral nerve (Sacral 2, 3, 4) supplies the visceral
remaining part of the wall of the large intestine
 But is inhibitory to the internal anal sphincter.

the parasympathetic supply :

 increases the tone and movements
 helps the emptying of the large
intestine and defecation.
 sympathetic supply Symp.
 It arises from lumbar 1-4. It is inhibitory to the L1-4
muscles of the entire colon
 but it is Excitatory to the internal anal sphincter.

Somatic supply
 The external anal sphincter is supplied by the
pudendal nerve from sacral 2-4.It is a voluntary
muscle
 Under voluntary, conscious, subconscious control;
subconsciously, the external sphincter is usually kept
continuously constricted unless conscious signals Pudendal
inhibit the constriction. S2-4
 Motility of the large intestine
 The movements of the colon include :
1) segmentation contractions
Like in the small muscle
2) peristaltic waves
3) the mass action contraction Only in the colon

 there is simultaneous contraction of the smooth muscle over large confluent areas. It is
facilitated by :
1) the gastro-colic reflex
2) Duodeno-colic reflexes
 These contractions :
 propel the fecal material in one segment en masse further down the colon.
 They also move material into the rectum, causing rectal distension which initiates the defecation reflex.
 Defecation
 Definition : It is a complex muscular act to empty the colon from the middle of the
transverse part to the anus

Involuntary
Preparing Voluntary
 Distention
g Both reflexes
ri n Duodenum Stomach
are transmitted
p a
Pr e by ANS
Duodeno-colic Gastro-colic
reflex reflex

Mass
contraction

Distention
rectum
 r y Distention rectum
n ta
o l u
v
In
Intrinsic reflex Parasympathetic reflex
Afferent signal Pelvic N. post. Root
S2,3,4
Myenteric plexus Spinal cord

Peristalsis: take deep Contract

-internal anal sphincter breath closure descent of
-descending abdominal
glottis the pelvic f.
-sigmoid downward, to
wall M.
-rectum straighten
the anorectal
angle to expel
the feces
 Distention rectum
ry
u n ta In newborn babies and in
l Rectal pressure some people with
Vo Afferent impulse
transected spinal cords,
the defecation reflexes
cause automatic emptying
Visceral cortex of the lower bowel at
inconvenient times during
the day because of lack
of conscious control
Sensation of desire exercised through
The frequent voluntary for defecation voluntary contraction or
inhibition of the relaxation of the
defecation reflex is external anal sphincter.
the most common
cause of constipation External Anal Sphincter

No Defecation Defecation
occur
 e r
e mb
e m
R
Intrinsic Gastrocoli
reflex c reflex
Parasympathetic Duodenocolic
reflex reflex
-peristalsis
-internal anal
sphincter
Intrinsic reflex Mass contraction