CHAPTER 6
DIGESTION
Learning Outcomes:
At the end of the three hours lecture –discussion on digestion, the students will be able to:
1. Describe digestion,
2. Identify the accessory organs of digestion and the organs in the gastrointestinal tract,
3. Describe and note which organ does the mechanical or the chemical process,
4. Explain thoroughly the important function of the accessory organs in digestive process,
5. Explain the absorption process of food.
DIGESTION- is the chemical and mechanical breaking down of food particles into molecules
small enough to be absorbed in the body’s system.
There are two main groups in the organs of digestion:
1. Gastrointestinal tract (alimentary canal) - a continuous tube that extends from
the mouth to the anus.
2. Accessory structures - are never in direct contact (except the teeth and the tongue), with
the food, but stores or produce secretions that help in chemical breakdown of food.
The main organs in the gastrointestinal tract are the mouth, pharynx, esophagus, stomach, small
intestine and large intestine. Whereas the accessories that play an essential role in digestion are
the teeth, tongue, salivary glands, liver, gallbladder and pancreas.
OVERVIEW OF DIGESTION
Processes Involved in Digestion:
1. Ingestion – when a person or an animal takes food into the mouth or commonly termed
as eating.
2. Mechanical digestion & chemical digestion - mastication, to tear and crush food, and
churning of the stomach. Addition of chemicals (acid, bile, enzymes, and water) to break
down complex molecules into simple structures.
3. Absorption - is the process of circulating the small molecules to the different parts of the
body. It also means the movement of nutrients from the digestive system to the circulatory
and lymphatic capillaries through osmosis, active transport, and diffusion.
4. Egestion - is the removal of undigested materials from the digestive tract through
defecation.
MAJOR ORGANS INVOLVED IN DIGESTION
MOUTH
The mouth is the first organ that
receives the macroscopic foods.
This is where the first digestion occurs.
Accessories like the teeth, do the
mechanical process in breaking
down foods into smaller particles.
Tongue, on the other hand do the
mechanical churning and
mastication, such that the food and
the saliva mixes. Saliva helps in
converting the food into a soft
substance, called bolus. Saliva has
two enzyme secreted in the mouth-
salivary amylase and lingual lipase.
Salivary amylase breaks down the
starches into shorter chains of
carbohydrates until they are broken down to monosaccharide. That is why in eating, it is very
important to chew on food for longer time so that there will be enough time for the enzyme to
work in the breaking of starches.
The enzyme lingual lipase (secreted from the tongue) also starts its catabolism of triglycerides into
fatty acids and monoglycerides. When the ingested food is finally turned to a bolus, it is now ready
for swallowing. Swallowing is voluntary when the bolus is still at the mouth, then forced to the back
of the oral cavity then to the pharynx. Once the bolus has passed in the oropharynx, the
involuntary pharyngeal stage follows.
ESOPHAGUS
From the oropharynx, the bolus passes through the upper esophageal sphincter and enters in the
esophagus. The esophagus is lined with constantly secreted mucus that protects from the
swallowed bolus and is composed of circular muscles (medulla oblongata).
When bolus enters the esophagus, it undergoes an alternate series of contraction and relaxation
of the circular muscles to propel it towards the stomach. The process is otherwise known as
peristalsis. This organ only performs mechanical process. When it reached the lower esophageal
sphincter, this muscle opens and allow entry of bolus to the stomach.
STOMACH
The human stomach is a muscular,
elastic, pear-shaped bag, lying
crosswise in the abdominal cavity
beneath the diaphragm. It changes
size and shape according to is
position of the body and the amount
of food inside. The stomach is about
12 inches (30.5 cm) long and is 6
inches. (15.2 cm) wide at its widest
point. Chemical and mechanical
reaction happens inside the
stomach. When the bolus is
received from the espophagus,
gentle rippling and peristaltic motion
happens. When it expands, the
production of gastric juices is
catalyzed and the peristaltic motion
increases. The peristaltic motion
allows a complete mixture between
the bolus and the enzymes. The enzyme pepsinogen is synthesized in the mucus lining. When it
contacts with HCl, it becomes activated form of pepsin. Pepsin is a protein enzyme that breaks
the peptide bonds to form amino acids.
On the other hand, there is a continuous reaction of enzyme amylase and lingual lipase, but
because the secretion of gastric juices increases the pH of the stomach, enzymes are destroyed,
thus polysaccharides are not completely broken to disaccharides and monosaccharide, while
fat are just reduced to fat globules.
The rapid peristaltic motion converts the bolus into a liquid form of food, chyme. During the
chemical reaction, carbohydrates are the first to be converted to chyme, thus they are the first to
be moved out from the stomach and goes out from the pyloric sphincter to the duodenum. Next
to be converted to a liquid form are the proteins and the last are the lipids.
As time passes, the stomach experiences a pressure towards the center of it due to the production
of the gastric juices and pepsin. When the stomach is empty, the neurons send a signal to the
hypothalamus to stop the production of gastric juices and pepsin.
Our stomach digests food for four hours. After four hours, the stomach is empty again. When the
person ingested something, digestion process repeats its cycle.
SMALL INTESINE
The small intestine is a
long, narrow, coiled
tube extending from the
stomach to the large intestine.
This is the place where most
digestion and absorption of
food takes place. The small
intestine of a human can be as
long as six to eight meters
long, depending on age and
size of being. Called the
‘small’ intestines
because of its
diameter not because of its
length. The small intestine is the
longest and most
convoluted of the intestines. It
is lined with mucosal
secretions. The mucusa forms
a series of microscopic villi,
brushlike in form where a lot of
absorption process occurs. It is divided into three segments:
Duodenum the first part of the small intestine that is connected to the pyloric sphincter.
This is also the shortest segment among the three and it’s about one foot
long.
Jejunum
the middle portion of the small intestine and it’s about 5-8 feet long.
the place where most nutrients are actively absorbed
Ileum the last division of the small intestine that is connected to the ileocecal
sphincter. It measures 16-20 feet long.
The small intestine is aided with the accessory organs in order to perform a complete digestion of
the macroscopic substances. These organs are the following:
1. Gallbladder stores and concentrate bile until they are needed by the small intestine
2. Liver
produces the bile salts – a yellowish, brownish olive green liquid which plays a very
important role in the breakdown of large lipid globules into suspension of droplets. Bilirubin
is the principal bile pigment. the heaviest part which weighs 1.4 kg
receives oxygenated and un oxygenated blood from the hepatic artery and hepatic
portal vein respectively.
it acts as a blood reservoir and a storage organ for vitamins such as A and D and for
digested carbohydrate (glycogen), which is released to sustain blood sugar levels. It
manufactures enzymes, cholesterol, proteins, vitamin A (from carotene), and blood
coagulation factors.
the liver filters out harmful substances or wastes, turning some of the waste into more bile.
The liver even helps figure out how many nutrients will go to the rest of the body, and how
many will stay behind in storage.
3. Pancreas the gallbladder and liver are connected by a duct in the
pancreas.
it is about six inches long and provides the body's most important enzymes. It secretes:
• Insulin, which accelerates the burning of sugar in the body.
• Pancreatic juice, which contains some of the body's most important
digestive enzymes - lipases, which split fats; proteases, which split proteins;
and amylases, which split starches.
Illustration:
The chyme from the stomach is slowly propelled to the small intestine through the pyloric
sphincter; but not the entire chyme is fully digested.
Carbohydrates are the first to enter the small intestine. The salivary amylase in the stomach are
destroyed the moment HCl is secreted in the stomach, thus an incomplete digestion of
carbohydrate. When it enters, the pancreas secretes the pancreatic amylase to continue the
digestion of carbohydrates. Pancreatic amylase helps reduce polysaccharides and
oligosaccharide to disaccharides and monosaccharide. But only a few are converted to
monosaccharide and our body absorbs monosaccharide sugars, thus brush border enzymes
dextrinase, maltase, lactase and sucrase convert it into monosaccharide sugars so that they can
be absorbed and used in the body’s system.
Proteins, on the other hand are reacted with pancreatic enzymes to break the peptide bonds of
different cleavages so that they can now be absorbed and transported to the different parts of
the body. The pancreatic enzymes of proteins are aminopeptidases, dipeptidases and
caboxylases.
The last to enter the small intestine is the triglycerides. They come out in the form of fat globules.
Pancreatic lipase acts successfully on triglycerides to produce fatty acids and monoglycerides.
When final digestion is accomplished, the nutrients are then transported through passive and
active transport.
The length of the small intestine helps in almost digesting and absorbing all the nutrients in the
body. The motion of the chyme is wavelike that encourages more contact with the reacting
substances. The small intestine experiences a chemical and a mechanical process. All the
digestion process is a chemical reaction, while the absorption of nutrients and propulsion of the
chime is a mechanical process.
In absorption, the nutrients are transported by active and passive transport, in propulsion, the
movement of the chime is segmented, Segmentation is a localized major movement in the small
intestine where there is a contraction in the areas containing the chyme. The contraction is
segmented and in an alternating fashion until the chyme is forwarded to the ileocecal sphincter.
The action is more or less the same as with the peristaltic motion.
LARGE INTESTINE
The large intestine is the last organ in digestion. It starts from the ileocecal sphincter and ends at
the anus where indigested substances are secreted as feces. It is divided into four parts; the
ascending colon – the one connected to the ileocecal sphincter and the first to receive the
chyme from the small intestine; then the transverse colon, descending and the sigmoid colon.
After the sigmoid, there is a small muscular tube, rectum, which is composed of an anal canal and
an anus. Enzymes do not thrive in large intestine, but rather, it is the bacteria that synthesize and
ferments the undigested substances found in the chyme. The fart that is produced is the result of
the fermentation process caused by bacteria. The bad odor we smell in our feces is caused by
the bacterial action in undigested proteins, producing indole and skatole. Bacteria also
synthesize some of the essential vitamins in our body like vitamin K and B.
The chyme from the small intestine enters the ileocecal sphincter and received by the ascending
colon of the large intestine. The large intestine is composed of a haustra which acts as a container
of the chyme. The mechanical process of the large intestine is the haustral turning and peristalsis.
One haustral sac should be filled in before it is transferred to the succeeding haustral sac. When
the haustra is filled, it contracts locally and transferred its chime to the next haustra. This process
is termed as haustral churning. Peristalsis still happens but just slowly. The process of haustral
churning aids the last stage of digestion and absorption. As the chyme is transferred from one
haustra to another, water is also absorbed until time will come that the chyme will be dehydrated
and become a soft solid.
When the solidified chyme reached the middle portion of the transverse colon, it experiences
mass peristalsis - this is a strong peristaltic wave that quickly drives the colonic contents into the
rectum.
People often feel the need to move their bowels during or after eating. This reaction is triggered
from the entry of food in the stomach, causing gastrocolic reflex in the colon. Mass peristalsis often
happen during these times.
When the solidified chyme reaches the sigmoid colon, the neurons send signals to the
hypothalamus that the waste is ready to be secreted. This creates so much pressure in the sigmoid
colon by applying pressure in it, causing its size to shorten or contract. The chyme is then is brought
forward toward the anus where it is controlled by two sphincters. One sphincter – the smooth
muscle of the internal sphincter reacts involuntarily. This is what we feel when we need to move
our bowel. Another sphincter, external skeletal muscle sphincter does the voluntary reaction. This
is the reason why despite the fact that our brain already signaled us to move the bowel would be
the next mass peristalsis.
Absorption and Transport of Nutrients
Digested molecules of food, water and minerals from the diet are absorbed from the cavity of
the upper small intestine. The absorbed materials cross the mucosa into the blood and are carried
off in the bloodstream to other parts of the body for storage or further chemical change. This
process varies with different types of nutrients.
Carbohydrates: Some of our most common foods contain mostly carbohydrates. Examples
are bread, potatoes, candy, rice, spaghetti, fruits, and vegetables. Many of these foods contain
both starch, which can be digested and fiber, which the body cannot digest.
• The digestible carbohydrates are broken into simpler molecules by enzymes in
the saliva, in juice produced by the pancreas, and in the lining of the small
intestine. Starch is digested in two steps: First, an enzyme in the saliva and
pancreatic juice breaks the starch into molecules called maltose; then an
enzyme in the lining of the small intestine (maltase) splits the maltose into
glucose molecules that can be absorbed into the blood. Glucose is carried
through the bloodstream to the liver, where it is stored or used to provide
energy for the work of the body.
• Table sugar is another carbohydrate that must be digested to be useful. An
enzyme in the lining of the small intestine digests table sugar into glucose and
fructose, each of which can be absorbed from the intestinal cavity into the
blood. Milk contains yet another type of sugar, lactose, which is changed into
absorbable molecules by an enzyme called lactase, also found in the intestinal
lining.
Fats: Fat molecules are rich source of energy for the body. The first step in digestion of a fat is
to dissolve it into the watery content of the intestinal cavity. The bile acids produced by the liver
act as natural detergents to dissolve fat in water and allow the enzymes to break the large fat
molecules into smaller molecules, some of which are fatty acids and cholesterol. The bile acids
combine with the fatty acids and cholesterol and help these molecules to move into the cells of
the mucosa. In these cells the small molecules are formed back into large molecules, most of
which pass into vessels (called lymphatics) near the intestine. These small vessels carry the
reformed fat to the veins of the chest, and the blood carries the fat to storage depots in different
parts of the body.
Fats are reduced to monoglycerides and free fatty acids so that they’re ready for
absorption by pancreatic lipases
Start with a large triglyceride
• Bile salts emulsify fats
• Pancreatic lipases fats down into monoglycerides and free fatty acids
• Transported by the micelles to the epithelium of the small intestines to the
intestinal wall where they can be absorbed
• New triglycerides are synthesized in the epithelial cells
• The triglycerides are wrapped in a protein coat to form a chylomicron
• They’re absorbed predominantly in the lacteal (part of the lymphatic system)
• The lymphatic system drains into the circulatory system (indirectly)
Proteins: Foods such as meat, eggs, and beans consist of large molecules of protein that must
be digested by enzymes before they can be used to build and repair body tissues. As the saliva
contains no enzymes for the hydrolysis of proteins, there is no digestion of proteins in the mouth.
An enzyme in the juice of the stomach starts the digestion of swallowed protein. Further digestion
of the protein is completed in the small intestine. Here, several enzymes from the pancreatic juice
and the lining of the intestine carry out the breakdown of huge protein molecules into small
molecules called amino acids. These small molecules can be absorbed from the hollow of the
small intestine into the blood and then be carried to all parts of the body to build the walls and
other parts of cells.
Proteins are broken down into smaller peptide fragments but they’re still not ready for
absorption
Pancreatic proteases break down proteins into short chain amino acids but they’re not
ready for absorption
Amino peptidases break the short chain amino acids into simple amino acids in the
“fuzz” of the intestines and they’re absorbed via the Na+ co-transport system
They’re then absorbed into the capillary and then the hepatic portal vein and the into
the sinusoids and the hepatic vein
If you’re lactose intolerant you lack lactase (the enzyme in the “fuzz”) which breaks
down lactose
Vitamins: Another important part of our food that is absorbed from the small intestine is the
class of chemicals we call vitamins. There are two different types of vitamins, classified by the fluid
in which they can be dissolved: water -soluble vitamins (all the B vitamins and vitamin C) and fat-
soluble vitamins (vitamins A, D, and K).
Water and Salt: Most of the material absorbed from the cavity of the small intestine is water in
which salt is dissolved. The salt and water come from the food and liquid we swallow and the
juices secreted by the many digestive glands. In a healthy adult, more than a gallon of water
containing over an ounce of salt is absorbed from the intestine every 24 hours.
KEY DIGESTIVE ENZYMES:
Phosphatase Polypeptides Free phosphate
Polynucleotidases Organic Nucleotides
Pancreatic lipase phosphate Fatty acids + glycerol
Elastase Nucleic acids Polypeptides,
dipeptides
Deoxyribonuclease Fats Nucleotides
Cholestero lester Protein Cholesterol, fatty
hydrolases acids
DNA
Cholesterol ester
KEY HORMONES OF
DIGESTION:
HORMONE SOURCE STIMULUS ACTION
Gastrin Pyloric section of Entry of food (bolus) Regulates secretion of
stomach into stomach of HCl from parietal
cells
Cholecystokinin Duodenum Arrival of food Stimulates gall bladder
Cholecysto = (lipidrich chyme) in the contraction, to release
Gallbladder small intestine bile salts (to emulsify
Kinin = movement fats) to intestines.
Stimulates secretion of
digestive enzymes
from pancreas.
Secretin Duodenum HCl entering the Stimulates pancreas to
duodenum secrete NaHCO3 to
neutralize stomach
acids (buffer)
Insulin Pancreas High blood glucose Stimulates the
levels conversion of glucose
into glycogen, stored
in the liver and muscle
Glucagon Pancreas Low blood glucose Stimulates the
levels conversion of
glycogen into glucose
Digestive System Problems
Nearly everyone has a digestive problem at one time or another. Some conditions, such
as indigestion or mild diarrhea, are common; they result in mild discomfort and get better on their
own or are easy to treat. Others, such as inflammatory bowel disease, can be long lasting or
troublesome. A doctor who specializes in the digestive system is called a GI specialist or
gastroenterologist.
Problems With the Esophagus
Problems affecting the esophagus may be congenital (present at birth) or noncongenital
(developed after birth). Examples include:
• Congenital conditions. Tracheoesophageal fistula is a connection between the
esophagus and the trachea (windpipe) where there shouldn't be one. In babies with
esophageal atresia, the esophagus comes to a dead end instead of connecting to the
stomach. Both conditions are usually detected soon after a baby is born — sometimes
even before — and require surgery to repair.
• Noncongenital conditions. Esophagitis (inflammation of the esophagus) can be caused
by infection, certain medications, or gastroesophageal reflux disease (GERD). With GERD,
the esophageal sphincter (the valve that connects the esophagus with the stomach)
doesn't work well and allows the acidic contents of the stomach to move backward up
into the esophagus. GERD often can be corrected through lifestyle changes, such as
dietary adjustments. Sometimes, though, it requires treatment with medication.
Problems With the Stomach and Intestines
Almost everyone has experienced diarrhea or constipation. With diarrhea, muscle
contractions move the contents of the intestines along too quickly and there isn't enough time for
water to be absorbed before the feces are pushed out of the body. Constipation is the opposite:
The contents of the large intestines do not move along fast enough and waste materials stay in
the large intestine so long that too much water is removed and the feces become hard.
Other common stomach and intestinal disorders include:
• Gastrointestinal infections can be caused by viruses, by bacteria (such as Salmonella,
Shigella, Campylobacter, or E. coli), or by intestinal parasites (such as amebiasis and
giardiasis). Abdominal pain or cramps, diarrhea, and sometimes vomiting are the common
symptoms of gastrointestinal infections. These usually go away on their own without
medicines or other treatment.
• Appendicitis, an inflammation of the appendix due to impacted feces (fecalith), most
often affects kids and teens between 11 and 20 years old, and requires surgery to correct.
The classic symptoms of appendicitis are abdominal pain, fever, loss of appetite, and
vomiting.
• Gastritis and peptic and duodenal ulcers arise when a bacterium, Helicobacter pylori, or
the chronic use of drugs or certain medications weakens the protective mucous coating
of the stomach and duodenum, allowing acid to get through to the sensitive lining
beneath. This can irritate and inflame the lining of the stomach (gastritis) or cause peptic
ulcers, which are sores or holes in the lining of the stomach or the duodenum ( duodenal
ulcers) that cause pain or bleeding. Medications usually successfully treat these conditions.
Duodenal ulcers are more common, they can be caused by a bacterial infection or
excessive H+ ion secretions which overwhelm the pancreatic bicarbonate.
• Inflammatory bowel disease (IBD) is chronic inflammation of the intestines that affects
older kids, teens, and adults. There are two major types: ulcerative colitis, which usually
affects just the rectum and the large intestine; and Crohn's disease, which can affect the
whole gastrointestinal tract from the mouth to the anus as well as other parts of the body.
They are treated with medications and, if necessary, intravenous (IV) feedings to provide
nutrition. In some cases, surgery may be necessary to remove inflamed or damaged areas
of the intestine.
• Celiac disease is a disorder in which the digestive system is damaged by the response of
the immune system to a protein called gluten, which is found in wheat and barley and a
wide range of foods, from breakfast cereal to pizza crust. People with celiac disease have
difficulty digesting the nutrients from their food and may experience diarrhea, abdominal
pain, bloating, exhaustion, and depression when they eat foods with gluten. Symptoms
can be managed by following a gluten-free diet. Celiac disease runs in families and can
become active after some sort of stress, such as surgery or a viral infection. A doctor can
diagnose celiac disease with a blood test and by taking a biopsy of the small intestine.
• Irritable bowel syndrome (IBS), a common intestinal disorder, affects the colon and may
cause recurrent abdominal cramps, bloating, constipation, and diarrhea. There is no cure,
but IBS symptoms may be treated by changing eating habits, reducing stress, and making
lifestyle changes. A doctor may also prescribe medications to relieve diarrhea or
constipation. No one test is used to diagnose IBS, but a doctor may identify it based on
symptoms, medical history, and a physical exam.
Problems With the Pancreas, Liver, and Gallbladder
Conditions affecting the pancreas, liver, and gallbladder often affect the ability of these
organs to produce enzymes and other substances that aid in digestion. Examples include:
• Cystic fibrosis is a chronic, inherited illness where the production of abnormally thick mucus
blocks the ducts or passageways in the pancreas and prevents its digestive juices from
entering the intestines, making it difficult to properly digest proteins and fats. This causes
important nutrients to pass out of the body unused. To help manage their digestive
problems, people with cystic fibrosis can take digestive enzymes and nutritional
supplements.
• Hepatitis, a condition with many different causes, is when the liver becomes inflamed and
may lose its ability to function. Viral hepatitis, such as hepatitis A, B, or C, is highly
contagious. Mild cases of hepatitis A can be treated at home; however, serious cases
involving liver damage may require hospitalization.
• The gallbladder can develop gallstones and become inflamed — a condition called
cholecystitis. Although gallbladder conditions are uncommon in kids and teens, they can
occur in those who have sickle cell anemia or are being treated with certain long-term
medications.
