Gastrointestinal Physiology

Dr. Bipin Shrestha

MBBS, MD

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 OVERVIEW
• Enumerate functions of different parts of GIT and
GIT Secretions
• Describe the process of deglutition and defecation
• Discuss the mechanism of intestinal movements
and list common disorders of intestinal motility
• Explain the process of Digestion and absorption of
Carbohydrates, fats and proteins
• List the functions liver
• Pathophysiology of peptic ulcer

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 General organization of digestive system:

 
•Provides continual supply of
water, electrolytes, and nutrients
•Gastrointestinal tract and
•Glandular organs—salivary
glands, liver, gall bladder and
pancreas.
•Total length is about 15 feet in
adults.
•open at both the ends.

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 Functions of gastrointestinal system:

1. Movement of food through the alimentary tract

2. Secretion of digestive juices (salivary glands,
liver, pancreas)
3. Digestion of the food
4. Absorption of water, various electrolytes, and
digestive products

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 Functions of gastrointestinal system:

5. Excretion of unwanted undigested food by process known

as defecation.

6. Stomach secretes intrinsic factor, responsible for

absorption of vitamin B12.

7. Protective(immune functions)- acidic pH of Stomach,

payers patches in intestine

8. Secretes hormones: gastrin, secretin, Cholecystokinin etc

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 Gastrointestinal motility
Two types of movements:
(1)Propulsive movements (PERISTALSIS)
(2)Mixing movements (segmentation)

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Types of movement in presence of
bolus
• Peristalsis

• Mixing
movements

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 Gastrointestinal motility
PERISTALSIS:
• cause food to move forward
along the tract
• at an appropriate rate to
accommodate digestion and
absorption.
• is a reflex response that is
initiated when the gut wall is
stretched by the contents of the
lumen,
• it occurs in all parts of the
gastrointestinal tract from the
esophagus to the rectum.
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Mechanism

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 Gastrointestinal motility
Segmentation(mixing movements):
- keep the intestinal contents
thoroughly mixed at all times.
-retard the movement of the intestinal
contents
- provide time for digestion and
absorption
-force the chyme both backward and
forward.
-Unlike peristalsis, retrograde
movement of the chyme occurs
routinely in the setting of
segmentation

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 Disorders of intestinal motility
• Small intestine:
– Paralytic ileus-condition in which the intestinal motility is
markedly decreased leading to retention of its contents.
– Causes:
• Direct inhibition of smooth muscles (abdominal
operations, trauma)
• Reflex inhibition of smooth due to increased discharge
of NA fibres (peritonitis, injury to peritoneum)
– Intestinal colic (obstruction) i.e. severe abdominal pain
caused by peristaltic rush-intense peristaltic wave due to
irritation of intestinal mucosa at the site of obstruction

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 Disorders of large intestinal motility
• Hirschsprung’s disease (aganglionic
megacolon)
– Congenital absence of auerbach’s plexus
– Leads to blockage of peristalsis and mass cotractions
– Feces accumulate and cause dilatation of colon
• Constipation:
– Failure of voiding of stool producing discomfort
– Results from decreased mass movement in colon
– Stool becomes hard and dry
• Diarrhea: increase frequency of stool with increased
water content
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Swallowing or Deglutition
 Swallowing is the movement of food from
mouth into the Stomach
 It is facilitated by secretion of saliva and
mucus
 It involves mouth, pharynx and esophagus
 It is coordinated by the swallowing center in
medulla oblongata and lower pons
 It involves 3 phases or stages (oral,
pharyngeal & esophageal)

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 Phases of Swallowing
1. Oral phase:
Voluntary
The swallowing starts
when the food bolus is
forced to the back of
the oral cavity and into
the pharynx by the
movement of the
tongue upward and
backward against the
palate
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Phases of Swallowing
2. Pharyngeal phase (Involuntary)

• Tongue sweeps backward → • Epiglotis and vocal cords

bolus into the oro-pharynx shut off the larynx
• Elevation of soft palate and • Reflex apnea
contraction of the upper constrictor • Relaxation of UES
muscle of the pharynx to close • Peristatic contraction begins in the
nasopharynx. upper constrictor muscle → middle &
inferior constrictor muscle
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Phases of Swallowing
3. Esophageal Phase (Involuntary)
 Begins once the food bolus enters the
esophagus
 Peristalsis pushes the bolus onwards.

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Esophageal Phase cont…

• At the lower part of the

oesophagus
– LES (Cardiac
sphincter) relaxes to
allow the bolus to
enter the stomach
– It is usually closed to
prevent gastric
reflux

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 Daefecation
• Defaecation: Process of excretion of fecal material.
• Usually the rectum is empty.
• Faecal matter enters the rectum causing its distension.
• Rectosphincteric reflex relaxes the anal sphincter and
generates urge to defecate.
• involves both voluntary and reflex activity
• In addition abdominal muscles and diaphragm contract
increase the intra-abdominal pressure
• In newborn babies or in person with transected spinal
cord, defecation reflex causes automatic emptying.

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Defecation Reflex Mass movement

Rectum is distended

Activation of stretch receptors

Signals to sacral spinal cord

Gives desire to defecate

Through pelvic nerve (parasympthatic),

relaxation of internal anal sphincter

If the conditions are Otherwise, the reflex

right: subsides until the
Voluntarily relaxation rectum is filled again
of external anal
sphincter
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defecation.
 Secretions of GIT
A. Salivary glands and Saliva
There are three pairs of main salivary glands:
1. Parotid(secretion containing enzyme ptyalin)
2. Submandibular (mucus secretion)
3. Sublingual (mucus secretion)
Normal salivary secretion is 800 to 1500 ml/day.
Salivary composition:
Main constituents of saliva:
Water: 99.5%
Solids: 0.5%.
Solids are further divided into:
Organic (0.3%). ptyalin, lysozyme, small amounts of urea, uric acid, cholesterol
and mucin.
Inorganic (0.2%). NaCl, KCl, Ca3CO3, potassium thiocyanate.
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 FUNCTIONS OF SALIVA
1. Mechanical functions
Mastication, lubrication, speech, antibodies.

2. Digestive functions
The main enzyme present in saliva is salivary amylase or ptyalin. It acts on
boiled starch, glycogen and dextrin. It digests starch to maltose.
3. Excretory function
Certain heavy metals and thiocyanate ions are excreted in saliva.
4. Helps in temperature regulation
When there is dehydration, there is reduced salivary secretion which induces
thirst

5. Helps in taste sensation

Saliva acts as a solvent for various foodstuffs.

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 Gastric secretions
B) Gastric Juice:
 Composition  
– Water: 99.45%.
– Solids: 0.55%.
• Inorganic (0.15%): NaCl, KCl, CaCl2, calcium phosphate,
magnesium phosphate, bicarbonate, etc.
• Organic(0.4%):Mucin, intrinsic factor, enzymes-
pepsin, gastric lipase, gastric amylase, gastric
gelatinase.
•free HCl (0.4 to 0.5%) pH 0.9 to 1.5.
•500-1000ml of gastric juice is secreted per day.
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 Gastric secretions
Gastric Juice:
Functions
1)HCl secreted provides optimal pH for enzyme action
2)hinders growth of bacteria and causes breakdown of
proteins.
2) Digestive functions: Protein, Carbohydrate and Fat
digestion.
3) Intrinsic factor helps in absorption of vitamin B12

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 Pancreatic Secretions

C) Pancreatic Juice: 
COMPOSITION
 
•Inorganic contents. High bicarbonate content ,Small
amounts of calcium, magnesium and zinc.
•Organic contents. Enzymes: trypsinogen,
chymotrypsinogen, procarboxypeptidase, nucleotidase
(ribonuclease, deoxyribonuclease), lipase and amylase.

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 Pancreatic Secretions

FUNCTIONS
1) neutralization of acidic contents of the chyme
because of high bicarbonate content.
2) alpha amylase hydrolyzes glycogen, and starch.
3) Pancreatic lipases (lipase, cholesterol lipase and
phospholipase) helps fat digestion.
4) Trypsin acts on proteins as well as on products of
protein digestion and converts them into lower peptides
(tri and dipeptides).

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 BILE
Composition:
97.5% water and 2.5% solids.
Composition of the solids:
Bile salts: 1.1%
Bilirubin: 0.04%
Cholesterol: 0.1%
Lecithin: 0.04%
Fatty acids: 0.12
Inorganic salts: 0.8%.

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 BILE
FUNCTIONS:

digestion and absorption of fat and fat soluble

vitamins by;
1. Act as detergent and emulsification (fat globule is
broken into multiple minute sized globules).
2. Form minute complexes called micelles. About 20
to 40 bile salt molecules aggregate and form micelle,
which is water-soluble so absorption is facilitated.

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 Functions of liver
1. Secretory functions: bile which is important for
digestion and absorption of fat
2. Metabolic functions: metabolism of
carbohydrate, protein and fats.
3. Detoxifying and protective functions: detoxifies
drugs, kuffer cells (removes bacteria and other foreign
subs.)
4. Storage functions: (stores glucose, Vit. B12, Vit. A)

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 Functions of liver
5. Excretory functions: excess Bile salts, exogenous
dyes
6. Synthesis functions: plasma proteins, clotting
factors, enzymes, urea, cholesterol
7. Miscellaneous:
– Erythropoiesis during fetal life
– Hormone metabolism
– Reservoir of blood
– RBCs destruction
– Thermal regulation
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 Intestinal secretions
Composition
98.5% water and 1.5% solids.
The solids are:
Inorganic (0.8%). Sodium, potassium, calcium,
magnesium with chloride, bicarbonate and phosphate.
Organic (0.7%). The enzymes as follows:
Enterokinase (enteropeptidase): activator of

trypsinogen.
Nuclease, nucleotidase, nucleosidase.

Arginase: acts on arginine producing urea and

ornithine.
Amylase, sucrase, maltase, lactase and isomaltase.
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 Intestinal secretions
Functions:

1. Several peptidases present digest peptides

into amino acids.
2. Disaccharidase, sucrase, maltase, lactase,
isomaltase splits disaccharides into
monosaccharides.
3. Intestinal lipase splits triglycerides.
4. Enterokinase activates trypsinogen to trypsin.

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• SUMMARY

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Digestion and Absorption

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 Introduction…
• DIGESTION: The process in which the Proteins, Fats
and Carbohydrates are broken down into absorbable
units principally in the small intestine
• ABSORPTION: The process in which the products of
digestion, vitamins, minerals and water cross the
mucosa and enter the lymph or the blood

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 Digestion Of Carbohydrates
Principal dietary Carbohydrates:
– Polysaccharides: starches (made of amylose
and amylopectin), dextrins, glycogen
– disaccharides: sucrose, lactose, maltose
– monosaccharides: glucose, fructose, sorbitol,
Non-digestible carbohydrates
dietary fibers, mainly cellulose : Fiber extremely
important for regular bowel movements.

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Carbohydrate digestion

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 Carbohydrate digestion
• Intestinal brush border enzymes
– Maltase: maltose Glucose
– Lactase: Lactose Galactose + glucose
– Sucrase: sucrose Fructose+ glucose
– α dextrinase: α dextrins, maltose, maltotriose
Glucose
• Glucose forms 80% of final digestion product,
fructose and galactose remaining 20%
• Applied:
– Enzyme deficiency: diarrhea, bloating, flatulence
– Lactose intolerance
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 Carbohydrate absorption
• Sugar molecules pass
from mucosal cells---
blood capillaries---portal
vein
• Absorption depends on:
– Sodium dependent
glucose transporter(SGLT-
1)—Glu, galactose from
gut
– Glucose transporter:
• GLUT-2 (Enterocytes to
interstitium)
• GLUT-5( Fructose
absorption from int.
lumen
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 Protein digestion
• Proteins: Long chains of amino acids bound by peptide
linkages
• Protein digestion begins in the stomach
• Pepsin acts in acidic pH of 2-3, digests
– Collagen
– Peptide linkages
– Forms peptones, proteoses, peptides

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Protein digestion

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 Protein absorption
• 7 different systems
for absorption of
amino acids
• 5 of these are Na
linked co-transport
• Di and tripeptides
are Co-transported
with H+ ions

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 Digestion of Fats
• Fats are of 3 types:
– Simple fats (neutral fats). Eg. TGL, CHO
– Compound fats: phospholipids
– Associated fats: steroids
• Dietary fat is both vegetable and animal
origin

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 Digestion of Fats
• Digestion of all the dietary fats occurs in the
small intestine
• Lingual Lipase and Gastric Lipase

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 Fat absorption
• Most of it occurs in
duodenum
• Absorption accomplished
by following steps:

1. Transportation of micelles to
the brush border membrane

2. Diffusion of lipids across the

enterocyte cell membrane

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3.Transport of lipids
from enterocytes to
ISF
• Diffusion across the basal
border
• Formation of Chylomicrons
and exocytosis

4.Transport of lipid
into circulation via
lymphatics

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Summary

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 Peptic ulcer
• Gastric and duodenal ulceration
• breakdown of the barrier that normally prevents irritation and
autodigestion of the mucosa by the gastric secretions
Causes:
a) Infection: Helicobacter pylori disrupts this barrier.
b) Aspirin and other Nonsteroidal Antiinflammatory drugs (NSAIDs),
inhibit the production of prostaglandins and consequently decrease
mucus and HCO – 3 secretion.
c) Prolonged excess secretion of acid. Example- Zollinger–Ellison
syndrome, which occurs in patients with Gastrinomas.

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 Peptic ulcer
Treatment
•drugs such as omeprazole and related drugs that inhibit
H+–K+ ATPase (“proton pump inhibitors”).
•If present, H. pylori can be eradicated with antibiotics,
(Tripple therapy)
•stopping the NSAID.
•Gastrinomas can sometimes be removed surgically.

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Questions?

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Thank you!!!!!!!

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