Physiology of GIT Nursing
Physiology of GIT Nursing
Physiology of GIT Nursing
PHYSIOLOGY
OF
DIGESTIVE SYSTEM
Shimelis M.
2017
Introduction
The gastrointestinal system carries out the following activities:
Ingestion: food intake, which is controlled by the feeding and
satiety center in the HT.
Mastication or chewing: mechanical grinding of food with the
aid of the teeth.
Swallowing or deglutition: propulsion of food from the mouth to
the stomach.
Chemical digestion of food
Secretion of enzymes, electrolytes (HCl, NaHCO3), mucus, and
hormones
Absorption of nutrients, water and electrolytes into the blood
Elimination: excretion of fecal matter through the process of
defecation
2
3
Functional Structures of Digestive System
Organs involved in the process of digestion are:
4
Digestive organs
5
Histology of the Alimentary Canal
From esophagus to the anal canal the walls of the GIT have
the same four layers (from the lumen to outward)
1. Mucosa,
2. Submucosa ,
3. Muscularis externa, and
4. Serosa
Each layer has a predominant tissue type and a specific
digestive function
6
7
A. Mucosa
Moist epithelial layer that lines the lumen of the alimentary canal
Secretion of mucus
1. A lining epithelium,
3. Muscularis mucosae
8
1. Epithelial Lining:
Two types of epithelial cells along the GIT:
i. Non-keratinized stratified squamous epithelium: mouth,
esophagus and anal canal
Function: protection
ii. Simple columnar epithelium: through out the rest of the
tract Function: absorption and secretion
The mucus secretions:
Protect digestive organs from digesting themselves
Ease food along the tract
Stomach and small intestine mucosa contain:
Enzyme-secreting cells
Hormone-secreting cells (enteroendocrine cells)
9
2. Lamina Propria:
Contains connective tissues, blood vessels and lymph vessels
3. Muscularis mucosae
Smooth muscle cells that produce local movements of mucosa
10
B. Sub-mucosal layer
Consists of loose connective tissues, secretory glands, lymph
nodes and blood vessels
The sub mucosal layer contains enteric nerve plexus
(Submucosal plexus (plexus of Meissner))
This plexus controls secretions by the GIT.
C. Muscularis externa
The muscularis of the mouth, pharynx, and upper esophagus
consists of skeletal muscles that produce voluntary swallowing.
The skeletal muscle also forms the external anal sphincter,
which permits voluntary control of defecation.
11
Through out the rest of the tract, the muscularis consists of
smooth muscles that is generally found in two sheets:
Inner sheet of circular fibers and
Outer sheet of longitudinal fibers
Involuntary contraction of both smooth muscles help
breakdown of food physically, mix it with digestive
secretions, and propel it along the tract.
The muscularis also contains the major nerve supply to the
GIT; the myenteric plexus (plexus of Auer Bach), which
consists of fibers from both autonomic divisions.
This plexus mostly controls GIT motility.
12
D. Serosa
13
Regulation of GIT
Regulation of digestion involves:
1. Mechanical and chemical stimuli:– stretch receptors,
osmolarity, and presence of substrate in the lumen
2. Extrinsic control system by ANS
Sympathetic NS = ↓GI function
Parasympathetic NS = ↑GI function
3. Intrinsic control system by enteric NS
Submucosal plexus (plexus of Meissner): controls GI
secretory activities
Myenteric plexus (plexus of auerbach): controls
motility of the gut
4. The GIT hormonal system
14
GIT reflexes
1. Reflexes that occur entirely within the ENS →these include
reflexes that control GI-secretion, peristalsis, mixing
contractions, local inhibitory effects.
2. Reflexes that arise from the gut go to the sympathetic ganglia
and then back to the GI-tract.
Examples:
a. The gastro-colic reflex: signals send from the stomach →to
cause evacuation of the colon.
b. The entero-gastric reflexes: signals from the colon and small
intestine →to inhibit stomach motility and secretion.
c. The colono-ileal reflex: reflexes from the colon →to inhibit
emptying of ileal contents into the colon.
3. Reflexes from the gut to the spinal cord or brain stem and then
back to GIT.
15 Example: defecation reflex
Hormonal control of GI function
Intero-endocrine cells: produce several GIT hormones → capable
of regulation of motility and secretory activities.
A. Cholecytokinin (CCK, 33aas) (intestinal and pancriozymine)
Secreted by the mucosa of the duodenum and jejunum in
response to the presence of fatty food in the intestine.
Has a very potent effect on gall bladder contractility→ for
expelling bile into the intestine in order to facilitate fat digestion
and absorption.
Inhibits stomach motility in order to give adequate time for fat
digestion.
B. Secretin (27aas)
Secreted by the mucosa of the duodenum in response to acidic
gastric juice pumped from the stomach.
It increases NaHCO secretion by the pancreas and other
3
pancreatic secretions.
16
Blood Supply to Digestive System
The blood vessels of the GI-system are part of a more extensive
system called the splanchnic circulation.
Splanchnic BF =1000 ml/min
Includes blood flow through the GIT plus through the spleen,
pancreas and the liver.
All of the blood that flows through the gut, spleen and pancreas
then passes into the liver by way of the portal vein.
In the liver, blood passes through millions of liver sinusoids and
finally leaves the liver by way of the hepatic veins that empty into
the inferior vena cava of the general circulation.
The advantage of sinusoidal passage of blood is that:
The reticulo-endothelial cells in the liver remove bacteria and
other particles → entering the blood from the GIT & preventing
pathogens
17
Blood Supply to… cont’d
Possible causes:
The release of vasodilator GI hormones during digestive
processes.
E.g. CCK, VIP, gastrin, secretin, bradykinin, nitric oxide.
18
Blood Supply to GIT (cont’d)
19
Blood Supply For GIT
20
Functional types of movements in the GIT
Two basic types of movements occur in the GIT:
1. Propulsive movements: which cause food to move forward along
the tract at an appropriate rate for digestion and absorption.
2. Mixing movements: which keep the GI contents thoroughly
mixed at all times.
21
Peristalsis Segmentation
22
B. Mixing Movements
Segmentation
Most areas of the small intestine.
These movements churn and fragment the digestive
materials, mixing the contents with intestinal secretions.
Haustration
At the same time, the longitudinal muscle of the colon,
which is aggregated into three longitudinal strips called the
teniae coli, contracts.
These combined contractions of the circular and
longitudinal strips of muscle cause the unstimulated portion
of the large intestine to bulge outward into baglike sacs
called haustrations.
23
Tongue
Occupies the floor of the mouth and fills the oral cavity when
mouth is closed
Functions include:
24
Teeth
There are two sets of teeth:
1. Primary/deciduous
2. Permanent
27
Dental Formula: Permanent Teeth
A shorthand way of indicating the number and relative position of
teeth
Written as ratio of upper to lower teeth for the mouth
2I 1C 2PM 3M
28
Digestive processes in the mouth
After food is ingested
Mechanical digestion begins → chewing/mastication
Propulsion is initiated → by swallowing
Salivary amylase begins chemical breakdown of starch
The pharynx and esophagus serve as conduits to pass food from
the mouth to the stomach
Mastication (Chewing)
It is a process of mechanical breakdown of food.
Salivary secretion containing amylase involves chemical digestion
and lubrication of the food.
Teeth, tongue, jaws and lips are involved in chewing.
29
Chewing (Mastication)…cont’d
Teeth are well adapted for this function as: incisors for cutting,
canine for tearing, molars and premolars for grinding.
Mastication muscles are supplied mainly by the motor branch of
the trigeminal nerve.
Chewing center is located in the pons
The movement of these organs are controlled by such centers
located in the brainstem, hypothalamus, amygdala and cerebral
cortex.
Chewing reflex:
The presence of food in the mouth→ reflex relaxation of the
mastication muscle → drop of the mandible → stimulation of the
stretch receptors → reflex contraction of the mastication muscle →
bolus of food pressed against the jaws→→→ the process
continues like this.
30
Deglutition (Swallowing)
It is the propulsion of food from mouth to the esophagus i.e.
controlled by the swallowing center in the medulla.
Involves the coordinated activity of the tongue, soft palate, pharynx,
esophagus and 22 separate muscle groups.
Has 3 stages
1. Voluntary stage of swallowing:
Buccal/oral phase→bolus is forced into the oropharynx
voluntarily.
2. Pharyngeal stage of swallowing:
It is the involuntary process and contributes the passage of food
through the pharynx to the esophagus.
Controlled by the medulla and lower pons.
3. The esophageal stage of swallowing:
Involuntary phase, promotes the passage of food to the stomach.
31
Deglutition (Swallowing)….cont’d
Bolus of food
Tongue
Uvula
Pharynx Bolus
Epiglottis
Epiglottis
(d) (e)
32
Lower esophageal (Gastro-esophageal) sphincter
It is a thickened circular smooth muscle at the junction b/n
the esophagus and the stomach.
Function: prevents the reflux of gastric contents into the
esophagus.
Gastro-esophageal reflux:
It is the entry of gastric contents into the lower part of the
esophagus due to incompetence of the LES → that leads to
ulcer of the mucosa of lower esophagus.
Achalasia:
Failure of LES to be relaxed, swallowing is inhibited.
Caused by increased in tone of LES due to high sensitivity
to gastrin, weak esophageal peristalsis
33
Lower esophageal sphincter… GEFD
34
Functional structure of the stomach
Chemical breakdown of proteins begins and food is converted to
chyme.
Cardiac region: surrounds the cardiac orifice
Fundus: dome-shaped region beneath the diaphragm
Body: midportion of the stomach
Pyloric region: made up of the antrum and canal which
terminates at the pylorus
The pylorus is continuous with the duodenum through the
pyloric sphincter
35
Stomach Structure…cont’d
Greater curvature:
entire extent of the
convex lateral
surface
Lesser curvature:
concave medial
surface
36
Function of the stomach
Storage of large quantities of food until it can be pumped
into the duodenum.
Stomach can accommodate large amount of food up to 1.5
Liters.
Mixing of food with gastric secretion to form a semi-fluid
chyme.
Slow emptying the food from the stomach into the small
intestine at a rate suitable for proper digestion and
absorption by the small intestine.
Secretory function: HCl, mucous, pepsin, gastrin, IF
Sterilization, digestion, absorption
Facilitates defecation
37
Glands distribution in Stomach
Body of stomach secretes:
Parietal cells (HCl, IF)
Chief cells (pepsinogen)
Antrum
G-cells (gastrin)
Chief cells (pepsinogen)
Mucus producing cells: all parts
38
Gross Anatomy of Small Intestine
Runs from pyloric sphincter to
the ileocecal valve
20 feet long &1 inch in diameter
Large surface area for majority
of absorption
Has three subdivisions:
Duodenum: the bile duct and
main pancreatic duct join the
duodenum
Jejunum: extends from the
duodenum to the ileum
Ileum: joins the large
intestine at the ileocecal valve
39
Microscopic Anatomy of SI
Structural modifications
of the small intestine
wall increase surface
area
Plicae circularis: deep
circular folds of the
mucosa and sub mucosa
Villi: finger-like
extensions of the mucosa
Microvilli: tiny
projections of absorptive
mucosal cells’ plasma
membranes
40
…cont’d
41
Ileocecal sphincter
Function: prevents back flow of fecal matter from the cecum to
the ileum
Factors regulating the sphincter
peristalsis
Pressure and chemical irritation of cecum inhibit peristalsis of
42
Large Intestine
43
Movement in the large intestine
Two types of movements
Mixing movements
reflex
Poor motility of the transverse colon causes → greater
Rectal Stimulation
distension of myenteric plexus
Relaxation of IAS by
parasym. Stimulation
myenteric plexus
Peristaltic wave
Voluntary forces feces
Relaxation to the anus
of EAS
46 Defecation
SECRETORY FUNCTIONS OF GIT
Primary secretory products of GIT are:
Digestive enzymes
GI-hormones
Mucus
Electrolytes, HCl, NaHCO3
GIT secretory glands
1. Goblet cells: mucous producing glands
2. Brunner’s gland: mucous glands
3. Crypts of Lieberkuhn: water and electrolytes
4. Gastric glands: Oxyntic, pyloric and mucous glands
5. Complex glands: salivary, pancreatic glands and liver
6. Enteroendocrine cells: produce hormones
• Secretory volume: 6~8 L/ day
47
…cont’d
48
Factors stimulating GIT secretions
Local mechanical factors: distension, irritation, pH
Nervous stimulation: ANS, ENS
Sympathetic stimulation: inhibits GIT-secretions
Parasympathetic stimulation: increases GIT-secretions
Meissner’s plexus: increases GIT-secretion
Hormonal mechanisms:
Gastrin: increases HCl secretion
Secretin: increases NaHCO3 secretion from pancreas
Mucus
FunctionComposition
Lubrication - Water
Protection - Electrolytes
- Glycoproteins
49
- Polysaccharides
Salivary Glands
Produce and secrete saliva
Saliva:
is a fluid that is continuously secreted into the mouth for
moistening, lubrication, dissolving and chemical
breaking down of food.
Saliva contains two major types of protein secretion:
(1)A serous secretion : contains ptyalin (an α-amylase) (pH:
6-7) → for starch digestion
(2)Mucus secretion: contains mucin → for lubrication and
surface protection
50
…cont’d
Three pairs of extrinsic salivary glands:
1. Parotid
2. Submandibular and
3. Sublingual
Intrinsic salivary glands (buccal glands): scattered throughout
the oral mucosa
Functions of Saliva:
Cleanses the mouth
Moistens and dissolves food chemicals
Aids in bolus formation
Contains enzymes that break down starch
Contains antimicrobial agents for protection
51
…cont’d
1. The parotid glands:
Located inferior and anterior to the ears b/n the skin and the
masseter muscle.
They secrete saliva into the mouth through the parotid ducts
(Stensen’s ducts) that pierces the buccinators muscle to open
into the second maxillary molars.
2. The sub-mandibular glands:
Found beneath the base of the tongue in the posterior part of
the floor of the mouth.
Their ducts, the submandibular (Wharton’s) ducts and
opened at the base of the lingual frenulum.
3. Sublingual glands:
Located superior to the submandibular glands.
Their ducts, the lesser sublingual (Rivinus) ducts open in to
the floor of the mouth.
52
53
…cont’d
Daily secretion of saliva 1000 - 1500 ml/day
Secretion is controlled by:
Nervous parasympathetic stimulation salivary output
Chemical stimulation of taste buds
Mechanical stimulation
Psychic stimulation → smell, sight, hearing about food
Source and Composition of Saliva:
Secreted from serous and mucous cells of salivary glands
A 97-99.5% water, hypo-osmotic, slightly acidic solution
containing
Electrolytes: Na+, K+, Cl–, PO42–, HCO3–
Digestive enzyme: salivary amylase
Proteins: mucin, lysozyme, defensins, and IgA
Metabolic wastes: urea and uric acid
54
Regulation of salivary secretion
Totally controlled by the PNS
55
Regulation of salivary secretion...cont’d
Appetite Sight
Centre (HT) Cortex Smell
+ + Sound
Medulla GPN
Ob.
Parotid
+ FN
VN SMG
Taste FN
Touch +
Temperature Lower esophagus SLG
Stomach
Upper SI
58
59
…cont’d
Pepsinogen:
Secreted by the peptic and mucous cells of the gastric glands
It comes in contact with hydrochloric acid, it is activated to form
active pepsin.
Pepsin:
An active proteolytic enzyme in a highly acid medium (optimum
pH 1.8 to 3.5)
but above a pH of about 5 it has almost no proteolytic activity
Intrinsic factor:
Essential for absorption of vitamin B12 in the ileum,
Pernicious anemia developed because of failure of maturation of
the RBCs in the absence of vitamin B12 stimulation of the bone
marrow.
Gastrin: plays a key role in controlling gastric secretion
60
Function of pepsinogen
protein
HCl
Pepsinogen Pepsin
pH 2-3.5
peptone
61
Regulation of Gastric Secretion
Neural, hormonal and mechanical mechanisms regulate
the release of gastric juice
Stimulatory and inhibitory events occur in three phases
1. Cephalic (reflex) phase: prior to food entry
62
63
Secretion of the Small Intestine
Mucosa of the SI secretes:
Digestive enzymes
Mucous: protective and lubricant
Electrolytes Intestinal secretory out put = 2-3 L/d, pH=7.0
Hormones
Intestinal secretory glands:
1. Brunner’s gland: mucous glands, duodenal in distribution
2. Crypts of Lieberkun: mucous and electrolytes. Distributed in the
SI below the duodenum and in the LI.
3. Goblet cells: mucous glands
4. Enterocytes: digestive enzymes
5. Enteroendocrine cells: produce hormones
6. Enterochromaffin cells: serotonin producing cells
64
Digestive enzymes secreted in the SI
1. Peptidase: splits peptides into amino acids
2. Four enzymes hydrolyzing dissaccharides into
monosaccharides: sucrase, maltase, isomaltase and lactase
3. Intestinal lipase: splits neutral fats into glycerol and fatty
acids.
Regulation of SI secretion
1. Local factors: tactile, distension, irritation, pH.
2. Hormonal: secretin, CCK, VIP, glucagon, GIP
3. Nervous:
Vagal stimulation increases intestinal secretion
Sympathetic stimulation decreases intestinal secretion
65
Secretion of the large intestine
Glands
66
THE PANCREAS
Pancreas Location:
Lies deep to the greater curvature of the stomach
Divided into: Head, body and tail
The head is encircled by the duodenum and the tail abuts
the spleen
Connected to the duodenum via the pancreatic duct (duct
of Wirsung) and accessory duct (duct of Santorini).
68
Composition and Functions of Pancreatic Juice
Out put: 1-2 L/day, pH of 7.1 to 8.2
Contains water, low Cl-, digestive enzymes & high sodium
bicarbonate ion
Isotonic due to high water permeability to ducts
Digestive enzymes
1. Proteolytic enzymes:
Trypsinogen---activated by enterokinase (also a brush
border enzyme in the small intestine) = trypsin
Chymotrypsinogen----activated by trypsin
Carboxypeptidase---activated by trypsin
Elastase---activated by trypsin
69
…cont’d
Trypsin inhibitor---combines with any trypsin produced
Collagenase
71
LIVER and GALL BLADDER
quadrate lobes.
The gallbladder is a sac located in a depression on the
74
Other Functions of the liver
4. Inactivation of drugs & hormones (Sulfonamide,
penicillin, thyroid, steroids)
5. Removes the waste product; bilirubin
6. Releases bile salts
7. Stores fat soluble vitamins: A, B12, D, E, K
8. Stores iron and copper
9. Filtration of blood: phagocytizes worn out blood cells
& bacteria. Removes blood clots and toxins from
portal circulation
10. Activates vitamin D
11. Storage of blood: a major blood reservoir
12. Synthesis of blood clotting factors (F-I, II, VII, IX, X)
75
Secretion of Bile
Bile is secreted by hepatocytes in the liver for two purposes
1. It facilitates fat digestion and absorption of fat
2. Serves as a means of excretion of waste products (bilirubin
and cholesterol)
77
Regulation of Bile Secretion
78
Secretion of Mucus by the Large Intestine
The mucosa of the large intestine, has many crypts of
Lieberkühn but, there are no villi.
The epithelial cells secrete almost no digestive enzymes.
Instead, they contain mucous cells that secrete only mucus.
This mucus contains moderate amounts of bicarbonate ions
secreted by a few non-mucus-secreting epithelial cells.
The rate of secretion of mucus is regulated principally by:
Direct stimulation
Tactile stimulation of the epithelial cells lining the large
intestine and
Local nervous reflexes to the mucous cells in the crypts
of Lieberkühn.
79
Digestion of Carbohydrates
Mouth---salivary amylase
Esophagus & stomach---nothing happens
Duodenum----pancreatic amylase
Brush border enzymes (maltase, sucrase & lactase)
Act on disaccharide and produce monosaccharides--
fructose, glucose & galactose
Lactose intolerance (no lactase enzyme; bacteria ferment
sugar)--gas & diarrhea
80
…cont’d
81
Digestion of Proteins
82
Digestion of Lipids
Mouth: lingual lipase
83
…cont’d
Dietary source of fat
Neutral fats (triglycerides)
Cholesterol and cholesterol esters
Phospholipids
Fat Emulsified fat
-Lingual lipase
-Pancreatic lipase
-Enteric lipase
FFA + Glycerides
Cholesterol and Bile salt FFA +
Cholesterol esters Cholesterol Glycerides
Esterase
Phospholipase FFA +
Phospholipids-A2 Phopholipids
84
Absorption in the Small Intestine
85
Where will the absorbed nutrients go?
86
Absorption of Monosaccharides
Absorption into epithelial cell
Glucose & galactose by active transport
Fructose by facilitated diffusion