Physiology of

Digestive System

By Dr. Hafiz Anwar ul Haq Sharif

Digestive System
 “The process by which food is broken down into
simple chemical substances that can be absorbed and
used as nutrients by body”
 Most of the substances in the diet can not be utilized
as such
 These substances must be broken into smaller
particles so that they can be absorbed into blood and
distributed to various parts of body for utilization
 This can be accomplished by mechanical and
enzymatic breakdown of food into simpler chemical
compounds
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 A normal young healthy adult consumes about 1kg
of solid diet and about 1 to 2 L of liquid diet
everyday
 All these food materials are subjected to digestive
process, before being absorbed into blood and
distributed to the tissue of body
 Digestive system plays a vital role in digestion and
absorption of food substances
 Digestive system is made up of gastro-intestinal-
tract or alimentary canel and accessory organ
which help in process of digestion and absorption
Function Of Digestive System
 Ingestion or consumption of food substance
 Breaking them into small particles
 Transport of small particle to different areas

of digestive tract
 Secretion of necessary enzymes and other

substances for digestion

 Digestion of food particles
 Absorption of digestive products
 Removal of unwanted substances from body
Gastrointestinal Tract (GIT)

 GIT is tubular structure extending from

mouth up to anus with a length of about 30
feet. It open to external environment on both
ends.
 It formed by two types of organ
 Primary digestive organ
 Accessory digestive organ
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 Primary Digestive Organ
 These organ are help in actual digestion and

include Mouth, Pharynx, Esophagus, Stomach,

Small intestine and Large intestine
 Accessory Digestive Organ
 These organ provide help to primary organ in

process of digestion and include Teeth,

Tongue, Salivary glands, Exocrine part of
pancreas, Liver and Gallbladder
Wall Of Gastro-Intestinal-Tract
 Wall of GIT is formed by four layers that are:

 Mucus layer
 Submucus layer
 Muscular layer
 Serous layer
MUCUS LAYER

 It is innermost layer of wall and it is also

called gastrointestinal mucosa or mucus
membrane
 It is divided into three sub layers:
 Epithelial lining
 Lamina propris
 Muscularis mucosa
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 SUB MUCUS LAYER
 It contain loose collagen fiber, elastic fiber and
reticuler fibers
 MUSCULAR LAYER
 It contains skeletal and smooth muscle fibers Wall
of stomach and intestine is formed by smooth
muscle fiber
 SEROUS LAYER
 Outermost layer of wall is fibrous in nature and
also called serosa and formed by connective
tissue
 It covers stomach, small and large intestine
MOUTH
 Mouth is known as oral cavity or buccal cavity
 It is formed by cheeks and lips
 Primary function of mouth is eating and it has few
other important function like
 MASTICATION
 Teeth cut and grind the food , lips and cheeks hold
food in mouth with help of tongue , Muscle of
mouth along with jaws help in chewing the food
properly and mix food with saliva , saliva softens
the food to facilitate swallowing
 It also help in taste, speech, expression and
breathing
Salivary Glands
 Parotid glands secrete saliva in Stensen duct which
is 35 to 40 mm long and emptied in oral cavity. It
is also called serous gland
 Submaxillary gland secret saliva in wharton duct
which is about 40mm long and emptied in buccal
cavity
 Sublingual gland secret saliva into Rivinus or
Bartholin duct. Weight of the gland is 2 to 3 gram.
 Minor salivary glands include buccal gland, lingual
gland, palatal gland and labial gland. These are
also called mixed gland
Properties, Composition and
Function of Saliva
 Properties
 1000mL to 1500mL of saliva is secreted per day
 Parotid gland secrete 25%, submaxillary gland 70%
and sublingual gland secrete 5% of total saliva
secretions.
 Saliva is slightly acidic with pH of 6.35 to 6.85
 Specific gravity of saliva is between 1.002 to 1.012
 Composition
 Water 99.5%
 Solid 0.5% (organic and in organic substances and
gases)
Function of Saliva
 Preparation of food for swallowing
 Appreciation of taste
 Cleansing and protective function
 Role in speech
 Excretory function
 Regulation of body temperature
 Regulation of water balance
 Regulation of salivary secretion
PHARYNX
 Pharynx is incomplete striated muscular tube
 It is funnel shaped leading from oral and

nasal cavity. The pharynx chamber serves

both respiratory and digestive function. It
consist on three regions nasopharynx,
oropharynx and laryngopharynx.
 The main function of pharynx is to delivers

food and liquid into esophagus which sends

them on your stomach. Your pharynx will
make sure that particles of food and liquid do
not tumble into trachea and lungs way
ESOPHAGUS
 Moves food from pharynx down to the
stomach
 Movement of food now called bolus is not

dependent on gravity
 Dependent on peristalsis the rhythmic

contraction of smooth muscle that move the

bolus down to stomach
 Epiglottis prevent the food from moving into

trachea
STOMACH
 Stomach is hollow organ organ situated just
below diaphragm on the left side in abdominal
cavity. Volume of empty stomach is 50mL. It can
expand 1 to 1.5L of solids and liquids However it
is capable of expanding still further upto 4L
 PARTS OF STOMACH
 Cardiac region
 Fundus
 Body or Corpus
 Pyloric region
 Cardiac sphincter and pyloric sphincter
Cardiac and pyloric sphincter
 Esophagus open into stomach. The opening is
guarded by sphincter called cardiac sphincter.
 Stomach open into small intestine. The opening
is guarded by sphincter called pyloric sphincter.
 FUNCTION OF STOMACH
 Storage function
 Formation of chyme (bolus+gastric
juice=semiolid material called chyme)
 Protective function
 Excretory function
Digestive function of stomach
 Gastric juice contain enzymes like pepsin, gastric
lipase, gastric amylase, galatinase and urase.
 Pepsinogen converted into pepsin by HCL at pH
of below 6. pepsin convert into polypeptides and
peptones
 Gastric lipase activate at pH at 4 to 5 and it
hydrolyze tributyrin into fatty acids and
glycerols.
 Urase act on urea and produce ammonia and
gastric amylase degrades starch
 Gelatinase degrades gelatin into peptides.
DISORDERS
 XEROSTOMIA
 It refers to dry mouth and also called pasties or cotton mouth. It is
due to hyposalivation.
 It is due to dehydration or renal failure.
 It is also due to radiotherapy or injury to ducts.
 It is also due to side effect of other drugs like anti depressent drugs.
 Smoking is also cause of this disorder.
 DROOLING
 Uncontrolled flow of saliva from outside the mouth and also called
ptyalism
 It is due to difficulty in swallowing and teeth eruption in children.
 MUMPS
 It is acute viral infection affecting the parotid gland and virus which
cause this disease is paramyxovirus. Swelling in cheeks is the sign of
the disease.
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 GASTRITIS
 Inflammation of gastric mucosa is called gastritis. It may acute or
chronic.it result in atrophy of mucosa with loss of parietal cells of
gland therefore the secretion of gastric juice decreases.
 PEPTIC ULCER
 Erosion of surface of any organ due to shedding of inflammed
necrotic tissue that line the organ
 If peptic ulcer is found in stomach it is called gastric ulcer and if
found in duodenum it is called duodenal ulcer.
 It is due to hyperacidic secretion and some drugs side effect like
NSAIDs.
 ZOLLINGER E ELLISON SYNDROME
 It is characterized by secretion of excess hydrochloric acid in
stomach. This disorder caused by tumor of pancreas which lead
to abdominal pain.
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 Pancreatitis
 It is inflammation of pancreatic acini. It has two types
acute and chronic pancreatitis
 Acute pancreatitis is occure due to heavy alcohol intake
and causes abdominal pain, fever, vomitting and loss of
weight
 Chronic pancreatitis is occure due to repeated action of
acute pancreatitis and it is due to long time
consumption of alcohol and it causes destruction of
pancreas and shock
 Steatorrhea
 It is formation of bulky foul smelling clay coloured
stools with large quantity of undigested fat because of
impaired digestion and absorption of fat
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 Jaundice
 It is also called Icterus and characterized by yellow
coloration of skin and mucus membrane due to
increased level of bilirubin in blood. The normal level of
serum billirubin is 0.5 to 1.5 mg/dL but incase of
jaundice it is increased up to 2 mg/dL. There are 3
types of Jaundice:
 Prehepatic or Hemolytic jaundice (it is due to
excessive destruction of RBCs that result in increase level of
bilirubin)
 Hepatic or hepatocelluler or cholestatic
jaundice (it is due to demage of hepatic cells)
 Posthepatic or obstructive or extrahepatic
jaundice (it is due to obstruction of bile flow)
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 Hepatitis
 It is liver damage characterized by swelling and
inadequate functioning of liver and it may lead to liver
failure or death. Its causes include viral infection,
bacterial infection, high intake of alcohol, poisons like
CCl4 and side effects of many drugs like paracetamol
 Symptoms of hepatitis includes fever, diarrhea,
weakness, stomach pain, dark colour urine and
paleness of skin
 Cirrhosis refer to inflammation and damage of liver
tissues(paranchyma). It results in degeneration of
hepatic cells and dysfunction of liver
 Gallstone is the formation of crystal that is formed by
cholesterol, calcium ions and bile pigments in
gallbladder or bile duct
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 Crohn’s Disease or Enteritis
 It is IBD characterized by inflammation of small
intestine usually it affects lower part of small
intestine that is ileum. The inflammation causes
diarrhea and malabsorption (failure of digestion)
 Ulcerative Colitis
 It is IBD characterized by inflammation of in the
wall of large intestine specially rectum and lower
part of colon are affected. It is also known as
proctitis. Abdominal pain , eye inflammation
skin rashes, anemia and diarrhea are the
common features of ulcerative colitis
PHASES OF GASTRIC SECRETION
 Cephalic phase..
 Secretion of gastric juice by stimuli arising from
head region that is cephalus is called cephalic
phase. This phase is regulated by nervous
mechanism. In this phase gastric secretion occures
even without the presence of food in stomach. The
quantity of juice is less but full of enzymes and HCl
 Two types of reflex action regulate this stage
 Unconditional reflex and conditional reflex and
involve vagus nerve that causes secretion of
acetylcholine and caused secretion of gastric juice
in stomach
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 Gastric phase..
 When food enter into stomach this is called gastric
phase and regulated by nervous and hormonal
mechanism
 Nervous mechanism takes place by local myentric
reflex and vagovagal reflex and hormonal
mechanism takes place by gastrin which stimulate
the secretion of HCL and pepsinogen
 Intestinal phase
 Gastric secretion when chyme enter into intestine
and it is regulated by mostly hormonal control.
Digestion of proteins,lipids and
carbohydrates…
 Digestion of proteins(mechanism)
 Digestion of proteins takes place by trypsin,
chymotrypsin, nucleases and elastases
 Trypsin is also called endopeptidase and break
the bond of protein molecules and covert into
proteoses and polypeptides. It also cause curdling
of milk by coverting caseinogen into casein.
 Nucleases covert DNA and RNA into
mononucleotides and help in the digestion of
nucleic acid
 Elastase is responsible for the digestion of fibers
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 Digestion of lipids(mechanism)
 Lipolytic enzymes present in pancreatic juice like
pancreatic lipase,cholesterol ester hydrolase and
phospho lipase A and B
 Pancreatic lipase convert triglycerides into
monoglycerides and fatty acid in the presence of bile
and optimum pH of 7 to 9
 Bile salt and colipase also necessary for this process.
 Cholesterol ester hydrolase coverts cholesterol into free
cholesterol and fatty acid by hydrolysis
 Pancreatic amylase also covert starch into dextrin and
maltose which is the example of digestion of
carbohydrates
LIVER
 Liver is a dual organ having both secretary and excretory
functions it is the largest gland in body weighing about
1.5kg in man. It is located in upper right side of
abdominal cavity and beneath the diaphragm.
 Liver is made up of many lobes called hepatic lobes and
each lobe consist of many lobules called hepatic lobule
which is structural and functional unit of liver. There are
50000 to 100000 lobules in liver. It is honeycomb like
structure and consist of hepatocytes
 Hepatocytes arranged in column and form hepatic plate
and in these plates a blood space is present called
sinusoid
 Each lobule surrounded by portal triads.
Blood supply to liver
 Hepatic artery arises from aorta and supplies
oxygenated blood to liver and then divided into
branches.
 Portal vein is formed by mesentric vein and splenic
vein. It brings deOxygenated blood.
 Flow of blood from intestine to liver through portal
vein is known as enterohepatic circulation
 The blood from hepatic artery mixed with blood
from portal vein in sinusoids
 Sinusoids drain the blood to central vein and
hepatic vein which open into inferior vena cava and
then right atrium
Composition,Properties and
Function of Bile..
 COMPOSITION
 It contain 97.6% water and 2.4% of solids
 PROPERTIES
 Volume ; 800 to 1200 mL/day
 Reaction ; alkaline
 pH ; 8 to 8.6
 Colour ; golden yellow or green
 SG ; 1.010 to 1.011
 It is secreted by hepatocytes through small ducts and
hepatic ducts and diverted into intestine or gallbladder.
Sodium and bicarbonates added into bile when it passes
through ducts. Theses substances secreted by epithelial
cells of ducts and increase the volume of bile
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 Function of bile includes Absorption of fats
and emulsification of fats.
 Function of liver includes metabolic function ,

storage function and secretion of bile.

GALLBLADDER
 Bile is secreted from liver and and stored into
gallbladder and its capacity is 50mL
 Function of gallbladder includes storage of bile,
concentration of bile , change the pH of bile and
secretion of mucin
 Regulation of bile secretion
 It is continuous process and its amount is less during
fasting and increase after eating the meals.
 Substances which increase the secretion of bile from
liver is called Choleretics and these agents includes
acetylcholine
 Substance which increase the release of bile into
intestine by contracting gallbladder is called
Cholagogues and these agents includes bile salts and
calcium
Small Intestine
 Small intestine is extending between pyloric sphincter of
stomach to ileocecal valve which open into large
intestine. Its length is about 6 m.
 Its part includes DUODENUM , JEJUNUM , ILEUM
 Mucus membrane of small intestine is covered by minute
projection called villi. The height of villi is about 1mm
and diameter is less then 1 mm.
 Villi are lined by columner cells which are called
enterocytes and each enterocytes give rise to hair like
structure called microvilli.
 There are two types of glands intestinal gland (secrete
mucus and cytokines) and Brunner gland(secrete mucus
and some enzymes).
Succus Entericus
 Secretion from small intestine is called succus entericus
and its volume is about 1800mL/day
 Its function includes Digestive function(many enzymes of
small intestine like peptidases, sucrase , lactase convert
peptides sucrose and lactose into amino acid and glucose)
 It also secrete defensin which is antimicrobial agent which
is used to encounter pathogen in intestinal area
 It also has activator function that is conversion of
trypsinogen into trypsin
 It has also heamopoietic function which is necessary for
absorption of vitamin B12
 It also help in absorption of lipids proteins and
carbohydrates
Large Intestine
 Large intestine extend from ileocecal valve upto anus.
 Parts of large intestine includes CECUM , COLON
(ascending, transverse , Descending , pelvic ) , rectum
and anus
 Its has also four structural layers like stomach
 It has same composition like saliva and pH is 8
 Its function is to absorption of substances like water,
alcohol and electrolytes
 Formation of feces
 Excretion of heavy metals like lead and mercury
 Also digest dietry fibers which is not digested by
stomach and small intestine
Gastro Intestinal Hormones
GAG REFLEX
 It is also known as pharyngeal reflex and it is
normal protective reflex
 This reflex prevents choking by thrusting objects
in throat towards opening of mouth hence expels
objects which may be harmful.
 It is very active in babies and prevent the passage
of hard and solids food into throat.
 Gag reflex occure by mass contraction of oral and
pharyngeal muscle and elevation of soft palate.
 Centre of this reflex is in nuclei of X cranial nerve.
Absorption /metabolism of carbs
Absorption/metabolism of proteins
Absorption/metabolism of lipids
Neural and Harmonal Control of GIT
 Parasympathetic nervous System
 Vagus Nerve
 Increase gastric motility
 Increased gastric acid secretion
 Sympathetic Nervous System
 Inhibit gastrointestinal activity

 Gastrin
 Increase gastric motility and promote stomach
emptying
 Secretin
 Decrease gastric acid secretion
TERMINOLOGIES
 BELCHING
 Process by which the gas accumulated in stomach is
expelled through mouth and also called burping. It occure
because of distention of stomach by swallowed air and
cause abdominal discomfort
 FLATULENCE
 It is the production of mixture of intestinal gases.the
mixture of gases is known as flatus and these gases
expelled from anus and gases include nitrogen ,oxygen,
methane and hydrogen e t c.
 DEGLUTITION
 The process by which food moves from mouth to stomach
and concist of three stages 1 oral stage 2 pharyngeal stage
3 esophageal stage
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 DIGESTION
 Process of dissolving and breaking down of food into
small molecules
 ABSORPTION
 The process in which molecules produced by digestion
moves from GIT across epithelial cells and enter the
blood
 MOTILITY
 Contraction of GIT smooth muscles
 PARALYTIC ILEUS
 Temporary cessation of gut motility that is most
commonly caused by abdominal surgery and its causes
include hypokalemia and narcotics
TREATMENT
 ANTIMICROBIAL AGENTS
 Amoxicillin, Tetracycline, Clarithromycin
 H2 HISTAMINE RECEPTOR BLOCKERS
 Famotidine, Ranitidine, Nizotidine
 PROTON PUMP INHIBITORS
 Omeprazole, Esomeprazole, Lanceprazole
 ANTACIDS
 Aluminium hydroxide , Megnesium hydroxide
 Calcium carbonate,