Physiology of Digestive System: by Dr. Hafiz Anwar Ul Haq Sharif
Physiology of Digestive System: by Dr. Hafiz Anwar Ul Haq Sharif
Physiology of Digestive System: by Dr. Hafiz Anwar Ul Haq Sharif
Digestive System
of digestive tract
Secretion of necessary enzymes and other
Mucus layer
Submucus layer
Muscular layer
Serous layer
MUCUS LAYER
dependent on gravity
Dependent on peristalsis the rhythmic
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.
Continue…
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.
Continue…
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
Continue….
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)
Continue…
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
Continue…
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
Continue…
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
Continue
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
Continue..
Function of bile includes Absorption of fats
and emulsification of fats.
Function of liver includes metabolic function ,
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
CONTINUE…
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,