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Review of GIT
Physiology
Prof.Dr.Rashid Mahmood
GIT: A long tube with Accessory
glands
© Prof.Dr.Rashid Mahmod 2
Lesson Contents
Mouth
Esophagus
Stomach
Pyloric Sphincter
Small intestine
Ileo-Cecal Valve & Sphincter
Large intestine
Internal & External Anal Sphincter
Accessory glands
© Prof.Dr.Rashid Mahmod 3
Mouth
Ingestion of food
Mastication
Swallowing
3 Stages
i. Voluntary Stage (Movement of Tongue)
ii. Pharyngeal Stage (Involuntary) (Swallowing Reflex)
iii. Esophageal Stage (Involuntary)
© Prof.Dr.Rashid Mahmod 4
Khyber Girls Medical CollegeProf.Dr.Rashid MahmoodProf.Dr.Rashid MahmoodProf.Dr.Rashid MahmoodProf.Dr.Rashid MahmoodProf.Dr.Rashid Mahmood
5
Mastication (Chewing Reflex)
• Components of reflex
1. Stimulus
2. Receptors
3. Afferent Nerve
4. CNS
5. Efferent Nerve
6. Effector
7. Response
• Components of Chewing reflex
1. Bolus of Food
2. Receptors of Sensory Nerves
3. 5th Nerve
4. Swallowing Centre
5. 5th Nerve
6. Muscles of Mastication
7. Reflex Inhibition →Rebound
Contraction
(Stretch Reflex)
Khyber Girls Medical CollegeProf.Dr.Rashid MahmoodProf.Dr.Rashid MahmoodProf.Dr.Rashid MahmoodProf.Dr.Rashid MahmoodProf.Dr.Rashid Mahmood
6Swallowing
Oropharyngeal stage of swallowing
Resting
Swallowing (Deglutition) Reflex
1. Stimulus→ Touch
2. Receptors→ Tactile
3. Afferent Nerve→ 5,9
4. CNS→ Swallowing Centre (Medulla & Lower
Pons)
5. Efferent Nerve→ 5,9,10,12
6. Effector→ Muscles of Pharynx & Upper
esophagus
7. Response → Contraction
© Prof.Dr.Rashid Mahmod 7
Esophagus
3rd Stage of swallowing
No secretion except mucus, more marked at
upper & lower end
Peristalsis
Upper and lower esophageal Sphincter
© Prof.Dr.Rashid Mahmod 8
Stomach
Movements (Motor functions)
Secretions
Digestion
Absorption
Regulation
© Prof.Dr.Rashid Mahmod 9
Movements (Motor functions) of
Stomach
1. Storage
• Until food is processed in stomach and intestine
2. Mixing (with gastric secretions)
• Unless semifluid mixture: chyme
3. Slow emptying
• At a rate suitable for digestion and absorption in
small intestine
4. Hunger contractions
© Prof.Dr.Rashid Mahmod 10
Secretions of Stomach
Components
1. HCl
2. Pepsins
3. Gastric Lipase
4. Gastric Amylase
5. Mucus
6. Intrinsic factor
7. Gelatinase (Liquefies
Gelatin)
8. Electrolytes
9. Water
Phases
Cephalic Phase
Gastric Phase
Intestinal Phase
© Prof.Dr.Rashid Mahmod 11
Digestion in Stomach
1. Gastric Lipase (Digestion of lipids)
2. Gastric Amylase (Digestion of
carbohydrates)
3.Pepsinogen (Digestion of Proteins)
Pepsinogen Pepsin
HCl
Causes
proteolysis
© Prof.Dr.Rashid Mahmod 12
Absorption in Stomach
 Water, if the body is dehydrated.
 Medication, like aspirin.
 Amino acids.
© Prof.Dr.Rashid Mahmod 13
Regulation of Gastric Functions
 Nervous Control
 Enteric Nervous System
 Autonomic Nervous System
 Reflexes:
 Entero Gastric Reflex
 Cephalic Phase of Gastric Secretion
 Hormonal Control
 Gastrin
 Secretin
 CCK
 GIP
 Motilin
© Prof.Dr.Rashid Mahmod 14
Pyloric Sphincter
Pyloric Pump & Gastric Emptying
1. Gastric factors
(Excitatory)
 Hormonal control
 GASTRIN →
 Mild to moderate
stimulation of gastric
movements
 Nervous control
 local Myenteric
reflexes
2. Duodenal factors
(Inhibitory)
(more powerful)
 Nervous control
 Enterogastric nervous
reflexes
 Hormonal control
i. Cholecystokinin
ii. Secretin
iii. GIP
© Prof.Dr.Rashid Mahmod 15
Small Intestine
 Movements
 Secretions
 Digestion
 Absorption
 Regulation
© Prof.Dr.Rashid Mahmod 16
Movements of Small Intestine
1. Mixing (Segmentation Contractions)
2. Propulsive (Peristalsis)
Overlap
3. Movements of Muscularis Mucosa
Folds
↑ surface area
4. Contraction of villi
“milk” the villi
↑ lymph flow
© Prof.Dr.Rashid Mahmod 17
Secretion of Small Intestine
Secreted Into Intestinal Lumen
Enterokinase
Enterocytes covering the villi contain enzymes
Digestion during absorption
For digestion of proteins
Peptidases
For digestion of carbohydrates
Sucrase, maltase, isomaltase, lactase
For digestion of fats
Intestinal lipase
© Prof.Dr.Rashid Mahmod 18
Hormones Secreted by
Small Intestine:
Secretin
CCK
Motilin
Digestion in Small Intestine
Final Digestion occurs inside the
Enterocytes lining the epithelium of small
intestine.
© Prof.Dr.Rashid Mahmod 19
Digestion of Carbohydrates
Cellulose: Not digested
Action of Ptylin (Amylase):
5% digestion in mouth
15-35% in stomach (before it is inactivated by HCl)
More Powerful
Contd………
Absorbed
Digestion of Proteins
Collagen (Meat)
Digestion of Fats
Lingual Lipase: < 10% digestion (Not important)
Enteric Lipase: < 10% digestion (Not important)
Cholesterol Esterase digests Cholesterol Esters
Phospolipase A2 digests Phospolipids
Which is the main enzyme for digestion of fats?
Absorption in Small Intestine
Final Absorption of all nutrients by
enterocytes
© Prof.Dr.Rashid Mahmod 23
Absorption of Carbohydrates
A small fraction as Disaccharides
Mainly Monosaccharides
Glucose (80%)
Galactose
Sodium Co-Transport
Fructose
Facilitated Diffusion
Presence of glucose also facilitates reabsorption
of Sodium
Absorption of Proteins
Protein molecules : rarely absorbed →
antigenic reaction
Absorbed as
Tripeptides
Bipeptides
Amino Acids
Mainly Co-transport with Sodium
Absorption of Fats
Fats
Monoglycerides
Fatty Acids
Bile Micelles
Microvilli
Bile Acids
Monoglycerides
Fatty Acids
Bile Acids
Epithelial Cells
New Triglycerides
Chylomicrons
Lymph
Intestinal Lumen
+
+ +
+
Regulation of Functions of Small
Intestine
Nervous Control
Enteric Nervous System
Autonomic Nervous System
Reflexes
Gastro-Enteric
Gastro-Ileal etc
Hormonal Control
Secretin
CCK
© Prof.Dr.Rashid Mahmod 27
Ileocecal valve and
Ileocecal sphincter
Excitatory
factors
Inhibitory
factors
Large Intestine
Movements
Secretions
No Digestion
Absorption
Formation of Feces
Other Functions
© Prof.Dr.Rashid Mahmod 29
Movements of Colon
Mixing Movements (Haustrations)
Proximal half
Propulsive Movements (Mass Movements)
Distal half
Functions of colon:
Absorption
Storage of fecal matter
Secretions of Large Intestine:
Mucus secretion
Crypts of Lieberkϋhan
No villi
No enzymes
Moderate amount of bicarbonate ions
Absorption in Large Intestine
Proximal Half:
Absorbing Colon
Water
Electrolytes
Distal Half:
Storage Colon
Formation of Feces
No villi
Other Functions of Large Intestine
Bacteria Normally present
Substances formed as a result of bacterial
action:
Vitamin K
Vitamin B12
Thiamine
Riboflavin
Gases (flatus)
CO2
Methane
Hydrogen
External &
Internal Anal
Sphincter:
Defecation
reflex
Defecation Reflexes
 Intrinsic Reflex
 Parasympathetic Defection reflex
• Rectum is empty most of the time
– Weak functional sphincter at juncture between
sigmoid colon & rectum
– Sharp angulation
• Feces into rectum → Defecation reflex
– Desire for Defecation
– Reflex contraction of rectum
– Reflex relaxation of anal sphincters
Voluntary/conscious/subconscious involuntary
External InternalPudendal nerve
Accessory glands
Salivary Glands
Pancreas
Liver/ Gall Bladder
© Prof.Dr.Rashid Mahmod 36
Salivary Glands: Saliva
1. Digestion
i. Salivary Amylase
 Secreted by salivary glands
ii. Lingual lipase
 Secreted by glands on the
tongue
2. Articulation
3. Moistening of food
4. Mastication
5. Water regulation (thirst)
6. Taste receptors
7. Swallowing
8. Keeps mouth clean
9. Neutralization of gastric
acid
Relieve of heartburn
10. Protection from bacteria
i. Wash away bacteria
ii. Wash away the food of
bacteria
iii. Destroy bacteria
11. Tooth Protection
1. By neutralizing acid
2. By affecting mineral
dissociation equilibrium by
means of its calcium
phosphate content.
3. Proline-rich proteins protect
the tooth enamel and bind
toxic tannins
12. Excretion:
Urea, Heavy Metals, Drugs etc
© Prof.Dr.Rashid Mahmod 37
Pancreas
Components of Pancreatic Secretion
1. Exocrine
i. Digestive enzymes
 Secreted by acinar cells
ii. HCO3- -
 Secreted by duct cells
2. Endocrine
i. Insulin
ii. Glucagon
Functions of Liver
1. Formation and secretion of bile
2. Nutrient and vitamin metabolism
3. Inactivation of various substances
4. Synthesis of plasma proteins
5. Immunity
Functions of Bile
Digestion of fats
Emulsification
Large fat particles →small fat particles
Absorption of fats
Excretion
Bilirubin
End product of hemoglobin destruction
Excess cholesterol
Emptying of Gall Bladder
Food in Duodenum
Mainly Fatty Food
Cholecystokinin
BLOOD
GALL BLADDER
EMPTYING
RELAXATION OF SPHINCTER OF ODDI
duodenum
Vagus nerve
Food in mouth
The End
Questions?
Next:
EOME

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Review of GIT physiology

  • 2. GIT: A long tube with Accessory glands © Prof.Dr.Rashid Mahmod 2
  • 3. Lesson Contents Mouth Esophagus Stomach Pyloric Sphincter Small intestine Ileo-Cecal Valve & Sphincter Large intestine Internal & External Anal Sphincter Accessory glands © Prof.Dr.Rashid Mahmod 3
  • 4. Mouth Ingestion of food Mastication Swallowing 3 Stages i. Voluntary Stage (Movement of Tongue) ii. Pharyngeal Stage (Involuntary) (Swallowing Reflex) iii. Esophageal Stage (Involuntary) © Prof.Dr.Rashid Mahmod 4
  • 5. Khyber Girls Medical CollegeProf.Dr.Rashid MahmoodProf.Dr.Rashid MahmoodProf.Dr.Rashid MahmoodProf.Dr.Rashid MahmoodProf.Dr.Rashid Mahmood 5 Mastication (Chewing Reflex) • Components of reflex 1. Stimulus 2. Receptors 3. Afferent Nerve 4. CNS 5. Efferent Nerve 6. Effector 7. Response • Components of Chewing reflex 1. Bolus of Food 2. Receptors of Sensory Nerves 3. 5th Nerve 4. Swallowing Centre 5. 5th Nerve 6. Muscles of Mastication 7. Reflex Inhibition →Rebound Contraction (Stretch Reflex)
  • 6. Khyber Girls Medical CollegeProf.Dr.Rashid MahmoodProf.Dr.Rashid MahmoodProf.Dr.Rashid MahmoodProf.Dr.Rashid MahmoodProf.Dr.Rashid Mahmood 6Swallowing Oropharyngeal stage of swallowing Resting
  • 7. Swallowing (Deglutition) Reflex 1. Stimulus→ Touch 2. Receptors→ Tactile 3. Afferent Nerve→ 5,9 4. CNS→ Swallowing Centre (Medulla & Lower Pons) 5. Efferent Nerve→ 5,9,10,12 6. Effector→ Muscles of Pharynx & Upper esophagus 7. Response → Contraction © Prof.Dr.Rashid Mahmod 7
  • 8. Esophagus 3rd Stage of swallowing No secretion except mucus, more marked at upper & lower end Peristalsis Upper and lower esophageal Sphincter © Prof.Dr.Rashid Mahmod 8
  • 10. Movements (Motor functions) of Stomach 1. Storage • Until food is processed in stomach and intestine 2. Mixing (with gastric secretions) • Unless semifluid mixture: chyme 3. Slow emptying • At a rate suitable for digestion and absorption in small intestine 4. Hunger contractions © Prof.Dr.Rashid Mahmod 10
  • 11. Secretions of Stomach Components 1. HCl 2. Pepsins 3. Gastric Lipase 4. Gastric Amylase 5. Mucus 6. Intrinsic factor 7. Gelatinase (Liquefies Gelatin) 8. Electrolytes 9. Water Phases Cephalic Phase Gastric Phase Intestinal Phase © Prof.Dr.Rashid Mahmod 11
  • 12. Digestion in Stomach 1. Gastric Lipase (Digestion of lipids) 2. Gastric Amylase (Digestion of carbohydrates) 3.Pepsinogen (Digestion of Proteins) Pepsinogen Pepsin HCl Causes proteolysis © Prof.Dr.Rashid Mahmod 12
  • 13. Absorption in Stomach  Water, if the body is dehydrated.  Medication, like aspirin.  Amino acids. © Prof.Dr.Rashid Mahmod 13
  • 14. Regulation of Gastric Functions  Nervous Control  Enteric Nervous System  Autonomic Nervous System  Reflexes:  Entero Gastric Reflex  Cephalic Phase of Gastric Secretion  Hormonal Control  Gastrin  Secretin  CCK  GIP  Motilin © Prof.Dr.Rashid Mahmod 14
  • 15. Pyloric Sphincter Pyloric Pump & Gastric Emptying 1. Gastric factors (Excitatory)  Hormonal control  GASTRIN →  Mild to moderate stimulation of gastric movements  Nervous control  local Myenteric reflexes 2. Duodenal factors (Inhibitory) (more powerful)  Nervous control  Enterogastric nervous reflexes  Hormonal control i. Cholecystokinin ii. Secretin iii. GIP © Prof.Dr.Rashid Mahmod 15
  • 16. Small Intestine  Movements  Secretions  Digestion  Absorption  Regulation © Prof.Dr.Rashid Mahmod 16
  • 17. Movements of Small Intestine 1. Mixing (Segmentation Contractions) 2. Propulsive (Peristalsis) Overlap 3. Movements of Muscularis Mucosa Folds ↑ surface area 4. Contraction of villi “milk” the villi ↑ lymph flow © Prof.Dr.Rashid Mahmod 17
  • 18. Secretion of Small Intestine Secreted Into Intestinal Lumen Enterokinase Enterocytes covering the villi contain enzymes Digestion during absorption For digestion of proteins Peptidases For digestion of carbohydrates Sucrase, maltase, isomaltase, lactase For digestion of fats Intestinal lipase © Prof.Dr.Rashid Mahmod 18 Hormones Secreted by Small Intestine: Secretin CCK Motilin
  • 19. Digestion in Small Intestine Final Digestion occurs inside the Enterocytes lining the epithelium of small intestine. © Prof.Dr.Rashid Mahmod 19
  • 20. Digestion of Carbohydrates Cellulose: Not digested Action of Ptylin (Amylase): 5% digestion in mouth 15-35% in stomach (before it is inactivated by HCl) More Powerful Contd……… Absorbed
  • 22. Digestion of Fats Lingual Lipase: < 10% digestion (Not important) Enteric Lipase: < 10% digestion (Not important) Cholesterol Esterase digests Cholesterol Esters Phospolipase A2 digests Phospolipids Which is the main enzyme for digestion of fats?
  • 23. Absorption in Small Intestine Final Absorption of all nutrients by enterocytes © Prof.Dr.Rashid Mahmod 23
  • 24. Absorption of Carbohydrates A small fraction as Disaccharides Mainly Monosaccharides Glucose (80%) Galactose Sodium Co-Transport Fructose Facilitated Diffusion Presence of glucose also facilitates reabsorption of Sodium
  • 25. Absorption of Proteins Protein molecules : rarely absorbed → antigenic reaction Absorbed as Tripeptides Bipeptides Amino Acids Mainly Co-transport with Sodium
  • 26. Absorption of Fats Fats Monoglycerides Fatty Acids Bile Micelles Microvilli Bile Acids Monoglycerides Fatty Acids Bile Acids Epithelial Cells New Triglycerides Chylomicrons Lymph Intestinal Lumen + + + +
  • 27. Regulation of Functions of Small Intestine Nervous Control Enteric Nervous System Autonomic Nervous System Reflexes Gastro-Enteric Gastro-Ileal etc Hormonal Control Secretin CCK © Prof.Dr.Rashid Mahmod 27
  • 28. Ileocecal valve and Ileocecal sphincter Excitatory factors Inhibitory factors
  • 29. Large Intestine Movements Secretions No Digestion Absorption Formation of Feces Other Functions © Prof.Dr.Rashid Mahmod 29
  • 30. Movements of Colon Mixing Movements (Haustrations) Proximal half Propulsive Movements (Mass Movements) Distal half Functions of colon: Absorption Storage of fecal matter
  • 31. Secretions of Large Intestine: Mucus secretion Crypts of Lieberkϋhan No villi No enzymes Moderate amount of bicarbonate ions
  • 32. Absorption in Large Intestine Proximal Half: Absorbing Colon Water Electrolytes Distal Half: Storage Colon Formation of Feces No villi
  • 33. Other Functions of Large Intestine Bacteria Normally present Substances formed as a result of bacterial action: Vitamin K Vitamin B12 Thiamine Riboflavin Gases (flatus) CO2 Methane Hydrogen
  • 35. Defecation Reflexes  Intrinsic Reflex  Parasympathetic Defection reflex • Rectum is empty most of the time – Weak functional sphincter at juncture between sigmoid colon & rectum – Sharp angulation • Feces into rectum → Defecation reflex – Desire for Defecation – Reflex contraction of rectum – Reflex relaxation of anal sphincters Voluntary/conscious/subconscious involuntary External InternalPudendal nerve
  • 36. Accessory glands Salivary Glands Pancreas Liver/ Gall Bladder © Prof.Dr.Rashid Mahmod 36
  • 37. Salivary Glands: Saliva 1. Digestion i. Salivary Amylase  Secreted by salivary glands ii. Lingual lipase  Secreted by glands on the tongue 2. Articulation 3. Moistening of food 4. Mastication 5. Water regulation (thirst) 6. Taste receptors 7. Swallowing 8. Keeps mouth clean 9. Neutralization of gastric acid Relieve of heartburn 10. Protection from bacteria i. Wash away bacteria ii. Wash away the food of bacteria iii. Destroy bacteria 11. Tooth Protection 1. By neutralizing acid 2. By affecting mineral dissociation equilibrium by means of its calcium phosphate content. 3. Proline-rich proteins protect the tooth enamel and bind toxic tannins 12. Excretion: Urea, Heavy Metals, Drugs etc © Prof.Dr.Rashid Mahmod 37
  • 38. Pancreas Components of Pancreatic Secretion 1. Exocrine i. Digestive enzymes  Secreted by acinar cells ii. HCO3- -  Secreted by duct cells 2. Endocrine i. Insulin ii. Glucagon
  • 39. Functions of Liver 1. Formation and secretion of bile 2. Nutrient and vitamin metabolism 3. Inactivation of various substances 4. Synthesis of plasma proteins 5. Immunity
  • 40. Functions of Bile Digestion of fats Emulsification Large fat particles →small fat particles Absorption of fats Excretion Bilirubin End product of hemoglobin destruction Excess cholesterol
  • 41. Emptying of Gall Bladder Food in Duodenum Mainly Fatty Food Cholecystokinin BLOOD GALL BLADDER EMPTYING RELAXATION OF SPHINCTER OF ODDI duodenum Vagus nerve Food in mouth