Digestion and Absorption © 2004, 2002 Elsevier Inc. All rights reserved. Digestive System Reduces particle size Helps to absorb micronutrients and trace elements Sets a physical and immunologic barrier Digestion Breaks down Carbohydrates (starch and sugar) → single sugar molecules Proteins → amino acids Fats → fatty acids, glycerol Enzymes Proteins that break bonds The Digestive System Is a long tube from the mouth to the anus Digestive System Mouth to anus – Epithelium lines the lumen – Barrier to invaders – Submucosal layer – Muscularis Taste and smell Peristalsis Muscular contractions that move food along throughout GI tract The Mouth Mastication: chewing Saliva – Salivary glands produce about 1.5 liters of saliva daily – Salivary amylase (ptyalin) begins to break down starch (inactivated in the stomach) – Salivary lipase: begins fat digestion, but has minimal effect – Mucus to lubricate the food for easier swallowing – Lysozyme to kill bacteria Tongue – Taste receptors: sweet, sour, salty, bitter, savory – Enzymes to help break down fatty acids Swallowing Bolus is the food swallowed at one time Epiglottis blocks windpipe, prevents choking The Esophagus Long tube Connects pharynx to the stomach Peristalsis, muscle contraction Lower esophageal sphincter Heartburn http://www.gerd.com/media/grossovw.gif The Stomach Lower esophageal sphincter and pyloric sphincter control entry and exit from stomach Storage capacity of ~4 cups Secretion of hydrochloric acid, enzymes, including a protease, gastric lipase; mucus, the hormone gastrin, and intrinsic factor (B12) Stomach secretes about 2000-2500 ml of gastric juice daily Stomach pH of stomach is low, 1 to 4; kills many bacteria and micro-organisms Achlorhydria, gastrectomy, GI dysfunction or disease ↑ risk of bacterial overgrowth in the intestines Protein digestion begins with pepsinogen which is converted to active pepsin in acidic stomach environment Chief cells secrete acid-stable gastric lipase, which has minor effect on shorter-chain triglycerides Stomach Most of a liquid meal exits in 1 to 2 hours and most of a solid meal in 2 to 3 hours Formation of chyme Mucus layer protects stomach from digestion Very little absorption of nutrients Physiology of the Stomach Stomach Acid Activates digestive enzymes Partially digests dietary protein Assists in calcium absorption Makes dietary minerals soluble for absorption The Small Intestine Most digestion and absorption happens here About 5-7 meters – Duodenum (.5 meters) – Jejunum (2-3 meters) – Ileum (3-4 meters) The Small Intestine Folded walls with villi projections Absorptive cells are located on the villi Increases intestinal surface area 600x Rapid cell turnover The Small Intestine Nutrient Absorption Passive diffusion: driven by concentration; fats, water, some minerals Active absorption: uses energy; glucose and amino acids Phagocytosis and pinocytosis: absorptive cells engulf compounds, generally larger molecules, as in immune substances in breast milk Nutrient Absorption Site of Absorption Absorption Digestion → small particles End products of digestion: Carbohydrates → monosaccharides Proteins → amino acids Fats → glycerol, fatty acids Absorption Through small intestine walls Absorbed into Blood – water soluble nutrients Lymph – fat soluble nutrients Blood → liver → general circulation – Liver detoxifies and repackages The Large Intestine ~3 1/2 feet in length No villi or enzymes present Little digestion occurs Absorption of water, some minerals, vitamins Bacteria break down fiber; produce Vitamin K Formation of feces for elimination Rectum Stool remains Stimulates elimination Muscle contraction Anal sphincters – Voluntary control – Opens for elimination Accessory Organs Salivary glands Pancreas Gallbladder Liver Salivary Glands Saliva Works in mouth Moistens Salivary amylase – Digests starch The Pancreas Produces glucagon and insulin (endocrine) Manufactures digestive enzymes→ small intestine Secretes pancreatic juices Bicarbonate needed to neutralize chyme when it enters small intestine The Liver Produces bile (fat digestion) Enterohepatic circulation The Gallbladder Stores bile Concentrates it Releases to small intestine when needed The Digestive System Sites of Secretion, Digestion, and Absorption Digestion in the Stomach Different nutrients leave the stomach at different rates: —Carbohydrates first, followed by protein, fat, and fibrous foods Summary of Enzymatic Digestion and Absorption Secretion Enzyme Substrate Action Saliva Ptyalin Starch Hydrolysis to form dextrins Gastric juice Pepsin Protein Gastric lipase Fats Hydrolysis of peptide bonds Hydrolysis into free fatty acids Final Product Summary of Enzymatic Digestion and Absorption —cont’d Secretion Enzyme Substrate Action Pancreatic exocrine secretion Lipase Fat Final Product Hydrolysis to Fatty monoacids glycerides Cholesterol Cholesterol esterase Hydrolysis to Cholesesters of terol cholesterol and fatty acids alphaAmylase Hydrolysis Starch, dextrins Dextrin, maltose Summary of Enzymatic Digestion and Absorption —cont’d Secretion Enzyme Substrate Action Pancreatic exocrine secretion Protein Hydrolysis Polypeptides Chymotrypsin Protein Hydrolysis Polypeptides Carboxypeptidase Hydrolysis Amino acids Trypsin Polypeptides Final Product Ribonuclease Ribonu-cleic Hydrolysis Monoacids nucleotides Elastase Fibrous protein Hydrolysis Amino acids Summary of Enzymatic Digestion and Absorption —cont’d Secretion Enzyme Substrate Action Brush border CarboxyPolypepenzymes peptidase; tides aminopeptidase; dipeptidase Hydrolysis Final Product Amino acids Enterokinase Trypsino-gen Activates to trypsin Polypeptidases and peptides Sucrase Sucrose Glucose, fructose Hydrolysis Enzymatic Digestion and Absorption —cont’d Secretion Enzyme Substrate Action Brush border enzymes Isomaltase Dextrin Final Product Hydrolysis Glucose Maltase Maltose Hydrolysis Glucose Lactase Lactose Hydrolysis Glucose, galactose Nucleotidases Nucleic acid Hydrolysis Nucleotides Nucleosidases Nucleosidases Hydrolysis Purine and and pyrimidine phosphorylase bases Features of Digestion and Absorption 92% to 97% of the diet is absorbed Small intestine—key role in digestion and absorption Intestines: 7 meters long —Villi and microvilli/brush border Villi of the Human Intestine Refeeding after Starvation GI tract compromised after starvation Feeding results in cellular proliferation, which restores normal gastrointestinal architecture and function after a few days Lipids The major portion of fat digestion takes place in the small intestine as a result of pancreatic lipase Summary of Fat Absorption Transport Pathways through the Cell Membrane Large Intestine 5 feet long Bacterial action to produce gases and organic acids Nutrients formed here—vitamin K, thiamin, vitamin B12, riboflavin The Gradual Breakdown of Large Starch Molecules Process of Digestion of Carbohydrate Sites of Secretion and Absorption into Gastrointestinal Tract Neurotransmitters Alpha-aminobutyric acid: relaxes LES Norepinephrine: decreases motility, increases contractions of sphincters, inhibits secretions Acetylcholine: increases motility, relaxes sphincters, stimulates secretions Neurotensin: inhibits release of gastric emptying and acid secretion Neuropeptide-Y: stimulates feeding behavior Hormones and GI Function: Gastrin Released from gastric mucosa and duodenum in presence of peptides and amino acids; stimulates secretion of hydrochloric acid and pepsinogen; increases gastric antral motility, increases LES tone Hormones and GI function: Secretin Secretin: from duodenal mucosa in presence of acid in small intestine; stimulates pancreas to secrete water and bicarb; also insulin and pancreatic enzymes Hormones and GI function: Cholecystokinin (CCK) Released from proximal small bowel in presence of peptices, amino acids, fat, HCL, stimulates pancreas to release pancreatic enzymes Hormones and GI function: Gastric Inhibitory Polypeptide (GIP) Released from small intestine in presence of glucose and fat; inhibits gastrin-stimulated release of gastric acid Hormones and GI Function (Motilin) Released from stomach and small and large intestine in presence of biliary and pancreatic secretions; promotes gastric emptying and increases GI motility Hormones and GI function: Somatostatin Released from stomach, pancreas, and upper small intestine in presence of acidity and products of protein and fat digestion; inhibits release of gastrin, motilin, and pancreatic secretions; decreases motility of GI tract Digestion and Absorption It’s important to know the physiology and function of the GI tract in order to understand the implications of pathophysiology