Download the digestive system

THE DIGESTIVE SYSTEM
Food
is
chemical
vital
for
reactions
life
because
occurring
it's
in
the
every
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source
cell.
of
Energy
energy
is
that
drives
needed
for
the
muscle
contraction, the conduction of nerve impulses, and the secretory and absorptive
activities of many cells. Food as it is consumed, however, is not in a state
suitable for use as an energy source by any cell. The food must be broken down
into
molecule-sized
pieces
so
that
it
can
be
transported
through
the
cell
membranes. The breaking down of food molecules for use by body cells is called
digestion, and the organs that collectively perform this function comprise the
digestive system.
The medical specialty that deals with the structure, function, diagnosis, and
treatment of diseases of the stomach and intestines is called gastroenterology
(gastro
m
stomach; enteron – intestines).
REGULATION OF FOOD INTAKE:
Within the hypothalamus are two centers related to food intake. One is a cluster
of nerve cells in the lateral nuclei called the
feeding (hunger) center. When
this area is stimulated in animals, they begin to eat heartily , even if they are
already
full.
The
second
center
is
a
cluster
of
neurons
in
the
ventromedial
nuclei of the hypothalamus referred to as the satiety center. When this center is
stimulated
in
animals,
it
causes
them
to
stop
eating,
even
if
they
have
been
starved for days. Apparently the feeding center is constantly active, but it is
inhibited by the satiety center. Other parts of the brain that assume a function
in feeding and satiety are the brain stem, amygdala, and limbic system.
When
blood
glucose
levels
are
low,
feeding
increases.
Conversely,
when
blood
glucose levels are high, feeding is depressed. Low levels of amino acids in the
blood also enhance feeding, whereas high levels depress eating. This mechanism,
however, is not as powerful as that for glucose.
Lipids are also believed to be related to the regulation of food intake. As the
amount of adipose tissue increases in the body, the rate of feeding decreases.
Another factor that affects food intake is body temperature. A cold environment
THE DIGESTIVE SYSTEM
enhances
eating,
while
a
warm
environment
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depresses
it.
Food
intake
is
also
regulated by distension of the gastrointestinal tract, particularly the st omach
and
duodenum.
When
these
organs
are
stretched,
a
reflex
is
initiated
that
activates the satiety center and depresses the feeding center. Also the hormone
cholecystokinin
(CCK),
secreted
when
fat
enters
the
small
intestine,
inhibits
eating.
DIGESTIVE PROCESSES:
The digestive system prepares food for consumption by the cells through five
basic activities.
1.
INGESTION: taking food into the body (eating).
2.
MOVEMENT of food along the digestive tract.
3.
DIGESTION: the breakdown of food by both chemical and mechanical processes.
4.
ABSORPTION: the passage of digested food from the digestive tract into the
cardiovascular and lymphatic systems for distribution to cells.
5.
DEFECATION: the elimination of indigestible substances from the body.
Chemical digestion is a series of catabolic reactions that break down the large
carbohydrate, lipid, and protein molecules that we eat into molecules usable by
body
cells.
walls
of
eventually
These
the
products
digestive
into
the
of
digestion
organs,
body's
into
cells.
are
the
small
blood
Mechanical
enough
and
to
pass
lymph
digestion
through
the
capillaries,
and
consists
of
various
movements that aid chemical digestion. Food is prepared by the teeth before it
can
be
churn
swallowed.
the
food
so
Then
it
the
is
smooth
muscles
thoroughly
mixed
of
the
with
stomach
the
and
enzymes
small
that
intesti ne
catalyze
the
reactions.
ORGANIZATION:
The organs of digestion are traditionally divided into two main groups. First is
the gastrointestinal (GI) _ tract
or
alimentary
canal,
a
continuous
tub
running
through the ventral body cavity and extending from the mouth to the anus. Organs
THE DIGESTIVE SYSTEM
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composing the g a s t r o i n t e s t i n a l tract include the mouth, pharynx, esophagus,
stomach, small intestine, and large intestine. The GI tract contains the food
from the time it is eaten until it is digested and prepared for elimination.
Muscular contractions in the wall of the GI tract break down the food physically
b y churning i t .
Secretions produced by cells along the tract break down the
food chemically.
The
second
group
of
organs
composing
accessory structures--the teeth,
the
digestive
system
consists
of
the
tongue, salivary glands, liver, gallbladder,
and pancreas. Teeth protrude into the GI tract and aid in the physical breakdown
of
food.
outside
The
the
other
tract
accessory
and
structures,
produce
or
store
except
for
secretions
the
that
tongue,
aid
in
lie
the
totally
chemical
breakdown of food. These secretions are released i n t o t h e tract t h r o u g h d u c t s .
GENERAL HISTOLOGY:
The wall of th e GI tract, especially from the e sophagus to the anal canal, has
the
same
basic
arrangement
of
t is s u e s .
The
four
coats
or
tunics
of
th e
tract from the inside out are the mucosa, submucosa, musc ularis, and serosa or
adventitia.
The mucosa, or inner lining of the tract, i s a mucous membrane attached to a
thin
layer
of
visceral
muscle.
Two
layers
compose
the
membrane:
a
lining
epithelium, which is in direct contact with the contents of the GI tract, and an
underl ying layer of loose connective tissue called th e lamina propria. Under the
lamina
propria
is
smooth
muscle
called
the
muscularis
mucosae.
The
epithelial
layer is composed of nonkeratinized cells that are stratified in the mouth and
esophagus, but are simple throughout the rest of the tract, The functions of the
s t r a t i f i e d epithelium are protection and secretion. The functions of the simple
epithelium are secretion and absorption.
The lamina propria is made of loose connective tissue containing many blood
and lymph vessels and scattered lymphatic nodules, masses of lymphatic
tissue that
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THE DIGESTIVE SYSTEM
are
not
encapsulated.
This
layer
supports
the
epithelium,
binds
it
to
the
muscularis mucosae, and provides it with a blood and lymph supply. The blood and
lymph vessels are the avenues by which nutrients in the tract reach the other
organs of the body. The lymphatic tissue also protects against disease Remember
that the GI tract is in contact with the outside environment and contains food
that often carries harmful bacteria. Unlike the skin, the mucous membrane of the
tract is not protected from bacterial entry by keratin.
The
muscularis
membrane
of
the
mucosae
contains
intestine
into
smooth
small
muscle
folds
fibers
that
that
increase
throw
the
the
mucous
digestive
and
absorptive area.
The submucosa consists of loose connective tissue that binds the mucosa to the
third tunic, called the muscularis. It is highly vascular and contains a portion of
the submucous plex, also known as the plexus of Meissner, or Meissner's plexus,
which is part of the autonomic nerve supply to the muscularis mucosae. This plexus
is also important in controlling secretions by the GI tract.
The muscularis of the mouth, pharynx, and esophagus consists in part of skeletal
muscle that produces voluntary swallowing. Throughout the rest of the tract, the
muscularis consists of smooth muscle that is generally found in two sheets: an
inner ring of circular fibers and an outer sheet of longitudinal fibers.
Contractions of the smooth muscles help to break food down physically, mix it
with digestive secretions, and propel it through the tract, The muscularis also
contains the major nerve supply to the alimentary tract--the myenteric plexus,
also known as the plexus of Auerbach or Auerbach's plexus, which consists of
fibers from both autonomic divisions. This plexus mostly controls GI motility.
The serosa is the outermost layer of most portions of the alimentary canal. It is
a serous membrane composed of connective tissue and epithelium. This layer is also
called the visceral peritoneum.
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The peritoneum is the largest serous membrane of the body . Serous membranes are
also
associated
with
the
heart
(pericardium)
and
lungs
(pleurae).
Serous
membranes consist of a layer of simple squamous epithelium (called mesothelium)
and an underlying supporting layer of connective tissue. The parietal peritoneum
lines the wall of the abdominal cavity. The visceral peritoneum covers some of
the organs and constitutes their serosa. The potential space between the parietal
and
visceral
contains
portions
serous
fluid.
of
In
the
peritoneum
certain
is
called
diseases,
the
the
peritoneal
peritoneal
cavity
cavity
may
and
become
distended by several liters of fluid so that it forms an actual space. Such an
accumulation
lie
on
the
of
serous
posterior
fluid
is
abdominal
called
wall
ascites,
and
are
or
ascites
covered
by
fluid.
Some
peritoneum
organs
on
their
anterior surfaces only. Such organs, including the kidneys and pancreas, are said
to be retroperitoneal.
Unlike the pericardium and pleurae, the peritoneum contains large folds that weave
in between the viscera. The folds bind the organs to each other and to the walls of
the cavity and contain the blood and lymph vessels and the nerves that supply the
abdominal organs. One extension of the peritoneum is called the mesentery. It is
an outward fold of the serous coat of the small intestine. The tip of the fold is
attached to the posterior abdominal wall. The mesentery binds the small intestine
to the posterior abdominal wall. A similar fold of parietal peritoneum, called the
mesocolon, binds the large intestine to the posterior body wall . It also carries
blood vessels and lymphatics to the intestines.
Other important peritoneal folds are the falciform ligament, the lesser omentum,
and
the
greater
omentum.
The
falciform
ligament
attaches
the
liver
to
the
anterior abdominal wall and diaphragm. The lesser omentum arises as two folds in
the serosa of the stomach and duodenum suspending the stomach and duodenum from
the
liver.
The
greater
omentum
is
a
four-layered
fold
in
the
serosa
of
the
stomach that hangs down like an apron over the front of the intestines. It then
passes up to part of the large intestine (the transverse colon), wraps itself
around it, and finally attaches to the parie tal peritoneum of the posterior wall of
the abdominal cavity. Because the greater omentum contains large quantities
THE DIGESTIVE SYSTEM
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of adipose tissue, it is commonly called the "fatty apron." The greater omentum
contains numerous lymph nodes. If an infection occurs in the intestine, plasma
cells formed in the Lymph nodes combat the infection and help prevent it from
spreading to the peritoneum.
MOUTH (ORAL CAVITY):
The mouth, also referred to as the oral, or buccal cavity is formed by the cheeks,
hard and soft palates, and tongue. Forming the lateral walls of the oral cavity are
the
cheeks--muscular
structures
covered
on
the
outside
by
skin
and
lined
by
nonkeratinized stratified squamous epithelium. The anterior portions of the cheeks
terminate in the superior and inferior lips.
The lips (labia) are fleshy folds surrounding the orifice of the mouth. They are
covered
on
transition
the
outside
zone
where
by
skin
and
two
kinds
the
on
of
the
inside
covering
by
a
mucous
tissue
meet
membrane.
is
called
The
the
vermilion. This portion of the lips is nonkeratinized, and the color of the blood
in the underlying blood vessels is visible through the transparent surface layer of
the vermilion. The inner surface of each lip is attached to its corresponding gum
by a midline fold of mucous membrane called the labial frenulum.
The
orbicularis
integumentary
oris
covering
muscle
and
and
the
connective
internal
tissue
mucosal
lie
lining.
between
During
the
external
chewing,
the
cheeks and lips help to keep food between the upper and lower teeth. The also
assist in speech.
The vestibule of the oral cavity is bounded externally by the cheeks and lips
and internally by the gums and teeth. The oral cavity proper extends from the
vestibule to the fauces, the opening between the oral cavity and the pharynx or
throat.
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THE DIGESTIVE SYSTEM
The hard palate, the anterior portion of the roof of the mouth, is formed by the
maxillae and palatine bones, is covered by mucous membrane, and forms a bony
partition
between
the
oral
and
nasal
cavities.
The
soft
palate
forms
the
posterior portion of the roof of the mouth. It is an arch-shaped muscular between
the oropharynx and nasopharynx and is lined by mucous membrane.
Hanging from the free border of the soft palate is a conical muscular process
called the uvula. On either side of the base of the uvula are two muscular folds
that run down the lateral side of the soft palate. Anteriorly, the palatoglossal
arch (anterior pillar) extends inferiorly, laterally, and anteriorly to the side of
the base of the tongue. Posteriorly, the platopharvngeal arch (posterior pillar)
projects inferiorly, laterally, and posteriorly to the side of the pharynx. The
palatine
tonsils
are
situated
between
the
arches,
and
the
lingual
tonsil
is
situated at the base of the tongue. At the posterior border of the soft palate, the
mouth opens into the oropharynx through the fauces.
TONGUE:
The tongue, together with its associated muscles, forms the floor of the oral
cavity. It is an accessory structure of the digestive system composed of skeletal
muscle covered with mucous membrane. The tongue is divided into symmetrical lateral
halves by a median septum extending through its entire length and the tongue is
attached inferiorly to the hyoid bone. Each half of the tongue consists of an
identical complement of extrinsic and intrinsic muscles.
The extrinsic muscles of the tongue originate outside the tongue and insert into
it. The extrinsic muscles move the tongue from side to side and in and out. These
movements maneuver food for chewing, shape the food into a rounded mass, called a
bolus, and force the food to the back of the mouth for swallowing. They also form
the floor of the mouth and hold the tongue in position. The intrinsic muscles
originate and insert within the tongue and alter the shape and size of the tongue
for speech and swallowing. The lingual frenulum, a fold of mucous membrane in the
midline of the undersurface of the tongue, aids in limiting the
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THE DIGESTIVE SYSTEM
movement of the tongue posteriorly. If the lingual frenulum is too short, tongue
movements are restricted, speech is faulty, and the person is said to be "tonguetied."
This
congenital
problem
is
referred
to
as
ankyloglossia.
It
can
be
corrected by cutting the lingual frenulum.
The upper surface and sides of the tongue are covered with papillae, projections
of the lamina propria covered with epithelium. Filiform papillae are conical
projections distributed in parallel rows over the anterior two-thirds of the
tongue.
They
are
whitish
and
contain
no
taste
buds.
Fungiform
papillae
are
mushroornlike elevations distributed among the filiform papillae, and are more
numerous near the tip of the tongue. They appear as red dots on the surface of
the tongue, and most of them contain taste buds. Circumvallate papillae (least
numerous), 10 to 12 in number, are arranged in the form of an inverted V on the
posterior surface of the tongue, and all of them contain taste buds. Although the
tip of the tongue reacts to all four primary taste sensations, it is highly
sensitive to sweet and salty substances. The posterior portion of the tongue is
highly sensitive to bitter substances, the lateral edges of the tongue are more
sensitive to sour substances.
SALIVARY GLANDS:
Saliva is a fluid that is continuously secreted by glands in or near the mouth.
Ordinarily, just enough saliva is secreted to keep the mucous membranes of the
mouth moist, but when food enters the mouth, secretion increases so the saliva can
lubricate, dissolve, and begin the chemical breakdown of the food. The mucous
membrane lining the mouth contains many small glands, the buccal glands, that
secrete small amounts of saliva. However, the major portion of saliva is secreted
by the salivary glands, accessory structures that lie outside the mouth and pour
their contents into ducts that empty into the oral cavity. There are three pairs
of salivary glands: parotid, submandibular (submaxillary), and sublingual glands.
THE DIGESTIVE SYSTEM
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The parotid glands are located under and in front of the ears between the skin
and masseter muscle. They are compound tubuloacinar glands. Each secretes into
the oral cavity vestibule via a duct, called the parotid (Stensen's) __ duct, that
pierces the buccinator muscle to open into the vestibule opposite the upper
second molar tooth. The submandibular glands, which are compound acinar glands,
are found beneath the base of the tongue in the posterior part of the floor of
the mouth. Their ducts, the submandibular, also known as Wharton's ducts, run
superficially under the mucosa on either side of the midline of the floor of the
mouth and enter the oral cavity proper just behind the central incisors. The
Sublingual
glands,
also
compound
acinar
glands,
are
anterior
to
the
submandibular glands, and their ducts, the lesser sublingual ducts, also known as
Rivinus's ducts, open into the floor of the mouth in the oral cavity proper.
Mumps is an inflammation and enlargement of the parotid glands accompanied by
moderate fever, malaise, and extreme pain in the throat, especially when swallowing
sour foods or acid juices.
Composition of Saliva:
The fluids secreted by the buccal glands and the three pairs of salivary glands
constitute
saliva.
approximately
1,000
Amounts
to
1,500
of
saliva
secreted
ml.
Chemically,
daily
saliva
is
vary
99.5%
from
water
between
and
0.5%
solutes. Among the solutes are salts--chlorides, bicarbonates, and phosphates of
sodium
and
potassium.
Some
dissolved
gases
and
various
organic
substances
including urea and uric acid, serum albumin and globulin, mucin, the bacteriolytic
enzyme lysozyme, and the digestive enzyme salivary amylase are also present.
The water is saliva provides a medium for dissolving foods so they can be tasted
and for initiating digestive reactions. The pH of saliva is 6.35 to 6.85 which is
slightly acidic. Mucus which is part of saliva lubricates the food so it can be
easily turned in the mouth, formed into a ball called a bolus, and swallowed. The
enzyme lysozyme destroys bacteria, thereby protecting the mucous membrane from
infection and also protecting the teeth from decay.
THE DIGESTIVE SYSTEM
Salivation
is
entirely
under
nervous
control.
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Normally,
moderate
amounts
of
saliva are continuously secreted in response to parasymphatetic stimulation to
keep the mucous membranes moist and to lubricate the movements of the tongue and
lips during speech. The saliva is then swallowed and reabsorbed to prevent fluid
loss. Impulses are conveyed from the receptors in the tongue to two salivary
nuclei in the brain stem called the superior and inferior salivary nuclei. The
nuclei are located at about the junction of the medulla and pons. Returning
parasymphatetic autonomic impulses from the nuclei activate the secretion of
saliva.
The smell, sight, touch, or sound of food preparation also stimulates increased
saliva secretion. Saliva continues to be secreted heavily sometime after food is
swallowed. This flow of saliva washes out the mouth and dilutes and buffers the
chemical remnants of irritating substances.
TEETH:
The teeth or dentes are accessory structures of the digestive system located in
sockets
of
the
alveolar
processes
of
the
mandible
and
maxillae.
The
alveolar
processes are covered by the gingivae or gums, which extend slightly into each
socket
forming
the
gingival
sulcus.
The
sockets
are
lined
by
the
periodontal
ligament, which consists of dense fibrous connective tissue and is attached to the
socket walls and the cemental surface of the roots. Thus it anchors the teeth in
position and also acts as a shock absorber to dissipate the forces of chewing.
A typical tooth consists of three principal portions. The crown is the portion
above the level of the gums. The root consists of one to three projections embedded
in the socket. The neck is the constricted junction line of the crown and the root.
Teeth are composed primarily of dentin, a bonelike substance that gives the tooth
its basic shape and rigidity. The dentin encloses a cavity. The enlarged
THE DIGESTIVE SYSTEM
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part of the cavity, the pulp cavity, lies in the crown and is filled with pulp, a
connective
tissue
containing
blood
vessels,
nerves,
and
lymphatics.
Narrow
extensions of the pulp cavity run through the root of the tooth are called root
canals. Each root canal has an opening at its base, the apical foramen. Through
the
foramen
enter
blood
vessels
bearing
nourishment,
lymphatics
affording
protection, and nerves providing sensation. The dentin of the crown is covered by
enamel
that
consists
primarily
of
calcium
phosphate
and
calcium
carbonate.
Enamel is the hardest substance in the body and protects the tooth from the wear
of chewing. It is also a barrier against acids that easily dissolve the dentin.
The dentin of the root is covered by cementum, another bonelike substance, which
attaches the root to the periodontal ligament.
The branch of dentistry that is concerned with the prevention, diagnosis, and
treatment of diseases that affect the pulp, root, periodontal ligament, and
alveolar bone is known as endodontics.
Everyone has two dentitions, or sets of teeth. The first of these, the deciduous
teeth, also known as milk teeth, or baby teeth, begin to erupt at about 6 months
of age, and one pair appears at about each month thereafter until all 20 are
present. The incisors, which are closes to the midline, are chisel-shaped and
adapted for
incisors,
on
cutting
the
into
basis
food. They are referred
of
their
position.
Next
to as
to
central,
the
or
incisors,
lateral
moving
posteriorly, are the cuspids (canines), which have a pointed surface called a
cusp. Cuspids are used to tear and shred food. The incisors and cuspids have only
one root apiece. Behind them lie the first, and second molars, which have four
cusps. Upper molars have three roots; lower molars have two roots. The molars
crush and grind food.
All the deciduous teeth are lost--generally between 6 and 12 years of age--and
are replaced by the permanent dentition. The permanent dentition consists of 32
teeth that appear between the age of 6 and adulthood. It resembles the deciduous
dentition with the following exceptions. The deciduous molars are replaced with
the first and second premolars (bicuspids), which have two cusps and one root
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(upper first biscuspids have two roots) and are used for crushing and grinding.
The permanent molars erupt into the mouth behind the bicuspids. They do not
replace any deciduous teeth and erupt as the jaw grows to accommodate them--the
first molars at age 6, the second molars at age 12, and the third molars also
known as wisdom teeth after age 18. The human jaw has become smaller through
time and often does not afford enough room behind the second molars for the
eruption of the third molars. In this case, the third molars remain embedded in
the alveolar bone and are said to be "impacted." Most often they cause pressure
and pain and must be surgically removed.
DIGESTION IN THE MOUTH:
1.
MechanicalDigestion - Through chewing, or mastication, the tongue manipulates
food, the teeth grind it, and the food is mixed with saliva. As a result, the
food is reduced to a soft, flexible bolus that is easily swallowed.
2.
Chemical Digestion - The enzyme salivary amylase, formerly known as ptyalin,
initiates the breakdown of starch. This is the only chemical digestion that
occurs in the mouth. Carbohydrates are either monosaccharide and disaccharide
sugars or polysaccharide starches. Most of the carbohydrates we eat are
polysaccharides. Since only monosaccharides can be absorbed into the
bloodstream, ingested disaccharides and polysaccharides must be broken down.
The function of salivary amylase is to break the chemical bonds between some
of
the
monosaccharides
in
the
starches
to
reduce
the
long-chain
polysaccharides to the disaccharide maltose. Food is usually swallowed too
quickly for all of the starches to be reduced to disaccharides in the mouth.
However, salivary amylase in the swallowed food continues to act on starches
for another 15 to 30 minutes in the stomach before the stomach acids
eventually inactivate it.
DEGLUTITION:
Swallowing, or deglutition, is the mechanism that moves food from the mouth to
the stomach. It is facilitated by saliva and mucus and involves the mouth,
pharynx, and esophagus. Swallowing is conveniently divided into three stages:
(1) The voluntary stage of swallowing, in which the bolus is moved into the
oropharynx.
(2) The pharyngeal stage of swallowing, the involuntary passage of the bolus
through the pharynx into the esophagus.
(3) The esophageal stage of swallowing, the involuntary passage of the bolus
through the esophagus into the stomach.
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Swallowing starts when the bolus is forced to the back of the mouth cavity and
into the oropharynx by the movement of the tongue upward and backward against
the palate. This represents the voluntary stage of swallowing. With the passage of
the bolus into the oropharynx, the involuntary pharvnaeal stage of swallowing
begins.
The
respiratory
interrupted.
The
bolus
passageways
stimulates
close
receptors
and
in
breathing
the
is
temporarily
oropharynx,
which
send
impulses to the deglutition center in the medulla and lower pons of the brain
stem. The returning impulses cause the soft palate and uvula to move upward to
close off the nasopharynx, and the larynx is pulled forward and upward under the
tongue.
As
the
larynx
rises,
it
meets
the
epiglottis,
which
seals
of
the
glottis. The movement of the larynx also pulls the vocal cords together, further
sealing
off
the
respiratory
tract,
and
widens
the
opening
between
the
laryngopharynx and esophagus. The bolus passes through the laryngopharynx and
enters the esophagus in 1 to 2 seconds. The respiratory passageways then reopen
and breathing resumes.
ESOPHAGUS:
The esophagus, the third principal organ involved in deglutition, is a muscular,
collapsible tube that lies behind the trachea. It is about 23 to 25 cm (10
inches) long and begins at the end of the laryngopharynx, passes through the
mediastinium anterior to the vertebral column, pierces the diaphragm through an
opening called the esophageal hiatus, and terminates in the superior portion of
the stomach.
HISTOLOGY:
The mucosa of
the esophagus
is lined by
nonkeratinized stratified squamous
epithelium, lamina propria, and a muscularis mucosae. The submucosa contains
connective
tissue
and
blood
vessels.
The
muscularis
of
the
upper
third
is
striated, the middle third is striated and smooth, and the lower third is smooth.
The outer layer is known as the adventitia rather than the serosa because the
loose connective tissue of the layer is not covered by epithelium and because
the
connective
structures.
tissue
merges
with
the
connective
tissue
of
surrounding
THE DIGESTIVE SYSTEM
The
esophagus
does
not
produce
digestive
Page 105
enzymes
and
does
not
carry
on
absorption. It secretes mucus and transports food to the stomach. The passage of
food from the laryngopharynx into the esophagus is regulated by a sphincter at
the entrance to the esophagus called the upper esophageal sphincter.
During the esophageal stage of swallowing, food is pushed through the esophagus by
involuntary
smooth
muscular
movements
called
peristalsis.
Peristalsis
is
a
function of the muscularis and is controlled by the medulla. In the section of the
esophagus lying just above and around the top of the bolus, the circular muscle
fibers contract. The contraction constricts the esophageal wall and squeezes the
bolus downward. Meanwhile, longitudinal fibers lying around the bottom of and just
below the bolus also contract. Contraction of the longitudinal fibers shortens
this lower section, pushing its walls outward so it can receive the bolus. The
contracts are repeated in a wave that moves down the esophagus, pushing the food
toward the stomach. Passage of the bolus is further facilitated by glands secreting
mucus. The passage of solid or semisolid food from the mouth to the stomach takes 4
to 8 seconds. Very soft foods and liquids pass through in about 1 second.
Just above the level of the diaphragm, the esophagus is slightly narrowed. This
narrowing has been attributed to a physiological sphincter in the inferior part of
the esophagus known as the lower esophageal (gastroesophageal) sphincter. The
lower esophageal sphincter relaxes during swallowing and thus aids the passage of
the bolus from the esophagus into the stomach. If the lower esophageal sphincter
fails to relax normally as food approaches, the condition is called achalasia. If,
on the the other hand, the lower esophageal sphincter fails to close adequately
after food has entered the stomach, the stomach contents can enter the lower
esophagus. Hydrochloric acid from the stomach contents can irritate the esophageal
wall, resulting in a burning sensation. This sensation is known as heartburn
because it is experienced in the region over the heart although it is not related
to any cardiac problem.
EXHIBIT 24-1 DIGESTION IN THE MOUTH
STRUCTURE
Cheeks
Lips
ACTIVITY
RESULT
Keep food between teeth during mastication.
Foods uniformly
chewed
Keep food between teeth during mastication
Foods uniformly
chewed
STRUCTURE
Pharynx
Tongue
Extrinsic
Muscles
Intrinsic
Muscles
Taste Buds
Buccal glands
Salivary
Move tongue from
side to side and in
and out.
Alter shape of
tongue.
Serve as receptors for food stimulus.
Secrete saliva.
Secrete saliva.
glands
Food rnaneuvered for mastication, shaped into bolus, and maneuvered for deglutition.
Deglutition and
speech.
Secretion of saIiva stimulated by
nerve impulses from taste
buds to salivatory nuclei in
brain stem to salivary glands.
ACTIVITY
RESULT
Pharyngeal stage
of deglutition.
Moves bolus from
oropharynx to Iaryngopharynx
and
into esophagus;
closes air passageways.
Moves bolus from
laryngopharynx
into esophagus.
Relaxation of upper esophageal
sphincter.
Esophagus
Esophageal stage of
deglutition
(peristalsis).
Relaxation of lower
esophageal
sphincter. Secretion
of mucus.
Forces bolus down
esophagus.
Moves bolus into
stomach.
Lubricates esophagus
for smooth passage
of bolus.
Lining d mouth and pharynx moistened and lubricated.
Lining of mouth
and pharynx
moistened and lubricated. Saliva softens, moist-ens, and dissolves food, coats food with
mucin, cleanses mouth and teeth. Salivary amylase reduces polysaccharides to the
disaccharide maltose.
Teeth
Cut, tear, and pulverize food.
Solid foods reduced to smaller
particles for swallowing.
THE DIGESTIVE SYSTEM
Page 107
STOMACH:
The
stomach
is
a
J-shaped
enlargement
of
the
GI
tract
directly
under
the
diaphragm in the epigastric, umbilical, and left hypochondriac regions of the
abdomen. The superior portion of the stomach is a continuation of the esophagus.
The inferior portion empties into the duodenum, the first part of the small
intestine. The empty stomach is about the size of a large sausage but it can
stretch to accommodate large amounts of food.
ANATOMY:
The stomach is divided into four areas: cardia, fundus, body, and pylorus. The
cardia surrounds the lower esophageal sphincter. The rounded portion above and to
the left of the cardia is the fundus. Below the fundus is the large central
portion of the stomach, called the body. The narrow, inferior region is the
pylorus. The superior concave medial border of the stomach is called the lesser
curvature, and the inferior convex lateral border is the greater curvature. The
pylorus
communicates
with
the
duodenum
of
the
small
intestine
by
way
of
a
sphincter called the pyloric sphincter or pyloric valve.
Pylorospasm
is characterized by
opening
the
of
pyloric
failure
sphincter
to
of
relax
the
muscle fibers encircling the
normally.
Pyloric
stenosis
is
a
narrowing of the pyloric sphincter caused by a tumor-like mass that apparently is
formed by enlargement of the circular muscle fibers.
HISTOLOGY:
The stomach wall is composed of the same four basic layers as the rest of the
alimentary canal, with certain modifications. When the stomach is empty, the
mucosa lies in large folds, called rugae that can be seen with the naked eye.
Microscopic
inspection
epithelium containing
of
the
mucosa
many narrow
reveals
openings
that
a
layer
of
simple
extend down into
columnar
the
lamina
propria. These pits, known as gastric glands, are lined with several kinds of
THE DIGESTIVE SYSTEM
Page 108
secreting cells: zymogenic, parietal, mucous, and enteroendocrine. The zymogenic
(peptic)
cells
secrete
the
principal
gastric
enzyme
precursor,
pepsinogen.
Hydrochloric acid, involved in the conversion of pepsinogen to the active enzyme
pepsin, and intrinsic factor, involved in the absorption of vitamin B12 for red
blood cell production, are produced by the parietal (oxyntic) cells. The mucous,
cells, secrete mucus. Secretions of the zymogenic, parietal, and mucous cells are
collectively
called
gastric
juice.
The
enteroendocrine
cells
secrete
stomach
gastrin, a hormone that stimulates secretion of hydrochloric acid and pepsinogen,
contracts the lower esophageal sphincter, mildly increases motility of the GI
tract, and relaxes the pyloric sphincter and relaxes the ileocecal sphincter.
The submucosa of the stomach is composed of loose areolar connective tissue,
which connects the mucosa to the muscularis.
The muscularis, unlike that in other areas of the alimentary canal, has three
layers of smooth muscle, an outer longitudinal layer, a middle circular layer,
and an inner oblique layer. This arrangement of fibers allows the stomach to
contract in a variety of ways to churn food, break it into small particles, mix it
with gastric juice, and pass it to the duodenum.
The serosa covering the stomach is part of the visceral peritoneum. At the
lesser curvature, the two layers of the visceral peritoneum come together and
extend upward to the liver as the lesser omentum. At the greater curvature, the
visceral peritoneum continues downward as the greater omentum hanging over the
intestines.
DIGESTION IN THE STOMACH:
1. Mechanical - Several minutes after food enters the stomach, gentle, rippling,
peristaltic movements called mixing waves pass over the stomach every 15 to
25 seconds. These waves macerate food, mix it with the secretions of the
gastric glands, and reduce it into a thin liquid called chyme. Few mixing
waves are observed in the fundus, which is primarily a
THE DIGESTIVE SYSTEM
Page 109
storage area. Foods may remain in the fundus for an hour or more without
becoming
mixed
with
gastric
juice.
During
this
time
salivary
digestion
continues.
As digestion proceeds in the stomach, more vigorous mixing waves begin at the
body of the stomach and intensify as they reach the pylorus. The pyloric
sphincter normally remains almost but not completely closed. As food reaches the
pylorus, each mixing wave forces a small amount of the gastric contents into
the duodenum through the pyloric sphincter. Most of the food is forced back
into the body of the stomach where it is subjected to further mixing. The next
wave pushes it forward again and forces a little more into the duodenum. The
forward and backward movement of the gastric contents are responsible for
almost all of the mixing in the stomach.
2. Chemical - The principal chemical activity of the stomach is to begin the
digestion of proteins. In the adult, digestion is achieved primarily through
the enzyme pepsin. Pepsin breaks certain peptide bonds between the amino acids
making up proteins. Thus a protein chain of many amino acids is broken down
into smaller fragments called peptides. Pepsin is most effective in the very
acidic
environment
of
the
stomach
(pH
-
2.0).
It
becomes
inactive
in
an
alkaline environment.
What keeps pepsin from digesting the protein in stomach cells along with the food?
First, pepsin is secreted in an inactive form called pepsinogen, so it cannot
digest the proteins in the zymogenic cells that produce it. It is not converted
into active pepsin until it comes in contact with the hydrochloric acid secreted by
the parietal cells. Second, the stomach cells are protected by mucus, especially
after pepsin has been activated. The mucus coats the mucosa to form a barrier
between it and the gastric juices.
Another
enzyme
of
the
stomach
is
gastric
lipase.
Gastric
lipase
splits
the
butterfat molecules found in milk. This enzyme operates best at a pH of 5.0 to 6.0
and has a limited role in the adult stomach. Adults rely almost exclusively on an
enzyme secreted by the pancreas into the small intestine to digest fats.
THE DIGESTIVE SYSTEM
Page 110
The infant stomach also secretes rennin, which is important in the digestion
of milk. Rennin and calcium act on the casein of milk to produce a curd. The
coagulation prevents too rapid a passage of milk from the stomach. Rennin is
absent in the gastric secretions of adults.
EXHIBIT 24-3 SUMMARY OF GASTRIC D I G E S T I O N
STRUCTURE
ACTIVITY
Mucosa
Zymogenic (peptic) cells
Parietal (oxyntic) cells
RESULT
Secrete pepsinogen.
Precursor of pepsin is produced.
Secrete hydrochloric acid.
Secrete intrinsic factor.
Converts pepsinogen into pepsin, which digests proteins into peptides.
Required for absorption of vitamin B 12 and erythrocyte formation.
Mucous cells
Secrete mucus.
Enteroendocrine cells
Secrete stomach gastrin.
Stimulates gastric secretion, contracts lower esophageal sphincter,
increases motility of the stomach, and relaxes pyloric sphincter.
Mixing waves.
Macerate food, mix it with gastric juice, reduce food to chyme, and
force chyme through pyloric sphincter.
Muscularis
Pyloric sphincter (valve)
Prevents digestion of stomach wall.
Opens to permit passage of
chyme into duodenum.
Prevents backflow of food from duodenum to stomach.
Regulation of Gastric Secretion:
Stimulation:
The
secretion
of
gastric
juice
is
related
by
both
nervous
and
hormonal
mechanisms. Parasympathetic impulses from nuclei in the medulla are transmitted
via the vagus cranial nerves (X) and stimulate the gastric glands to secrete
pepsinogen, hydrochloric acid, mucus, and stomach gastrin. Stomach gastrin is
also secreted by gastric glands in response to certain foods that enter the
stomach.
Ceohalic _ (Reflex)Phase:
The
cephalic
(reflex)
phase of
gastric
secretions
occurs before food enters the stomach and prepares the stomach for digestion.
The
sight,
smell,
taste,
or
thought
of
food
initiates
this
reflex.
Nerve
impulses from the cerebral cortex or feeding center in the hypothalamus send
impulses to the medulla. The medulla relays impulses over the parasympathetic
fibers in the vagus (X) nerve to stimulate the gastric glands to secrete.
THE DIGESTIVE SYSTEM
Gastric Phase:
Page 111
Once the food reaches the stomach, both nervous and hormonal
mechanisms ensure that gastric secretion continues. This is the gastric phase of
secretion. Food of any kind causes distention and stimulates receptors in the
wall of the stomach. These receptors send impulses to the medulla and back to the
gastric glands, and they may send messages to the glands as well. The impulses
stimulate the flow of gastric juice. Emotions such as anger, fear, and anxiety
may slow down digestion in the stomach because they stimulate the sympathetic
nervous system, which inhibits the impulses of the parasympathetic fibers.
Protein foods and alcohol stimulate the pyloric mucosa to secrete the hormone
stomach gastrin. It is absorbed into the bloodstream, circulated through the
body,
and
finally
reaches
its
target
cells,
the
gastric
glands,
where
it
stimulates secretion of large amounts of gastric juice. It also contracts the
lower esophageal sphincter, increases motility of the GI tract, and relaxes the
pyloric sphincter and ileocecal sphincter.
Intestinal
Phase:
Some
investigators
believe
that
when
partially
digested
proteins leave the stomach and enter the duodenum, they stimulate the duodenal
mucosa to release enteric gastrin, a hormone that stimulates the gastric glands
to continue their secretion. This constitutes the intestinal phase of secretion.
However, this mechanism produces relatively small amounts of gastric juice.
Inhibition
Even though chyme stimulates gastric secretion during the gastric phase, it can
inhibit secretion during the intestinal phase. For example, the presence of food in
the small intestine during the intestinal phase initiates an enterogastric reflex
in which nerve impulses carried to the medulla from the duodenum return to the
stomach
and
inhibit
parasympathetic
gastric
stimulation
and
secretion.
stimulate
These
impulses
sympathetic
ultimately
activity.
inhibit
Stimuli
that
initiate this reflex are distention of the duodenum, the presence of acid or
partially
digested
duodenal mucosa.
proteins
in
food
in
the
duodenum,
or
irritation
of
the
Page 112
THE DIGESTIVE SYSTEM
Several intestinal hormones also inhibit gastric secretion. In the presence of
acid,
partially
irritating
digested
substances
proteins,
in
chyme,
fats,
the
hypertonic
intestinal
or
hypotonic
mucosa
fluids,
releases
or
secretin,
cholecystokinin (CCK), and gastric inhibiting peptide (GIP). All three hormones
inhibit gastric secretion and decrease motility of the GI tract. Secretin and
cholecystokinin are also important in the control of pancreatic and intestinal
secretion, and cholecystokinin also helps regulate secretion of bile from the
gallbladder.
Regulation of Gastric Emptying:
Gastric
emptying
is
stimulated
by
tow
principal
factors:
nerve
impulses
in
response to distension, and stomach gastrin released in the presence of certain
types
of
foods.
During
the
gastric
phase
of
secretion,
distension
and-the
presence of partially digested proteins and alcohol stimulate secretion of gastric
juice and stomach gastrin. In the presence of stomach gastrin, the lower esophageal
sphincter
contracts,
the
motility
of
the
stomach
increases,
and
the
pyloric
sphincter relaxes. The net effect of these actions is stomach emptying.
The stomach empties all of its contents into the duodenum within 2 to 6 hours
after ingestion. Foods rich in carbohydrate spend the least time in the stomach.
Protein
focds
are
somewhat
slower,
and
emptying
is
slowest
after
a
meal
containing large amounts of fat.
Stomach emptying is inhibited by the enterogastric reflex and hormones released in
response
to
inhibits
gastric
secretin,
inhibit
certain
constituents
secretion,
cholecystokinin
gastric
secretion
it
chyme.
also
(CCK),
and
in
and
inhibit
The
inhibits
enterogastric
gastric
reflex
motility.
gastric
inhibiting
gastric
motility.
The
peptide
The
rate
not
hormones
(GIP)
of
only
also
stomach
emptying is limited to the amount of chyme that the small intestine can process.
Excessive gastric emptying in the wrong direction sometimes occurs. Vomiting is
the
forcible
expulsion
of
the
contents
of
the
upper
GI tract
(stomach
sometimes duodenum) through the mouth. The strongest stimuli for vomiting are
and
Page 113
THE DIGESTIVE SYSTEM
irritation and distension of the stomach. Basically vomiting involves squeezing
the stomach between the diaphragm and abdominal muscles and expelling of the
contents through open esophageal sphincters.
Absorption:
The stomach wall is permeable to the passage of most materials into the blood, so
most substances are not absorbed until they reach the small intestine. However,
the
stomach
does
participate
in
the
absorption
of
some
water,
electrolytes,
certain drugs (especially aspirin), and alcohol.
PANCREAS:
The next organ of the GI tract involved in the breakdown of food is the small
intestine. Chemical digestion in the small intestine depends not only on its own
secretions but also on activities of three accessory structures of digestion
outside the alimentary canal: the pancreas, liver, and gallbladder.
Anatomy:
The pancreas is a soft, oblong tubuloacinar gland about 12.5 cm (6 inches) long and
2.5 cm (1 inch) thick. It lies posterior to the greater curvature of the stomach
and is connected by a duct (usually two) to the duodenum. The pancreas is divided
into a head, body, and tail. The head is the expanded portion near the C-shaped
curve of the duodenum. Moving superiorly and to the left of the head are the
centrally located body and the terminal tapering tail.
The pancreas is linked to the small intestine usually by two ducts. Pancreatic
secretions pass from the secreting cells in the pancreas to small ducts that
unite to form the two ducts that convey the secretions into the small intestine.
The large of the two ducts is called the pancreatic duct (duct of Wirsung). In
most people the pancreatic duct unites with the common bile duct from the liver
and
gallbladder
and
enters
the
duodenum
in
a
common
duct,
called
the
hepatopancreatic ampulla (ampulla of Vater). The ampulla opens on an elevation of
the duodenal mucosa known as the duodenal papilla, about 10 cm (4 inches)
THE DIGESTIVE SYSTEM
Page 114
below the pylorus of the stomach. The smaller of the two ducts is the accessory
duct (duct of Santorini), which leads from the pancreas and empties into the
duodenum about 2.5 cm. (1 inch) above the ampulla of Vater.
Histology:
The pancreas is made up of small clusters of glandular epithelial cells. About 1%
of the cells, the pancreatic islets _ (islets of
Langherhans),
form
the
endocrine portion of the pancreas and consist of alpha, beta, and delta cells
that secrete hormones (glucagon, insulin, and somatostatin, respectively). The
remaining
99%
of
the
cells
called
acini
are
the
exocrine
portions
of
the
pancreas. Secreting cells of the acini release a mixture of digestive enzymes
called pancreatic juice.
Pancreatic Juice:
Each day the pancreas produces 1,200 to 1,500 ml (about 1.2 to 1.5 qt) of
pancreatic juice, a clear, colorless liquid. It consists mostly of water, some
salts, sodium bicarbonate, and enzymes. The sodium bicarbonate gives pancreatic
juice a slightly alkaline pH (7.1 to 8.2) that stops the action of pepsin from
the stomach and creates the proper environment for the enzymes in the small
intestine.
enzyme
trypsin,
The
called
enzymes
in
pancreatic
chymotrypsin,
pancreatic
amylase;
and
juice
several
include
a
carbohydrate-digesting
protein-digesting
carboxypolypeptidase;
the
enzymes
principal
called
fat-digesting
enzyme in the adult body called pancreatic lipase; and nucleic acid-digesting
enzymes called ribonuclease and deoxyribonuclease.
Just
as
pepsin
pepsinogen,
so
is
too
produced
are
the
in
the
stomach
protein-digesting
in
an
enzymes
inactive
of
the
form
known
pancreas.
as
This
prevents the enzymes from digesting cells of the pancreas. The active enzyme
trypsin is secreted in an inactive form called trypsinogen. Its activation to
trypsin is accomplished in the small intestine by an enzyme secreted by the
intestinal mucosa when the chyme comes in contact with the mucosa. The
Page 115
THE DIGESTIVE SYSTEM
a c t i v a t i n g enzyme is called enterokinase. Chymotrypsin is activated in
the
small
intestine
chymotrypsinogen.
small
intestine
by
trypsin
from
its
is
also
Carboxypolypeptidase
by
trypsin.
Its
inactive
form,
activated
inactive
form
in
is
t he
called
procarboxypolypeptidase.
Regulation of Pancreatic Secretions:
Pancreatic
secretion,
like
gastric
secretion,
is
regulated
by
both
nervous and hormonal mechanisms. When the cephalic and gastric phases
of gastric secretion occur, parasympathetic impulses are simultaneously
transmitted along the vagus (X) nerves to the pancreas that result in
the secretion of pancreatic enzymes.
In
response
to
chyme
contains
partially
fluids,
or
in
the
digested
irritating
small
intestine,
proteins,
fats,
substances,
the
especially
hypertonic
small
chyme
or
that
hypotonic
intestinal
mucosa
secretes secretin and cholecystokinin (CCK), two hormones that a f f e c t
pancreatic
secretion.
pancreatic
juice
Cholecystokinin
Secretin
that
(CCK)
is
stimulates
rich
stimulates
in
a
the
pancreas
sodium
to
secrete
bicarbonate
pancreatic
secretion
ions.
rich
in
d i g e s t i v e enzymes.
LIVER:
The l i v e r weights about 1.4 kg (about 3 lb) in the average adult. I t
is
located
under
the
diaphragm
and
occupies
most
of
the
right
and
completely
hypochondrium and part of the epigastrium of the abdomen .
Anatomy:
The
liver
covered
is
by
a
peritoneum. I t
the
left
the
right
almost
completely
covered
dense
connective
tissue
peritoneum
layer
that
lies
beneath
the
is divided into to principal lobes --the right lobe and
lobe--separated
lobe
by
are
the
by
the
inferior
falciform
quadrate
ligament.
lobe
and
lobe. The falciform ligament is a r e f l e c t i o n of the
Associated
posterior
with
caudate
THE DIGESTIVE SYSTEM
Page 116
parietal peritoneum, which extends from the undersurface of the diaphragm to the
superior surface of the l i v e r , between the two principal lobes of the liver.
In the free border of the falciform ligament is the ligamentum teres also known as
the (round ligament). It extends from the liver to the umbilicus. The ligamentum
teres is a fibrous cord derived from the umbilical vein of the fetus.
Bile, one of the liver's products, enters bile capillaries or c a n a l i c u l i that
empty into small ducts. These small ducts eventually merge to form the larger right
and l e f t
hepatic ducts, which unite to leave the
liver to become the common
hepatic duct. Further on, the common hepatic duct joins the cystic duct from
the gallbladder. The two tubes become the common bile duct. The common b i l e
duct and pancreatic duct enter the duodenum i n
a
common
duct c a l l e d
the
hepatopancreatic ampulla (ampulla of Vater).
Histology:
The lobes of the liver are made up of numerous functional units called lobules,
which may be seen under a microscope. A lobule consists of cords of hepatic
(liver) cells arranged in a radial pattern around a c e n t r a l v e i n . Between the
cords are endothelial-lined spaces called sinusoids, through which blood passes,
The sinusoids are also partly lined with phagocytic c e l l s , termed s t e l l a t e
reticuloendothelial or (Kupffer's) cells,
blood
cells
and
bacteria.
The
liver
that destroy wornout white and red
contains
sinusoids
instead
of
typical
capillaries.
Blood Supply:
The liver receives a double supply of blood. From the hepatic artery it obtains
oxygenated blood, and from the hepatic portal vein it receives deoxygenated blood
containing newly absorbed nutrients. Branches of both the hepatic artery and the
hepatic portal vein carry the blood into the sinusoids of the lobules, where
o x y g e n , m o s t o f t h e nutrients and certain poisons are extracted by the hepatic
cells. Nutrients are stored are used to ;Hake new materials. The poisons
THE DIGESTIVE SYSTEM
Page 117
are stored or detoxified. Products manufactured by the hepatic cells and nutrients
needed by other cells are secreted back into the blood. The blood then drains into
the central vein and eventually passes into a hepatic vein. Unlike the other
products of the liver, bile normally is not secreted into the bloodstream.
Bile:
Each day the hepatic cells secrete 800 to 1,000 ml (about 1 qt) of bile, a
yellow, brownish, or olive-green liquid. It has a pH of 7.6 to 8.6. Bile consists
mostly of water and bile salts, cholesterol, a phospholipid called lecithin, bile
pigments, and several ions.
Bile is partially an excretory product and partially a digestive secretion. Bile
salts assume a role in emulsification, the breakdown of fat globules into a
suspension of very tiny fat droplets and absorption of fats following their
digestion. Cholesterol is made soluble in bile by bile salts and lecithin. The
principal bile pigment is bilirubin. When red blood cells are broken down, iron,
globin, and bilirubin are released. The iron and globin are recycled, but some of
the bilirubin is excreted into the bile ducts. Bilirubin is eventually broken down
in the intestine, and one of its breakdown products, known as urobilinogen, gives
feces their color.
If insufficient bile salts or lecithin are present in bile, or if there is
excessive
cholesterol,
the
cholesterol
precipitates
out
of
solution
and
crystalizes to form gallstones (biliary calculi). If the liver is unable to
remove bilirubin from the blood because of increased destruction of red blood
cells or obstruction of bile ducts, large amounts of bilirubin circulate through
the bloodstream and collect in other tissues, giving the skin and eyes a yellow
color. This condition is called jaundice. If the jaundice is due to damaged red
blood cells, it is called hemolytic Jaundice; if it is due to obstruction in the
biliary system, it is known as obstructive jaundice. Since the liver of the
newborn functions poorly for the first week or so, large amounts of bilirubin are
excreted into blood instead of being incorporated into bile in the liver. The
result is a type of jaundice called neonatal (physiological) jaundice.
THE DIGESTIVE SYSTEM
Page
118
Regulation of Bile Secretion:
The rate at which bile is secreted is determined by several factors. Va t-,al
stimulation can increase the production of bile to more than twice the normal
rate. Secretin, the hormone that stimulates the synthesis of pancreatic juice
rich in sodium bicarbonate, also stimulates the secretion of bile. Within limits,
as
blood
flow
through
the
liver
increases,
so
does
the
secretion
of
bile.
Finally, the presence of large amounts of bile sales in the blood also increases
the rate of bile production.
Functions of the Liver:
The liver performs many vital functions. Among these are the following:
1.
The liver manufactures bile salts which are used in the small intestine for
the emulsification and absorption of fats, cholesterol, phospholipids, and
lipoproteins.
2.
The liver, together with mast cells, manufactures the anticoagulant heparin
and most of the other plasma proteins, such as prothrombin, fibrinogen, and
albumin.
3.
The stellate reticuloendothelial (Kupffer's) cells of the liver phagocytize
worn-out red and white blood cells and some bacteria.
4.
Liver cells contain enzymes that either break down poisons or transform them
into less harmful compounds. When amino acids are burned for energy, for
example, they leave behind toxic nitrogenous wastes (such as ammonia) that
are converted to urea by the liver cells. Moderate amounts of urea are
harmless to the body and are easily excreted by the kidneys and sweat glands.
5.
Newly absorbed nutrients are collected in the liver. Depending on the body's
needs, it can change any excess monosaccharides into glycogen or fat, both of
which can be store, or it can transform glycogen, fat, and protein into
glucose.
6.
The liver stores glycogen, copper, iron, and vitamins A, B12, D, E, and K.
It also stores some poisons that cannot be broken down and excreted. High
levels of DDT are found in the livers of animals, including humans, who eat
sprayed fruits and vegetables.)
7. The liver and kidneys participate in the activation of vitamin D.
The hepatic triad or portal triad refers to the hepatic portal vein,
hepatic artery, and bile duct.
Page 119
THE DIGESTIVE SYSTEM
GALLBLADDER:
The gallbladder is a pear-shaped sac about 7 to 10 cm (3 to 4 inches) long. It
is located in a fossa of the visceral surface of the liver.
Histology:
The inner wall of the gallbladder consists of a mucous membrane arranged in
rugaa resembling those of the stomach. The middle, muscular coat of the wall
consists
of
smooth
muscle
fibers.
Contraction
of
these
fibers
by
hormonal
stimulation ejects the contents of the gallbladder into the cystic duct. The
outer coat is the visceral peritoneum.
Function:
The function of the gallbladder is to store and concentrate bile (up to 10-fold)
until it is needed in the small intestine. In the concentration process, water
and many ions are absorbed by the gallbladder mucosa. Bile from the liver enters
the small intestine through the common bile duct. When the small intestine is
empty, a valve around the hepatopancreatic ampulla (ampulla of Vater) called the
sphincter of the hepatopancreatic ampulla or sphincter of Oddi, closes, and the
backed-up bile overflows into the cystic duct to the gallbladder for storage.
Emptying of the Gallbladder:
In
order
for
the
gallbladder
to
eject
bile
into
the
small
intestine
to
participate in the digestive process, the muscularis must contract to force bile
into the common bile duct and the sphincter of the hepatopancreatic ampulla must
relax.
Chyme
entering
the
duodenum
that
contains
particularly
high
concentrations of fats or partially digested proteins stimulates the intestinal
mucosa to secrete cholecystokinin (CCK). This hormone brings about contraction
of
the
muscularis
coupled
with
relaxation
of
the
sphincter
hepatopancreatic ampulla, resulting in emptying of the gallbladder.
of
the
THE DIGESTIVE SYSTEM
Page 120
SMALL INTESTINE:
The major portions of digestion and absorption occur in a long tube called the
small
intestine.
The
small
intestine
begins
at
the
pyloric
sphincter
of
the
stomach, coils through the central and lower part of the abdominal cavity, and
eventually opens into the large intestine. It averages 2.5 cm (1 inch) in diameter
and about 6.35 m (21 feet) in length.
Anatomy:
The small intestine is divided into three segments. The duodenum, the shortest
part, originates at the pyloric sphincter of the stomach and extends about 25 cm
(10 inches) until it merges with the jejunum. The jeiunum is about 2.5 m (8 ft)
long and extends to ileum. The final portion of the small intestine, the ileum,
measures about 3.6 m (12 ft) and joins the large intestine at the ileocecal
sphincter or ileocecal valve.
Histology:
The wall of the small intestine is composed of the same four tunics that make up
most of the GI tract. However, both the mucosa and the submucosa are modified to
allow the small intestine to complete the process of digestion and absorption.
The
mucosa
of
the
small
intestines
epithelium. These pits known as the
contains
many
pits
lined
with
glandular
intestinal glands (crypts of Lieberkuhn)
secrete intestinal juice. The submucosa of the duodenum contains duodenal glands
known as Brunner's glands, which secrete an alkaline mucus to protect the wall of
the small intestine from the action of the enzymes and to aid in neutralizing acid
in the chyme. Some of the epithelial cells in the mucosa and submucosa have been
transformed to goblet cells, which secrete additional mucus.
Since almost all the absorption of nutrients occurs in the small intestine, its
structure is specially adapted for this function. Its length alone provides a
THE DIGESTIVE SYSTEM
large
surface
area
for
absorption
and
that
Page 121
area
is
further
increased
by
modification in the structure of its wall. The epithelium covering and lining the
mucosa consists of simple columnar epithelium. These epithelial cells, except
those transformed into goblet cells, contain microvilli, fingerlike projections
of the plasma membrane. Larger amounts of digested nutrients diffuse into the
intestinal wall because the microvilli increase the surface are of the plasma
membrane. They also increase the surface area for digestion.
The mucosa lies in a series of villi, projections 0.5 to 1 mm high, giving the
intestinal mucosa its velvety appearance. The enormous number of villi (10-40 per
square millimeter) vastly increases the surface area of the epithelium available
for absorption and digestion. Each villus has a core of lamina
propria, the
connective tissue layer of the mucosa. Embedded in this connective tissue are an
arteriole, a venule, a capillary network, and a lacteal, or lymphatic vessel.
Nutrients that diffuse through the epithelial cells that cover the villus are able
to pass through the capillary walls and the lacteal and enter the cardiovascular
and lymphatic systems.
In addition to the microvilli and villi, a third set of projections called plicae
circulares or circular folds, further increases the surface area for absorption
and digestion of nutrients. The plicae are permanent ridges, about 10 mm (0.4
inch) high, in the mucosa. The plicae circulares enhance absorption by causing
the chyme to spiral rather than to move in a straight line as it passes through the
small intestine. Since the plicae circulares and villi decrease in size in the
distal ileum, most absorption occurs in the duodenum and jejunum.
The muscularis of the small intestine consists of two layers of smooth muscle.
There is an abundance of lymphatic tissue in the form of lymphatic nodules,
masses of lymphatic tissue not covered by a capsule wall. Solitary lymphatic
nodules are most numerous in the lower part of the ileum. Groups of lymphatic
nodules, referred to as aggregated lymphatic follicles or Peyer's patches, are
numerous in the ileum of the small intestine.
THE DIGESTIVE SYSTEM
Page 122
Intestinal Juice:
Intestinal juice is a clear yellow fluid secreted in amounts of about 2 to 3
liters (about 2 to 3 qt) a day. It has a pH of 7.6, which is slightly alkaline,
and contains water and mucus. The juice is rapidly reabsorbed by the villi and
provides a vehicle for the absorption of substances from chyme as they come in
contact with the villi. Most digestion by enzymes of the small intestine occurs
within the cells on the surfaces of their microvilli. Most digestion by enzymes of
the small intestine occurs in or on the epithelial cells that line the villi,
rather than in the lumen, as in other parts of the gastrointestinal tract. Among
the enzymes produced by small intestinal cells are three carbohydrate-digesting
enzymes called maltase, sucrase, and lactase; several protein-digesting enzymes
called
peptidases;
and
two
nucleic
acid-digesting
enzymes,
ribonuclease
and
deoxyribonuclease.
Digestion in the Small Intestine:
1. Mechanical Digestion:
The movements of the small intestine are arbitrarily divided into two types:
segmentation and peristalsis. Segmentation is the major movement of the small
intestine. It is strictly a localized contraction in areas containing food.
It mixes chyme with the digestive juices and brings the particles of food
into contact with the mucosa for absorption. It does not push the intestinal
contents along the GI tract. The segmentation sequence of events is repeated
12 to 16 times a minute sloshing the chyme back and forth. Segmentation
depends
mainly
on
intestinal
distension
which
initiates
impulses
to
the
central nervous system. Returning parasympathetic impulses increase motility.
Sympathetic impulses decrease intestinal motility as distension decreases.
Peristalsis propels the chyme onward through the intestinal tract.
Peristaltic contractions in the small intestine are normally very weak
THE DIGESTIVE SYSTEM
Page 123
compared to those in the esophagus or stomach. Chyme moves through the small
intestine at a rate of about 1 cm/min. Thus, chyme remains in the small
intestine for 3 to 5 hours. Peristalsis, like segmentation, is initiated by
distension and controlled by the autonomic nervous system.
2. Chemical Digestion:
In the mouth salivary amylase converts starch, or polysaccharide, to maltose (a
disaccharide).
In
the
stomach,
pepsin
converts
proteins
to
peptides
(small
proteins). Thus, chyme entering the small intestine contains partially digested
carbohydrates,
partially
completion
the
of
proteins,
digestion
of
and
essentially
carbohydrates,
undigested
proteins,
and
lipids.
lipids
The
is
a
collective effort of pancreatic juice, bile, and intestinal juice in the small
intestine.
Carbohydrates: E v e n though the action of salivary amylase may continue in the
stomach for some time, its activity is blocked by the acidic pH of the stomach.
Thus, few starches are reduced to maltose by the time chyme leaves the stomach. Any
starches not already broken down into the disaccharide are converted by pancreatic
amylase, an enzyme in pancreatic juice that acts in the small intestine.
Sucrose and lactose, two disaccharides, are ingested as such and are not acted
upon until they reach the small intestine. Three enzymes in the intestinal juice
digest the disaccharides into monosaccharides. Maltase splits maltose into two
molecules of glucose. Sucrase breaks sucrose into a molecule of glucose and a
molecule of fructose. Lactase digests lactose into a molecule of glucose and a
molecule of galactose. This completes the digestion of carbohydrates.
In some individuals the mucosal cells of the small intestine fail to produce
lactase, which is essential for the digestion of lactose. This condition is
called lactose _ intolerance. Its symptoms include diarrhea, gas, bloating,
and abdominal cramps following consumption of milk and other dairy products.
THE DIGESTIVE SYSTEM
Proteins:
Protein
digestion
starts
in
Page 124
the
stomach,
where
proteins
are
fragmented by the action of pepsin into peptides. Enzymes found in pancreatic
juice continue the digestion. Trypsin and chymotrypsin continue to break down
proteins
into
peptides.
Although
pepsin,
trypsin,
and
chymotrypsin
all
convert whole proteins into peptides, their actions differ somewhat since each
splits peptide bonds between different amino acids. carboxypolypeptidase acts
on peptides and breaks the peptide bond that attaches the terminal amino acid
to the carboxyl or acid end of the peptide. Protein digestion is completed by
the peptidases. Aminopeptidase acts on peptides and breaks the peptide bonds
that attach amino acids to the amino end of the peptide. Dipeptidase splits
dipeptides, which are two amino acids joined by a peptide bond, into amino
acids that can be absorbed.
Lipids: In an adult, almost lipid digestion occurs in the small intestine.
The
first
step
in
the
process
involves
the
preparation
of
neutral
fats
(triglycerides) by bile salts. Neutral fats, or just simply fats, are the
most abundant lipids in the diet. They are called triglycerides because they
consist of a molecule of glycerol and three molecules of fatty acid. Bile
salts break the globules of fat into very small droplets. This process is
called emulsification. It is necessary so that the fat-splitting enzyme can
get at the lipid molecules. In the second step, pancreatic lipase, an enzyme
found in pancreatic juice, hydrolyzes each fat molecule into fatty acids and
monoglycerides, end products of fat digestion. Lipase removes two of the
three fatty acids from glycerol; the third remains attached to the glycerol,
thus forming monoglycerides.
Nucleic Acids: Both intestinal juice and pancreatic juice contain nucleases,
that digest nucleotides into their constituent pentoses and nitrogen bases.
ribonuclease acts on ribonucleic acid nucleotides, and deoxyribonuclease acts
on deoxyribonucleic acid nucleotides.
Regulation of Intestinal Secretion:
The
most important
means for
regulating
small
intestinal secretion
is local
reflexes in response to the presence of chyme. Also, secretin and cholecystokinin
(CCK) stimulate the production of intestinal juice.
THE DIGESTIVE SYSTEM
Page 125
Absorption:
All the chemical and mechanical phases of digestion from the mouth down through the
small intestine are directed toward changing food into forms that can pass through
the epithelial cells lining the mucosa into the underlying blood and lymph vessels.
These forms are monosaccharides (glucose, fructose, and galactose), amino acids,
fatty acids, glycerol, and glycerides. Passage of these digestive nutrients from the
alimentary canal into the blood or lymph is called absorption.
About 90% of all absorption of nutrients takes place throughout the length of the
small intestine. The other 10% occurs in the stomach and large intestine. Any
undigested or unabsorbed material left in the small intestine is passed on to the
large intestine. Absorption of materials in the small intestine occurs specifically
through the villi and depends on diffusion, facilitated diffusion, osmosis, and
active transport.
Carbohydrates:
Essentially
all
carbohydrates
are
absorbed
as
monosaccharides.
Glucose
and
galactose are transported into epithelial cells of the villi by an active process
that is coupled with the active transport of sodium. Fructose is transported by
facilitated diffusion. Transported monosaccharides then move out of the epithelial
cells by diffusion and enter the capillaries of the villi. From here they are
transported in the bloodstream to the liver via the hepatic portal system. After
their passage through the liver, they move through the heart and then enter the
general circulation.
Proteins:
Most proteins are absorbed as amino acids, and the process occurs mostly in the
duodenum and jejunum. Amino acid transport into epithelial cells of the villi is an
active transport process also coupled with active sodium transport. Amino acids
move out of the epithelial cells by diffusion to enter the bloodstream. The follow
the same route as that taken by monosaccharides.
THE DIGESTIVE SYSTEM
Page 126
Lipids:
As a result of emulsification and fat digestion, neutral fats, or triglycerides) are
broken down into monoglycerides and fatty acids. Lipase removes two of three fatty
acids from glycerol during fat digestion. The other fatty acid remains attached to
glycerol thus forming monoglycerides. Short-chain fatty acids, those with less than
10 to 12 carbon atoms, pass into the epithelia cells by diffusion and follow the
same route taken by monosaccharides and amino acids.
Most fatty acids are long-chain fatty acids. They and the monoglycerides are
transported differently. Bile salts form spherical aggregates called micelles.
They are are about 2.5 namometers in diameter and consist of 20 to 50 molecules of
bile salt. Despite their relatively large size, micelles have the ability to
dissolve in water in the intestinal fluid. During fat digestion, fatty acids and
monoglycerides dissolve in the center of the micelles, and it is in this form
that they reach the epithelial cells of the villi. On coming into contact with
the surfaces of the epithelial cells, fatty acids and monoglycerides diffuse into
the cells, leaving the micelles behind in chyme. The micelles continually repeat
this ferrying function. The majority of bile salts in the small intestine are
ultimately reabsorbed in the ileum to be returned by the blood to the liver for
resecretion. This cycle is called enterohepatic circulation. Insufficient bile
salts, due to obstruction of the biliary ducts or removal of the gallbladder, can
result
in
the
loss
of
up
to
40%
of
lipids
in
feces
due
to
improper
lipid
absorption. Also, when lipids are not absorbed properly, the fat-soluble vitamins
(A, D, E, K) are not adequately absorbed.
Within the epithelial cells, many monoglycerides are further digested by lipase in
the cells to glycerol and fatty acids. Then the fatty acids and glycerol are
recombined to form triglycerides in the smooth endoplasmic reticulum of the
epithelial
cell.
aggregate into
The
globules
triglycerides,
along
still
in
with phospholipids
the
endoplasmic
and cholesterol
reticulum,
and
become
coated with proteins. These masses are called chylomicrons. The protein coat
keeps the chylomicrons suspended and from sticking to each other. The
THE DIGESTIVE SYSTEM
Page 127
chylomicrons leave the epithelial cells and enter the lacteal of a villus. From
here, they are transported by way of lymphatic vessels to the thoracic duct and
enter the cardiovascular system at the left subciavian vein. Finally they arrive at
the liver through the hepatic artery.
Water:
The total volume of fluid that enters the small intestine each day is about 9
liters (±9 qt). This fluid is derived from ingestion of liquids (about 1.5
liters) and from various gastrointestinal secretions (about 7.5 liters). Roughly 8
to 8.5 liters of the fluid in the small intestine is absorbed; the remainder,
about 0.5 to 1.0 liter, passes into the large intestine. There most of it is also
absorbed.
The absorption of water by the small intestine occurs by osmosis from the lumen of
the small intestine through epithelial cells and into the blood capillaries in
the villi. The normal rate of absorption is about 200 to 400 ml/hour. Water can
move across the intestinal mucosa in both directions. The absorption of water
from the small intestine is associated with the absorption of electrolytes and
digested foods in order to maintain an osmotic balance with the blood.
Electrolytes:
The
electrolytes absorbed by
gastrointestinal
secretions.
the small
Some
are
intestine are mostly constituents
also
components
of
ingested
foods
of
and
liquids. Sodium is able to move in and out of epithelial cells by diffusion. It
can also move into mucosal cells by active transport for removal from the small
intestine. Chloride, iodide, and nitrate ions can passively follow sodium ions or
be actively transported. Calcium ions are also actively transported, and their
movement depends on parathyroid hormone, also known as parathormone and vitamin
D. Other electrolytes such as iron, potassium, magnesium, and phosphate can also
move by active transport.
THE DIGESTIVE SYSTEM
Page 128
Vitamins:
Fat-soluble vitamins, such as A , D, E, and K are absorbed along with ingested
dietary fats in micelles. In fact, they cannot be absorbed unless they are
ingested with some fat. Most water-soluble vitamins, such as the B vitamins and
C are absorbed by diffusion. Vitamin B12 requires combination with intrinsic
factor produced by the stomPch for its absorption.
EXHIBIT 24-6 ` SUMMARY OF DIGESTION AND ABSORPTION IN THE SMALL INTESTINE
STRUCTURE
ACTIVITY
Pancreas
Liver
Delivers pancreatic juice into the duodenum via the pancreatic duct (see Exhibit 24-5 for pancreatic enzymes
and their functions).
Produces bile which is necessary for emulsification of fats.
Gall Bladder
Stores, concentrates, and delivers bile into the duodenum via the common bile duct. Secrete
Small Intestines
Mucosa and submucosa
Intestinal Glands
.
Secrete intestinal juice (see Exhibit 24 5 for intestinal enzymes and their functions).
Duodenal (Brunner’s glands) Secrete mucus for protection and lubrication.
Microvilli
Fingerlike projections of epithelial cells that increase surface area for absorption and digestion.
Villi
Projections of mucosa that are the sites of absorption of digested food and also increase the surface area
for absorption and digestion.
Plicae circulars
Muscularis
Segmentation
Peristalsis
Circular folds of mucosa and submucosa that increase surface area for absorption and digestion.
Consists of alternating contractions of circular fibers that produce segmentation and resegmentation of
portions of the small intestine; mixes chyme with digestive juices and brings food into contact with the mucosa for
absorption.
Consists of mild waves of contraction and relaxation of circular and longitudinal muscle passing the length
of the small intestine; moves chyme toward ileocecal valve.
LARGE INTESTINE:
The overall functions of the large intestine are the completion of absorption,
the manufacture of certain vitamins, the formation of feces, and the expulsion
of feces from the body.
T H E D IG E S T I V E SYSTEM
Page 129
Anatomy:
The la r g e intestine is about 1.5 m (5 ft) in length and averages 6.5 cm (2.5
inches) in diameter. It extends from the ileum to the anus and is attached to the
posterior abdominal wall by its mesocolon of visceral peritoneum. Structurally,
the large intestine is divided into four principal regions: cecum, colon, rectum,
and anal canal.
The opening from the ileum into the large intestine is guarded by a fold of
mucous membrane called the ileocecal sphincter or ileocecal valve. This structure
allows
materials
from
the
small
intestine
to
pass
into
the
large
intestine.
Hanging below the ileocecal valve is the cecum, a blind pouch about 6 cm (2.5
inches) long. Attached to the cecum is a twisted, coiled tube, measuring about 8 cm
(3 inches) in length, called the vermiform appendix. The visceral peritoneum of
the appendix, called the mesoappendix, attaches the appendix to the inferior part
of the ileum and adjacent part of the posterior abdominal wall.
The open end of the cecum merges with a long tube called the colon. The colon is
divided
ascending
into
ascending,
colon
ascends
transverse,
on
the
descending,
right
side
of
and
the
sigmoid
abdomen,
portions.
The
reaches
the
undersurface of the liver, and turns abruptly to the left. Here it forms the
right colic flexure, also known as the
hepatic flexure. The colon continues
across the abdomen to the left side as the transverse colon. It curves beneath
the lower end of the spleen on the left side as the left colic flexure or splenic
flexure and passes downward to the level of the iliac crest as the descending
colon. The sigmoid colon begins at the left iliac crest, projects inward to the
midline, and terminates as the rectum at about the level of the third sacral
vetebra.
The rectum, the last 20 cm (8 inches) of the GI tract, lies anterior to the
sacrum and coccyx. The terminal 2 to 3 cm (1 inch) of the rectum is called the
anal canal. The mucous membrane of the anal canal is arranged in longitudinal
THE DIGESTIVE SYSTEM
folds
called
anal
columns,
or
columns
of
Morgagni
Page 130
that
contain
a
network
of
artaries and veins. The opening of the anal canal to the exterior is called the
anus. It is guarded by an internal sphincter of smooth muscle which is involuntary
and an external sphincter of skeletal muscle which is voluntary. Normally the anus
is closed except during the elimination of the wastes of digestion. The medical
specialty that deals with the diagnosis and treatment of disorders of the rectum
and anus is called proctologv.
Varacosities in any veins involve inflammation and enlargement. Varacosities of the
rectal veins are known as hemorrhoids or piles.
Histology:
The wall of the large intestine differs from that of the small intestine in several
respects. No villi or permanent circular folds are found in the mucosa, which does,
however,
contain
simple
columnar
epithelium
with
numerous
goblet
cells.
The
columnar cells function primarily in water absorption. The goblet cells secrete
mucus that lubricates the colonic contents as they pass through the colon. Both
columnar and mucous cells are located in long, straight, tubular intestinal glands
that extend the full thickness of the mucosa. Solitary lymphatic nodules also are
found in the mucosa. The submucosa of the large intestine is similar to that found
in the rest of the alimentary canal. The muscularis consists of an external layer
of longitudinal muscles and an internal layer of circular muscles. Unlike other
parts of the digestive tract tract, portions of the longitudinal muscles are
thickened, forming three conspicuous longitudinal bands referred to as taeniae
coli. Each band runs the length of most of the large intestine. Tonic contractions
of the bands bather the colon into a series of pouches called haustra, which give
the colon its puckered appearance. The serosa of the large intestine is part of the
visceral peritoneum. Small pouches of visceral peritoneum filled with fat are
attached to taeniae cols and are called epiploic appendages (folds).
T H E D IG E S T I V E S Y S T E M
Page 131
Digestion in the Large Intestine:
1.
Mechanical Digestion: The passage of chyme from the ileum into the cecum is
regulated by the action of the ileocecal valve. The value normally remains
mildly contracted so that the passage of chyme into the cecum is usually a
slow process. Immediately following a meal, there is a gastroileal reflex in
which ileal peristalsis is intensified and any chyme in the ileum is forced
into the cecum. The hormone stomach gastrin also relaxes the valve. Whenever
the cecum is distended, the degree of contraction of the ileocecal valve is
intensified.
Movements of the colon begin when substances enter through the ileocecal
valve. Since chyme moves through the small intestine at a fairly constant
rate, the time required for a meal to pass into the colon is determined by
gastric evacuation time. As food passes through the ileocecal valve, it fills
the cecum and accumulates in the ascending colon.
One movement characteristic of the large intestine is haustral churning. In
this process, the haustra remain relaxed and distended while they fill up.
When the distension reaches a certain point, the walls contract and squeeze
the contents into the next haustrum. Peristalsis also occurs, although at a
slower rate than in other portions of the tract (3 to 12 contractions per
minute). A final type of movement is mass peristalsis, a strong peristaltic
wave that begins in about the middle of the transverse colon and drives the
colonic contents into the rectum. Food in the stomach initiates this reflex
action in the colon. Thus mass peristalsis usually takes place three to four
times a day, during a meal or immediately after.
2. Chemical Digestion: The last stage of digestion is chemical and occurs
through bacterial, not enzymatic, action in the large intestine. Mucus is
secreted by the glands of the large intestine, but no enzymes are secreted.
Chyme is prepared for elimination by the action of bacteria. These bacteria
ferment any remaining carbohydrates and release hydrogen, carbon dioxide, and
methane gas. These gases
THE DIGESTIVE SYSTEM
Page 132
contribute to flatus (gas) in the colon. They also convert remaining
to
amino
acids
and
break
down
the
amino
acids
into
simpler
p
roteins
substances:
indole, skatole, hydrogen sulfide, and fatty acids. Some of the indole and
skatole is carried off in the feces and contributes to their odor. The rest
are absorbed and transported to the liver, where they are converted to less
toxic compounds and excreted in the urine. Bacteria also decompose bilirubin
to
simpler
pigments
(urobilinogen),
which
give
feces
their
brown
color.
Several vitamins needed for normal metabolism, including some B vitamins and
vitamin K, are synthesized by bacterial action and absorbed.
Absorption and Feces Formation:
By the time the chyme has remained in the large intestine 3 to 10 hours, it has
become solid or semisolid as a result of absorption and is now known as feces.
Chemically,
feces
consist
of
water,
inorganic
salts,
sloughed
off
epithelial
cells from the mucosa of the alimentary canal, bacteria, products of bacterial
decomposition, and undigested parts of food.
Although most water absorption occurs in the small intestine, the large intestine
absorbs enough to make it an important organ in maintaining the body's water
balance. Of the 0.5 to 1.0 liter that enters the large intestine, all but about
100 ml is absorbed. The absorption is greatest in the cecum and ascending colon.
The large intestine also absorbs sodium and chloride.
Defecation:
Mass peristaltic movements push fecal material from the sigmoid colon into the
rectum.
The
resulting
distension
of
the
rectal
wall
stimulates
pressure-
sensitive receptors, initiating a reflex for defecation, the emptying of the
rectum.
Diarrhea refers to frequent frequent defecation of liquid feces caused by
increased motility of the intestines.
THE DIGESTIVE SYSTEM
Page 133
Constipation refers to infrequent or difficult defecation.
DISORDERS: HOMEOSTATIC IMBALANCES
1.
Dental Caries,
softening
of
initiated
when
enamel.
sticky
or
tooth
the
decay ,
enamel
bacteria
Microbes
such
polysaccharide
bacteria
causing
dextran,
and
them
other
and
act
as
on
involve
dentin.
to
to
debris
stick
adhering
to
off
mutans
sucrose
the
demineralization
process
giving
Streptococcus
from
gradual
The
sugars
produced
a
teeth
dental
acids
causes
forms
teeth.
of
a
Masses
are
or
caries
demineralize
is
the
caries.
Dextran,
capsule
around
of
bacterial
collectively
a
the
cells,
called
dents
plaque.
2.
Periodontal Disease
characterized
alveolar
called
bone,
by
is
a
inflammation
periodontal
pyorrhea.
collective
and
term
for
degeneration
ligament,
and
The initial symptoms are
a
of
cementum.
variety
the
One
enlargement
of
conditions
gingivae
such
(gums),
condition
is
and inflammation
of
the soft tissue and bleeding gums.
3.
Peritonitis is an acute inflammation of the serous membrane lining the
abdominal cavity and covering the abdominal viscera .
4.
Peptic Ulcers: An ulcer is a craterlike lesion in a membrane. Ulcers that
develop in areas of the a limentary canal exposed to acid gastric juice are
called peptic ulcers. Peptic ulcers occasionally develop in the lower end of
the esophagus, but most occur on the lesser curvature of the stomach, where
they are called gastric ulcers, or in the first part of the duodenum where
they are called duodenal ulcers. Most peptic ulcers are duodenal.
Hypersecretion
of
acid
gastric
juice
seems
to
be
the
immediate
cause
of
duodenal ulcers. Among the factors believed to stimulate an increase in acid
secretion
are
emot ions,
certain
foods,
or
medications,
and
also
alcohol,
coffee, and aspirin, as well as overstimulation of the vagus nerve. The most
common complication of peptic ulcers is bleeding.
THE DIGESTIVE SYSTEM
5.
Page 134
Appendicitis: An inflammation of the vermiform appendix. It is preceded by
obstruction of the lumen of the appendix by fecal material, inflammation, a
foreign body, carcinoma of the cecum, stenosis, or kinking of the organ. The
infection
that
follows
may
result
in
edema,
ischemia,
gangrene,
and
perforation. Rupture of the appendix develops into peritonitis.
6.
Tumors:
Both
benign
and
malignant
tumors
can
occur
in
all
parts
of
the
gastrointestinal tract. The benign growths are much more common. Carcinoma of
the colon and rectum is one of the most common malignant diseases ranking
second to that of the lungs in males and lungs and breasts in females. Over
50% of colorectal cancers occur in the rectum and sigmoid colon.
Malignant
tumors
of
the
rectum
may
be
detected
by
digital
rectal
examination. The easiest method for detecting cancer of the colon is fecal
occult blood testing, in which a sample of stool is tested for the presence
of occult (hidden) blood, a sign that a malignant tumor might be present.
Another test in a routine examination for intestinal disorders is the filling
of the gastrointestinal tract with barium, which is either swallowed or given
in an enema. Barium, a mineral, shows up on x rays the same way that calcium
appears in bones. Tumors as well as ulcers can be diagnosed this way.
7.
Diverticulitis: Diverticula are saclike outpouchings of the wall of the colon
in
places
where
the
muscularis
has
become
weak.
The
development
of
diverticula is called diverticulosis. Many people who develop diverticulosis
are asymptomatic and experience no complications. About 15% of people with
diverticulosis will eventually develop an inflammation within diverticula, a
condition known as diverticulitis.
8.
Cirrhosis: Cirrhosis refers to a distorted or scarred liver as a result of
chronic inflammation. Cirrhosis may be caused by hepatitis which is
inflammation of the liver. Certain chemicals that destroy liver cells,
parasites that infect the liver, and alcoholism.
THE DIGESTIVE SYSTEM
9.
Page 135
Hepatitis: Refers to inflammation of the liver and can be caused by viruses,
drugs,
and
chemicals,
including
alcohol.
Clinically
several
types
of
hepatitis are recognized.
Hepatitis A (least serious form) also known as infectious hepatitis is caused by
hepatitis A virus and is spread by fecal contamination of food, clothing, toys,
eating utensils, and so forth. This is known as the fecal-oral route. It is
generally a mild disease of children and young adults characterized by anorexia,
malaise, nausea, diarrhea, fever, and chills. Eventually jaundice appears. It does
not cause lasting liver damage. Most people recover in four to six weeks.
Hepatitis B also known as serum hepatitis is caused by hepatitis B virus and is
spread primarily by contaminated syringes and transfusion equipment. It can also
be spread by an secretion of fluid by the body (tears, saliva, semen). Hepatitis
B can produce chronic liver inflammation and can persist for years or even a
lifetime.
Persons
who
harbor
the
active
hepatitis
B
virus
are
at
risk
for
cirrhosis and also become carriers.
Non-A, Non-B (NANB) Hepatitis: A form of hepatitis that cannot be traced to either
hepatitis A or hepatitis B viruses. It is clinically similar to hepatitis B and
is often spread by blood transfusions. It is believed to account for considerably
more posttransfusion hepatitis than that related to hepatitis B.
10.
Gallstones: The cholesterol in bile may crystallize at any point between
bile
canaliculi,
where
it
is
first
apparent,
and
the
hepatopancreatic
ampulla, where the bile enters the duodenum. The fusion of single crystals is
the
beginning
of
95%
of
all
gallstones,
also
known
as
biliary
calculi.
Following their formation, gallstones gradually grow in size and number and
may cause minimal, intermittent, or complete obstruction to the flow of bile
from the gallbladder into the duct system. If obstruction of the outlet
occurs and the gallbladder cannot empty as it normally does after eating,
THE DIGESTIVE SYSTEM
Page 136
the pressure within it increases and the individual may have intense pain or
discomfort (binary colic). Complete obstruction of the flow of bile into the
duodenum may result in death.
11. Anorexia Nervosa: Anorexia Nervosa is a disorder characterized by loss of
appetite
and
starvation
bizarre
appears
patterns
to
be
a
of
eating.
response
to
The
subconsciously
emotional
self-imposed
conflicts
about
self-
identification and acceptance of a normal adult sex role. The disorder is
found predominantly in young, single females. The physical consequence of the
disorder
is
menstruation)
severe
and
a
and
progressive
lowered
basal
starvation.
metabolic
rate
Amenorrhea
reflect
(absence
the
of
depressant
effects of the starvation.
12. Bulimia,:
A
disorder
that
typically
affects
single,
middle-class,
young,
white females. It is also known as binge-purge syndrome. It is characterized
by uncontrollable overeating followed by forced vomiting or overdoses of
laxatives.
overweight,
This
binge-purge
stress,
cycle
depression,
occurs
and
in
response
physiological
to
fears
disorders
of
being
such
as
hypothalamic tumors.
Bulimia can upset the body's electrolyte balance and increase susceptibility
to flu, salivary gland infections, dry skin, acne, muscle spasms, loss of
hair, kidney and liver diseases, tooth decay, ulcers, hernias, constipation,
and hormone imbalances.
13. Dietary Fiber (Roughage) and GI Disorders: A deficiency in our diet that has
received recent attention is lack of dietary fiber or roughage. Dietary
fiber consists of indigestible substances, such as cellulose, lignin, and
pectin, found in fruits, vegetables, grains, and beans. The bulk of our
intake consists of extensively purified carbohydrates--mainly starches and
sugars--as well as substantial amounts of fats and oils. People who chose a
fiber-rich, unrefined diet will greatly reduce their chances of developing
disease of overnutrition (such as obesity, diabetes, gallstones, and
THE DIGESTIVE SYSTEM
coronary
heart
disease),
disease
of
the
Page 137
underworked
mouth
(caries
and
peridontal disease), and diseases of underfed large bowel (constipation,
varicose veins, hemorrhoids, colon spasm, diverticulitis, appendicitis, and
large intestinal cancer).
14.
Botulism:
A
type
of
food
poisoning
caused
by
a
toxin
produced
by
Clostridium botulinum. The bacterium is ingested in improperly cooked or
preserved food. Symptoms include paralysis, nausea, vomiting, blurred or
double vision, difficulty in speech, difficulty in swallowing, dryness of
mouth, and general weakness.
15.
Cholecystitis:
Inflammation
of
the
gallbladder
that
often
leads
to
infection. Some cases are caused by obstruction of the cystic duct with bile
stones.
16.
Cholelithiasis: The presence of gallstones.
17.
Colitis: Inflammation of the colon and rectum. This inflammation of the
mucosa
reduces
feces,
and,
in
absorption
severe
of
cases,
water
and
salts,
dehydration
and
producing
salt
watery,
depletion.
bloody
Irritated
muscularis spasms produce cramps.
18.
Colostomy: An incision of the colon to create an artificial opening or
"stoma" to the exterior. This opening serves as a substitute anus through
which feces are eliminated.
19.
Dysphagia: Difficulty in swallowing.
20.
Enteritis: An inflammation of the intestine, particularly the small
intestine.
21.
Flatus:
Excessive
amounts
of
air
(gas)
in
the
stomach
or
intestine,
usually expelled through the anus. If the gas is expelled through the mouth,
it is called eructation or belching (burping).
THE DIGESTIVE SYSTEM
Page 138
22. Gastrectomy: Removal of a portion of the entire stomach.
23. Hernia: Protrusion of an organ or part of an organ through a membrane or
cavity
wall
wall,
usually
the
abdominal
cavity.
Diaphragmatic
(hiatal)
hernia is the protrusion of the lower esophagus, stomach, or intestine in the
thoracic cavity through the opening in the diaphragm (esophageal hiatus) that
allows
passage
abdominal
of
organs
the
esophagus.
through
the
navel
Umbilical
area
of
hernia
the
is
the
abdominal
protrusion
wall.
of
Inguinal
hernia is a protrusion of the hernial sac containing the intestine into the
inguinal
opening.
It
may
extend
into
the
scrotal
compartment,
causing
strangulation of the herniated part.
24. Inflammatory Bowel Disease (IBD): Disorder that exists in two forms:
(1)
Chron's disease (inflamed intestine)
(2)
Ulcerative colitis (inflammation of the colon consisting of ulcerations
and usually accompanied by rectal bleeding).
25.
Irritable
Bowel
Syndrome:
Disease
of
the
entire
gastrointestinal
tract
characterized by abnormal muscular contractions, especially a spastic colon,
excessive mucus in stools, and alternating diarrhea and constipation.
26. Nausea: Discomfort preceding vomiting. Possibly, it is caused by distention
or irritation of the gastrointestinal tract, most commonly the stomach.
27. Pancreatitis: Inflammation of the pancreas.
Page 139
Minerals Vital to the Body
MINERAL
COMMENTS
Calcium
Phosphorus
Iron
IMPORTANCE
Most abundant cation in body. Appears In combination
with of bones and teeth, blood clotting, normal muscle and nerve activity,
Formation
:
phosphorus in ratio of 2 1.5. About 99 percent
is stored in
endocytosis
and exocytosis, cellular motility, chromosome movement prior to cell divibone and teeth. Remainder stored in muscle,
soft metabolism, and synthesis and release of neurotransmitters.
sion,other
glycogen
tissues, and blood plasma. Blood calcium level controlled by
calcitonin (CT) and parathyroid hormone (PTH). Absorption
occurs only in the presence of vitamin D. Most is excreted
in feces and small amount in urine. Sources are milk, egg
yolk, shellfish, green leafy vegetables.
Formation of bones and teeth. Constitutes a major buffer system of
About 80 percent found in bones and teeth. Remainder
blood. Plays important role in muscle contraction and nerve activity.
distributed in muscle, brain cells, blood. More functions
Component of many enzymes. Involved in transfer and storage of
than any other mineral. Blood phosphorous level conenergy (ATP). Component of DNA and RNA.
trolled by calcitonin (CT) and parathyroid hormone (PTH).
Most excreted in urine, small amount eliminated in feces.
Sources are dairy products, meat, fish, poultry, nuts.
About 66 percent found in hemoglobin of blood. Remain-der
distributed in skeletal muscles, liver, spleen, enzymes.
Normal losses of iron occur by shedding of hair, epithelial
cells, and mucosal cells, and in sweat, urine, feces, and
bile. Sources are meat, liver, shellfish, egg yolk, beans,
legumes, dried fruits, nuts, cereals.
As component of hemoglobin, carries O2 to body cells. Component of
cytochromes involved in formation of ATP from catabolism.
Iodine
Essential component of thyroid hormones. Excreted in
urine. Sources are seafood, cod-liver oil, and vegetables
grown in iodine-rich soils or iodized salt.
Required by thyroid gland to synthesize thyroid hormones, hormones
that regulate metabolic rate.
Copper
Some stored in liver and spleen. Most excreted in feces.
Sources include eggs, whole-wheat flour, beans, beets,
liver, fish, spinach, asparagus.
Required with iron for synthesis of hemoglobin. Component of enzyme
necessary for melanin pigment formation.
Sodium
Most found in extracellular fluids, some in bones. Excreted
in urine and perspiration. Normal intake of NaCl (table salt)
supplies required amounts.
As most abundant cation in extracellular fluid, strongly affects
distribution of water through osmosis. Part of bicarbonate buffer
system. Functions in nerve impulses conduction.
Principal cation in intracellular fluid. Most is excreted in
urine. Normal food intake supplies required amounts.
Found in extracellular and intracellular fluids.
Principal anion of extracellular fluid. Most excreted in urine.
Normal intake of NaCl supplies required amounts.
Potassium
Chlorine
Magnesium
Component of soft tissues and bone. Excreted in urine and
feces. Widespread in various foods.
Sulfur
Constituent of many proteins (such as insulin) and some
vitamins (thiamine and biotin). Excreted in urine. Sources
include beef, liver, lamb, fish, poultry, eggs, cheese, beans.
Zinc
Important component of certain enzymes.
many foods, especially meats.
Widespread in
Fluorine
Component of bones, teeth, other tissues
Manganese
Some stored in liver and spleen. Most excreted in feces.
Cobalt
Constituent of vitamin B12
Functions in transmission of nerve impulses and muscle contraction.
Assumes role in acid-base balance of blood, water balance, and
formation of HCI in stomach.
Required for normal functioning of muscle and nervous tissue.
Participates in bone formation. Constituent of many coenzymes.
As component of hormones and vitamins, regulates various body
activities.
As a component of carbonic anhydrase, important in carbon dioxide
metabolism. Necessary for normal growth and wound healing, proper
functioning of prostate gland, normal taste sensations and appetite,
and normal sperm counts in males. As a component of peptidases, it
is involved in protein digestion.
Appears to improve tooth structure and inhibit carcinogenesis
Activates several enzymes. Needed for hemoglobin synthesis, urea
formation, growth, reproduction, and lactation.
As part of B12, required for maturation of erythropoeisis.
.
Page 140
EXHIBIT 25-3 (Continued)
MINERAL
Chromium
COMMENTS
Found in high concentrations in brewer's yeast. Also found
in wine and some brands of beer.
IMPORTANCE
Necessary for the proper utilization of dietary sugars and
other carbohydrates by optimizing the production and
effects of insulin. Helps increase blood levels of HDL, while
decreasing levels of LDL.
An antioxidant. Prevents chromosome breakage and may
Selenium
Found in seafood, meat, chicken, grain cereals, egg yolk,
milk, mushrooms, and garlic.
assume a role in preventing certain birth defects.
EXHIBIT 25-4 THE PRINCIPAL VITAMINS
VITAMIN
FUNCTION
COMMENT AND SOURCE
DEFICIENCY SYMPTOMS
AND DISORDERS
FAT-SOLUBLE
A
Formed from provitamin carotene
Maintains general health and vigor
(and other provitamins) in intestinal
of epithelial cells.
tract. Requires bile salts and fat for
absorption. Stored in liver. Sources
of carotene and other provitamins
include
yellow
and
Deficiency results in atrophy and
keratinization of epithelium, leading
to dry skin and hair, increased
incidence of ear, sinus, respiratory,
urinary, and digestive infections,
inability to gain weight, drying of
cornea
with
ulceration
(xerophthalmla), nervous disorders, and skin sores.
green
vegetables; sources of vita-min A
Essential for formation of
rhodopsin,
light-sensitive
chemical in rods of retina.
Growth of bones and teeth by
apparently helping to regulate
activity of osteoblasts and
osteoblasts
Night blindness or decreased
ability for dark adaptation.
Slow and faulty development of
bones and teeth.
Page
VITAMIN
D
E (tocopherols)
K
WATER-SOLUBLE B1
(thiamine)
COMMENT AND SOURCE
In presence of sunlight, dehydrocholesterot in the skin is converted
t o chotecalcif erol (vitamin D,). In the
liver, cholecalciferol is converted to
25-hydroxychotecalciferol. In the
kidneys,
25-hydroxychotecalciferol
i s
converted
to
1,25dihydroxycalciferot, the active form of
vitamin D. Dietary vitamin 0 requires
moderate amounts of bile salts and
fat for absorption. Stored in tissues to
slight extent. Most excreted via bile.
Sources include fish-liver oils, egg
yolk, fortified milk.
Stored in liver, adipose tissue, and
muscles. Requires bile salts and tat
for absorption. Sources include fresh
nuts and wheat germ, seed oils,
green leafy vegetables.
FUNCTION
Essential for absorption and utilization of calcium and phosphorus
from gastrointestinal tract. May work
with parathyroid hormone (PTH) that
controls calcium metabolism.
Believed t o
inhibit catabolism of
certain fatty acids that help form call
structures, especially membranes.
Involved in formation o f
DNA,
RNA, and red blood cells. May
promote wound heating, contribute to
the normal structure and functioning
of the nervous system, prevent
scarring and reduce the severity of
visual
loss
associated
with
retrolental fibroplasia (an eye
disease in premature infants caused
by too much oxygen in incubators) by
functioning as an antioxidant.
Believed to help protect liver from
toxic
chemicals
like
carbon
tetrachloride.
Produced in considerable quantities
by intestinal bacteria. Re-quires bile
salts and fat for absorption. Stored in
liver and spleen. Other sources
include
spinach,
cauliflower,
cabbage, liver.
Coenzyme believed essential for
synthesis of prothrombin by liver and
several clotting factors. Also known
as antihemorrhagic vita-min.
Rapidly destroyed by heat. Not
stored in body. Excessive intake
eliminated in urine. Sources include
whole-grain products, eggs, pork,
nuts, liver, yeast.
Acts as coenzyme for many different
enzymes involved in carbohydrate
metabolism of pyruvic acid to CO,
and H=O. Essential for synthesis of
acetylcholine.
141
DEFICIENCY SYMPTOMS
AND DISORDERS
Defective utilization of calcium by
bones leads to rickets in children and
osteomalacla in adults. Possible
toss of muscle lone.
May cause the oxidation of unsaturated fats resulting in abnormal
structure and function of mitochondria, lysosomes, and plasma
membranes, a possible consequence being hemolytic anemia.
Deficiency also causes muscular
dystrophy in monkeys and sterility
in rats.
Delayed clotting time
excessive bleeding.
results
in
Improper carbohydrate metabolism
leads to buildup of pyruvic and lactic
acids and insufficient energy for
muscle and nerve calls. Deficiency
leads to two syndromes: (1) beriberi—partial paralysis of smooth
muscle of GI tract causing digestive
disturbances, skeletal muscle paraysis, atrophy of limbs; (2) polyneuritis—due to degeneration of myelin
sheaths
reflexes
related
to
kinesthesia are impaired, impairment of sense of touch, de-creased
intestinal motility, stunted growth in
children, and poor appetite.
EXHIBIT 25-4 (Continued)
VITAMIN
B2 (riboflavin)
COMMENT AND SOURCE
Not stored in large amounts in tissues.
Most is excreted in urine. Small
amounts supplied by bacteria of GI
tract. Other sources include yeast,
liver, beef, veal, Iamb, eggs,
whole-grain products, asparagus,
peas, beets, peanuts.
FUNCTION
Component of certain coenzymes
(e g., FAD) concerned with carbohydrate and protein metabolism,
especially in cells of eye,
integument, mucosa of intestine,
blood.
Niacin (nicotinamide)
Derived from amino acid tryptophan. Sources include yeast, meats, Essential component of coenzyme
liver, fish, whole-grain products, (NAD) concerned with energyreleasing reactions. In lipid
peas, beans, nuts.
metabolism, inhibits production of
cholesterol and assists in fat
breakdown.
May function as coenzyme in fat
metabolism. Essential coenzyme
B6 (pyridoxine) Formed by bacteria of GI tract. Stored in
for normal amino acid metabolism.
liver, muscle, brain. Other sources
Assists production of circulating
include salmon, yeast, tomatoes,
antibodies.
yellow corn, spinach, whole-grain
products, liver, yogurt.
Coenzyme necessary for red blood
B12 (cyanocobalaOnly B vitamin not found in vegecell formation, formation of amino
min)
tables; only vitamin containing cobalt.
acid methionine, entrance of some
Absorption from GI tract deamino acids into Krebs cycle, and
pendent on HCI and intrinsic
manufacture of eholine (chemical
factor secreted by gastric musimilar in function to acetylcholine).
cosa. Sources include liver, kidney, milk, eggs, cheese, meat.
Constituent of coenzyme A essential for transfer of pyruvic acid
Pantothenic acid Stored primarily in liver and kidneys.
into Krebs cycle, conversion of
Some produced by bacteria of GI
lipids and amino acids into glutract. Other sources include
cose, and synthesis of cholesterol
kidney, liver, yeast, green vegetaand steroid hormones.
bles, cereal.
Synthesized by bacteria of GI tract. Other
sources include green leafy
vegetables and liver.
Component of enzyme systems
synthesizing purines and pyrimidines built into DNA and RNA. Essential for normal production of
red and white blood cells.
Biotin Synthesized by bacteria of GI tract. Other sources
include yeast, liver, egg yolk,
kidneys.
Essential coenzyme for conversion
of pyruvic acid to oxaloacetic acid
and synthesis of fatty acids and
purines.
Folic acid
C (ascorbic acid) Rapidly destroyed by heat. Some stored
in glandular tissue and plasma.
Sources include cirtrus fruits,
tomatoes, green vegetables.
Exact role not understood. Promotes many metabolic reactions,
particularly protein metabolism,
including laying down of collagen
in formation of connective tissue.
As coenzyme may combine with
poisons, rendering them harmless
until excreted. Works with antibodies. Promotes wound healing.
DEFICIENCY SYMPTOMS
AND DISORDERS
Deficiency may lead to improper
utilization of oxygen resulting in
blurred vision, cataracts, and corneal ulcerations. Also dermatitis and
cracking of skin, lesions of intestinal
mucosa, and development of one
type of anemia.
Principal deficiency is pellagra,
characterized by dermatitis, diarrhea, and psychological disturbances.
Most common deficiency symptom
is dermatitis of eyes, nose, and
mouth.
Other
symptoms
are
retarded growth and nausea.
Pernicious anemia and malfunction
of nervous system due to degeneration of axons of spinal cord.
Experimental deficiency tests indicate fatigue, muscle spasms,
neuromuscular degeneration, insufficient production of adrenal
steroid hormones.
Production of abnormally large red
blood cells (macrocytic anemia).
Mental depression, muscular pain,
dermatitis, fatigue, nausea.
Scurvy; anemia; many symptoms
related to poor connective tissue
growth and repair including tender
swollen gums, loosening of teeth
(alveolar processes also deteriorate), poor wound healing, bleeding (vessel walls fragile because
of connective tissue degeneration), and retardation of growth.
Page 143
EXHIBIT 25-5 ABNORMAL CONDITIONS ASSOCIATED WITH MEGADOSES OF SELECTED MINERALS AND
VITAMINS
SUBSTANCE
ABNORMALITY
MINERALS
Calcium
Depresses nerve function, causes drowsiness, extreme lethargy, calcium deposits, kidney stones.
Iron
Damage to liver, heart, and pancreas.
Zinc
Masklike fixed expression, difficulty in walking, slurred speech, hand tremor, involuntary laughter.
Cobalt
Goiter, polycythemia, and heart damage.
Selenium
Nausea, vomiting, fatigue, irritability, and loss of fingernails and toenails.
VITAMINS
A
Blurred vision, dizziness, ringing in the ears, headache, skin rash, nausea, vomiting, diarrhea, hair loss, menstrual
irregularities, fatigue, liver damage, abnormal bone growth, and damage to nervous system.
D
Calcium deposits, deafness, nausea, loss of appetite, kidney stones, weak bones, hypertension, high cholesterol.
E
Thrombophlebitis, pulmonary embolism, hypertension, severe fatigue, breast tenderness, and slow wound healing.
Niacin
Flushing, peptic ulcers, liver dysfunction, gout, arrhythmias, and hyperglycemia.
B.
Impaired sense of position and vibration, diminished tendon reflexes, numbness and loss of sensations in hands
and feet, difficulty in walking.
C
Dependence on megadoses may lead to scurvy when withdrawn, kidney stones, diarrhea, hemolysis, and blood
clotting.
megadose is defined as taking 10
the National Research Council.
A
or
more times the adult recommended daily allowances (RDA's) set by