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Digestive System SALIVARY GLANDS Produce saliva – Names of some salivary glands: Parotid (largest). Mumps is a virus that attacks here. Submandibular Sublingual – Functions of salivary glands To moisten food so you can swallow, especially crackers. The mucus in the saliva is what moistens the food. To inhibit growth of bacteria (which like dark, warm, moist areas). What does this are the antibodies, enzymes, and macrophages in the saliva. STRUCTURE OF TOOTH GINGIVA are the gums CROWN is the area above the gingiva ROOT is embedded in a socket in the bone. In the maxilla, the root can extend into the maxillary sinus. Damage to the sinus can be a lot of problems. ENAMEL is the external layer of the tooth. It is stronger than bone, but does wear out. It is suppose to be ivory color, not white. Whitening procedures scrape away outer oxidized layer, to expose the layer underneath, which is white, but it will oxidize, too. DENTIN is deep to the enamel. It is like bone, with living tissues and cells. PULP CAVITY with PULP is deep to the dentin. It has blood vessels and nerves. PERIODONTAL LIGAMENT attaches the tooth to the bone. It’s like periosteum. Disease of this structure is the most common cause of tooth loss in adults. Tooth Structure Figure 22.11 Tooth Problems When bacteria eat away at the enamel, what’s it called? CAVITY The dentist removes a larger area where the bacteria are, and fills it in. If the cavity extends into the pulp cavity, there is no way to clean it up. The treatment is to make a big hole, scrape out the pulp, and fill up the whole thing = ROOT CANAL. This is a dead tooth, but still there. Bacteria between the gingiva and tooth causes inflammation of the gingiva = GINGIVITIS. When it gets worse, the gingiva pulls away from the tooth and the bacteria extends down to the periodontal ligament = PERIODONTITIS. This is the major cause of tooth loss. The tooth loosens and falls out. That’s why you need to floss. Layers of GI Tube There are four layers: 1. MUCOSA (inner layer). The lining varies from region to region. – Epithelium – Lamina Propria: Loose connective tissue – Muscularis mucosae: very thin smooth muscle, causes little twitches within the mucosa. 2. SUBMUCOSA (moderate dense connective tissue). Lots of elastic fibers, blood vessels, and lymphatic vessels. 3. MUSCULARIS EXTERNA (smooth muscle layer with two parts: – Circular Layer (inner) – Longitudinal layer (outer) 4. Serosa Serosa Mucosa Muscularis Externa Submucosa 3. Muscularis Externa Muscularis Externa is extremely important for digestion. It allows for 2 types of actions: a. PERISTALSIS: a rhythmic contraction to push something along. This pushes food down by smooth muscle contraction. b. SEGMENTATION: A back-and-forth squeezing of the muscle to grind up food. Food moves forward then backward a little, then forward again. Function is to churn up the food inside. Some areas have thicker smooth muscle = SPHINCTER. Circular muscles open and closes an opening. – Controls the flow of food from one region to another. Layers of GI Tube 4. SEROSA is not in all regions (none in esophagus). – Simple squamous epithelium – Loose connective tissue – From internal to external, the layers of this tube are the mucosa, submucosa, muscularis, serosa. Esophagus Extends from the oropharynx to the stomach, about 25 cm long. The things that are specialized in the esophagus are: 1. MUCOSAL EPITHELIUM (non-keratinized stratified squamous epithelium). Why? It protects against things you swallow; pointy potato chips, etc. Cuboidal would slough. 2. MUSCULARIS EXTERNUM in upper half = skeletal muscle. Lower half = smooth muscle. Why? The upper half, skeletal muscle, is under voluntary control. Smooth muscle is not voluntary. Food gets caught in the lower half because it hasn’t started peristalsis. Cardiac Sphincter The esophagus goes through the thoracic cavity. It needs to go through the diaphragm’s opening (esophageal hiatus). It empties to the stomach through a CARDIAC SPHINCTER = a thickening of the muscularis externa. This is NOT A TRUE SPHINCTER. Stomach Anatomy Stomach: Functions Store Food Mechanically churns food into a paste called CHYME Kill bacteria Some digestion: of proteins Some absorption: of water, alcohol Gastric emptying is the release of food from the stomach into the duodenum; the process is tightly controlled with liquids being emptied much more quickly than solids. STOMACH FUNCTIONS 1. Store Food, so it can be slowly released into a small intestine. Your whole Thanksgiving dinner can take your stomach diameter from 2” to 8” diameter. 2. Mechanically Churns food. Secretions from the stomach is added, turns everything into a gooey paste. When you throw up, you can see the enzyme secretions = CHYME. 3. Kill bacteria. The stomach is very acidic (pH 1) like battery acid. Chyme will even eat through clothing. 4. Some digestion: of proteins. 5. Some absorption: of water, alcohol (alcohol is absorbed in the mouth, too!) Food takes four hours to completely leave the stomach. The Stomach Figure 22.15a-c Stomach Cells PARIETAL CELLS in the stomach secrete hydrochloric acid and digestive enzymes which kill bacteria in the stomach. They also secrete intrinsic factor, which is needed to absorb vitamin B12. CHIEF CELLS secrete an enzyme called pepsinogen. When pepsinogen is exposed to hydrochloric acid (HCl), it is cleaved into pepsin, its active form. Pepsin digests proteins. Intrinsic Factor The parietal cells in the stomach secrete a substance called INTRINSIC FACTOR. Vitamin B12 requires intrinsic factor in order to be absorbed. A person who lacks intrinsic factor (such as those who have a stomach stapling procedure or gastric bypass) will not be able to absorb vitamin B12 and they will get a type of anemia called pernicious anemia. Treatment is injectable B12 shots monthly for the rest of their lives. Gastric gland Figure 22.15a-c Two major causes of Peptic Ulcers: 1) 60% of gastric and up to 90% of duodenal ulcers are due to a bacterium called Helicobacter pylori. – The body responds by increasing gastrin secretion, which erodes the stomach lining. 2) NSAIDs (non-steroidal anti-inflammatory drugs, such as aspirin) block prostaglandin synthesis. – Prostaglandins promote the inflammatory reaction. They also are found in the stomach, protecting it from erosion. 19 Problems With the Stomach The cardiac sphincter doesn’t close well, since it is not a true sphincter; consequences: – You can throw up (reverse peristalsis). Rats do have a true cardiac sphincter, and can’t vomit! – That’s why rat poison won’t kill people or dogs; they can throw it up. Another consequence: hiatal hernia. HIATAL HERNIA Part of the stomach, protrudes through esophageal hiatus, causing pain and difficulty swallowing. It is the most common of all hernias. There is a great amount of acid reflux; erodes walls of esophagus, causing ulcerations of esophagus. Treatment is surgical; pull down the stomach, and tighten the hernia in a laparoscopic procedure. The Small Intestine Crypt of Lieberkuhn Figure 22.17a-c Small Intestine Regions Duodenum “12 finger widths long” Jejunum “hungry when empty” Ileum “twisted” DUODENUM This is the shortest region, only one foot long. It receives chyme from the stomach. This is where digestion begins. There are two ducts at the beginning of the duodenum from the pancreas and gallbladder. It is the site of action of liver secretions (bile) and pancreas secretions (digestive enzymes and bicarbonate). Pancreas PANCREAS is an endocrine gland, and also participates in digestion. Most of the digestive enzymes are made here. They go out the PANCREATIC DUCT to enter the small intestine. It also produces BICARBONATE (from a hormone called SECRETIN) to increase the pH (decrease the acidity) of the chyme coming from the stomach. If there is too much acid there, get a DUODENAL ULCER. PANCREAS ACINAR CELLS: secretes digestive enzymes ISLETS OF LANGERHANS: secretes insulin and glucagon Pancreas Acinar cells (secrete enzymes) Islet of Langerhans (secretes insulin and glucagon) GALL BLADDER This is located inferior to the liver, and its function is to store and concentrate bile. Bile is a detergent/soap (not an enzyme) which emulsifies fat: It breaks down the fat into microscopic droplets which can be broken down by pancreatic enzymes. It does NOT make or secrete bile; that is done by the liver. Bile is made in the liver from Hemoglobin (Hgb), and also contains cholesterol and other things. The function of bile is to break down lipids (fats) so they can be digested. Jejunum JEJUNUM (“empty”) This is the part of the small intestine where most digestion and absorption occurs. It is 3 feet long. Ileum ILEUM (“twisted”) is 5-10 feet long. It is the terminal portion of the small intestine. Much of the absorption takes place here. Crypt of Lieberkuhn Lacteal Crypt of Lieberkuhn Figure 22.17a-c Absorption in Small Intestine In the villis is a fenestrated capillary bed, which needs to absorb a lot of material. The small intestine absorbs carbohydrates, fats, and proteins (although protein enzymes have already begun working earlier in the digestive tract in the stomach). The walls of the small intestine secrete most of the digestive enzymes that are active in its lumen. Lymphatics of Small Intestine There are also large lymphatic capillaries in each villis called LACTEALS, whose function is to absorb breakdown products of fat. The vessel is large so it won’t get clogged up. Under all this are the MUSCULARIS MUCOSA muscles which can twitch to move the villa so food does not get stuck. Problem with Small Intestine Crohn’s Disease – Autoimmune disease of the GI tract – Most common area affected is small intestine Celiac disease (Sprue; gluten intolerance) Large Intestine (Colon, or large bowel) This is about 5 feet long, diameter of 4”. Absorbs a LOT of water and salts Absorbs electrolytes (Na, K, etc) Stores feces for defecation (terminal portion) Contains abundant bacteria (E. coli): – – – – Make vitamins (B5, K, biotin) Allow material to move through large intestine easier Keep out harmful bacteria They eat things you can’t digest Fiber Some sugars that we don’t have enzymes for Regions of the Large Intestine Cecum Ascending colon Transverse colon Descending colon Sigmoid colon Rectum Anus Large Intestine Figure 22.18a Problems with Large Intestine DIVERTICULITITS INFLAMMATORY BOWEL DISEASE – Crohn’s Disease – Ulcerative colitis IRRITABLE BOWEL SYNDROME COLON CANCER – SIGMOIDOSCOPY or a COLONOSCOPY POLYPS HEMORRHOIDS DIVERTICULITITS DIVERTICULUM (Diverticula is plural) can form, a small pouch in the large intestine. They can become inflamed, usually from a small, hard piece of feces, causes the condition known as DIVERTICULITITS. These are painful and often need to be surgically removed. May be caused by lack of fiber, causing increased pressure in the colon. Inflammatory Bowel Disease (IBD) IBD is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis IRRITABLE BOWEL SYNDROME (IBS) IBS is a diagnosis of exclusion. Symptoms are chronic abdominal pain, bloating, and alteration of bowel habits in the absence of any detectable organic cause. May manifest as diarrhea or constipation or may alternate between the two. May be caused by infection, stress, or onset of maturity No cure; treatments attempt to relieve symptoms, including dietary adjustments, medication and psychological interventions. COLON CANCER This is the #1 most deadly cancer (kills more people) because it metastasizes and there are no symptoms. It can be diagnosed by seeing blood in the stool; this is an easy test, but not very accurate. A more accurate test is a SIGMOIDOSCOPY. A tube is inserted into the sigmoid colon, done in the doctor’s office. The tube has a light, and they look for growths on the walls of the intestine = POLYPS, which are pre-cancerous growths. A colonoscopy is done under general anesthesia since the tube has to go through the entire colon, but it’s more effective. Hepatic Portal System Almost all of the blood coming from the digestive system drains into a special venous circulation called the portal circulation. Before these absorbed substances can go into the systemic circulation (the main blood circulation in the body), it must be filtered first to remove or detoxify toxic substances first. This filtering and detoxification is one of the 500+ functions of the liver. Liver Makes blood Makes blood proteins (clotting factors) Makes bile Regulates glucose levels Processes fats Makes cholesterol Processes amino acids Detoxifies chemicals Liver Hepatic Triad: Vein, Artery, Bile Duct Figure 22.23a, c, d Liver: sinusoids and hepatocytes Blood Flow in the Liver Blood flow to the liver is unique in that it receives both oxygenated and deoxygenated blood. Nutrient-rich, oxygen-poor blood from the intestine enters the liver by the hepatic portal vein. It flows through the sinusoids for detoxification. Oxygen-rich blood enters the liver by the hepatic artery. It flows through the sinusoids to supply them with oxygen. All of the blood mixes together, and when the oxygen demand of the hepatocytes is satisfied, and the toxins have been removed, the oxygen-depleted blood collects in a central vein within each lobule, which drains into the hepatic vein. The hepatic vein subsequently drains into the inferior vena cava and back to the heart. Function of Hepatocytes Detoxification of poisons Picking up and processing of nutrients from the portal blood – This includes picking up glucose from the nutrient-rich blood coming from the small intestine and stores it as glycogen (the storage form of glucose) for when the body needs it later. Storage of some vitamins Kupffer Cells Within the sinusoids are KUPFFER CELLS, which are macrophages. As blood flows through the sinusoids, they phagocytize old erythrocytes. The released Hgb is given to the hepatocytes, which convert it to bilirubin, one of the main components of BILE. Bile flows through a series of channels called the BILE CANNICULI to the bile duct. Problems with the Liver HEPATITIS CIRRHOSIS JAUNDICE Liver Problems Infection of the liver = HEPATITIS (can be deadly) CIRRHOSIS is when the hepatocytes die and are replaced by connective tissue. This is often from alcoholism, which kills the hepatocytes. Jaundice One of the symptoms from any liver disorder is a connection of the bile canaliculi and the sinusoid so some bilirubin can enter the blood. Bilirubin is yellow-green (later in its degradation it will turn brown and that is what gives the feces its color). The yellow color of bilirubin in the skin is known as JAUNDICE. GREATER OMENTUM GREATER OMENTUM is flat, and is in front of the intestines like an apron. Its function is to store fat, especially in men. GI Physiology Part 1: Metabolic Pathways Part 2: GI Physiology 56 Simple and Complex Carbohydrates There are three main simple sugars (AKA monosaccharides or simple carbohydrates) – Glucose – Fructose – Galactose If you join a glucose to any of these, you get a disaccharide – Glucose + Glucose = Maltose – Glucose + Galactose = Lactose 57 Simple and Complex Carbohydrates If you join many monosaccharides and/or disaccharides together, it is called a polysaccharide (AKA complex carbohydrate). These are stored in the liver as glycogen. They can be broken down later into glucose as needed. The storage form in plants is called starch. When we eat starch, we covert it to glycogen and then store it. 58 Glucagon and Insulin Glucagon, a hormone secreted by the pancreas, raises blood glucose levels. Its effect is opposite that of insulin, which lowers blood glucose levels. The pancreas releases glucagon when blood sugar (glucose) levels fall too low. Glucagon causes the liver to beak down the stored glycogen into glucose, which is released into the bloodstream. Since glycogen is being broken down, this process is called glycogenolysis. Don’t confuse this with glycolysis (break down of glucose to ATP)! High blood glucose levels stimulate the release of insulin. Insulin allows glucose to be taken up and used by insulin-dependent tissues. Thus, glucagon and insulin are part of a feedback system that keeps blood glucose levels at a stable level. 59 Glycolysis Glycolysis is the process where cells take in glucose and break it down into pyruvate, and ATP is released. This is how we get ATP from glucose. Fructose and galactose can also be broken down into pyruvate and ATP. During glycolysis, NAD (an energy molecule) is reduced to NADH. If you run out of NAD, glycolysis will stop. Therefore, we need to oxidize NADH to convert it back into NAD. This can be done by aerobic or anaerobic respiration, or fermentation. 60 Aerobic vs. Anaerobic Respiration Aerobic respiration (in the mitochondria)will result in 6 ATP’s. Anaerobic respiration (in our cytoplasm) will result in only 2 ATP’s. More importantly, we get our NAD back, so glycolysis can continue. 61 Making ATP by Aerobic Respiration Takes place in the mitochondria Requires oxygen Breaks down glucose to produce ATP Waste products are CO2 and H2O (we exhale them) The good thing about making ATP from our mitochondria is that we can make a LOT of it. The bad things are that it takes longer to make it, and it requires oxygen, and a muscle cell may have used up all the oxygen during a sprinting run. Making ATP by Anaerobic Respiration Takes place in the cytoplasm Does not require oxygen Breaks down glucose to produce ATP Waste product is lactic acid The good thing about making ATP this way is that we can make it FAST. The bad thing is that it does not make much ATP, and we deplete the reserves quickly. Lactic Acid Build-up During strenuous workouts where oxygen becomes deficient, the pyruvate product of glycolysis does not have enough oxygen to use for aerobic respiration, so it has to undergo anaerobic respiration. The enzyme lactate dehydrogenase (LDH) is used to transfer hydrogen from the NADH molecule to the pyruvate molecule. Pyruvate with the extra hydrogen is called lactate. Lactic acid is formed from lactate. This causes muscle aches and fatigue. Lactic acid is deactivated by the addition of oxygen to it. Therefore, breathing heavily adds the oxygen to our system to deactivate lactic acid, and the muscle pains go away. Warm water or ultrasound will also increase oxygenated blood to the muscles, easing muscle cramps from lactic acid. 64 ATP and Creatinine Phosphate What do we do when we run out of ATP? Muscle fibers cannot stockpile ATP in preparation for future periods of activity. However, they can store another high energy molecule called creatinine phosphate. Creatine phosphate is made from the excess ATP that we accumulate when we are resting. During short periods of intense exercise, the small reserves of ATP existing in a cell are used first. Then creatinine phosphate is broken down to produce ATP. Aerobic vs. Anaerobic Respiration When do we use aerobic respiration? – Resting (can breathe easily) – Running marathons (can breathe easily on long runs) Marathon runners want to make sure there will be enough readily available energy for the muscles, so they eat a lot of carbohydrates over a two-day period before the marathon. That’s why they load up on pasta before a marathon. When do we use anaerobic respiration? – Sprint running (can’t talk while sprinting!) Gluconeogenesis Gluconeogenesis is a metabolic pathway that results in the generation of new glucose from non-carbohydrate carbon substrates such as lactate, glycerol, and amino acids. Therefore, if we do not have enough glucose in our body, we will break down proteins (muscles) to make glucose. It is one of the two main mechanisms to keep blood glucose levels from dropping too low (hypoglycemia). The other means of maintaining blood glucose levels is through the degradation of glycogen (glycogenolysis). 67 Part 2 GI Physiology Figure 62-1; Guyton & Hall 68 Saliva The saliva serves to clean the oral cavity and moisten the food. It also contains digestive enzymes such as salivary amylase, which aids in the chemical breakdown of polysaccharides such as starch into disaccharides such as maltose. It also contains mucus, a glycoprotein which helps soften the food and form it into a bolus. 69 Stomach The stomach is responsible for the digestion of protein and ionization of minerals. Mucous cells (in the stomach) secrete mucous. The pancreas secretes bicarbonate. Mucous, bicarbonate, and prostaglandins protect the stomach lining from being digested. The parietal cells of the stomach secrete hydrochloric acid (gastric acid) and intrinsic factor. Hydrochloric acid (HCl), along with pepsin (from the chief cells), breaks down proteins to their individual amino acids. 70 Stomach Protection and Damage Downloaded from: StudentConsult (on 23 April 2010 06:51 PM) © 2005 Elsevier Downloaded from: StudentConsult (on 23 April 2010 06:51 PM) © 2005 Elsevier © 2005 Elsevier Stomach Acid The acid itself does not break down food molecules. It provides an optimum pH for the activation of pepsin, and kills many microorganisms that are ingested with the food. It can also denature proteins. The parietal cells of the stomach also secrete a glycoprotein called intrinsic factor, which enables the absorption of vitamin B-12. 74 Stomach Acid Diseases Hypochlorhydria Hyperchlorhydria 75 Small Intestine Duodenum – Absorption of minerals – Receives pancreatic digestive enzymes – Secretes hormones when acidic chyme enters duodenum Secretin – Tells pancreas to secrete bicarbonate – Tells liver to make bile Cholecystokinin (CCK) – Tells pancreas to release protein-digesting enzymes – Tells the gallbladder to release stored bile. – Therefore, it stimulates digestion of fat and protein. GIP – stimulates insulin secretion Motilin – Initiates peristalsis (increases GI motility) – Tells the Chief cells to secrete pepsinogen – Secretes enzymes to break down polysaccharides Maltase: breaks maltose down into glucose Lactase: breaks lactose down to galactose plus glucose Sucrase: breaks sucrose down into fructose plus glucose 76 Small Intestine Duodenum – When there is no more chyme entering the duodenum, it secretes glucose-dependent insulinotropic peptide (GIP). – GIP is synthesized by K cells, which are found in the duodenum and jejunum. – GIP stimulates insulin secretion. – Insulin is in the blood stream. It takes the absorbed sugars and pulls them into cells that need it. – GIP also stimulates lipoprotein lipase activity in adipocytes. This causes fat to be broken down into fatty acids. 77 Lipid digestion and absorption • Lipid digestion utilizes lingual and pancreatic lipases, to release fatty acids and monoglycerides. – Bile salts improve chemical digestion by emulsifying lipid drops – Lipid-bile salt complexes called micelles are formed 78 Fatty Acid Absorption • Fatty acids and monoglycerides enter intestinal cells via diffusion; bile salts can be reused to ferry more monoglycerides • They are combined with proteins within the cells • Resulting chylomicrons are extruded • They enter lacteals and are transported to the circulation via lymph 79 Small Intestine Jejunum – Absorbs water-soluble vitamins, protein and carbohydrates. – The proteins began to be broken down into amino acids in the stomach by pepsin and acid. – Proteins are further broken down into amino acids in the duodenum by trypsin and chymotrypsin (made by the pancreas and secreted into the duodenum). – The carbohydrates are broken down in the duodenum by enzymes from the pancreas and liver into sugars. 80 Small Intestine Ileum – Absorbs fat-soluble vitamins, fat, cholesterol, and bile salts. – Fats are broken down into fatty acids in the duodenum. First, bile emulsifies the fat (breaks it down into droplets). Then, lipase (made in the pancreas) breaks the fat into fatty acids, which are small enough to be absorbed. 81 Pancreas Enzymes The pancreas secretes about one and a half liters of pancreatic juice a day! Pancreatic juice secretion is regulated by the hormones secretin and cholecystokinin, which is produced by the walls of the duodenum upon detection of acid food, proteins and fats. The enzymes produced by the pancreas include – Lipases – Amylases – Proteases 82 Pancreas Enzymes Lipases – Digestion of fats, oils, and fat-soluble vitamins Amylases – Break down starch molecules into smaller sugars. – Break down carbohydrates into maltose Proteases – Break down protein into smaller amino acids – Proteases include trypsin, chromotrypsin and carboxypeptidase. – Proteases are also responsible for keeping the small intestine free from parasites (intestinal worms, yeast overgrowth and bacteria). – A lack of proteases can cause incomplete digestion that can lead to allergies and the formation of toxins. 83 Regulation of Pancreatic Secretion • Secretin and CCK are released when fatty or acidic chyme enters the duodenum • CCK and secretin enter the bloodstream • Upon reaching the pancreas: – CCK induces the secretion of enzyme-rich pancreatic juice – Secretin causes secretion of bicarbonate-rich pancreatic juice • Vagal stimulation also causes release of pancreatic juice 84 The Pancreas Exocrine function (98%) – Acinar cells make, store, and secrete pancreatic enzymes Endocrine function – – cells (delta cells) release somatostatin (inhibitory to gastrin and insulin and glucagon) – β-cells –release insulin – α-cells-Release glucagon 85 The Pancreas as an Endocrine Gland Insulin – Beta cells – Promotes glucose uptake – Prevents fat and glycogen breakdown and inhibits gluconeogenesis – Increases protein synthesis – Promotes fat storage Epi/Norepi inhibit insulin! Help maintain glucose levels during times of stress and increase lipase activity in order to conserve glucose levels Picture from:http://www.dkimages.com/discover/Home/Health-and-Beauty/Human-Body/Endocrine-System/Pancreas/Pancreas-1.html 86 The Pancreas as an Endocrine Gland Glucagon – Increases blood glucose levels – Maintains blood glucose between meals and during periods of fasting by breaking down glycogen (stored in liver) into glucose. – Initiates glycogenolysis in liver (within minutes). – Stimulates gluconeogenesis. This process involves breaking down amino acids (proteins) into glucose. – Stimulates amino acid transport to liver to stimulate gluconeogenesis – Nervous tissue (brain) does not need insulin; but is heavily dependent on glucose levels! Image from: http://www.dkimages.com/discover/previews/768/74261.JPG 87 Liver and Gallbladder The liver produces bile that is either stored by the gallbladder or secreted into the small intestine. – Bile emulsifies fats and fat-soluble vitamins. – It also helps keep the small intestine free from parasites. The liver does not make the digestive enzymes for carbohydrates, amino acids and proteins (the pancreas and small intestine do that), but the liver does metabolize proteins, carbohydrates and cholesterol. It also is responsible for the detoxification of toxins, drugs and hormones. 88 Large Intestine The large intestine absorbs water, electrolytes and some of the final products of digestion. Food products that cannot go through the villi, such as cellulose (dietary fiber), are mixed with other waste products from the body and become hard and concentrated feces. 89 Physiology of the large intestine – Reabsorption of water and electrolytes – Coliform bacteria make: Vitamins – K, biotin, and B5 – Organic wastes are left in the lumen 90 Phases of gastric secretion Cephalic phase Gastric phase Intestinal phase 91 Cephalic phase This phase occurs before food enters the stomach and involves preparation of the body for eating and digestion. Sight and thought stimulate the cerebral cortex. Taste and smell stimulus is sent to the hypothalamus and medulla oblongata. After this it is routed through the vagus nerve and release of acetylcholine. Gastric secretion at this phase rises to 40% of maximum rate. Acidity in the stomach is not buffered by food at this point and thus acts to inhibit parietal (secretes acid) and G cell (secretes gastrin) activity via D cell secretion of somatostatin. 92 G cell secretion of gastrin D cell secretion of somatostatin 93 G cells and Gastrin G cells are found deep within the gastric glands of the stomach. When food arrives in the stomach, the parasympathetic nervous system is activated. This causes the vagus nerve to release a neurotransmitter called Gastrin-releasing peptide onto the G cells in the stomach. Gastrin-releasing peptide, as well as the presence of amino acids in the stomach, stimulates the release of gastrin from the G cells. Gastrin tells parietal cells to increase HCl secretion, and it also stimulates other special cells to release histamine. Gastrin also tells the chief cells to produce pepsinogen. Gastrin is inhibited by low pH (acid) in the stomach. When enough acid is present, it turns off. 94 Gastrin Gastrin is released in response to – Stomach distension – Vagus nerve stimulation – The presence of proteins or amino acids Gastrin release is inhibited by – The presence of enough HCl in the stomach (negative feedback) – Somatostatin also inhibits the release of gastrin 95 D cells D cells can be found in the stomach, intestine and the Islets of Langerhans in the pancreas. When gastrin is present, D cells increase somatostatin output. When D cells are stimulated by Ach, they decrease somatostatin output. 96 Somatostatin Somatostatin is also known as growth hormone-inhibiting hormone. It suppresses the release of gastrointestinal hormones – Gastrin – Cholecystokinin (CCK) – Secretin – GIP It suppresses the release of pancreatic hormones. It slows down the digestive process. It inhibits insulin release. It inhibits the release of glucagon. 97 Gastric phase This phase takes 3 to 4 hours. It is stimulated by distension of the stomach, presence of food in stomach and decrease in pH. This activates the release of acetylcholine which stimulates the release of more gastric juices. As protein enters the stomach, it binds to hydrogen ions, which raises the pH of the stomach. Inhibition of gastrin and gastric acid secretion is lifted. This triggers G cells to release gastrin, which in turn stimulates parietal cells to secrete gastric acid. Acid release is also triggered by acetylcholine and histamine. 98 Intestinal phase This phase has 2 opposing actions: the excitatory and the inhibitory. Partially digested food fills the duodenum. This triggers gastrin to be released. It also triggers the enterogastric reflex, which inhibits the Vagus nerve. This activates the sympathetic nervouse system, which causes the pyloric sphincter to tighten to prevent more food from entering the duodenum. 99 Digestive Enzymes Salivary glands -amylase lingual lipase Stomach pepsin Intestinal Mucosa sucrase maltase lactase Pancreas amylase trypsin chymotrypsin carboxypeptidase lipase cholesterolesterase 100 The Activities of Major Digestive Tract Hormones 101 Figure 24.22 Organ Pancreas Region of the Organ Acinar cells Acinar cells Substances Amylase (enzyme) Lipase (enzyme) Acinar cells Acinar cells Protease enzymes (trypsin, chymotrypsin, carboxypeptidase) Bicarbonate (not an enzyme) Islet of Langerhans; Alpha cells Islet of Langerhans; Beta cells Islet of Langerhans; Delta cells glucagon (hormone) insulin (hormone) Somatostatin (hormone) Function Breaks down starch and carbohydrates into glucose Breaks down fat into fatty acids Breaks down proteins into amino acids and also kills intestinal parasites and bacteria Raises pH in duodenum Causes glycogenolysis, the process which breaks down glycogen into glucose to raise blood glucose. Also causes gluconeogenesis to make new glucose molecules Removes glucose in bloodstream and brings it into cells. Lowers blood glucose levels. Inhibits gastrin, insulin, and glucagon (inhibits digestive system) Liver Bile (a detergent) Salivary glands Amylase (enzyme) Stomach Mucous (not an enzyme) Protect the stomach lining Prostaglandins (not an enzyme) Protect the stomach lining Breaks down starch and carbohydrates into glucose Parietal cells HCl (not an enzyme) Parietal cells Intrinsic factor (not an enzyme) Allows Vit B12 to be absorbed, which is needed to make RBCs. Without it, you get megaloblastic (pernicous) anemia. Chief cells G cells Pepsinogen --> pepsin (enzyme) Gastrin (hormone) Breaks proteins into amino acids Tells parietal cells to secrete HCl Duodenum Secretin (hormone) CCK (hormone) K cells GIP (hormone) Motilin (hormone) Allows Pepsinogen to be converted to pepsin, and it also kills bacteria Tells pancreas to secrete bicarbonate Tells pancrease to secrete proteases, and tells gallbladder to release stored bile (stimulates fat and protein digestion) Tells pancreas to release insulin and also causes fat to be broken down into fatty acids Initiates perstalsis and tells Chief cells to secrete pepsinogen Maltase, Lactase, Sucrase (enzymes) Break down complex carbohydrates into glucose 102 The Ovaries Small, almond-shaped organs, each 1 ½” x 1” Within the peritoneal cavity on the posterior body wall Covered by a superficial epithelium called the VISCERAL PERITONEUM. Held in place by mesentery called MESOVARIUM Also held in place by ligaments – BROAD LIGAMENT: where the mesentery attaches to the uterine (fallopian) tube; this is an extension of the mesovarium. – SUSPENSORY LIGAMENT: holds the ovary superiorly – OVARIAN LIGAMENT: connects ovary to the uterus Ovarian arteries – arterial supply through the mesentery to the ovary The Female Reproductive System Figure 24.11a Female Internal Reproductive Organs Figure 24.10 Ovary Medulla Cortex Tunica albuginia Primary follicle Secondary follicle Graafian follicle Primary Follicle • The oocyte is surrounded by a group of cells called FOLLICULAR CELLS. • The whole structure is called the PRIMARY FOLLICLE. • At puberty there is a change in hormones which causes development of some of these oocytes. Primary Follicle Oocyte Follicular cells The Ovarian Cycle Ovulation – occurs about halfway through each ovarian cycle – Oocyte exits from one ovary (it is now called an ovum) Enters the peritoneal cavity – Is swept into the uterine tube Luteal Phase – occurs after ovulation – Remaining follicle becomes a corpus luteum Secretes progesterone Acts to prepare for implantation of an embryo Secondary follicles with oocyte The Ovarian Cycle Primary follicles with oocyte Graafian follicle with oocyte ovum corpus luteum Figure 24.13 The average ovarian cycle is 28 days. Day 1 This is the first day of menstruation. The primary follicle begins to develop. The female sex cycle begins on the first day of menstruation. OVARIAN CYCLE Day 1-7 The oocyte develops and the follicle cells grow and divide. The adenohypophysis secretes FSH (follicle stimulating hormone). This causes 20-30 eggs to be stimulated in both ovaries. Day 1 Day 7 SECONDARY FOLLICLE It has now become a SECONDARY FOLLICLE, which starts to produce the hormone ESTROGEN. Estrogen causes a build up the lining of the uterus and also inhibits the development of the follicles. Secondary follicles with oocyte The Ovarian Cycle Primary follicles with oocyte Graafian follicle with oocyte ovum corpus luteum Figure 24.13 Day 14: GRAAFIAN FOLLICLE The follicle is fully mature = GRAAFIAN FOLLICLE. The oocyte is now fully mature = ovum The ovum is surrounded by a ring called the CORONA RADIATA. It is then surrounded by a space = ANTRUM, which contains a clear fluid. The antrum is surrounded by the follicular cells. OVULATION The mature follicle is still producing estrogen. It has become so big that it forms a blister on the outside of the ovary. The adenohypophysis secretes another hormone called LH (leuteinizing hormone). LH causes fluid to rapidly flow into the antrum, which then expands and pops, which also breaks through the tunica albuginia. The egg and corona radiata are released into the peritoneum. This process is called OVULATION. Can be some pain. Ovulation OVULATION The follicle cells that are leftover remain in the ovary and are called the CORPUS LUTEUM (“yellow body”). After a pregnancy the corpus luteum disintegrates into dead tissue; a white scar called the CORPUS ALBICANS (“white body”). In autopsy, you can see how many of these scars are present to determine the number of pregnancies she had. The Ovarian Cycle CORPUS ALBICANS corpus luteum Figure 24.13 Day 14-21 The egg takes a week to make its way down to the entrance of the uterus. The follicular cells continue to grow and now they make progesterone, which builds the uterus lining so it’s ready for the egg by the time it gets there. Ovarian Cycle Day 23 If no fertilization, the egg starts to break down. Day 27 There is no more estrogen. Day 28 Menstruation starts as the uterine lining breaks down Day 1 FERTILITY PILLS Women who have trouble conceiving take fertility pills = FSH, which causes 100 follicles to develop, 4-5 of which may mature multiple births. BIRTH CONTROL PILLS Birth Control Pills are made of estrogen, so they inhibit the development of the follicles, but the uterine lining still grows. They are taken for 3 weeks, then one week is taken off to allow for menstruation. Some of the new estrogen pills can cause a period only every 3 months instead, but there are side effects. Estrogen The estrogen allows for deposition of subcutaneous fat, which is what gives women their curves. In pregnancy, the breasts get larger, the mammary glands get bigger. Fertilization If the egg is fertilized, the corpus luteum grows until the pregnancy is over and then disintegrates into the CORPUS ALBICANS, which is a scar that can be seen on autopsy; reveals the number of pregnancies she had. UTERINE (FALLOPIAN) TUBES The ovary is in the peritoneal cavity, surrounded by the peritoneum, with an egg releasing. The uterine tube has FIMBRIAE (“fingers”) that surround the ovary. When the egg is released, it goes into the peritoneal cavity, but the CILIA that line the uterine tube create a current that drags the egg in. Uterine Tube UTERINE(FALLOPIAN ) TUBES The uterine (fallopian) tubes are held up by the broad ligament and the suspensory ligament. The uterine tubes are about 10cm long (3”), but only 7/10cm in diameter, and the actual lumen where the tube enters the uterus is tiny. The Uterine Tubes Figure 24.11a The Uterine Tubes The uterine tube is made of the INFUNDIBULUM (funnel), the AMPULLA (most of the tube), and the ISTHMUS (the part of the tube closest to the uterus). The ampulla is where fertilization usually occurs. If the egg implants outside of the uterus or on the external surface of the wall of the uterus, it is called an ECTOPIC PREGNANCY. The most common location for an ectopic pregnancy is the uterine tubes. ECTOPIC PREGNANCY The egg is normally fertilized in the uterine tube, goes down into the uterus and implants there. If it implants anywhere else, it is called an ECTOPIC PREGNANCY. If it implants in the uterine tube = TUBAL PREGNANCY, a type of ectopic pregnancy. The uterine tube is the most common location for an ectopic pregnancy. Ectopic pregnancies are fatal to the mother and embryo, but nowadays there are few deaths of the mother because it is very painful, so she will go to the ER and they will do surgery. PELVIC INFLAMMATORY DISEASE Sperm swim out of the opening of the uterine tube and into the peritoneal cavity. That means any STD can also enter there, causing PELVIC INFLAMMATORY DISEASE (PID), which is when it spreads to the ovaries. It could then continue to all organs in the pelvis EXCEPT those organs which are retroperitoneal (Kidney, ureter, and urethra). It includes SALPINGITIS (inflammation of the uterine tube). PID The most common cause of PID and infertility in women is STD, usually Chlamydia or gonorrhea. The inflammation and scarring closes off the uterine tube; although PID does not inhibit ovulation, it can lead to sterility. UTERUS Endometrium UTERUS It is held in place by by the ROUND LIGAMENT and mesentery = the BROAD LIGAMENT. When a woman stands upright, the uterus sits on top of the urinary bladder The Female Reproductive System Figure 24.11a Layers of the Uterus ENDOMETRIUM (two layers) – STRATUM FUNCTIONALE – STRATUM BASALE: the deeper layer, can divide and grow to replace itself. UTERUS The stratum functionale develops with the hormone cycle, which causes it to grow, along with its glands and blood vessels. When the hormones stop, the stratum functionale breaks down, leaving only the stratum basale. UTERUS Deep to the endometrium is the MYOMETRIUM, made of smooth muscles which contract during birth. The PERIMETRIUM (Or Epimetrium) is the name of the visceral perineum. ENDOMETRIOSIS Pieces of the endometrium are supposed to fall down the vagina, but sometimes its cells go up the uterine tube and enter the peritoneal cavity. They can lodge anywhere; on top of the fundus, even on the lung pleura. One lady got a collapsed lung every month! FIBROIDS These are benign tumors like scar tissue in the myometrium. They can get large and be painful, especially during contraction of menses and pregnancy. Fibroids are the most common reason for hysterectomy (surgical removal of the uterus). EXTERNAL GENITALIA = VULVA Parts of the vulva MONS PUBIS is a pad of adipose tissue above the pubic symphysis, covered with pubic hair. LABIA MAJORA is an extension on either side of the vestibule, also with pubic hair. It is the female equivalent of the scrotum. LABIA MINORA is medial to the labia majora. They are thin folds of tissue and erectile tissue. CLITORIS (equivalent of the penis), which also has erectile tissue. The clitoris is covered by a PREPUCE and has a CORPORA CAVERNOSA. The External Genitalia and Female Perineum Figure 24.20 EPISIOTOMY A purpose of an episiotomy during childbirth is to minimize tearing of the central tendon and muscles of the pelvic floor. Reproductive System Cancers in Females Ovarian cancer – arises from cells in the germinal epithelium Endometrial cancer – arises from the endometrium of the uterus Cervical cancer – slow-growing, arises from epithelium at the tip of the cervix Reproductive System Cancers in Females Breast cancer – Second most common cause of cancer deaths in women 97% occurs in women over 50 Usually arises from cells in the milk ducts When the skin is dimpled from breast cancer, the suspensory ligaments of the breast are causing the dimpling. Treatment – – – – Surgical removal of the mass (lumpectomy) Radiation therapy Administration of selected hormones Chemotherapy Embryology Embryology – study of the origin and development of single individual This is an amazing process that one cell can grow into an entire organism is 9 months! Remember, typical (diploid) cells of the body have 46 chromosomes; and each gamete has 23 chromosomes. -At the moment of conception, you spent about half an hour as a single cell. Fertilization occurs in the ampulla portion of the uterine tube. The most common site of ectopic pregnancy is the uterine tube Figure 3.3 hCG Hormone The trophoblast cells secrete a hormone = hCG (human chorionic gonadotrophin). This hormone maintains the growth of the uterine lining. If no hCG is present, there will be menses. hCG is the hormone which is measured in a pregnancy test. It will be in sufficient quantities to be measured within about one week after a missed period. Implantation CHORIONIC VILLI are projections from the fetus that burrow into the uterus. The capillaries within a chorionic villus of the placenta contain blood from the fetus only, not the mother. Therefore, this tissue can be used for genetic testing for birth defects. Figure 3.4 FETAL DEVELOPMENT The heart starts to pump during the fourth week. Male and female fetuses can first be distinguished by their genitals at 3 months. Birth Defects FETAL ALCOHOL SYNDROME from the mother drinking alcohol is the most common cause of mental retardation in the United States. The most common birth defects worldwide involve the heart and circulation. Fetal Alcohol Syndrome Birth Defects A TERATOGEN (“monster maker”) is any chemical, physical, or biological agent that induces birth defects. THALIDOMIDE was a medicine used for morning sickness in the late 1950’s and early 1960’s until it was found to cause the babies to be born without arms and legs. About 20,000 babies in 46 countries were affected. Teratogen Affect EMBRYONIC DEVELOPMENT OF THE SCROTUM 7 Months in utero The testis (singular) is retroperitoneal, located up high, above the pubic symphysis. The vas deferens comes off it. A fibrous band = GUBERNACULUM goes from the pubic symphysis and inserts onto the skin under the penis. 7 Months 8 Months The gubernaculum shrinks, and testes are pulled down. The peritoneum forms a pouch =VAGINAL PROCESS. The abdominal muscles come down and goes around the testes. 8 months Birth The vaginal process is pinched off, forming the TUNICA VAGINALIS. The vas deferens goes into the abdominal cavity. The DARTOS MUSCLE (cutaneous) lines the scrotum, leading in to the CREMASTER MUSCLE. – The function of the cremaster muscle is to help keep a gonad cool or warm. Decent of the Gonads Figure 24.29a-c Spermatic Cord Vas deferens (ductus deferens) Cremaster muscle Spermatic (testicular) artery and vein Pampiniform plexus (Nerves and lymphatic vessels). The Dartos and cremaster muscles both elevate the testes in the cold so they can stay warm, and they relax in the heat to allow the testes to descend to stay cool. – Tight underwear can cause a low sperm count ERECTION IN MALES The erectile tissue is lined by tissue which extends into itself, creating vascular spaces which can fill with blood, causing the penis to become more rigid and expand. The erection is due to vasodilation, with blood moving into erectile tissue. The Male Reproductive System The testes: this is the primary sex organ in the male, not the penis. The scrotum – skin and superficial fascia surrounding the testes – Positioning provides an environment 3˚ cooler than body temperature Dartos muscle – layer of smooth muscle Cremaster muscle – bands of skeletal muscle surrounding the testes – Elevates the testes Testes In order for sperm to be produced, the temperature has to be a few degrees lower than normal (3˚ cooler). To insure a lower temperature, the testes are located outside of the body, in the scrotum (outside of the pelvis). The temperature is maintained by muscles that elevate and depress the testes. Problems at Birth 1. CONGENITAL INGUINAL HERNIA – The vaginal process doesn’t close off completely, and a piece of intestine gets caught there INGUINAL HERNIA – If you do heavy lifting, it increases the abdominal pressure, and a piece of intestine gets pushed into the opening called the inguinal canal. Requires surgery. 2. UNDESCENDED TESTES – Sperm will still be able to exit from the body, male sex hormones will still circulate in the body, and the testes will still have adequate blood supply. However, viable sperm will not be produced. Needs a surgery to yank them down. Structure of the Testes Are enclosed in a serous sac – the tunica vaginalis Tunica albuginea – fibrous capsule of the testes – Divides each testis into 250-300 lobules Lobules contain 1-4 coiled seminiferous tubules The Testes Figure 24.3a The Seminiferous Tubules Seminiferous tubules – They are 70 cm (2 feet) long. Function of seminiferous tubules is to make sperm. – Spermatogenic cells – sperm-forming cells – Columnar sustentacular cells – support cells Interstitial Cells Between the seminiferous tubules are groups of cells = INTERSTITIAL CELLS, which produce testosterone. Epididymis The seminiferous tubules come together to form the EPIDIDYMIS, the tube of which is 5 meters (the width of this room!). The function of the epididymis is to allow sperm to mature and to store them. It takes 20 days for the sperm to go from production to storage. If sperm is not ejaculated, it will just die and be phagocytyzed. The epididymis has smooth muscles for peristalsis during ejaculation to move the sperm along. The Epididymis Tube leading out of the epididymis Figure 24.3a Spermatic Cord The SPERMATIC CORD leaves the epididymus and contains the spermatic artery, vein, nerves, and the DUCTUS (VAS) DEFERENS which is the tube that carries the sperm out of the epididymis. The Vas deferens is long, 45cm (2 feet). It goes through the inguinal canal, loops around urinary bladder and down the other side. It’s easy to see on a cat. The Ductus (Vas) Deferens Figure 24.1 The Spermatic Cord Figure 24.2 Most common cause of infertility In spermatic cord is a network of vessels. The veins there can become varicose = VERICOCELE. As they expand, there is less blood flow, temperature drops in testes leading to infertility. Second most common cause of infertility is STD (inflammation blocks vas deferens). Seminal Vesicles Posterior to the urinary bladder = SEMINAL VESICLES The EJACULATORY DUCT meets up with the PROSTATIC URETHRA in the prostate. Seminal Vesicle Figure 24.1 Seminal Fluid The functions of the seminal vesicles (60%) and the prostrate (40%) are to produce most of the seminal fluid (seminal fluid plus sperm = semen). Functions of the Semen Medium for sperm to swim in Nutrients for sperm (fructose) Neutralizes acidity in vagina to allow sperm to survive Prostate The urethra goes through the middle of the prostate, and the prostate continues to grow throughout life. PROSTATIC HYPERTROPHY – Can constrict the urethra, causing retention of urine because it is hard to urinate. Needs surgery to open. Final Journey of the Sperm The vas deferens picks up fluid from the prostate, and the semen enters the urethra. It picks up more secretions from the bulbourethral glands. BULBOURETHRAL GLANDS At the base of the urethra Secretes mucous during erection Function is to lubricate the urethra for sperm to swim in and neutralize pH from urine there. – It allows the semen to flow and survive. – Only a small amount of fluid is produced. Review The testes are the primary sex organ in the male because it makes the hormone that creates secondary male sex characteristics. A male secondary sex characteristic is a deep voice, facial hair, prominent thyroid cartilage. Sperm is made in the testes, goes into the vas deferens, loops over the urinary bladder, and goes into the seminal vesicle and prostate gland. Bulbourethral Gland Figure 24.1 Cross-Section of Penis In cross-section, within the penis there are three tubes (2 posterior) called CYLINDERS OF ERECTILE TISSUE. The posterior two are the CORPUS CAVERNOSUM (Corpora cavernosa, plural). The anterior one is the CORPUS SPONGIOSUM, within which is the urethra. Cross-Section of Penis The Penis Figure 24.8a, b The Penis Figure 24.8a, b Penile Erection The erectile tissue in the corpora cavernosa is lined by dense fibrous connective tissue which extends into itself, creating vascular spaces which can fill with blood, causing the penis to become more rigid and expanding. The erection is due to vasodilation, with blood moving into erectile bodies (tissue). The corpus spongiosum doesn’t get as rigid or it would squeeze urethra shut. Viagra Medicine which allows vasodilation, but if you have heart disease, it can give you a heart attack. An erection squeezes the veins shut so the blood can’t leak out. If Viagra (or anything else) causes an erection for longer than four hours (called priapism), the erection decreases the blood flow, and the tissue is killed. Other Problems with the Penis Hypospadia is the most common congenital abnormality of the urethra, and is in males only. The skin around the urethra does not close all the way, and the urethra is open to the outside of the body. It requires surgical closure within one year of birth. Hypospadias Reproductive System Cancers in Males Testicular cancer – Affects 1 of 50,000 males – Cured in 95% of cases Prostate cancer – Slow-growing – Risk factors Fatty diet Genetic predisposition