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The Pancreas
- Spongy gland posterior to greater curvature of stomach
- Head encircled by duodenum, tail on far left, body in between
- Endocrine and exocrine gland: Insulin/glucagon and pancreatic juice
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Pancreatic Juice
- Alkaline mixture of water, enzymes, enzyme precursors, electrolytes
- Bicarbonate buffers stomach acid
- Flows down pancreatic duct and gets into duodenum with bile through hepatopancreatic sphincter
- Also gets into duodenum through accessory pancreatic duct (bypass sphincter)
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Pancreatic Amylase
Digests Starch
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Pancreatic Lipase
Digests Fat
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Nucleases
Break down DNA and RNA
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Proteolytic Enzymes
- Break down proteins
- Secreted as enzyme precursors to avoid breaking down acinar cells themselves
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Acetylcholine
- released from parasympathetic nervous system during cephalic phase
- Stimulates acini to secrete enzymes
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Cholecystokinin (CCK)
- Released from duodenum when fatty chyme is detected
- Stimulates acini to secrete enzymes and relaxes hepatopancreatic sphincter
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Secretin
- Released from duodenum when acidic chyme arrives
- Stimulates liver and pancreas to secrete more sodium bicarbonate to raise pH
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Small Intestine
- Site of almost all chemical digestion and nutrient absorption
- Longest part of the digestive tract (2.4-4.5 m long)
- Smaller diameter than large intestine
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Duodenum
- Begins at pyloric sphincter
- Forms arch
- Ends at duodenojejunal flexure
- Receives chyme, pancreatic juice, bile
- Site of stomach acid neutralization
- Fats emulsified by bile acids
- Pancreatic enzymes continue chemical digestion
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Jejunum
- Begins at duodenojejunal flexure
- 40% of the post-duodenal small intestine
- Rich blood supply
- Site of most digestion and nutrient absorption
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Ileum
- largest part of the SI
- Thin walls, not as much blood supply
- Ends at ileocecal junction
- Ileocecal valve regulates entry of food residue into large intestine
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Microanatomy of SI
Surface area maximized for effective absorption
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Circular Folds
- Large folds in intestinal wall
- Occur from duodenum to middle of ileum
- Cause chyme to flow in spiral path and have more contact with mucosa
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Villi
- Fingerlike projections
- Covered by absorption and goblet (mucous cells)
- Capillaries in villi absorb most of the nutrients
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Microvilli
- Projections on each absorptive cell (villi on villi)
- Increase absorptive surface area
- Brush border enzymes in plasma membrane carry out final stages of digestion
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Intestinal Crypts
- Pores that open into tubular glands between villi
- Secrete 1-2 L of intestinal juice per day
- Secrete it in response to acid, chyme, and intestinal distension
- Contains water, mucus, and a little bit of enzymes
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Intestinal Motility
- 3 Functions of intestinal contractions
- Mix chyme with intestinal juice, bile, and pancreatic juice
- Churn chyme and bring it into contact with mucosa for nutrient absorption
- Move residue towards large intestine
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Segmentation
- Parts of SI walls contract to form segments
- Purpose is for mixing and churning
- Pacemaker cells in muscularis externa control segmentation
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Peristalsis
Wave-like contractions that moves food residue toward large intestine
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Nutrient Digestion and Absorption
Carbohydrates, proteins, lipids, vitamins, minerals
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Carbohydrate Digestion
- Begins in mouth, salivary amylase breaks some starch down into oligosaccharides
- Pancreatic amylase breaks remaining starch down in small intestine
- Brush border enzymes convert oligosaccharides into glucose
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Carbohydrate Absorption
- Plasma membrane of absorptive cells has transport proteins to absorb monosaccharides
- 80% of absorbed sugar is glucose
- Monosaccharides absorbed by capillaries in the villus, then go to liver via hepatic portal vein
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Lactose Intolerance
- Many adults lack lactose enzyme in the brush border
- Lactose passes into large intestine undigested
- Increases osmolarity of intestinal contents, which leads to water retention and diarrhea
- Bacteria in colon digest lactose via fermentation and produce gas
- Yogurt and cheese have bacteria that break down lactose
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Protein Digestion
- Pepsin begins protein breakdown in stomach
- Other enzymes continue digestion in the SI
- Brush border enzymes continue digestion to form amino acids
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Protein Absorption
Very similar to that of carbohydrates
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Lipid Digestion
- Lingual lipase from salivary glands begins lipid digestion (actually occurs in stomach)
- Gastric lipase continues lipid digestion in stomach
- Fat enters duodenum as large globules
- Emulsified by bile
- Broken up by segmentation
- Pancreatic lipase continues to digest lipids in small intestine
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Lipid Absorption
- Absorption of lipids depends on micelles in bile
- In the duodenum micelles absorb fat soluble vitamins, cholesterol, free fatty acids, monoglycerides
- Micelles transport lipids to surface of absorptive cells
- Lipids released and diffuse through plasma membrane
- Micelles recycled
- Free fatty acids and monoglycerides synthesized into triglycerides, packaged into vesicles, secreted into lymph (dumped into bloodstream)
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Vitamin Absorption
- Vitamins not digested (absorbed as-is)
- Fat-soluble vitamins absorbed with other lipids
- Vitamins A, D, E, K
- Not absorbed at all if they are not ingested with fat
- Wat-soluble vitamins absorbed by simple diffusion in SI
- B Complex, C
- B12 absorbed only if intrinsic factor is available
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Mineral (Electrolyte) Absorption
- Absorbed along small intestine
- Na+ and Cl- absorbed constantly
- Iron absorbed as needed
- Stimulated by liver hormone
- Calcium absorbed as needed
- Parathyroid hormone stimulates vitamin D synthesis by liver
- Vitamin D increases ability of duodenum to absorb calcium
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Water Balance
- Digestive tract receives about 9 L of water/day (most from GI secretions)
- 8 L absorbed by SI, .8 L absorbed by LI, .2 L voided in feces
- Diarrhea occurs when LI doesn't absorb enough water
- Occurs if feces passes too quickly because of irritated intestine
- Occurs if feces contains high solute concentration like lactose
- Constipation occurs when feces moves too slowly, too much water is absorbed, and feces hardens
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Large Intestine
Absorbs water and salts out of feces before elimination
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Regions of LI
Regions: Cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal
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Taenia Coli
Longitudinal fibers of muscularis externa
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Haustra
Pouches in the colon caused by taenia coli
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Microanatomy of Large Intestine
- No circular folds of villi
- Intestinal crypts: glands in lamina propia
- Lots of goblet cells secreting mucus
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Bacteria Flora
- About 800 kinds of bacteria in large intestine
- Ferment cellulose and other undigested carbs
- Produces 7-10 L gas/day, most reabsorbed and about 500 ml/day eliminated as flatus
- Produce some sulfur compounds that produce the distinctive smell of feces
- Help synthesize vitamins B and K
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Absorption
- Large intestine takes 12-24 hours to reduce food residue to feces
- Reabsorbs water and electrolytes
- Feces consists mostly of water, but also some bacteria, undigested fiber, fat, mucus, dead epithelial cells
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Motility
- Haustral contractions (equivalent of segmentation) occurs every 30 minTriggered by distention when food enters
- Mass movements (equivalent of peristalsis) occurs 1-3 times/day
- Triggered when food enters stomach and duodenum
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Irritable Bowel Syndrome
- Extremely prevalent digestive disorder
- Intestines either produce very strong, long contractions or exact opposite
- If overactive: food reside is pushed through too quickly, causing gas and diarrhea
- If underactive: residue progresses slowly and too much water is reabsorbed, constipation and intestinal distention result
- Most people control it with strict diet
- No caffein, alcohol, carbonation, lactose etc
- Stress is a major contributor
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Anal Canal
- Passes through levator ani muscle and pelvic floor
- Terminates in anus
- Anal columns and sinuses secrete mucus and lubricant during defecation
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Internal Anal Sphincter
- Smooth muscle of muscularis externa
- (Involuntary)
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External Anal Sphincter
- Skeletal muscle
- (Voluntary)
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Control of Defecation
- Stretching of rectum stimulates defecation reflexes
- External anal sphincter must be voluntarily relaxed
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Intrinsic Reflex
Within myenteric plexus and causes muscularis to contract and intrinsic sphincter to relax
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Parasympathetic Reflex
Activates parasympathetic neurons to cause muscle contraction and internal sphincter relaxation
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