4/03/2015

The gastrointestinal system

UTS, Faculty of Health

Anatomy and Physiology: Pregnancy
and Childbirth
Subject Number: 92272
Heather Pierce

References & Resources

Waugh & Grant, Chapter 12
Stables & Rankin Chs: 21,22,23
Marieb & Hoehn, Chapter 23
Tucker Blackburn, Chapter 12
Other resources:
http://www.foodauthority.nsw.gov.au/consumers/lifeevents-and-food/pregnancy/#.UYc-xTZ-_EY
http://www.nutritionaustralia.org/national/resource/hea
lthy-eating-during-pregnancy
http://www.nlm.nih.gov/medlineplus/pregnancyandnutri
tion.html

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Objectives
GIT anatomy, functions & processes
GIT physiology: travel through the GIT
Accessory organ functions:
Liver
Gallbladder
Pancreas

Maternal implications

Digestive System: Overview

The gastrointestinal (GI) tract (digestive /alimentary
canal) digests and absorbs food
GI tract:
Continuous fibro muscular tube
mouth, pharynx, oesophagus, stomach, small and
large intestine, bowel and anus
Approx 4.5m long from mouth to anus
Accessory digestive organs
teeth, tongue, tonsils, gallbladder, salivary glands,
liver, gall bladder and pancreas

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Digestive Process
The GI tract is a disassembly line
Gradual breakdown of foods until they are in a
form suitable for absorption
The constituents of food are released: amino
acids, mineral salts, fat & vitamins
Digestive enzymes are secreted into the canal by
specialised glands
After absorption, nutrients are used to provide
the raw materials for the manufacture of new
cells, hormones, enzymes and energy

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Figure 23.2

Gastrointestinal Tract Activities

Ingestion
taking food into the digestive tract
Propulsion
swallowing and peristalsis: waves of contraction & relaxation of
muscles in the organ walls, mixes and moves content along tract
Mechanical digestion
chewing, breakdown, mixing, and churning food
Chemical digestion
catabolic breakdown of food by enzymes present in secretions
Absorption
movement of nutrients to the blood or lymph capillaries
Defaecation
elimination of indigestible solid wastes

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Peritoneum and Peritoneal Cavity

Peritoneum serous membrane of the abdominal cavity
Visceral covers external surface of most digestive
organs
Parietal lines the body wall
Peritoneal cavity
Lubricates digestive organs
Allows them to slide across one another
Mesentery double layer of peritoneum that provides:
Vascular and nerve supplies to the viscera
A means to hold digestive organs in place and store fat

GI tract anatomy
From the oesophagus to the anal canal the walls of
the GI tract have the same four tunics
mucosa
submucosa
muscularis externa
serosa
Each tunic has a predominant tissue type and a
specific digestive function

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Figure 23.6

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Nerve Supply of GI tract

Supplied by parasympathetic and sympathetic NS (autonomic)
Actions are agonistic; one has a greater influence over the
other according to body needs
PNS:
Vagus nerves (pair of cranial nerves) supply most of canal
and accessory organs
Sacral nerves supply distal part of tract
Stimulation muscular activity/peristalsis
glandular secretion

SNS:
Nerves from the thoracic and lumbar regions
Stimulation muscular activity/peristalsis
stimulation of the submucosal plexus: glandular
secretion

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Functions of the stomach

Stomach size may be 1.5L or more in an adult
Activity of gastric muscles breaks down the bolus &
mixes it with gastric juice
Peristaltic waves propel the contents to the pylorus
Gastric motility and secretion are by the PNS
The pyloric sphincter is closed when stomach active
Chyme: stomach contents after they are liquefied
Chyme is forced through pyloric sphincter when
sufficiently acidified and liquefied

Gastric juice
2L secreted daily
Peaks 1 hour after meal, then to fasting level at 4 hours
Content:
Water: liquefies food
Mineral salts
Mucus: prevents mechanical and chemical injury to the
stomach wall
Hydrochloric acid: kills microbes, acidifies food, provides
environment necessary for digestion
Intrinsic factor: (protein) necessary for absorption of B12
Pepsinogens: inactive enzyme precursors activated into
pepsins by HCl, begin the digestion of proteins

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Secretion of gastric juice

Cephalic phase: flow of juice before food reaches the
stomach due to reflex stimulation by the PNS
initiated by the sight, smell, taste of food
Gastric phase: the presence of food stimulates the
secretion of gastrin, a hormone that passes directly
into the blood, gastrin stimulates the gastric glands
to produce more gastric juice
Intestinal phase: partially digested contents reach
the small intestine. Two hormones, secretin and
cholecystokin slow down the secretion of gastrin and
gastric motility

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Small intestine

Continuous with stomach at the pyloric sphincter

~ 5 m long
Leads to the large intestine
Chemical digestion of food (carbohydrates,
proteins & fats) is completed in the villi
Most of the absorption of nutrients takes place
Three parts: duodenum, jejunum, ileum
Secretion of intestinal juice by the PNS
Site of secretion of horomones secretin and
cholecystokinin

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Small Intestine: Microscopic Anatomy

Figure 23.21

Liver
The largest gland in the body
Situated in right hypochondriac region
Functions:
Carbohydrate metabolism from stored glycogen:
maintains plasma glucose levels
Fat metabolism
Protein metabolism

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Liver functions (cont)

Breakdown of erythrocytes and defense against
microbes
Detoxifies drugs and toxic substances
Produces heat
Secretes bile; bile salts to emulsify fats in the
small intestine
Storage: glycogen, fat soluble vitamins A, D, E, K;
water soluble vitamin B12

Regulation of Blood Glucose Levels

The
hyperglycemic
effects of
glucagon and
the
hypoglycemic
effects of
insulin
Figure 16.17

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The fate of
bilirubin
from the
breakdown
of worn out
erythrocytes

Structure of Haemoglobin

Figure 17.4

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The source,
distribution
and use of
glucose

The Gallbladder
Thin-walled, green muscular sac on the ventral
surface of the liver
Stores and concentrates bile by absorbing its
water and ions

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Regulation of Bile Release

Figure 23.25

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Pancreas
Location
Lies deep to the greater curvature of the stomach
The head is encircled by the duodenum and the
tail abuts the spleen
Exocrine function
Secretes pancreatic juice which breaks down all
categories of foodstuff
Pancreatic juice is alkaline (pH 8), contains
enzymes: amylase and lipase
Endocrine function release of insulin and glucagon

Regulation of Pancreatic Secretion

Figure 23.28

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Large Intestine
1.5 m long; divided into caecum, colon, sigmoid
colon, rectum & anal canal
Functions:
Absorption of water by osmosis; absorption of
mineral salts, vitamins and some drugs
Microbial activity: heavily colonised by bacteria,
eg E coli, which synthesize Vit K and folic acid
Mass movement: a wave of strong peristalsis ~
twice per hour, forcing contents to move into
descending and sigmoid colons, precipitated by
entry of food into the stomach
Figure 23.29a
Defaecation

Large Intestine

Figure 23.29a

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Defaecation

Figure 23.32

Maternal implications
Pancreas: Alterations in glucose metabolism due
to increased insulin resistance may precipitate
diabetes; Blood glucose levels are 10-20% lower:
lower insulin levels so that more glucose is
available for fetus
Gallbladder: reduced muscle tone from
progesterone increases volume and reduces
emptying rate may lead to retention of bile salts
(increased risk of gallstones)
Liver: size and blood flow appear unchanged;
displaced by the uterus; potential discomfort
from itching

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Maternal implications
Secondary effects from hormonal changes:
Increased appetite, cravings, progesterone an
appetite stimulant
Gum swelling/bleeding: effect of oestrogen
Heartburn: reflex oesophagitis from progesterone
smooth muscle relaxation
Delayed gastric emptying in the stomach due to
progesterone and lower gastric juice
No increase in absorption in the small intestine;
Prolonged transit time of chyme and faeces, and
increased water absorption in large intestine can
lead to constipation

Maternal implications
Nutrition: essential as poor nutrition may lead to
low birth weight baby
Metabolism: basal metabolic rate increases,
reflecting increased metabolic demand of fetus;
recommended extra energy requirement
200kcal/day in last trimester (UK) actual
requirements are individual
Facilitated absorption of iron and calcium
Lipids: fat storage increased in first 2 trimesters,
mediated by progesterone

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Maternal Implications

Maternal weight gain: 11-15kg

35% placenta & fetus
62% water
30% fat
8% protein
Obesity issues

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