Digestive System - Physiology into glucose and fructose.

c. Lactose is acted on by
of the Pancreas, Liver, and lactase and broken down
Biliary Tree into glucose and galactose.
3. Trypsin, chymotrypsin, and elastase
Scope: This lecture reviews the functions of the all digest proteins.
pancreas, the liver, and the biliary tree. The 4. Lipase digests triglycerides into fatty
pancreas and liver secrete digestive juices and acids and monoglycerides.
enzymes that aid in digestion and absorption. In
this lecture, we review the components of the C. Physiological considerations
exocrine pancreas, the main pancreatic hormones, 1. Almost all pancreatic enzymes are
and the mechanisms by which pancreatic enzymes secreted in an inactive form to
are secreted into the small intestine. After prevent autodigestion
reviewing several pancreatic disorders (pancreatitis (pancreas literally means "eats all
and pancreatic cancer), we turn to the liver and flesh"). Inactive forms end in -gen,
examine the various functions that it performs. We e.g., trypsinogen.
conclude with a review of common liver disorders, 2. In severe pancreatitis, activated
notably jaundice, trauma, hepatocellular enzymes may travel back into the
carcinoma, cirrhosis, and cholelithiasis. pancreas and digest it.
I. The primary processes of digestion and 3. Acinar cells also contain a trypsin
absorption occur in the small intestine. inhibitor that inactivates any active
However, these functions depend heavily on trypsin accidentally released in the
pancreatic tissues.
the digestive juices and hormones secreted by
4. Enterokinase (from the small
the pancreas and the liver. intestine) activates the enzymes
II. The exocrine pancreas has the following once they are in the safe confines of
components and functions: the small intestine.

A. Pancreatic juice III. Basic pancreatic function (chemical

1. The pancreas produces 1,000-1,500 production)
ml per day.
2. It consists mainly of water, NaCl A. Food consists of generally complex
(sodium chloride, or salt), and molecules that are broken down into simple
NaHC03 (sodium bicarbonate). molecules and reassembled into necessary
3. Sodium bicarbonate buffers the compounds by the pancreas, liver, and
juice and makes it alkaline (pH 7.1- other organs.
8.2). B. The body has evolved to favor molecules
4. The alkalinity stops the action of with similar structures.
gastric pepsin and prepares chyme 1. For example, the
for the milieu of the small intestine. cyclopentanophenanthrene ring
structure is common to cholesterol,
B. Pancreatic hormones estradiol, testosterone, and cortisol.
1. Amylase digests the remaining 2. The only differences between these
carbohydrates into simple sugars. It compounds are one or two groups
is released into the blood in cases of attached to the outside of a ring
pancreatitis. structure.
2. Amylase acts on three main sugars. 3. However, these compounds have
These sugars are composed of enormously different functions in the
other, simpler sugar molecules. body.
a. Maltose is acted on by C. The body can replace a particular missing
maltase and broken down compound by modifying the creation
into two molecules of process of a similar compound.
glucose.
b. Sucrose is acted on by IV. Regulation of pancreatic secretion
sucrase and broken down
 b. It is a vital organ; without it,
A. Parasympathetic stimulation to the the organism will die within
pancreas (via the vagus nerve) occurs in days.
response to the digestive processes of the c. It synthesizes proteins from
stomach. amino acids.
1. It stimulates the secretion of all d. It also converts forms of
pancreatic enzymes. amino acids when needed
2. This is a preparation response. for specific proteins.
B. The acid chyme enters the duodenum, e. It converts toxic ammonia
along with partially digested fats, proteins, (from amino acid
and carbohydrates. conversions) into less toxic
1. Enteroendocrine cells of the small urea (which is excreted).
intestine release cholecystokinin f. It uses amino acids and
(CCK) and secretin. proteins for energy
2. These two enzymes circulate into production or storage as fats
the bloodstream. and carbohydrates.
3. These enzymes stimulate secretion 2. Carbohydrate (CHO) metabolism
of pancreatic enzymes into the small a. The liver is the storehouse of
intestine and raise the pH. carbohydrates as glycogen
4. Secretin decreases gastric (glycogenesis) and lipids
secretion; CCK inhibits gastric (lipogenesis).
emptying. b. It can rapidly break down
large amounts of CHO
V. What can go wrong? (glycogenolysis) and release
it as glucose into the
bloodstream.
A. Pancreatitis
c. It can create glucose from
B. Cancer of the pancreas
lactic acid
1. The causes of the rising incidence
(gluconeogenesis).
of pancreatic cancer are not known,
though this disorder is linked to
smoking.
2. There are some 25,000 cases per
year, with 95% mortality 3. Lipid (fat) metabolism
a. The liver can store fats in
various forms.
VI. The liver has multiple functions
b. It can break down and
release stored fat for
A. The portal circulation is the place of extraordinary needs.
absorption and excretion of the liver. c. It synthesizes cholesterol
B. The liver has a reserve capacity of some from fatty acids and vice
50-80%. versa.
C. The liver is one of the few human organs d. Current therapy for high
that can regenerate itself. Though it grows cholesterol uses drugs to
faster than any known cancer, regeneration block hepatocyte
does not become malignant, and the liver mechanisms for cholesterol
will stop growth at approximately its normal synthesis.
size.

D. Liver functions
1. Protein metabolism
4. Excretion of bilirubin
a. The liver synthesizes
a. Bilirubin removes broken-
proteins. It makes almost all
down pigments from dead
prothrombin and fibrinogen
red blood cells.
(clotting factors), as well as
b. It is metabolized with bile
albumin, the major blood
salts and excreted in the
protein.
feces.
 c. In obstructive jaundice, intestine to get ready, and
bilirubin is not excreted, stimulates insulin release
producing clay-colored from the pancreas
feces. (endocrine) to prepare for
5. Processing of hormones and drugs absorption of glucose.
a. The liver detoxifies drugs 2. Secretin is released from the small
and alcohol. intestine.
b. It can be up- or a. Its target organs are the
downregulated to meet pancreas, liver, and
demand. gallbladder.
c. It excretes toxins into bile b. It is released by acid chyme.
and, thence, into the c. It increases the bicarbonate
intestines for excretion. in pancreatic juice and,
d. It alters the molecular thereby, increases the pH to
structures of hormones to neutralize acid. It also
deactivate them. inhibits gastric juice
secretion and maintains the
6. Storage depot pancreas.
a. The liver stores all the fat-
soluble vitamins (A, B12, D, 3. Cholecystokinin (CCK) is also released
E, and K). from the small intestine.
b. It stores iron and copper. a. Its target organs are the
c. The liver stores fat under pancreas, liver, and
stress or damage; too much gallbladder.
storage of fat, iron, or copper b. It is released by fatty acids in
can damage liver cells. the duodenum and by
7. Vitamin D activation partially broken-down
8. Synthesis of bile salts. The bile salts proteins.
emulsify fats to make them more c. It increases bile secretion
water-soluble and easier to absorb. from the liver, stimulates
emptying of the gallbladder,
VII. Intestines closes the pylorus, and
causes a feeling of satiety.
A. The enteroendocrine glands secrete gastrin 4. Other minor hormones
in response to gastric distension and the a. Vasoactive intestinal peptide
presence of proteins in the stomach. turns off gastric acid
1. Gastrin stimulates the parietal cells secretion.
(H+ secreters) of the fundus of the b. Stimulators of intestinal
stomach itself. motility include motilin,
2. It increases gastric motility. bombesin, and substance P.
3. It closes the lower esophageal c. Gastrin-releasing peptide.
sphincter. d. Somatostatin turns off
gastrin release.
B. Small intestine
1. Gastric inhibitory peptide is released VIII. What can go wrong?
from the duodenum and upper small
intestine. A. Trauma to the internal organs and
a. Its target organ is the intestines is often fatal because of the large
stomach. blood supply to these systems.
b. It is released by fatty acids B. Hepatocellular carcinoma is rare in the
and by incompletely broken- United States but common in Africa and
down CHO. Asia. It is related to a combination of insults
c. This hormone inhibits gastric to hepatocytes:
secretion, slows stomach 1. Aflatoxin from fungus (Aspergillus
emptying, allows the small Flavus)
2. Hepatitis B virus infection