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OBJECTIVES

OBJECTIVES

After studying this chapter, you should be able to:

  • Understand the functional significance of the gastrointestinal system, and in particular, its roles in nutrient assimilation, excretion, and immunity.

  • Describe the structure of the gastrointestinal tract, the glands that drain into it, and its subdivision into functional segments.

  • List the major gastrointestinal secretions, their components, and the stimuli that regulate their production.

  • Identify the nature and sources of the major hormones, other peptides, and key neurotransmitters of the gastrointestinal system, and their targets and mechanisms of action.

  • Describe the special features of the enteric nervous system, the mucosal immune system and the splanchnic circulation.

  • Describe water balance in the gastrointestinal tract and explain how the level of luminal fluidity is adjusted to allow for digestion and absorption.

INTRODUCTION

The primary function of the gastrointestinal tract is to serve as a portal whereby nutrients and water can be absorbed into the body. In fulfilling this function, the meal is mixed with a variety of secretions that arise from both the gastrointestinal tract itself and organs that drain into it, such as the pancreas, gallbladder, and salivary glands. Likewise, the intestine displays a variety of motility patterns that serve to mix the meal with digestive secretions and move it along the length of the gastrointestinal tract. Ultimately, residues of the meal that cannot be absorbed, along with cellular debris, are expelled from the body. All of these functions are tightly regulated in concert with the ingestion of meals. Thus, the gastrointestinal system has evolved a large number of regulatory mechanisms that act both locally and over long distances to coordinate the function of the gut and the organs that drain into it. In keeping with its functional continuity with the external environment and its lifelong interaction with a complex microbiota, moreover, the gastrointestinal tract also harbors well-developed innate and adaptive immune systems. Nevertheless, it remains an important portal for infection.

STRUCTURAL CONSIDERATIONS

The parts of the gastrointestinal tract that are encountered by the meal or its residues include, in order, the mouth, esophagus, stomach, duodenum, jejunum, ileum, cecum, colon, rectum, and anus (Figure 25–1). Throughout the length of the intestine, glandular structures deliver secretions into the lumen, particularly in the stomach and mouth. Also important in the process of digestion are secretions from the pancreas and the biliary system of the liver. The intestine itself also has a very substantial surface area, which is important for its absorptive function. The intestinal tract is functionally divided into segments by means of muscle rings known as sphincters, which restrict the flow of intestinal contents to optimize digestion and absorption. These sphincters include the upper and lower esophageal sphincters, the pylorus that retards emptying of the stomach, the ileocecal valve that retains colonic contents (including large numbers of bacteria) in the large intestine, and the inner and outer anal sphincters. After ...

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