DIGESTIVE SYSTEM

PRESENTED BY: MR K. MORAPEDI

NSC 121
HUMAN ANATOMY&PHYSIOLOGY
2022/23 SEM 2
 DIGESTIVE SYSTEM
• A system that contributes to homeostasis by breaking down
food, into forms that can be absorbed & used by body cells
• Functions
a. Breakdown of food into smaller fragments
b. Absorbs water, nutrients and vitamins into the blood
stream
c. Eliminates wastes and indigestible remains from body

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DIVISIONS OF THE DIGESTIVE
SYSTEM
• Two groups of organs make the digestive system
1. Gastrointestinal (GI) tract or alimentary canal: Mouth, Pharynx,
esophagus, stomach, small intestine and large intestine.
• Digests food
• Absorbs digested food into the blood
2. Accessory digestive organs: Teeth, Tongue & salivary glands (in the
mouth/ oral cavity)
• liver, gallbladder and pancreas (connect to the GI tract through ducts)
• Only teeth and tongue are in direct contact with food, other accessory digestive
organs are not in direct contact with food, they produce secretions that aid in
chemical breakdown of food.

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D I G E S T I V E S Y S T E M : A N AT O M Y
OVERVIEW

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 DIGESTIVE PROCESSES
• Food need to be broken down into molecules that are smaller enough to enter
body cells, and this happens by the process of Digestion.
• Digestion involves 6 stages or processes
a. Ingestion: Taking food and liquids into digestive tract through mouth
(eating).
b. Propulsion: moves food through the alimentary canal
• Swallowing & Peristalsis
c. Mechanical digestion: physical breakdown of food in preparation for chemical
digestion. Includes chewing, mixing of food with saliva by tongue &
segmentation

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d. Chemical digestion: series of catabolic steps in which complex food molecules are
broken down to their chemical building block by enzyme.
e. Absorption: the passage of end products of digestion, vitamins, minerals and water
from the lumen of the GI tract through the mucosal cells by active or passive transport
into blood or lymph.
f. Defecation: eliminates indigestible substances from the body via the anus in the
form of feces
GASTROINTESTINAL
ACTIVITIES (SUMMARY)

Figure 23.2
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 PERITONEUM
• Largest serous membrane of the abdominopelvic cavity.
• Comprise: Simple epithelium (mesothelium) and areolar connective tissue.
• Divided into: Parietal peritoneum (Lines the wall of abdominopelvic cavity) and
Visceral peritoneum (covers some organs in the cavity).
• Peritoneal cavity found between the two peritoneums.
• Peritoneal cavity contains serous fluid that lubricates mobile digestive organs
• Digestive organs within the peritoneal cavity are called Intraperitoneal organs. Eg
stomach
• Organs covered by peritoneum on anterior surfaces only and lie on posterior
abdominal wall are said to be Retroperitoneal eg Kidneys, pancreas, spleen,
adrenal glands

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 PERITONEAL FOLDS
• Large folds weave between viscera. The folds bind the organs to one another and
to walls of the abdominal cavity and also contain blood vessels, lymphatic vessels
and nerves for abdominal organs.
• 5 major folds: Greater omentum, Falciform ligament, Lesser omentum,
Mesentery and Mesocolon
• Greater omentum: largest. Cover transverse colon and coils of the small intestines.
has large adipose tissue deposit. Also find lymph nodes.
• Lesser omentum: Arise as two folds around stomach and duodenum suspending
them from liver. Has lymph nodes

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 H I S TO LO G Y O F T H E G I T R AC T
• There are structural characteristics which promote similar functions . From esophagus
to anus find same four basic layers which are Mucosa, Submucosa, Muscularis externa
and serosa
• Mucosa: Inner most epithelial membrane from mouth to anus.
• Functions:
• a. Secretion of mucus, digestive enzymes and hormones.
• b. Absorption of end products of digestion into blood.
• c. Protection against infectious disease.

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• Typical digestive mucosa consists of 3 sublayers ie Lining epithelium, lamina propria
and muscularis mucosae
• Lining epithelium – simple columnar epithelium.
• Rich in mucus secreting cells. Mucus facilitates easier food passage along the tract.
Also protects against destruction by some digestive enzymes. E.g, trypsin
• Lamina propria- loose areolar connective tissue.
• Underlies the epithelium
• Its capillaries nourish the epithelium & absorb digested nutrients
• Houses MALT which help defend against pathogens of the digestive tract
• Muscularis mucosae- smooth muscle cells that produce local movement of the mucosa
• E.g twitching dislodges food particles that have adhered to the mucosa
• In the small intestines, responsible for formation of small folds which increase the
intestinal surface area
CONT………
 Submucosa: Just external to mucosa. Areolar connective tissue with blood and
lymphatic vessels, lymphoid follicles and nerve fibers (submucosal plexus). Elastic
fibers in it make stomach regain shape after large meals, Its vascular network
supply tissues surrounding the GI tract wall.
 Muscularis externa: Deep to the submucosa. Function: Segmentation and
peristalsis. Has inner circular and outer longitudinal layers of smooth muscle cells
(Prevent back flow and control food passage from one organ to other,)
 Serosa (visceral peritoneum): Outer most layer of intraperitoneal organs. In
esophagus serosa replaced by adventitia (Areolar connective tissue). Where do
you find serosa and adventitia in retroperitoneal organs?

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BASIC STRUCTURE OF THE
A L I M E N TA RY C A N A L

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Marieb, 2004, Figure 23.6
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ENTERIC NERVOUS SYSTEM OF GI
T R AC T
• GI tract contains an Enteric nervous system (intrinsic) to regulate digestive system activity
• Submucosal and myenteric nerve plexuses are the two major
intrinsic nerve plexuses found in the walls of the GI tract.
oSubmucosal – in submucosa – includes sensory & motor neurons
oRegulates activity of glands and smooth muscle of that layer.
oMyenteric – large – lies between circular and longitudinal
muscle layers – control GI tract motility (movement) –
segmentation and peristalsis.
GI tract also connects to CNS and responds to extrinsic
parasympathetic (Vagus x nerve) and sympathetic(from spinal
cord): (Autonomic Nervous System) nerve stimulation.

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A N AT O M Y O F T H E O R A L
C AV I T Y : M O U T H
• Formed by cheeks, hard and soft
palates and tongue.
• Function
i. Chewing: Baccinator muscles of
cheeks and orbicularis oris muscle
in lips keep food between upper
and lower teeth. The muscles also
assist in speech.
ii. Swallowing : Soft palate and
uvula close nasopharynx peventing
food from entering nasal cavity.
Larynx rise & epiglottis covers
respiratory passageway.
TONGUE • Tongue is muscle (skeletal with
mucous membrane).
• Functions to:
✓ push food to the teeth.
✓ mix food with saliva.
✓forms food into bolus for
swallowing.
✓contain papillae with taste buds
and also aid in speech (intrinsic
muscles).
✓Aid in Chewing and swallowing
(extrinsic muscles).
O R A L C AV I T Y A N D P H A RY N X :
ANTERIOR VIEW

Figure 23.7b
S A L I V A RY G L A N D S
• Saliva acts to cleanse, dissolve, moisten &
chemical breakdown of starch
• Parotid, submandibular, sublingual, buccal
(buccal are scattered throughout –
intrinsic- constantly active)
• Saliva is mostly water, slightly acidic,
contains the enzyme amylase, antibodies &
lysozymes & defensins
• Control of salivation: ANS
(Parasympathetic promotes continous
secretion of saliva, sympathetic stimulation
dominates during stress, or dehydration
resulting in dryness of mouth)

Figure 23.9a
PERMANENT TEETH OF THE
L O W E R J AW

Figure 23.10.2
D E N T I T I O N A N D D E N TA L F O R M U L A
• Teeth classification based on shape and function:
• Incisors: chisel shaped for cutting
• Canines: conical cuspids for tear and pierce
• Premolars (bicuspids) and molars (cusps): Grinding or crushing
• Dental formula: shorthand way of indicating the numbers and relative positions
of different types of teeth on mouth. Ratio for upper/lower jaw teeth for one-
half of mouth.
• Primary dentition: 2I, 1C, 2M (upper jaw)
------------------------------ x 2 = 20 teeth
2I, 1C, 2M (lower jaw)

• Permanent dentition: 2I, 1C, 2PM, 3M (upper jaw)

------------------------------------ x 2 = 32 teeth
2I, 1C, 2PM, 3M (lower jaw)
 TOOTH STRUCTURE (LONGITUDINAL
SECTION OF A CANINE TOOTH)
• Enamel is hardest substance in
body – cells that produce
enamel are gone once the tooth
erupts
• Root is embedded in jawbone.
Molars have more than one root
• Periodontal ligaments anchors
tooth to bone
• Inner part of tooth (pulp)
contains nerve fibers and blood
vessels – nourishes the dentin
• Dentin form majority of tooth
(70% calcifified connective
tissue)

Figure 23.11
DIGESTIVE PROCESS

• chewing
 SWALLOWING (DEGLUTITION)
• Swallowing is a process, whose action could be divided into 3
stages/phases.
1. Oral stage: Only voluntary stage. Bolus forced to the back of oral cavity and into
oropharynx by tongue movement upward and backward against the palate. Muscles
involved: Masseter, temporalis, pterygoids (Chewing), Baccinator and orbicularis oris
(prevents drooling).
2. Pharyngeal stage: Involuntary. The bolus stimulates receptors in oropharynx and
send impulses to the deglutition centre in medulla oblongata and lower pons of brain
stem. Soft palate and uvula move upward to close off nasopharynx thus food
prevented from entering nasal cavity. Epiglottis also closes off larynx and respiratory
tract. Upper esophageal sphincter relaxes owing to cricopharyngeus muscle
relaxation.
3. Esophageal stage: Also involuntary. Begins once bolus enters the esophagus.
Peristalsis pushes the bolus onward to the stomach. Mucus secreted by esophageal
glands lubricates bolus and reduces friction. Refer to histology of the esophagus .
Tortora and Derrickson, 2006. figure 24.9 pg909.
 DEGLUTITION (SWALLOWING)
Bolus of
food

Tongue
Uvula
Pharynx Bolus
Epiglottis
Epiglottis
Glottis

Trachea Esophagus Bolus

(a) Upper esophageal (b) Upper esophageal (c) Upper esophageal

sphincter contracted sphincter relaxed sphincter contracted

Relaxed Relaxed muscles

muscles Circular muscles
contract, constricting
passageway and pushing Gastroesophageal
Bolus of food bolus down sphincter open

Longitudinal muscles
contract, shortening
passageway ahead of bolus

Gastroesophageal
sphincter closed Stomach

(d) (e) Figure 23.13

 STOMACH
• Serve as mixing chamber and holding reservoir
• Secretes gastric juice
• Can accommodate large food quantities
• Digestion of starch and triglycerides continue in the stomach,
protein digestion start
• Semisolid bolus converted to liquid (chyme)
• Has same basic layers of the GI tract ie Mucosa, submucosa,
muscularis and serosa
• There are four main regions in body: Cardia, Fundus, Body and
Pylorus (has two parts pyloric antrum and canal)
Picture of the stomach from a cadever
A N AT O M Y O F T H E S T O M AC H

Figure 23.14a
M I C RO S C O P I C A N AT O M Y O F T H E
STOMACH( FOR USE WITH SLIDE 29 &30 UPNEXT)

Figure 23.15
GASTRIC GLANDS

 Develop from the mucosal layer (Epithelial cells extend down into lamina
propria)
 Contain 3 types of exocrine gland cells: Mucous neck cells, Chief cells and
parietal cells
 The secretions of the cells form gastric juice
 Also have enteroendocrine cell (G cell) located in the pyloric antrum and
secrete hormone gastrin into bloodstream.
 Food can stay in the fundus not mixed with gastric juice: Digestion by
salivary amylase continues, chyme mix with acidic gastric juice, lingual
lipase activated.
 Give names of enzymes active in the stomach and substance acted
upon.
SPECIALIZED CELLS IN GASTRIC
GLANDS
• Mucous cells- found in the “neck” part of the gastric glands.
Not the same mucous as the goblet cells
• Parietal cells – secrete HCl (VERY acidic)- for activation of
pepsin, to kill bacteria, denaturing protein and intrinsic factor
(for absorption of vitamin B12)
• Chief cells- produce pepsinogen – becomes pepsin (HCl
cleaves it) which is needed to digest protein
• Enteroendocrine cells – produce hormones (gastrin, histamine,
serotonin, cholecystokinin, somatostatin). These hormones act
on the digestive process! *G cells produce gastrin*
VOMITING
Is the forcible expulsion of the contents of the upper GI tract
(stomach and sometimes duodenum) through mouth
How is it stimulated?
• Irritation (from bacterial toxins) and distension of the
stomach
• Unpleasant sights,dizziness,
• certain drugs such as morphine.
• Excessive alcohol
 HOW DOES IT HAPPEN?(VOMITTING)

• Nerve impulses are transmitted to the vomiting center (emetic

center) in the medulla oblongata,
• returning impulses propagate to the upper GI tract organs,
diaphragm, and abdominal muscles.
• The diaphragm and abdominal walls contract, increasing intra-
abdominal pressure
• The gastroesophagal sphincter relaxes and the soft palate rises
to close the nasal passages
• As a result, the stomach contents are forced upward through
the oesophagus and pharynx, through to the mouth.

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HOW DOES THE STOMACH PROTECT
ITSELF? MUCOSAL BARRIER

Factors contributing to maintenance of mucosal

barrier:
• Neutralizing mucous on the stomach wall (A thick coating of bicarbonate-rich
mucus).
• Tight junctions to prevent gastric juice from getting into underlying tissue
layers.
• Damaged epithelial mucosal cells are shed and replaced every 3-6 days from
undifferentiated stem cells.
• Enzymes produced in inactive form.
• Some plasma membranes of glandular cells impermeable to HCl.
 RELEASE OF GASTRIC JUICE
• Both neural (vagus nerve & enteric nerves) and hormonal (gastrin)
mechanisms
• Gastrin stimulates secretion of HCl and enzymes
• Stimuli acting on the brain (cephalic), the stomach (gastric) and the small
intestine (intestinal) trigger or inhibit the release of gastric juice,
• Hence there are 3 phases of gastric secretion called
• Cephalic phase / reflex phase- occurs before food enters the
stomach, triggered by aroma, taste or thought of food
• Gastric phase- occurs as food enter the stomach, triggered by
stomach distention and food chemicals (e.g peptides and caffeine)
• Intestinal phase- triggered by entry of partially digested food in
the duodenum as stomach begins to empty.
• READ ABOUT INHIBITORY EVENTS OF GASTRIC JUICE
SECRETION
RELEASE OF GASTRIC JUICE

Figure 23.16
R E G U L AT I O N A N D M E C H A N I S M
OF HCL SECRETION
• Gastrin (peptide hormone)
produced by G cells stimulates
release of HCl by parietal cells
• Stretch receptors in stomach
send signals for ACh release –
stimulates HCl secretion
• Histamine stimulates through
cAMP
• Secretion is inhibited by low
stomach pH

Figure 23.17
 G A S T R I C C O N T R AC T I L E AC T I V I T Y

• Peristaltic waves of contraction from cardia to pylorus in a rhythmn

(3/min) – stomach “beat”
• Only liquid chyme is passed to duodenum
• Pyloric valve opening & closing (in addition to stomach churning)
thoroughly mix the food
• Presence of food in duodenum INHIBIT gastric activity to slow
digestion to rate that duodenum can handle
Figure 23.18
 INTESTINES

• Major events of digestion and absorption occur in the small intestine

following activity of Pancreas, liver and gall bladder
• How are small intestine adapted most of the digestion and absorption
occurring? Length, folds, villi and microvilli.
• Large intestine mark end of absorption, production of vitamins, feces
formation and expulsion
S M A L L I N T E S T I N E : G RO S S A N AT O M Y
Has three subdivisions: duodenum, jejunum, and
ileum.
• The duodenum is shortest. 25cm. From pyloric sphincter to jejunum
• The jejunum. (1m) extends from the duodenum to the ileum
• The ileum (2m) joins the large intestine at the ileocecal sphincter or valve
• Duodenum: Segment where bile and pancreatic juice mix with chyme
• Jejunum-Ileum: Major absorbing segments
SMALL INTESTINE: MICROSCOPIC
A N AT O M Y & D I G E S T I O N
➢3 structural modifications of the small intestine wall increase surface area
• deep circular folds of the mucosa and submucosa
• Villi – fingerlike extensions of the mucosa
• Microvilli – tiny projections of absorptive mucosal cells’ plasma membranes
➢Digestion in the small intestines
• As chyme enters the duodenum from the stomach:
• Carbohydrates and proteins are only partially digested (salivary amylase and
pepsin)
• Most of lipid digestion occur in small intestine by pancreatic lipase
SMALL INTESTINE: HISTOLOGY OF
THE WALL
• The epithelium of the mucosa is made up of:
• Absorptive cells (absorb and digest nutrients in small intestinal chyme) and
goblet cells (secrete mucus).
• Enteroendocrine cells (S cells, CCK cells, and K cells)
• Interspersed T cells called intraepithelial lymphocytes
• Cells of intestinal crypts secrete intestinal juice
• Peyer’s patches are found in the submucosa
• Brunner’s glands in the duodenum secrete alkaline mucus to neutralize gastric acid
in chyme
MOTILITY IN THE SMALL INTESTINE
• The most common motion of the small intestine is segmentation (Mix
chyme with digestive juices and make food particles in contact with
mucosa for absorption)
• It is initiated by intrinsic pacemaker cells
• Moves contents back and forth and steadily toward the
ileocecal valve
• After nutrients have been absorbed:
• Peristalsis begins with each wave beginning distal to the
previous
• Meal remnants, bacteria, mucosal cells, and debris are moved
into the large intestine
S E G M E N TAT I O N

• Local enteric neurons of the GI tract

coordinate intestinal motility
• segmentation involves alternating
contraction and relaxation of circular
smooth muscle cells
• This moves chyme back and forward in the
lumen and thereby mixing the chyme
• As this happens, segmentation also
gradually moves intestinal contents slowly
towards the ileococal valve at a rate slow
enough to allow optimal digestion and
absorption

Figure 23.3
 P E R I S TA L S I S I N T H E S M A L L I N T E S T I N E S
• Peristalsis (involuntary movements of the longitudinal and circular muscles)
• Occurs after most nutrients have been absorbed
• Duodenal mucosa begins to release hormone motilin- as motilin levels rise,
peristaltic waves are initiated in the peristaltic waves are initiated at the
proximal duodenum every 90 to 120 minutes
• Each successive wave is initiated a bit more distally, a process known as
Migrating Motility Complex (MMC). This facilitates sweeping last remnants of
chyme into the large intestines.

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 • Is subdivided into the cecum,
appendix, colon, rectum, and
anal canal
LARGE INTESTINE
• The saclike cecum:Lies below the
ileocecal valve. Is 1st part of the
large intestine
• Appendix: Contain masses of lymphoid
tissue, also ideal place for bacterial
accumulation
• Appendicitis: Swelling of the appendix.
Could result from hard faecal matter
(faecoliths), kinking and foreign
particles. Microbial infection and growth
characteristic.

Figure 23.29a
LARGE INTESTINE: MICROSCOPIC
A N AT O M Y
• Colon mucosa is simple columnar epithelium except in the anal canal
• Has numerous deep crypts lined with goblet cells
• Anal canal mucosa is stratified squamous epithelium(to reduce friction)
• Anal sinuses exude mucus and compress feces
• Superficial venous plexuses are associated with the anal canal
• Inflammation of these veins -- itchy --hemorrhoids
FUNCTIONS OF THE LARGE INTESTINE
• Other than digestion by gut bacteria (Converts proteins to aa, breakdown aa and
produce Vit B and K), no further digestion takes place
• Formation of feces and defecating (empty to rectum)
• Vitamins, water, and electrolytes are reclaimed
• Its major function is propulsion of fecal material toward the anus
BAC T E R I A L F LO R A
• The bacterial flora of the large intestine:
• Colonize the colon
• Ferment indigestible carbohydrates
• Release irritating acids and gases
• Synthesize B complex vitamins and vitamin K
 D E F E C AT I O N R E F L E X
• Distension of rectal walls
caused by feces:
• Stimulates contraction of
the rectal walls
• Relaxes the internal anal
sphincter
• Voluntary signals stimulate
relaxation of the external
anal sphincter and
defecation occurs

Figure 23.32
STRUCTURE OF THE ANAL CANAL

Figure 23.29b
A B S O R P T I O N A N D M E TA B O L I S M
• How are lipids broken down during digestion and how are they
absorbed?
• Describe the chemical digestion of proteins and where this occurs.
• What are the enzymes involved in carbohydrate catabolism and what do
they do?
 A C C E S S O RY O R G A N S
• Not part of the path of food, but play a
critical role.

• Include: Liver, gall bladder,and

pancreas
 LIVER
Liver is second heaviest to skin.
Location: Inferior to diaphragm, occupies right
hypochondriac region and epigastric regions
• Have specialized epithelial cells called Hepatocytes.
• Has highly permeable capillaries called sinusoids.
• Also has phagocytes, kupffer cells.
Blood supply to liver:
➢Hepatic artery (carry oxygenated blood)
➢Hepatic portal vein ( carry deoxygenated blood, nutrients, drugs,
microbes and toxins from GI tract)
Hepatic blood flow
Hepati
c
artery Right
Inferio atrium
Sinusoid Centra Hepati
s
r vena of
Hepati l vein c vein
c cava heart
portal
vein
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FUNCTION OF THE LIVER
• Directly affects digestion by producing bile
➢Bile is used in the emulsification and absorption of lipids in small intestine. Bile
also has sodium and potassium salts.
Other functions of the liver:
• Metabolism of carbohydrates, lipids and proteins.
• filters out toxins and waste including drugs and alcohol.
• Storage of glycogen, vitamins (A, B12, D, E and K), Minerals (Iron, copper).
• Excretion of bilirubin
• Phagocytosis
• Synthesize the active form of Vitamin D (Calcitriol).
 GALL BLADDER

• Pear-shaped, on posterior surface of

the liver.
• Lacks submucosa.
• Empty contents into cystic duct
following contraction of smooth muscle
fibers.
Function of gall bladder
• Stores bile from the liver, concentrate
(water and ions absorbed by gallbladder
mucosa) it and releases into the small
intestine when needed.
Fatty diets can cause gallstones.
 PA N C R E A S
• Location: Retroperitoneal
Function: Has both exocrine and
endocrine functions.
Exocrine portion (99% Acinar cells):
Secrete pancreatic juice (water, salts, sodium bicarbonate
and enzymes. carbohydrates digestion (pancreatic
amylase), Proteins (Trypsin, carboxypeptidase, elastase
and chymotripsin). Lipids (pancreatic lipase). Nucleic
acids (ribonuclease, deoxyribonuclease).

Endocrine portion (1% Islets of

Langerhans): Secrete hormones eg glucagon (α-
cells), insulin (β-cells),somatostatin, pancreatic
polypeptide.
• Regulates blood sugar levels.
• Insulin is a hypoglycemic hormone
• Glucagon is a hyperglycemic
A LT E R AT I O N S I N D I S E A S E
• Gastric ulcers: a break in the mucosal barrier of the stomach
lining that penetrates through the muscularis mucosa and are
greater than 5 mm in diameter
• Generally develop in the antral region of stomach. Damage to
underlying tissues promote gastric ulcers.
• Manifests similarly to duodenal ulcers.
• Epigastric pain usually occurs within 15-30 minutes following a
meal in patients with a gastric ulcer;
• on the other hand, the pain with a duodenal ulcer tends to occur 2-3
hours after a meal
• Predisposing factors: Hypersecretion of hydrochloric acid
• Hyposecretion of mucus (bicarbonate ions)
• Triggered by:
• Aspirin and nonsteroidal (lipid soluble) anti-inflammatory drugs (ibuprofen) ie
ulcerogenic drugs.
• Stimulants (Cigarettes, coffee, alcohol)
• Acid resistant Helicobacter pylori

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CONT……………..
• Jaundice: Yellow color of the skin and whites of the eyes caused by excess
bilirubin in the blood (hyperbilirubinemia).
• normal serum levels of bilirubin < 1mg/dl;
• the clinical presentation of jaundice > 3 mg/dl
• Neonatal jaundice- Congenital disorders, overproduction from hemolysis,
defective bilirubin uptake,
• Adult jaundice- Bile duct stones, drug-induced liver disease, and malignant
biliary obstruction .
• Diarrhea: Increased frequency of defecation, fluidity and volume of
feces.
• There is little time for absorption. Result in dehydration and electrolyte imbalances.

IN HIV PATIENTS

• Decreased absorption of nutrients: Diarrhea can cause malabsorption of nutrients,

such as carbohydrates, fats, and proteins.
• When food moves too quickly through the intestine, there is less time for nutrients to be
broken down and absorbed.
• This can lead to nutrient deficiencies, which can further weaken the immune system and
exacerbate the effects of HIV.

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• Reduced effectiveness of medications:
• Diarrhea can also affect the absorption of medications taken
by HIV-positive individuals.
• If antiretroviral drugs or other medications are not absorbed
properly, they may not work as effectively in controlling the
virus.
• This can lead to a higher viral load and increased risk of
developing opportunistic infections.

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• Electrolyte imbalances:
• Diarrhea can cause significant fluid and electrolyte loss, which can lead to
dehydration, low blood pressure, and other complications.
• Electrolytes, such as sodium, potassium, and magnesium, play important roles
in maintaining the proper function of various bodily systems.
• If electrolyte levels become too low, it can lead to a variety of symptoms,
including weakness, fatigue, muscle cramps, and irregular heartbeat.

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Constipation:
• Difficult or infrequent defecation, characterized by
decreased bowel movement, hard stools.
Can be caused by neurogenic disorders, lack of exercise, diet
(low fiber diet) and muscle weakness.

• Effects of dietary fiber on constipation

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• Increases stool bulk: Dietary fiber absorbs water as it moves through the
digestive system, which helps to increase the bulk of the stool. This, in turn, can
help to stimulate the muscles in the colon and encourage bowel movements
(defecation reflex)

• Softens stool: Fiber can help to soften the stool, making it easier to pass. This is
because fiber helps to retain moisture in the stool, preventing it from becoming
hard and dry.

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• Promotes healthy gut bacteria: Certain types of fiber, such as prebiotic fibers,
are fermented by beneficial gut bacteria in the colon. This fermentation process
produces short-chain fatty acids, which can help to stimulate bowel movements and
promote gut health.

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 DIABETES MELLITUS
• Results from hyposecretion or hypoactivity of insulin
• Excess glucose (hyperglycemia) observed in blood, also appear in urine (glycosuria).
• As glucose not used at cellular level: Lipidema result, severe cases result in fatty acid
metabolites (ketones)
Causes: Genetic abnormalities, mutations, defective receptor proteins, immune disorders,
hormonal imbalances obesity etc
Types of DM
Type I (Insulin dependent): Lack of insulin activity. Leads to vascular and neural
problems due to lipidema and high cholesterol levels.
Type II (non-insulin dependent): Insulin inaqequate or receptors unresponsive, also
called insulin resistance.
REVISION QUESTIONS
1. Describe 3 (three) structural modifications of the small intestines that increase
surface area. 3 marks
2. Explain why a person with chronic gastritis is likely to develop anaemia. 3
marks
• Which layer of the gastrointestinal tract contains blood vessels, elastic fibers &
lymphatic nodules?
• a. mucosa
• [Link]
• c. submucosa
• d. muscularis externa

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3. Which of the following is not a component of gastric juice?
a. Pepsin
b. mucus
c. Amylase
d. Hydrochloric acid
[Link] part of the colon is stimulated by nerve impulse when the defecation reflex is initiated?
a. sigmoid
b. transverse
c. ascending
d. descending
5. Which type of digestion occurs to all solid food ingested in the mouth?
a. Physical digestion by amylase
b. chemical digestion by lingual lipase
c. chemical digestion by teeth
d. mechanical digestion by teeth

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• 6. Which of the following regions of the stomach is in contact with the diaphragm?
• a. body
• b. cardiac
• c. fundus
• [Link]
• 7. List any one cardinal sign of diabetes mellitus and provide the rationale for the
occurrence of the symptom. (2 marks)

6
9