GASTROINTESTINAL TRACT

PHYSIOLOGY

by
ADEJARE, A. A.

Department of Physiology
Faculty of Basic Medical Sciences
College of Medicine
University of Lagos
 OUTLINE
• General organization/functional anatomy of the GIT
• Review of smooth muscle function
• GIT motility
• GIT secretions and hormones
• Digestion and absorption of food substances
 Digestion
 Process whereby the body breaks down food into absorbable
nutrients.
 The gastrointestinal system is the portal through which nutritive
substances, vitamins, minerals, and fluids enter the body
 To digest food, five different body organs secrete digestive
juices: the salivary glands, the stomach, the small intestine, the
liver (via the gallbladder), and the pancreas.
 These secretions enter the GI tract at various points along the
way, bringing an abundance of water and a variety of enzymes.
 Mouth
 Digestion of carbohydrate begins in the mouth, where the
salivary glands secrete saliva, which contains water, salts,
and enzymes
 The salivary enzyme amylase begins digestion.
 Starch is attacked by salivary α-amylase.
 However, the optimal pH for this enzyme is 6.7, and its
action is inhibited by the acidic gastric juice when food
enters the stomach
 Mouth
• Protein
• Chewing and crushing moisten protein-rich foods and mix
them with saliva to be swallowed
• Fat
The sublingual salivary gland in the base of the tongue
secretes as salivary lipase. Some hard fats majorly neutral
fats and cholesterol begin to melt as they reach body
temperature.
The enzymes in the mouth do not affect the fats, proteins,
vitamins, minerals, and fiber that are present in the foods
people eat.
 Stomach
 Secretes hydrochloric acid:
 Begins protein digestion.
 Kills microorganisms in food.
 Block salivary amylase activity
 mucus that coats and protects the stomach’s lining.

 Initiates breakdown of proteins. Both pepsin and the stomach acid

involved. The pepsin precursors are called pepsinogens and are
activated by gastric acid.

 Human gastric mucosa contains a number of related pepsinogens,

(pepsinogen I and pepsinogen II). Pepsinogen I is found only in acid-
secreting regions, whereas pepsinogen II is also found in the pyloric
region. Maximal acid secretion correlates with pepsinogen I levels.

 Protein is converted to proteoses, peptones and polypeptides

 Stomach
Fat
The acid-stable salivary/lingual lipase splits one bond of
triglycerides to produce diglycerides and fatty acids. The
stomach’s churning action mixes fat with water and acid. A
gastric lipase accesses and hydrolyzes a very small amount of
fat. (minimal effect)
 Small Intestine
 Most digestion and absorption occurs in the small intestine.
 Pancreatic enzymes released to digest carbohydrates,
proteins and fats.
 Bile released to emulsify fat.

 Final digestive enzymes in intestinal lining break down

carbohydrates, proteins and fats into absorbable units.

α dextrinase
 Small intestine
• Pancreatic enzymes for protein digestion
 Small intestine
Protein

Then enzymes on the surface of the small intestinal

cells hydrolyze these peptides and the cells absorb
them.
• Only a small percentage of the proteins are digested all the
way to their constituent amino acids by the pancreatic
juices.
• The last digestive stage of the proteins is achieved by the
enterocytes that line the villi of the small intestine
• Aminopolypeptidase and dipeptidases present in the
microvilli of the enterocytes split the remaining
polypeptides into tripeptides and dipeptides and a few into
amino acids.
• Both the amino acids plus the dipeptides and tripeptides
are easily transported through the microvillar membrane to
the interior of the enterocyte.
• Finally, the enterocytes contain
peptidases that are specific for
the remaining types of linkages
between amino acids.
• the last dipeptides and
tripeptides are digested to form
single amino acids;
• these then pass on through to
the other side of the enterocyte
and thence into the blood.
• More than 99 per cent of the
final protein digestive products
that are absorbed are individual
amino acids,
 Fat
• Fats are relatively insoluble, which limits their ability to cross
the unstirred layer and reach the surface of the mucosal cells.
However, they are finely emulsified in the small intestine by the
detergent action of bile salts, lecithin, and monoglycerides.

• Most fat digestion begins in the duodenum, pancreatic lipase

being one of the most important enzymes involved
• The first step in fat digestion is physically to break the fat
globules into very small sizes so that the water-soluble digestive
enzymes can act on the globule surfaces. This process is called
emulsification of the fat.
• The emulsification is caused by bile salts and lecithin: make the
fat globules fragmentable
• Apart from causing emulsification, bile salts also cause
formation of micelles that help to accelerate fat digestion
• The bile salt micelles act as a transport medium to carry
the monoglycerides and free fatty acids, both of which
would otherwise be relatively insoluble, to the brush borders
of the intestinal epithelial cells.
• There the monoglycerides and free fatty acids are absorbed
into the blood
• the bile salts themselves are released back into the chyme
to be used again and again for this “ferrying” process.
 fat
 Bile is secreted continuously by the liver and is concentrated and
stored in the gallbladder. Bile is not an enzyme but an emulsifier that
brings fats into suspension in water .After the fats are emulsified,
enzymes can work on them.

Pancreatic lipase flows in from the pancreas (via the

pancreatic duct):
 DIGESTION IN THE LARGE INTESTINE

 Undigested residues, such as some fibers, are not absorbed but

continue through the digestive tract as a semisolid mass.

 Fiber also retains water, keeping the stools soft, and carries some
bile acids, sterols, and fat out of the body.
 Overview of Digestion & Absorption (Cont.)
Vitamin Water and Minerals

Mouth No action. The salivary glands add water to

and disperse and carry food.
salivary
glands

Stomach Intrinsic factor attaches to Stomach acid (HCl) acts on iron to

vitamin B12. reduce it, making it more absorbable.
The stomach secretes enough watery
fluid to turn a moist, chewed mass of
solid food into liquid chyme.

Small Bile emulsifies fat- The small intestine, pancreas, and

intestine soluble vitamins and aids liver add enough fluid so that
in their absorption with approximately 2 gallons are secreted
other fats. Water-soluble into the intestine in a day. Many
vitamins are absorbed. minerals are absorbed. Vitamin D aids
in the absorption of calcium.
Large Bacteria produce vitamin More minerals and most of the water
intestine K, which is absorbed. are absorbed.
 Fibers

Most fiber passes intact through the digestive tract to

the large intestine. Here, bacterial enzymes digest some
fiber:

Fiber holds water; regulates bowel activity; and binds

cholesterol and some minerals, carrying them out of the
body as it is excreted with feces
 Final Digestion Products
 Final digestion products absorbed by cells lining small
intestine.
 Carbohydrates:
 Monosaccharides
 Proteins:
 Amino acids
 Chains of 2 or 3 amino acids
 Fats:
 Fatty acids
 Glycerol
 Monoglycerides
 Vitamins, minerals, water and some larger fat-like
compounds such as cholesterol are not broken down
before they are absorbed.
 The Absorptive System
 Most absorption takes place in the small intestine.
 Small intestine’s inner surface looks smooth, but viewed
through a microscope, it turns out to be wrinkled into
hundreds of folds (folds of Kerckring).
 Each fold is covered with thousands of fingerlike
projections called villi.
 A single villus, magnified still more, turns out to be
composed of several hundred cells, each covered with
microscopic hairs called microvilli.
 Thus, the combination of the folds of Kerckring, the
villi, and the microvilli increases the total absorptive
area of the mucosa perhaps 1000-fold.
 A villus has
➢ A vascular system: for nutrient and water absorption
➢ Central lacteal: for absorption into the lymph
➢ Pinocytic vesicles
➢ Microvilli or brush border
The Villus
 Absorption in the small intestine
 Water: by osmosis from chyme to plasma
 Sodium ions: active transport of sodium from inside the epithelial
cells through the basal and side walls of these cells into paracellular
spaces and by facilitated diffusion from lumen to the inside of the
epithelial cells. Sodium is lost in diarrhea. Enhanced by aldosterone

 Chloride ions: passively “dragged” by the positive electrical charges

of the sodium ions.
 Bicarbonate ions absorption in the duodenum and jejunum:
hydrogen ions are secreted in exchange for the reabsorbed
sodium. The hydrogen ions combine with bicarbonate ions
to form carbonic acid (H2CO3), which then dissociates to
form water and carbon dioxide.
 The water remains as part of the chyme in the intestines,
but the carbon dioxide is readily absorbed into the blood
and subsequently expired through the lungs.
 Bicarbonate ions are however secreted in the ileum and
large intestine by HCO3-Cl antiport system: this
bicarbonate is to help neutralise the acid products
formed by bacteria in the large intestine
 Calcium ions: by active absorption. Regulated by PTH and
Vitamin D.
 Iron ions, potassium, magnesium, phosphate and others:
also by active absorption
 Absorption of nutrients
 Carbohydrates: mainly glucose, galactose and fructose
 Co-transport with sodium through intestinal membrane. This is
because glucose (and galactose) and Na+ share the same
cotransporter, or symport, the sodium-dependent glucose
transporter (SGLT, Na+ glucose cotransporter)
 It is the initial active transport of sodium through the basolateral
membranes that provides the eventual motive force for moving
glucose also through the membranes.
 Fructose is transported by facilitated diffusion all the way
through the intestinal epithelium but not coupled with sodium
transport. Much of the fructose becomes phosphorylated, then
converted to glucose, and finally transported in the form of
glucose the rest of the way into the blood.
SGLT-1 is responsible for uptake
of dietary glucose from the gut.
The related transporter, SGLT 2,
is responsible for glucose
transport out of the renal tubules

Because the intracellular Na+

concentration is low in intestinal
cells as it is in other cells, Na+
moves into the cell along
its concentration gradient.
Glucose moves with the Na+
and is released in the cell

When the Na+/glucose

cotransporter is congenitally
defective, the resulting
glucose/galactose malabsorption
causes severe diarrhea that is
often fatal if glucose and
galactose are not promptly
removed from the diet.
 Proteins: mainly as amino acids, mono and dipeptides
 Also co-transport with sodium or through membrane
transport proteins
 At least seven different transport systems transport amino
acids into enterocytes. Five of these require Na+ and
cotransport amino acids and Na+ in a fashion similar to
the cotransport of Na+ and glucose
 The di- and tripeptides are transported into enterocytes by
a system known as PepT1 (or peptide transporter 1) that
requires H+ instead of Na +
 There is very little absorption of larger
peptides. In the enterocytes, amino acids
released from the peptides by intracellular
hydrolysis plus the amino acids absorbed
from the intestinal lumen and brush border
are transported out of the enterocytes along
their basolateral borders by at least five
transport systems. From there, they enter
the hepatic portal blood. Absorption of
amino acids is rapid in the duodenum and
jejunum but slow in the ileum.

 Only 2–5% of the protein in the small

intestine escapes digestion and absorption.
Some of this is eventually digested by
bacterial action in the colon. Almost all of
the protein in the stools is not of dietary
origin but comes from bacteria and cellular
debris.
 FAT ABSORPTION
 The fate of the fatty acids in enterocytes depends on their
size. Fatty acids containing less than 10 to 12 carbon
atoms are water-soluble enough that they pass through the
enterocyte unmodified and are actively transported into
the portal blood. They circulate as free (unesterified) fatty
acids.
 The fatty acids containing more than 10 to 12 carbon
atoms aretoo insoluble for this. They are reesterified to
triglycerides in the enterocytes. In addition, some of the
absorbed cholesterol is esterified. The triglycerides and
cholesterol esters are then coated with a layer of protein,
cholesterol, and phospholipid to form chylomicrons.
These leave the cell and enter the lymphatics.
Absorbed fatty acids (FA) and
monoglycerides (MG) are
reesterified to form triglyceride
(TG) in the smooth endoplasmic
reticulum.
Apoproteins synthesized in the
rough endoplasmic reticulum are
coated around lipid cores, and the
resulting chylomicrons are
secreted from the basolateral pole
of epithelial cells by exocytosis
 TRANSPORT OF LIPIDS: LIPOPROTEINS
 Within the circulatory system, lipids always travel from
place to place bundled with protein, as lipoproteins.
 VLDL, LDL, HDL, and chylomicrons transport newly
absorbed lipids from the intestinal cells to the rest of the
body.
 The liver can assemble different lipoproteins, which are
known as VLDL. As the body’s cells remove triglycerides
from the VLDL, the proportions of their lipid and protein
contents shift. As this occurs, VLDL become cholesterol-
rich LDL.
 Cholesterol returning to the liver for metabolism or
excretion from other parts of the body is packaged in
lipoproteins known as HDL.
Lipid transport and use
Lipoproteins & Lipid Transport, and Distribution
 Two Major Groups of Lipoproteins

 Low-density lipoproteins (LDL)

o Deliver cholesterol to peripheral tissue

o May end up in arterial plaque

o Considered to be bad lipoproteins

 High-density lipoproteins (HDL)

o Transport excess cholesterol from peripheral tissues to the liver

o Does not cause circulatory problems

 𝐋𝐢𝐩𝐢𝐝 𝐏𝐫𝐨𝐟𝐢𝐥𝐞 Story

 𝐀 𝐫𝐞𝐧𝐨𝐰𝐧𝐞𝐝 𝐝𝐨𝐜𝐭𝐨𝐫 𝐬𝐡𝐚𝐫𝐞𝐝 𝐚 𝐛𝐞𝐚𝐮𝐭𝐢𝐟𝐮𝐥 𝐬𝐭𝐨𝐫𝐲 𝐞𝐱𝐩𝐥𝐚𝐢𝐧𝐢𝐧𝐠 𝐥𝐢𝐩𝐢𝐝 𝐩𝐫𝐨𝐟𝐢𝐥𝐞𝐬 𝐢𝐧 𝐚

𝐮𝐧𝐢𝐪𝐮𝐞 𝐰𝐚𝐲.

 𝐈𝐦𝐚𝐠𝐢𝐧𝐞 𝐨𝐮𝐫 𝐛𝐨𝐝𝐲 𝐢𝐬 𝐚 𝐬𝐦𝐚𝐥𝐥 𝐭𝐨𝐰𝐧. 𝐓𝐡𝐞 𝐦𝐚𝐢𝐧 𝐭𝐫𝐨𝐮𝐛𝐥𝐞𝐦𝐚𝐤𝐞𝐫𝐬 𝐢𝐧 𝐭𝐡𝐢𝐬 𝐭𝐨𝐰𝐧 𝐚𝐫𝐞
𝐂𝐡𝐨𝐥𝐞𝐬𝐭𝐞𝐫𝐨𝐥.

 𝐓𝐡𝐞𝐲 𝐡𝐚𝐯𝐞 𝐬𝐨𝐦𝐞 𝐚𝐜𝐜𝐨𝐦𝐩𝐥𝐢𝐜𝐞𝐬 𝐭𝐨𝐨. 𝐓𝐡𝐞 𝐦𝐚𝐢𝐧 𝐩𝐚𝐫𝐭𝐧𝐞𝐫-𝐢𝐧-𝐜𝐫𝐢𝐦𝐞 𝐢𝐬 𝐓𝐫𝐢𝐠𝐥𝐲𝐜𝐞𝐫𝐢𝐝𝐞.

 𝐓𝐡𝐞𝐢𝐫 𝐣𝐨𝐛 𝐢𝐬 𝐭𝐨 𝐫𝐨𝐚𝐦 𝐭𝐡𝐞 𝐬𝐭𝐫𝐞𝐞𝐭𝐬, 𝐜𝐚𝐮𝐬𝐢𝐧𝐠 𝐜𝐡𝐚𝐨𝐬, 𝐚𝐧𝐝 𝐛𝐥𝐨𝐜𝐤𝐢𝐧𝐠 𝐭𝐡𝐞 𝐫𝐨𝐚𝐝𝐬.

 𝐓𝐡𝐞 𝐇𝐞𝐚𝐫𝐭 𝐢𝐬 𝐭𝐡𝐞 𝐜𝐢𝐭𝐲 𝐜𝐞𝐧𝐭𝐞𝐫 𝐨𝐟 𝐭𝐡𝐢𝐬 𝐭𝐨𝐰𝐧. 𝐀𝐥𝐥 𝐫𝐨𝐚𝐝𝐬 𝐥𝐞𝐚𝐝 𝐭𝐨 𝐭𝐡𝐞 𝐡𝐞𝐚𝐫𝐭. 𝐖𝐡𝐞𝐧 𝐭𝐡𝐞
𝐭𝐫𝐨𝐮𝐛𝐥𝐞𝐦𝐚𝐤𝐞𝐫𝐬 𝐢𝐧𝐜𝐫𝐞𝐚𝐬𝐞 𝐢𝐧 𝐧𝐮𝐦𝐛𝐞𝐫, 𝐲𝐨𝐮 𝐤𝐧𝐨𝐰 𝐰𝐡𝐚𝐭 𝐡𝐚𝐩𝐩𝐞𝐧𝐬. 𝐓𝐡𝐞𝐲 𝐭𝐫𝐲 𝐭𝐨
𝐝𝐢𝐬𝐫𝐮𝐩𝐭 𝐭𝐡𝐞 𝐡𝐞𝐚𝐫𝐭'𝐬 𝐟𝐮𝐧𝐜𝐭𝐢𝐨𝐧.

 𝐁𝐮𝐭 𝐨𝐮𝐫 𝐛𝐨𝐝𝐲-𝐭𝐨𝐰𝐧 𝐡𝐚𝐬 𝐚 𝐩𝐨𝐥𝐢𝐜𝐞 𝐟𝐨𝐫𝐜𝐞 𝐭𝐨𝐨.

 𝐇𝐃𝐋 𝐢𝐬 𝐭𝐡𝐞 𝐠𝐨𝐨𝐝 𝐜𝐨𝐩 𝐰𝐡𝐨 𝐚𝐫𝐫𝐞𝐬𝐭𝐬 𝐭𝐡𝐞 𝐭𝐫𝐨𝐮𝐛𝐥𝐞𝐦𝐚𝐤𝐞𝐫𝐬 𝐚𝐧𝐝 𝐩𝐮𝐭𝐬 𝐭𝐡𝐞𝐦 𝐛𝐞𝐡𝐢𝐧𝐝 𝐛𝐚𝐫𝐬
(𝐭𝐡𝐞 𝐥𝐢𝐯𝐞𝐫). 𝐓𝐡𝐞 𝐥𝐢𝐯𝐞𝐫 𝐭𝐡𝐞𝐧 𝐭𝐡𝐫𝐨𝐰𝐬 𝐭𝐡𝐞𝐦 𝐨𝐮𝐭 𝐨𝐟 𝐭𝐡𝐞 𝐛𝐨𝐝𝐲 𝐭𝐡𝐫𝐨𝐮𝐠𝐡 𝐭𝐡𝐞 𝐝𝐫𝐚𝐢𝐧𝐚𝐠𝐞
𝐬𝐲𝐬𝐭𝐞𝐦.
 𝐇𝐨𝐰𝐞𝐯𝐞𝐫, 𝐭𝐡𝐞𝐫𝐞'𝐬 𝐚 𝐛𝐚𝐝 𝐜𝐨𝐩 𝐭𝐨𝐨, 𝐋𝐃𝐋, 𝐰𝐡𝐨'𝐬 𝐩𝐨𝐰𝐞𝐫-𝐡𝐮𝐧𝐠𝐫𝐲.

 𝐋𝐃𝐋 𝐫𝐞𝐥𝐞𝐚𝐬𝐞𝐬 𝐭𝐡𝐞 𝐭𝐫𝐨𝐮𝐛𝐥𝐞𝐦𝐚𝐤𝐞𝐫𝐬 𝐟𝐫𝐨𝐦 𝐣𝐚𝐢𝐥 𝐚𝐧𝐝 𝐩𝐮𝐭𝐬 𝐭𝐡𝐞𝐦 𝐛𝐚𝐜𝐤 𝐨𝐧 𝐭𝐡𝐞 𝐬𝐭𝐫𝐞𝐞𝐭𝐬.

 𝐖𝐡𝐞𝐧 𝐭𝐡𝐞 𝐠𝐨𝐨𝐝 𝐜𝐨𝐩 𝐇𝐃𝐋 𝐢𝐬 𝐨𝐮𝐭𝐧𝐮𝐦𝐛𝐞𝐫𝐞𝐝, 𝐭𝐡𝐞 𝐭𝐨𝐰𝐧 𝐛𝐞𝐜𝐨𝐦𝐞𝐬 𝐜𝐡𝐚𝐨𝐭𝐢𝐜. 𝐖𝐡𝐨 𝐥𝐢𝐤𝐞𝐬
𝐥𝐢𝐯𝐢𝐧𝐠 𝐢𝐧 𝐬𝐮𝐜𝐡 𝐚 𝐭𝐨𝐰𝐧?

 𝐃𝐨 𝐲𝐨𝐮 𝐰𝐚𝐧𝐭 𝐭𝐨 𝐫𝐞𝐝𝐮𝐜𝐞 𝐭𝐡𝐞 𝐭𝐫𝐨𝐮𝐛𝐥𝐞𝐦𝐚𝐤𝐞𝐫𝐬 𝐚𝐧𝐝 𝐢𝐧𝐜𝐫𝐞𝐚𝐬𝐞 𝐭𝐡𝐞 𝐠𝐨𝐨𝐝 𝐜𝐨𝐩𝐬?

 𝐒𝐭𝐚𝐫𝐭 𝐰𝐚𝐥𝐤𝐢𝐧𝐠!_ 𝐖𝐢𝐭𝐡 𝐞𝐯𝐞𝐫𝐲 𝐬𝐭𝐞𝐩, 𝐭𝐡𝐞 𝐠𝐨𝐨𝐝 𝐜𝐨𝐩𝐬 𝐇𝐃𝐋 𝐰𝐢𝐥𝐥 𝐢𝐧𝐜𝐫𝐞𝐚𝐬𝐞, 𝐚𝐧𝐝 𝐭𝐡𝐞
𝐭𝐫𝐨𝐮𝐛𝐥𝐞𝐦𝐚𝐤𝐞𝐫𝐬 𝐂𝐡𝐨𝐥𝐞𝐬𝐭𝐞𝐫𝐨𝐥, 𝐓𝐫𝐢𝐠𝐥𝐲𝐜𝐞𝐫𝐢𝐝𝐞, 𝐚𝐧𝐝 𝐋𝐃𝐋 𝐰𝐢𝐥𝐥 𝐝𝐞𝐜𝐫𝐞𝐚𝐬𝐞.

 𝐘𝐨𝐮𝐫 𝐭𝐨𝐰𝐧 (𝐛𝐨𝐝𝐲) 𝐰𝐢𝐥𝐥 𝐫𝐞𝐠𝐚𝐢𝐧 𝐢𝐭𝐬 𝐯𝐢𝐭𝐚𝐥𝐢𝐭𝐲. 𝐘𝐨𝐮𝐫 𝐡𝐞𝐚𝐫𝐭 𝐭𝐡𝐞 𝐜𝐢𝐭𝐲 𝐜𝐞𝐧𝐭𝐫𝐞 𝐰𝐢𝐥𝐥 𝐛𝐞 𝐬𝐚𝐟𝐞
𝐟𝐫𝐨𝐦 𝐭𝐡𝐞 𝐭𝐫𝐨𝐮𝐛𝐥𝐞𝐦𝐚𝐤𝐞𝐫𝐬' 𝐛𝐥𝐨𝐜𝐤𝐚𝐝𝐞𝐬 (𝐡𝐞𝐚𝐫𝐭 𝐛𝐥𝐨𝐜𝐤). 𝐀𝐧𝐝 𝐰𝐡𝐞𝐧 𝐲𝐨𝐮𝐫 𝐡𝐞𝐚𝐫𝐭 𝐢𝐬
𝐡𝐞𝐚𝐥𝐭𝐡𝐲, 𝐲𝐨𝐮'𝐥𝐥 𝐛𝐞 𝐡𝐞𝐚𝐥𝐭𝐡𝐲 𝐭𝐨𝐨.

 𝐒𝐨, 𝐬𝐭𝐚𝐫𝐭 𝐰𝐚𝐥𝐤𝐢𝐧𝐠 𝐰𝐡𝐞𝐧𝐞𝐯𝐞𝐫 𝐲𝐨𝐮 𝐠𝐞𝐭 𝐭𝐡𝐞 𝐜𝐡𝐚𝐧𝐜𝐞!

 Central message

 Stay healthy...and have a good health

 This is quite a good article to increase the
GOOD HDL and decrease the BAD LDL mainly
by walking. Every walking step will increase
HDL.

 THEREFORE, WALK, WALK and WALK.

 Indigestible Matter

 After digestion and absorption of nutrients, indigestible

matter, such as fiber moves into the large intestine.
 Indigestible matter is compacted by removing water.
 Little nutrient absorption occurs in large intestine.
 Absorption in the large intestine
• Sodium ions: by active transport
• Chloride ions: by co transport with sodium
• Bicarbonate ions: are secreted by counter transport
with chloride ions
• Water: osmosis
Water
Typical volume and
composition of fluid that
traverses the small and large
intestines daily.

Of the 9 L of fluid typically

presented to the small
intestine each day, 2 L are
from the diet and 7 L are
from secretions (salivary,
gastric, pancreatic, and
biliary).

The absorptive capacity of

the colon is 4–5 L per day.
 Absorption of vitamins and minerals
• Most vitamins are absorbed in the upper small
intestine, but vitamin B12 is absorbed in the ileum
(in the presence of intrinsic factor)
• Vitamin B12 absorption and folate absorption are
Na+-independent, but all seven of the remaining
water-soluble vitamins—thiamin, riboflavin, niacin,
pyridoxine, pantothenate, biotin, and ascorbic
acid—are absorbed by carriers that are Na+
cotransporters.
• A total of 30–80% of ingested calcium is absorbed Ca 2+ absorption is
facilitated by protein. It is inhibited by phosphates and oxalates because
these anions form insoluble salts with Ca2+ in the intestine.
• Magnesium absorption is also facilitated by protein.

• Iron
• In adults, the amount of iron lost from the body is relatively small.
The losses are generally unregulated, and total body stores of iron
are regulated by changes in the rate at which it is absorbed from the
intestine. Most of the iron in the diet is in the ferric (Fe3+) form,
whereas it is the ferrous (Fe2+) form that is absorbed.
• Fe2+ is transported into the
enterocyte by the apical membrane
iron transporter DMT1. Heme is
transported into the enterocyte by a
separate heme transporter (HT), and
HO2 releases Fe2+ from the heme.
Some of the intracellular Fe2+ is
converted to Fe3+ and bound to
ferritin. The rest binds to the
basolateral Fe2+ transporter
ferroportin (FP) and is transported
to the interstitial fluid. The transport
is aided by hephaestin (Hp). In
plasma, Fe2+ is converted to Fe3+
and bound to the iron transport
protein transferrin (TF).