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SILVERTHORN SAMENVATTING/SUMMARY - Chapter 21

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In this document, you get the chapter notes from Chapters 21 from ‘Human Physiology, An Integrated Approach’ (Dee Silverthorn) 7th Edition. These chapters cover the gastrointestinal system. I used these notes to prepare for the SUMMA entrance exam. I ultimately got selected for SUMMA in May 2025. This essentially means that my summaries really effectively and thoroughly cover each chapter (namely Chapters 7 through 26). In other words, you won't miss anything! I include digital images directly from the book. Whether you are trying to catch up in a course, or prepare for the SUMMA entrance exam (like I did), these summaries are excellent. These notes are written in English, as Silverthorn is written in English. If you need associated questions, check out the packet: COMPLEET SUMMA SELECTIE PAKKET, by me! This includes these notes AND over 1400 flashcards covering chapters 7 to 26 (NOTE: the questions I wrote are in Dutch).

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General Anatomical Overview – GI tract
The digestive tract exists as follows:
1.​ Food is immediately taken up by the oral cavity
responsible for the physical breakdown of food.
a.​ Salivary Glands: The submandibular, parotid,
and sublingual glands
2.​ Swallowed food enters the esophagus, connecting the
stomach and oral cavity
a.​ Upper ⅓ propels food using skeletal muscle
b.​ Lower ⅔ propels food using smooth muscle
3.​ The esophagus connects the the stomach, responsible for
continued digest, mixing food with acid and creating chyme
a.​ The stomach is composed of three regions: Upper
fundus, Central body, Lower antrum
b.​ The stomach connects to the S.I. via the pylorus and
pyloric valve (smooth muscle)
4.​ Integrated signals regulate the rate at which chyme enters the
small intestine via the pylorus. The small intestine is
responsible for most of the digestion.
a.​ The small intestine is composed of three regions:
duodenum, jejunum, ileum.
5.​ Digestion in the SI is aided by intestinal enzymes and
exocrine secretion by the pancreas and liver.
6.​ Food continues into the large intestine, responsible for
the absorption of nutrients
a.​ Colon (1st ½): water and electrolytes are
absorbed into the ECF
b.​ Rectum (terminal section): distension of wall responsible for defecation reflex.
7.​ Feces leaves the GI tract via the anus through the external anal sphincter (skeletal muscle)


The GI wall is crumpled to increase surface area
-​ In the stomach these folds are called rugae
-​ Possess tubular invagination: gastric glands
-​ In the small intestine these folds are called plicae
-​ Possess fingerlike projections: villi
-​ Possess tubular invaginations: crypts

,Layers of GI tract Wall
The gut wall is composed of four layers:
-​ Inner mucosa: inner layer of epithelium facing the lumen.
-​ Submucosa:
-​ Muscularis Externa: layers of smooth muscle (2).
-​ Serosa: outermost layer of connective tissue.


#1 – Inner Mucosa: Epithelial layer of GI tract.
The inner mucosa is composed of three layers:
1.​ Mucosal epithelium: epithelial layer of GI tract
a.​ Contains transporting epithelial cells, endocrine and exocrine secretory cells, stem cells.
b.​ At the mucosal surface: cells secreted ions, enzymes, mucus, and paracrine molecules.
c.​ At the serosal surface: substances absorbed pass into the ECF
d.​ Cell-to-cell junctions are tight in the stomach and jejunum, but
e.​ GI stem cells are rapidly dividing. Newly formed cells move from bottom of crypt to top
2.​ Lamina Propria: subepithelial connective tissue
a.​ Contains nerve fibers and blood vessels to supply epithelium
b.​ Contains wandering immune cells
c.​ Collections of lymphoid tissue adjoining the epithelium form small nodules and larger Peyer’s
Patches, a major part of gut-associated lymphoid tissue
3.​ Muscularis Mucosae: thin layer of smooth muscle
a.​ Contraction of muscle in this layer alters effective surface area
#2 – Submucosa: Connective tissue layer of GI tract
-​ Composed of connective tissue with larger blood and lymph vessels
-​ Contains submucosal plexus (one of two major nerve networks of the enteric NS)

, -​ Innervates both epithelial layer and muscularis mucosae
#3 – Muscularis Externa: Outer wall of GI tract, consists of two layers of smooth muscle
-​ Inner smooth muscle: circular → decreases diameter of tube
-​ Outer smooth muscle: Longitudinal → shortens length of tube
-​ Contains myenteric plexus (second of two major nerve networks in enteric NS)
-​ Innervates the muscular activity of the muscularis externa
#4 – Serosa: Continuation of the peritoneal membrane, covering the GI tract.
-​ Peritoneum also forms mesentery


Digestion Function & processes:
The primary function of the digestive system is to move nutrients, water, and electrolytes from the external
environment into the body’s external environment. This is accomplished by:
1.​ Digestion: the chemical and mechanical breakdown of foods.
2.​ Absorption: the movement of substances from the lumen into the ECF.
3.​ Secretion: The movement of substances from the ECF to the lumen OR the release of substances
synthesized by GI epithelial cells into the lumen or ECF.
4.​ Motility: The movement of material in the GI tract, as a result of muscular contraction.
-​ Motility and secretion are the most regulated.
The GI tract faces three significant challenges.
1.​ Avoiding autodigestion: Enzymes used to digest food cannot digest host cells. When protective
mechanisms fail → peptic ulcers.
2.​ Mass balance: Must match fluid input with output
a.​ Input of fluid = 2L/day, exocrine/endocrine output = 7L/day
3.​ Vomiting and diarrhea
4.​ Immune Defense


Secretion
Each day, we secrete more fluids than we ingest. Secretions include:
1.​ Digestive Enzymes: Secreted either by exocrine glands (pancreas and salivary glands) or epithelial
cells (stomach and S.I.)
a.​ Peptide hormones: synthesized on RER, packaged by GA, released on demand by exocytosis.
b.​ Secreted inactively so as to not damage cells known as zymogens (e.g. pepsinogen)
2.​ Mucus: Secretion of glycoproteins called mucins.
a.​ Lubricate the contents of the gut and protect the gut
b.​ Secreted by mucous cells in the stomach and goblet cells in the intestine
c.​ Parasympathetic innervation triggers release
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