1– Discuss the digestion and absorption of carbohydrates
: Carbohydrates are taken in as starches, glycogen and sugars. In the mouth salivary amylase hydrolyses starch → maltose and dextrins. In the stomach little digestion occurs. In the duodenum pancreatic amylase continues the breakdown → maltose, maltotriose and dextrins. In the small intestine brush‑border enzymes (maltase, sucrase, lactase) convert disaccharides → glucose, fructose and galactose. Glucose and galactose are taken up by sodium‑glucose cotransport → enterocytes → portal blood. Fructose enters by facilitated diffusion. All monosaccharides then travel to the liver via the portal vein.
2 – Discuss the digestion and absorption of fats
: Dietary fats are mainly triglycerides. In the mouth and stomach there is no significant hydrolysis. In the duodenum bile salts emulsify the fat droplets → increase surface area. Pancreatic lipase (with colipase) hydrolyses triglycerides → 2 fatty acids + monoglyceride. The products form micelles with bile salts, diffuse to the brush border, and are taken up by enterocytes. Inside the cell fatty acids and monoglyceride are re‑esterified to triglyceride, packaged into chylomicrons and released into lacteals → lymphatic system → thoracic duct → systemic circulation.
3 – Discuss the digestion and absorption of proteins (MØLV)
: Proteins are ingested as large polypeptide chains. In the stomach pepsin (activated by HCl) cleaves proteins → smaller polypeptides. In the duodenum pancreatic proteases (trypsin, chymotrypsin, elastase, carboxypeptidase) further hydrolyse polypeptides → oligo‑peptides and free amino acids. Brush‑border peptidases complete the breakdown to single amino acids. Amino acids are absorbed by active transport (Na⁺‑dependent) and some by facilitated diffusion into enterocytes, then pass into the portal blood and are carried to the liver.
4.– Discuss absorption of water and electrolytes (MSØV)
: The majority of water and electrolytes are absorbed in the small intestine by isotonic absorption. Sodium is actively transported across the mucosa → creates an osmotic gradient that draws water passively. Chloride follows sodium. Potassium is absorbed by diffusion. In the large intestine additional water and electrolytes are absorbed, concentrating the feces.
5– Describe the absorption of vitamins and minerals (MSØV)
: Fat‑soluble vitamins (A, D, E, K) are incorporated into micelles, taken up with dietary lipids, and absorbed with chylomicrons. Water‑soluble vitamins (B‑complex, C) are absorbed by active transport or simple diffusion in the proximal small intestine. Minerals such as iron, calcium, magnesium, zinc are absorbed mainly in the duodenum and jejunum. Iron is taken up by a carrier protein (DMT1) after reduction to Fe²⁺; calcium uses active transport (vitamin D‑dependent) and passive diffusion; magnesium and zinc are absorbed by both active and passive mechanisms.
6.– Observe the liver function test
: Liver function tests include serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ‑glutamyl transferase (GGT) and bilirubin. Elevated ALT and AST indicate hepatocellular injury; raised ALP and GGT suggest cholestasis; increased bilirubin reflects impaired excretory function.
7.– Perform the inspection of gastrointestinal system in clinical examination
: The examiner looks at the abdomen with the patient standing and supine. Observe contour (flat, scaphoid, distended), skin changes (scars, striae, jaundice), visible pulsations, peristaltic waves, and any masses or hernias.
8.– Interpret the findings of inspection of gastrointestinal system in clinical examination (MSØV)
: A normal abdomen is soft, flat or mildly convex, skin intact, no visible pulsations or masses. Distension may indicate obstruction, ascites or organomegaly. Visible peristalsis suggests intestinal hyperactivity. Jaundice points to hepatic or biliary disease. Hernial bulges indicate weakness of the abdominal wall.
9 – Perform the palpation of gastrointestinal system in clinical examination
Answerorgans. The examiner uses fingertips in a systematic pattern (quadrants or clock‑face) while the patient breathes normally.
10 – Interpret the findings of palpation of gastrointestinal system in clinical examination (MSØV)
: Normal findings are a non‑tender abdomen with no palpable masses and a smooth, mobile liver edge. Tenderness suggests inflammation, infection or irritation. Palpable masses may be tumors, enlarged organs or cysts. A rigid board‑like abdomen indicates peritonitis.
11 – Perform the percussion of gastrointestinal system in clinical examination
: Percussion is performed over all four quadrants using the fingertip‑thumb technique. Tympanic sounds are expected over gas‑filled bowel; dullness over solid organs or fluid‑filled areas.
12.– Interpret the findings of percussion of gastrointestinal system in clinical examination (MSØV)
: Normal abdomen yields a tympanic resonance throughout, with dullness over the liver and spleen. Localized dullness may indicate a mass, organomegaly or fluid collection. Hyper‑resonance can suggest excessive gas or pneumoperitoneum.
13.– Perform the auscultation of gastrointestinal system in clinical examination
: Using a stethoscope, listen to all four quadrants while the patient is at rest. Record the frequency, intensity and character of bowel sounds.
14.– Interpret the findings of auscultation of gastrointestinal system in clinical examination
: Normal bowel sounds are intermittent clicks or gurgles occurring 5‑30 per minute. Hyperactive sounds (tinkling, rushes) suggest hypermotility (diarrhea, early obstruction). Hypoactive or absent sounds may indicate ileus, peritonitis or severe obstruction. Continuous high‑pitched sounds can be a sign of vascular compromise.