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The Digestive System

B. Pimentel, M.D.
University of Makati
College of Nursing
Overview

There are 2 major groups of organs in the digestive


system:
 Alimentary Canal - Organs thru which food
actually passes (in order they are the: oral
cavity, pharynx, esophagus, stomach, small
intestine, and large intestine).
 Accessory Organs - They assist in digestion, but
no food actually passes through them. Includes
the teeth, tongue, salivary glands, pancreas,
liver, and gallbladder.
Overview
Functions

 Ingestion
 Mastication
 Propulsion
 Mixing
 Secretion
 Digestion
 Absorption
 Elimination
The Abdominal Cavity

 The majority of digestive organs are located


 Peritoneum
 Visceral peritoneum
 Parietal peritoneum
 Peritoneal cavity
 Mesenteries
 Retroperitonium
 Duodenum
 Pancreas
 Colon
The Abdominal Cavity
Histology

1. Mucosa - innermost tunic, consists of three


layers.
 Mucosa epithelium, stratified squamous
epithelium
 Lamina propria, loose connective tissue.
 Muscularis mucosae, outer thin smooth
muscle.
Histology

2. Submucosa – thick connective tissue layer


containing nerves blood vessels and small
glands.
3. Muscularis – inner layer of circular smooth
muscle and an outer layer of longitudinal
smooth muscle.
 Exceptions superior esophagus has striated
muscle, and the stomach has three muscular
layers.
4. Serosa or Adventitia – connective tissue.
Histology
Histology
Histology
The Oral Cavity

Boundaries
 Anteriorly by the lips
 Laterally by the cheeks
 Superiorly by the hard
and soft palates
 Inferiorly by the tongue

 Epithelial lining: non-


keratinized stratified
squamous epithelium
The Oral Cavity

STRUCTURE FUNCTION
Lips Mastication, speech,
& entrance
Frenula Mucosal folds attach
upper lip to alveolar
process of the
maxilla, and from the
alveolar process of
the mandible to
lower lip.
Cheeks Mastication ,speech,
& facial expression
The Oral Cavity

Palate (hard & soft) Mastication, soft


palate prevents food
from entering nasal
cavity.
Tongue Movement of food in
mouth for
mastication,
swallowing, taste,
speech.
Intrinsic muscles Flattening and
elevating tongue for
swallowing.
The Oral Cavity

Extrinsic muscles Protrude and retract,


side to side, and
shape change.
Teeth Mastication and
speech
Incisors Cutting or nipping
off food
Canines Tear and pierce
Premolars Grinding and
crushing
Molars Grinding and
crushing
The Oral Cavity
The Oral Cavity
Salivary Glands

Structure Location
Parotid glands Just anterior to the ear,
bilaterally.
Submandibular glands Inferior border of the
posterior mandible
Sublingual glands Immediately below the
mucus membrane in
the floor of the mouth
Salivary Glands
Salivary Glands

Saliva
 Secretion rate 1 to 1.5L/day
 Salivary amylase – serous saliva breaks down apart
glucose molecules in starch and other polysaccharides into
disaccharides.
 Prevents bacterial infection together with lysozyme
 Mucin – proteoglycan that gives saliva a lubricating
quality.
 Stimulated primarily by the parasympathetics and less by
sympathetics.
Esophagus (Gross Anatomy)

 Approx. 25 cm.

 Between pharynx and stomach

 Located in the mediastinum anterior to vertebrae


and posterior to trachea.
Esophagus (Gross Anatomy)

 Esophageal hiatus – opening in diaphragm and


ends at stomach.

 Upper esophageal and Lower esophageal


sphincter – regulate the movement of materials
into and out of esophagus.
Esophagus (Histology)

 Mucosa stratified
squamous epithelium
with mucous glands
that secret a thick
lubricating mucus.
 4 tunics: mucosa,
submucosa,
muscularis, and
adventitia.
Deglutition
Deglutition
Stomach (Gross Anatomy)

 Enlarged segment in left superior part of


abdomen.

 Gastroesophageal opening (cardiac) – opening of


stomach from esophagus.

 Cardiac region – located around the cardiac


opening where food enters from the esophagus
Stomach (Gross Anatomy)

 Fundus – left and superior to the cardiac region.

 Body – largest part of stomach curves to the right


forming the greater and lesser curvature.
 Greater curvature
 lateral surface of the stomach
 anchors the greater omentum
 Lesser Omentum
 medial surface
 anchors the lesser omentum
Stomach (Gross Anatomy)
Stomach (Gross Anatomy)

 Pyloric region – region where body narrows

 Pyloric opening - joins to the small intestine.

 Pyloric sphincter – thick smooth muscle


surrounding the pyloric opening.
Stomach (Gross Anatomy)
Stomach (Histology)

 Serosa – visceral
peritoneum, outer most
layer.

 Muscularis – three layers,


longitudinal layer,
circular layer, and an
inner oblique layer.

 Rugae – large folds of


submucosa and mucosa,
allows stomach to stretch.
Stomach (Histology)

 Stomach is lined with simple columnar cells, with


tube like gastric pits, which are openings for the
gastric glands.

 Surface mucous cells – produce mucus on the


surface and lines the gastric pit.
Stomach (Histology)
Stomach (Histology)

Gastric gland cells


 Mucous neck cells – produce mucus.

 Parietal cells – produce hydrochloric acid and


intrinsic factor.

 Chief cells – produce pepsinogen.

 Endocrine cells –produce regulatory hormones.


Stomach Secretions

Chyme – food and stomach secretions mixed


SECRETION SOURCE FUNCTION

Mucus Surface and neck mucus Lubricates, protects


cells .
Intrinsic factor Parietal cells in gastric Binds with and makes more
glands of the pyloric readily absorbed in the
region. ilium VITAMIN B12
Hydrochloric acid Parietal cells Low pH bactericidal,
denature proteins,
provides proper pH for
Pepsinogen Chief cells pepsin.to pepsin, catalyzes
Converts
the cleavage of peptide
bonds in proteins.
Phase of Secretion
Phase of Secretion
Phase of Secretion
Functions of Gastrointestinal Hormones

Site of Method of
Secretory Effects Motility Effects
Production Stimulation
Gastrin
Distention, Increased gastric
partially emptying by
digested increasing
Stomach & Increases gastric
proteins, motility and
duodenum secretions
autonomic relaxing
stim., alcohol pyloric
& caffeine sphincter.
Functions of Gastrointestinal Hormones

Site of Method of Motility


Secretory Effects
Production Stimulation Effects
Secretin
Inhibits gastric
secretions, stimulates
pancreatic secretions,
Decreases
Duodenum Acidity of chyme increases the rate of
gastric motility
bile and increases
intestinal secretions;
mucus secretion
Functions of Gastrointestinal Hormones

Site of Method of Motility


Secretory Effects
Production Stimulation Effects

Cholycystokinin

Slightly inhibits
gastric secretions,
stimulates pancreatic
Fatty acids and secretions, Decreases
Intestines
other lipids contraction of gall gastric motility
bladder, relaxation
of hepatopancreatic
ampular sphincter.
Site of Method of Motility
Secretory Effects
Production Stimulation Effects

Gastric Inhibitory
Polypeptide

Duodenum & Fatty acids and Inhibits gastric Decreases


Jejunum other lipids secretions gastric motility
Gastric Movements

Mixing of Stomach Contents

 Gentle mixing waves which are peristalsis like


contractions proceed from the body toward the
pyloric sphincter. 80%

 Peristaltic waves occur less frequently,


significantly more powerful, force chyme near the
periphery of the stomach toward the pyloric
sphincter. 20%
Gastric Movements

Stomach Emptying

 Fluids remain in the stomach approx. 1.5 to 2.5


hours, food approx. 3 to 4 hours.

 Each peristaltic contraction is strong enough to


force a small amount of chyme through the
pyloric sphincter and into the duodenum, this is
referred to as Pyloric Pump.
Gastric Movements

Regulation of stomach emptying

 Hormonal – Gastrin

 CNS - distention of stomach wall and local


reflexes

All promote increased in stomach emptying.


Small Intestines

 Consists of three parts:


 Duodenum
 Jejunum
 ilium
 Length approx. 4.6 to 9 meters (14 to 29 feet).
 Site of greatest amount of digestion and
absorption.
 8 to 8.5 liters of water enter the small intestine per
day.
Small Intestines (Duodenum)

 Begins with a short superior end, which is where


it exits the pylorus of the stomach, and ends in a
sharp bend, where it joins the jejunum.

 Major duodenal papilla & lesser duodenal papilla


- two small mounds 2/3 of the down the
descending part. At the major papilla the
common bile duct and pancreatic duct join to
form the hepatopancreatic ampular sphincter
which empties into the duodenum.
Small Intestines (Duodenum)
Small Intestines (Duodenum)

 Hepatopancreatic sphincter - regulates the opening of the


ampular.

 Internal surface has modifications which increase surface


area about 600 fold.

 Circular folds - mucosa and submucosa form a series of


folds.

 Villi- tiny fingerlike projections of the mucosa, simple


columnar epithelium, contains blood capillary network
and lacteals.
Small Intestines (Duodenum)
Small Intestines (Duodenum)
Small Intestines (Duodenum)

 Microvilli - most of the cells of the surface of the


villi have these numerous cytoplasmic projections
to further increase surface area.

 Brush border - the combined microvilli on the


entire epithelial surface.
Small Intestines (Duodenum)
Small Intestines (Duodenum)
Small Intestines (Duodenum)

Cells Function

Absorptive Microvilli, produce digestive enzymes,


absorb digested food

Goblet Produce a protective mucus

Granular cells Protect the intestinal epithelium from


bacteria

Endocrine Produce regulatory hormones


Small Intestines (Jejunum & Ileum)

Similar in structure to duodenum, EXCEPT


1. Gradual decrease in the size of the lumen.
2. Decrease in thickness of the intestinal wall
3. Number of circular folds decrease
4. Decrease in number of microvilli
Small Intestines (Jejunum & Ileum)

 The duodenum and jejunum are major sites of


nutrient absorption.

 Lymph nodes called Peyer’s Patches are


numerous in the mucosa and submucosa of the
ileum.
Small Intestines (Jejunum & Ileum)
Small Intestines (Jejunum & Ileum)

 Ileocecal junction – junction between the ileum


and the large intestine.

 Ileocecal sphincter – ring of smooth muscle.

 Ileocecal valve – one way flow.


Small Intestines (Jejunum & Ileum)

 Duodenal glands, intestinal glands, and goblet


cells secrete large amounts of mucus.

 Mucus provides most of the wall with protection


from the acidic chyme, and digestive enzymes.
Small Intestines (Jejunum & Ileum)

 Secretin & Cholycystokinin are released from the


intestinal mucosa and stimulate pancreatic and
hepatic secretions.

 Enzymes of the intestinal mucosa are bound to the


membranes of the absorptive cell microvilli
Small Intestines (Jejunum & Ileum)

1. Disaccharidase – breaks down disaccharides to


monosaccharides.

3. Peptidase – hydrolyze the peptide bonds of


amino acid chains.

5. Nucleases – break down nucleic acids.


Movements of the Small Intestine

 Mixing and propulsion of chyme are the primary


mechanical events.

 Mechanical movement occurs due to segmental or


peristaltic contractions of the smooth muscle wall,
only propagated small distances.
Movements of the Small Intestine

 Segmental contractions – mix intestinal contents.

 Peristaltic contractions – propel the intestinal


contents along the entire length of the intestine.

 Wave of contraction can begin in the stomach.

 Rate of movement 1cm/min


Movements of the Small Intestine

Regulation
1. Distention of intestinal wall

3. Hypertonic or hypotonic solutions

5. pH of contents
Large Intestine

 Extends from the ileocecal junction to the anus.


 Consists of:
 Cecum
 Colon
 Rectum
 Anal canal
Large Intestine
Large Intestine (Cecum)

 Proximal end of the large intestine.

 Extends approx. 6cm. Inferiorly past the ileocecal


junction to form a blind sac.

 Vermis Appendix – a small blind tube extending


approx. 9cm from the blind sac. Contains many
lymph nodes.
Large Intestine (Cecum)
Large Intestine (Colon)

 Consists of four parts:


 Ascending colon
 Transverse colon
 Descending colon
 Sigmoid colon
Large Intestine (Colon)

The ascending colon


travels up the right
side of the abdominal
cavity and turns
medially (the right
colic flexure or
hepatic flexure) and
travels across the
abdominal cavity as
the transverse colon.
Large Intestine (Colon)

 At the spleen the


transverse colon turns
downward (the left
colic flexure or
splenic flexure) and
descends on the left
side as the descending
colon
Large Intestine (Colon)

 Inferiorly, the
decending colon
enters the pelvis
where it becomes the
sigmoid colon
Large Intestine (Colon)

 The last segment of


the is the anal canal
which begins where
the rectum penetrates
the muscles of the
pelvic floor
Large Intestine (Colon)

 The external opening


is the anus.
Controlling this exit
are the internal anal
sphincter (smooth
muscle and
involuntary) and the
external anal sphincter
(skeletal muscle and
voluntary (to a point)).
Large Intestine (Colon)

 The circular muscular layer of the colon is


complete, but the longitudinal layer of muscle is
incomplete

 The mucosal lining consists of simple columnar


epithelium.

 Lining is not folded or villi, but has numerous


straight tubules glands called crypts.
Large Intestine (Colon)

 Crypts are similar to the


glands of the small
intestine, with absorptive,
goblet, and granular cells.

 The major difference is


goblet cells are the
predominate cell type
while the others decrease
in number.
Large Intestine (Rectum)

 Straight muscular tube that begins at the


termination of the sigmoid colon and ends at the
anal canal

 Simple columnar epithelium.

 The muscular tunic is relatively thick compared to


the rest of the digestive tract.
Large Intestine (Anal Canal)

 Last 2 to 3cm of the digestive tract.

 Begins at the inferior end of the rectum an ends at


the anus.

 The smooth muscle layer is even thicker than that


of the rectum.
Large Intestine (Anal Canal)

 Internal anal sphincter – superior end of anal


canal.

 External anal sphincter – skeletal muscle, inferior


end of the canal.

 Simple columnar to stratified squamous from


superior to inferior anal canal.
Movement of the Large Intestines

 Major secretory product, mucus.


 Mucus lubricates and helps fecal matter to stick
together

 Peristaltic waves are largely responsible for


moving chyme along the ascending colon.
Movement of the Large Intestines

 Mass Movements – several strong contractions in


the transverse and descending colon. This large
contraction propels the colon contents a
considerable distance toward the anus.
Movement of the Large Intestines

 Defecation Reflex – local reflex distention of the


rectal wall by feces, weak contractions of the
rectum and relaxation of internal and external anal
sphincters. Parasympathetic reflexes cause strong
contractions of the rectum, normally responsible
for most of defecation.
The Liver
The Liver

 Largest gland in the


body

 Occupies most of the


right hypochondriac
and epigastric regions.
Inferior to diaphragm,
protected by ribs.
The Liver

 Four lobes:
 Right lobe – largest
 Left lobe
 Caudate lobe –
posterior
 Quadrate lobe –
inferior to left lobe
The Liver
The Liver
The Liver

 Falciform Ligament
separates right and left
lobes, suspends liver the
liver from the diaphragm.

 Porta hepatis – entrance


for the hepatic artery and
hepatic portal vein, and
common hepatic duct.
The Liver

 Bile leaves the liver through several bile ducts


that form the left and right hepatic ducts which
then combine to yield the common hepatic duct

 The common hepatic duct will fuse with the


cystic duct from the gallbladder to form the
common bile duct which empties into the
duodenum
The Liver
The Liver (Histology)

 Each functional unit is called a liver lobule.


 Roughly hexagonal in shape.
The Liver (Histology)

 Hepatocytes – liver
cells, plates of
hepatocytes are
arranged around a
central vein.
The Liver (Histology)

 Portal triad – located


at each of the six
corners, three basic
structures are always
present.
 Hepatic artery
 Hepatic portal vein
 Bile duct
The Liver (Histology)
The Liver (Function)

 Detoxification
 Production of bile
 Fat emulsifier
 Yellow green alkaline solution
 Contains
 Bile salts, Bile pigments, Cholesterol neutral fats ,
Phospholipids, Electrolytes
The Liver
The Gall Bladder

 Storage of bile
 Concentration of bile.
 Thin walled, green, muscular sac.
 Located in a shallow fossae on the ventral surface
of the liver.
 Secretes bile by muscular wall contracting, bile
travels out the cystic duct and then flows to the
common bile duct.
The Gall Bladder (Biliary Calculi)
The Pancreas

 Lies deep to the stomach.


 Produces a broad spectrum of digestive enzymes.
The Pancreas

 Has both exocrine and endocrine functions


 Pancreatic juice- exocrine product, drains via the
Main pancreatic duct.
 Acini – small clusters of secretory cells.
 Secretions
 Pancreatic juice, Trypsinogen, Carboxypeptidase,
Chymotrypsin, Amylases, Lipases, Nucleases
The Pancreas
The Pancreas

 Insulin and glucagon is secreted on its endocrine


portion via patches of hormone-secreting cells
known as Islets of Langerhans
 Insulin and glucagon act in antagonistic fashion
The Pancreas
End