Histology of Gastrointestinal System

LEARNING OBJECTIVE
After performing laboratory activity, the student should be able to:
1. Describe the microscopic structure of lingua (slide ID: SD-2, SD-3, SD-4)
2. Describe the microscopic structure of parotic gland, submandibular gland, sublingual
gland (slide ID: SD-9, SD-10, SD-11)
3. Describe the microscopic structure of esophagus (slide ID: SD-12)
4. Describe the microscopic structure of stomach (slide ID: SD-14, SD-15)
5. Describe microscopic structure wall layers of duodenum (slide ID: SD-17)
6. Describe microscopic structure wall layers of jejunum (slide ID: SD-18)
7. Describe microscopic structure wall layers of ileum (slide ID: SD-19)
8. Describe microscopic structure wall layer of appendix and cecum (slide ID: SD-20)
9. Describe microscopic structure wall layer of ascending, transverse, descending, and
sigmoid colon (slide ID: SD-21)
10. Describe microscopic structure wall layer of rectum (slide ID: SD-22)
11. Describe microscopic structure wall layers of anal canal (slide ID: SD-22)
12. Describe the microscopic structure of the liver (slide ID: SD-24, SD-25)
13. Describe the biliary tract and its microscopic structure
14. Describe the microscopic structure of the gallbladder (slide ID: SD-27)
15. Describe the microscopic structure of the pancreas (slide ID: SD-28)

RESOURCE PERSON
1. Astrid F. Khairani, dr., M.Kes., PhD
2. Nur Atik, dr., M.Kes., PhD
3. Resti Gradia D., dr., M.Kes

REFERENCES
1. Junqueira, L.Carlos and Carneiro J. Basic Histology Text and Atlas. 10th Edition. Lange
Medical Books McGraw-Hill. pp 291-347
2. Di Fiore, Mariano S. H. Atlas of Human Histology. 4th Edition. Lea & Febiger. Philadelphia.
pp122-161
3. Paulsen, Douglas F. Basic Histology Examination & Board Review. 2nd Edition. Appleton &
Lange. pp 202-233
4. HISTOLOGY A TEXT AND ATLAS with Correlated Cell and Molecular Biology, Wojciech
Pawlina, 7th Edition

INTRODUCTION
The digestive system consists of the digestive tract-oral cavity, esophagus, stomach,
small intestine, rectum, and anus-and its associated glands-salivary glands, liver, and pancreas.
Its function is to obtain from ingested food the molecules necessary for the maintenance,
growth, and energy needs of body. Large molecules such as protein, fats, complex
carbohydrates, and nucleic acids are broken down into small molecules that are easily
absorbed through the lining of the digestive tract, mostly in small intestine. Water, vitamins,
and minerals are also absorbed from ingested food. In addition, the inner layer of the
digestive tract is protective barrier between the content of the tract’s lumen and the internal
milieu of the body. Esophagus is long, narrow, muscular tube transport food from the pharynx
to the stomach. Stomach is dilated portion of the digestive tract temporarily holds ingested
food, adding mucus, acid, and the digestive enzyme pepsin. Muscular contractions of the
stomach blend these components into a viscous mixture called chime. The chyme is then
divided into parcels for further digestion and absorption by the intestine.

Lab Manual GIS | 38

 The organs associated with the digestive tract include the salivary glands, the pancreas,
the liver, and gallbladder. The liver is the second-largest organ of the body [the largest is the
skin] and the largest gland, weighing about 1.5 kg. The liver produces bile, an important fluid
in the digestion of fats. The liver plays a major role in lipid, carbohydrate, and protein
metabolism and inactivates and metabolizes many toxic substances and drugs. It also
participates in iron metabolism and the synthesis of blood proteins and the factors necessary
for blood coagulation. The main function of the gallbladder is to store bile, concentrate it by
absorbing its water, and release it when necessary into the digestive tract. The pancreas is
both an exocrine gland that produces digestive juices and an endocrine gland that
manufactures hormones.
The small intestine, which includes the duodenum, jejunum, and ileum, receives chyme
from the stomach, bile from the liver, and digestive enzymes from the pancreas. Here,
nutrients are hydrolyzed into an absorbable form; they are absorbed and transferred to blood
and lymphatic capillaries. Undigested material is moved to the large intestine by peristalsis.
Large intestine includes: the cecum [and appendix]; the ascending, transverse,
descending, and sigmoid colon; and the rectum. The cecum is the distended first part of the
large intestine. Appendix is a small blind-ended tubular sac extending from cecum just distal to
the ileocecal junction. Large intestine converts undigested material received from the small
intestine into feces by remove water and adding mucus. The colon is shorter than small
intestine and has a wader lumen. The rectum is the short dilated terminal portion of the large
intestine.
Anal canal is about 4 cm long and connects the rectum and the anal opening.

During laboratory activity, the students will be asked to show any anatomical parts
using model, interactive CD, as well as histological preparates and finally also discuss about
important aspects of physiology and pathogenesis. Before activity, the students have to
accomplish the homework assignment first, read the primary references, so that they will be
more readily performing laboratory activity

Lab Manual GIS | 39

HOMEWORK ASSIGNMENT
Please label the following pointed parts of the picture with the information below

Figure 1. Upper third esophagus, transverse section

Stratified squamous epithelium, Lamina propria, Muscularis mucosae, Submucosa, Circular
muscle [skeletal], Connective tissue between muscle layers, Longitudinal muscle layer
[skeletal], Adventitia, Lymphatic nodule, Duct passing through mucularis mucosae, Mucos
alveoli [esophageal glands], Ducts, Arteriole and venule, Adipose cells, Venule, Adipose
tissue, Artery, Vein, Nerves

Lab Manual GIS | 40

Please label the following pointed parts of the picture with the information below

Figure 2. Esophageal – cardiac junction

Muscularis external [inner layer], Submucosa, Muscularis mucosae, Stratified squamous
epithelium of esophagus, Esophageal glands, Esophageal cardiac glands, Ducts of
esophageal glands, Lamina propria of esophagus, Lamina propria of stomach, Cardiac
glands, Gastric epithelium, Foveola [gastric pits], Gastric glands, Chief cells, Mucous neck
cells, Parietal cells

Lab Manual GIS | 41

Please label the following pointed parts of the picture with the information below

Figure 3. Regions of the stomach and their histologic structure

Pit of cardia , Pit of body, Pit of pylorus, Junction of gland and base of cardial pit, lamina
propria of cardia, cardiac glands, muscularis mucosae of cardia.
Duodenum, pyloric sphincter.
Neck of pyloric glands, pyloric glands, lamina propria of pylorus, lymph nodule in lamina
propria of pylorus, muscularis mucosae of pylorus, submucosa of pylorus.
Glands of body[ neck and base ], muscularis mucosae of body.

Lab Manual GIS | 42

Please label the following pointed parts of the pictures with the information below

Figure 4. Fundus and body

Surface epithelium, Basement membrane, Lamina propria, Foveola [gastric pits], Gastric
glands, Mucous neck cells, Parietal cells, Foveola, Gastric gland opening into foveola,
Gastric gland [neck], Gastric gland transverse section, Chief cells

Lab Manual GIS | 43

Please learn the pointed parts of this figure [ 3 types of liver lobules ]

FIGURE 5.The schematic of Classic liver lobules, Hepatic acinus, and Portal lobules

PS: Portal space

CV: Central Vein

Lab Manual GIS | 44

Please learn the pointed parts of this figure

FIGURE 6.Three dimensional aspect of the normal liver

Lab Manual GIS | 45

Please learn the pointed parts of this figure

FIGURE 7.Liver lobule

Lab Manual GIS | 46

Please learn the pointed parts of this figure

FIGURE 8.Gallbladder

Lab Manual GIS | 47

Please learn the pointed parts of this figure

FIGURE 9. PANCREAS

Lab Manual GIS | 48

Please label the following pointed parts of the picture with the information below

FIGURE 10. Duodenum (longitudinal section)

Lining epithelium, columnar cells with striated borders and goblet cells, Intervillus space,
Intestinal villus, Muscle fibers in the villus, Intestinal glands, Duodenal glands, Muscularis
external: inner circular and outer longitudinal layers, Serosa [visceral peritoneum]

Lab Manual GIS | 49

Please label the following pointed parts of the picture with the information below

FIGURE 11. Jejunum - Ileum

Villus, Intervillus space, Intestinal glands [crypts of Lieberkuhn], Surface epithelium,
Lamina propria, Muscularis mucosae, Submucosa, Circular muscle layer, Longitudinal
muscle layer, Serosa, Lymphatic nodule

Lab Manual GIS | 50

Please learn the pointed parts of this figure

APPENDIX

Lab Manual GIS | 51

Please match the following pointed parts of the picture with the information below

LARGE INTESTINE, TRANSVERSE SECTION

Mucosa, Submucosa, Muscularis external [ inner circular layer and outer longitudinal layer],
Serosa, Surface epithelium, Intestinal glands, Lymphatic nodule

Lab Manual GIS | 52

Please match the following pointed parts of the picture with the information below

ANAL CANAL

Epithelium of the rectum, Epithelium of the anal, Rectum anus junction, Internal anal
sphincter, External anal sphincter, Anal valve, Internal hemorrrhoidal plexus, Muscularis
external of the rectum, Levator ani muscle [skeletal muscle]

Think first and answer the question correctly and concisely!

1. Describe the microscopic structure of lingua
2. Describe the microscopic structure of parotic gland, submandibular gland, sublingual gland
3. Describe the histologic structures of the esophagus.
4. Describe the histologic structures of each region of the stomach.
5. Describe general structure of the liver
6. Describe blood supply of the liver
7. Describe cell type of the liver
8. Describe type of liver lobules
9. Describe biliary tract of the biliary system
10. Describe microscopic structure of gallbladder
11. Describe microscopic structure of pancreas
12. Describe general structure the walls of small intestine
13. Describe microscopic structure wall layers of duodenum
14. Describe microscopic structure wall layers of jejunum
15. Describe microscopic structure wall layers of ileum
16. Describe microscopic structure wall layer of appendix and cecum

Lab Manual GIS | 53

17. Describe microscopic structure wall layer of ascending, transverse, descending, and
sigmoid colon
18. Describe microscopic structure wall layer of rectum
19. Describe microscopic structure wall layers of anal canal

LABORATORY ACTIVITY
Pre-requisites: The students have to do the homework assignment and read the references as
listed in the first page.

Task:
1. Discus the homework materials in the small group [tutorial group].
2. See the specimen under microscope and try to make a schematic draw and put the
most important description based on the schematic draw.

Specimen No. 1
Schematic Draw Description

Specimen No.2

Lab Manual GIS | 54

 Schematic Draw Description

Specimen No. 3
Schematic Draw Description

Specimen No. 4

Lab Manual GIS | 55

 Schematic Draw Description

Specimen No. 5
Schematic Draw Description

Lab Manual GIS | 56

Specimen No. 6
Schematic Draw Description

Specimen No. 7
Schematic Draw Description

Lab Manual GIS | 57

Specimen No. 8
Schematic Draw Description

Specimen No. 9
Schematic Draw Description

Lab Manual GIS | 58

Specimen No. 10
Schematic Draw Description

Specimen No. 11
Schematic Draw Description

Lab Manual GIS | 59

Specimen No. 12
Schematic Draw Description

Specimen No. 13
Schematic Draw Description

Lab Manual GIS | 60

Specimen No. 14
Schematic Draw Description

Specimen No. 15
Schematic Draw Description

Lab Manual GIS | 61

PATHOLOGY OF
GASTROINTESTINAL TRACT, LIVER
AND GALL BLADDER
LEARNING OBJECTIVE
I. General Learning objective
After completing this session, the students should be able to understand the correlation of the
pathogenesis of specific gastrointestinal diseases and its pathological finding

II. Specific Learning objective

After performing laboratory activity, the students should be able to:
1. Understand the pathogenesis, macroscopic and microscopic appearance of chronic
gastritis caused by H.pylori.
2. Understand the pathogenesis, macroscopic and microscopic appearance of peptic
ulcer.
3. Understand the pathogenesis, macroscopic and microscopic appearance Hirschsprung
disease
4. Understand the pathogenesis, macroscopic and microscopic appearanceof acute and
chronic appendicitis
5. Understand the pathogenesis, macroscopic and microscopic appearanceof Hemorrhoid
6. Understand the pathogenesis, macroscopic and microscopic appearanceof colorectal
cancer
7. Understand the pathogenesis, macroscopic and microscopic appearancechronic
hepatitis
8. Understand the pathogenesis, macroscopic and microscopic appearancecirrhosis
9. Understand the pathogenesis, macroscopic and microscopic appearancecholecystitis

REFERENCE
Kumar V, Abbas AK and Fausto N. Robbins and Cotran Pathologic Basis of Diseases 8th Edition.
Elsevier Saunders.

RESOURCE PERSON
Herry Yulianti, dr., SpPA(K)., M.Kes
Dr. Hermin Aminah, dr.,SpPA(K)
Dr. Hasrayati Agustina, dr., SpPA(K)., M.Kes

HOMEWORK ASSIGNMENT

A. Fill in the box under each picture below !

B.
1. Read and understand the pathogenesis of chronic gastritis caused by H.pylori.
2. Read and understand the pathogenesis of peptic ulcer.
3. Read and understand the pathogenesis of acute and chronic appendicitis
4. Read and understand the pathogenesis of Hirschsprung disease
5. Read and understand the pathogenesis of Hemorrhoid
6. Read and understand the pathogenesisof colorectal cancer
7. Read and understand the pathogenesis chronic hepatitis
8. Read and understand the pathogenesis cirrhosis
9. Read and understand the pathogenesis cholecystitis
Lab Manual GIS | 62
LABORATORIUM MATERIAL
1. Kumar V, Abbas AK and Fausto N. Robbins and Cotran Pathologic Basis of Diseases 8th
Edition. Elsevier Saunders
2. Pencil Color (blue and red)

1. CHRONIC GASTRITIS CAUSED BY HELICOBACTER PYLORI

A 48-year-old female complain nausea and vomiting for several months. No history of
hematemesis. On physical examination, there are no abdominaltenderness, an d bowel sounds
are presents. Upper endoscopy reveals erythematous areas in the stomach

Macroscopic :

Lab Manual GIS | 63

 Microscopic:

Morphology of Helicobacter Pylori:

2. PEPTIC ULCER
A 50-year-old female complain nausea and vomiting for several months. She has
experienced hematemesis. On physical examination, there are no abdominal tenderness, and

Lab Manual GIS | 64

bowel sounds are presents. Upper endoscopy reveals erythematous areas and ulcer in the
stomach

Macroscopic :

Microscopic:

Lab Manual GIS | 65

 3. HIRSCHSPRUNG’S DISEASE

Macroscopic:

Microscopic:

Lab Manual GIS | 66

 4. HEMORRHOID

Macroscopic:

Microscopic:

Lab Manual GIS | 67

 5. COLORECTAL ADENOCARCINOMA

Macroscopic:

Microscopic:

Lab Manual GIS | 68

 6. ACUTE APPENDICITIS
A 27-year-old male complained sudden onset of right lower quadrant abdominal pain.
He has fever, nausea and vomiting. His abdomen distended and rebound tenderness was
positive. Laboratory finding : leukocytosis.
 Macroscopic:
Macroscopic

Microscopic

Microscopic:

Lab Manual GIS | 69

 7. CHRONIC APPENDICITIS

Macroscopic
Macroscopic:

2.2. Microscopic
 Microscopic:

Lab Manual GIS | 70

 8. CHRONIC B HEPATITIS

Microscopic:

Lab Manual GIS | 71

 9. LIVER CIRRHOSIS
1.1. Macroscopic

Macroscopic:
 Microscopic:

10. CHRONIC CHOLECYSTITIS

A 35-year-old female presents with nausea, vomiting, intolerance for fatty food and
colicky epigastria or right upper quadrant pain.

Lab Manual GIS | 72

3.1. Macroscopic

Macroscopic:

.3.2. Microscopic

Microscopic:
Lab Manual GIS | 73