GIT Notes:

How does the GIT form? endoderm.

Foregut: Pharynx to the proximal duodenum. Includes liver, gallbladder, pancreas.
Midgut: distal duodenum to left splenic flexure of transverse colon (proximal 2/3rd of the transverse colon)
6th week: midgut herniates through umbilical ring.
10th week: returns to abdo cavity and rotates around SMA, a total 270 degrees counterclockwise
Hindgut: Rest of colon to anal canal ABOVE pectinate line

What Are The Layers of the Gut?

● MSMS
● Mucosa: epithelium, lamina propria, muscularis mucosa
● Submucosa: includes Submucosal nerve plexus (Meissner). Secretes fluid.
● Muscularis Externa: includes Myenteric nerve plexus (Auerbach). Motility.
● Serosa: if intraperitoneal. Adventita if retroperitoneal.
● In the abdomen, whether an organ is covered in adventitia or serosa depends upon whether it is peritoneal
or retroperitoneal: intraperitoneal organs are covered in serosa (a layer of mesothelium, the visceral
peritoneum).Retroperitoneal organs are covered in adventitia (loose connective tissue)
● Ulcers can extend into submucosa. Erosions are in the mucosa only.
● Frequency of basal electric rhythms (slow waves)
● Stomach: 3 waves/min
● Duodenum: 12 waves/min
● Ileum: 8-9 waves/min
How does the GIT look like on
histology?
● Esophagus: nonkeratinized stratified squamous
● Stomach: gastric glands
● Duodenum: Villi and Brunner's Glands (HCO- secreting).
These enlarge during ulcer disease. Crypts of Lieberkuhn start
here
● Jejunum: No Brunners or Peyers Patches. Just
plicae circulares (large flaps) and crypts.
● Ileum: Plicae circulares continue from jejunum to
proximal Ileum. Crypts still present. Largest
amount of goblet cells in the small intestine.
Peyers patches.
● Unencapsulated lymphoid tissue in
lamina propria and submucosa
● Specialized M presenter cells.
● Presents to B Cells in the germinal
centers of Peyers Patches that
ultimately diffentiate into IgA
secreting plasma cells. IgA is
ultimately transported across epithelium
into the gut to deal with intraluminal
antigens.
● Colon: Colon has crypts but no villi. Lots of
goblet cells for lube.
What Is The Blood Supply of GIT?
● The arteries that supply the GIT come from
the aorta. Arteries supplying GI structures
branch anteriorly. Arteries supplying non-GI
structures branch laterally.
● Foregut: Supplied by the celiac branches
(T12/L1): left gastric, splenic, common
hepatic
● Midgut: SMA (L1). Can have SMA
syndrome: transverse (third) part of the
duodenum is trapped between the SMA
and aorta. This causes obstruction and
postprandial pain. Seen when there is
diminished mesenteric fat – like in low
body weight or malnutrition (loss of
cushion)
● Hindgut: supplied by IMA (L3).
Nerve Innervations
● Parasympathetic innervations:
● Foregut/Midgut: from vagus nerve
● Hindgut: Pelvic nerve
● Sympathetic innervations:
● Foregut/midgut: thoracic splanchnics nerves
● Hindgut: lumbar splanchnics
What is This Pectinate/Dentate Line?
● This is where the endoderm (hindgut) meets the outside skin (ectoderm). Above pectinate line:
● Still part of your hindgut, it gets it's blood supply from the superior rectal artery (IMA).
It's venous drainage is through the superior rectal vein --> inferior mesenteric vein -->
portal system
● Lymph drainage to internal iliac lymph nodes
● In terms of pathology: cancer can occur here. Because there are lots of glands here (to help
lubricate the incoming stool), it is adenocarcinoma.
● Small blood vessels may dilate, especially in chronic constipation. These dilated veins are
called hemorrhoids. Because they are located internally, we call them internal
hemmorhoids. This area has visceral innervation, and NOT painful. Treamtent is
band ligation.
● Below pectinate line
● The arterial supply is through the inferior rectal artery (branch of internal pudendal
artery). The venous drainage is through the inferior rectal vein --> internal pudendal
vein --> internal iliac vein --> IVC
● Lymph draining to superficial inguinal nodes
● In terms of pathology: cancer of the skin include squamous cell carcinoma, not
adenocarcinoma. Dilation of veins can also occur here, and since they are on the
outside, they are called external hemorrhoids. This area is under somatic innervation
(inferior rectal branch of pudendal nerve). Painful.
● You can also have tears in the skin called anal fissures. It will present with pain while
defecating, with bright red blood on the paper. It most commonly effects the
posterior portion as it is poorly perfused.