GASTROINTESTINAL SYSTEM

EMERITA C. MENDOZA, R.N., M.D.

DIGESTIVE TRACT
• aka alimentary tract/ canal • 7.6m (25ft) long from mouth to anus • “Gastrointestinal tract” • Mouth pharynx esophagus stomach  sm.intestine (duodenum, jejunum, ileum) l. intestine (cecum, colon, rectum)

Processes that FOOD undergo
A. INGESTION
Food taken in, chewed, swallowed

B. DIGESTION 1. Physical/Mechanical 2. Chemical – enzymes - ABSORPTION - TRANSPORT via blood circulation 1. liver2. body cells - ELIMINATION via defecation

Layers of Digestive Tract
Basic Plan: (from lumen  outwards)  MUCOSA (aka mucous membrane) - epithelial tissue resting on layer of loose CT (lamina propria) - STRATIFIED SQUAMOUS epithelial found in the esophagus & anal canal - COLUMNAR epithelial found in other structures of GI tract

 SUBMUCOSA –area rich in blood vessels & nerves  MUSCULARIS EXTERNA inner circular muscle longitudinal muscle 5. SEROSA (aka ADVENTITIA) a. visceral peritoneum – below level of diaphragm b. parietal peritoneum – lines walls of the abdominal & pelvic cavities *peritonitis – inflammation of the peritoneum

PERITONEAL FOLDS
• MESENTERY
– Fused double layer of peritoneal tissue that suspends s.intestines to dorsal aspect of peritoneal cavity

• GREATER OMENTUM aka fatty apron
– Large (14”x10”) double fold of peritoneum attached to duodenum, stomach, & large intestines – Apron-like structure that hangs over intestines – Highly vascular with large fat deposits; lymph nodes also present

• LESSER OMENTUM
– Suspends the stomach & duodenum from the liver

• MESOCOLON
– Fold of peritoneum that attaches the colon to the posterior abdominal wall

INSIDE THE MOUTH
• aka oral cavity • Hard palate serves as the roof

• With tiny projections called papillae • Also with taste buds

TONGUE

TEETH
• Noted in sockets (alveoli) on the mandible & maxilla • GINGIVAE = gums
– Cover the alveolar sockets of the mandible & maxilla

Structure of a Tooth
• ENAMEL – hardest substance in body
– For protection

• DENTIN – calcified connective tissue for rigidity & shape • CEMENTUM – root region • PULP – extremely sensitive connective tissue w/ blood vessels & nerves • ROOT CANALS –

SALIVARY GLANDS
• •    • g) produce 1-2L of saliva/day 3 main pairs: Parotid Submandibular Sublingual Saliva component Serous secretion
-Ptyalin & lysozyme

h) Mucous secretion
• Mucin

FUNCTIONS OF SALIVA
 Lubricates tissues of mouth & pharynx  Helps dissolve food particles  By moistening food  produce BOLUS which activates swallowing (deglutition) reflex

The PHARYNX (Throat)
• muscular tube 12cm (4.8in) long • Foyer of the respiratory tract & GI tract. • 3 Regions: 4. Oropharynx 5. Nasopharynx 6. Laryngopharynx

Structures associated with the Pharynx
• FAUCES – opening leading from mouth to nasopharynx • UVULA – small conical process at the middle of the lower border of soft palate • EPIGLOTTIS – tissue flap that closes the laryngeal opening on swallowing • SOFT PALATE – pulled upward to close nasopharynx during swallowing

The ESOPHAGUS
• From the pharynx through thoracic cavity then through diaphragm & empties into the stomach • w/ peristaltic contraction • (+) cardiac or lower esophageal sphincter

The STOMACH
• Large, muscular hotdog-shaped or beanshaped organ • Mucosal folds called “RUGAE” line it that has capacity to stretch to inc capacity (>1 liter) • Muscular contractions mash & churn food & move it along via peristalsis • Stomach lining: simple columnar epithelium that secrete mucus

• Millions of gastric glands that secrete:
– HCl – secreted by parietal cells; kills bacteria & breaks down CT in meat – Pepsin – secreted by chief cells as pepsinogen; breaks down food proteins into smaller peptides  stimulate sensory receptors to increase stomach motility & secretion

• CHYME – soupy solution of food + gastric juice

The SMALL INTESTINE
• Long, coiled tube 5m (16ft) long x 4 cm (1.5”) diameter • Sections:
– Duodenum – Jejunum – ileum

• Characteristics: – Circular folds of mucous membrane – Intestinal villi – tiny fingerlike projection of the mucous membrane – Microvilli – folds of cytoplasm on the exposed borders of the epithelial cells – Intestinal glands – bet. villi that secrete medium for digestion & absorption of

• Bile from the liver & enzymes from the pancreas  released into the duodenum & act on the chyme + enzymes from epithelial cells of duodenum  breakdown of food particles for absorption

The PANCREAS
• Large, elongated gland that lies in the abdomen inferior to the stomach • Pancreatic head is located at Cshaped curve of duodenum

• Function:
– 99% exocrine gland: secretes pancreatic juice with digestive enzyme – 1% endocrine gland: done by Islets of Langerhans A cells – secrete the glucagon B cells – secrete the insulin D cells – secrete the somatostatin

Pancreatic Hormones
• INSULIN – hypoglycemic hormone
– Function: facilitates transport of glucose across cell membranes for utilization

• GLUCAGON – hyperglycemic hormone
– Function: mobilize glucose from its major storage source, liver glycogen

• SOMATOSTATIN – local tissue hormone
– Function: inhibits secretion of both insulin & glucagon

The LIVER
• Located just inferior to the diaphragm • R lobe > L lobe • Lobe is divided into thousands of microscopic lobules which consists of liver cells

Functions of the liver:
        Secretes bile for fat digestion Converts glucose to glycogen & stores it Stores iron & vitamins Converts excess amino acids to fatty acids & urea Metabolism of proteins, fats, & carbohydrates Manufactures plasma proteins found in the blood Detoxifies many drugs & poisons that enter the body Phagocytizes bacteria & worn-out RBC. Release bilirubin via bile

The GALLBLADDER
• Pear-shaped storage of bile • CCK (Cholecystokinin) stimulates GB to contract, releasing bile into the cystic duct • *Common Bile Duct:
– Cystic duct + bile duct + pancreatic duct  opens into the duodenum

The LARGE INTESTINE
-long, tube-like organ that is connected to the small intestine at one end to the anus . -four parts: cecum, colon, rectum, and anal canal. -food moves through the cecum into the colon, where water and some nutrients and electrolytes are removed. -solid waste called stool, moves through the colon, is stored in the rectum, and leaves the body through the anal canal and anus

• • • • •

Approximately 1.5m (5”) long Diameter > small intestine CECUM: pouch where SI joins LI VERMIFORM APPENDIX COLON: cecum to rectum
– Ascending colon – Transverse colon – Descending colon – Sigmoid colon

• RECTUM – last 12cm • ANUS – (anal canal)

• Characteristics:
– (-) villi – (-) digestive enzymes – Surface epithelium consists of cells specialized for absorption & goblet cells that secrete mucus – Taenia epiploicae – circular muscle – Haustrae – Ileocecal sphincter

Functions of the large intestines
1. Absorption of Na & water 2. Incubation of bacteria 3. Elimination of wastes:
– Undigested and unabsorbed food – Sloughed-off cells from intestinal epithelium – Bile pigments

RECTUM
• After meals, the motility of large intestine increases + distention of the stomach with food initiates contractions of the rectum, stimulating the desire to defecate

ANUS
• 2 anal sphincters:
1. Internal – smooth muscle 2. External – voluntary muscle

CHEMICAL DIGESTION
• Digestive enzymes speed up chemical reactions and help in the breakdown (digestion) of complex nutrients • complex carbohydrates  simple sugars (i.e. glucose) • complex proteins  simpler amino acids • complex lipids  fatty acids + glycerol

Digestion of Carbohydrates
• mouth: salivary amylase
– starch & glycogen  maltose + small polysaccharides

• stomach: salivary amylase is inactivated by acidic pH • duodenum: pancreatic amylase
– polysaccharides  maltose – maltose maltase  glucose + glucose – sucrose sucrase  glucose + fructose – lactose lactase  glucose + galactose

Digestion of Proteins
• goal: to break the peptide bonds & release free amino acids • stomach: pepsin
– proteins  polypeptides

• pancreas: trypsin, chymotrypsin
– polypeptides  tri- & dipeptides

• stomach: peptidase
– tripeptides + dipeptides  free amino acids

Digestion of Lipids
• duodenum: pancreatic bile
– fat  emulsified fat – fat (triacylglcerol) pancreatic lipase  fatty acids + glycerol

• a.a. & simple sugars are absorbed through intestinal villi • fatty acids are absorbed through the lymph system before entering the blood