Digestive System Top to Bottom
Dr Usama ALAlami
³Breakdown of huge food molecules into small ones´
  Ingestion ³Taking food into the digestive tract´ Propulsion ³Move food through alimentary canal´
In olun ary (Peristalsis)
Volunta y (Swallowing)
³Adjacent sections of the alimentary canal alternately contract and relax´
Coordin ted Muscul r Contr ctions Produce Perist ltic Movements
Chewing Mixing of food with saliva using tongue Churning of food in the stomach Segmentation
Begins in the mouth and ends in the small intestine.
Absorption´Digested end products (+minerals, vitamins and water) absorbed to blood and lymph supply´ Defecation´Need I explain this ?´
Digestive Tract (Alimentar Canal)
Mouth Pharynx Oesophagus Stomach Small intestine Large intestine Rectum Anal canal Anus ARSE
Digestive Tract (Alimentar Canal)
Ke To The Diagram Of The Digestive S stem
1. 2. 3. 4. 5. 6. 7. 8. Buccal cavity. Tongue. Oesophagus. Diaphragm. Stomach. Pyloric sphincter. Liver. Gall bladder.
Ke To The Diagram Of The Digestive S stem
9. Bile duct. 10. Pancreas. 11. Duodenum. 12. Ileum. 13. Caecum. 14. Appendix. 15. Colon. 16. Rectum. 17. Anus.
Accessor Digestive Organs
Teeth Tongue Gallbladder Salivary Glands (Saliva) Liver (Bile) Pancreas (Enzymes)
Aid in food breakdown
Arteries branch off the abdominal aorta to: a) Digestive Organs b) Hepatic Portal Circulation
Hepatic Artery (supply liver) Splenic (supply spleen) Left gastric (supply stomach) Branch from celiac trunk
Superior/inferior mesenteric arteries (supply small and large intestine) Digestive system receives approximately 25% of cardiac Output. This increases after a meal.
Composite Micrograph Showing Variations n Gut Wall Structure
Histolog of the Alimentar Canal
Histolog Of The Alimentar Canal
From innermost to outermost layer.
Lines the luminal surface of the digestive tract. Three layers: a) Mucous Membrane Epithelial cells for secretion, absorption and protection Exocrine and endocrine cells for secretion of digestive Juices and GI hormones respectively.
b) Lamina Propria Well vascularized (nerves and lymph vessels) Defence against intestinal bacteria bacteria c) Muscularis Mucosa Outer layer of smooth muscle
Thick layer of connective tissue. Provide distensibility and elasticity Contain large blood and lymph vessels. Contains nerve networks = SUBMUCOUS PLEXUX Therefore, controls local activity of each gut region.
Muscul ris Ext r
Major smooth muscle layer.
uter l n itu inal area
Inner circular area
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MYENTERIC PLEXUS between the two layers = regulate local gut activity.
Outer covering of digestive tract. Secretes serous fluid lubricate and prevent friction between digestive organs and surrounding viscera. Serosa is continuous with mesentery. Mesenteric tearing HERNIA Hernia ³Protrusion of an organ through the muscular wall of the cavity that contains them´
Regulation Of Digestive Function
Digestive function is controlled by four factors: * * * * Autonomous smooth muscle function. Intrinsic nerve plexuses Extrinsic nerves Gastrointestinal hormones
Autonomous Smooth Muscle Function
Smooth muscle cells of the digestive system possess ³Basic Electrical Rhythm´ (BER). This does not directly induce contraction When a large group of cells reach excitation contraction Whether contraction is achieved depends on: @ @ @ Mechanical effects Nervous system Hormonal effects
Intrinsic Nerve Ple uses
Nerve Plexus³Interconnecting network of nerve cells´ (1) Submucous (Meissner¶s) plexus in submucosa (2) Myenteric (Auerbach¶s) plexus between longitudinal and circular smooth muscle cell layers. They run the entire length from oesophagus to anus.
Intrinsic plexuses influence: a) Smooth muscle contractility b) Exocrine cell secretion (digestive juices) c) Endocrine cell secretions (digestive hormones)
Sympathetic and parasympathetic nerve branches. Sympathetic ³fight or flight´ = slow digestive function. Parasympathetic dominant in quiet relaxed situations. Arrive by way of VAGUS nerve increase smooth muscle contractility + secretion of digestive enzymes and hormones. Autonomous nervous system also coordinates between different organs of the digestive tract.
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Endocrine cells within mucosa release hormones into blood They affect: @ @ @ Exocrine gland secretions Smooth muscle cells Pancreatic endocrine cells influence food storage and uptake.
GI hormones released in response to changes in luminal content (protein, fat or acid). Effect is direct on endocrine glands or indirect on nerve plexuses or extrinsic autonomous nerves.
Receptors Of The Digestive Tract
   Chemoreceptors Mechanoreceptors (Pressurereceptors) Osmoreceptors
Activities of these receptors results in: a) Short neural reflex (via intrinsic nerve plexuses) b) Long neural reflexes (via autonomous nerves)
The oral cavity (buccal cavity) has four boundaries:     Lips Cheeks Palate Tongue (anterior) (lateral) (superior) (inferior)
Anterior opening is the oral orifice Posteriorly, the oral cavity is continuous with the oropharynx
Reddened area known as red margin (or scoring zone !!!) Lips help to guide and contain food in the mouth Non digestive functions: a) Speech b) Snogging
Arched roof separating mouth from nasal passage Allows chewing, breathing and sucking to take place Simultaneously. Failure of this fusion causes CLEFT PALATE. Anterior = Hard palate = bone Posterior= Soft palate = skeletal muscle Uvula = Hangs from soft palate seals off nasal passage during swallowing.
Composed of voluntary skeletal muscle Houses taste buds, serous and mucous glands Helps reposition food between teeth and mix it with saliva (Bolus) Non digestive functions: * * Speech Snogging
First step in digestive process is mastication (chewing). Exposed portion of tooth = enamel = hardest substance in body. Occlusion ³Upper and lower teeth fit together when jaws are closed´ Malocclusion due to: 1) Overcrowding of teeth too large to fit in the jaw space 2) One jaw displaced in relation to the other
This results in inefficient chewing and pain in the temporomandibular joint. Purpose of mastication: 1} 2} 3} Grind food into smaller pieces to fascilitate swallowing Mix food with saliva Stimulate taste buds
Tooth and Gum Diseases
 Dental Caries (Rottenness)
Also known as cavities Due to dental decay Decay due to dental plaque (film of sugar, bacteria and mouth debris) Bacteria metabolise sugar acid decay
Effect of plaque on gums Disrupt seal between gingivae and teeth Risk of gum infection Gums bleed, sore and swollen (Gingivitis) (reversible) If plaque not removed, this leads to ..  Peridontal Disease (Peridontitis)
Treated by antibiotics
Saliva secreted by   Extrinsic salivary glands (Major) Intrinsic salivary glands (minor) (in mucosa lining the cheeks)
Extrinsic Salivar Glands
Extrinsic Salivar Glands
Sublingual Parotid Submandibular
Extrinsic Salivar Glands
Lie outside oral cavity and discharge saliva through small ducts into mouth. Sublingual: Below tongue Submandibular: Below mandible Parotid: (par=near, otid=ear) anterior to ear. Mumps ³Inflammation of the parotid gland caused by the mumps virus (myxovirus) resulting in fever and pain upon chewing´ Composed mainly of serous cells (watery secretion of enzymes and ions) and mucous cells (viscous secretion of mucus).
Sublingual: Mostly mucous cells Submandibular and buccal: Equal proportion of both Parotid: Only serous cells
Composition Of Saliva
99.5% water, 0.5% protein and electrolytes Saliva begins digestion of carbohydrates in mouth by salivary amylase.
Saliva facilitates swallowing by moistening food particles via mucus (thick and slippery) Saliva possesses antibacterial action through: @ @ Lysozymes Rinsing away material that may serve as food source for bacteria.
Saliva is neither sugary or salty important for perception of sweet and salty tastes. Bicarbonate in saliva neutralizes acid in food.
Facilitates speech via moistening of lips and tongue Xerostomia ³Diminished saliva secretion´ Result in difficulty in chewing, swallowing, inarticulate speech and dental caries.
Control Of Salivar Secretion
1-2 litres daily Basal secretion due to direct autonomic nerve stimulation
Enhanced secretion of saliva due to: (1) Simple unconditional salivary reflex (2) Acquired or conditional salivary reflex Very little digestion action in mouth Amylase action accomplished in body of stomach No absorption of foodstuff However, absorption of therapeutic agents occurs via oral mucosa (e.g. nitroglycerine)
Phar nx and Oesophagus
Motility associated with pharynx and oesophagus is ³swallowing or deglutition´. Bolus from mouth through oesophagus into stomach. Swallowing is initiated voluntarily. But once initiated it can¶t be stopped
Peristalsis In The Oesophagus (Anterior View)
Mechanism Of Swallowing
fferent Impulses to Swallowing
Smmot muscl cell contr ct
 Orophar ngeal Stage
Lasts about 1 second Mouth to pharynx to oesophagus Food must be prevented from re-entering: a) Mouth: Position of tongue against hard palate. b) Nasal Passages: Uvula elevated against back of throat. c) Trachea: Cartilaginous flap = epiglottis = seals trachea.
Muscular tube (approx 25 cm long) Connects pharynx to stomach. Penetrates diaphragm at oesophageal hiatus Stomach protrusion through this Hiatal Hernia Two locks or sphincters: 1) Pharyngooesophageal sphincter (top): Prevents large volumes of air entering digestive tract eructation (burping). 2) Gastrooesophageal sphincter (lower) Food moves down oesophagus by active process (peristalsis)
Diseases Of The Gastrooesophageal Sphincter
GES closed except during swallowing When gastric contents (acidic) enter oesophagus despite GES being closed HEARTBURN This is followed by opening of sphincter to allow contents back into stomach If sphincter remains shut ACHALASIA Complications of achalasia = ASPIRATION PNEUMONIA
Diagram Of The Stomach Showing The Three Muscle Layers
J-shaped saclike chamber lying between the oesophagus and the small intestine. Divided according to anatomical and histological parameters to: [a] Fundus: Dome-shaped, this smooth muscle portion of the stomach. Lies above oesophageal opening [b] Body: Midportion of the stomach This layer of smooth muscle
[c] Antrum: Pyloric antrum narrows to form pyloric anal and ends in pylorus (gatekeeper). Main function of stomach is storing ingested food until it can be emptied into small intestine at a rate appropriate for optimal digestion and absorption. Second function is secretion of HCl and proteindigesting enzymes Final product from the stomach is CHYME
Extra oblique layer of muscle to allow churning and mixing of food. Muscularis mucosa has mucus-secreting goblet cells. Also contains gastric pits leading to gastric glands with specialized cells (secrete gastric juice)  Mucous Neck Cells
Secrete thin mucus
Secrete inactive pepsinogen (active pepsin = proteindigesting enzyme).  Parietal (Oxyntic) Cells
Secrete HCl and intrinsic factor Pepsinogen activated by HCl Intrinsic factor = absorption of vitamin B12 in small intestine Gastric mucosa atrophy or gastrectomy loss of chief and parietal cells treated by regular vitamin B12 injections
Surface View of the Gastric Mucosa Showing Entrance To Gastric Pits SEM (x35)
Secret hormones (Gastrin, Serotonin, Endorphine,«) into blood Occur in antrum region Gastrin secreted by G cells into blood Travels back to oxyntic mucosa stimulate chief and Parietal cells stimulate gastric juices Also stimulates growth of stomach and small intestine mucosa.
Control Of Gastric Secretions
 Cephalic Phase
Seeing/smelling food Vagus stimulates HCl and pepsinogen secretion via intrinsic nerve plexuses Vagus stimulates Gastrin secretion by G cells increased secretion of HCl and pepsinogen
Stomach distension causes activation of stretch receptors As with cephalic phase, HCl and pepsinogen secretion is stimulated via vagal pathways Caffeine and alcohol stimulate gastric juices even if stomach is empty aggravate existing ulcer.  Intestinal Phase
Protein fragments entering duodenum stimulate intestinal gastrin travel by blood to stomach
Control Of Gastric Secretions: The Cephalic Phase
Control Of Gastric Secretions: The Gastric Phase
Control Of Gastric Secretions: The Intestinal Phase
Summary Of Information Relating To Gastrin
Gastric Mucosal Barrier (GMB)
  Luminal membrane impermeable to HCl Tight junctions between cells
Peptic ulcer in oesophagus, stomach or duodenum Weakness in GMB. Increased acidity leads to increased histamine leading to increased acidity and a vicious cycle Helicobacter Pylori 90% of peptic ulcers
Treatment Of Peptic Ulcers: @ @ @ @ Antihistamine (Cimetidine) Cutting vagus nerve supply to stomach Removal of stomach antrum Diet void of caffeine and alcohol
A Donor Kebab, A Curry and Get Pissed. WHY?
No food could be absorbed through the stomach Alcohol can be however. Alcohol more rapidly absorbed through small intestine into blood. Fat-rich food (kebab/curry) delays gastric motility delay arrival of alcohol into duodenum delay alcohol from producing its effects rapidly Aspirin can also be absorbed through stomach exert effect more quickly.
Regulation Of Stomach Motility
 Gastric Filling
Plasticity ³Ability of stomach smooth muscle to be stretched without greatly increasing its tension As food is travelling down oesophagus Receptive Relaxation. As food enters stomach Adaptive Relaxation.
BER means slow weak contraction of smooth muscle in fundus and body while stronger in antrum Therefore, food is stored in fundus and body.  Gastric Mixing
Peristaltic movement in antrum mixing chyme push forward to pyloric sphincter
Expulsion of chyme into duodenum. Amount of chyme emptied depends on strength of peristalsis. Rate depends on: (a) Volume of chyme (b) Fluidity of chyme (c) Duodenal factors such as fat, acid and distension Emotions may influence gastric motility via autonomous nervous system (e.g. sad reduced emptying)
Induced by: a) b) c) d) e) Bacterial toxins Unpleasant odours Stressful situation Excessive alcohol Drugs
Mediated by emetic centre in the medulla
Tadpole-shaped gland behind and below the stomach
Contains both endocrine and exocrine tissue Acini ³ Cluster of secretory cells that form sacs´
Acini empty into main pancreatic duct Endocrine portion = Islets of Langerhans (secrete insulin and glucagon)
Main Pancreatic Duct
Bile Duct From Liver
Duodenum (Small Intestine)
Composition Of Pancreatic Juices
  Enzymatic secretions Aqueous secretions rich in sodium bicarbonate
a) b) c)
Proteolytic enzymes Pancreatic amylase Pancreatic lipase
-Trypsinogen -Chymotrypsinogen -Procarboxypeptidase Trypsinogen p Trypsin in small intestine by enterokinase
Cymotrypsinogen and procarboxypeptidase both activated in the small intestine by the activated trypsin
Secreted in the active form Digest carbohydrates c) Pancreatic Lipase
Secreted in the active form Only enzyme in digestive system that can digest fats to monoglycerides and fatty acids Steatorrhea = Pancreatic exocrine insufficiency 60-70% indigested fat in faeces Protein/carbohydrate digestion impaired to a lesser extent
Pancreatic Aqueous Alkaline Secretions
Fact 1: Pancreatic enzymes work at neutral to alkaline environment. Fact 2: They start their function in the duodenum Fact 3: Chyme emptied from stomach into duodenum is highly acidic OH SHIT WE HAVE A PROBLEM Solution: Neutralize acidity of chyme in duodenum by alkaline secretions from the pancreas
Regulation Of Pancreatic Secretions
Chyme Enters Duodenum
Acinar cells stimulated
Duct cells in pancreas stimulated
Pancreatic enzymes released
Sodium bicarbonate released
Summary Of Information Relating To Intestinal Hormones
Liver and Gallbladder
Liver and gallbladder form the biliary system secrete bile into duodenum Bile: Breaks down bid fat molecules into smaller ones that are accessible to digestive enzymes Liver: Detoxifies waste and drugs Removal of bacteria due to resident kupffer cells. Liver cells = Hepatocytes and Kupffer cells. Blood enters liver via hepatic artery
All digestive organs drain venous blood into hepatic portal vein of the liver for: a) b) c) Processing Storage Detoxification
Blood from hepatic portal vein drains into hepatic vein and subsequently into the inferior vena cava.
Liver made of four lobules
Each lobule is hexagonal Each hexagonal part has 1) Hepatic artery branch 2) Hepatic portal vein branch 3) Bile duct
a) Blood from hepatic artery branch and hepatic portal vein branch flow into an expanded capillary = Sinusoids b) Kupffer cells line inside of sinusoids and hepatocytes on outside. c) The blood from sinusoids from all six sections of lobule drains into central vein d) Central vein from all four lobules drains into hepatic vein
e) Bile secreted by hepatocytes flows into canaliculi between cells. f) Bile canaliculi carry bile to bile duct in each lobule
g) Bile ducts from each of four lobules drains into common bile duct
Bile produced by liver enters duodenum ONLY during digestion of a meal. Therefore, must be stored somewhere before it is released Gallbladder is site for storage of bile
Composition Of Bile
Sodium bicarbonate from duct cells Bile salts Cholesterol Lecithin Bilirubin
Bile salts are derivatives of cholesterol
Biliary calculi Due to excess proportion of cholesterol compared to bile salts and lecithin. Obstruct flow of bile Symptoms: Pain radiating to right thoracic region Treatment: Drugs to dissolve crystals Pulverising them with ultrasound (Lithotripsy) Vaporising with laser Surgical removal of gallbladder
75% due to cholesterol, 25% due to precipitation of bilirubin
Pigment resulting from breakdown of haem portion of haemoglobin. Bilirubin converted to urobilinogen by small intestine bacteria (this gives faeces its brown colour).
Diseases Of The Liver
Prehepatic: excessive breakdown of RBC. Hepatic: Liver is diseased and not able to deal with normal levels of bilirubin. 91
Posthepatic: Obstructive jaundice due to bile duct obstruction bilirubin cannot be eliminated in faeces Patients appear yellowish especially in the whites of their eyes  Hepatitis
Due to toxins such as alcohol, tranquillisers and mushroom poisoning. Viruses: Hepatitis A = Transmitted through sewagecontaminated water
Hepatitis B = Transmitted via blood transfusions and could results in cancer. Vaccines for hepatitis A and B have now been developed. Hepatitis C = Treated by combination drug therapy of immunosuppressing steroid prednisone and genetically engineered interferon.
Cirrhosis (Orange Coloured)
Due to chronic alcoholism or chronic hepatitis Connective fibrous tissue mass of the liver increases. Blocks blood flow through hepatic portal system portal hypertension Hepatic portal vein drains into small veins Excess blood small veins burst vomit blood Snakelike network of veins surrounding the naval (Caput medusae = medusae head)
Site of digestion and absorption 6.3 m long and 2.5 cm wide Coiled between stomach and large intestine Duodenum, Jejunum and ileum Food is mixed and moved along small intestine by segmentation Segmentation influenced by: 1) Intestinal distension 2) Gastrin 3) Extrinsic nerve activity
Segmentation more frequent in upper part of small intestine compared to lower one Allows food to move forward more than backwards Also allows more time for absorption
Most absorption in duodenum and jejunum Vitamin B12 and bile salt absorption in ileum  Inner surface of small intestine lined by finger-like projections = Villi (Increase surface area) Villi have mucous and epithelial cells Epithelial cells have microvilli on their surface (digestion of protein and carbohydrates finished and absorption occurs)
Crypts of Lieberkuhn between villi regenerate epithelial cells on villi
Radiation and anticancer agents inhibit this epithelial cell regeneration reduced absorption weak, lethargic patient.
Structure Of The Ileum
Villi Form A Dense Covering Over The Surface Of The Ileum
Longitudinal Section Of A Villus Light Microscope Image (x252)
Digestion and Absorption
Digestion Exocrine glands in small intestinal mucosa secrete 1.5 litres/day of water and mucus In the lumen: 1) Fat digestion is complete 2) Proteins reduced to peptides and amino acids 3) Carbohydrates reduced to disaccharides. How is protein and carbohydrate digestion complete ?
Epithelial cells contain: Enterokinase: Activates pancreatic trypsinogen Disaccharidase: Reduced disaccharides to monosaccharides Aminopeptidase: Reduces peptides to amino acids
Thus, carbohydrate and protein digestion is completed in the epithelial cells of brush border
Lactase deficiency Lactose accumulates in small intestine lumen Water, carbon dioxide and methane gas accumulate as a result abdominal cramps and diarrhoea
Capillary Within Villi
Salt and water Salt: Active or passive absorption Water: Passive absorption Carbohydrates Enter from lumen to brush border by energy-consuming transport Fats, vitamins, calcium and iron Only difference is that iron could be absorbed into epithelial cells and then stored as ferritin before release into blood
Excessive defecation of highly fluid faecal material. Eliminates harmful material from the body Also eliminates water (dehydration), nutrient material and HCO3 (metabolic acidosis) Caused by: @ @ @ Viral/bacterial infection leading to excessive intestinal motility Lactase deficiency Toxins of Vibrio Cholerae (bacterium) secretion of vast amounts of fluid by small intestinal mucosa 107
Cecum: Pouch shaped Appendix: Lymphoid tissue housing lymphocytes Colon: Ascending, transverse, descending (last section is sigmoid colon) Rectum: (Meaning straight) Walls of large intestine = pocketlike sacs = haustra Material reaching large intestine = indigestible food (e.g. Cellulose), unabsorbed biliary compounds and fluid. Large intestine absorbs more water and salt and stores faeces
Absorptive & Storage Functions Of The Colon
Emptying At The Ileocaecal Valve
Histological Detail Of The Colon
Histological Detail Of The Colon
Haustral contractions = slow =allow bacteria to brow in large intestine Ascending and transverse colon contract simultaneously to drive faeces to descending colon. Once faeces reaches the rectum, it stretches and sphincters relax External sphincter is skeletal voluntary muscle Abdominal muscles contract and the individual breaths a sigh of relief.
Constipation and Appendicitis
Faeces remains in colon for large periods More water absorbed dry faeces. Can cause headache, depression, nausea and haemorrhoids. If faecal material is lodged in appendix loss of blood supply inflammation Appendicitis
Farting and Burping
Air swallowed during breathing or produced by bacteria must exit, SOMEHOW This gives rise to gurgling sounds (borborygmi) Air either leaves by burping (eructation) The alternate is to FART (flatus)
Human Physiology from cells to systems. Lauralee Sherwood. West Publishing Company