DIGESTIVE SYSTEM

BY ACHMAD AMINUDDIN
 FUNCTIONS
 INGESTION:
taking food into the mouth.
 SECRETIO:
release of water,acid, buffer, and enzymes
into the lumen of the GI tract.
 MIXING AND PROPULSION:
churning and propulsion of food through the
GI tract.
 CONTINUATION
 DIGESTIO:
mechanical and chemical breakdown of food
 ABSORPTION:
passage of digested products from the GI
tract into the blood and lymph.
 DEFECATION:
the elimination of feces from the GI tract.
 ORAL REGION
 INCLUDES :
– THE ORAL CAVITY
– TEETH
– GINGIVAE
– TONGUE
– PALATE
– THE REGION OF THE PALATINE
– TONSILS
 ORAL CAVITY
 CONSIST OF
– THE ORAL VESTIBULE
– THE ORAL CAVITY PROPER
 IS WHERE FOOD IS INGESTED AND
PREPARED FOR DIGESTION
 THE TEETH AND SALIVA FASILITATE
THE FORMATION OF A MANAGEABLE
FOOD BOLUS
 THE ORAL VESTIBULE
 IS THE SLIT LIKE SPACE BETWEEN THE
LIPS AND CHEEKS SUPERFICIALLY.
 COMMUNICATES WITH THE EXTERIOR
THROUGH THE ORAL FISSURE ( ORIFI
CE OF MOUTH )
 THE SIZE OF THIS OPENING IS CONTRO
LED BY THE ORBICULARIS ORIS M.
 THE ORAL CAVITY PROPER
 BOUNDARIES
– LATERAL AND ANTERIOR
 THE MAXILLARY AND MANDIBULAR ALVEOLAR ARCHES
HOUSING THE TEETH.
– POSTERIOR
 THE TERMIAL GROOVE OF THE TONGUE.
 PALATOGLOSSAL ARCHES.
– THE ROOF
 THE PALATE.
– POSTERIORLY COMMUNICATES WITH
 THE OROPHARYNX.
 ORAL VESTIBULE
 CONTAIN
 ORBICULARIS M.
 SUPERIOR AND INFERIOR LABIAL M.
 VESSELS AND NERVES.
 ARE COVERED BY
 SKIN.
 MUCOUS MEMBRANE
 PHILTRUM.
 THE VERMILLION BORDER.
 THE GINGIVAE
 COMPOSED OF FIBROUS TISSUE COVE
RED WITH MUCOUS MEMBRANE.
 FIRMLY ATTACH TO THE ALVEOLAR
PROCESSES OF THE JAWS AND THE
NECKS OF THE TEETH.
 TEETH
 SET IN THE ALVEOLI OF THE UPPER AND LOWER
JAWS.
 CHILDREN HAVE 20 DECIDUOUS ( PRI MARY ) TEETH.
 THE FIRST TOOTH USUALLY ERUPS AT 6 TO 8
MONTH OF AGE AND THE LAST TOOTH BY 20 TO 24
MONTH OF AGE.
 THE PERMANENT TEETH NORMALLY 16 INEACH JAW,
3 MOLARS, 2 PREMOLARS,1 CA NINE AND 2
INCISORS, USUALLY IS COMPLE TE BY THE
MIDTEENS EXCEPT FOR THE 3rd MOLAR, WICH USUAL
LY ERUP DURING THE LATE TEENS OR EARLY
TWETIES
 TEETH
 CONSIST OF,
– THE CROWN
 PROJECTS FROM THE GINGIVA
– THE NECK
 THE PART OF THE TOOTH BETWEEN THE
CROWN AND ROOT.
– THE ROOT
 IS FIXED IN THE ALVEOLUS BY A FIBROUS
PERIODONTAL MEMBRANE.
COMPOSITION OF THE TOOTH
 DENTIN is covered by
 ENAMEL over the crown
 CEMENT over the root
 PULP CAVITY, contain
– CONNECTIVE TISSUE.
– BLOOD VESSELS.
– NERVES.
 ROOT CANAL transmits the nerves and vessels to
and from the pulp cavity
 SALIVA
 SALIVARY AMYLASE
source ; salivary glands.
substrates : starches ( polysacharides ).
products : maltose ( disaccharide ).
maltotriose ( trisaccharide ).
a-dextrins.
 LINGUAL LIPASE
source : lingual glands in the tongue.
substrates : triglycerides ( fats and oils ) and
other lipids.
products : fatty acids and diglycerides.
 PALATE
 THE HARD PALATE
– SEPARATES THE AMTERIOR PART OF THE
ORAL CAVITY FROM THE NASAL CAVITY.
 THE SOFT PALATE
– SEPARATES THE POSTERIOR PART OF THE
ORAL CAVITY FROM THE NASOPHARYNX
SUPERIOR
 THE PALATINE TONSIL
 LIES IN A TONSILAR SINUS ( FOSSA ),
BOUNDED BY,
– PALATO GLOSSAL ARCH.
– PALATOPHARYNGEAL ARCH.
– TONGUE.
 PHARYNX
 EXTENDS FROM THE CRANIAL BASE TO
THE INFERIOR BORDER OF THE
CRICOID CARTILAGE ANTERIORLY AND
THE INFERIOR BORDER OF THE C6
VERTEBRA POSTERIORLY.
 INTERIOR OF THE PHARYNX
- NASOPHARYNX.
- OROPHARYNX.
- LARYNGOPHARYNX
 ESOPHAGUS
 A MUSCULAR TUBE THAT EXTENDS FROM
THE PHARYNX TO THE STOMACH
 DESCENDS THROUGH THE POSTERIOR
MEDIASTINUM, ESOPHAGEAL HIATUS IN THE
DIAPHRAGM JUST JUST TO THE LEFT OF
MEDIAN PLANE AT THE LEVEL OF VT 10 ,
ENTER THE STOMACH THROGH CARDIAL
ORIFICE TO THE LEFT OF MID LINE AT THE
LEVEL OF THE 7 TH LEFT COSTAL
CARTILAGE AND VT 11
 ESOPHAGUS
 Pharyngoesophageal junction – cardia.
 Striated muscle ( voluntary ) – upper third.
 Smooth muscle ( involuntary – lower third.
 Mixture -- in between.
 Cervical eophagus
- upper third.
- begin posterior to and at the level of the
inferior border of the cricoid cartilage / C6
vertebra.
- Pharyngoesophageal junction is the superior
esophageal shincter is produced by the cricopharyngeal
part of the inferior constrictor muscle.
- lie between the trachea and the cervical vertebral column.
- the recurrent laryngeal n.lie in the tracheoesophageal groove.
 ESOPHAGUS
 The esophagus descends in to the posterior
mediastinum from the superior mediastinum
passing posterior and to the right of the arch of the
aorta.
 Passes through the esophageal hiatus in the
diaphragm at the level of the T10 vertebra anterior
to the aorta.
 Three constrictions
- the arch of the aorta.
- the left main bronchus.
- the diaphragm.
 NERVES OF THECERVICAL
ESOPHAGUS
 Somatic motor and sensorik – upper half.
 Parasympathetic, sympathetic
and visceral sensory -- lower half.
 The cervical esiphagus receives
- somatic fibers via branches from the
recurrent laryngeal nerve.
- vasomotor fibers from the cervical
sympathetic trunk.
VESSELS OF THE CERVICAL
ESOPHAGUS

 Branches of the inferior thyroid arteries.

 Tributaries of the inferior thyroid veins.
 Paratracheal lymp nodes.
 Inferior deep cervical lymph nodes.
 DEGLUTITION
 THE MOVEMENT OF FOOD FROM THE MOUTH
INTO THE STOMACH.
 FACILITATED BY THE SECRETION OF SALIVA
AND MUCUS AND INVOLVES THE
MOUTH,PHARYNX AND ESOPHAGU
 THREE STAGES;
- the voluntary stage, the bolus is passed in
to the oropharynx.
- the pharyngeal stages.
- the esophageal stage.
 STAGE I : VOLUNTARY

 THE BOLUS IS COMPRESSED AGAINST

THE PALATE AND PUSHED FROM THE
MOUTH IN TO THE OROPHARYNX,
MAINLY BY MOVEMENTS OF THE
MUSCLES OF THE TONGUE AND SOFT
PALATE
Fig 8.39 A , B
 STAGE 2 INVOLUNTAY AND
RAPID
 THE SOFT PALATE IS ELEVATED,
SEALING OFF THE NASOPHARYNX
FROM THE OROPHARYNX AND
LARYNGOPHARYNX.
 THE PHARYNX WIDENS AND SHORTENS
TO RECEIVE THE BOLUS OF FOOD AS
THE SUPRAHYOID MUSCELS AND
LONGITUDINAL PHARYNGEAL MUSCLES
CONTRACT, ELEVATING THE LARYNX
 STAGE 3 ; INVOLUNTARY

 SEQUENTIAL CONTRACTION OF ALL

THREE CONSTRICTOR MUSCLES
FORCES THE FOOD BOLUS INFERIORLY
IN TO THE ESOPHAGUS
 STOMACH
 A FOOD BLENDER.
 RESERVOIR.
 CHIEF FUNCTION , ENZYMATIC DIGESTI
ON, GASTRIC JUICE CONVERTS A MASS
OF FOOD IN TO A LIQUID MIXTURE –
CHYME – THAT PASSES IN TO
DUODENUM.
 STOMACH
 HAS 4 PARTS AND 2 CURVATURES,
– CARDIA.
– FUNDUS.
– BODY.
– PYLORIC PART.
– LESSER CURVATURE.
– GREATER CURVATURE.
 FUNCTIONS OF THE STOMACH
 MIXES SALIVA, FOOD AND GASTRIC JUICE TO
FORM CHYME.
 SERVES AS RESERVOIR FOR FOOD BEFORE
RELEASE INTO SMALL INTESTINE.
 SECRETE GASTRIC JUICE, WHICH CONTAIN
HCl ( kills bacteria and denatures protein ),
PEPSIN ( begins the digestion of proteins ),
INTRINSIC FACTOR ( aids absorption of vit.
B12 ), AND GASTRIC LIPASE ( aids digestion of
triglycerides ).
 SECRETES GASTRIN INTO BLOOD.
VISCERAL REFERED PAIN
 SMALL INTESTINE

 EXTENDS FROM THE PYLORUS TO THE

ILEOCECAL JUNCTION.
 THE PRIMARY SITE OF ABSORPTION OF
NUTRIEN FROM INGESTED MATERIAL.
 CONSIST OF DUODENUM, JEJUNUM
AND ILEUM.
 DUODENUM

 SUPERIOR PART.
 DESCENDING PART.
 HORIZONTAL PART.
 ASCENDING PART.
 JEJUNUM AND ILIEUM
 6 – 7 METERS.
 JEJUNUM , two – fifth.
 ILEUM , three – fifth.
 THE MESENTERY
– ATTACHES THE JEJUNUM AND ILEUM TO THE
POSTERIOR ABDOMINAL WALL.
– THE ROOT OF THE MESENTERY, EXTENDS FROM
THE DUODENOJEJUNAL JUNCTION ON THE LEFT
DIDE OF V.L. 2 TO THE ILEOCOLIC JUNCTION AT
THE RIGHT SACROILIAC JOINT ( 15 CM LONG ).
LARGE INTESTINE
 CONSIST OF
– CECUM.
– COLON
 ASCENDING.
 TRANSVERSE.
 DESCENDING.
 SIGMOID.
– RECTUM.
– ANAL CANAL.
 COLON CAN BE
DISTINGUISED FROM SMALL
INTESTINE,
 TENIA COLI (excep appendix and rectum ).
 HAUSTRA.
 OMENTAL APPENDICES.
 CALIBER.
 CECUM
 THE FIRST PART OF THE LARGE
INTESTINE.
 INTRA PERITONEALLY.
 HAS NO MESENTERY.
 THE ILEUM ENTER THE CECUM ,
– ILEOCECAL ORIFICE.
– ILEO CECAL VALVE.
 APPENDIX
 EXTENDS FROM THE POSTEROMEDIAL
ASPECT OF THE CECUM, INFERIOR TO
THE ILEOCECAL JUNCTION/
 HAS THE MESOAPPENDIX.
 USUALLY RETROCECAL.
 ITS BASE MOST OFTENLIES DEEP TO
Mc. BURNEY POINT.
 THE ASCENDING COLON

 FROM THE CECUM TO THE RIGHT

COLIC FLEXURE.
 RETROPERITONEAL ( 25 0/0 has a short
mesentery ).
THE TRANSVERSE COLON

 THE LARGEST AND MOST MOBILE.

 FROM THE RIGHT FLEXURE TO THE
LEFT COLIC FLEXURE.
 DESCENDING COLON
 RETRO PERITONEALLY.
 FROM THE LEFT COLIC FLEXURE IN TO
THE LEFT ILIAC FOSSA.
 IN THE ILIAC FOSSA HAS A SHORT
MESENTERY ( 33 0/0 ).
 THE SIGMOID COLON
 S SHAPED LOOP.
 FROM THE ILIAC FOSSA TO THE THIRD
SACRAL.
 HAS ASIGMOID MESOCOLON.
 THE ROOT OF THE SIGMOID COLON
HAS AN INVERTED V SHAPED
ATTACHMENT.
RECTUM AND ANAL CANAL
 THE FIXED TERMINAL PART OF THE
LARGE INTESTINE.
 CONTINUOUS INFERIORLY WITH
THE ANAL CANAL.
RECTUM
fig 3.33 429
 RECTUM
 The rectosigmoid junction lies anterior to the S3
vertebra. At this point , the taenia of the sigmoid
colon spread out to form a continuous outer
longitudinal layer of smooth muscle, and the fatty
omental appendices are discontinued.
 The sacral flexure of the rectum
 The rectum ends anteroinferior to the tip of the
coccyx, immediately before the anorectal flexure
of the anal canal, that occur as the gut perforates
the pelvic diaphragm
fig 241 272
 RECTUM
 The roughly 80° the anorectal flexure is an
important mechanism for fecal continence,
being maintained during the resting stage by
the tonus of the puborectalis muscle and by
its contraction during peristaltic contraction if
defecation is not to occur.
 The ampula of the rectum receives and
holds an accumulating fecal mass until it is
expelled during defcation
fig 3.8 372
 RECTUM
 Peritonium covers the anterior and lateral
surface of the superior third of the rectum,
only the anterior surface of the middle third,
and no surface of the inferior third because
it is subperitoneal.
 Rectovesical pouch.
 Rectouterine pouch.
 Pararectal fosae
fig 3.34 430
 ARTERIL SUPPLY OF THE
RECTUM
 The superior rectal artery, the continuation of the
inferior meenteric aretry, supply the proximal part
of the rectum.
 The right and left middle rectal arteies, arising
from the inferior vesical arteries, supply the middle
and inferior parts of the rectum
 The inferior rectal arteries, arising from the
pudendal arteries, supply hte anorectal junction
and anal canal.
 Anastomosis betwen these arteries provide
potential colateral circulation
 VENOUS DRAINAGE
 The superior , middle and inferior rectal veins.
 The superior rectal vein drains into the portal
venous system.
 The middle and inferior rectal veins drains into
systemic system
 The rectal venous plexus
- the internal rectal venous plexus.
- the externsl rectal venous plexus
 LYMPHATIC DRAINAGE
 From the superior half of the rectum pass to
the pararectal l.n , and then to the inferior
mesenteric l.n , -- lumbar l.n.
 From the inferior half of the rectum drains
directly to sacral l.n.
 From distal ampulla , drains into the internal
iliac l.n.
FIG 3,35 431
 INNERVATION OF THE RECTUM
 The sympathetic supply is from the lumbar spinal
cord, conveyed via lumbar splanchnic nerves and
the hypogastric / pelvic plexuses and through the
periarterial plexus of the inferior mesenteric and
superior rectal arteri
 The parasympathetic supply is from the S2 – S4
spinal cord level, passing via the pelvic splanchnic
nerves and the left and right inferior hypogastric
plexuses to the rectal plexus.
 All visceral afferent fibers follow the
parasympathetic fibers retrogradely to the S2 – S4
spinal sensory ganglia.
INNERVATION OF THE RECTUM

fig 3.36 432

 ANAL CANAL

 Anal canal extends from the superior

aspect of the pelvic giaphragm to the anus.
 Surrounded by internal and axternal anal
sphincters, descends posteroinferiorly
between the anococcygeal ligament and the
perineal body
FIG 3.42 B
FIG 3.43
THE INTERNAL ANALSPHINCTER
 IAS, is an involuntary sphincters
surrounding the superior two third of the
anal canal
 It contraction ( tonus ) is stimulated and
maintained by sympathetic fibers from the
superior rectal ( periarterial ) and
hypogastric plexuses ; its contraction is
inhibited by parasympathetic fiber stimulatin
 THE EXTERNAL ANAL
SPHINCTER
 EAS , is a large voluntary sphincter that forms a
broad band on each side of the inferior two thirds
of the anal canal
 EAS , is attached anteriorly to the perineal body
and posteriorly to the to the coccyx via the
anococcygeal ligament; it blends superiorly with
the puborectalis muscle.
 EAS , is supplied mainly by S4 through the inferior
rectal nerve, although its deep part also receives
fibers from the nerve to the levator ani
 ANAL CANAL
 Extends from the superior aspect of the
pelvic diaphragm to the anus
 Surroumded by internal and external anal
sphincter,descends posteroinferiorly
between the anococcygeal ligamentum and
the perineal body.
 Anal column
- contain the terminal branches of the
superior rectal artery and vein
fig 3.45
ARTERIAL SUPPLY OF THE ANAL
CANAL
 The superior rectal arteriy supplies the anal
canal superior to the pectinate line.
 The two inferir rectal arteries supply the
inferior part of the anal canal as well as the
surrounding muscles and perianal skin.
 The middle rectal arteries assist with the
blood supply to the anal canal by forming
anastomses with the superior and inferior
rectal arteries.
 VENOUS DRAINAGE OF THE
ANAL CANAL
 Superior to the pectinate line, the internal rectal
plexus drains chiefly into the superior rectal vein
( tributary of the IMV ).
 Inferior to the pectinate line, thr internal rectal
plexus drains into the inferior rectal vein ( tributary
of the caval venous system ) around the margin of
the external anal sphincter .
 The middle rectal veins ( tributary of the internal
iliac veins ) mainly drain the muscularis externa of
the ampula and form anastomoses with hte
superior and inferior rectal veins
 LYMPHATIC GRAINAGE OF THE
ANAL CANAL
 Superior to the pectinata line, the lymphatic
vessels drain deeply into the internal iliac
lymph nodes ---- the common iliac and
lumbar lymph nodes.
 Inferior to the pectinata line , the lymphatic
vessels drain superficially into the superficial
inguinal lymph nodes
 INNERVATION OF THE ANAL
CANAL
 Seuperior to the pectinate line is visceral
innervation from the inferior hypogastric
plexus, involving sympathetic,
parasympathetic, and visceral afferent fibers
Sympathetic fibers maintain the tonus of the
internal sphincter
Parasympathetic fibers inhibit the tonus of
the internal sphincter and evoke peristaltic
contraction for defecation.
 INNERVATION OF THE ANAL
CANAL
 All visceral afferent travel with the
parasympathetic fibers to spinal sensory
ganglia S2 – S4.
 The nerve supply of the anal canal Inferior
to the pectinate line, is somatic innervation
derived from the inferior anal ( rectal )
nerves, branches of the pudendal nerve.
 Somatic efferent fibers stimulate contraction
of the voluntary external anal sphincter.