The digestive system

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 The digestive system
Consists of the digestive tract: Oral cavity,
esophagus, stomach, small and large
intestines, rectum, and anus—and its
associated glands—salivary glands, liver,
and pancreas
Its function is to obtain the molecules
necessary for the maintenance, growth, and
energy needs of the body from ingested food

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 The Oral Cavity

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 The Oral Cavity
The oral region includes the oral cavity,
teeth, gingivae, tongue, palate, and the
region of the palatine tonsils
The oral cavity is where food is ingested
and prepared for digestion in the stomach
and small intestine

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 Oral Cavity
The oral cavity consists of two parts: the
oral vestibule and the oral cavity proper
The oral vestibule is the slit-like space
between the teeth and buccal gingiva and
the lips and cheeks
The vestibule communicates with the
exterior through the oral fissure

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 Oral Cavity
The size of the oral fissure (the oral
opening) is controlled by the circumoral
muscles, such as the orbicularis oris (the
sphincter of the oral fissure), the
buccinator, risorius, and depressors and
elevators of the lips (dilators of the fissure)

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 Oral Cavity
The oral cavity proper is the space between the
upper and the lower dental arches or arcades
It is limited laterally and anteriorly by the
maxillary and mandibular sets of teeth
 The roof of the oral cavity is formed by the
palate
Posteriorly, the oral cavity communicates with
the oropharynx (oral part of the pharynx)

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 Lips and Cheeks
The lips are mobile, musculofibrous folds
surrounding the mouth
They contain the orbicularis oris and
superior and inferior labial muscles, vessels,
and nerves
The lips are covered externally by skin and
internally by mucous membrane

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 Lips and Cheeks
The lips function as the valves of the oral
fissure, that control entry and exit from the
mouth and upper alimentary tracts
The lips are used for grasping food, sucking
liquids, keeping food out of the oral
vestibule, forming speech, and osculation
(kissing)
The transitional zone of the lips from
external surface to the internal is vermillion
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 Gingivae
The gingivae (gums) are composed of fibrous
tissue covered with mucous membrane
Are of two types: attached and unattached
The gingiva proper (attached gingiva) is
firmly attached to the alveolar processes of
the jaws
The alveolar mucosa (unattached gingiva) is
normally shiny red and non-keratinizing

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 Teeth
The teeth are set in the tooth sockets and are
used in mastication and speech
Two sets of teeth:primary/deciduous and
permamnet
Children have 20 deciduous teeth; adults
normally have 32 permanent teeth

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 Teeth
The 20 deciduous teeth consist of
2 incisor, 1 canine, and 2 molar teeth on
each side of the upper and lower jaws
These teeth are replaced by the incisor,
canine, and premolar teeth of the permanent
teeth

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 Parts of the Teeth
A tooth has a crown, neck, and root
The crown: the visible part of teeth that
projects from the gingiva
The neck is between the crown and the root
The root is the part fixed in the tooth
socket, which is variant in number

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 Layers of Teeth
Enamel: the outer most layer of teeth in the
crown
Cementum: the outer most layer of teeth in the
root
Dentin: the middle layer of teeth,forms the main
density of teeth
The pulp cavity: the central part of
teeth,contains connective tissue, blood vessels,
and nerves
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 Types of Teeth
The different types of teeth are distinguished
on the basis of morphology, position, and
function
The incisor teeth: are the 'front teeth' and
have one root and a chisel-shaped crown,
which 'cuts';
The canine teeth: are posterior to the
incisors, are the longest teeth, have a crown
with a single pointed cusp
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 Types of Teeth
The premolar teeth: have a crown with
two pointed cusps, one root or two)
The molar teeth: are behind the premolar
teeth, have three roots and crowns with
three to five cusps

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 THE PALATE

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 Palate
Forms the roof of the mouth
Separates the oral cavity from the nasal
cavities
Is covered with oral mucosa, densely
packed with glands
Has two parts: hard and soft

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 Palate
Consists of two
regions: the hard
palate anteriorly and
the soft palate
posteriorly

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 Hard Palate
The anterior two thirds of the palate has a
bony skeleton formed by the palatine
processes of the maxillae and the
horizontal plates of the palatine bones
This bones are covered by mucosa
containing several glands and form the hard
palate

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 Soft Palate
The soft palate is the movable posterior
third of the palate and is suspended from the
posterior border of the hard palate
The soft palate has no bony skeleton
It consists of muscles covered by oral
mucosa

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 Soft Palate
The soft palate extends
posteroinferiorly as a
curved free margin
from which hangs a
conical process, the
uvula

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 Features of the Palate
Radiating laterally from the incisive papilla
are several parallel transverse palatine folds
or rugae
These folds assist with manipulation of
food during mastication
Palatine rugae can be used in forensic
medicine

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 Muscles of the Soft Palate
The five muscles that form the soft palate are:
Tensor veli palatine
Levator veli palatine
Palatoglossus
Palatopharyngeus and
Uvulis

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 The tongue
The tongue (L. lingua; G. glossa) is a mobile
muscular organ that can assume a variety of
shapes and positions
It is partly in the oral cavity and partly in the
oropharynx
It is involved with mastication, taste, deglutition
(swallowing) and oral cleansing; however, its
main functions are forming words during speaking
and squeezing food into the oropharynx when
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swallowing
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 Parts and Surfaces of the Tongue
The tongue has a root,
a body, an apex, a
curved dorsum, and
an inferior surface

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 Parts and Surfaces of the Tongue
The root of the tongue:
Is the part of the tongue
that rests on the floor of
the mouth
It is usually defined as
the posterior 1/3rd of the
tongue

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 Parts and Surfaces of the Tongue
The body of the tongue:
Is the anterior two thirds
of the tongue
The apex (tip) of the
tongue:
Is the anterior end of the
body, which rests against
the incisor teeth
The body and apex of the
tongue are extremely
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mobile
 Parts and Surfaces of the Tongue
The dorsum (dorsal surface) of the tongue is
the superior surface, which is located partly
in the oral cavity and partly in the
oropharynx
It is characterized by a V-shaped groove,
the terminal sulcus or groove (L. sulcus
terminalis), the angle of which points
posteriorly to the foramen cecum

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 Parts and Surfaces of the Tongue
The terminal sulcus divides the dorsum of
the tongue into the anterior (oral) part in
the oral cavity proper and the posterior
(pharyngeal) part in the oropharynx

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 Parts and Surfaces of the Tongue
The mucous membrane on the anterior 2/3 rd
of the dorsum of the tongue is rough
because of the presence of numerous small
lingual papillae
Filiform, Fungiform, Foliate &
Circumvalate papillae

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 Parts and Surfaces of the Tongue
Most of these
papillae except
filiform contain
taste buds
They increase
surface area for
mastication

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 Filiform papillae
• Makes up majority of
the papillae and covers
the anterior part of the
tongue
• They are conical,
keratinized projections
• These papillae facilitate
mastication
• NO TASTE BUDS
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 Fungiform papillae
Mushroom shaped
Interspersed between
the filiform papilla
More numerous near
the tip of the tongue
Taste buds are usually
seen within the
epithelium

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 Foliate papillae
Foliate Papillae
Leaf-like
Present on the lateral
margins of the posterior
tongue
Consist of 4 to 11
parallel ridges that
alternate with deep
grooves in the mucosa,
and a few taste buds are
present in the epithelium
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 Circumvallate papillae
• 10 to 15 in number
• Seen along the v-shaped
sulcus terminalis
• Large, ~ 3 mm in diameter
with a deep surrounding
groove
• Ducts of von ebnerglands
(serous salivary glands)
open into the grooves
• Taste buds are seen lining
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the walls of the papillae
 Parts and Surfaces of the Tongue
The inferior surface of the tongue is
covered with a thin, transparent mucous
membrane through which one can see the
underlying veins
This surface is connected to the floor of the
mouth by a midline fold called the
frenulum of the tongue

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 Muscles of the Tongue
The tongue has two types of muscles:
extrinsic and Intrinsic
In general, however, extrinsic muscles alter
the position of the tongue while intrinsic
muscles alter its shape

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 Extrinsic Muscles of the Tongue
The extrinsic muscles of the tongue are:
Genioglossus, Hyoglossus, Styloglossus,
and Palatoglossus originate outside the
tongue and attach to it
They mainly move the tongue

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 Intrinsic Muscles of the Tongue
The superior and inferior longitudinal,
transverse, and vertical muscles are
confined to the tongue
They have their attachments entirely within
the tongue and are not attached to bone
They mainly alter the shape than altering
the position

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 Taste sensations on Tongue
There are four basic taste sensations: sweet,
salty, sour, and bitter
Sweetness is detected at the apex, saltiness
at the lateral margins, and sourness and
bitterness at the posterior part of the tongue

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 Salivary Glands

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 Salivary glands
Are glands that secret saliva into the oral
cavity
Are of two types: major and minor ones
The majors: parotid, submandibular and
sublingual
The minors: many smaller salivary glands
that continuously release saliva into the oral
cavity

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 Saliva
Keeps the mucous membrane of the mouth
moist
Lubricates the food during mastication
Begins the digestion of starches
Serves as an intrinsic mouthwash
Plays significant roles in the prevention of
tooth decay and in the ability to taste.

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 The Parotid Gland

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 Parotid Gland
Is the largest of three paired salivary glands
Is found on the lateral part of head, inferior
to the external acoustic meatus and posterior
to the ramus of the mandible
Its duct, approximately 5 cm long, opens
into the vestibule of the oral cavity opposite
the upper second molar teeth

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 Submandibular Glands
Is the second largest salivary gland in the
floor of the oral cavity
Its duct opens into the floor of the oral
cavity on the sides of the lingual frenulum

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 Sublingual Glands
Are the smallest and most deeply situated of
the major salivary glands
Lie in the floor of the mouth between the
mandible and the genioglossus muscle
Numerous small sublingual ducts open into
the floor of the mouth along the sublingual
folds

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 Esophagus
Is a muscular tube that extends from the
oral cavity to the stomach
It is 25 cm in length
Serves as a passage of bollus coming from
the oral cavity
Is found in the Neck, Thorax and in the
Abdomen

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 Esophagus
Has 3/4 main constrictions at which food or any
swallowed object can be lodged
The constrictions are formed as the structures
cross the esophagus in its sides
The esophagus is compressed by three structures:
 The junction with pharynx
The arch of the aorta
 The left main bronchus and
 The diaphragm
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 Stomach
Is the most dilated part of the GIT and has a
J-like shape
Is found in the abdominal cavity
Receive esophagus from above and
continues to the first part of the small
intestine, duodenum

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 Parts of the Stomach
The cardia- surrounds the opening of the
esophagus
The fundus- the highest region of the stomach
The body of stomach- the largest region
The pyloric part- continuation site to the
small intestine which is divided into the pyloric
antrum and pyloric canal and is the distal end
of the stomach

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 Other features of the stomach
Has two curvatures: the greater and the
smaller curvatures
Has two ends: esophageal and intestinal
The cardial notch: is the superior angle
created when the esophagus enters the
stomach
The angular incisure : which is a bend on
the lesser curvature

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 INTERIOR OF STOMACH
The gastric mucosa is thrown into
longitudinal ridges or wrinkles called gastric
folds (gastric rugae),which are most
marked toward the pyloric part and along
the greater curvature
The gastric folds diminish and obliterate as
the stomach is distended (fills)

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 Small intestine
Is the longest part of the gastrointestinal
tract
Is approximately 6 -7 m long with a
narrowing diameter from beginning to end
Consists of:
 The duodenum
 The jejunum and
 The ileum

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 Small intestine
Is the primary site for absorption of
nutrients from ingested materials
Extends from the pylorus to the ileocecal
junction where the ileum joins the cecum

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 Duodenum
The first and shortest (25 cm) part of the
small intestine
Is also the widest and most fixed part
Pursues a C - shaped course around the
head of the pancreas
Begins at the pylorus on the right side and
ends at the duodenojejunal junction on the
left side

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 Duodenum
Contains:
The major duodenal papilla : is the
common entrance for the bile and pancreatic
ducts, and
The minor duodenal papilla: is the
entrance for the accessory pancreatic duct

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 Jejunum
The jejunum represents the proximal 2/5 th of
the small intestine
It is larger in diameter and has a thicker wall
than the ileum
 The less prominent arterial arcades and
longer vasa recta (straight arteries) compared
to those of the ileum are a unique
characteristic of the jejunum

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 Ileum
Makes up the distal 3/5th of the small intestine
Compared to the jejunum, the ileum has
thinner walls, shorter vasa recta, more
mesenteric fat, and more arterial arcades
Attaches to the large intestine towards its
termination
The internal mucosa falls into folds known as
plicae circularis, which diminish towards the
termination of ileum
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 Ileum
Opens into the cecum
Has two flaps projecting into the lumen of the
cecum which serve as sphincters to prevent
the back flow of feces from the large intestine
to the ileum

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 Large intestine
Extends from the cecum to the anus
Is approximately 1.5 m in length
Absorbs fluids and salts from the gut contents,
thus forming feces
Consists of:
The cecum
Appendix
Colon (ascending, transverse, descending and
sigmoid)
Rectum, and Anal canal
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Structural features of the Large
Intestine
Omental appendices:
Small, fatty projections on the surface of the LI
Teniae coli:
Three distinct longitudinal smooth muscle
bands
Haustra:
Sacculations of the wall of the colon between
the teniae

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 Large intestine
Beginning in the right groin as the cecum,
with its associated appendix, the large
intestine continues upward as the ascending
colon into the right hypochondrium
Just below the liver, it bends to the left,
forming the right colic flexure (hepatic
flexure)

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 Large intestine
Crosses the abdomen as the transverse
colon to the left hypochondrium
Just below the spleen, the large intestine
bends downward, forming the left colic
flexure (splenic flexure), and continues as
the descending colon through the left flank
and into the left groin

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 Large intestine
It enters the upper part of the pelvic cavity
as the sigmoid colon, continues on the
posterior wall of the pelvic cavity as the
rectum, and terminates as the anal canal

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 The cecum
Is the first part of the large intestine
It is inferior to the ileocecal opening and in
the right iliac fossa
The appendix is attached to the
posteromedial wall of the cecum, just
inferior to the end of the ileum

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 The appendix
The appendix: is a blind intestinal diverticulum
(6-10 cm in length)
It arises from the posteromedial aspect of the
cecum inferior to the ileocecal junction
Has a short triangular mesentery, the
mesoappendix, which derives from the posterior
side of the mesentery of the terminal ileum
Its position is variable, but it is usually retrocecal

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 Positions of the appendix
It may be:
Posterior to the cecum: retrocecal or
retrocolic
Suspended over the pelvic brim in a pelvic or
descending position: pelvic
Below the cecum- subcecal
Anterior to the ileum- preileal
Posterior to the ileum- retro ileal
NB: The most common position is retrocecal
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 The Appendix
The base of the appendix is at the junction of
the lateral one third and middle two-thirds of a
line from the anterior superior iliac spine to
the umbilicus (McBurney's point)
People with appendicular problems may
describe pain near this location

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 Appendicitis
Appendicitis in young people is usually caused
by hyperplasia of lymphatic follicles in the
appendix that occludes the lumen
In older people, the obstruction usually results
from a feces concretion
Rupture of the appendix results in infection of
the peritoneum covering the abdominal viscera,
increased abdominal pain, nausea and/or
vomiting, and abdominal rigidity
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 Appendectomy
Surgical removal of the appendix
(appendectomy) is usually performed for
patients with appendicitis before it raptures

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 Colon
The colon extends superiorly from the
cecum and consists of the ascending,
transverse, descending, and sigmoid colon

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 Ascending Colon
Is found in the right side of the body
Ascends from the cecum to the liver inferior
surface
Turns to the right after it contacts the liver
and becomes a transvers colon

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 The transverse colon
Approximately 45 cm long
is most mobile part of the large intestine
It crosses the abdomen from the right colic
flexure to the left colic flexure, where it
bends inferiorly to become the descending
colon
The left colic flexure is in contact with the
spleen

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 The sigmoid colon
Is “S” shaped loop of variable length
Links the descending colon and the rectum
Is found in the left lower quadrant of the
abdomen

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 Rectum
The rectum is found in the pelvic cavity
Is continuous proximally with the sigmoid
colon and distally with the anal canal
Is where the feces is temporarily stored
until defecation takes place

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Rectum
Has three internal infoldings (transverse
rectal folds): two on the left and one on the
right side
These folds control and limit the feces
being defecated
 The Anal Canal
Is the terminal part of the large intestine,
and of the entire alimentary canal
Extends from the rectum above to the anus
Is 2.5 - 3.5 cm long
The canal ends at the anus, the external
outlet of the alimentary tract
Is surrounded by internal and external
sphincters

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 THE LIVER

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 The Liver
Is the largest gland in the body, after the skin
It weighs approximately 1.5kg in adults
Nutrients absorbed from the digestive tract are
initially conveyed to the liver by the portal
venous system
In addition to its many metabolic activities, the
liver stores glycogen and secretes bile
Is Surrounded by a strong connective tissue
capsule known as Glisson’s capsule
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 Hilum of the Liver
The porta hepatis, or hilum of the liver, is the
site of entrance and exit of structures to and
from the liver
Contains
 The right and left hepatic ducts
 The right and left branches of the hepatic
artery
 The portal vein

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 Liver
Has two surfaces:
A diaphragmatic surface : related to the
inferior surface of the diaphragm
A visceral surface: is related to the
abdominal viscera

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 Ligaments associated with the liver
The liver is attached to the anterior abdominal
wall by the falciform ligament

The liver is attached to other structures such as

to:
the stomach-by hepatogastric ligament
the duodenum- hepatoduodenal ligament and
the diaphragm- right and left triangular
ligaments and anterior and posterior coronary
ligaments
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 Lobes of the Liver
The liver is divided into right and left lobes
by fossae for the gallbladder and the inferior
vena cava
The right lobe of liver is the larger lobe,
whereas the left lobe of liver is smaller
The quadrate and caudate lobes are
described as arising from the right lobe of
liver

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 Blood supply
The blood vessels conveying blood to the
liver are the hepatic artery (20-25%) and
portal vein (75-80%)
The hepatic artery brings oxygenated blood
to the liver, and the portal vein brings
venous blood rich in the products of
digestion

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 Blood supply
The arterial and venous blood is conducted
to the central vein of each liver lobule by the
liver sinusoids
The central veins drain into the right and
left hepatic veins which open directly into
the inferior vena cava

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 Bile Ducts of the Liver
Bile is secreted by the liver cells known as
hepatocytes
 When digestion is not taking place, the bile is
stored and concentrated in the gallbladder; later,
it is delivered to the duodenum
The interlobular ducts join one another to form
progressively larger ducts and, eventually, at the
porta hepatis, form the right and left hepatic
ducts
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 Cirrhosis of the Liver
The liver is the primary site for detoxification
of substances absorbed by the digestive
system, and so it is vulnerable to cellular
damage and consequent scarring
There is progressive destruction of hepatocytes
in hepatic cirrhosis and replacement of them by
fat and fibrous tissue
The condition develops most frequently in
persons suffering from chronic alcoholism
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 Cirrhosis of the Liver
Fibrous tissue surrounds the intrahepatic
blood vessels and biliary ducts, making the
liver firm, and impeding the circulation of
blood through it (portal hypertension)
 The treatment of advanced cirrhosis may
include the surgical creation of a
portosystemic or portocaval shunt,
anastomosing the portal and systemic
venous systems
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 Gallbladder
Pear-shaped organ which stores and
concentrates bile
Can hold up to 50 mL of bile
7-10 cm long
Lies in the fossa for the gallbladder on the
visceral surface of the liver

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 Parts of the gallbladder
Fundus: the wide end of the organ
Body: contacts the visceral surface of the
liver
Neck: narrow and tapered joining the cystic
duct

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 The cystic duct
3- 4 cm long
Connects the neck of the gallbladder to the
common hepatic duct
The mucosa of the neck spirals into the
spiral fold
Joins the common hepatic duct to form the
bile duct

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 Gallstones
Are concretions in the gallbladder, cystic duct,
or bile duct composed chiefly of cholesterol
crystals
In approximately 50% of persons, gallstones
are silent (asymptomatic)
For gallstones to cause clinical symptoms, they
must obtain a size sufficient to produce
mechanical injury to the gallbladder or
obstruction of the biliary tract
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 Duct system for bile
The duct system for the passage of bile
extends from the liver, connects with the
gallbladder, and empties into the descending
part of the duodenum
The coalescence of ducts begins in the liver
parenchyma and continues until the right and
left hepatic ducts are formed
These drain the respective lobes of the liver

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 Duct system for bile
The two hepatic ducts combine to form the
common hepatic duct
As the common hepatic duct continues to
descend, it is joined by the cystic duct from the
gallbladder
This completes the formation of the bile duct
Finally, the bile duct and the main pancreatic
duct unit and open to the second part of
duodenum
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 The Pancreas
Is an elongated, accessory digestive gland that
lies in the abdominal cavity
The pancreas produces:
An exocrine secretion (pancreatic juice from the
acinar cells) that enters the duodenum through the
main and accessory pancreatic ducts
Endocrine secretions (glucagon and insulin from
the pancreatic islets of Langerhans) that enter the
blood
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 The Pancreas
Is both an exocrine and an endocrine gland
Lies mostly posterior to the stomach
Consists of:
A head with uncinate process
Neck
Body and
 Tail

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 The Pancreas cont’d…
The head of pancreas :
- Lies within the “C”-shaped concavity of the
duodenum
 Projecting from the lower part of the head is the
uncinate process
The neck of pancreas :
 Is the narrow region of the pancrease
The tail of pancreas: passes forward and
comes in contact with the hilum of the spleen
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