Sei sulla pagina 1di 51

A&P 302 GI/Digestive System Lecture Notes:

Digestive System Function:

Break food into nutrient molecules

Absorb the molecules
Eliminate the indigestible remains

Digestive System Anatomical Divisions:

Alimentary Canal
Accessory Digestive Organs

Digestive System Alimentary Canal:


Small intestine
Large intestine

Digestive System Accessory Digestive Organs:


Teeth teeth are a digestive organ

Digestive glands
o Salivary
o Liver
o Pancreas

Digestive System Digestive Process:

Mechanical Digestion
Chemical Digestion

Digestive Process Ingestion:

Taking food into the digestive tract via the mouth

Digestive Process Propulsion:

Movement of food through the alimentary canal

Peristalsis is the major means of propulsion
o Caused by a wave of alternating muscle contraction and relaxation
Big point: When looking at moving food through the canal you do it
by propulsion via peristalsis (also have peristalsis in ureters to move
urine to the bladder). When it constricts the lumen gets longs and

Digestive Process Mechanical Digestion:

Mixing of food with saliva by the tongue
Churning food in the stomach
Segmentation or local constriction in the intestine
Segmentation kinda like peristalsis but peristalsis moves in one
direction, while segmentation goes back and forth

Prepares the food for chemical digestion

Digestive Process Chemical Digestion:

Series of catabolic steps which breakdown complex food into its chemical building
Starts in the mouth and ends in the small intestine
Nothing much happens in the esophagus

No digestive takes place in the large intestine

Digestive Process Absorption:

Passage of digested end products from the lumen of the GI tract into the blood or lymph
The small intestine is the major absorptive site

Most absorption takes place in the first 8 inches of

the small intestine

There is a very rich blood supply to carry the nutrients to the liver

Digestive Process Defecation:

Elimination of the indigestible substances

Digestive System Basic Functional Concepts:

Control of digestive activity

o Provoked by a large range of mechanical and chemical stimuli
o Controls are both intrinsic and extrinsic

Elearn document on digestive process

Intrinsic distention directly gives you a response (peristalsis),
Extrinsic salivating when you hear a bell (like in psych), it goes to the

Control of Digestive Activity Stimuli:

Mechanical receptors monitor stretch

Chemical receptors monitor ON TEST:

o Osmolarity
o pH
o Presence of substrates

Proteins, fats, and carbs each have their own set of enzymes.
More bile will be produced if you have a high fat diet

Control of Digestive Activity Intrinsic Control:

Local nerve plexus or hormone control

Short reflexes are mediated entirely of local (enteric) control

Control of Digestive Activity Extrinsic Control:

Initiated by stimuli arising inside or outside the digestive tract involving CNS center and
extrinsic autonomic nerves

Digestive System Abdominal Cavity:

Peritoneum the serous membrane

o Visceral peritoneum covers the external surface of most digestive organs
o Parietal peritoneum lines the body wall

o Mesentery
Abdominal cavity no line to tell where abdominal and pelvic begins
Serous membrane because its enclosed
Mesentery important. This is where the blood vessels run through. If
the mesentery gets twisted and the blood supply gets pinched off then
the organ will die

Abdominal Cavity Peritoneum:

Peritoneal cavity the slitlike space between the visceral and parietal peritoneum
o Intraperitoneal or peritoneal organs
o Retroperitoneal
Surrounded by the peritoneal?
Between the parietal peritoneum and body wall retroperitoneal. Like
kidneys and ureters
It is a potential space. Even though the serous is one the body wall
theres the possibility of it forming a cavity and something abscess
Peritonitis it is extremely painful when there is movement of the
organs inside and when you push on the abdomen the muscles are
rigid. If you really ant to see if they have it, then you check for
rebound tenderness.

Abdominal Cavity Intraparitoneal Cavity:

Organs that are contained by the parietal peritoneum

Abdominal Cavity Retroperitoneal Organs:

Organs that lay between the parietal peritoneum and the body wall
o Pancreas
o Some of the large intestine

Abdominal Cavity Mesentery:

Double layer of peritoneum that extends to the digestive organs from the body wall

Tethers the organs to the body wall

Contains blood vessels

Can use this to your advantage, stuff mesentery can also be absorbed
and filter out of the mesentery.
Important for dialysis (intraperitoneal dialysis), you fill abdomen with
fluid and it absorbs all the waste and toxins.
Also used to give medications, meds can be absorbed through the

Digestive System Blood Supply:

Splanchnic Circulation
Hepatic Portal Circulation

Digestive System Splanchnic Circulation:

Those arteries that branch off the aorta
- Celiac serves the liver, stomach, and spleen first artery to come off the aorta
below the diaphragm
- Mesenteric superior and inferior serve the intestine
Really refers to intestine.
4 branches
Splanchnic is arterial
Superior mesentery supplies the small intestine
Inferior supplies the large intestine
Basically taking blood to the intestine
The hepatic portal is venous return

Digestive System Hepatic Portal Circulation:

Collects nutrient rich venous blood from the intestine and transports it to the liver
Liver absorbs and collects nutrients

Functional Anatomy Functional Separations:

Small intestine
Large intestine
Accessory organs

Functional Anatomy Mouth:

Lips and Cheeks
Salivary glands

Mouth General Description:

Also called the oral cavity or buccal cavity

o Anterior oral orifice
o Posterior oropharynx (toward the back of the throat)

Buccal membranes in mouth. Something you would document if the

pt has dehydration (dry or moist)

Mouth Histology:

Stratified squamous epithelium

Slightly keratinized on the gums, hard palate, and dorsum of the tongue
Produces defensins
Keratin here is a little different from the skin, its there to give the
tissue a little more toughness because it is an area of high mechanical
stress doesnt have to do with water absorption or replacement.
What kind of connection do we have here? We have desmosomes
here d/t high mechanical wear

Mouth Lips and Cheeks:

Lips formed by the orbicularis oris

Cheeks formed by the buccinators
Vestibule bounded externally by the lips and internally by the teeth (just the
Red margin reddened area of the lips
Labial frenulum median fold that joins the lip to gum

Mouth Palate:

Forms the roof of the mouth

Consists of the:
o Hard palate
o Soft palate - it is more functional it comes back and closes off the
nasal cavity

Palate Hard Palate:

Underlain by palantine bones and palantine processes of the maxillae

Raphe ridges for added friction (in the roof of the mouth, allows the food to
be held firmly up there so that the tongue can work on it and get the
saliva mixed in)
Forms a rigid surface for the tongue to force food during chewing

Palate Soft Palate:

Mostly composed of skeletal muscle

Contains the uvula

Closes off the nasopharynx during swallowing

Dont worry about the bottom two
Anchored to the tongue by the palatoglossal arches
Anchored to the oropharynx by the palatopharyngeal arches

Mouth Tongue:

o Intrinsic muscle
o Extrinsic muscle
o Lingual frenulum
o Papillae
o Sulcus terminalis

Tongue Internal Structures:

Intrinsic muscle not attached to bone

o Runs in several different planes
o Alters the shape of the tongue for chewing and speech production
Extrinsic muscle attached to skull
o Changes the position of the tongue
Intrinsic alters the shape of the tongue (makes it able to speak and
enunciate, also used for chewing)
Extrinsic which allows you to stick the tongue out

Tongue External Structures:

Lingual frenulum secures the bottom of the tongue to the floor of the mouth
o Lingual = tongue
o If it is too long and attaches to far then they can have speech
problems tongue tied. and because it runs down the middle,
instead of seeing a rounded tongue you will se a forked tongue
3 different types of pili:

Filiform papillae give external tongue a roughness for added friction

Fungiform house taste buds
Circumvallate house taste buds

Sulcus terminales groove down the center of the tongue goes down the center

Mouth Salivary Glands:

Composition of Saliva
Control of Salivation

Salivary Glands Function:

Cleanses the mouth

Dissolves food
Moistens food to aid swallowing
Contains enzymes that breakdown starchy foods
Salivary glands produce saliva it cleans the mouth (there are
antibiotic like substances and enzymes)
Enzyme that breaks down starch salivary amylase (there is also
pancreatic amylase) Remember!
First part of chemical digestion is with starches/amylase

Salivary Glands Structure:

Serous cells produce watery secretion to moisten food

Mucous cells produce mucus for protection
Ducts deliver saliva

Salivary Glands Components:

Extrinsic glands
- Parotid gland
- Submandibular gland
- Sublingual gland
Intrinsic glands scattered throughout the buccal mucosa
Extrinsic WILL have the ducts!
The Intrinsic do NOT!

Extrinsic Glands Parotid Gland:

Anterior to the ear

Lies between the masseter muscle and the skin
Drains through the parotid duct that exits near the second upper molar there is only
ONE parotid gland on each side!!

Extrinsic Glands Submandibular Gland:

Lies along the medial aspect of the mandibular body

The duct opens at the base of the lingual frenulum Only ONE duct on each side!!

Extrinsic Glands Sublingual Gland:

Lies anterior to the submandibular gland

Opens via 10 to 12 ducts in the floor of the mouth
Have 10-12 ducts that open into the mouth!!

Salivary Glands Composition of Saliva:

97+% water
Slightly acidic
IgA secretory immunoglobin and lysozyme are there for protection
(to kill off bacteria)

Salivary Glands Control of Salivation:

Intrinsic salivary glands continuously secrete saliva to keep the mouth
Extrinsic salivary glands are activated when food enters the mouth (Like
Pavlovs dogs)

Under parasympathetic
Motor impulses come from the facial and glossopharyngeal nerves
Important to have continuous saliva to help prevent tooth decay
(caries) d/t the lysozymes and IGA.

Mouth Teeth:

Children have 20 teeth

Adults have 32 teeth

Enamel acellular covering that bears the brunt of chewing

Crown portion of the tooth above the gingiva
Root portion embedded in the mandible or maxilla
Dentin bone like material under the enamel hardest substance in the body
Pulp cavity central cavity containing nerves and blood vessels

Digestive System Pharynx:

Oropharynx and laryngeal pharynx both are food passageways (food and air
Surrounded by pharyngeal constrictor muscles that help propel food (involved in

Digestive System Esophagus:

Food in the laryngeal pharynx is routed to the esophagus

The esophagus pierces the diaphragm at the esophageal hiatus
Joins the stomach at the cardiac (has NOTHING to do with the heart) or
gastroesophageal sphincter - keeps the esophagus closed until swallowing occurs
LES (lower esophageal sphincter)
Esophagus sits in the mediastinum, trachea sits right above it, aorta
right under it.
Lower esophageal sphincter (LES), closes off the stomach so acid
doesnt go into the esophagus can cause scarring and changes that
could lead to cancer
Lower esophageal sphincter is weak, it has to sit at the level of the
diaphragm, if it doesnt it will be too weak

Digestive Process Early Digestion:

Pharyngeal-Esophageal Phase

Early Digestion Mouth:

Mechanical digestion (mastication)
Initiate propulsion by swallowing (deglutition)
Chemical digestion by amylase

Early Digestion Pharyngeal-Esophageal Phase:

Controlled by the swallowing centers in the medulla and lower pons

Tongue blocks off the mouth comes up the roof
Soft palate blocks off the nasopharynx
Epiglottis covers the airways
The false vocal cords and the epiglottis prevent food from entering the
Food as it is going through the esophagus is called a bolus

Digestive System Stomach:

Gross Anatomy
Microscopic Anatomy

Stomach Gross Anatomy:

Varies from 15 to 25cm in length

Has a volume of 50ml empty and 4L full
Rugae internal folds
Cardia or cardiac region surrounds the cardiac orifice

Raphe hard palate

Rugae internal folds of somtach

Fundus dome-shaped part directly under the diaphragm fundus = top of any
dome shaped organ
Body mid portion of the stomach
Pyloric region distal portion of the stomach the other term used is the
terminal portion of the stomach
Pyloric antrum superior part of the pyloric region
Pyloric canal formed by a narrowing of the pyloric antrum
Pyloric terminal portion of the pyloric region
Pyloric sphincter muscle that controls emptying of the stomach
o Very substantial, it works well
o And it has to work well because if too much food leaves the
stomach then the small intestine cant absorb it all
o When food is in the stomach and from there on it is known as
Greater curvature convex lateral portion of the stomach
o Greater omentum attaches
o Greater omentum does not attach to anything else acts as an
apron that sits over the in intestine

Lesser curvature the concave medial portion of the stomach

o Lesser omentum attaches
o Lesser omentum goes from the lesser curvature to the liver!

Stomach Microscopic Anatomy:

Lining is dotted with millions of gastric pits that lead to gastric glands that produce
gastric juice
Cell walls of gastric pit are primarily goblet cells
Goblet cells produce mucus

Mucous Neck Cells

Parietal Cells
Chief Cells
Enteroendocrine Cells
Mucosal Barrier

Stomach Mucous Neck Cells:

Found in the upper neck region of the stomach

Produces an acidic mucus significance unknown

Stomach Parietal Cells:

Found mainly in the middle region of the stomach

Secretes hydrochloric acid
Secretes intrinsic factor that helps with the absorption of vitamin B12
If producing an acid, you have hydrogen ions. Where do they come
from? The blood
Remember that parietal cells, hydrochloric acid and intrinsic factor

Stomach Chief Cells:

Occur mainly in the basal region

Produces pepsinogen which is converted to pepsin by pepsin and HCL


important function that HCL

Pepsin is a protein digesting enzyme
Pep = protein, like peptide
They dont damage the cells where theyre being produced,
theyre produced in an inactive form
o Cleaves pepsinogen to pepsin is a positive feedback loop

Stomach Enteroendocrine Cells:

Throughout the stomach release:

o Gastrin works on the stomach
o Cholecystokinin works on the gallbladder
o Endorphins

o Serotonin
o Somatostatin
o Histamine causes the release of acid

Stomach Mucosal Barrier:

Protects the mucosa from damage by the acid and digestive enzymes in the stomach
H. Pylori and NSAIDs are bad for the stomach/mucosal barrier
Big concern with gastric ulcer? They can extend all the way through
the stomach (perforation)

Mucosal Barrier Components:


Thick coating of bicarbonate-rich mucus

Epithelial cells have tight junction
Gastric gland plasma membrane is impermeable to HCl

Undifferentiated stem cells in the gastric pits replace shed or damaged cells rapidly
There is a rapid turnover of cells
Small intestine replaces cells every 2-3 days

Stomach Regulation of Gastric Secretions:

Cephalic head
Gastric gastric secretions, production of acid and pepsin

Regulation of Gastric Secretions Cephalic Phase:

Occurs before food enters the stomach

Triggered by aroma, taste, sight, or thought of food
Produce more salvia and more stomach secretions
Prime example of extrinsic control (coming from the brain telling it to
make acid)
Input from taste buds and olfactory nerves is relayed to the hypothalamus
Stimulates the vagal nuclei of the medulla
o Released acetylcholine causes the production of acid that
stimulates the stomach glands
Stimulates the stomach glands

Regulation of Gastric Secretions Gastric Phase:

Local neural and hormonal mechanisms initiated when food hits the stomach
Stimuli are distension, peptides, and low acidity
Phase lasts 3 to 4 hours
Intrinsic controlled
pH comes up acidity goes down and vice versa

Activation of stretch receptors:

o Local reflexes
o Sends impulses to the medulla which activates the vagal nerve
Parietal cells are stimulated to produce HCL by:
o Gastrin
o Histamine
o Acetylcholine

H2 blocker = histamine blocker - specifically designed to stop the

production of acid
Losec, zantec

Acid is produced by a proton pump which pumps hydrogen ions into the stomach lumen
against a large gradient
Potassium is pumped into the cells
Exchanging H and K to try to keep charge the same

Chloride is pumped into the lumen to maintain electrical neutrality

Blood leaving the stomach is more alkaline and is called the alkaline tide
Alkaline tide taking H ions out of the blood
PPI (proton pump inhibitor) like prylosec

Gastrin plays the major role in acid production and release is stimulated
o Rising pH
o Partially digested protein
o Caffeine

Rising pH lower acidity

Extremely important what does gastrin cause? Production of HCL via
the parietal cells. Therefore, the same list could be what caused to
produce acid. Exchange gastrin and acid for the same thing
Taking antacid raises the pH causing it to produce more acid

Gastrin is produced by G cells

Gastrin stimulates parietal cells to produce HCl

The higher the protein in the meal the more gastrin is secreted

o Goes back to the fact hat the stomach monitors solutes (what is
being digested). Monitors for protein and fats
o Fats are mostly ingested in the small intestine

Regulation of Gastric Secretions Intestinal Phase:

Two phases
o Excitatory Cephalic and gastric stage are both excitatory
(extrinsic control)
o Inhibitory
Partially digested food caused the intestinal mucosa to release intestinal (enteric) gastrin
which has the same effect as gastrin
Distention of the intestine causes the enterogastric reflex:
o Inhibits the vagal nerve
o Inhibits local reflexes
o Activates the sympathetic system
With the first phase just trying to gear up (small intestine telling
stomach to produce more acid), once the intestine starts to distend it
tells it to slow down via the enterogastric reflex

TO know how to read reflex:

o Entero (intestine) triggered,
o Gastric target (intended purpose/place)
o The intestines target the stomach to slow down
so the intestine has more time to absorb

Also triggered are the enterogastrones

o Cholecystokinin causes the gallbladder to contract and expel bile
o Secretin causes the liver to secrete bile! AND In order to
digest fat have to have bile
o Vasoactive intestinal peptide (VIP)
o Gastric inhibitory peptide (GIP)
GIP is the big thing

The enterogastrones inhibit stomach secretions

Second phase in inhibitory

Digestive System Gastric Motility and Emptying:

Response to Stomach Filling

Gastric Contractile Activity
Regulation of Gastric Emptying
Small intestine phases of gastric secretion starts of excitatory
produce more secretions, once the small intestine fills it stops because
to have max. absorption you have to have the chyme going through
the GI at a small rate

Gastric Motility and Emptying Response to Stomach Filling:

Pressure in the stomach does not rise until 1L of food is ingested

Unchanging pressure is due to:
o Reflex mediated relaxation
o Plasticity

Response to Stomach Filling Reflexive Relaxation:

Receptive relaxation from the brain stem in response to food moving through the
Adaptive relaxation from stretch of the stomach
A lot of what goes on is die to stretch

Response to Stomach Filling Plasticity:

Intrinsic ability of visceral smooth muscle to exhibit the stress-relaxation response (to be
stretched without increasing its tension)
This is surrounded by smooth muscle when you expand it it contracts,
but not so much in the stomach

Gastric Motility and Emptying Gastric Contractile Activity:

Peristalsis begins weakly at the cardia and gains strength as it reaches the pylorus

Each peristaltic wave pushes about 3ml of chyme into the small intestine!!
The rate of gastric peristalsis is controlled by pacemaker cells called
interstitial cells of Cajal
Creates its basic electrical rhythm (BER) of three waves per minute
Rate remains constant
o The BER does NOT very, it will always be 3 per
minute regardless of how empty or full the
stomach is

Distention of the stomach cause an increase of strength in the peristaltic waves

o You increase how much you release (but not too much d/t
absorption), peristalsis does not increese.
o Digestion has to end in the small intestine

Gastric Motility and Emptying Regulation of Gastric Emptying:

Complete emptying takes about 4 hours

The larger the meal and more liquid it contains the faster the stomach empties
Liquids empty first, solids last
Rate is dependent on the duodenum talking about how much goes into
the intestine
As the duodenum is stretched, gastric activity is inhibited
Carbohydrates in the intestine move fast digestion starts in mouth
Fats move slowly
Remember peristalsis waves are still every 3
Bottom line looking at the inhibitory phase of gastric secretions
Proteins chemical digestion in stomach
Fats chemical digestion in small intestine

Digestive System Small Intestine:

Gross Anatomy
Microscopic Anatomy
Digestive Process

Small Intestine Gross Anatomy:

Extends from the pyloric sphincter to the ileocecal valve

2.5 to 4 cm in diameter potential space, if nothing (chyme or air) in
there it will collapse on itself
2 to 4 m long

Small Intestine Gross Anatomy:


Know the top three IN ORDER

Know the length of the duodenum for the TEST

Blood supply

Small Intestine Duodenum:

About 10 inches long 8-10 inches

Shortest of the segments

Relatively immoveable

Curves around the head of the pancreas

o very important, find the pancreas sits in the c shape of the

Receives bile and pancreatic juice from the hepatopancreatic ampulla via the major
duodenal papilla remember the ampulla
Entry of bile controlled by the hepatopancreatic sphincter (of Oddi)
The liver secretes bile (necessary to digestive fat)
Sphincter controls whether the digestive juices will enter the intestine
or not
CCK causes the gallbladder to constrict
In order for the gallbladder to fill the sphincter has to be closed, when
digestive starts to take place the sphincter has to relax and constrict
he gallbladder to release the bile CCK does this

The majority of absorption of nutrients takes place in the duodenum

Small Intestine Jejunum:

The middle piece

About 8 feet long
Extends from the duodenum to the ileum

Small Intestine Ileum:

About 12 feet in length

Joins the large intestine at the ileocecal valve
Ileum comes in at a 90-degree angle and joins the large intestine,
everything else is curved
Valve controls chyme from small into large intestine
Can do barium swallow to image small intestine

Small Intestine Mesentary:

Fan shaped membrane that tethers the small intestine (and part of the large intestine) to
the posterior abdominal wall
Carries blood vessels
Cancer in the small intestine is rare
Mesentery extension of parietal peritoneum, carries blood vessels

Small Intestine Innervation:

Parasympathetic from the vagus nerve

Sympathetic from the thoracic splanchnic nerve
Both relayed from the superior mesenteric and celiac nerve ganglia

Small Intestine Microscopic Anatomy:

Modifications for Absorption

Histology of the Wall
Intestinal juice

Small Intestine Modification for Absorption:

Plicae circulares or circular folds can be up to 1 cm tall force the chyme to spiral and
slow down
Lacteals lymph vessels that absorb nutrients
Have spiral folds in small intestine that slows down the chyme
One of the reason there is a distinction of the 3 the Plicae circulares
are in the jejunum
Nutrients from blood supply to liver hepatic portal system; thats
blood vessels (veins) and lymph also take nutrients to liver
Lacteal means milk because the lymph is a creamy color going through

Villi fingerlike projection that are the chief absorptive column

Microvilli tiny projections called the brush border with brush border

In order to be transported the proteins, etc. has to be broken down

even further this is done with microvilli
Proteins are further broken down into amino acids by the brush border
Fructose is found in fruit

Small Intestine Histology of the Wall:



Small Intestine Mucosa:

Epithelium of the mucosa is simple columnar absorptive cells with goblet cells and
enteroendocrine cells
Intraepithelial lymphocytes which kill without being primed
o B cell and T cell have to come together to produce antibodies,
but not the case of the mucosa in small intestine.
o Will produce antigens with an adequate fit, i.e. immune system
elsewhere is tailor made while this is off the rack this is not
acquired immunity it is a one time shot.
Intestinal crypts or crypts of Lieberkuhn pits that pierce the mucosa
Epithelial cells in the crypts secrete intestinal juice that is a carrier fluid for nutrients
intestinal juice is enzyme POOR
o Carrier fluid there is NOT anything in that fluid that helps it

Paneth cells in the crypts release lysozyme for protection

Stem cells at the base of the crypt divide to replace epithelial cells

Epithelium is replaced every 3 to 6 days

The small intestine is a hostile environment it cannot tolerate high
acid levels but acid is coming out of the stomach even though it gets
neutralizes the cells have to be replaced ever 3-6 days
With chemotherapy you target rapid growth, it is stupid it doesnt know
the difference between normal and cancer cells
Causes N&S d/t the chemo killing off the epithelium in the small
Chemotherapy is a poison (toxin), giving just enough to kill the cancer

Small Intestine Submucosa:

Areolar connective tissue

Individual lymphoid follicles

Peyers patches aggregated lymphoid follicles

o The highest concentration of peyers patches is in the appendix

(comes off the cecum)
Duodenal (Brunners) glands secrete mucus only found in the duodenum
Mucus protects the intestine from acid (most of the protection from acid in
small intestine comes from bicarbonate ions produced by the pancreas)
The nutrients can flow through, but the mucus the acid cant

Small Intestine Muscularis:

Is bilayered
Has an adventitia
Covered by the peritoneum (except the portion of small intestine that is retroperitoneal )
Layer here is important for peristalsis & segmentation

Small Intestine Digestive Process:

Intestinal Juice

Optimal Activity

Small Intestine Intestinal Juice:

Intestinal glands produce 1 to 2 L daily

Major stimulus is distention
Slightly alkaline (not a major contributor to neutralizing the acid its from
ions in the pancreas)
You absorb most of the fluid back
Contains some mucus
Relatively enzyme poor

Small Intestine Optimal Activity (for digestion):

Pancreatic enzymes
Bicarbonate ions
Slow measured delivery of chyme from the stomach

Small Intestine Motiltiy:

Moves chyme, intestinal juice, bile and pancreatic enzymes from the duodenum to the
ileocecal valve
Peristalsis is used to move food out
Segmentation just moves it back and forth
Segmentation takes place intestinal content is moved back and forth
Alternating contractions of rings of smooth muscle
Mixes chyme
Segmentation is considered mechanical digestion its mixing
chemicals in with the food but by itself it is considered mechanical

Pacemaker sets the pace at 12 14 contractions per minute in the duodenum and 8 9
contractions per minute in the ileum

Allows ample time for absorption of nutrients

True peristalsis only occurs after most of the nutrients are absorbed

o You monitor the nutrients in the chyme, thats how you know
absorbiton is complete nd persitalsis can start
Migrating mobility complex each successive wave starts a little more distal to the last
Gastroileal reflex enhanced activity of the stomach enhances the force of segmentation
Prefix in reflex origin (where stimulus is taking place)
Suffix target of stimulus know this so you can get answers right!
When stomach is fill it makes the ilium work faster want the intestine
to work slowly, but for some reason this reflex happens

Digestive System Large Intestine:

Gross Anatomy
Microscopic Anatomy
Bacterial Flora
Digestive Process

Large Intestine Gross Anatomy:

Anal Canal
External Features

Large Intestine Cecum:

First part of the large intestine

Lies below the ileocecal valve in the right iliac fossa
It is the pouch below the ileum
Nobody know the purpose of the cecum

Large Intestine Appendix:

Vermiform appendix a worm like structure

Contains masses of lymph tissue (Peyers patches)
Whats significant is where it is at, it can be closer to the body wall or
the medial structures
Appendix LRQ pain, fever, vomiting. Is the pain d/t the swelling in the
appendix? No! Blood vessels and nerve follow each other during
development, so the same nerves that is connected to the appendix is
also connected to the peritoneum (rock hard abdomen, pain,)
Two pts one with kidney stones one with appendicitis, without touching
just looking can you tell which is which? Yes! The difference, in
peritonitis it hurts to move, they will be absolutely still. Pt with kidney
stone doesnt have peritonitis, they are rolling back and forth trying to
find a comfortable spot

Large Intestine Colon:

Ascending colon
Right colic or hepatic flexure
Transverse colon
Left colic or splenic flexure
Descending colon
Sigmoid colon
Except the transverse and sigmoid (they are retroperitoneal), the colon is attached
to the posterior abdominal wall by the mesentery
Will have to be able to identify this! Can be hard in the pig, dont see
where it bends
Sigmoid colon is the S shaped part
Colon cancer: Rare to see cancer in small intestine. Will be colon
cancer if it is in the GI tract.
Sigmoidoscopy pt is awake
Colostomy under twilight sedation
Occult blood cant see it, bleeding going on very slowly. Not changing
the color of the stool. What youre measuring for is not blood, but iron.
Bottom line: most bleeding isnt caused by cancer, and most cancers
dont bleed

Large Intestine Rectum:

In the pelvis the sigmoid colon joins the rectum

Rectal valves three transverse folds that separate flatus from stool

Large Intestine Anal Canal:

Last segment of the large intestine

Opens at the anus
Has two sphincters the internal and external
Difference between sphincters: one in voluntary and the other is not

Large Intestine External Features:

Teniae coli longitudinal muscle forms three bands

The teniae coli cause the wall to pucker into pocketlike sacs called haustra
o Haustra help move stool
Epiploic appendages small fat filled pouches that hang from the visceral peritoneum
Significance unknown

Large Intestine Microscopic Anatomy:

Mucosa simple columnar epithelium

Mucosa is thick with numerous goblet cells
o Here the mucosa helps with bowel movements and move stool
In the anal canal the mucosa is stratified epithelium that merges with true skin
Anal sinuses in recesses between the anal columns secrete mucus

Large Intestine Bacterial Flora:

Colon is colonized by bacteria that survived the small intestine and those that gained
entrance from the anus
Synthesize B complex vitamins and vitamin K
Digestion does NOT take place in the colon, expect for the bacteria in
the colon that synthesizes B complex vitamins and Vitamin K.
Babies dont have bacteria in the GI tract and they dont produce a lot
of acid in their stomach
Ferment indigestible carbohydrates creating:
o Hydrogen
o Nitrogen
o Methane
o Carbon dioxide
o Dimethyl sulfide gas the one that has the odor

Large Intestine Digestive Processes:



Large Intestine Digestion:

Only digestion that occurs is by the enteric bacteria

Water and electrolyte are reclaimed

Absorption is NOT the major function of the large intestine
Absorption of water and nutrients is NOT the major function of the
large intestine

Large Intestine Motility:

Haustral contractions are sluggish and short lived (little compartments

moving approx. every 30 minutes)

Haustral contractions are an intrinsic reflex
Occur about every 30 minutes
Stimulus is the distension of the large colon
Mass movements long powerful contractile waves that occur 3 to 4 times a day to
force contents toward the rectum
Typically occur after eating, known as the gastrocolic reflex
Mass movements is what moves stool
Gastro stomach (organ that the stimulus originates), tells colon to
start moving things
With IBS the gastrocolic reflex is very exaggerated known as dumping

Large Intestine Defecation:

Defecation reflex initiated by stretching of the rectal wall
Spinal cord mediated (parasympathetic reflex)
Defecation depends on voluntary relaxation of the external sphincter
Know for test?

Valsalva maneuver closes the glottis and contract the diaphragm and abdominal wall
muscle to aid in the process

Digestive System Accessory Organs:

Liver and Gall Bladder


Digestive System Liver and Gallbladder:

Gross Anatomy
Microscopic Anatomy
Composition of Bile
Gall Bladder
Regulation of Bile Release

Liver and Gallbladder Function:

Produces bile - a fat emulsifier (necessary for breakdown of fat)

Process nutrient rich venous blood returning from the intestine

Processes toxins including medication
Process toxins
Hepatic portal Brings nutrient rich blood to the liver
Process toxins includes drugs/medications
There are certain meds that are inactive unless they pass through the
liver = the first pass effect
Cytochrome P 450 detoxifies the blood. Deals with alcohol, its
what breaks it down.
Class of drug used to prevent a drunk going into withdrawals
benzodiazepines (valium and Librium) and Xanax

Cytochrome p 450 reeves up and gives people tolerance to alcohol, but

it can only do that for a certain amount of time then the liver gets
Cirrhosis of the liver alcoholic liver, see accumulation of fluid in
the abdomen (ascites)
Why do they get ascites? Hydrostatic pressure and osmotic pressure
moves fluid out of the capillaries. What is the substance that creates
most of the osmotic pressure? Protein. So why does fluid go to the
abdomen? Most the protein is made in the liver = not as much protein
in the blood = osmotic pole is decreased = fluid moves in the stomach
and there is a problem with hydrostatic pressure
Fluid from intestine is going to the liver and the liver is stiff and wont
accept it so there is engorgement in the venous system.
Causes the veins to dilate in cirrhosis d/t back up leads to Varicose
veins like hemorrhoids and esophageal varices
If a pt is being detoxed but has liver damage you have to be very
careful with dosage and interval

Liver and Gallbladder Gross Anatomy:

Largest organ in the body

Located in the right hypochondriac and epigastric region
o Located in RUQ
o In the rib cage for protection, there are lots of blood vessels and
it likes to bleed if it gets hurt
Lies almost entirely within the rib cage

Liver and Gallbladder Gross Anatomy:

4 lobes
o Right lobe
o Left lobe
o Caudate lobe
o Quadrate lobe

Falciform ligament separates the right and left lobes

Not concerned with learning the lobes
But know ligament!

Round ligament or ligament of teres remnant of the umbilical cord that stays attached
to the liver
Lesser omentum anchors the lesser curvature of the stomach to the liver
Ligament for the liver used to be the umbilical cord
Lesser omentum from stomach to liver so that both are tied down
Greater omentum comes of the greater curvature of the stomach not
attached to anything
The hepatic artery and the hepatic portal vein enter the liver at the porta hepatis
The gall bladder lies in the recess of the inferior right lobe

Bile leaves the liver through the common hepatic duct

The common hepatic duct fuses with the cystic duct of the gall bladder to form the bile
Memorize this picture below! Will have to use it on test!!
Common bile duct goes into duodenum (small intestine)
Cystic = bladder
Gallbladder bile is concentrated and at the appropriate time it
squeezes and pushes the bile out
Liver makes bile
Sphincter of ode if it is closed the bile backs up into the gallbladder
Gall stones 80% will develop them and vast majority will not know.
Biliary colic when a gallstone blocks off the gallbladder from pushing
out bile
Will either have small or large gallstones, not a mixture
Can remove the gallbladder without any problems

Liver and Gallbladder Microscopic Anatomy:

Liver lobules sesame seed sized structural and function units that are hexagonal

in shape
Hepatocytes or liver cells are arranged around a central vein (hepatocytes are
mature liver cell)
Hepatocytes have large amounts of rough and smooth endoplasmic reticulum, Golgi
apparatuses, peroxisomes, and mitochondria
The liver regenerates

Hepatocytes also the FUNCTION of the Liver

o Process bloodborne nutrients
o Store glycogen
o Convert amino acids to plasma proteins
o Detoxify the blood
o Tylenol (acetaminophen) is the worst med for liver damage

At the six corners of the lobule is a portal triad (portal tract region)
o Hepatic artery oxygen travels through the hepatic artery (lots of mitochondra so
they need it)
o Hepatic portal vein
o Bile duct
Liver sinusoids enlarged leaky capillaries between hepatocyte plates
Hepatic macrophages (Kupffer cells) make up part of the wall of the sinusoids
Blood from the hepatic portal vein and hepatic artery percolate from the triad region to
the sinusoids to the central vein
Blood and oxygen travel to the center vein
While bile travels to the corners where it is transferred to the bile ducts
Secreted bile flows through bile canaliculi

Blood and bile flow in opposite directions in the liver

Liver and Gallbladder Composition of Bile:

Yellow-green alkali solution that contains:
Bile salts
Bile pigments
Neutral fats

Remember this for test?!

Pigments and cholesterol are a source for stones
Dietary cholesterol is removed from body by the liver
Cholesterol in blood is being produced by fatty acids

Bile salts emulsify fats

Bile salts are recycled by the enterohepatic circulation
o Reabsorbed by the ileum (strange because the bile enters the

duodenum, then goes to jejunum, to ileum)

o Returned via hepatic portal blood
Bilirubin the chief pigment from the breakdown of hemoglobin is converted to
urobilinogen in the liver (what you see with jaundice)
Urobilinogen gives stool is brown color - urobilinogen can be released in the

urine, but it is not *normally* released there. Only released If the bile
cant make it into the small intestine

Bile release from liver cells is stimulated by secretin released by the intestine that is
exposed to fatty chyme
o Secretin is produced in the small intestine
o Fat is being measured In the stomach

Stercoblin is actually what gives the stool its color,

not urobilinogen know for test?

Liver produces 500 to 1000 ml of bile per day

With babies, the liver isnt prepared to breakdown bilirubin yet why
some get jaundice
And if a baby is breastfed they will be jaundice! But it is normal, the
bilirubin doesnt hurt anything. If they arent being breastfed and the
bilirubin gets too high the baby can have permanent brain damage
If an adult gets jaundice = something wrong with liver
Why wont it make to the intestine?
1) Gallstone blocking the bile duct
2) Or tumor pushing on bile duct
Can ask the pt?
1) Why color is your urine? The urine will be dark
2) What color is your stool? If not getting ther stercoblin the stool will
be pasty white
Risk factors for gallstones:
- Fat
- Female
- Forty
- Fertile

Liver and Gallbladder Ballbladder:

Thin-walled green muscular sac about 10cm long
Fundus protrudes form the inferior margin of the liver
Stores and concentrates bile - does NOT produce (doesnt add anything
to the bile)
When empty the mucosa develops honeycomb like folds
When the muscle contracts, bile is expelled through the cystic duct

Liver and Gallbladder Regulation and Release of Bile:

When no digestion is occurring the hepatopancreatic sphincter is closed and bile backs up
into the gall bladder via the cystic duct
Pancreas makes digestive enzymes
Hepatopancreatic sphincter if its closed the bile will back up

Cholecystokinin (CCK)
o Contraction of the gall bladder
o Secretion of pancreatic juice
o Relaxation of the hepatopancreatic sphincter
Any chemical In small intestine to digest food is either made from the
pancreas or bile from liver, the small intestine makes none

Digestive System Pancreas:

Composition of Pancreatic Juice
Regulation of Pancreatic Secretion

Pancreas Anatomy:
Head is encircled in the C-shaped duodenum
Tail abuts the spleen
Lies deep to the greater curvature of the stomach
Favorite question on test is where it is found
When dissecting the pig, look for the duodenum to find the

Produces pancreatic juice that drains via the main pancreatic duct that fuses with the
bile duct
Accessory pancreatic duct empties directly into the duodenum
o Accessory duct may or may not be present, the pancreas cannt
tolerate much of the enzymes it produces to the accessory duct
helps empty it

Acini clusters of secretory cells surrounding ducts

Zymogen granules dark staining granules in the rough endoplasmic reticulum

Pancreas Composition of Pancreatic Juice:

1200 to 1500 ml per day

o Water
o Enzymes
o Bicarbonate - Bicarb is extremely important, the duodenum doesnt
like acid and the bicarb neutralizes it from the pancreas
Has a high pH that neutralizes chime
Pancreatic enzymes
o Carboxypeptidase
o Chymotrypsin both carboxypeptidase are chymotrypsin are
released in inactive forms so they dont get autodigested by the

o Amylase - also in the mouth. And even though they do the same
thing (break down straches), but the difference is the amylaese
produced by the pancreas isnt going to survive acid like that
made in the mouth
o Lipase digests fat
o Nuclease destroys nuclei, 2-3 day turnover in small intestine,
there will be a lot of nuclei there.
Carboxypeptidase and chymotrypsin are released in inactive forms
Carboxypeptidase chews up peptides
The villi has microvilli produce brush border enzymes, its these
enzymes that finally break down (particularly peptides into amino acids
and glucose into glycogen) the food/chyme.
Trypsinogen is activated to trypsin in the duodenum
Trypsin activates the enzymes