ANATOMY AND PHYSIOLOGY OF THE DIGESTIVE SYSTEM

Your gastrointestinal, or "GI" tract, runs from your mouth all the way to your
anus. It is essentially a very long and windy tube through which food is broken
apart, digested, and the nutrients absorbed into your system. To get a good
understanding of the process which turns your lunch into a BM (Bowel
Movement), let’s follow the course of a turkey sandwich with mayo and lettuce
through your GI tract.

You start off by taking a bite out of the sandwich and your teeth chew it up.
Saliva (water and enzymes) from your salivary glands (parotid, sublingual, and
submaxillary) moistens the food and begin to digest the starch in the bread. A
chewed up ball of sandwich (bolus) in your mouth then is swallowed and travels
down your esophagus. The esophagus is a muscular tube about 22-30 cm long
that passes through the middle of your chest, through your diaphragm, and
attaches to your stomach. A sphincter - a muscle that works like the drawstring
of a purse - relaxes to let the food into your stomach, and then tightens to keep
food from going back up the esophagus. Your stomach makes hydrochloric acid
and enzymes which break down the protein - in this case, the turkey. If the
sphincter isn't working just right, one gets the acidic stomach contents refluxing
back into the esophagus. This is Gastro-Esophageal Reflux Disease, or GERD.
This is also known as heartburn. The stomach is very muscular and also acts to
grind up the food by squeezing and relaxing. Okay, our turkey sandwich is now
essentially mincemeat.
The stomach is connected to the small intestine, and another sphincter opens
to let the food through. The small intestine is another hollow tube. If fully
stretched out, it would measure between 15 and 34 feet. It's divided into three
sections. You can't tell where one section starts and the other stops with the
naked eye - only under a microscope. The three sections, in order, are: the
DUODENUM, the JEJUNUM, and the ILEUM.

Our chewed-up sandwich now enters the DUODENUM. The liver makes bile,
which is green and helps the digestion of fats. Bile is stored in the gall bladder,
and conveniently squirted into the DUODENUM when food enters.
PANCREATIC juice also enters the duodenum. The pancreas makes strong
enzymes which help break down the fats, carbohydrates, and proteins in the
mayonnaise, bread, and turkey, respectively. This is where most of our sandwich
is fully broken down! The pancreatic juice also contains bicarbonate, which
neutralizes the strong hydrochloric acid the stomach has contributed to the
mixture.

The tail end of the DUODENUM, the JEJUNUM and the ILEUM absorb the
nutrients from the broken down food. They also reabsorb water from the food
mixture, and from all the saliva and other secretions that were used to break
down the food. The small intestine also contains helpful bacteria which aid the
digestion of certain vitamins. It may take 2-4 hours for food to pass from one end
of the small intestine to the other.

While the length of the intestinal tract contains lymphoid tissue, only the ileum
has abundant Peyer's patches, unencapsulated lymphoid nodules that
contain large numbers of lymphocytes and other cells of the immune system.
Peyer’s patches are aggregations of lymphoid tissue that are usually found in
the lowest portion of the small intestine ileum in humans; as such, they
differentiate the ileum from the duodenum and jejunum. Peyer's patches are
observable as elongated thickenings of the intestinal epithelium measuring a
few centimeters in length. About 30 are found in humans. Microscopically,
Peyer’s patches appear as oval or round lymphoid follicles (similar to lymph
nodes) located in the lamina propria layer of the mucosa and extending into
the submucosa of the ileum. Because the lumen of the gastrointestinal
tract is exposed to the external environment, much of it is populated with
potentially pathogenic microorganisms. Peyer's patches thus establish their
 importance in the immune surveillance of the intestinal lumen and in
facilitating the generation of the immune response within the mucosa.
Pathogenic microorganisms and other antigens entering the intestinal tract
encounter macrophages, dendritic cells, B-lymphocytes, and T-
lymphocytes found in Peyer's patches and other gut-associated lymphoid
tissue (GALT).
Peyer's patches are covered by a special epithelium that contains specialized
cells called microfold cells (M cells) which sample antigen directly from the
lumen and deliver it to antigen-presenting cells . B-cells and memory cells are
stimulated upon encountering antigen in Peyer's patches. These cells then
pass to the mesenteric lymph nodes where the immune response is amplified.
Activated lymphocytes pass into the blood stream via the thoracic duct and
travel to the gut where they carry out their final effector functions.
In adults, B lymphocytes are seen to predominate in the follicles' germinal
centers. T lymphocytes are found in the zones between follicles.

After the remaining undigested food, including the chewed-up lettuce, passes
through the last part of the small intestine (the ILEUM), it passes through another
SPHINCTER and enters the large intestine, also known as the COLON.

The colon is normally inhabited by a large number of bacteria (see the section on
gas), and is between 3 and 7 feet long when fully stretched. The COLON's main
function is to dry out the remaining food mixture to form stool. It does this by
reabsorbing water. Stool slowly forms as it goes through the colon, starting out
as a runny mixture in the beginning and ending as soft, but formed, stool. The
colon also makes mucus to help the stool slide along through the colon. The
turkey sandwich may take up to 48 hours total to complete its journey through the
gut - most of that time is spent in the colon.

At this point, what's left in the stool? Most of the carbohydrates, fats and protein
have been digested and the nutrients extracted. What remains is undigested and
indigestible food, which includes fiber - like most of the lettuce in the sandwich,
bile, and mucus. Stool also contains a large amount of bacteria - in fact, bacteria
make up around 60% of the final stool!
The last parts of the colon are the SIGMOID COLON (so named because it is
slightly shaped like an "S"), the RECTUM, and the ANUS. The rectum is where
stool is stored before excreted. The opening through which stool leaves your
body is called the anus (double-pointed arrow). The ANUS has two muscular
sphincters, the Internal (I), and the External (E) sphincters. These strong
muscles are crucial in keeping the stool in your RECTUM until you can find a
nice toilet. You can consciously control the external sphincter, but not the
internal one. The Levator Ani (L) is part of the pelvic floor muscles that also help
keep you from moving your bowels before you find a toilet.