ANATOMY and PHYSIOLOGY

DIGESTIVE SYSTEM
 The organs of the digestive system can be separated into 2 main
groups: those forming the alimentary canal, and the accessory
digestive organs. The alimentary canal performs the whole menu of the
digestive functions (ingest, digest, absorbs and defecates). The
accessory organs (teeth, tongue and several digestive glands) assist
the process of digestive breakdown in various ways.

Organs of Alimentary Canal

The alimentary canal also called the gastrointestinal tract, is
continuous, coiled, hollow, muscular tubes that winds through the
ventral body cavity is opened at both ends. its organs is the mouth,
pharynx, esophagus, stomach, small intestines and large intestines.
The large intestines lead to the terminal opening or the anus. In the
cadaver, the alimentary canal is approximately 9 m (about 30 ft) long,
but in the living person, it is considerable shorter because of its
relatively constant muscle tone. Food material within the tube is
technically outside the body, because it has contact only with cells
lining the tract and is open to the external environment at both ends.

Mouth
Food enters the digestive tract through the mouth, for oral
cavity, a mucous membrane-lined cavity. The lips or labia protect its
anterior opening, the cheeks form its lateral walls, the hard palate
forms its anterior roof, and the soft comma forms its posterior roof. The
uvula is a fleshy finger like projection of the soft palate, which extends
downward from its posterior edge. The space between the lips and the
cheeks externally and the teeth and the gums internally is the
vestibule. The area contained by the teeth is the oral cavity proper.
The muscular tongue occupies the floor of the mouth. The tongue has
several bony attachments- two of these are to the hyoid bone and the
styloid processes of the skull. The lingual frenulum, a fold of mucous
membrane, secures the tongue to the floor of the mouth and limits its
posterior movement.

Pharynx
From the mouth, food passes posterior into the oropharynx and
lanryngopharynx, both of which are common passageways for food,
fluids, and air. The pharynx is subdivided into the nasopharynx, part of
the respiratory passageway; the or pharynx, posterior to the oral
cavity; and the laryngopharynx which is continous to the esophagus
below.
The walls of the pharynx contain two skeletal muscle layers. The
cells of the inner layer run longitudinally; those of the outer layer( the
constrictor muscles) run around the wall in the circular fascia.
Alternating contractions of this two muscle layers propel food through
the pharynx into the esophagus below. This propelling mechanisms,
called peristalsis.

Esophagus
The esophagus, or gullet, runs from the pharynx through the
diaphragm to the stomach. About 25 cm. (10 inches) long, it is
essentially a passageway that conducts food (by peristalsis) to the
stomach.
The walls of the alimentary canal organs from the esophagus to
the large intestine are made up of the same basic four basic tissue
layers, or tunics.]
1. The mucosa is the inner most layer, a moist membrane that
lies the cavity, or lumen, of the organ. It consists primarily of
a surface epithelium plus a small amount of connective tissue
(lamina propria) and scanty smooth muscle layer. Beyond the
 esophagus, which has a friction-resisting stratified squamous
epithelium, the epithelium is mostly simple columnar.
2. The sub mucosa is found just beneath the mucosa. it is a soft
connective tissue layer containing blood vessels, nerve
endings, lymph nodules, and lymphatic vessels.
3. The muscularis externa is a muscle layer typically made up of
an inner circular layer and outer longitudinal layer of smooth
muscle cells.
4. The serosa is the outer most layer of the wall. It consists of a
single layer of flat serous fluid-producing cells, the visceral
peritoneum. The visceral peritoneum is continuous with this
lick, slippery parietal peritoneum, which lies the
abdominopelvic cavity way of a membrane extension, the
mesentery.

The alimentary canal wall contains two important nerve

plexuses- the submucosal nerve plexus and the myenteric (intestinal
muscle) nerve plexus. an additional small sub serous plexus is
associated with the serosa. These networks of nerve fibers are actually
part of the autonomic nervous system. They help regulate the mobility
and secretory activity of GI tract organs.

Stomach
The C-shaped stomach is on the left side of the abdominal cavity,
nearly hidden by the liver and diaphragm. Different regions of the
stomach have been named. The cardiac region (named for its position
near the heart) surrounds the cardio esophageal sphincter through
which food enters the stomach from the esophagus. The fundus is the
expanded part of the stomach lateral to the cardiac region. The body is
the midportion, and the funnel-shaped pylorus is the terminal part of
the stomach. The pylorus is continuous with the small through the
pyloric sphincter, or valve.the stomach is approximately 25 cm. (10
inches) long, but its diameter depends on how much food it contains.
When it is full, it can hold above 4 liters (1 gallon) of food. When it is
empty, it collapses inward on itself and its mucosa is thrown into large
folds called rugae (wrinkle fold). The convex lateral surface of the
stomach is the greater curvature; its concave medial surface is the
lesser curvature.
The lesser omentum, a double layer of peritoneum extends from
the liver to the lesser curvature. The greater omentum, another
extension of the peritoneum drapes downward and covers the
abdominal organs like a lazy apron before attaching to the posterior
body wall. The greater omentum is riddled with fat, which helps to
insulate, cushion and protect the abdominal organs, and has large
collections of lymph nodules containing macrophages and defensive
cells of the immune system.
The stomach acts as temporary “storage tank” for food as well
as a sight for food breakdown besides the usual longitudinal and
circular muscle layers, its wall contains a third obliquely arranged layer
in the muscularis externa. This arrangement allows the stomach not
only to move food along the tract but also to churn, mix, and pummel
the food, physically breaking it down into smaller fragments. In
addition, chemical breakdown of proteins begins in the stomach; the
mucosa of the stomach is a simple columnar epithelium that produces
large amounts of mucous. This otherwise smooth lining is dotted with
millions of deep gastric pits, which lead into gastric glands that secrete
a solution called gastric juice. The chief cells produce protein digesting
enzymes mostly pepsinogens, and the parietal cells produce corrosive
hydrochloric acid, which makes this, acidicand activates the enzymes.
The mucous neck cells produce sticky alkaline mucous, which links to
the stomach mucosa and protects the stomach wall itself from being
damaged by the acid and digested enzymes. Still other cells produce
local hormones, such as gastrin, that are important to digestive
activities of the stomach.
Most digestive activity occurs in the pyloric region of the
stomach after food has been processed in the stomach, it resemble
heavy cream and is called chime. The chime enters the small intestine
through the pyloric sphincter.

Small Intestine
Small intestine is the body’s major digestive organ within its
wasted passageways; has able is finally prepared for its journey into
the cells of the body. The small intestine is a muscular tube extending
form the pyloric sphincter ileocecal valve. It is the longest section of
the alimentary tube with an average length form 2-4 m (6-13ft) in a
living person. The small intestine hangs in a sausage like coils in the
abdominal cavity suspended from the posterior abdominal wall by the
fan-shaped mecentery. The large intestine encircles and frames it in
the abdominal cavity.
Small intestine has 3 subdivisions. The duodenum (12 finger
width) which curves around the head of the pancreas is about 25 cm
(10inches long). The jejunum is about 2.5 m (8 ft) long and extends
from the duodenum to the ileum. The ileum, about 3.6 cm (12 ft) long,
is the terminal part of the small intestine. It joins the ileocecal.
Chemical digestion of food begins in the earnest small intestine
is able to process only small amount of food at one time. The pyloric
sphincter (literally gatekeeper) controls food movement into the small
intestine form the stomach and prevents the small intestine from being
overwhelmed. Enzymes, produced by the intestinal cells by the
pancreas inducted into the duodenum to the pancreatic ducts,
complete the chemical breakdown of foods in the small intestine. Bile
also enters the duodenum through the bile duct in the same area. The
main pancreatic and bile ducts join at the duodenum to form the
flashlight hepatopancreatic ampulla, literally, the liver-pancreatic
enlargement. From there, the bile and pancreatic juice travel through
the duodenal papilla and enter the duodenum together.
Nearly all food absorptions occur in the small intestine. The small
intestine is well suited for its function. Its wall has 3 structures that
increase the surface tremendously-microvilli, and circular folds.
Microvilli are tiny projections of the plasma membrane of the mucosa
cells that give the cell surface a fuzzy appearance, sometimes referred
to as brush border. The villi are fingerlike projection of the mucosa that
gives it a velvety appearance and fee, much like the soft nap of a
Turkish towel. Within
each villus are a rich capillary bed and a modified lymphatic capillary
bed called a lacteal. The digested foodstuffs are absorbed through the
mucosa cells into both the capillaries and the lacteal. Circular folds,also
called plicae circulares, are deep folds of both mucosa and submucosa
layers. Unlike the rugae folds of the stomach, the circular folds do not
disappear when food fills the small intestine. All these structural
modifications, which increase the surface area, decrease in number
toward the end of the small intestine. On the other hand, local
collections of lymphatic tissue (called Peyer’s patches) found in the
submucosa increase toward the end of the small intestine. This reflects
the fact that the remaining (undigested) food residue in the intestine
contains huge numbers of bacteria, which must be prevented from
entering the bloodstream if at all possible.

Large Intestine
The large intestine is much larger in diameter than the small
intestine, btu shorter in length. About 1.5 m (5 feet) long, it extends
from ileocecal valve to the anus. Its major functions are to dry out the
indigestible food residue by absorbing water, to eliminate these
residues from the body as feces. It frames the small intestine on three
sides and has following subdivisions: cecum, appendix, colon, rectum
and anal canal. The saclike cecum is the first part of the large
intestine. Hanging form the cecum is the wormlike appendix, a
potential trouble spot. Since it is usually twisted, it is an ideal location
for bacteria to accumulate and multiply. Inflammation of the appendix,
appendicitis, is usual result. The colon is divided into several distinct
regions. The ascending colon travels up the right side of the abdominal
cavity and makes turn, the right colic, or hepatic flexure, to travel
across the abdominal cavity as the transverse colon. It then turns
again at the left colic, or splenic flexure and continues down the left
side as the descending colon, to enter the pelvis, where it becomes S-
shaped sigmoid colon. The sigmoid colon, rectum and anal canal lie in
the pelvis. The anal canal ends at the anus, which opens to the
exterior. The anal canal has an external voluntary sphincter composed
of skeletal muscle and an internal involuntary sphincter formed by
smooth muscle. These sphincters, which act rather like purse strings to
open and close the anus, are ordinarily closed except during
defecation, when feces are eliminated from the body.
Because most nutrient absorption has occurs before the large
intestine is reached, no villi are seen in the large intestine, but there
are tremendous numbers of goblet cells in its mucosa that produce
mucus. The mucus acts as a lubricant to ease the passage of feces to
the end of the digestive tract.
In the large intestine, the longitudinal muscle layer of the
muscularis externa is reduced to three bands of muscle called teniae
coli. Since these muscle bands usually display some degree of tone
(are partially contracted), they cause the wall to pucker into pocketlike
sacs called haustra.

Accessory digestive Organs

Salivary Glands
Three pairs of salivary glands empty their secretions into the
mouth. The large parotid glands lie anterior to the ears. Mumps, a
common childhood disease, is an inflammation of the parotid glands.
The submandibular glands and the small sublingual glands
empty their secretions onto the floor of the mouth through tiny ducts.
The product of salivary glands, saliva is a mixture of mucus and serous
fluids. The mucus moistens and helps to bind fluid together into a mass
called bolus, which makes chewing and swallowing easier. The clear
serous portion contains an enzyme, salivary amylase, which begins the
process of starch digestion in the mouth. Saliva contains substances
such as lysozyme and antibodies (IgA) that inhibit bacteria; therefore;
it has a protective function as well. Lastt but notleast, saliva dissolves
food chemicals so they can be tasted.

Teeth
The role of the teeth in food processing needs little introduction.
We masticate, or chew, by opening or closing our jaws and moving
them form side to side while continually using our tongue to move the
food between our teeth. In the process, the teeth tear and grind the
food, breaking it down into smaller fragments.
Ordinarily, by the age of 21, two sets of teeth have been formed.
The first set is the deciduous teeth, also called baby teeth or milk
teeth. The deciduous teeth begin to erupt around 6 months, and a
baby has full set (20 teeth) by the age of 2 years. The first teeth to
appear are the lower central incisor, an event that is usually anxiously
awaited by the child’s parents,
As the second set of teeth, the deeper permanent teeth enlarge
and develop, the roots of the milk teeth are reabsorbed, and between
the ages of 6 to 12 years they loosen and fall out. All of the permanent
teeth but the third molars have erupted by the end of adolescence.
The third molars also called wisdom teeth emerge later, between the
ages 17 to 25.although there are 32 permanent teeth in a full set, the
wisdom teeth often fail to erupt; sometimes they are completely
absent. The teeth are classified according to shape and function as
incisors, canines, premolars and molars. The chisel-shaped incisors are
adapted for cutting; the fanglike canines are for tearing or piercing.
The premolars and molars have broad crowns rounded cusps and are
best suited for grinding. A tooth consists of two major regions, the
crown and the root. The enamel-covered crown is the exposed part of
the tooth above the gingival or gum. Enamel is the hardest substance
in the body and is fairly brittle because it is heavenly mineralized with
calcium salts. The portion of the tooth embedded in the jawbone is the
root; the root and crown are connected by the tooth region called the
neck. The outer surface of the root is covered by a substance called
cementum, which attaches the tooth to the periodontal membrane.
This ligament holds the tooth in place in the body jaw. Dentin, a
bonelike material, underlies the enamel and forms the bulk of the
tooth. It surrounds a central pulp cavity, which contains a number of
structures (connective tissues, blood vessels and nerve fibers)
collectively called pulp. Pulp supplies nutrients to the tooth tissues and
provides for tooth sensations. Where the pulp cavity extends into the
root, it becomes the root canal, which provides a route for blood
vessels, nerves and other pulp structures to enter the pulp structures
to enter the pulp cavity of the tooth.

Pancreas
The pancreas is a soft, pink, triangular gland that extends across
the abdomen from the spleen to the duodenum. Most of the pancreas
lies posterior to the parietal peritoneum; hence its location is referred
to as retroperitoneal. The pancreas produces enzymes that break down
all categories of digestible foods. The pancreatic enzymes are secreted
into the duodenum in an alkaline fluid, which neutralizes the acidic
chyme coming in from the stomach. The pancreas also has an
endocrine function; it produces the hormones insulin and glucagon.

Liver and Gallbladder

The liver is the largest gland in the body. The liver has four lobes
and is suspended from the diaphragm and abdominal wall by a delicate
mesentry cord, the falciform ligament. The liver is able to produce bile.
Bile leaves the liver through the common hepatic duct and enters the
duodenum through the bile duct. Bile is a yellow-to-green, watery
solution containing bile salts, bile pigments, cholesterol, phospholipids,
and a variety of electrolytes. Of these components, only the bile salts
and phospholipids aid the digestive process. Bile does not contain
enzymes, but its bile salts emulsify fats by physically breaking large fat
globules into smaller ones, thus providing more surface area for the
fat-digesting enzymes to work on.
The gallbladder is a small, thin-walled green sac that snuggles in
a shallow fossa in the inferior surface of the liver. When food digestion
is not occurring, bile backs up the cystic duct and enters the
duodenum, ahormonal stimulus prompts the gallbladder to contract
and spurt out stored bil,making it available to the duodenum. If the bile
is stored in the gallbladder for too longer or too much water is
removed, the cholesterol it contains may crystallize, forming
gallstones. Since gallstones tend to be quite sharp, agonizing pain may
occur when gallbladder contracts (the typical gallbladder attack).
Blockage of the common hepatic or bile ducts (for example, by
wedged gallstones) prevents bile from entering the small intestine, and
it begins to accumulate and eventually backs up into the liver. This
exerts pressure on the liver cell, and bile salts and bile pigments begin
to enter blood stream. As bile pigments circulate through the body, the
tissues become yellow, or jaundiced. Blockage of the ducts is just one
cause of jaundice. More often it results from actual liver problems such
as hepatitis (an inflammation of the liver) or cirrhosis, a chronic
inflammatory condition in which the liver is severely damaged and
becomes hard and fibrous. Hepatitis is most often due to viral infection
resulting from drinking contaminated needles. Cirrhosis is almost
guaranteed when one drinks alcoholic beverages in excess for many
years, and it is common consequence of severe hepatitis.

Functions of the Digestive System

The major functions of the digestive tract are usually
summarized in two words—digestion and absorption. However, many
of its specific activities, such as smooth muscle activity, and certain
regulatory events are not really covered by either term. To describe
digestive system processes a little more accurately, we really have to
consider a few more functional terms. The essential activities of GI
tract include the six processes.
1. Ingestion—Food must be placed into the mouth before it can be
acted on. This is an active, voluntary process called ingestion.
2. Propulsion—If foods are to be processed by more than one
digestive organ (and indeed they are), they must be propelled
from one organ to the next. Swallowing is one example of food
movement that depends largely on the propulsive process called
peristalsis. Peristalsis is involuntary and involves alternating
waves of contraction and relaxation of the muscles in the organ
wall. The net effect is to squeeze the food along the tract.
Although segmentation may help to propel foodstuffs through
the small intestine, it normally moves food back and forth across
the internal wall of the organ, serving to mix it with the digestive
juices. Thus, segmentation is more example of mechanical
digestion than of propulsion.
3. Food breakdown: Mechanical digestion—Mixing of food in
 the mouth by the tongue, churning of food in the stomach, and
segmentation in the small intestine are all examples of physical
processes contributing to mechanical digestion. Mechanical
digestion prepares food for further degradation by enzymes.
4. Food breakdown: Chemical digestion—the sequence of steps
in which large food molecules are broken down to their building
blocks by enzymes is called chemical digestion. The building
blocks or units of carbohydrate foods are monosaccharides or
simple sugars. There are three that are common in our diet;
glucose, fructose and galactose. Gluscose is by far the most
important and when we talk about blood sugar levels, glucose is
the “sugar” being referred to. Fructose is the most abundant
sugar in fruits and galactose is found in milk. Essentially, the only
carbohydrates that our digestive system digests or breaks down
to simple sugars are sucrose (table sugars), lactose (milk sugar),
maltose and starch. Sucrose, maltose and lactose are referred to
as disaccharides or double sugars, because each consists of two
simple sugars linked together. Starch is a polysaccharide formed
of hundreds of glucose units. Although we eat foods containing
other polysaccharides such as cellulose, we do not have
enzymes capable of breaking them down. The indigestible
polysaccharides do not provide us with any nutrients, but they
help move the foodstuffs along the gastrointestinal tract by
providing bulk or fiber in our diet. Proteins are digested to their
building blocks, which are amino acids. Intermediate products of
protein digestion are polypeptides and peptides. When lipids are
digested, they yield two different types of building blocks—fatty
acids and an alcohol called glycerol. The chemical breakdown of
carbohydrates, proteins, and fats.
5. Absorption—Transport of digested end products from the lumen
of the GI tract to the blood or lymph is absorption. For absorption
 to occur, the digested foods must enter the mucosal cells by
active or passive transport processes. The small intestine is the
major absorptive site.
6. Defecation—Defecation is the elimination of the indigestible
substances from the body via the anus in the form of feces.

HORMONE SOURC STIMULUS ACTION

E FOR
SECRETION
Gastrin Stomac Food in Stimulates release of
h stomach gastric juice; stimulates
(chemical mobility of small intestine;
stimulus) relaxes ileocecal valve.
Histamine Stomac Food in Activates parietal cells to
h stomach secrete hydrochloric acid.
Somatostat Stomac Food in Inhibits secretion of gastric
in h stomach juice and pancreatic juice;
inhibits emptying of
stomach and gallbladder.
Secretin Duoden Acidic chyme Increases output of
um and partially pancreatic juice rich in
digested bicarbonate ions; increases
foods in bile output by liver; inhibits
duodenum. gastric mobility and gastric
gland secretion.
Cholecysto Duoden Fatty chyme Increases output of
kinin (CCK) um in duodenum enzyme-rich pancreatic
juice; stimulates
gallbladder to expel stored
bile; relaxes sphincter of
duodenal papilla to allow
bile and pancreatic juice to
enter the duodenum.
Gastric Duoden Fatty chyme Inhibits gastric mobility and
inhibitory um in duodenum secretion of gastric juice.
peptide
(GIP)