The Digestive Tract

The GI tract
(gastrointestinal tract)

The muscular alimentary canal Mouth Pharynx Esophagus Stomach Small intestine Large intestine Anus

The accessory digestive organs

Supply secretions contributing to the breakdown of food Teeth & tongue Salivary glands Gallbladder Liver Pancreas

The Digestive Process

Ingestion
Taking in food through the mouth

Propulsion (movement of food)

Swallowing Peristalsis propulsion by alternate contraction &relaxation

Mechanical digestion
Chewing Churning in stomach Mixing by segmentation

Chemical digestion
By secreted enzymes: see later

Absorption
Transport of digested end products into blood and lymph in wall of canal

Defecation
Elimination of indigestible substances from body as feces
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 Chemical digestion
Complex food molecules (carbohydrates, proteins and lipids) broken down into chemical building blocks (simple sugars, amino acids, and fatty acids and glycerol) Carried out by enzymes secreted by digestive glands into lumen of the alimentary canal

Ways to divide.
The more common

Plus: epigastric periumbilical suprapubic flank

Histology of alimentary canal wall

Same four layers from esophagus to anal canal

1. Mucosa 2. Submucosa 3. Muscularis externa 4. Serosa

from lumen (inside) out
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Inner layer: the mucosa*

(mucous membrane)

Three sub-layers
*

1. Lining epithelium 2. Lamina propria 3. Muscularis mucosae

More about the mucosa

Epithelium: absorbs nutrients, secretes mucus
Continuous with ducts and secretory cells of intrinsic digestive glands (those within the wall) Extrinsic (accessory) glands: the larger ones such as liver and pancreas

Lamina propria
Loose connective tissue with nourishing and absorbing capillaries Contains most of mucosa-associated lymphoid tissue (MALT)

Muscularis mucosae
Thin layer of muscle producing only local movements 8

Second layer: the submucosa*

Connective tissue containing major blood and lymphatic vessels and nerves Many elastic fibers so gut can regain shape after food passes
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Next in, the muscularis externa*

(AKA just muscularis) Two layers of smooth muscle responsible for peristalsis and segmentation Inner circular layer (circumferential) *
Squeezes In some places forms sphincters (act as valves)

Outer longitudinal layer: shortens gut

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Last (outer), the serosa*

(the visceral peritoneum) Simple squamous epithelium (mesothelium)
Thin layer of areolar connective tissue underneath

Exceptions: *
Parts not in peritoneal cavity have adventitia, lack serosa Some have both, e.g. retroperitoneal organs
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Smooth muscle

Smooth muscle

6 major locations:

Muscles are spindle-shaped cells One central nucleus Grouped into sheets: often running perpendicular to each other Peristalsis No striations (no sarcomeres) Contractions are slow, sustained and resistant to fatigue Does not always require a nervous signal: can be stimulated by stretching or hormones
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1. inside the eye 2. walls of vessels 3. respiratory tubes 4. digestive tubes 5. urinary organs 6. reproductive organs

Nerves
Enteric nervous system: the guts own
Visceral plexuses within gut wall controlling the muscles, glands and having sensory info
Myenteric: in muscularis Submucosal

100 million neurons! (as many as the spinal cord)

Autonomic input: speeds or slows the system

Parasympathetic
Stimulates digestive functions

Sympathetic
Inhibits digestion

Largely automatic

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Review of some definitions.

Peritoneum: serous membranes of the abdominopelvic cavity Visceral peritoneum: covers external surfaces of most digestive organs Parietal peritoneum: lines body wall Peritoneal cavity: slit-like potential space between visceral and parietal peritoneum
Serous fluid lubricating
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New definitions
Mesentery
Double layer of peritoneum Extends to digestive organs from body wall Hold organs in place Sites of fat storage Route by which circulatory vessels and nerves reach organs Most are dorsal
Extend dorsally from gut to posterior abdominal wall

Ventral mesentery from stomach and liver to anterior abdominal wall Some mesenteries are called ligaments though not technically such

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Mesenteries
Note dorsal, ventral and formation of retroperitoneal position

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Mesenteries
Two ventral mesenteries
Falciform ligament
*
Binds anterior aspect of liver to anterior abdominal wall and diaphragm

Lesser omentum (=fatty skin) see diagram*

All other mesenteries are dorsal (posterior)

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Mesenteries continued (all these are dorsal)

Greater omentum
Connects stomach to posterior abdominal wall very roundabout Wraps around spleen: gastrosplenic ligament Continues dorsally as splenorenal ligament A lot of fat Limits spread of infection by wrapping around inflamed e.g. appendix

Mesentery or mesentery proper

Supports long coils of jejunum and ileum (parts of small intestine)

Transverse mesocolon
Transverse colon held to posterior abdominal wall Nearly horizontal sheet fused to underside of greater omentum

Sigmoid mesocolon
Connects sigmoid colon to posterior abdominal wall see next slides for pics
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Note mesenteries: falciform ligament, lesser omentum, greater omentum

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Note: greater omentum, lesser omentum, falciform ligament, transverse mesocolon, mesentery, sigmoid mesocolon

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Some organs are retroperitoneal

Are behind the peritoneum Fused to posterior (dorsal) abdominal wall Lack a mesentery Include:
Most of duodenum (1st part of small intestine) Ascending colon Descending colon Rectum Pancreas

Tend to cause back pain, instead of abdominal pain (This is as opposed to the organs which are intraperitoneal, or just peritoneal)
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The Mouth
Mouth = oral cavity
Lining: thick stratified squamous epithelium

Lips- orbicularis oris muscle Cheeks buccinator muscle

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 Vermillion border or red border

Between highly keratinized skin of face and mucosa of mouth Needs moisture

Note frenulums (folds of mucosa) Palate roof of mouth

Hard plate anteriorly Soft palate posterioly

Uvula
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Tongue
Mostly muscles
Grip and reposition food Forms bolus of food (lump) Help in swallowing Speech help form some consonants

Note frenulum on previous slide: can be too tight Taste buds contained by circumvallate and fungiform papillae Lingual tonsil back of tongue

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Teeth
Called dentition (like dentist) Teeth live in sockets (alveoli) in the gumcovered margins of the mandible and maxilla Chewing: raising and lowering the mandible and moving it from side to side while tongue positions food between teeth
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Teeth
Two sets
Primary or deciduous
Baby teeth Start at 6 months 20 are out by about 2 years Fall out between 2-6 years

Permanent: 32 total
All but 3rd set of molars by end of adolescence 3rd set = wisdom teeth
Variable

Some can be impacted (imbedded in bone)

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Teeth are classified according to shape and function

Incisors: chisel-shaped for chopping off pieces Canines: cone shaped to tear and pierce Premolars (bicuspids) and Molars - broad crowns with 4-5 rounded cusps for grinding
Cusps are surface bumps
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incisor

canine

premolar molar

Tooth structure
Two main regions
A. Crown (exposed) B. Root (in socket) C. Meet at neck
A

Enamel
99% calcium crystals Hardest substance in body

Dentin bulk of the tooth (bone-like but harder than bone, with collagen and mineral) Pulp cavity with vessels and nerves
Root canal: the part of the pulp in the root

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Tooth structure
Cementum bone layer of tooth root
Attaches tooth to periodontal ligament
Anchors tooth in boney socket of the jaw Continuous with gingiva (gums)
A

Periodontal ligament

B

Cavities or caries - rot Plaque film of sugar, bacteria and debris

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Salivary glands (tuboalveolar glands)

Intrinsic salivary glands within mucosa
Secrete saliva all the time to keep mouth moist

Extrinsic salivary glands

Paired (2 each)
Parotid Submandibular Sublingual Saliva: mixture of water, ions, mucus, enzymes keep mouth moist dissolves food so can be tasted moistens food starts enzymatic digestion buffers acid antibacterial and antiviral

External to mouth Ducts to mouth Secrete saliva only right before or during eating
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Extrinsic salivary glands

Parotids* - largest (think mumps)
Facial nerve branch at risk during surgery here

Submandibular # - medial surface mandible Sublingual + - under tongue; floor of mouth

*

+
#
Compound = duct branches Tubo = tubes Alveolar = sacs 31

Pharynx
___oropharynx

Oropharynx and laryngopharynx

Stratified squamous epithelium

___laryngopharynx

Three constrictor muscles* *

* Sequentially squeeze bolus of food into esophagus Are skeletal muscles
Voluntary action Vagus nerve (X)

*
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Esophagus
Continuation of pharynx in mid neck Muscular tube collapsed when lumen empty Esophagus___________ Descends through thorax
On anterior surface of vertebral column Behind (posterior to) trachea

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Esophagus continued
Passes through esophageal hiatus in the diaphragm to enter the abdomen Abdominal part only 2 cm long Joins stomach at cardiac orifice*
Cardiac sphincter at cardiac orifice to prevent regurgitation (food coming back up into esophagus) Gastroesophageal junction and GERD

___________________esophageal hiatus
(hiatus means opening)

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Microscopic anatomy of esophagus

Contains all 4 layers (see right)

Epithelium: nonkeratinized stratified squamous epithelium

At GE junction thin simple columnar epithelium

Mucus glands in wall Muscle (muscularis externa) changes as it goes down

Superior 1/3 of esophagus: skeletal muscle (like pharynx) Middle 1/3 mixture of skeletal and smooth muscle Inferior 1/3 smooth muscle (as in stomach and intestines)

When empty, mucosa and submucosa lie in longitudinal folds

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Esophagus histology

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Stomach
J-shaped; widest part of alimentary canal Temporary storage and mixing 4 hours
Into chyme

Starts food breakdown

Pepsin (protein-digesting enzyme needing acid environment) HCl (hydrochloric acid) helps kill bacteria Stomach tolerates high acid content but esophagus doesnt why it hurts so much when stomach contents refluxes into esophagus (heartburn; GERD)

Most nutrients wait until get to small intestine to be absorbed; exceptions are:
Water, electrolytes, some drugs like aspirin and alcohol (absorbed through stomach)
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Stomach
Lies mostly in LUQ
But pain can be epigastric or lower
epigastrium

Just inferior to (below) diaphragm Anterior (in front of) spleen and pancreas Tucked under left lower margin of liver junction with Anchored at both ends but esophagus mobile in between contains pyloric Main regions in drawing to sphincter right------------------------------- Capacity: 1.5 L food; max funnel shaped capacity 4L (1 gallon)

dome

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Stomach Regions
Cardiac region Fundus (dome shaped) Body
Greater curvature Lesser curvature
dome junction with esophagus contains pyloric sphincter

Pyloric region
Antrum Canal Sphincter

funnel shaped

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 Rugae: longitudinal folds on internal surface (helps distensibility) Muscularis: additional innermost oblique layer (along with circular and longitudinal layers)

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Histology of stomach
Simple columnar epithelium: secrete bicarbonate-buffered mucus Gastric pits opening into gastric glands
Mucus neck cells Parietal cells
HCL Intrinsic factor (for B12 absorption)

Chief cells
Pepsinogen (activated to pepsin with HCL) Stimulated by gastrin: a stomach hormone
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Small intestine
Longest part of alimentary canal (2.7-5 m) Most enzymatic digestion occurs here
Most enzymes secreted by pancreas, not small intestine

Almost all absorption of nutrients 3-6 hour process Runs from pyloric sphincter to RLQ
Small intestine___________
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 Small intestine has 3 subdivisions

Duodenum 5% of length Jejunum almost 40% Ileum almost 60%

Blood supply: superior mesenteric artery; Veins drain into hepatic portal vein

Duodenum is retroperitoneal (stuck down under peritoneum); others are loose Duodenum receives bile from liver and gallbladder via bile duct* enzymes from pancreas via main pancreatic duct*

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 Small intestine designed for absorption

Huge surface area because of great length Structural modifications also increase absorptive area
Circular folds (plicae circulares) Villi (fingerlike projections) 1 mm high simple columnar epithelium: velvety Microvilli

Absorptivie cell with microvilli to increase surface area & many mitochondria: nutrient uptake is energydemanding

Lacteal*: network of blood and lymph capillaries

-Carbs and proteins into blood to liver via hepatic portal vein -Fat into lymph: fat-soluble toxins e.g. pesticides circulate systemically before going to liver for detoxification

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Intestinal crypts

* (of Lieberkuhn) inbetween villi

Cells here divide every 3-6 days to renew epithelium (most rapidly dividing cells of the body) Secrete watery intestinal juice which mixes with chyme (the paste that food becomes after stomach churns it)

Intestinal flora the permanent normal bacteria

Manufacture some vitamins, e.g. K, which get absorbed

Duodenal glands Mucus to counteract acidity from stomach Hormones:

Cholecystokinin (stimulates GB to release stored bile, also pancreas) Secretin (stimulates pancreatic ducts to release acid neutralizer)

*
*

-have many mitochondria: nutrient uptake is energydemanding

-produce mucus

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General histology of digestive tract

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Large intestine
Digested residue reaches it Main function: to absorb water and electrolytes

Subdivisions Cecum Appendix Colon Rectum Anal canal

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Three special features

1. Teniae coli (3 longitudinal muscle strips) 2. Haustra (puckering into sacs) 3. Epiploic appendages (omental or fat pouches)

3. 2.

1.

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Colon has segments: ascending, transverse and descending colon; then sigmoid colon Right angle turns: hepatic flexure* in RUQ and splenic flexure* in LUQ

Between ileum and cecum 1st part Blind tube S-shaped

Movement sluggish and weak except for a few mass peristaltic movements per day to force feces toward rectum powerfully

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 Rectum
In pelvis No teniae Strong longitudinal muscle layer Has valves

Anal canal
Pectinate line*
Inferior to it: sensitive to pain

Hemorrhoids (enlarged veins)

Superior to pectinate line: internal Inferior to pectinate line: external

* *

Sphincters (close opening)

Internal*
smooth muscle involuntary

*
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External*
skeletal muscle voluntary

Defecation
1. Triggered by stretching of wall, mediated by spinal cord parasympathetic reflex 2. Stimulates contraction of smooth muscle in wall and relaxation of internal anal sphincter 3. If convenient to defecate voluntary motor neurons stimulate relaxation of external anal sphincter (aided by diaphragm and abdominal wall muscles called Valsalva maneuver)
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Histology large intestine

No villi
Fewer nutrients absorbed

Columnar cells in pic = absorptive cells

Take in water and electrolytes

A lot of goblet cells for mucus

Lubricates stool

More lymphoid tissue

A lot of bacteria in stool
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The Liver
Largest gland in the body (about 3 pounds) Over 500 functions Inferior to diaphragm in RUQ and epigastric area protected by ribs R and L lobes
Plus 2 smaller lobes

Falciform ligament
Mesentery binding liver to anterior abdominal wall

2 surfaces
Diaphragmatic Visceral

Covered by peritoneum
Except bare area fused to diaphragm
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posterior

Fissure on visceral surface Porta hepatis: major vessels and nerves enter and leave - see pics Ligamentum teres: remnant of umbilical vein in fetus, attaches to navel see next slide

anterior

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Fetal circulation

Umbilical vein

___________

Ligamentum teres__________
Navel_______

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Just some of the livers repertoire

Produces bile Picks up glucose from blood Stores glucose as glycogen Processes fats and amino acids Stores some vitamins Detoxifies poisons and drugs Makes the blood proteins
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Liver histology
Liver lobules (about one million of them)
Hexagonal solid made of sheets of hepatocytes (liver cells) around a central vein Corners of lobules have portal triads (see next pic)

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 Portal triad
Portal arteriole Portal venule
Branch of hepatic portal vein Delivers substances from intestines for processing by hepatocytes

Bile duct
Carries bile away

Liver sinusoids
Large capillaries between plates of hepatocytes Contribute to central vein and ultimately to hepatic veins and IVC

Kupffer cells
Liver macrophages Old blood cells and microorganisms removed
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Hepatocytes (liver cells)

Many organelles
Rough ER manufactures blood proteins Smooth ER help produce bile salts and detoxifies blood-borne poisons Peroxisomes detoxify other poisons, including alcohol Golgi apparatus packages Mitochondria a lot of energy needed for all this Glycosomes - role in storing sugar and regulation of blood glucose (sugar) levels

Produce 500-1000 ml bile each day

Secrete into bile canaliculi (little channels) then ducts

Regeneration capacity through liver stem cells

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Gallbladder*
Bile is produced in the liver Bile is stored in the gallbladder Bile is excreted into the duodenum when needed (fatty meal) Bile helps dissolve fat and cholesterol If bile salts crystallize, gall stones are formed
Intermittent pain: ball valve effect causing intermittent obstruction Or infection and a lot of pain, fever, vomiting, etc.

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Lies in LUQ kind of behind stomach Is retroperitoneal Has a head, body and tail Head is in C-shaped curve of duodenum Tail extends left to touch spleen Main pancreatic duct runs the length of the pancreas, joins bile duct

Pancreas (exocrine and

endocrine)

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one acinus

Pancreatic exocrine function

Compound acinar (saclike) glands opening into large ducts (therefore exocrine) Acinar cells make 22 kinds of enzymes
Stored in zymogen granules Grape-like arrangement

Enzymes to duodenum, where activated 68

Pancreatic endocrine function (hormones released into blood)

Islets of Langerhans (AKA islet cells) are the hormone secreting cells Insulin (from beta cells)
Lowers blood glucose (sugar)

Glucagon (from from alpha cells)

Raises blood glucose (sugar) (more later)
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Endocrine cells:

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