Histology

of the Stomach, Small

intes3nes, and Large intes3nes
Grace Mendoza- Bardelosa, MD, FPDS
Department of Human Structural Biology
 Intended Learning Outcomes
•  Discuss the layers of the stomach, small
intes3nes, and large intes3nes.
•  Describe the segments of the stomach, small
intes3nes, and large intes3nes.
•  Correlate common clinical condi3ons affec3ng
the stomach, small intes3nes, and large
intes3nes.
 Major Layers of the GIT
•  Mucosa
•  Submucosa
•  Muscularis
•  Serosa/ Adven33a
 Mucosa
•  Epithelial lining
•  Lamina propria
–  LCTs, BVs, lympha3cs, lymphocytes, SM cells,
small glands
•  Muscularis mucosae
–  Thin layer of SM
–  Separates mucosa from submucosa
–  Allows local movements of mucosa
 Submucosa
•  Dense connec3ve 3ssue
•  BVs, LVs
•  Meissner’s plexus of autonomic nerves
•  Glands
•  Lymphoid 3ssue
 Muscularis
•  Two or more sublayers of SMs
•  ICOL
•  CT between contains BVs, LVs
•  Myenteric/ Auerbach’s nerve plexus
•  Enteric Nervous System of the diges3ve tract:
Myenteric + Meissner’s
 Serosa
•  LCT
•  BVs, LVs, adipose
•  Mesothelium – simple squamous
•  Con3nuous with mesenteries
 Adven33a
•  Diges3ve tract not suspended in a cavity
•  Bound directly to adjacent structures
•  CT layer that merges with surrounding 3ssue
•  Lacks mesothelium
STOMACH
 Stomach
•  Func3ons
–  Con3nue diges3on of carbohydrates
–  Produc3on of chyme
–  Begin diges3on of triglycerides = lipase
–  Ini3al diges3on of proteins
 Major Regions
•  Cardia
•  Pylorus
•  Fundus
•  Body
 Major Regions
•  Cardia
–  Narrow transi3onal zone
–  1.5-3 cm wide
–  Between esophagus and stomach
–  Involved with mucous produc3on
 Major Regions
•  Pylorus
–  Funnel-shaped region
–  Opens into the small intes3ne
–  Involved with mucous produc3on
 Major Regions
•  Fundus and Body
–  Iden3cal microscopically
–  Sites of gastric glands releasing acidic gastric juice

 Rugae
•  Large, longitudinally directed folds in an empty
stomach
•  Mucosa and submucosa
•  Flat when full
 Gastric and Duodenal Ulcers
•  Painful erosive lesions of the mucosa
•  Between lower esophagus and jejunum
•  Causes
–  Infec3on with Helicobacter pylori
–  Effects of NSAIDs
–  Overproduc3on of HCl or pepsin
–  Lowered produc3on or secre3on of mucus or
bicarbonate
 Mucosa
•  Lining epithelium
–  Simple columnar
•  Deeply invaginates into LP
•  Gastric pits open to lumen
Surface mucous cells

–  Line lumen and

gastric pits
–  Thick, adherent,
highly viscous
mucous
–  Alkaline fluid
containing mucin
–  Bicarbonate ions
–  Protects mucosa
•  Food
•  Stomach acid
Mucous neck cells

–  Necks of gastric
glands
–  Round nuclei and
apical secretory
granules
–  Acidic fluid
containing mucin
Parietal/ Oxyn3c cells

–  Produce HCl,
intrinsic factor
–  Large rounded or
pyramidal
–  One or two central
round nuclei
–  Highly eosinophilic
Chief/ Zymogenic cells

–  Predominate in lower
regions of gastric
glands
–  Pepsinogen
•  Pepsins ini3ate
hydrolysis of proteins
–  Gastric lipase
•  Digests lipids
Enteroendocrine cells

–  Endocrine and
paracrine func3ons
–  Serotonin and
gastrin
 Other Layers

•  Submucosa
–  CT, large BVs & LVs,
lymphoid cells,
macrophages, mast cells
•  Muscularis
–  IOMCOL
–  Pylorus: middle
thickened to be pyloric
sphincter
•  Serosa
SMALL INTESTINE
 Small Intes3ne
•  Site where diges3ve processes are completed
•  Nutrients are absorbed
•  5 meters
–  Duodenum
–  Jejunum
–  Ileum
 Leiomyomas
•  Benign tumors of SMs
•  Most common in stomach & small intes3ne
•  50% of >50 years old, muscularis of stomach
 Mucosa
•  Plicae circulares
–  Permanent circular or semilunar folds
–  Consis3ng of mucosa and submucosa
Plicae circulares of Jejunum
 Mucosa
•  Villi
–  Covers en3re mucosa
–  Finger or leaflike projec3ons
–  Core of LCT, SM fibers, capillaries, cells, Lacteals
–  Covered with simple columnar of absorp3ve
enterocytes and GCs
 Mucosa
•  Intes3nal glands or Crypts of Lieberkühn
–  Short tubular glands
•  Enterocytes
•  Goblet cells
•  Paneth cells
•  Enteroendocrine cells
•  M (microfold) cells
Intes3nal Crypts
 Mucosa
•  Enterocytes
–  Tall columnar absorp3ve cells
–  Oval nucleus located basally
–  3000 microvilli on each cell
–  Microvilli, villi, and plicae circulares all increase
mucosal surface
–  Striated or Brush border
 Mucosa
•  Striated border
–  A layer of densely packed microvilli covered by
glycocalyx
–  Nutrients are taken into cells
 Celiac disease
•  SI disorder
•  Malabsorp3on
•  Damage or destruc3on of villi
•  Immune reac3on against gluten
•  Reduced nutrient absorp3on
 Mucosa
•  Goblet cells
–  Glycoprotein mucous
–  Protect and lubricate lining of the intes3ne
 Mucosa
•  Paneth cells
–  Basal por3on of crypts
–  Large eosinophilic secretory granules
–  Lysozyme, phospholipase A, defensins
•  Bind and breakdown membranes of
microorganisms and bacterial cell walls
–  Important in innate immunity

 Mucosa
•  Enteroendocrine cells
–  Pep3de hormones
–  Sample certain nutrients in intes3nal lumen to
regulate hormone release
–  Control gut mo3lity
–  Regulate secre3on of enzymes, HCl, bile and other
components for diges3on
–  Produce the sense of sa3ety in the brain
Enteroendocrine cell
 Mucosa
•  M (microfold) cells
–  Specialized epithelial cells
–  Selec3vely endocytose an3gens
–  Transport to lymphocytes and dendri3c cells,
migrate to LN’s for immune response
 Mucosa
•  Lamina propria
–  LCT, BV’s, LV’s, N’s, SM fibers
–  Penetrates core of villus
•  Muscularis mucosa
–  Produce local movements of plicae that propel
lymph from lacteals
 Submucosa
–  LCTs
–  Larger BVs, LVs
–  Nerves: Meissner’s plexus
•  Parasympathe3c ganglion cells
•  Supply mucosal cells and smooth muscles
 Submucosa
– Duodenum
•  Brunner’s glands
– Dis3nctly alkaline mucous
– Ileum
•  Peyer’s patches (both LP and submucosa)
– Large lymphoid nodular aggregates
Duodenal (Brunner) glands
 Muscularis
•  Inner circular
•  Outer longitudinal
•  Myenteric or Auerbach’s plexus
•  Produce peristalsis
Small Intes3ne Muscularis
Muscularis and Myenteric Plexus
 Serosa
–  Mesothelium con3nuous with that of
mesenteries
LARGE INTESTINE
 Mucosa
•  Tubular intes3nal glands
–  Goblet cells
–  Absorp3ve cells
–  Enteroendocrine cells
•  Columnar cells or colonocytes
–  With microvilli & dilated intercellular spaces
–  Ac3ve fluid absorp3on
•  GCs more numerous
 Mucosa
•  Lamina propria
–  Rich in lymphoid nodules
–  Extends to submucosa
–  Large bacterial popula3on
 Colorectal Cancer
•  Adenocarcinoma
•  Polyps in epithelium of rectum, sigmoid, distal
descending colons
•  Low fiber diets
•  Prolonged contact of mucosa with fecal toxins
•  Sigmoidoscopy, colonoscopy
•  Fecal occult blood
 Submucosa
– LCT, BV’s, plexuses
 Muscularis
–  ICOL
–  Outer longitudinal subdivided into three bands of
smooth muscles called taenia coli
–  Intraperitoneal por3ons covered by serosa
•  Small, pendulous protuberances of adipose 3ssue
 Other Features
•  Rectoanal junc3on
–  Simple columnar to SSNKE
•  Anal columns: longitudinal folds of the mucosa and
submucosa
–  Include sinuses of rectal venous plexuses
•  Internal and external anal sphincters
 Hemorrhoids
•  Swollen BVs in mucosa and submucosa of anal canal
•  Increased pressure on BVs
•  Causes
–  Low fiber diet
–  Cons3pa3on
–  Straining
–  Prolonged sijng
THANK YOU