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The stomach:
Is a muscular, hollow, dilated part of the gastrointestinal tract that functions as an
important organ in the GIT. In humans and many other vertebrates it is involved in the
second phase of digestion, following mastication in the mouth (chewing). It secretes
digestive enzymes and gastric acid to aid in food digestion. The pyloric sphincter
controls the passage of partially digested food (chyme) from the stomach into the 
duodenum where peristalsis takes over to move this through the rest of the intestines.

(Fig. 1): The stomach is located centre left in the human body.
The stomach lies between the esophagus and the duodenum. It is in the left upper
part of the abdominal cavity. The top of the stomach lies against the diaphragm. Lying
behind the stomach is the pancreas. A large double fold of visceral peritoneum called
the greater omentum hangs down from the greater curvature of the stomach. Two
sphincters keep the contents of the stomach contained; the lower esophageal
sphincter (found in the cardiac region), at the junction of the esophagus and stomach,
and the pyloric sphincter at the junction of the stomach with the duodenum.
The stomach is surrounded by parasympathetic (stimulant) and sympathetic
(inhibitor) plexuses (networks of blood vessels and nerves in the anterior  gastric,
posterior, superior and inferior, celiac and myenteric), which regulate both the
secretions activity and the motor (motion) activity of its muscles. In adult humans, the
stomach has a relaxed, near empty volume of about 75 millilitres. Because it is a
distensible organ, it normally expands to hold about one litre of food. The stomach of
a newborn human baby will only be able to retain about 30 millilitres.
Stomach histology:
The gastric mucosa is the mucous membrane layer of the stomach which contains
the glands and the gastric pits. In humans it is about 1 mm thick and its surface is
smooth, soft, and velvety. It consists of epithelium, lamina propria, and the muscularis
mucosae.
In its fresh state, it is of a pinkish tinge at the pyloric end and of a red or reddish-
brown color over the rest of its surface. In infancy it is of a brighter hue, the vascular
redness being more marked.
It is thin at the cardiac extremity, but thicker toward the pylorus. During the
contracted state of the organ it is thrown into numerous plaits or rugae, which, for the
most part, have a longitudinal direction, and are most marked toward the pyloric end
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of the stomach, and along the greater curvature. These folds are entirely obliterated
when the organ becomes distended.

(Fig. 2): Endoscopic image of fundic gland polyposis.


When examined with a lens, the inner surface of the mucous membrane presents a
peculiar honeycomb appearance from being covered with funnel-like depressions or
foveolae of a polygonal or hexagonal form, which vary from 0.12 to 0.25 mm in
diameter. These are the ducts of the gastric glands, and at the bottom of each may be
seen one or more minute orifices, the openings of the gland tubes. Gastric glands are
simple or branched tubular glands that emerge on the deeper part of the gastric
foveola, inside the gastric areas and outlined by the folds of the mucosa.
There are three types of glands: cardiac glands (in the proximal part of the
stomach), fundic (oxyntic) glands (the dominating type of gland), and pyloric glands.
The cardiac glands mainly contain mucus-producing cells called foveolar cells. The
bottom part of the oxyntic glands is dominated by zymogenic (chief) cells that
produce pepsinogen (an inactive precursor of the pepsin enzyme). Parietal cells,
which secrete hydrochloric acid (HCl) are scattered in the glands, with most of them
in the middle part. The upper part of the glands consist of mucous neck cells; in this
part the dividing cells are seen. The pyloric glands contain mucus-secreting cells.
Several types of endocrine cells are found in throughout the gastric mucosa. The
pyloric glands contain gastrin-producing cells (G cells); this hormone stimulates acid
production from the parietal cells. Enterochromaffin-like cells (ECLs), found in the
oxyntic glands release histamine, which also is a powerful stimulant of the acid
secretion. The "A-cells" produce glucagon, which mobilizes the hepatic glycogen, and
the enterochromaffin cells produce serotonin, which stimulates the contraction of the
smooth muscles.
The surface of the mucous membrane is covered by a single layer of columnar
epithelium. This epithelium commences very abruptly at the cardiac orifice, where
there is a sudden transition from the stratified epithelium of the esophagus. The
epithelial lining of the gland ducts is of the same character and is continuous with the
general epithelial lining of the stomach. An important iodine concentration by
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sodium-iodide symporter (NIS) is present in mucinous cells of surface epithelium and


gastric pits of the fundus and pyloric part of the stomach.

(Fig. 3): Anatomy of stomach and layers of its wall.

Duodenum:
The duodenum is the first section and the short part of the small intestine which
precedes the  jejunum and ileum. In humans, the duodenum is a hollow jointed tube
about 25-38 cm (10-15 inches) long connecting the stomach to the jejunum with a C-
shaped structure lying adjacent to the stomach. It begins with the duodenal bulb and
ends at the suspensory muscle of duodenum. Anatomically, it can be divided into four
parts or 4 sections. The first part of the duodenum lies within the peritoneum but its
other parts are retroperitoneal.
The pancreatic duct and common bile duct enter the descending duodenum, through
the major duodenal papilla. The second part of the duodenum also contains the minor
duodenal papilla, the entrance for the accessory pancreatic duct.
Histology:
Microscopically, the duodenum has a villous mucosa, distinct from the mucosa of
the pylorus, which directly joins to the duodenum. Like other structures of
the gastrointestinal tract, the duodenum has a mucosa, submucosa, muscularis externa,
and adventitia. Glands line the duodenum, known as Brunner's glands, which
secrete mucus and bicarbonate in order to neutralise stomach acids. These are distinct
glands not found in the ileum or jejunum, the other parts of the small intestine.
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(Fig. 4): Duodenum with brush border (microvillus)


Jejunum:
Is the second part of the small intestine in  humans lies between the duodenum and
the ileum. The jejunum is considered to begin at the attachment of the suspensory
muscle of the duodenum to the duodenum, a location called the duodeno-jejunal
flexure. The division between the jejunum and ileum is not anatomically distinct. In
adult humans, the small intestine is usually 6-7m long, about two-fifths of which (2.5
m) is the jejunum.
The interior surface of the jejunum, exposed to ingested food, is covered in finger-like
projections of mucosa, called villi, which increase the surface area of tissue available
to absorb nutrients from ingested foodstuffs. The epithelial cells which line these villi
have microvilli. The villi in the jejunum are much longer than in the duodenum or
ileum. The pH in the jejunum is usually between 7 and 9 (neutral or slightly alkaline).
The jejunum contains very few Brunner's glands (found in the duodenum) or Peyer's
patches (found in the ileum). However, there are a few jejunal lymph nodes
suspended in its mesentery. The jejunum has many large circular folds in its
submucosa called plicae circulares which increase the surface area for nutrient
absorption. The plicae circulares are the best developed in the jejunum. There is no
line of demarcation between the jejunum and the ileum. However, there are subtle
histological differences:

 The jejunum has less fat inside its mesentery than the ileum.
 The jejunum is typically of larger diameter than the ileum.
 The villi of the jejunum look like long, finger-like projections, and are a
histologically identifiable structure.
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 While the length of the entire intestinal tract contains lymphoid tissue, only
the ileum has abundant Peyer's patches, which are unencapsulated lymphoid
nodules that contain large numbers of lymphocytes and immune cells,
like microfold cells.

(Fig.4 ): TEM of microvilli in jejunum.

(Fig. 5): Three regions of small intestine for comparison purposes.


The lining of the jejunum is specialized for the absorption, by enterocytes, of small
nutrient particles which have been previously digested by enzymes in the duodenum.
Once absorbed, nutrients (with the exception of fat, which goes to the lymph) pass
from the enterocytes into the enterohepatic circulation and enter the liver via the
hepatic portal vein, where the blood is processed. The jejunum is involved in
magnesium absorption
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Ilium:
The ileum is the third and final part of the small intestine which follows the 
duodenum and jejunum and is separated from the cecum by the ileocecal valve (ICV).
In humans, the ileum is about 2-4 m long, and the pH is usually between 7 and 8
(neutral or slightly alkaline). Ileum is derived from the Greek word eilein, meaning
"to twist up tightly. There is no line of demarcation between the jejunum and the
ileum. There are, however, subtle differences between the two:

 The ileum has more fat inside the mesentery than the jejunum.
 The diameter of its lumen is smaller and has thinner walls than the jejunum.
 Its circular folds are smaller and absent in the terminal part of the ileum.
 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.
The 4 layers that make up the wall of the ileum are consistent with those of the 
gastrointestinal tract:

a. A mucous membrane, itself formed by three different layers: A single layer of tall
cells that line the lumen of the organ. The epithelium that forms the innermost part of
the mucosa has five distinct types of cells that serve different purposes, these are: 
enterocytes with microvilli, which digest and absorb nutrients; goblet cells, which
secrete mucin, a substance that lubricates the wall of the organ; Paneth cells, most
common in the terminal part of the ileum, are only found at the bottom of
the intestinal glands and release antimicrobial substances such as alpha defensins and
lysozyme; microfold cells, which take up and transport antigens from the lumen to
lymphatic cells of the lamina propria; and enteroendocrine cells, which secrete
hormones.

b. An underlying lamina propria composed of loose connective tissue and containing


germinal centers and large aggregates of lymphoid tissue called Peyer's patches,
which are a distinctive feature of the ileum.

c. A thin layer of smooth muscle called muscularis mucosae.

2. A submucosa formed by dense irregular connective tissue that carries the larger


blood vessels and a nervous component called submucosal plexus, which is part of
the enteric nervous system.

3.An external muscular layer formed by two layers of smooth muscle arranged in


circular bundles in the inner layer and in longitudinal bundles in the outer layer.
Between the two layers is the myenteric plexus, formed by nervous tissue and also a
part of the enteric nervous system.

4.A serosa composed of mesothelium, a single layer of flat cells with varying


quantities of underlying connective and adipose tissue. This layer represents
the visceral peritoneumand is continuous with the mesentery.[4]:571
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(Fig. 6): General structure of the gut wall. Brunner's glands are not found in the
ileum, but are a distinctive feature of the duodenum.
 

(Fig. 7): Goblet cells in the wall of an ileum vili. At its sides, enterocytes are
visible over a core of  lamina propria.
 

(Fig. 8): Cross section of ileum with a Peyer's patchcircled.


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Large intestine (Colon):


Is the last part of the GIT. Water is absorbed here and the remaining waste material is
stored as feces before being removed by defecation. In humans, the large intestine
begins in the right iliac region of the pelvis, just at or below the waist, where it is
joined to the end of the small intestine at the cecum, via the ileocecal valve. It then
continues as the colon ascending the abdomen, across the width of the abdominal
cavity as the transverse colon, and then descending to the rectum and its endpoint at
the anal canal. Overall, in humans, the large intestine is about 1.5 metres (5 ft) long,
which is about one-fifth of the whole length of the gastrointestinal tract.

(Fig. 9): Layers of colon.

(Fig. 10): Details of the large intestine.


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The wall of the large intestine is lined with simple columnar epithelium with 
invaginations. The invaginations are called the intestinal glands or colonic crypts.
There are about 100 colonic crypts per square millimeter of the colonic epithelium.
Since the average length of the human colon is 160.5 cm and the average inner
circumference of the colon is 6.2 cm the inner surface epithelial area of the human
colon has an average area of about 995 sq cm, which includes 9,950,000 (close to 10
million) crypts.

(Fig 11): The mucosa of large intestine demonstrates the goblet cells and the shape
of the rugae.

(Fig. 12): The junction of colon with the anal canal. Note the change in the
epithelial tssue.

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