digestive SYSTEM

By DR. Maeen Gamal AL-Hadhrami

➢ The digestive system describes the alimentary canal ‫ القناة الهضمية‬, its accessory organs
‫ أعضائها الملحقة‬and a variety of digestive processes ‫ العمليات الهضمية‬that prepare food eaten
in the diet for absorption.
➢ The alimentary canal begins at the mouth, passes through the thorax, abdomen and
pelvis and ends at the anus. ‫تبدأ القناة الهضمية من الفم وتمر عبر الصدر والبطن والحوض وتنتهي عند‬
‫فتحة الشرج‬
➢ It has a basic structure which is modified ‫ يتم تعديله‬at different levels to provide for the
processes occurring at each level.
➢ The digestive processes gradually break down ‫ تفتيت‬the foods eaten until they are in a
form suitable for absorption. ‫تعمل عمليات الهضم على تفتيت األطعمة التي يتم تناولها تدريجيًا حتى تصبح‬
‫في شكل مناسب لالمتصاص‬
o For example, meat, even when cooked, is chemically too complex to be absorbed
from the alimentary canal. ‫ معقد كيميائيًا للغاية بحيث ال‬، ‫ حتى عند طهيه‬، ‫ اللحم‬، ‫على سبيل المثال‬
‫يمكن امتصاصه من القناة الهضمية‬
➢ The activities of the digestive system can be grouped under five main headings.
1) Ingestion ‫ االبتالع‬: This is the taking of food into the alimentary tract, i.e. eating and
drinking.
2) Propulsion ‫ الدفع‬: This mixes and moves the contents ‫ يمزج ويحرك المحتويات‬along the
alimentary tract.
3) Digestion ‫ الهضم‬: This consists of:
a. Mechanical breakdown ‫ التكسير الميكانيكي لألغذية‬of food by, e.g. mastication
(chewing ‫)المضغ‬
b. Chemical digestion ‫ الهضم الكيميائي للغذاء‬of food into small molecules by
enzymes present in secretions ‫ اإلفرازات‬produced by glands and accessory
organs of the digestive system.
4) Absorption ‫ االمتصاص‬: This is the process by which digested food substances pass
through the walls of some organs of the alimentary canal into the blood and lymph
capillaries for circulation and use by body cells.
5) Elimination ‫االخراج‬: Food substances that have been eaten but cannot be digested and
absorbed are excreted from the alimentary canal as faeces by the process of
defecation. ‫المواد الغذائية التي تم تناولها ولكن ال يمكن هضمها وامتصاصها يتم إخراجها من القناة الهضمية‬
‫كبراز عن طريق عملية التغوط‬
❖ Organs of digestive system:
➢ Alimentary canal:
✓ Also known as the Gastro-Intestinal tract (GIT), this is essentially a long tube through
which food passes. ‫هو عبارة عن أنبوب طويل يمر عبره الطعام‬
✓ It begins at the mouth and terminates at the anus, and the various organs along its
length have different functions, although structurally they are similar. ‫يبدأ من الفم وينتهي‬
‫ على الرغم من أنها متشابهة من الناحية‬، ‫ واألعضاء المختلفة بطولها لها وظائف مختلفة‬، ‫عند فتحة الشرج‬
‫الهيكلية‬

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 ✓ The parts are:
1- Mouth ‫الفم‬
2- Pharynx ‫البلعوم‬
3- Esophagus ‫المرئ‬
4- Stomach ‫المعده‬
5- Small intestine ‫االمعاء الدقيقة‬
6- Large intestine ‫االمعاء الغليظة‬
7- Rectum and Anal canal.‫المستقيم وفتحة الشرج‬
➢ Accessory organs:
✓ Various secretions are poured ‫ يتم سكب إفرازات مختلفة‬into the alimentary tract, some by
glands in the lining membrane of the organs ‫ بعضها عن طريق الغشاء المبطن لألعضاء‬, e.g.
gastric juice ‫ العصارة المعدية‬secreted by glands in the lining of the stomach, and some by
glands situated outside the tract.
✓ The latter are the accessory organs of digestion ‫ هذه األخيرة هي األعضاء الملحقة للهضم‬and
their secretions pass through ducts to enter the tract. They consist of:
1- Three pairs of Salivary glands ‫الغدد اللعابية‬
2- The Pancreas ‫البنكرياس‬
3- The Liver and Biliary tract ‫ الكبد والقنوات الصفراوية‬.

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❖ Basic structure of the Alimentary canal:
✓ The layers of the walls of the alimentary canal follow a consistent pattern from the
ً ‫تتبع طبقات جدران القناة الهضمية نم‬
esophagus onwards. ‫طا ثابتًا من المريء فصاعدًا‬
✓ The walls of the alimentary tract are
formed by four layers of tissue:
1- adventitia or serosa – outer covering
2- muscle layer
3- submucosa
4- mucosa – lining.

1) Adventitia or serosa :
a. This is the outermost layer.
b. In the thorax it consists of loose
fibrous connective tissue and in the
abdomen the organs are covered by
a serous membrane (serosa) called
peritoneum.
2) Muscle layer:
a. With some exceptions this consists
of two layers of smooth
(involuntary) muscle.
b. The muscle fibers of the outer layer are arranged longitudinally, and those of
the inner layer encircle the wall of the tube. ‫يتم ترتيب ألياف العضالت في الطبقة الخارجية‬
‫ وتلك الموجودة في الطبقة الداخلية تحيط دائريا بجدار األنبوب‬، ‫طوليًا‬
c. Contraction and relaxation of these muscle layers occurs in waves, which push the
contents of the tract onwards. ‫يحدث تقلص واسترخاء هذه الطبقات العضلية على شكل موجات‬
‫تدفع محتويات المسالك إلى األمام‬
d. This type of contraction of smooth muscle is called peristalsis‫التمعج او الحركة الدودية‬
e. Onward movement of the contents of the tract is controlled at various points by
sphincters ‫ العضلة العاصرة‬, which are thickened rings of circular muscle.
f. Contraction of sphincters regulates
forward movement. They also act as
valves‫ كما أنها تعمل كصمامات‬, preventing
backflow in the tract.
g. This control allows time for digestion
and absorption to take place. ‫يتيح هذا‬
‫التحكم وقتًا للهضم واالمتصاص‬

3) Submucosa ‫ تحت المخاطية‬:

a. This layer consists of loose areolar
connective tissue containing collagen
and some elastic fibers, which binds
the muscle layer to the mucosa.
b. Within it are blood vessels, nerves and
lymph vessels

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4) Mucosa ‫ الغشاء المخاطي‬:
a. This consists of three layers of tissue:
i. Mucous membrane formed by columnar epithelium is the innermost layer,
and has three main functions:
1. protection
2. secretion
3. absorption
ii. lamina propria consisting of loose connective tissue
iii. Muscularis mucosa ‫ الغشاء المخاطي العضلي‬, a thin outer layer of smooth
muscle
b. Mucous membrane: in parts of the tract that are subject to great wear and tear or
mechanical injury, this layer consists of stratified squamous epithelium with
mucus-secreting glands just below the surface. In areas where the food is already
soft and moist and where secretion of digestive juices and absorption occur, the
mucous membrane consists of columnar epithelial cells interspersed with mucus-
secreting goblet cells
‫ تتكون هذه الطبقة من ظهارة‬، ‫في أجزاء من الجهاز الهضمي التي تتعرض لتآكل كبير أو إصابة ميكانيكية‬
‫ في المناطق التي يكون فيها الطعام طريًا ورطبًا‬.‫حرشفية طبقية مع غدد تفرز المخاط تحت السطح مباشرة‬
‫ يتكون الغشاء المخاطي من خاليا‬، ‫بالفعل وحيث يحدث إفراز عصارات الجهاز الهضمي وامتصاصه‬
.‫ظهارية عمودية تتخللها خاليا تفرز المخاط‬

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❖ Nerve supply:
✓ The alimentary canal and its related accessory organs are supplied by nerves from both
divisions of the Autonomic Nervous System ‫ الجهاز العصبي الالإرادي‬, i.e. both
parasympathetic ‫ الجارسمبثاوي‬and sympathetic ‫ سمبثاوي‬parts.
✓ Their actions are generally antagonistic ‫ مضادة‬to each other and at any particular time
one has a greater influence than the other, according to body needs, at that time.
✓ When digestion is required, ‫ عندما يكون الهضم مطلوبًا‬this is normally through increased
activity of the parasympathetic nervous system.
✓ The parasympathetic supply: One pair of cranial nerves, the vagus nerves, supplies
most of the alimentary canal and the accessory organs.
✓ The effects of parasympathetic stimulation on the digestive system are:
1- Increased muscular activity, especially peristalsis.
2- Increased glandular secretion.
✓ The sympathetic supply: This is provided by numerous nerves that emerge from the
spinal cord in the thoracic and lumbar regions.
✓ The effects of sympathetic stimulation on the digestive system are to:
1- Decrease muscular activity, especially peristalsis.
2- Decrease glandular secretion.

Mouth:
✓ The oral cavity is lined throughout with mucous membrane, consisting of stratified
squamous epithelium containing small mucus-secreting glands.

Tongue:
✓ The tongue is composed of voluntary muscle.
✓ Functions of the tongue: The tongue plays an important part in:
1- chewing (mastication) ‫المضغ‬
2- swallowing (deglutition) ‫البلع‬
3- speech
4- taste ‫التذوق‬

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Teeth:
✓ There are 20 temporary teeth ‫ سن مؤقت‬, 10 in each jaw. They begin to erupt ‫تبدأ في‬
‫ الظهور‬at about 6 months of age, and should all be present by 24 months.
✓ The permanent teeth ‫ األسنان الدائمة‬begin to replace the temporary (deciduous) ‫استبدال‬
)‫ األسنان المؤقتة (اللبنية‬teeth in the 6th year of age and this dentition, consisting of 32
teeth, is usually complete by the 21st year.
✓ Functions of the teeth: Teeth have different shapes depending on their functions:
1- Incisors ‫ القواطع‬and canine ‫ االنياب‬teeth are the cutting teeth and are used for biting
off pieces of food
2- The premolar ‫ الطواحن‬and molar ‫ الضروس‬teeth, with broad, flat surfaces, are used for
grinding or chewing food.

Salivary glands:
✓ Salivary glands release their secretions
into ducts that lead to the mouth.
✓ There are three main pairs:
1- The Parotid glands ‫الغدة النكفية‬
2- The Submandibular glands ‫الغدد تحت‬
‫الفك السفلي‬
3- The Sublingual glands ‫الغدد تحت اللسان‬
.
✓ Composition of Saliva ‫مكونات اللعاب‬:
• Saliva is the combined secretions from
the salivary glands and the small mucus-secreting glands of the oral mucosa. ‫اللعاب‬
‫هو عبارة عن إفرازات مشتركة من الغدد اللعابية والغدد المخاطية الصغيرة في الغشاء المخاطي للفم‬
• About 1.5 liters of saliva is produced daily and it consists of:
o Water
o Mineral salts ‫األمالح المعدنية‬
o Salivary amylase; a digestive enzyme
o Mucus
o Antimicrobial substances; immunoglobulins and the enzyme lysozyme ‫إنزيم‬
‫الليزوزيم‬.
✓ Secretion of saliva:
• Secretion of saliva is controlled by the Autonomic Nervous System.
• Parasympathetic stimulation causes profuse secretion‫ إفراز غزير للعاب‬of watery saliva
• Sympathetic stimulation results in secretion of small amounts of saliva
• Reflex secretion ‫ اإلفراز االنعكاسي‬: occurs when there is food in the mouth and the
reflex can easily become conditioned so that the sight, smell and even the thought of
food stimulates the flow of saliva. ‫يحدث عندما يكون هناك طعام في الفم ويمكن أن يتكيف المنعكس‬
‫بسهولة بحيث يحفز البصر والشم وحتى التفكير في الطعام على تدفق اللعاب‬
✓ Functions of saliva:
• Chemical digestion of polysaccharides ‫ الهضم الكيميائي للسكريات‬:
o Saliva contains the enzyme amylase ‫ إنزيم األميليز‬that begins the breakdown of
complex sugars, including starches ‫ النشويات‬, reducing them to the disaccharide
maltose.

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 • Lubrication of food ‫ترطيب الطعام‬:
o The high water content means that dry food entering the mouth is moistened
and lubricated by saliva before it can be made into a bolus ready for
swallowing. ‫المحتوى العالي من الماء يعني أن الطعام الجاف الذي يدخل الفم يتم ترطيبه وتشحيمه‬
‫بواسطة اللعاب قبل أن يتم تحويله إلى بلعة جاهزة للبلع‬
• Cleaning and lubricating the mouth ‫ تنظيف وتزليق الفم‬:
o An adequate flow of saliva is necessary to clean the mouth, and to keep it
soft, moist and pliable. ‫التدفق الكافي للعاب ضروري لتنظيف الفم وإبقائه طريًا ورطبًا‬
‫ومرنًا‬
o This helps to prevent damage to the mucous membrane by rough or
abrasive food.‫يساعد هذا في منع تلف الغشاء المخاطي بسبب الطعام الخشن أو الكاشط‬

Pharynx:
✓ The pharynx is divided into three parts, the nasopharynx, oropharynx and
laryngopharynx.
✓ The nasopharynx is important in respiration.
✓ The oropharynx and laryngopharynx are passages common to both the respiratory and
the digestive systems.
✓ Food passes from the oral cavity into the pharynx then to the esophagus below, with
which it is continuous.

Esophagus:
✓ The esophagus is about 25 cm long and about
2 cm in diameter and lies in the median plane
in the thorax in front of the vertebral column
and behind the trachea and the heart.
✓ It is continuous with the pharynx above and
just below the diaphragm it joins the stomach.
✓ The upper and lower ends of the esophagus are
closed by sphincters. ‫يتم إغالق النهايتين العلوية‬
‫والسفلية للمريء بواسطة العضلة العاصرة‬
✓ The upper esophageal sphincter prevents air
passing into the esophagus during inspiration.
✓ The cardiac or lower esophageal sphincter
prevents the reflux of acid gastric contents into
the esophagus. ‫ارتجاع محتويات المعدة الحمضية إلى‬
‫المريء‬
❖ Functions of the mouth, pharynx and esophagus:
1- Formation of a bolus ‫تشكيل بلعة‬
a. When food is taken into the mouth it is
chewed (masticated) by the teeth and
moved around the mouth by the tongue
and muscles of the cheeks. ‫عندما يؤخذ‬
‫ تمضغه األسنان (مضغ) وتحركه‬، ‫الطعام في الفم‬
‫حول الفم عن طريق اللسان وعضالت الخدين‬

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 b. It is mixed with saliva and formed into a soft mass or bolus ready for
swallowing. ‫يخلط مع اللعاب ويتشكل في كتلة ناعمة أو بلعة جاهزة للبلع‬
2- Swallowing (deglutition):
a. This occurs in three stages after chewing is complete and the bolus has been
formed. ‫يحدث هذا على ثالث مراحل بعد اكتمال المضغ وتشكيل البلعة‬
b. It is initiated voluntarily but completed by a reflex (involuntary) action.
i. Oral stage: With the mouth closed, the voluntary muscles of the tongue
and cheeks push the bolus backwards into the pharynx. ‫ تدفع‬، ‫مع إغالق الفم‬
‫عضالت اللسان والخدين اإلرادية البلعة للخلف في البلعوم‬
ii. Pharyngeal stage: The muscles of the pharynx are stimulated by a reflex
action initiated in the walls of the oropharynx and coordinated by the
swallowing center in the medulla. ‫يتم تحفيز عضالت البلعوم من خالل عمل انعكاسي‬
‫يبدأ في جدران البلعوم ويتم تنسيقه بواسطة مركز البلع في النخاع‬
iii. Esophageal stage: The presence of the bolus in the pharynx stimulates a
wave of peristalsis that propels the bolus through the esophagus to the
stomach. ‫إن وجود البلعة في البلعوم يحفز موجة من التمعج الذي يدفع البلعة عبر المريء إلى‬
‫المعدة‬

Stomach:
✓ The stomach is a J-shaped dilated portion of the alimentary tract
✓ The stomach is divided into three regions:
o the fundus. ‫القاع‬
o the body.
o the pylorus. ‫البواب‬
✓ At the distal end of the pylorus is the pyloric sphincter ‫ العضلة العاصرة البوابية‬, guarding
the opening between the stomach and the duodenum. ‫في النهاية البعيدة للبواب توجد العضلة‬
‫ التي تحرس الفتحة بين المعدة واالثني عشر‬، ‫العاصرة البوابية‬
✓ Walls of the stomach: The four layers of tissue that comprise the basic structure of the
alimentary canal are found in the stomach but with some modifications.
o Muscle layer: This consists of three layers of smooth muscle fibers:
▪ An outer layer of longitudinal fibers. ‫طبقة خارجية من األلياف الطولية‬
▪ A middle layer of circular fibers. ‫طبقة وسطى من الياف دائرية‬
▪ An inner layer of oblique fibers. ‫طبقة داخلية من األلياف المائلة‬

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 o Mucosa ‫ الغشاء المخاطي‬: When the stomach is empty the mucous membrane
lining is thrown into longitudinal folds or rugae. ‫ يتم إلقاء بطانة‬، ‫عندما تفرغ المعدة‬
‫الغشاء المخاطي في طيات طولية أو روجي‬
o Numerous gastric glands are situated below the surface in the mucous
membrane and open on to it. They consist of specialized cells that secrete
gastric juice into the stomach. ‫توجد العديد من الغدد المعدية تحت سطح الغشاء المخاطي وتفتح‬
‫ تتكون من خاليا متخصصة تفرز عصارة المعدة‬.‫بداخلها‬

❖ Gastric juice ‫ عصارة المعدة‬and functions of the stomach:

✓ Stomach size varies with the volume of food it contains, which may be 1.5 liters or
more in an adult. ‫ لتر أو‬1.5 ‫ والذي قد يصل إلى‬، ‫يختلف حجم المعدة باختالف حجم الطعام الذي تحتويه‬
‫أكثر عند البالغين‬
✓ When a meal has been eaten the food accumulates in the stomach in layers ‫عند تناول‬
‫ يتراكم الطعام في المعدة على شكل طبقات‬، ‫الوجبة‬
✓ Mixing with the gastric juice takes place Graduallyً ‫الخلط مع العصارة المعدية يحدث تدريجيا‬
✓ The gastric muscle generates a churning action that breaks down the bolus and mixes
it with gastric juice, and peristaltic waves that propel the stomach contents towards the
pylorus. ‫ والموجات التمعجية‬، ‫تولد عضلة المعدة عمالً متماو ًجا يكسر البلعة ويمزجها مع العصارة المعدية‬
‫التي تدفع محتويات المعدة نحو البواب‬
✓ When the stomach is active the pyloric sphincter closes. ‫عندما تكون المعدة نشطة تنغلق‬
‫العضلة العاصرة البوابية‬
✓ Parasympathetic stimulation increases the motility of the stomach and secretion of
gastric juice; sympathetic stimulation has the opposite effect.

➢ Gastric juice:
✓ About 2 liters of gastric juice are secreted daily by specialized secretory glands in the
mucosa It consists of:
o Water
o mineral salts
o mucus
o hydrochloric acid ‫حمض الهيدروكلوريك‬
o intrinsic factor
o inactive enzyme ‫انزيمات غير نشطه‬
✓ Functions of gastric juice:
o Water further liquefies the food swallowed.
o Hydrochloric acid:
▪ Acidifies the food and stops the action of salivary amylase ‫يحمض الطعام‬
‫ويوقف عمل األميليز اللعابي‬
▪ Kills ingested microbes‫يقتل الميكروبات المبتلعة‬
▪ Provides the acid environment needed for the action of pepsins. ‫يوفر البيئة‬
‫الحمضية الالزمة لعمل الببسين‬
o Pepsinogens are activated to pepsins by hydrochloric acid, these enzymes
begin the digestion of proteins, breaking them into smaller molecules. ‫تم تنشيط‬
‫ وتبدأ هذه اإلنزيمات في هضم البروتينات‬، ‫البيبسينوجينات للبيبسين بواسطة حمض الهيدروكلوريك‬
‫وتقسيمها إلى جزيئات أصغر‬

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 o Intrinsic factor (a protein) is necessary for the absorption of vitamin B12 from
the ileum. 12 ‫لعامل الداخلي (البروتين) ضروري المتصاص فيتامين ب‬
o Mucus prevents mechanical and chemical injury to the stomach

➢ Secretion of gastric juice:

✓ There are three phases of secretion of gastric juice:
1- Cephalic phase:
a. This flow of juice occurs before food reaches the stomach and is due to
reflex stimulation of the vagus (parasympathetic) nerves initiated by the
sight, smell or taste of food. ‫يحدث تدفق العصير هذا قبل وصول الطعام إلى المعدة ويرجع‬
‫ذلك إلى التحفيز االنعكاسي لألعصاب المبهمة (السمبتاوي) الذي يبدأ عن طريق رؤية الطعام أو‬
‫رائحته أو طعمه‬
2- Gastric phase: stimulated by the presence of food.
3- Intestinal phase:
a. When the partially digested contents of the stomach reach the small intestine,
two hormones, secretin and cholecystokinin, are produced by cells in the
intestinal mucosa. ‫ يتم‬، ‫عندما تصل محتويات المعدة المهضومة جزئيًا إلى األمعاء الدقيقة‬
‫ بواسطة خاليا في الغشاء المخاطي لألمعاء‬، ‫ سيكريتين وكوليسيستوكينين‬، ‫إنتاج هرمونين‬
b. They slow down the secretion of gastric juice and reduce gastric motility.
‫إنها تبطئ إفراز العصارة المعوية وتقلل من حركية المعدة‬
c. A carbohydrate meal leaves the stomach in 2–3 hours, a protein meal
remains longer and a fatty meal remains in the stomach longest.

➢ Functions of the stomach:

1- Temporary storage allowing time for the digestive enzymes to act ‫التخزين المؤقت مما‬
‫يتيح الوقت الالزم لعمل اإلنزيمات الهاضمة‬
2- chemical digestion: pepsins break proteins into polypeptides
3- mechanical breakdown
4- limited absorption ‫ امتصاص محدد لـ‬:
a. water, alcohol and some lipid soluble drugs

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 5- Non-specific defense against microbes:
a. provided by hydrochloric acid in gastric juice.
b. Vomiting may occur in response to ingestion of gastric irritants, e.g. microbes
or chemicals ‫ الميكروبات أو المواد‬.‫ على سبيل المثال‬، ‫قد يحدث القيء نتيجة تناول مهيجات المعدة‬
‫الكيميائية‬
6- preparation of iron for absorption
7- production and secretion of intrinsic factor needed for absorption of vitamin B12 in
the terminal ileum
8- regulation of the passage of gastric contents into the duodenum.

Small intestine:
✓ The small intestine is continuous with the stomach at the pyloric sphincter.
✓ The small intestine is about 2.5 cm in diameter, a little over 5 meters long and leads
into the large intestine
✓ It lies in the abdominal cavity surrounded by the large intestine.
✓ In the small intestine the chemical digestion of food is completed and absorption of
most nutrients takes place. ‫في األمعاء الدقيقة يكتمل هضم الطعام الكيميائي ويتم امتصاص معظم‬
‫العناصر الغذائية‬
✓ The small intestine comprises three continuous parts:
1) Duodenum ‫ االثني عشر‬:
a. a C shaped about 25 cm long (about 10 Inch) and curves around the head of the
pancreas.
b. Secretions from the gall bladder and pancreas enter the duodenum
2) Jejunum ‫الصائم‬:
a. This is the middle section of the small intestine and is about 2 meters long.
3) Ileum ‫الفائفي‬:
a. This terminal section is about 3 meters long and ends at the ileocecal valve, which
controls the flow of material from the ileum to the caecum, the first part of the
large intestine, and prevents backflow.

➢ Intestinal juice:
✓ About 1500 mL of
intestinal juice are secreted daily by the glands of the small intestine.
✓ It is slightly basic (alkaline) and consists of water, mucus and mineral salts.

11
➢ Functions of the small intestine:
1- Absorption of nutrients.
2- Onward movement of its contents by peristalsis, which is increased by
parasympathetic stimulation
3- Secretion of intestinal juice, also increased by parasympathetic stimulation
4- Completion of chemical digestion of carbohydrates, protein and fats in the
enterocytes of the villi
5- Protection against infection by microbes that have survived the antimicrobial
action of the hydrochloric acid in the stomach
6- Secretion of the hormones cholecystokinin (CCK) and secretin

➢ Chemical digestion in the small intestine:

✓ When acid chyme passes into the small intestine it is mixed with pancreatic juice,
bile and intestinal juice, and is in contact with the enterocytes of the villi.
✓ The digestion of all nutrients is completed:
o Carbohydrates are broken down to monosaccharides
o Proteins are broken down to amino acids
o Fats are broken down to fatty acids and glycerol.

➢ Pancreatic juice ‫العصارة البنكرياسية‬:

✓ Pancreatic juice is secreted by the exocrine pancreas and enters the duodenum
✓ It consists of:
o Water
o mineral salts
o enzymes:
▪ amylase
▪ lipase
o inactive enzyme including:
▪ trypsinogen
▪ chymotrypsinogen.
✓ Pancreatic juice is basic (alkaline, pH 8) because it contains significant quantities
of bicarbonate ions ‫ أيونات البيكربونات‬, which are basic (alkaline) in solution.
✓ Functions of pancreatic juice:
o Digestion of proteins ‫ هضم البروتينات‬.
▪ Trypsinogen and chymotrypsinogen are activated into the trypsin and
chymotrypsin.
▪ These enzymes convert polypeptides to amino acids.
o Digestion of carbohydrates. ‫هضم الكربوهيدرات‬
▪ Pancreatic amylase converts all digestible polysaccharides (starches)
not acted upon by salivary amylase to disaccharides.
o Digestion of fats ‫هضم الدهون‬
▪ Lipase converts fats to fatty acids and glycerol.

➢ Bile ‫العصارة الصفراوية‬:

✓ Bile, secreted by the liver to the gall bladder where it is stored ‫العصارة الصفراوية التي‬
‫يفرزها الكبد إلى المرارة حيث يتم تخزينها‬
✓ It consists of:

12
 o Water
o mineral salts
o mucus
o bile salts
o bile pigments, mainly bilirubin
o Cholesterol.
✓ Functions:
o Bile salts‫ أمالح الصفراء‬:
▪ Emulsification of fats in the small intestine ‫استحالب الدهون في األمعاء الدقيقة‬
▪ Making cholesterol and fatty acids soluble, enabling their absorption
along with the fat-soluble vitamins ‫جعل الكوليسترول واألحماض الدهنية قابلة‬
‫ مما يتيح امتصاصها جنبًا إلى جنب مع الفيتامينات التي تذوب في الدهون‬، ‫للذوبان‬
o Excretion of bilirubin (a waste product from the breakdown of red blood
cells), most of which is in the form of stercobilin. ‫إفراز البيليروبين (نفايات ناتجة‬
‫ ويكون معظمها على شكل ستيركوبيلين‬، )‫عن تكسر خاليا الدم الحمراء‬.

13
❖ Absorption of nutrients:
• Absorption of nutrients from the small intestine through the enterocytes occurs
by several processes, including diffusion, osmosis, facilitated diffusion and
active transport.
‫ بما في ذلك‬، ‫• امتصاص المغذيات من األمعاء الدقيقة من خالل الخاليا المعوية يحدث بعدة عمليات‬
‫االنتشار والتناضح واالنتشار الميسر والنقل النشط‬
• Monosaccharides and amino acids pass into the blood capillaries in the villi.
‫• تنتقل السكريات األحادية واألحماض األمينية إلى الشعيرات الدموية في الزغابات‬
• Fatty acids and glycerol enter the lymphatic vessels to the thoracic duct where
they enter the circulation.
‫• األحماض الدهنية والجلسرين تدخل األوعية اللمفاوية إلى القناة الصدرية حيث تدخل الدورة الدموية‬
• Other nutrients such as vitamins, mineral salts and water are also absorbed from
the small intestine into the blood capillaries.
‫ضا امتصاص العناصر الغذائية األخرى مثل الفيتامينات واألمالح المعدنية والمياه من األمعاء الدقيقة‬ ً ‫• يتم أي‬
‫إلى الشعيرات الدموية‬
• Fat-soluble vitamins are absorbed into the lymphatic vessels along with fatty
acids and glycerol.
.‫• يتم امتصاص الفيتامينات التي تذوب في الدهون في األوعية اللمفاوية مع األحماض الدهنية والجلسرين‬
• Vitamin B12 combines with intrinsic factor in the stomach and is actively
absorbed in the terminal ileum.
‫ مع العامل الجوهري في المعدة ويتم امتصاصه بفاعلية في نهاية اللفائفي‬12 ‫• يتحد فيتامين ب‬
• The surface area through which absorption takes place in the small intestine is
greatly increased by the circular folds of mucous membrane and by the very
large number of villi and microvilli present.
‫• تزداد مساحة السطح التي يتم من خاللها االمتصاص في األمعاء الدقيقة بشكل كبير عن طريق الطيات‬
‫الدائرية لألغشية المخاطية والعدد الكبير جدًا من الزغابات والزغابات الدقيقة الموجودة‬

14
Large intestine, rectum and anal canal:
✓ The large intestine is about 1.5 meters
long, beginning at the caecum in the
right iliac fossa and terminating at the
rectum and anal canal deep within the
pelvis.
✓ Its lumen is about 6.5 cm in diameter.
✓ the large intestine is divided into
o Caecum ‫االعور‬
o Colon ‫القولون او األمعاء الغلظة‬
o Sigmoid colon ‫القولون السيني‬
o Rectum ‫المستقيم‬
o Anal canal. ‫فتحة الشرج‬
The Caecum:
✓ This is the first part of the large intestine
✓ It is a dilated region which has a blind
end inferiorly and is continuous with the ascending
colon superiorly
✓ The vermiform appendix ‫الزائدة الدودية‬
o is a fine tube, closed at one end, which leads from
the caecum.
o It is about 8–9 cm long and has the same structure
as the walls of the large intestine but contains
more lymphoid tissue.
o The appendix has no digestive function but can
cause significant problems when it becomes
inflamed (Appendicitis) ‫ال تحتوي الزائدة الدودية على‬
)‫وظيفة في الجهاز الهضمي ولكنها قد تسبب مشاكل كبيرة عندما تلتهب (التهاب الزائدة الدودية‬

The colon:
✓ The colon has four parts which have the same structure and functions:
• The ascending colon ‫القولون الصاعد‬
o This passes upwards from the caecum to the level of the liver
• The transverse colon ‫القولون المستعرض‬
o This part extends across the abdominal cavity in front of the duodenum
and the stomach to the area of the spleen
• The descending colon ‫القولون النازل‬
o This passes down the left side of the abdominal cavity then curves
towards the midline.
• The sigmoid colon ‫القولون السيني‬
o This part describes an S-shaped curve in the pelvic cavity that continues
downwards to become the rectum.

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 The rectum
✓ This is a slightly dilated section of the large
intestine.
✓ About 13 cm long.
✓ It leads from the sigmoid colon and terminates
in the anal canal.

The anal canal

✓ This is a short passage about 4 cm long in the
adult and leads from the rectum to the
exterior.
✓ Two sphincter muscles control the anus;
o The internal sphincter, consisting of
smooth muscle, is under the control of
the autonomic nervous system ‫العضلة‬
‫ تخضع لسيطرة الجهاز العصبي الالإرادي‬، ‫ التي تتكون من العضالت الملساء‬، ‫العاصرة الداخلية‬
o The external sphincter, formed by skeletal muscle, is under voluntary control.
‫العضلة العاصرة الخارجية المكونة من العضالت الهيكلية تخضع للتحكم اإلرادي‬.

➢ Functions of the large intestine, rectum and anal canal:

1) Absorption ‫ االمتصاص‬:
a. In the large intestine absorption of water, by osmosis, continues until the
familiar semisolid consistency of faeces is achieved. ‫ يستمر‬، ‫في األمعاء الغليظة‬
‫امتصاص الماء بالتناضح حتى يتحقق االتساق شبه الصلب المألوف للبراز‬
b. Mineral salts, vitamins and some drugs are also absorbed into blood capillaries
from the large intestine. ‫ضا امتصاص األمالح المعدنية والفيتامينات وبعض األدوية في‬ ً ‫يتم أي‬
‫الشعيرات الدموية من األمعاء الغليظة‬
2) Microbial activity ‫ النشاط الجرثومي‬:
a. The large intestine is heavily colonized by certain types of bacteria, which
synthesize vitamin K and folic acid. ‫األمعاء الغليظة مستعمرة بشدة من قبل أنواع معينة من‬
‫ والتي تصنع فيتامين ك وحمض الفوليك‬، ‫البكتيريا‬
b. These microbes are commensals, i.e. normally harmless, in humans. However,
they may become pathogenic if transferred to another part of the body ‫هذه‬
‫ قد تصبح مسببة لألمراض إذا تم‬، ‫ ومع ذلك‬.‫ في البشر‬، ‫ أي غير ضارة في العادة‬، ‫الميكروبات متكافئة‬
‫نقلها إلى جزء آخر من الجسم‬
c. Gases
i. In the bowel consist of some of the constituents of air, mainly nitrogen,
swallowed with food and drink. ، ‫تتكون في األمعاء من بعض مكونات الهواء‬
‫ التي تبتلع مع الطعام والشراب‬، ‫وخاصة النيتروجين‬
ii. Hydrogen, carbon dioxide and methane are produced by bacterial
fermentation of unabsorbed nutrients, especially carbohydrate. ‫يتم إنتاج‬
‫الهيدروجين وثاني أكسيد الكربون والميثان عن طريق التخمر البكتيري للعناصر الغذائية غير‬
‫ وخاصة الكربوهيدرات‬، ‫الممتصة‬
iii. Gases pass out of the bowel as flatus (wind). ‫تخرج الغازات من األمعاء على‬
‫شكل ريح‬

16
3) Mass movement:
a. A wave of strong peristalsis sweeps along the transverse colon forcing its
contents into the descending and sigmoid colons ‫تنتشر موجة من التمعج القوي على‬
‫طول القولون المستعرض وتدفع بمحتوياته الى القولون النازل والسيني‬
4) Defecation ‫ التغوط‬:
a. Usually the rectum is empty, but when a mass movement forces the contents of
the sigmoid colon into the rectum the nerve endings in its walls are stimulated
by stretch. ‫ ولكن عندما تدفع حركة جماعية محتويات القولون السيني‬، ‫غا‬ً ‫عادة ما يكون المستقيم فار‬
‫ يتم تحفيز النهايات العصبية في جدرانه عن طريق التمدد‬، ‫إلى المستقيم‬
b. Defecation involves
i. Involuntary contraction of the muscle of the rectum and relaxation of the
internal anal sphincter. ‫االنقباض الالإرادي لعضلة المستقيم واسترخاء العضلة العاصرة‬
‫الشرجية الداخلية‬
ii. Contraction of the abdominal muscles and lowering of the diaphragm to
increase the intra-abdominal pressure and so assist defecation ‫تقلص‬
‫عضالت البطن وخفض الحجاب الحاجز لزيادة الضغط داخل البطن وبالتالي يساعد على التغوط‬
Pancreas:
✓ The pancreas is a pale grey gland
weighing about 60 grams.
✓ It is about 12–15 cm long
✓ It consists of
o Head: lies in the curve of the duodenum
o Body: behind the stomach
o Tail: lies in front of the left kidney and
just reaches the spleen.
✓ The pancreas is both an exocrine and
endocrine gland.
1- The exocrine pancreas:
a. This consists of a large number
of lobules
b. Each lobule is drained by a tiny duct to pancreatic duct that opens into the
duodenum ‫يتم تصريف كل فصيص من خالل قناة صغيرة إلى قناة البنكرياس التي تفتح في االثني‬
‫عشر‬
c. The function of the exocrine pancreas is to produce pancreatic juice
containing enzymes, some in the form of inactive form, that digest
carbohydrates, proteins and fats.
2- The endocrine pancreas:
a. Distributed throughout the gland are groups of specialized cells called the
pancreatic islets (of Langerhans). ‫تتوزع في جميع أنحاء الغدة مجموعات من الخاليا‬
)‫المتخصصة تسمى جزر البنكرياس (النجرهانز‬
b. The islets have no ducts so the hormones diffuse directly into the blood. ‫الجزر‬
‫ليس لديها قنوات لذلك تفرز الهرمونات مباشرة في الدم‬
c. The endocrine pancreas secretes the hormones insulin and glucagon, which
are principally concerned with control of blood glucose levels ‫يفرز البنكرياس‬
‫ والتي تهتم بشكل أساسي بالتحكم في مستويات‬، ‫الصماوي هرمونات األنسولين والجلوكاجون‬
‫الجلوكوز في الدم‬

17
 Liver:
✓ The liver is the largest gland in the body
✓ Weighing between 1 and 2 kg.
✓ It is situated in the upper part of the
abdominal cavity
✓ Functions of the liver:
1- Carbohydrate metabolism.
2- Fat metabolism
3- Protein metabolism
4- Breakdown of erythrocytes
5- Defense against microbes
6- Detoxification of drugs and toxic substances
7- Inactivation of hormones
8- Production of heat: It is the main heat-
producing organ of the body.
9- Secretion of bile
10- Storage: Stored substances include:
a. Glycogen
b. Fat-soluble vitamins: A, D, E, K
c. Iron, copper
d. Some water-soluble vitamins, e.g. vitamin B12.

Gall bladder ‫ المرارة‬:

✓ The gall bladder is a pear-shaped sac attached to the posterior surface of the liver
‫المرارة عبارة عن كيس على شكل كمثرى متصل بالسطح الخلفي للكبد‬
✓ It has :
o A fundus or expanded
end
o a body or main part
o a neck, which is
continuous with the cystic
duct.‫رقبة متصلة بالقناة الكيسية‬
➢ Functions of the gall bladder:
1- reservoir for bile
2- concentration of the bile by up
to 10- or 15-fold, by absorption
of water through the walls of the
gall bladder ‫تركيز العصارة‬
‫ ضعفًا‬15 ‫ أو‬10 ‫الصفراوية بما يصل إلى‬
‫عن طريق امتصاص الماء عبر جدران‬
‫المرارة‬
3- release of stored bile

18