a.k.

a gastrointestinal tract
alimentary canal
WORD MEANING
ROOTS
Chol/e gall; bile
col/o colon
cyst/o bladder/sac
duoden/o duodenum WORD MEANING
emet/o vomit ROOTS
gloss/o tongue
enter/o intestine
esophag/o esophagus hepat/o liver

gastr/o stomach peps/o digestion

dyspepsia
gingiv/o gums
rect/o rectum

sigmoid/o sigmoid
colon
o 8 meters long
o starts from mouth to anus
o pathway:mucous membranes
and mucosa-associated
lymphatic tissue (MALT) line
the alimentary canal to fight any
foreign invaders—such as
bacteria—that may enter with the
food
Two groups of organs
1. Digestive Tract or Gastrointestinal (GI)
Tract is a muscular tube that winds through
the body and is responsible for the
digestion and absorption of food
 Oral cavity, pharynx,
esophagus, stomach,
small intestine, large
intestine, and anus
2. Accessory Digestive
Organs aid in the breakdown
of foodstuffs
 Teeth, tongue,
gallbladder, salivary
glands, liver, and
pancreas
 1. Ingestion: taking food into mouth.
2. Secretion: release of water, acid, buffers, and enzymes into lumen of GI
tract.
3. Mixing and propulsion/ MOTILITY: churning and movement of food
FUNCTIONS through GI tract.
4. Digestion:
mechanical-chewing, mixing, and churning food
chemical- digestive enzymesbreakdown of food.
5. Absorption: passage of digested products from GI tract into blood and
lymph.
6. Defecation: elimination of feces from GI tract
 Types of Digestion
1. Mechanical
-breakdown of large pieces of
complex molecules to smaller
pieces of complex molecules

2. Chemical
-breakdown of complex
molecules to their building
blocks so they can be absorbed.
DIGESTIVE TRACT ORGANS
 • also referred to as the oral or buccal cavity
Mouth • is formed by the cheeks, hard and soft palates, and
tongue
• Space that extends from the inner surface of the lips
and to the beginning of the oropharynx.
Boundaries:
Roof:
ü Hard palate (Maxilla+Palatine bones)
ü Soft palate
lateral walls:
ü Cheeks (Buccinator muscle=Blowing muscle)
Floor:
ü Mylohyoid muscle that is occupied by tongue
CHEEKS
-form the lateral walls of the oral cavity
PRIMARY SECONDARY
-are covered externally by skin and internally by a mucous
FUNCTIONS FUNCTIONS membrane,
-consists of nonkeratinized stratified squamous epithelium.
Ingestion of food Speech  Buccinator muscles and connective tissue lie
Mastication Ventilation between the skin and mucous membranes of the cheeks.
Deglutition
The anterior portions of the cheeks end at the lips.
LIPS
-are fleshy folds surrounding the opening of the
mouth.

- contain the orbicularis oris muscle and are

covered externally by skin and internally by a
mucous membrane.

The inner surface of each lip is

attached to its corresponding gum by a midline
fold of mucous membrane called the labial
frenulum
Red portion of the lips=vermillon
-During chewing, contraction of the buccinator Area between the vermillon and
muscles in the cheeks and orbicularis oris
muscle in the lips helps keep food between the the skin=vermillon border.
upper and lower teeth. These muscles also
assist in speech.
ORAL VESTIBULE
-is the space bounded externally by the cheeks and lips
and internally by the gums and teeth.
ORAL CAVITY PROPER
-is the space that extends from the gums and teeth
FAUCES
-the opening between the oral cavity and the
oropharynx (throat)

PALATE
-is a wall or septum that separates the oral cavity from the
nasal cavity and forms the roof of the mouth.
-structure makes it possible to chew and breathe at the
same time
HARD PALATE(the anterior portion of the roof of the
mouth)
- is formed by the maxillae and palatine bones and
is covered by a mucous membrane; it forms a bony
partition between the oral and nasal cavities.
SOFT PALATE(the posterior portion of the roof of the
mouth)
-is an arch-shaped muscular partition between the
oropharynx and nasopharynx that is lined with
mucous membrane.
UVULA
-a fingerlike muscular structure hanging from the
free border of the soft palate.
- During swallowing, the soft palate and uvula are drawn
superiorly, closing off the nasopharynx and preventing
swallowed foods and liquids from entering the nasal cavity.

Lateral to the base of the uvula are two muscular folds

that run down the lateral sides of the soft palate:

a. palatoglossal arch
- ANTERIORLY, extends to the side of the base of
the tongue
b. palatopharyngeal arch
- posteriorly, extends to the side of the pharynx

The palatine tonsils are situated between the arches, and

the lingual tonsils are situated at the base of the tongue.
At the posterior border of the soft palate, the mouth opens
into the oropharynx through the fauces

Teeth/ Dentes
• are accessory digestive
organs located in sockets of the
alveolar processes of the
mandible and maxillae.
• alveolar processes are covered by the gingivae, or gums
• sockets are lined by the periodontal ligament or periodontal membrane, which
consists of dense fibrous connective tissue that anchors the teeth to the socket
walls and acts as a shock absorber during chewing.
• tooth has three major external regions:
• crown is the visible portion above the level of the gums.
• root Embedded in the socket
• neck is the constricted junction of the crown and root near the gum line.
 DENTIN
- consists of a calcified connective tissue that gives
the tooth its basic shape and rigidity.
-is harder than bone because of its higher content of
hydroxyapatite (70% versus 55% of dry weight
- (crown) is covered by enamel, which consists
primarily of calcium phosphate and calcium
carbonate.
Enamel
- is also harder than bone because of its even
higher content of calcium salts (about 95% of
dry weight).
-enamel is the hardest substance in the body.
-It serves to protect the tooth from the wear
and tear of chewing. It also protects against
acids that can easily dissolve dentin.
-The dentin of the root is covered by cementum,
another bonelike substance, which attaches the root
to the periodontal ligament.
• The dentin of a tooth encloses a space. The enlarged part
of the space, the pulp cavity, lies within the crown and is
filled with pulp, a connective tissue containing blood
vessels, nerves, and lymphatic vessels. Narrow extensions
of the pulp cavity, called root canals, run through the root
of the tooth.
• Each root canal has an opening at its base, the apical
foramen, through which blood vessels, lymphatic vessels,
and nerves enter a tooth. The blood vessels bring
nourishment, the lymphatic vessels offer protection, and
the nerves provide sensation.
Humans have two dentitions or sets of teeth: deciduous and permanent.

1. DECIDUOUS TEETH/ PRIMARY TEETH

- also called primary teeth, milk teeth, or baby teeth

-begin to erupt at about 6 months of age, and approximately two teeth appear
each month thereafter, until all 20 are present
INCISORS
-are closest to the midline, are chisel-shaped and adapted for cutting into
food.
-are referred to as either central or lateral incisors based on their position.

CANINES
-have a pointed surface called a cusp.

-are used to tear and shred food. Incisors and canines have only one root
apiece.
THE FIRST AND SECOND DECIDUOUS MOLARS

-have four cusps.

-Maxillary (upper) molars have three roots; mandibular (lower) molars have
two roots.
- The molars crush and grind food to prepare it for swallowing.
2. PERMANENT / SECONDARY TEETH
- contains 32 teeth that erupt between age 6
and adulthood
- The pattern resembles the deciduous dentition,
with the following exceptions.
qdeciduous molars are replaced by the first
and second premolars (bicuspids), which
have two cusps and one root and are used
for crushing and grinding.
q permanent molars, which erupt into the
mouth posterior to the premolars, do not
replace any deciduous teeth and erupt as
the jaw grows to accommodate them:
qfirst permanent molars at age 6 (six-year
molars),
q second permanent molars at age 12
(twelve-year molars),
q third permanent molars (wisdom teeth)
after age 17 or not at all.
 • an accessory digestive organ composed of
skeletal muscle covered with mucous membrane.
• it forms the floor of the oral cavity.
• Each half of the tongue consists of an identical
complement of extrinsic and intrinsic muscles.

q EXTRINSIC MUSCLES:
- move the tongue from side to side and in and out to
maneuver food for chewing, shape the food into a
rounded mass, and force the food to the back of
the mouth for swallowing
- form the floor of the mouth and hold the tongue in
position
-hyoglossus, genioglossus, and styloglossus muscles

q INTRINSIC MUSCLE:
-alter the shape and size of the tongue for speech and
swallowing
-longitudinalis superior, longitudinalis inferior,
transversus linguae, and verticalis linguae muscle
Palatoglossus-elevates
Hyoglossus- Depresses The purpose of the tongue is to manipulate what is
Genioglossus- Protrusion ingested(eaten) and to provide the sense of taste.
Styloglossus- curling
dental caries/dental cavity
- is an erosion through themenamel into the dentin. If the
erosion continues to the pulpcavity, bacteria may gain
access and travel beyond the tooth’s
root. This infection is called an abscess.

(gingivitis)
- inflamed and infected gingiva from acidic waste of
bacteria

The daily bacteria buildup that forms on the tooth is

plaque.
Can be removed by flossing and toothbrushing

tartar
-hardened plaque that can be removed by a dental
professional.
LINGUAL FRENULUM
- a fold of mucous membrane in the midline of the
undersurface of the tongue, is attached to the floor of the
mouth and aids in limiting the movement of the tongue
posteriorly
ANKYLOGLOSSIA: lingual frenulum is abnormally
short or rigid—the person is said to be “tongue-tied”
because of the resulting impairment to speech.

PAPILLAE
- projections of the lamina propria covered with stratified
squamous epithelium that makes the dorsum (upper
surface) and lateral surfaces of the tongue
--houses taste buds
Tastes: Salty, sweet, sour, bitter, umami
spicy?=perceived as pain stimuli

Lingual glands in the lamina propria of the tongue secrete

both mucus and a watery serous fluid that contains the
enzyme lingual lipase ,which acts on as much as 30% of
dietary triglycerides (fats and oils) and converts them to
simpler fatty acids and diglycerides.
 SALIVARY GLANDS
• a gland that releases a secretion called
saliva into the oral cavity.
• saliva is secreted to keep the mucous
membranes of the mouth and pharynx
moist and to cleanse the mouth and
teeth.
• food enters the mouth,secretion of
saliva i n c r e a s e s , a n d i t l u b r i c a t e s ,
dissolves,
-Produces and
1.0-1.5L begins
of saliva the chemical
per day.
breakdown of the food.
• The mucous membrane of the mouth
and tongue contains glands which
include labial, buccal, and palatal
glands in the lips, cheeks, and palate,
and lingual glands in the tongue, all of
which make a small contribution to
saliva.
• Produces 1.0-1.5L of saliva per day.
 Major Salivary Glands
- lie beyond the oral mucosa, into ducts that lead to the oral
cavity
- three pairs of major salivary glands

1. Parotid Glands
- located inferior and anterior to the ears, between the skin and
the masseter muscle.
-secretes saliva into the oral cavity via a parotid duct that
pierces the buccinator muscle to open into the vestibule
opposite the second maxillary (upper) molar tooth.
--found anterior to the ears
-Cranial nerve 9/ Glossopharyngeal nerve

2.Submandibular Glands
-found in the floor of the mouth; they are medial and partly
MUMPS inferior to the body of the mandible.
-mumps virus(paramyxovirus) attacks the parotid glands -the submandibular ducts, run under the mucosa on either side
- an inflammation and enlargement of parotid gland of the midline of the floor of the mouth and enter the oral cavity
a c c o m p a n i e d b y m o d e r a t e f e v e r , m a l a i s e ( g e n e r a l proper lateral to the lingual frenulum.
discomfort) and extreme pain in the throat, especially when
swallowing sour foods or acidic juices. 3. Sublingual Glands
-swelling occurs on one or both sides of the face just anterior - are beneath the tongue and superior to the submandibular
to the ramus of the mandible. glands.
- in about 30% of males past puberty, the testes may also -the lesser sublingual ducts, open into the floor of the mouth in
become inflamed; sterility rarely occurs because testicular the oral cavity proper
involvement is usually unilateral (one testis only) -found below the tongue
- since a vaccine became available for mumps in 1967, the Submandi+sublimgual= Cranial nerve7/ Facial nerve
incidence of the disease has declined dramatically.
Composition and Functions of Saliva
• Chemically, saliva is 99.5% water and 0.5% solutes.
q solutes are ions,
sodium,
potassium,
chloride,
bicarbonate, and
phosphate.

• some dissolved gases and various organic

substances
q urea and uric acid,
q mucus,
q immunoglobulin A, (antibodies)
q the bacteriolytic enzyme lysozyme
-not used for digestion
- destroy and inhibit the
growth of bacteria that
may have entered with
the bite.

q salivary amylase, a digestive enzyme that acts on

starch.
pH: 6.8-7.0 q lingual lipase:activated later by the lower pH of the
stomach
• The water in saliva provides a medium for dissolving foods so that
they can be tasted by gustatory receptors and so that digestive
reactions can begin.

• Chloride ions in the saliva activate salivary amylase, an enzyme

that starts the breakdown of starch in the mouth into maltose,
maltotriose, and α-dextrin.

• Bicarbonate and phosphate ions buffer acidic foods that enter

the mouth, so saliva is only slightly acidic (pH 6.35–6.85).

• Salivary glands (like the sweat glands of the skin) help remove
waste molecules from the body, which accounts for the
presence of urea and uric acid in saliva.

• Mucus lubricates food so it can be moved around easily in the

mouth, formed into a ball, and swallowed.
• Immunoglobulin A (IgA) prevents attachment of microbes so
they cannot penetrate the epithelium, and the enzyme lysozyme
kills bacteria; however, these substances are not present in large
enough quantities to eliminate all oral bacteria.
PHYSIOLOGY OF DIGESTION IN THE
MOUTH
*Mastication *Muscles that work together
-process of chewing to keep the food between
the teeth
>tongue
*Muscles of Mastication
>orbicularis oris
-Moves the jaw >Buccinator
Temporalis-postural muscle
of the face *Matication is the beginning
Internal/Medial pterygoid of mechanical digestion;
Masseter salivary amylase breaking
down carbohydrates is the
External/lateral pterygoid beginning of chemical
digestion.
Mechanical and Chemical Digestion in the Mouth

Mechanical digestion :
- results from chewing,
or mastication ; food is
manipulated by the
tongue, ground by the
teeth, and mixed with saliva.
- result : the food is
reduced to a soft , flexible,
easily swallowed mass
called a bolus.
Chemical Digestion:
Two enzymes:
a. SALIVARY AMYLASE
- is secreted by the salivary glands, initiates the breakdown of
starch.
Dietary carbohydrates are either monosaccharide and disaccharide sugars or
complex polysaccharides such as starches. Most of the carbohydrates we eat are
starches, but only monosaccharides can be absorbed into the bloodstream.
Thus, ingested disaccharides and starches must be broken down into
monosaccharides.
- function is to begin starch digestion by breaking down starch into
smaller molecules such as the disaccharide maltose, the
trisaccharide maltotriose, and short-chain glucose polymers
called α-dextrins.
Even though food is usually swallowed too quickly for all starches to be broken down
in the mouth, salivary amylase in the swallowed food continues to act on the starches
for about another hour, at which time stomach acids inactivate it.

b. LINGUAL LIPASE
- is secreted by lingual glands in the tongue.
- enzyme becomes activated in the acidic environment of the
stomach and thus starts to work aft er food is swallowed.
-breaks down dietary triglycerides (fats and oils) into fatty acids
and diglycerides
꘢ consists of a glycerol molecule that is attached to two
fatty acids.
 PHYSIOLOGY OF DIGESTION IN THE MOUTH
SALIVARY
TEETH CRUSHES
AMYLASE
FOOD INTO SMALL SALIVA MIXES PARTIALLY
PIECES WITH FOOD BREAKS DOWN
(BEGINNING OF INSIDE THE CARBS
MECHANICAL MOUTH (BEGINNING OF
DIGESTION
CHEM DIGESTION)

LYSOZYMES AND MUCUS IN SALIVA

DIGESTION IN THE
ANTIBODIES MOISTENS FOOD
MOUTH IS FINISHED
DESTROY AND
WHEN THE TONGUE
INHIBIT GROWTH OF
MAKING IT EASIER
PUSHES THE BOLUS TO SWALLOW
BACTERIA THAT MAY
TO THE PHARYNX. (BOLUS)
ACCOMPANY FOOD.
 Pharynx
• is composed of skeletal
muscle and lined by
mucous membrane, and
is divided into three
parts: the nasopharynx,
the oropharynx, and the
laryngopharynx.
1. Nasopharynx
-purely air

*5 openings
ü2 openings to internal nares
ü2 openings going to Eustachian
tubes/ auditory tube
ü1 opening to oropharynx

*Tonsil: Pharyngeal tonsil/Adenoid

2. Oropharynx
-intermediate portion of pharynx
-funnel leading from oral cavity
to laryngopharynx
-lined with stratified squamous
epithelium and has a wall with
smooth muscles.

*Fauces
*tonsils: Palatine,lingual tonsils
3. Laryngopharynx
-inferior portion of the
pharynx
-hyoid bone to esophagus
posteriorly and trachea
anteriorly
-both a respiratory and a
digestive pathway
*Epiglottis
-a large, leaf-shaped piece of
elastic cartilage that is
covered with epithelium
-Helps prevent aspiration
- During swallowing, the
pharynx and larynx rise.
Elevation of the pharynx
widens it to receive food or
drink; elevation of the larynx
causes the epiglottis to move
down and form a lid over the
glottis, closing it off.
 Esophagus
qis a collapsible muscular tube, about 25 cm
(10 in.) long, that lies posterior to the
trachea.
qis a straight, muscular tube that extends
from thelaryngopharynx, travels through
the mediastinum, penetrates
thediaphragm, and connects to the
stomach.
qis lined by stratified squamousepithelial
tissue. Deep to the epithelial lining is a
submucosa of connectivetissue containing
esophageal glands that secrete protective
mucus for theesophagus.

qupper one-third of the esophagus has

skeletal muscle in itswalls
qthe middle one-third has a mixture of
skeletal and smooth muscle and
qthe lower one-third has just smooth
muscle in the walls of the esophagus.
Histology of the Esophagus
I. MUCOSA
consists of:
a.nonkeratinized stratified squamous epithelium,
b. lamina propria (areolar connective tissue), and
c. a muscularis mucosae (smooth muscle).
II. SUBMUCOSA
- contains areolar connective tissue, blood vessels, and mucous glands.

III. MUSCULARIS of the superior third of the esophagus is skeletal muscle,

the intermediate third is skeletal and smooth muscle, and the inferior third
is smooth muscle.
- the muscularis becomes slightly more prominent and forms two
sphincters:
1. upper esophageal sphincter (UES)(skeletal muscle)
- regulates the movement of food from the pharynx into the
esophagus
2. lower esophageal (cardiac) sphincter (LES)
- consists of smooth muscle and is near the heart
- regulates the movement of food from the esophagus into the
stomach.
 PHYSIOLOGY
DEGLUTITION/ SWALLOWING

--controlled by MO
-Requires 4 cranial nerves
CNV: Trigeminal
CNVII: Facial
CNIX: Glossopharyngeal
CNXII: Hypoglossal

-stimulate muscle contraction necessary to move bolus from the

pharynx to esophagus.

→ is facilitated by the secretion of saliva and mucus and involves

the mouth, pharynx, and esophagus. Swallowing occurs in three
stages:
(1) the voluntary stage, in which the bolus is passed into the
oropharynx;
(2) the pharyngeal stage, the involuntary passage of the bolus
through the pharynx into the esophagus; and
(3) the esophageal stage, the involuntary passage of the bolus
through the esophagus into the stomach.

→ Swallowing starts when the bolus is forced to the back of the

oral cavity and into the oropharynx by the movement of the
tongue upward and backward against the palate; these actions
constitute the voluntary stage of swallowing.
Pharyngeal Stage of Swallowing

• With the passage of the bolus into the

oropharynx, the involuntary stage of swallowing
begins
Ꙭ The bolus stimulates receptors in the oropharynx,
which send impulses to the deglutition center in the
medulla oblongata and lower pons of the brain
stem.
Ꙭ The returning impulses cause the soft palate and
uvula to move upward to close off the nasopharynx,
which prevents swallowed foods and liquids from
entering the nasal cavity.
Ꙭ In addition, the epiglottis closes off the opening
to the larynx, which pre v e n ts th e bo lu s fro m
entering the rest of the respiratory tract.
ꙬThe bolus moves through the oropharynx and the
laryngopharynx. Once the upper esophageal
sphincter relaxes, the bolus moves into the
esophagus.
Esophageal Stage of Swallowing

• begins once the bolus enters the esophagus.

• PERISTALSIS: a progression of coordinated contractions and
relaxations of the circular and longitudinal layers of the
muscularis, pushes the bolus onward
1. In the section of the esophagus just superior to the bolus, the
circular muscle fibers contract, constricting the esophageal wall
and squeezing the bolus toward the stomach
2. Longitudinal fibers inferior to the bolus also contract, which
shortens this inferior section and pushes its walls outward so it can
receive the bolus. The contractions are repeated in waves that
push the food toward the stomach. Steps 1 and 2 repeat until the
bolus reaches the lower esophageal sphincter muscles.
3. The lower esophageal sphincter relaxes, and the bolus moves
into the stomach. Mucus secreted by esophageal glands
lubricates the bolus and reduces friction. The passage of solid or
semisolid food from the mouth to the stomach takes 4 to 8
seconds; very soft foods and liquids pass through in about 1
second.
 STEPS OF SWALLOWING
1. Tongue pushes the bolus to the back
of pharynx.
2. Larynx pushes up and the epiglottis
closes over glottis.
3. The bolus moves to the esophagus.
4. Esophageal muscles move the bolus
towards the stomach through peristaltic
contractions.
*Dysphagia=difficulty in swallowing
*Odynophagia=painful swallowing
IMPORTANT NOTES:
*Gravity aids in the movement
toward the stomach if the
individual is in an upright
position, but being upright is
not necessary.
*The bolus can still move to the
stomach even if the person is
upside-down.
 → is a J-shaped enlargement of the GI
tract directly inferior to the diaphragm in
the abdomen
→is a muscular saccapable of holding 1.0
to 1.5 L after a meal, but it can stretch to
STOMACH

hold up to 4L when extremely full.

→ one of the functions is to serve as a
mixing chamber and holding reservoir
→ In the stomach, digestion of starch and
triglycerides continues, d ig e st io n o f
proteins begins, the semisolid bolus is
converted to a liquid, and certain
substances are absorbed.
→ The medical specialty that deals with
the structure, function, diagnosis, and
treatment of diseases of the stomach and
intestines is called gastroenterology
Stomach
 Anatomy of the Stomach
Regions:
A. Cardia: surrounds the opening of the esophagus into the
stomach. (cardiac sphincter/ lower esophageal sphincter)
B. Fundus: rounded portion superior to and to the left of the
cardia
C. Body : the large central portion of the stomach inferior
to the fundus
D. Pyloric parts:
d.1. pyloric antrum-connects to the body of the
stomach
d.2. pyloric canal-
d.3. pylorus-connects to the duodenum
CLINICAL CONNECTION
- communicates with the duodenum of the small
intestine via a smooth muscle sphincter called the Pylorospasm and Pyloric Stenosis
Two abnormalities of the pyloric sphincter can occur in
pyloric sphincter (valve) infants. In pylorospasm, the smooth muscle fibers of the
The concave medial border of the stomach is called the sphincter fail to relax normally, so food does not pass easily
from the stomach to the small intestine, the stomach
lesser curvature; the convex lateral border is called the becomes overly full, and the infant vomits often to relieve
greater curvature the pressure. Pylorospasm is treated by drugs that relax the
muscle fibers of the pyloric sphincter.
Pyloric stenosis is a narrowing of the pyloric sphincter that
must be corrected surgically. The hallmark symptom is
projectile vomiting- the spraying of liquid vomitus some
distance from the infant.
Longitudinal wrinkles called
gastric rugae can be seen
inside the stomach when
the stomach is empty.

They also allow formore

s u r f a c e a r e a t o
accommodate microscopic
depressions in the
lining,called gastric pits,
that extend to form gastric
glands.

Histology of the
Stomach
GASTRTIC PITS AND GASTRIC
GLANDS

*Gastric pits
-microscopic depressions in the
lining of the stomach.

*Gastric glands
-extensions of gastric pits
CELLS THAT LINE THE
GASTRIC PITS AND GASTRIC
GLANDS

1. Mucous cells
-secretes highly alkaline mucus
to protect the stomach walls from
the hostile environment caused by
acid and digestive enzymes
produced by the stomach.

2. Endocrine Cells
-secrete many hormones but
focus mainly on GASTRIN.
3. Parietal Cells
-produce and secrete Hydrochloric Acid
and intrinsic factors

4. Chief Cells
-secretes pepsinogen and gastric lipase

5. Regenerative cells
-stem cells that divide and differentiate to
replace any of the other cells of the gastric
pits and gastric glands.
-very necessary since cells that line the
gastric pits and glands lasts 3-6 days only
due to the harsh environment of the
stomach.
• The secretions of the
mucous, parietal, and
chief cells form gastric
juice, which totals
2000–3000 mL (roughly
2–3 qt) per day. In
addition, gastric glands
include a type of
enteroendocrine cell, the
G cell, which is located
mainly in the pyloric
antrum and secretes the
hormone gastrin into the
bloodstream.
 Gastric Juices: Chemicals Produced in the Gastric Pits and Gastric Glands of the
Stomach
Produced by Chemical Function
Endocrine Cells Gastrin q Tells chief and parietal cell to produce their products

Hydrochloric Acid Tells chief and parietal cell to produce their products
q converts pepsinogen to pepsin, which partially breaks down proteins
through chemical digestion
Parietal Cells q activates lingual lipase, which, along with gastric lipase, partially breaks
down lipids through chemical digestion
q converts iron in the diet to a usable form that can be absorbed
q destroys some bacteria
Intrinsic Factor q allows Vitamin B12 to be absorbed

Chief Cell Pepsinogen q Changes to pepsin to partially break down proteins

Gastric Lipase q Partially breaks down lipids
Mucous Cells Mucus q protects the stomach walls;secrete a highly alkaline mucus to protect the
stomach walls from the hostile environment caused by the acid and
digestive enzymes produced in the stomach
Regenerative cells are stem cells that divide and differentiate to replace any of the other cells of the gastric pits and gastric glands.
-are very necessary because the cells lining the stomach are short lived, lasting only 3 to 6 days due to the stomach’s harsh,
acidic environment. The gastric pits’ cells must be continually replaced.
• The stomach has several mechanisms it
uses to protect itself from the harsh
environment created by the cells of the
gastric pits and gastric glands.
• These mechanisms include the following:
1. The lining has the highly alkaline mucous
coat that resists the hydrochloric acid and
digestive enzymes.

2. There is epithelial cell replacement of the

lining by the regenerative cells.

3. There are tight junctions between

epithelial cells, so acid and enzymes
cannot get to the submucosa and smooth
muscle walls made of mostly protein
 PHYSIOLOGY OF DIGESTION IN THE STOMACH
During swallowing, the
MO sends signals to Bolus moves down Cardiac Sphincter
the stomach telling it to Bolus Enters
the esophagus opens
relax.

Churning of stomach 3 layers of smooth

continues mechanical
digestiion by mixing all
the gastric juices woth
the bolus.
peristaltic waves in muscle in stomach
Filling of Stomach
the direction of walls stretch,
pyloric canal. causing muscular
walls to contract.

As Mixing continues,
pH of chyme falls due Pyloric Sphincter
Churning of stomach to HCL’s low pH level, begin to open,
Chief cells and
continues mechanical and when the pH of allowing approx 3mL
parietal cells are also
digestiion by mixing all stomach contents of chyme to leave
prevented from
the gastric juices with reaches 2, the stomach at a time.
producing tehir
the bolus causing endocrine cells is products.
liquefaction and be prevented from Chyme travels to
called as Chyme. producing Gastrin. duodenum.
 Gastrin targets chief cells and Hydrochloric acid
Endocrine cells of parietal cells telling the chief cells produced by parietal
Bolus Enters the gastric pits to produce pepsinogen and cells convert
Stomach produce the gastric lipase and telling parietal pepsinogen to pepsin
hormone Gastrin. cells to produce HCL and which partially break
intrinsic Factor. down protein.

Intrinsic factor produced by
parietal cells allows vitamin B12
to be absorbed later in the small
intestine.
Hydrocholic acid
activates lingual
lipase from the saliva
and it works togaether
with the gastric lipase
produced by the chief
cells to partially break
down the lipids.

CELLULAR ACTIONS IN THE STOMACH DURING

DIGESTION
ANATOMY OF DIGESTIVE ACCESSORY
STRUCTURES

1. LIVER
-large, reddish brown organ
immediately inferior to the diaphragm
on the right side of the abdominal
cavity.

4 lobes:
Right lobe
Left lobe
Quadrate lobe
Caudate lobe
*Falciform ligament
-separates Left and Right
lobe
-sheet of mesentery that
suspends the liver from the
diaphragm and anterior
abdominal wall.

*Round Ligament
-remnant of the umbilical
vein
>Internally, the liver is divided into eight
segments
>Liver segments are divided into lobules.

Liver/Hepatic Lobules
– Hexagonal-shaped
– structural and functional units of the
liver
– Composed of hepatocyte (liver cell)
plates radiating outward from a
central vein
– Portal triads are found at each of the
six corners of each liver lobule
Portal triads consist of:
– Hepatic duct:
conduct bile toward
the duodenum
– Hepatic artery:
supplies oxygen-rich
blood to the liver
– Hepatic portal vein:
carries venous blood
with nutrients from
digestive viscera
The hepatic cords are
composed of columns of
hepatocytes separated by
the bile canaliculi
Sinusoids are enlarged spaces
filled with blood and lined with
endothelium and hepatic
phagocytic cells
– Kupffer cells: hepatic
macrophages found in
liver sinusoids
Digestive Functions of
Hepatocytes Other contents of Bile
-to produce bile übilirubin
-approx. 500-1000mL/day ücholesterol
üneutral fats
*Bile übile pigments
üminerals
-yellow-green fluid
containing bile acids,
synthesized from cholesterol
and lecithin which functions
to aid in digestion and
emulsification of lipid
droplets.

*Emulsification
-involves breaking the lipid
into smaller droplets to
complete the chemical
digestion of lipids more
efficiently.
BILE TRANSPORT
Hepatocytes

Bile Canaliculi

Hepatic ductules

R and L hepa ducts

Common
Cystic Duct
Hepatic Duct

Common Bile
Pancreatic Duct
duct

Hepatopancreatic
Ampulla

Major Duodenal
Papilla
ü Gallbladder
-pear-shaped sac that stores and
concentrates the bile produced by the
liver.
Liver produces bile
Filling of Common bile
duct

Since hepatopancreatic
ampulla remains closed,
bile from the common
bile duct overflows to the
cystic duct.

Gallbladder stores and

concentrates the bile by
absorbing water and
electrolytes .
ü REGULATION OF BILE SECRETION
Acidic, fatty chyme causes the
duodenum to release:

Cholecystokinin (CCK) and secretin

into the bloodstream

qCholecystokinin causes:
– The gallbladder to
contract and releases bile
– Relaxation of the
sphincters of the bile duct
and hepatopancreatic
ampulla

q Secretin increases bile

secretion
-As a result, bile enters the
duodenum
ü PANCREAS
-ribbon -like and has pebbly
appearance
-retroperitoneal

Functions as:
Ø Endocrine Gland
-Produces:
ü Insulin
ü Glucagon
-directly into the blood
Ø Exocrine gland
-produces:
ü bicarbonate ions
ü enzymes for protein, lipid and
carbs
-secreted through the pancreatic
duct
ü PANCREATIC SECRETIONS

>Aqueous Component
-produced by the small pancreatic ducts
-contains bicarbonate ions /HCO3
• Neutralizes acidic chyme
• Provides optimal environment
for pancreatic enzymes

>Enzymatic Component
-Produced by the acini
- contains enzymes that digest
carbohydrates, lipids, and proteins
-Enzymes are released in inactive form and
activated in the duodenum
SMALL INTESTINE
-composed of duodenum, jejunum and ileum.
-digestion is completed in the DUODENUM and
absorption takes place throughout the Small
intestine.

*Duodenum
-first 25cm/10 inches of small intestine
-located immediately after the stomach’s pyloric
sphincter
>Villi
-covered with simple columnar epithelial cells and
mucus producing Goblet cells.
>Brush Border
-composed of microvilli
-gives cells extra surface area for absorbing nutrients.
(+) Lacteals-lymphatic vessels inside the villi
*Jejunum
-second part of small intestine
-has very rich blood supply that
gives it a pink appearance
-measure approx 2.2-2.4 meters
in length
-has slightly smaller villi than
duodenum
-most of the absorption of
nutrients takes place in here.
-has circular folds on its wall
which allows extra surface
area for absorption.
* Ileum
-last part
-3.3-3.6 meters longs
-walls are less muscular and thinner than
jejunum
-its lining is characterized by nodules of
lymphocytes called PEYER’S PATCHES.
-increases in size as they approach the
large intestine.
-functions to destroy any bacteria or
pathogens entering the small
intestine from the large intestine.

*Iliocecal valve
-a sphincter muscle at the juncture of
the ileum and the large intestine.
-regulates passage of materials from
the ileum to the large intestine.
 PHYSIOLOGY OF DIGESTION IN THE SMALL INTESTINE
Acidic chyme enters duodenum

Endocrine cells of duodenum secrete CCK and secretin.

role: 1 role: 2
Parietal and chief cells stop producing their secretions of
hydrochloric acid and pepsinogen Pancreas to release enzymes

a negative feedback to Completion of lipid, carbohydrate and protein digestion in duodenum

maintain homeostasis

q duodenal endocrine cells secretes SECRETIN----targets pancreas to release BICARBONATE ION

-carries PANCREATIC ENZYMES for lipids, protein and carbohydrate
-combine with the hydrogen ion of the hydrochloric acid to form carbon dioxide and water

q lipids enter duodenum---endocrine cell secretes CHOLECYSTOKININ---target is gallbladder and hepatopancreatic sphincter ----
squeeze gallbladder to release bile and relaxation of the HPS to relax.

q lipase-----lipids --- fatty acids and glyceron movement in small intestine:

q pancreatic enzyme---protein-----amino acids segmentation: stationary constriction of
q carbohydrate digesting enzyme----- monosaccharides smooth muscle in ringlike pattern
peristalsis: wavelike contractions
LARGE INTESTINE
-colon
-6 regions:
-cecum
-ascending colon
-transverse colon
-descending colon
-sigmoid colon
-rectum
-1.5meters in length and 1.6
centimeters in diameter
*Cecum
-blind pouch inferior to the
juncture of the ileocecal
valve in the lower right
quadrant of the abdomen.

>Appendix
-dead-end tube extending
approximately 7cm from the
inferior portion of the cecum.
-contains many lymphocytes.
* Ascending Colon
-begins at the ileocecal valve and passes up the
right side of the abdominal cavity toward the
right lobe of the liver.

>Right colic flexure

-a right-angle formed by the ascending colon as it
bends to continues as transverse colon

*Transverse Colon
-continuation of large intestine that extends
from the right colic flexure across the abdomen
to teh area of the spleen.

*Descending Colon
-continuation of the large intestine that extends
from the left colic flexure down the left side of
the abdominal cavity
*Sigmoid Colon
-continuation of the large intestine that
forms an S-shape in the pelvic cavity
-it connects to the last part of the large
intestine.

*Rectum
-approx 15cm long and ends with the
anal canal.

>ANUS
-Internal anal sphincter
-External anal sphincter
 PHYSIOLOGY OF DIGESTION IN THE LARGE INTESTINE
distention of the stomach and duodenum
chyme enters large intestine causes a MASS MOVEMENT which moves
feces from transverse colon to descending
colom

absorbs water, electrolyte(Na & Cl), Vitamin K distention(expansion) of rectum wall triggers
defecation reflex
stores fecal matter
defecation reflex:drives feces downward and
relaxes the internal anal sphincter (inv) but still
defecation is done if the external anal
sphincter is voluntarily relaxed.
water absorb feces still has 75% water & 25% Vitamin K and Vit B produced by bacteria is
solid matter necessary to produce clotting factors

solid matter consist of bacteria(N), indigestible

carbohydrates(dietary fiber), lipid, mixture of sloughed off produce FLATUS, a gas that is undesirable;
epithelial cells , digestive juices, mucus and small amount of causes bloating and unpleasant odor
protein Normal: 7-10L of gas
expel/day: 500mL of gas

constipation: LI absorbs too much water

hemorrhoids: increase pressure + constipation cause bulging of anal veins---internal or external

diarrhea:LI absorbs too little water casued by irritation of the intestines by bacteria
 Types of Absorbed Nutrients

major nutrients other nutrients

proteins: amino acids Fat Soluble Vitamins:

carbohydrates: monosaccharides A, D, E, K
lipids: fatty acids + glycerol Minerals and Electrolytes (SI)
sodium: + sugar & amino acids
Water Soluble Vitamins: chloride: ileum
B complex and C potassium
B12 nedds to bind to intrinsic factor in
stomach b4 endocytosed by the Ileium

All blood from the capillaries in the stomach and intestines is circulated directly to the hepatic portal system so that it can
be processed in the liver.The hepatic portal vein drains the nutrient-rich blood fromthe capillaries in the villi and carries it to
the capillary beds in the liver.
There, the liver removes excess glucose, amino acids, iron, vitamins, andother nutrients for storage. It also recycles the 80%
of bile acids reabsorbed from the ileum to form bile for lipid digestion in the future. The fatty acids and glycerol absorbed
into lacteals in the villi will join the bloodstream at the subclavian veins and eventually reach the liver through the hepatic
artery.
 Effects of Aging on the Digestive System

The effects of aging on the digestive system can be seen in many of thestructures along the alimentary canal,
starting with the mouth.

q The effects of aging can be seen in the mouth. The enamel on the teeth thins and the gingiva recedes,
allowing for increased tooth decay and loosening of the teeth. This interferes with proper mastication. Proper
dental hygiene can minimize these effects. The receptors in the taste buds and nose become less sensitive,
leading to a decreased appetite. This may compromise the nutritional status. Although the person may be
eating less because of a diminished appetite, there may be weight gain due to a slower metabolism.

q The lining of the stomach begins to atrophy with age. This can result in less intrinsic factor produced. With
less intrinsic factor, less vitamin B12 is absorbed from the diet, possibly leading to pernicious anemia.

q The liver may metabolize drugs differently as it ages. Geriatric patients may need to have dosages adjusted
for drugs they had been taking long term.

q Movement through the large intestine slows with age. The longer materials stay in the large intestine, the
more water is absorbed. This can lead to constipation.
Diagnostic Tests for Digestive System Disorders
 Digestive System Disorders

1. Leukoplakia
q white patches that occur on the surface of the
tongue,inside the mouth, or on the inside surfaces of the
cheek.
q white patches are caused by constant irritation, usually
from contact with rough surfaces such as dentures,
tobacco products, or teeth with rough surfaces.

Hairy leukoplakia
q is a disorder commonly seen in people with HIV or with
compromised immune systems.
q is caused by the Epstein-Barrvirus and is characterized by
fuzzy, white patches on the tongue
Gastroenteritis

q is inflammation of the gastrointestinal tract caused

by a bacterial, viral, or parasitic infection.
q can cause diarrhea, stomach cramping, vomiting,
fever, weight loss, excessive sweating, and
dehydration.

A health care provider may perform an examination

of the abdomen and rectum along with a stool
culture to diagnose the cause of gastroenteritis.

Although the body will usually fight off the infection,

caremust be taken to replace the fluids and
electrolytes lost from the vomiting and diarrhea.
Diverticular Disease

q It is common for people to develop small

pouches (diverticula) in the lining of the
large intestine as they age.
q The diverticula tend to bulge outward
through weak portions in the wall of the
large intestine.
q A person with multiple diverticula has a
condition known as diverticulosis.
q Diverticulosis is common in people over
the age of 60.

Although this condition usually does not

cause symptoms of pain or discomfort, in
some people it may cause bloating and
constipation.

Diverticular disease is diagnosed through

colonoscopy to detect the presence of diverticula.

Is treated by maintaining the appropriate amount

of fiber in the diet.
Diverticulitis

q is inflammation of the diverticulum. Individuals

suffering from diverticulitis have abdominal pain
and tenderness.
q The pain can be mild to severe and can be
accompanied by nausea, vomiting, fever, or
diarrhea.
q In severe cases, diverticulitis can cause
bleeding, infection, small tears (perforations), or
blockages in the colon.
q Only some people wit h di v e r t i c u l o s i s g e t
diverticulitis, in which case a person is said to
have diverticular disease.

Ultrasound and CT scans can reveal diverticulitis in specific locations

within the colon.

Antibiotics and painmedications may also be used to help with any

infection or discomfort associated with the condition.
Abdominal Hernias

q are protrusions of the contents in the abdomen

through a weak portion in the abdominal wall.

1.Inguinal hernias are protrusions into the groin.

q are morecommon in males due to weakness
remaining in the abdominal wallfollowing the
descent of the testes through the inguinal canal
into the scrotum

2. Umbilical hernias are protrusions through the

umbilicus.
q occur due to weakness in the abdominal wall
where the umbilical cord was once attached

3.Incisional hernias are protrusions through an

incision from past abdominalsurgery.
Irritable bowel syndrome (IBS)

q is a condition characterized by abdominal pain

and discomfort, a change in the frequency of
bowel movements, and a change in the
consistency of stool.
q Patients may experience cramping, diarrhea, and
constipation.
q The cause of IBS is unknown.
q IBS is diagnosed by physical exam, stool cultures,
sigmoidoscopy, colonoscopy, and blood tests.
q Treatment depends on the symptoms
experienced by the patient.
Crohn’s Disease

q is a type of autoimmune inflammatory bowel

disease that causes chronic inflammation along
the gastrointestinal tract.
q While any part of the gastrointestinal tract may be
affected, usually the inflammation associated with
Crohn’s affects the intestines.
q Symptoms of Crohn’s disease include abdominal
cramping, fever, fatigue, diarrhea, and weight loss.
q Physical exam, barium enema, colonoscopy, CT
scan, endoscopy, MRI, sigmoidoscopy, upper GI
series, blood tests, and stool culture can all be
used when diagnosing this disorder.
q Treatment can involve dietary changes,
medications, and surgery.
 Peptic Ulcers

q are erosions of the digestive tract lining due to an

imbalance of gastric juices (hydrochloric acid and
pepsin) and the protection provided by the
mucosa.

q Esophageal ulcers may happen in the lower

esophagus if there is reflux of gastric juices through
the cardiac sphincter.
q Gastric ulcers of the stomach are often the result
of a bacterium, Helicobacter pylori (H. pylori).
Continued use of nonsteroidal anti-inflammatory
drugs (NSAIDs), such as aspirin, may also cause
these ulcers.
q Duodenal ulcers—the most common—result when
the acidic chyme entering the duodenum through
the pyloric sphincter is not sufficiently neutralized.

Chronic stress increase the chances of an ulcer forming and can slow its healing. During chronic stress, the sympathetic nervous system reduces the production of mucus in the digestive tract, lowering the protection
from the gastric juices.
Intussusception

q occurs when a portion of the intestines folds back

into itself, similar to a telescope, resulting in
obstruction of the intestines and possible ischemia.
q This condition usually occurs in children, in the
area where the small and large intestines meet.
q Ultrasound is used to diagnose intussusception,
and if confirmed, an air enema (introduction of air
into the larger intestine) may be performed to
reduce or “uncoil” the affected area. If the
reduction using the air enema does not work,
surgery is required.

The ileum has invaginated into the cecum

The cecum is called the intussuscipiens.
The ileum is called the intussusceptum.
Cirrhosis
q is a condition of the liver characterized by the
formation of scar tissue.
q The scar tissue will eventually block blood flow to parts
of the liver and interfere with the liver’s ability to
function properly.
q maincauses of cirrhosis are excessive alcohol
consumption and chronic hepatitis infection.
q Although symptoms in the early stages are uncommon,
as the disease progresses, one might experience
weakness, weight loss, fatigue,nausea, fluid
accumulation in the abdomen, and itching.
q Physicians may usephysical exams, blood tests for liver
function, CT, MRI, and ultrasound todiagnose cirrhosis.
q Treatment for cirrhosis is geared toward treating the
complications of impaired liver function and treating
the causes of the disease. While the liver has the ability
to regenerate new cells to replace damaged ones, a
liver with advanced cirrhosis no longer has this
capability.For this reason, a liver transplant may also
be necessary.
Hepatitis

q is inflammation of the liver, usually caused by a viral

infection.
q is a serious condition that can lead to cirrhosis, liver
cancer, and liverfailure.
q five types of hepatitis are described in the following list:

1. hepatitis A
q virus causes acute liver disease that can last for a few
months
q transmitted by ingestion of fecal matter, direct contact
with a person who is infected, or ingestion of
contaminated food products.

2. hepatitis B
q virus causes liver disease that ranges in severity.
Hepatitis B infections can be acute or chronic.
q transmitted by contact with infected blood or other body
fluids, by sexual contact with a person who is infected,
from mother to newborn, or by shared contaminated
needles during drug use.
3. hepatitis C
q virus can lead to an acute condition but more likely causes a
chronic infection that can eventually cause cirrhosis or liver cancer.
q usually spreads through contact with infected blood by sharing
contaminated needles during drug use.

4. hepatitis D
q virus causes a very serious liver disease, which is uncommon in the
United States.
q must have the hepatitis B virus present in order to spread throughout
the body, causing damage to the liver. This virus spreads in the same
way as hepatitis B.

5. hepatitis E
q virus causes an acute liver infection, is also uncommon in the United
States but is common in other countries around the world. It is
transmitted by ingestion of fecal matter.
q Outbreaks of hepatitis E are usually associated with contaminated
water supplies.

v Other medical conditions such as alcohol and drug misuse, and

certain medications, can also cause hepatitis.
v The symptoms of hepatitis include an enlarged liver, fluid in the
abdomen, and jaundice.
v Hepatitis can bediagnosed by ultrasound, liver function tests, liver
biopsy, and blood tests for the presence of the virus.
Vomiting

q can result from irritation anywhere along the

digestive tract.
q It is controlled by an emetic center in the medulla
oblongata. It begins with a deep breath.
q The hyoid bone and larynx are elevated, closing
off the glottis,while the soft palate is elevated,
closing off the nasopharynx.
q The diaphragm and abdominal muscles forcefully
contract, putting pressure onthe stomach and its
contents.
q The cardiac sphincter opens and the contents of
the stomach are forcefully expelled.
Food Poisoning

1. Staphylococcal food poisoning

q is usually contracted from a food handler.
q Bacteria contaminating the food make toxins, which
cause nausea, diarrhea, and vomiting.
q The symptoms occur 1 to 6 hours after eating the
contaminated food

2. Salmonellosis
q is caused by the bacteria in contaminated food (meat,
poultry, milk).
q These bacteria are destroyed by heat.
q The symptoms of nausea, diarrhea, and vomiting can
occur up to 36 hours after eating.

3. Botulism
q is caused by toxins made by a common bacterium
found in the soil.
q toxin is a powerful neurotoxin that prevents muscle
contractions.
q You may eat a raw green bean directly from the garden
and ingest the bacteria. This is not harmful. However, if
the green beans are improperly canned and not all of
the bacteria are destroyed in the process, the toxins they
produce may be fatal.
Parasites
q is an organism that lives on or in another organism (the
host) and obtains its nourishment there. Parasites may
or may not be harmful to the host.

Pinworms.
q These small, white worms commonly live in the
digestive tract of humans and feed on the partially
digested food going by.
q They crawl out the anus to lay their eggs, which causes
an itching sensation.
q Contaminated fingers then spread the eggs to surfaces
on which they are able to survive.

Tapeworms.
q The larvae of these worms—from undercooked beef,
pork, or fish—infect the digestive tract.
q They attach to the intestinal wall by suckers and feed
off the partially digested materials passing by.
q are segmented worms, and their segments may break
off and appear in the feces.
q Tapeworms may live in the digestive tract for years and
can grow up to 6 meters in length.
Roundworms.
q The ingested eggs of this parasite hatch into larvae in
the upper intestine, enter the bloodstream, and travel to
the lungs. Here, they cause respiratory symptoms.
q When coughed to the pharynx, the larvae are then
swallowed, returning the worms to the intestine.
q The adult worms may stay in the intestine, or they may
migrate, cutting through intestinal walls.
Giardia.
q These protozoans are prevalent in streams, lakes, and
rivers, especially where beavers are present.
q This infection results from ingesting untreated,
contaminated water.
q The symptoms of nausea, abdominal cramps, and
weight loss may last for weeks.
Malabsorption
q is the inability to absorb the appropriate
nutrients needed by the body.
q This inability results from problems with
digestion of food, absorption of nutrients from
food, or transport of nutrients from food to the
bloodstream.
q Symptoms include diarrhea, weight loss
(despite the amount of food consumed), and
anemia.
q Malabsorption can be diagnosed on the basis
of physical exams, blood tests, stool culture,
endoscopy, and contrast imaging tests.