Bicol University - College of Medicine | AY 2023- 2024

GASTRO - INTESTINAL TRACT MODULE | CASE 1

Presented by, SGD B5

Marpuri, Miriam M. Rojas, Erica Mae A.

Martinez, Diego Von Deneb G. Sopsop, Khryssnelle Vezz T.
Moradillo, Samantha Cain M. Tamayo, Florie L.
Nuñez, Cherry Ann M. Taway, Samuel L.
Ostonal, Alyanna Erika B. Villanueva, John Carlo C.
Pincaro, Mary Rose N. Yaldua, Giear S.
Ramirez, Jeremy E.
PRECEPTOR: DR. ARIANNE JOY PAMA
 ORAL CAVITY | ANATOMY AND HISTOLOGY
ORAL CAVITY LIPS
The oral cavity (mouth) consists of two parts
the oral vestibule
slit-like space between the teeth and gingivae (gums) and the lips and cheeks
The vestibule communicates with the exterior through the oral fissure (opening)
TEETH
the oral cavity proper Lining: stratified squamous epithelium (keratinization depending on Has well-developed core of striated
space between the upper and the lower dental arches or arcades (maxillary and Children have 20 deciduous teeth; adults normally have 32 permanent teeth
location) muscles which makes it highly mobile
mandibular alveolar arches and the teeth they bear). Before eruption, the developing teeth reside in the alveolar arches as tooth buds
The types of teeth are identified by their characteristics:
flattened superficial cells of the oral epithelium undergo continuous 3 different covered surfaces:
Boundaries:
laterally and anteriorly → dental arches incisors, thin cutting edges; desquamation, or loss at the surface— shed cells retain their nuclei Internal Mucous surface
roof → palate canines, single prominent cones; Cells: Lining mucosa with thick,
posteriorly → communicates with the oropharynx (oral part of the pharynx). premolars (bicuspids), two cusps; Keratinized cell layers nonkeratinized epithelium
When the mouth is closed and at rest, the oral cavity is fully occupied by the molars, three or more cusps Masticaotry mucosa on the gingiva & hard palate
tongue Surfaces Vermillion zone
Nonkeratnizied squamous epithelium covered by very thin keratinized
vestibular surface (labial or buccal) of each tooth is directed outwardly
lingual surface is directed inwardly
Lining mucosa stratified squamous epithelium
mesial surface of a tooth is directed toward the median plane of the facial part of the Soft palate transitional between the oral
cranium Cheeks mucosa and skin
distal surface is directed away from this plane Floor of the mouth Outer surface
note: both mesial and distal surfaces are contact surfaces—that is, surfaces that Pharynx (throat)
contact adjacent teeth. The masticatory surface is the occlusal surface. Has thin skin, consisting of
Posterior region of oral cavity leading to the esophagus epidermal and dermal layers,
Vasculature
The superior and inferior alveolar arteries, branches of the maxillary artery, supply sweat glands, many hair follicles
the maxillary and mandibular teeth, respectively with sebaceous gland
The alveolar veins have the same names and distribution accompany the arteries.
Lymphatic vessels from the teeth and gingivae pass mainly to the submandibular
lymph nodes

TONGUE TASTE BUDS

LIPS ovoid structures within the stratified epithelium on the tongue’s
mass of striated muscle covered by mucosa surface,
Parts: sample the general chemical composition of ingested material
externally by skin
Lining Lower surface: smooth, with typical lining mucosa Approximately 250 taste buds are present on the lateral surface of
internally by mucous membrane
Dorsal surface: irregular, hundreds of small protruding papillae (anterior 2/3) each vallate papilla, with many others present on fungiform and foliate
Muscular orbicularis oris and superior and inferior labial muscles massed lingual tonsils (posterior third or root of the tongue) Taste buds have 50-100 cells

Upper lip → superior labial (branches of the facial and infra-

orbital arteries)
TONGUE Sulcus terminalis- V-shaped groove that separates the papillary and tonsillar
areas of the lingual surface
4 types of lingual papillae:
Types of cells:
Gustatory (taste) cells
Turn over with 7-10 day life span
Vascular
Lower lip → inferior labial (branches of the facial and mental Filliform papillae Apical end
arteries.)
Very numerous Taste pore- microvilli project toward a 2-μm-wide opening in
mobile muscular organ Elongated conical shape
Upper lip →superior labial branches of the infra-orbital nerves covered with mucous membrane.
Heavily keratinized, give their surface gray or whitish appearance
the structure
(of CN V2 ) It is partly in the oral cavity and partly in the oropharynx. Categories of tastants:
Innervation
Lower lip →inferior labial branches of the mental nerves (of CN The tongue has a root, body, and The tongue features two surfaces Fungiform papillae sodium ions (salty);
V3) Dorsum Less numerous, interspersed among the filiform papillae hydrogen ions from acids (sour);
terminal sulcus of the tongue, the angle of which points posteriorly to the foramen Lightly keratinized sugarsand related compounds (sweet);
valves of the oral fissure, containing the sphincter (orbicularis cecum Mushroom shaped alkaloids and certain toxins (bitter); and
oris) The terminal sulcus divides the dorsum of the tongue transversely into a presulcal
Function Foliate papillae amino acids such as glutamate and aspartate (umami;
For grasping food, sucking liquids, keeping food out of the anterior part in the oral cavity proper and a postsulcal posterior part in the
oropharynx.
consist of several parallel ridges on each side of the tongue, savory)
vestibule, forming speech, and osculation (kissing).
Anterior Vallate / Circumvallate papillae Supportive cell
Special A midline groove divides the anterior part of the tongue into right and left largest papillae, with diameter of 1-3 mm Immature cell
Vermillion Zone (Transition zone)
Structures General
parts Eight to twelve vallate papillae are normally aligned just in front of the Basal stem cells- slowly dividing; gives rise to other cell types
Contains papillae terminal sulcus (V-shaped line)
Information
Posterior
The mucosa of the posterior part of the tongue is thick and freely movable.
It has no lingual papillae

CHEEKS lymphoid nodules give this part of the tongue an irregular, cobblestone appearance.
The lymphoid nodules are known collectively as the lingual tonsil
Inferior surface
covered with a thin, transparent mucous membrane
connected to the floor of the mouth by a midline fold called the frenulum of the tongue
On each side of the frenulum, a deep lingual vein is visible through the thin mucous
the external aspect of the cheeks constitutes the buccal
membrane.
region
A sublingual caruncle (papilla) is present on each side of the base of the lingual
anteriorly by the oral and mental regions (lips and
frenulum that includes the opening of the submandibular duct from the
Boundaries chin)
submandibular salivary gland.
superiorly by the zygomatic region
posteriorly by the parotid region
inferiorly by the inferior border of the mandible In general, extrinsic muscles alter the position of the tongue, and intrinsic muscles alter its
Muscular
shape

Muscular principal muscles of the cheeks are the buccinators

derived from the lingual artery, which arises from the external carotid artery
Vascular The dorsal lingual arteries supply the root of the tongue; the deep lingual arteries supply
Vascular supplied by buccal branches of the maxillary artery
the lingual body.

Innervation innervated by buccal branches of the mandibular nerve.

MOTOR: All muscles of the tongue, except the palatoglossus, receive motor innervation from
Function CN XII, the hypoglossal nerve.
SPECIAL SENSORY:
buccal glands lie between the mucous membrane and the Anterior = chorda tympani nerve, a branch of CN VII
Innervation
Special buccinators Posterior = lingual branch of the glossopharyngeal nerve (CN IX)
Structures Superficial to the buccinators are encapsulated GENERAL SENSORY:
collections of fat; these buccal fat-pads Anterior = lingual nerve, a branch of CN V 3
Posterior = lingual branch of the glossopharyngeal nerve (CN IX)
ESOPHAGUS | ANATOMY AND HISTOLOGY
The esophagus is a muscular tube that connects the pharynx to the stomach. It begins in the neck where it is
continuous with the laryngopharynx at the pharyngo-esophageal junction (Figs. 8.42 and 8.46B).

TEETH
Follows the curve of the vertebral column
Parts
Its first part = the cervical esophagus, is part of the voluntary upper third.
It begins immediately posterior to, and at the level of, the inferior border of the cricoid cartilage in the
median plane.
This is the level of the C6 vertebra.
the pharyngo-esophageal junction appears as a constriction produced by the cricopharyngeal part of Specific parts
Periodontium
the inferior pharyngeal constrictor muscle (the superior esophageal sphincter) Dentin
the narrowest part of the esophagus
structures responsible for maintaining
calcified tissue harder than
slightly to the left the teeth in the maxillary and
bone, consisting of 70%
The esophagus is in contact with the cervical pleura at the root of the neck mandibular bones
hydroxyapatite
Thoracic Esophagus Comprised of:
enters the superior mediastinum between the trachea and vertebral column, where it lies anterior to the Contents: type I collagen,
GENERAL Cementum
bodies of the T1–T4 vertebrae. proteoglycans
INFORMATION covers the dentin of the root and
usually flattened anteroposteriorly. Cell type: odontoblast
Initially, it inclines to the left but is pushed back to the median plane by the arch of the aorta. resembles bone, but it is
tall polarized cells
compressed anteriorly by the root of the left lung. avascular
Abdominal Esophagus Type of cell: Cementocyte
trumpet-shaped Less labile than bone
only 1.25 cm long Enamel
Periodontal ligament
passes from the esophageal hiatus in the right crus of the diaphragm to the cardial orifice of the hardest component of the
fibrous connective tissue with
stomach human body
anterior surface is covered with peritoneum of the greater sac bundled collagen fibers (Sharpey
96% calcium hydroxyapatite ;
posterior surface of the abdominal part of the esophagus is covered with peritoneum of the omental fibers)
2%-3% organic material (very
bursa Alveolar bone
esophagogastric junction lies to the left of the T11 vertebra on the horizontal plane that passes through
few proteins, no collagen)
lacks the typical lamellar pattern
the tip of the xiphoid process. Enamel rods
of adult bone
Surgeons and endoscopists designate the Z-line, a jagged line where the mucosa abruptly changes uniform, interlocking
from esophageal to gastric mucosa, as the junction. columns surrounded by
thinner layer of enamel
Type of cell: ameloblast
Cervical constriction (upper esophageal sphincter): at its beginning at the pharyngoesophageal junction, Tall, polarized cells
approximately 15 cm from the incisor teeth; caused by the cricopharyngeus muscle (see Chapter 8).
Secretes matrix for the
Thoracic (broncho-aortic) constriction: a compound constriction where it is first crossed by the arch of
CONSTRICTIONS the aorta, 22.5 cm from the incisor teeth, and then where it is crossed by the left main bronchus, 27.5 cm from enamel rods
the incisor teeth; the former is seen in anteroposterior views, the latter in lateral views. Ameloblast / Tomes process
Diaphragmatic constriction: where it passes through the esophageal hiatus of the diaphragm,
approximately 40 cm from the incisor teeth (Fig. 2.33A).

The esophagus consists of:

HISTOLOGY: ESOPHAGUS
striated (voluntary) muscle in its upper third
Muscular
smooth (involuntary) muscle in its lower third
mixture of striated and smooth muscle in between.

Cervical Esophagus
branches of the inferior thyroid arteries
each artery gives off ascending and descending branches that anastomose with each other and across
Muscular tube, about 25 cm long 4 Layers of GI tract
Vascular the midline
Veins from the cervical esophagus are tributaries of the inferior thyroid veins. transports swallowed material from the pharynx to the stomach Mucosa
Lymphatic vessels of the cervical part of the esophagus drain into the paratracheal lymph nodes and Esophageal mucosa: nonkeratinized stratified squamous epithelium consists of an epithelial lining
inferior deep cervical lymph node Esophageal submucosa: small mucus secreting glands (Esophageal glands) Underlying lamina propria of loose connective tissue
Parts: Muscularis mucosa- separates mucosa from submucosa
UPPER HALF: somatic motor and sensory Upper one-third Submucosa
Cervical Esophagus
muscularis is exclusively skeletal muscle like that of the tongue contains denser connective tissue with larger blood and lymph vessels
Innervation somatic fiber = branches from the recurrent laryngeal nerves
Middle portion Submucosal / Meissner plexus of autonomic nerves
vasomotor fibers = the cervical sympathetic trunks
LOWER HALF: parasympathetic (vagal), sympathetic, and visceral sensory to the lower half. combination of skeletal and smooth muscle fibers Muscularis
Lower third Composed of smooth muscle cells organized as 2 or more sublayers
muscularis is exclusively smooth muscle Adventitia
Layer of connective tissue continuous with surrounding tissue
STOMACH | ANATOMY AND HISTOLOGY Regions of the
REGIONS OF THE STOMACH NEUROVASCULAR SUPPLY Stomach:
Arterial supply
LC 1.) CARDIA
Gastric arteries

GC
(R/L) 2.) PYLORUS
Gastroomental
arteries (R/L)
3.) FUNDUS
Fundus & Upper
The stomach has two curvatures
Lesser curvature (LC) Body 4.) BODY
Greater curvature (GC) Short & Post.
gastric arteries
Venous Drainage
STOMACH RELATIONS LC
Gastric veins (R/L)
Drains to HPV
GC
Gastroomental vein (R/L)
Drains to HPV
Short gastric vein
Drains to SV TO HPV
**Ultimately drains to SMV
Lympathics and Nerve innervation

LYMPHATIC DRAINAGE
Superior 2/3
Gastric lymph nodes
Right 2/3
Greater and Lesser omentum Pyloric lymph nodes
Left 1/3
Pancreaticoduodenal
lymph nodes
Major Types of Cells in
the Mucosa
1.) Mucous Neck Cells
2.) Parietal (Oxyntic) Cells
3.) Chief (Zymogenic) Cells
4.) Enteroendocrine Cells

NERVE INNERVATION Layers of the Stomach:

Parasympathetic 1.) MUCOSA
CN X
Sympathetic
2.) SUBMUCOSA
From T6 to T9 3.) MUSCULARIS
Greater splanchnic Inner Oblique layer
Bed of stomach nerve
Middle Circular Layer
Outer Longitudinal Layer
Acid secretion in Ultrastructure of Gastric 4.) SEROSA
Parietal Cell Glands
 SMALL INTESTINE | ANATOMY AND HISTOLOGY
DUODENUM
First and shortest in the small intestine. Pursues a C-shaped course around
the head of pancreas. Begins at the pylorus on the right side and ends at the
duodenojejunal flexure.
DUODENUM
BLOOD SUPPLY

LYMPHATICS & INNERVATION

PARTS OF DUODENUM
Celiac Trunk
Superior Mesenteric Artery
JEJUNUM Jejunal Artery Branches

VENOUS DRAINAGE
Hepatic Portal Vein
(through superior mesenteric
and splenic veins)
ILIUM
Occupies the upper left infracolic compartment, extending
down to the umbilical region at the upper left quadrant (ULQ).
JEJUNUM
First one or two loops occupy a recess between the left part of the transverse mesocolon and the left kidney
Comparison:
Jejunal loops: situated in the upper abdomen to the left of the midline
Ileal loops: lower right part of the abdomen and pelvis

The last part of the small intestines. Ends at the ileocaecal junction,

ILEUM
HISTOLOGY
opening to the first part of the large intestine, the cecum. Mainly lies in the
MUCOSA GOBLET CELLS - most numerous in distal
portion. Provides lubrication and protection lower right quadrant region.
VILLI - fingerlike projections covered from intestinal contents
by a simple columnar epithelium PANETH CELLS - regulates the
called enterocytes. microenvironment of the intestinal crypts.
ENTEROCYTES - most numerous cell Releases defensins which binds and breaks BLOOD SUPPLY VENOUS DRAINAGE LYMPHATICS INNERVATION
type in the small intestinal lining. down membranes of microorganisms and
Responsible for nutrient absorption. bacterial cell walls. Superior Mesenteric Artery Superior Superior Mesenteric Nodes Superior Mesenteric
SUBMUCOSA
→ Branches → Arterial Arcades → Mesenteric Vein Regulates fluid homeostasis and transport of
Plexus
Vasa Recta → Ileal Wall dietary fat and fat-soluble vitamins
Parasympathetic
BRUNNER’S GLANDS - neutralizes the pH of the mucous membrane from the vasoconstrictor of vessels
chyme entering the duodenum from the pylorus. inhibitor of musculature
CIRCULAR FOLDS/PLICAE CIRCULARES - ridges/large valvular flaps projecting into Sympathetic
the lumen of the small intestine that enhances nutritional absorption. Preganglionic→ intermediolateral
Mesentery grey matter → greater and lesser
MUSCULARIS EXTERNA splanchnic nerves →superior
mesenteric ganglia
Arterial arcades
Thin, external longitudinal layer, and thick, internal circular layer of smooth muscle
cells. Aids in peristalsis. Ileum

SEROSA
Visceral peritoneum that covers the majority of muscularis externa. Also secretes
fluids for lubrication.
 LARGE INTESTINE | ANATOMY AND HISTOLOGY RECTUM
CECUM 3-5 in (8-13 cm)
APPENDIX ANAL CANAL the fixed terminal part of L.I continuous
with the sigmoid colon
5 in (13 cm) long; S3 vertebrae
continuous with anal canal
Base is attached to the posteromedial surface of the cecum about 1 in below the ileocecal junction.
Lies below the level of the junction of Has complete peritoneal covering, attached to the mesentery of the SI by a short mesentery of its own -->
mucosa is similar to distal colon with
the ileum with the large intestine mesoappendix straight tubular glands and numerous
Appendix is attached to its Inside the abdomen, base of the appendix is easily found by identifying teniae coli of the cecum and tracing them goblet cells
to the base of the appendix, where to converge to form a continuous longitudinal muscle coat
posteromedial surface
Presence of peritoneal folds in the LAYERS OF THE RECTUM BOUNDARIES OF THE RECTUM LYMPH DRAINAGE
vicinity of the cecum creates the COMMON POSITIONS OF THE APPENDIX TIP
1. Hanging down the pelvis against the right pelvic wall 1.5 in (4cm) long; passes downward and backward from Peritoneum: anterior and lateral POSTERIORLY Upper rectum
superior ileocecal, inferior ileocecal,
2. Coiled up behind the cecum rectal ampulla to anus
and retrocecal recesses surface of the first 3rd, anterior of in contact w/ sacrum and coccyx Pararectal node
3. Projecting upward along the lateral side of the keeps lateral walls in apposition except during
Longitudinal muscle is restricted to defacation: middle 3rd piririformis, coccygeus, levatores Inferior mesenteric node
cecum
three flat bands, TENIAE COLI levator ani muscle Muscular coat: outer longitudinal, ANTERIORLY Lower Rectum
4. In front of or behind the terminal part of the ileum
The opening is provided with two O: puborectalis, pubococcy inner circular layers of smooth Males follows MRA
folds, or lips --> ileocecal valve BLOOD SUPPLY geus, illiococcygeus muscles upper 2/3: sigmoid, colon, ileum; internal iliac nodes
Appendicular artery --> Posterior Cecal Artery I: Pubococcygeous, 3 tenia coli of sigmoid colon: retro-vesical pouch
Iliococcygeus broad band on anterior & lower 1/3: pos. of bladder, vas
BOUNDARIES Appendicular vein --> Posterior cecal vein
A: stability & support
posterior rectal surface deferens, & seminal vesicle NERVE SUPPLY
Anteriorly: anal sphincters
Coils of SI LYMPH DRAINAGE Mucous membrane: transverse folds Females
O: skin & fascia Sympathetic and
Superior mesenteric nodes of the rectum upper 2/3: sigmoid colon, ileum;
Sometimes part of the greater I: perineal body, Parasympathetic
omentum anococcygeal ligament circular muscle layer + 2-3 layers recto-uretine pouch Inferior Hypogastric
NERVE SUPPLY action: contracts, relaxes
Anterior abdominal wall in the Superior mesenteric plexus of semi-circular permanent folds lower 1/3: posterior of vagina Plexus
right iliac region Afferent nerve fibers concerned with the conduction Sensitive only to stretch
Posteriorly: of visceral pain from the appendix accompany the BLOOD SUPPLY Rectal Vasculature
Psoas and iliacus muscle sympathetic nerves and enter the spinal cord at the VEINS
ARTERIES
Femoral nerve level of T10 Superior RV: to inferior mesenteric vein
Superior RA from inferior mesenteric artery
Lateral cutaneous nerve if the Middle RV: Internal Iliac Vein
Middle RA: Internal Iliac Artery
thigh
Appendix is commonly found
DIFFERENCE BETWEEN Inferior RA: Internal Pudendal Artery
anatasamoses: mra at anorectal jxn
Inferior RV: Internal Pudendal Vein
Anorectal Portal-Systemic Anastomosis
behind the cecum union of rectal veins
Medially:
Appendix arises from the cecum
SMALL AND LARGE
on its medial side
BOUNDARIES OF THE ANAL CANAL ANAL SPHINCTERS BLOOD SUPPLY
BLOOD SUPPLY INTESTINES
Arterial Supply --> Ileocolic artery POSTERIORLY INTERNAL SPHINCTERS Rectal Vasculature
SMALL INTESTINES LARGE INTESTINES anococcygeal body involuntary ARTERIES
Anterior cecal artery
Mobile Fixed Upper half
Posterior cecal artery mass of tissue bwn anal canal thick smooth muscle of the
Caliber: <3 cm Caliber: <6 cm Superior Rectal Artery from inferior mesenteric artery
Venous Supply --> Superior and coccyx circular coat at the upper end
Mesenteric Vein Longitudinal muscle: LATERALLY EXTERNAL SPHINCTER Lower half
Anterior cecal vein Continuous layer fat-filled ischiorectal fossae sheath of skeletal muscle Inferior Rectal Artery: Internal Pudendal Artery
around the gut Collected into three
Posterior cecal vein bands, teniae coli ANTERIORLY encloses the internal sphincter VEINS
No fatty tags attached Upper half
Fatty tags: Omental MALE voluntary
to its wall Superior rectal vein --> inferior mesenteric vein
LYMPHATIC DRAINAGE Smooth wall appendices perineal body
Superior mesenteric nodes Sacculated wall in large urogenital diaphragm Lower half
folds: Haustra membranous (urethra) Inferior rectal vein --> Internal Pudendal Artery
NERVE SUPPLY bulb of penis
Superior mesenteric plexus FEMALE LYMPH DRAINAGE

Consists of two horizontal folds of SIGMOID COLON perineal body

urogenital diaphragm
lower vagina
Upper half
Pararectal nodes --> Inferior Mesenteric Nodes

ILEOCECAL mucous membrane that project

around the orifice of the ileum
Ileocecal sphincter
Circular muscle at the lower
Anteriorly: In the male, BLOOD SUPPLY
the urinary bladder. In
the female, the
posterior surface of the
Sigmoid branches of the
inferior mesenteric
artery
LAYERS OF THE ANAL CANAL
Lower half
Medial group of Superficial Inguinal Nodes

NERVE SUPPLY
end of ileum uterus and the upper Inferior mesenteric vein
part of the vagina. LYMPH DRAINAGE Mucous Membrane

VALVE Controls the flow of contents

from the ileum into the colon
Smooth muscle tone is reflexly
increased when the cecum is
•Posteriorly:The rectum
and the sacrum. The
sigmoid colon is also
related to the lower
Inferior mesenteric
nodes
NERVE SUPPLY
Inferior hypogastric
upper half
columnar epithelium
lower half
stratified squamous
Mucous membrane of upper half: sensitive to stretch
Visceral Afferent Fibers: Inferior Hypogastric Plexus
Lower half: sensitive to pain, touch, temperature and pressure
somatic afferent fibers: Inferior Rectal Nerves
distended coils of the terminal plexus Muscle Coat Involuntary Internal Sphincter Muscles
part of the ileum Sympathetic fibers from the inferior hypogastric plexus
outer longitudinal
inner circular layer Voluntary External Sphincter Muscles
Inferior rectal nerve from the pudendal nerve ; perineal branch of S4
Skin around anus
Inferior Rectal Nerve from the pudendal nerve
LARGE INTESTINE | ANATOMY AND HISTOLOGY POSTERIOR AND ANTERIOR RELATIONS

HISTOLOGY OF THE LARGE INTESTINES ASCENDING, TRANSVERSE, &

Large Intestine
Cecum; Ascending, Transverse, Descending Colon; Sigmoid;
Rectum
DESCENDING COLON
Figure 15-31a
Mucosa → shallow plicae, no villi
Muscularis
Circular layer
Longitudinal layer → teniae coli → haustra (colon wall)
Serosa - continuous with supporting mesenteries
omental appendages - suspended masses of adipose tissue
Figure 15-31b
Mucosa and submucosa of the anal canal
Venous sinus
Anal Columns (of Morgagni)
Anal sinuses
Defecation
Internal anal sphincter and external sphincter

BLOOD SUPPLY

Figure 15-32: Wall of the Large Intestine Figure 15-33: Colon Mucosa
15-32a: 15.33a: Transverse section of colon
Submucosa - vascularized Muscularis externa (including tenia coli)
Muscularis - inner circular layer; Submucosa
longitudinal layer present in three equally Mucosa - tubular intestinal glands
spaced bands → teniae coli
15-32b:
15.33b: Transversely cut glands
Simple columnar epithelial cells
LYMPH DRAINAGE & NERVE SUPPLY
Mucosa Tubular lumen (L)
Intestinal glands lymphocytes embedded in the lamina propria
extends as deep as muscularis 15.33c: Longitudinal section of one intestinal gland
mucosa and by lamina propria rich Mucus in the lumen
in MALT two major cell types
Goblet cells
Columnar cells
Transition from
15.33d: TEM of the absorptive cells (aka colonocytes)
simple columnar
Short microvilli (apical end)
(rectum) → stratified
Dilated intercellular spaces with interdigitating
squamous
leaflets of cell membrane (L)
epithelium (anal
canal)
 GASTROINTESTINAL TRACT | EMBRYOLOGY
FORMATION OF INTESTINAL LOOP
MIDGUT HINDGUT
Rapid elongation of the gut and its mesentery give rise to the distal third of the transverse colon, the descending colon, sigmoid, rectum
Primary intestinal loop and the upper part of the anal canal
Cephalic: Distal part of duodenum, Jejunum, Parts of the ileum Endoderm lining - internal lining of the bladder and urethra
Caudal: Lower part of Ileum, Cecum, Appendix, Ascending colon, Proximal 2/3 of Terminal portion - enters primitive anorectal canal
transverse colon Allantois - enters the primitive urogenital sinus
Cloacal membrane - formed by the boundary between the endoderm and ectoderm
PHYSIOLOGICAL HERNIATION Urorectal septum - derived from wedge of mesoderm between the allantois and hingut
End of 7th week - cloacal membrane ruptures, creating : Anal opening for hindgut and Ventral
Rapid elongation of primary intestinal loop + Rapid growth and expansion of the liver
opening for the urogenital sinus.
Physiological umbilical herniation
intestinal loops enter the extraembryonic cavity in the umbilical cord
Occurs during 6th week

ROTATION OF THE MIDGUT

Growth in length --> the primary intestinal loop rotates around an axis formed by the
superior mesenteric artery
Counterclockwise direction
90°
Amounts to approximately 270° when it is complete
Remaining 180° during return of the intestinal loops into the abdominal cavity

RETRACTION OF THE HERNIATED LOOP Upper part of anal canal (2/3) - from endoderm of the hindgut
Occurs during 10th week Lower part of anal canal (1/3) - from ectoderm around the protocdeum —-> anal pit
Factors: Regression of mesonephric kidney, Liver growth reduction, and Expansion of Degeneration of cloacal membrane (anal membrane) - continuity between the upper and lower parts
the abdominal cavity of the anal canal.
Jejunum first to reenter --> Lie on left side Caudal part of the anal canal - inferior rectus arteries
Cecal bud last to reenter cranial part of the anal canal - superior rectal artery
Forms: Hepatic flexure, Ascending colon, & Appendix Pectinate line - junction between the endodermal and ectodermal regions. At this line, the epithelium
changed from columnar to stratified squamous epithelium
MESENTERIES OF THE INTESTINAL LOOP Hindgut Abnormalities
Undergoes changes with rotation and coiling of the bowel
Caudal limb of loop moves to the right --> Dorsal mesentery twists around the
origin of superior mesenteric artery
Midgut and Hindgut mesentery remains as a single continuous entity from
duodenojejunal flexure to mesorectal level
Remains free at jejunum, ileum, transverse mesocolon, mesoappendiX,
mesosigmoid, and mesorectum
In the ascending and descending colon, the mesentery becomes attached to the
peritoneum on the posterior wall of the body cavity with Toldt fascia Rectovaginal fistulas Rectoanal fistulas Imperforate anus Congenital megacolon
GASTROINTESTINAL TRACT | PHYSIOLOGY
OVERVIEW OF DIGESTIVE SYSTEM
DIVIDED INTO:
ALIMENTARY TRACT OR GASTROINTESTINAL
TRACT (GIT)
ACCESSORY DIGESTIVE ORGANS

ACTIONS OF DIGESTIVE SYSTEM:

1. Ingestion
2. Propulsion
3. Mechanical Breakdown
4. Digestion
5. Absorption
6. Defecation
GASTROINTESTINAL TRACT | PHYSIOLOGY
ABSORPTION IN THE LARGE INTESTINE: FORMATION OF FECES
COLON COMPOSITION OF FECES DEFECATION REFLEX
principal function of colon: PARASYMPATHE
Normally composed of : ENS
1. Absorption of water and MYENTERIC PLEXUS
TIC PELVIC
three-fourths - Water NERVES
electrolytes (from chyme to
one-fourth - Solid material
form solid feces)
Dead bacteria - 30%
2. Storage of fecal matter Feces enter the
Fat - 10-20% STIMULUS
Feces enter the rectum -
rectum - distention
distention of rectal wall
of rectal wall
Inorganic matter - 10-20%
Proximal half of the colon - “Absorbing
Protein - 2-3%
colon”
Undigested roughage - 30%
concerned principally with RECEPTOR
stretch receptors in the Stretch receptors
rectal wall in the rectal wall
absorption
Distal Half of the colon - “Storage colon”
Storage of feces
DEFECATION REFLEX Sensory fibers Sensory fibers
AFFERENTS terminating in terminating in S2-
the elimination of feces from the digestive tract MYENTERIC plexus S4 cord level

through the rectum. (Mosby’s Medical

MOVEMENTS OF COLON Dictionary)
Initiated by defecation reflexes: CENTER MYENTERIC PLEXUS
S2-S4 Spinal cord
segments
1. Intrinsic reflex
2. Parasympathetic defecation reflex
Pelvic
Motor signal to smooth
EFFERENT muscles
Parasympathetic
nerves

Smooth muscle cells of Smooth muscle

Descending colon, cells of Descending
EFFECTOR sigmoid colon, and colon, sigmoid
Rectum colon, and Rectum

MIXING MOVEMENT PROPULSIVE MOVEMENTS Peristaltic waves forcing

Peristaltic waves
forcing feces
feces towards rectum - towards rectum -
“HAUSTRATION” “MASS MOVEMENTS” RESPONSE Relaxation of internal Relaxation of
anal sphincter internal anal
sphincter
 io
ion
n T ION
L
att
A ETIOLOGY

E
a
CAUSES

R
p
divided into two main groups: primary constipation and secondary

p
R
i
constipation. Chronic constipation stems from inadequate fiber/fluid intake,

i
O
t
disordered colonic transit, or anorectal function. Causes include

C
t
neurogastroenterologic disturbance, certain drugs, aging, and

L Primary Constipation

C onns s
systemic diseases affecting the GI tract.

I C A Primary constipation can be divided into three types: normal-

Recent onset constipation can indicate organic issues like tumors,
anorectal irritation, or strictures.

I N transit constipation (NTC), slow-transit constipation (STC), and Idiopathic constipation involves delayed colon emptying and

o
L
pelvic floor dysfunction. reduced propulsive movements.

CC
NTC is the most common type, where stool passes through the
colon at a normal rate but patients struggle to evacuate their
bowels. It may overlap with irritable bowel syndrome with
persistent, difficult, infrequent, or seemingly incomplete constipation (IBS-C), but lacks prominent abdominal pain or
defecation - Harrison's discomfort.
STC is characterized by infrequent bowel movements, decreased
urgency, or straining. It's more common in females and involves
difficulty in passing stools or incomplete or infrequent passage of
impaired colonic motor activity.
hard stools - Mosby's
Pelvic floor dysfunction involves issues with the pelvic floor or
a symptom rather than a disease, generally defined as when bowel anal sphincter, leading to prolonged straining, incomplete
evacuation, or the need for perineal pressure or digital evacuation
movements occur three or fewer times a week and are difficult to pass -
during defecation.
MedScape
Secondary Constipation
Secondary constipation can result from various dietary issues
such as inadequate water or fiber intake, overuse of coffee, tea,
alcohol, recent dietary changes, or ignoring the urge to defecate.
Reduced exercise levels may also contribute.
Structural causes include anal fissures, thrombosed hemorrhoids,
colonic strictures, obstructing tumors, volvulus, and idiopathic
megarectum.
Systemic diseases like endocrinologic and metabolic disorders
(e.g., hypercalcemia, hypothyroidism, pregnancy, diabetes
mellitus), neurologic disorders (e.g., stroke, Parkinson's disease,
multiple sclerosis), and connective tissue disorders (e.g.,
scleroderma, amyloidosis) can also lead to constipation.
Outlet obstruction (evacuation disorders) affects about a quarter
of constipation cases, treatable with biofeedback.
Hospitalization or chronic illness can worsen constipation due to
inactivity or physical immobility.
Manifestations
vague abdominal discomfort to acute pain, nausea, and vomiting.
Symptoms include decreased frequency of stools, hard and dry
stools, small stools, bloody stools, increased flatulence, rectal
pressure and pain, straining, and decreased appetite.
Valsalva maneuver during straining can pose risks for individuals
with cardiac disease or cerebral edema.
Complications include fecal impaction and colon perforation.
Chronic constipation can lead to diverticulosis and rectal mucosal
ulcers, especially in older adults.
Interventions
Most cases of constipation are managed with diet therapy,
increased activity levels, stool softeners, bulk forming agents,
laxatives, and enemas. Constipation from slowed or absent GI
motility requires a long-term bowel program.
INVESTIGATION OF SEVERE CONSTIPATION

Note the large amount of A large stool mass is Colon distention

stool throughout the visible in the hepatic secondary to fecal
colon on this radiograph. flexure of the colon. impaction.
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