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Chapter 16
Digestive System
ANA101:
ANATOMY & PHYSIOLOGY
WITH PATHOPHYSIOLOGY
MARK MAGBUHOS, RMT

College of Medical Technology
COLLEGE OF MEDICAL TECHNOLOGY
Calayan Educational Foundation, Inc.
LEARNING OBJECTIVES:
• List the major functions of the digestive system.
• Describe the general histology of the digestive tract.
• Describe the structure of a tooth.
• Describe the major salivary glands. Compare their structures and
functions.
• Describe mastication and swallowing.
• Outline the anatomical and physiological characteristics of the stomach.
• Describe the stomach secretions, their functions, and their regulation.
• Describe gastric movements and stomach emptying and how they are
regulated.
• List the characteristics of the small intestine that account for its large
surface area.
• Describe the secretions and movements that occur in the small intestine.
• Describe the anatomy, histology, and ducts of the liver and pancreas.
• Describe the major functions of the liver and pancreas, and explain
how they are regulated.
• List the parts of the large intestine, and describe its anatomy and
histology.
• Describe the major functions of the large intestine, and explain how
movement is regulated.
• Describe the digestion, absorption, and transport of carbohydrates,
proteins, vitamins, and minerals.
• Describe the digestion, absorption, and transport of fats and lipids.
• Discuss water movement into and out of the digestive tract.
• Describe the effects of aging on the digestive system.
Case Study
• Mark kept attributing his recurring abdominal pain to “something I
ate”— and he was partly right about that. Several times during the past
year, eating high-fat meals had led to episodes of serious abdominal
pain.
• During the most recent attack, the discomfort became so intense that
Mark went to the emergency room, where he was given medication to
relieve the pain. Still, over the next few hours, his skin took on a
yellowish tint, and the next morning he had diarrhea and clay-colored
feces.
• Following lab tests and ultrasonography, a physician diagnosed
gallstones and recommended the removal of Mark’s gallbladder.
• Explain how gallstones led to Mark’s pain and other symptoms.
Digestion and the Digestive System

• Digestion is the breakdown of large organic molecules into smaller
molecules that can be absorbed.
• The digestive system performs the task of digestion.
• Food is taken into the digestive system, where it is enzymatically
broken down into smaller and smaller particles for absorption.
Digestive System Functions

1. Ingestion of solids and liquids
2. Digestion of organic molecules
3. Absorption of nutrients
4. Elimination of waste
Digestive System
Digestive System
Digestive System
Digestive System
• The digestive system consists of the digestive tract, plus specific
associated organs.
• The digestive tract is also referred to as the GI (gastrointestinal tract)
• The tract is one long tube from the mouth to the anus.
Digestive Tract Components

• The digestive tract consists of the:
• oral cavity (mouth)
• pharynx
• esophagus
• stomach
• small intestines
• large intestines
• rectum
• anus
Associated Organs
• The digestive system includes some associated organs not directly in
the digestive tract, but have ducts that lead into the tract.
• These associated organs are the:
• salivary glands
• liver
• gallbladder
• pancreas
Layers of Digestive Tract Wall

• The layers of the tract wall are also termed tunics.
1. Mucosa:
• innermost layer
• secretes mucus
2. Submucosa:
• above mucosa
• contains blood vessels, nerves, small glands
Layers of Digestive Tract Wall

3. Muscularis:
• above submucosa
• longitudinal, circular, and oblique muscles
4. Serosa/adventitia:
• outermost layer
• peritoneum is present called serosa
• no peritoneum then called adventitia
Digestive Tract Histology
Peritoneum
• Layer of smooth epithelial tissue
• Mesenteries:
• connective tissue of organs in abdominal cavity
• Lesser omentum:
• mesentery connecting lesser curvature of stomach to liver and
diaphragm
• Greater omentum:
• mesentery connecting greater curvature of stomach to transverse
colon and posterior body wall
Peritoneum and Mesenteries
Oral Cavity
• First part of digestive system
• Contains stratified squamous epithelia
• Salivary glands:
• produce saliva which contains enzymes to breakdown carbohydrates
into glucose
• cleanse mouth
• dissolve and moisten food
Oral Cavity
• Amylase:
• salivary enzyme that breaks down carbohydrates
• Lysozyme:
• salivary enzymes that are active against bacteria
• Tongue:
• house taste buds and mucus
Oral Cavity
Teeth
• 32 teeth in normal adult
• Incisors, canine, premolars, molars, wisdom
• 20 primary teeth (baby teeth)
• Each tooth has crown, cusp, neck, root
• Center of tooth is pulp cavity
• Enamel is hard covering protects against abrasions
• Cavities are breakdown of enamel by acids from bacteria
Teeth
Palate
• Palate:
• roof of oral cavity
• Hard palate:
• anterior part
• Soft palate:
• posterior part
Salivary Glands
• Salivary Glands:
• includes submandibular, sublingual, parotid
• produce saliva contains enzymes to breakdown food
• mumps is inflammation of parotid gland
Functions of Major Digestive Secretions
Functions of Major Digestive Secretions
Pharynx
• Throat
• Connects the mouth to the esophagus
• It has three parts:
• nasopharynx
• oropharynx
• laryngopharynx
Esophagus
• Tube that connects the pharynx to the stomach
• Transports food to the stomach
• Joins stomach at cardiac opening
• Heartburn:
• occurs when gastric juices regurgitate into esophagus
• caused by caffeine, smoking, or eating or drinking in excess
Swallowing
• Voluntary phase:
• bolus (mass of food) formed in mouth and pushed into oropharynx
• Pharyngeal phase:
• swallowing reflex initiated when bolus stimulates receptors in
oropharynx
• Esophageal phase:
• moves food from pharynx to stomach
• Peristalsis:
• wave-like contractions moves food through digestive tract
Events During the Three Phases of Swallowing
Peristalsis
Stomach
• Located in abdomen
• Storage tank for food
• Can hold up to 2 liters of food
• Produces mucus, hydrochloric acid, protein digesting enzymes
• Contains a thick mucus layer that lubricates and protects epithelial cells
on stomach wall form acidic pH (3)
Stomach
• 3 muscular layers:
• outer longitudinal, middle circular, and inner oblique to produce
churning action
• Rugae:
• large folds that allow stomach to stretch
• Chyme:
• paste-like substance that forms when food begins to be broken
down
Anatomy and Histology of the Stomach
Stomach
• Pyloric opening:
• opening between stomach and small intestine
• Pyloric sphincter:
• thick, ring of smooth muscle around pyloric opening
• Hunger pangs:
• stomach is stimulated to contract by low blood glucose levels
usually 12-24 hours after a meal
Regulation of Stomach Secretions

• Parasympathetic stimulation, gastrin, histamine increase stomach
secretions
• Cephalic phase:
• 1st phase
• stomach secretions are initiated by sight, smell, taste, or food
thought

• Gastric phase:
• 2nd phase
• partially digested proteins and distention of stomach promote
secretion

• Intestinal phase:
• 3rd phase
• acidic chyme stimulates neuronal reflexes and secretions of
hormones that inhibit gastric secretions by negative feedback loops
Functions of the Gastrointestinal Hormones
Cephalic Phase of Stomach Control
Gastric Phase of Stomach Control
Intestinal Phase of Stomach Control
Movement in Stomach
• Mixing waves:
• weak contraction
• thoroughly mix food to form chyme
• Peristaltic waves:
• stronger contraction
• force chyme toward and through pyloric sphincter
• Hormonal and neural mechanisms stimulate stomach secretions
• Stomach empties every 4 hours after regular meal, and 6 to 8 hours
after high fatty meal
Movement in the Stomach
Small Intestine
• Measures 6 meters in length
• Major absorptive organ
• Chyme takes 3 to 5 hours to pass through
• Contains enzymes to further breakdown food
• Contains secretions for protection against the acidity of chyme
Parts of Small Intestine

• Duodenum:
• first part
• 25 cm long
• contains absorptive cells, goblet cells, granular cells, endocrine cells
• contains microvilli and many folds
• contains bile and pancreatic ducts
Parts of Small Intestine

• Jejunum:
• second part
• 2.5 meters long and absorbs nutrients
• Ileum:
• third part
• 3.5 meters long
Small Intestine
Mucosa of the Small Intestine

• The mucosa of the small intestine is simple columnar epithelium with
four major cell types.
1. Absorptive cells, which have microvilli, produce digestive enzymes,
and absorb digested food
2. Goblet cells, which produce a protective mucus
3. Granular cells, which may help protect the intestinal epithelium from
bacteria; and
4. Endocrine cells, which produce regulatory hormones.
Mucosa of the Small Intestine

• The epithelial cells are located within tubular glands of the mucosa,
called intestinal glands or crypts of Lieberkühn, at the base of the villi.
• Granular and endocrine cells are located in the bottom of the glands.
• The submucosa of the duodenum contains mucous glands, called
duodenal glands, which open into the base of the intestinal glands.
Secretions of the Small Intestine

• The epithelial cells in the walls of the small intestine have enzymes
bound to their free surfaces.
• Peptidases enzymatically breakdown proteins into amino acids for
absorption.
• Disaccharidases enzymatically breakdown disaccharides into
monosaccharides for absorption.
Anatomy and Histology of the Duodenum
Movement in the Small Intestine

• Mixing and propulsion of chyme are the primary mechanical events
that occur in the small intestine.
• Peristaltic contractions proceed along the length of the intestine for
variable distances and cause the chyme to move along the small
intestine.
• Segmental contractions are propagated for only short distances and
mix intestinal contents.
Movement in the Small Intestine

• The ileocecal sphincter at the juncture of the ileum and the large
intestine remains mildly contracted most of the time.
• Peristaltic contractions reaching the ileocecal sphincter from the small
intestine cause the sphincter to relax and allow chyme to move from
the small intestine into the cecum.
• The ileocecal valve prevents movement from the large intestine back
into the ileum.
Segmental Contractions in the Small Intestine
Liver Anatomy
• Weighs about 3 lbs.
• Located in the right upper quadrant of the abdomen under the
diaphragm
• Consists of right, left, caudate, and quadrate lobes
• Porta:
• gate where blood vessels, ducts, nerves enter and exit
• Receives arterial blood from the hepatic artery
Liver
Liver Anatomy
• Lobules:
• divisions of liver with portal triads at corners
• Portal triad:
• contain hepatic artery, hepatic portal vein, hepatic duct
• Hepatic cords:
• between center margins of each lobule
• separated by hepatic sinusoids
Liver Anatomy
• Hepatic sinusoids:
• contain phagocytic cells that remove foreign particles from blood
• Central vein:
• center of each lobule
• where mixed blood flows towards
• forms hepatic veins
Liver Ducts
• Hepatic duct:
• transport bile out of liver
• Common hepatic duct:
• formed from left and right hepatic duct
• Cystic duct:
• joins common hepatic duct
• from gallbladder
• Common bile duct:
• formed from common hepatic duct and cystic duct
Bile and Pancreatic Secretions
Blood and Bile Flow Through the Liver

Functions of the Liver

• Digestive and excretory functions
• Stores and processes nutrients
• Detoxifies harmful chemicals
• Synthesizes new molecules
• Secretes 700 milliliters of bile each day
• Bile:
• dilutes and neutralizes stomach acid and breaks down fats
Control of Bile Secretion and Release
Pancreas
• Located posterior to stomach in inferior part of left upper quadrant
• Head near midline of body
• Tail extends to left and touches spleen
• Endocrine tissues have pancreatic islets that produce insulin and
glucagon
• Exocrine tissues produce digestive enzymes that travel through ducts
Pancreatic Secretions
• The major protein-digesting enzymes are:
1. Trypsin
2. Chymotrypsin
3. Carboxypeptidase
Pancreatic Secretions
• Pancreatic amylase continues the polysaccharide digestion that began
in the oral cavity.
• The pancreatic enzyme lipase is a lipid-digesting enzyme.
• The pancreatic nuclease enzymes degrade DNA and RNA to their
component nucleotides.
Duodenum and Pancreas
Control of Pancreatic Secretions
Large Intestine
• Function is to absorb water from indigestible food
• Contains cecum, colon, rectum, anal canal
• Cecum:
• joins small intestine at ileocecal junction
• has appendix attached
• Appendix:
• 9 cm structure that is often removed
Large Intestine
• Colon:
• 1.5 meters long
• contains ascending, transverse, descending, sigmoid regions
• Rectum:
• straight tube that begins at sigmoid and ends at anal canal
Large Intestine
• Anal canal:
• last 2 to 3 cm of dig. tract
• Food takes 18-24 hours to pass through
• Feces is product of water, indigestible food, and microbes
• Microbes synthesize vitamin K
Large Intestine
Digestive Process
1. Digestion:
• breakdown of food occurs in stomach and mouth
2. Propulsion:
• moves food through digestive tract includes swallowing and
peristalsis
3. Absorption:
• primarily in duodenum and jejunum of small intestine
4. Defecation:
• elimination of waste in the form of feces
Digestion
Digestion of Carbohydrates, Lipids, and Proteins
Carbohydrate Digestion
• Polysaccharides split into disaccharides by salivary and pancreatic
amylases
• Disaccharides are broken down into monosaccharides by
disaccharidases on the surface of intestinal epithelium
• Glucose is absorbed by cotransport with Na+ into the intestinal
epithelium
• Glucose is carried by the hepatic portal vein to the liver and enters
most cells by facilitated diffusion
Transport of Glucose Across the Intestinal Epithelium
Lipid Digestion
• Lipase breaks down triglycerides into fatty acids and monoglycerides.
• Bile salts surround fatty acids and monoglycerides to form micelles.
• Micelles attach to the plasma membranes of intestinal epithelial cells,
and the fatty acids and monoglycerides pass by simple diffusion into
the intestinal epithelial cells.
Lipid Digestion
• Within the intestinal epithelial cell, the fatty acids and monoglycerides
are converted to triglycerides.
• Proteins coat the triglycerides to form chylomicrons, which move out of
the intestinal epithelial cells by exocytosis.
• The chylomicrons enter the lacteals of the intestinal villi and are
carried through the lymphatic system to the blood.
Transport of Lipids Across the intestinal Epithelium
Lipoproteins
• Lipids are packaged into lipoproteins to allow transport in the lymph
and blood.
• Lipoproteins are molecules that are part water soluble and part lipid
soluble.
• Since lymph and blood contain water and lipids are not water soluble,
lipoproteins are necessary for transport.
• Lipoproteins include chylomicrons, low-density lipoproteins (LDL), and
high-density lipoproteins (HDL).
Lipoproteins
Protein Digestion
• Pepsin is a protein-digesting enzyme secreted by the stomach.
• The pancreas secretes trypsin, chymotrypsin, and carboxypeptidase
into the small intestine in an inactive state.
• In the small intestines these enzymes are activated.
Protein Digestion
• In the small intestine, other enzymes termed peptidases, bound to the
microvilli of the intestinal epithelium further break down small
peptides into tripeptides.
• Absorption of tripeptides, dipeptides, or individual amino acids occurs
through the intestinal epithelial cells by various cotransport
mechanisms.
Transport of Amino Acids Across the Intestinal Epithelium
Water and Minerals

• Water can move across the intestinal wall in either direction
• The movement depends on osmotic pressures
• 99% of water entering intestine is absorbed
• Minerals are actively transported across wall of small intestine
Fluid Volumes in the Digestive Tract
Clinical Impact
Enteric neurons
• Hirschprung disease, also called megacolon, is a painful
developmental disorder caused by the absence of enteric neurons in
the distal large intestine.
• Mutations in the RET gene have been identified in patients with
Hirschprung disease.
• The RET gene encodes a receptor that is normally activated by the
growth factors required for the survival and differentiation of a subset
of enteric neurons.
• The mutations in RET that lead to loss of receptor function result in
loss of enteric neurons, which results in poor intestinal motility and
severe constipation.
Enteric neurons
• Conversely, a different set of mutations in the RET gene is linked to an
inherited cancer called multiple endocrine neoplasia type 2 (MEN2).
• In contrast to the loss of function due to Hirschprung mutations, the
MEN2 mutations cause a gain of RET receptor function, so that it is
active even in the absence of growth factors.
• Hence, two types of mutations in the same gene result in two very
different syndromes.
• Rapid DNA tests are used to screen patients and family members for
suspected Hirschprung and MEN2 mutations.
Dental Diseases
• Dental caries, or tooth decay, is a breakdown of enamel by bacterial
acids on the tooth surface.
• Because the enamel is nonliving and cannot repair itself, a dental
filling is necessary to prevent further damage.
• If the decay reaches the pulp cavity, with its rich supply of nerves, a
toothache may result.
• Sometimes, when decay has reached the pulp cavity, a dentist must
perform a procedure called a root canal, which consists of removing
the pulp from the tooth.
Dental Diseases
• Periodontal disease is the inflammation and degradation of the
periodontal ligaments, gingiva, and alveolar bone. This disease is the
most common cause of tooth loss in adults.
• Gingivitis is an inflammation of the gingiva, often caused by food
deposited in gingival crevices and not promptly removed by brushing
and flossing. Gingivitis may eventually lead to periodontal disease.
• Pyorrhea is a periodontal disease accompanied by pus.
• Halitosis, or bad breath, often occurs with periodontal disease and
pyorrhea.
Peptic Ulcer
• Peptic ulcers are caused when the gastric juices (acid and pepsin)
digest the mucosal lining of the digestive tract.
• Approximately 80% of peptic ulcers occur on the duodenal side of the
pyloric sphincter, but peptic ulcers can also occur in the stomach
(gastric ulcers) or esophagus (esophageal ulcers).
• Nearly all peptic ulcers are due to infection by a specific bacterium,
Helicobacter pylori,which is also linked to gastritis and gastric cancer.
Peptic Ulcer
• Stress, diet, smoking, and alcohol cause excess acid secretion in the
stomach, these lifestyle patterns were deemed responsible for ulcers
for many years.
• Although these factors can contribute to ulcers, it is now clear that
the root cause is H. pylori.
• Antibiotic treatment to eradicate H. pylori is the best therapy for
ulcers.
• A combination of antibiotics and antacids cures 95% of gastric and
74% of duodenal ulcers within 2 months, with less than a 10%
recurrence rate.
Peptic Ulcer
• Most bacteria cannot survive in the stomach. Hence, H. pylori is one
of the most pervasive of human pathogens because it inhabits a niche
without competition.
• It seems likely that both H. pylori infection and conditions that elevate
acid secretion or damage the stomach wall, such as stress or the
excessive ingestion of alcohol or aspirin, contribute to the
development of an ulcer.
Gastroesophageal Reflux
• Gastroesophageal reflux is the reflux of acidic chyme from the stomach into
the esophagus.
• Gastroesophageal reflux is commonly called heartburn because the refluxed
acid causes a painful, burning sensation in the chest. The pain is usually short-
lived but may be confused with the pain of an ulcer or a heart attack.
• The lower esophageal sphincter normally prevents acid reflux. Overeating
(especially fatty and fried foods), lying down immediately after a meal,
consuming too much alcohol or caffeine, smoking, and wearing extremely
tight clothing can all cause gastroesophageal reflux.
• Gastroesophageal reflux commonly occurs in infants, but they usually outgrow
it by their first birthday
• Chronic reflux more than twice a week in infants or adults is more
serious and is called gastroesophageal reflux disease (GERD).
• GERD in young infants can be difficult to diagnose. Women commonly
experience GERD during pregnancy because of increased abdominal
pressure from the fetus and higher levels of the hormone
progesterone, which relaxes the lower esophageal sphincter.
• For most adults, lifestyle changes and medications that decrease
gastric acid secretion are sufficient to relieve the symptoms of GERD.
• Antacids that buffer gastric acid can also alleviate minor discomfort.
• One class of drugs acts by blocking the H2 histamine receptors on
parietal cells. H2 receptors are different from the H1 receptors
involved in allergic reactions.
• Drugs that block allergic reactions do not affect histamine-mediated
stomach acid secretion, and vice versa.
• Cimetidine (Tagamet®) and ranitidine (Zantac®) are histamine
receptor antagonists that prevent histamine from binding to
receptors on parietal cells.
• These chemicals are extremely effective inhibitors of gastric acid
secretion.
• Cimetidine, one of the most commonly prescribed drugs, is also used
to treat gastric acid hypersecretion associated with gastritis and
gastric ulcers.
• The most effective inhibitors of gastric acid secretion are the proton
pump inhibitors, such as omeprazole (Prilosec®) and lansoprazole
(Prevacid®).
• These drugs inhibit the proton pumps on parietal cells, thus
preventing acid secretion into the stomach.
• If not treated, GERD can lead to serious complications, including
esophageal ulcers, scarring that constricts the esophagus, and
esophageal cancer.
Vomiting
• Vomiting is usually a protective mechanism against the ingestion of
toxic or harmful substances.
• Vomiting can result from irritation (e.g., overdistension or
overexcitation) anywhere along the digestive tract.
• Action potentials travel through the vagus nerve and spinal visceral
afferent nerves to the vomiting center in the medulla oblongata.
Hepatitis, Cirrhosis, and Liver Damage

• Hepatitis is an inflammation of the liver that can be caused by alcohol
consumption or a viral infection.
• Hepatitis A, also called infectious hepatitis.
• Hepatitis B, also called serum hepatitis, is a more chronic infection.
• Hepatitis C, also called non-A and non-B hepatitis. Hepatitis C is
caused by one or more virus types that cannot be identified in blood
tests, and it is spread by blood transfusions or sexual intercourse.
• If hepatitis is not treated, liver cells die and are replaced by scar
tissue, resulting in loss of liver function. Liver failure and death can
occur.

• Cirrhosis of the liver involves the death of hepatocytes and their
replacement by fibrous connective tissue.
• The liver becomes pale in color (the term cirrhosis means a tawny or
orange condition) because of the presence of excess white connective
tissue. It also becomes firmer, and the surface becomes nodular.
• The buildup of connective tissue can impede blood flow through the liver.
The loss of hepatocytes eliminates the function of the liver, often resulting
in jaundice, in which the skin and eyes appear yellowish due to buildup of
bile pigments in the blood and interstitial fluid.
• Cirrhosis develops in many alcoholics and may result from biliary
obstruction, hepatitis, or nutritional deficiencies.

• Under most conditions, mature hepatocytes can proliferate and replace
lost parts of the liver. However, if the liver is severely damaged, the
hepatocytes may not have enough regenerative power to replace the lost
parts. In this case, a liver transplant may be necessary.
• The liver also maintains an undifferentiated stem cell population, called
“oval” cells, which gives rise to two cell lines, one forming bile duct
epithelium and one producing hepatocytes.
• Researchers hope that these stem cells can one day be used to reconstitute
a severely damaged liver. It may even become possible to remove stem
cells from a person with hemophilia, genetically engineer the cells to
produce the missing clotting factors, and then reintroduce the altered stem
cells into the person’s liver
Appendicitis
• Appendicitis is an inflammation of the vermiform appendix that
usually occurs because of an obstruction of the appendix.
• Secretions from the appendix cannot pass the obstruction and
accumulate, resulting in enlargement and pain. Bacteria in the area
can cause infection of the appendix.
• Symptoms include sudden abdominal pain, particularly in the right-
lower portion of the abdomen; slight fever; loss of appetite;
constipation or diarrhea; nausea; and vomiting.
Appendicitis
• In the right-lower quadrant of the abdomen, about one-third the
distance along a line from the right anterior superior iliac spine to the
umbilicus, is an area called the McBurney point.
• This area of the body surface becomes very tender in patients with
acute appendicitis because of pain referred from the inflamed
appendix.
• The usual treatment is surgical removal of the appendix, called an
appendectomy.
• If the appendix bursts, the infection can spread throughout the
peritoneal cavity, causing peritonitis, with life-threatening results.
Lactose Intolerance
• Lactose intolerance is the inability to digest the lactose in milk and
other dairy products.
• Adults in most of the world are lactose intolerant, although infants
are not. Adults lack the enzyme lactase.
• Lactase, present on the surface of absorptive cells in the intestinal
mucosa, digests the disaccharide lactose down to two
monosaccharides.
• Lactase is made at birth but is no longer synthesized after about age
6, therefore, these people can no longer digest lactose.
Lactose Intolerance
• The main symptom of lactose intolerance is diarrhea due to fluid loss
as water follows lactose through the digestive tract.
• In addition, a considerable amount of gas is generated from lactose
metabolism by bacteria in the large intestine.
• Even though these colonic bacteria metabolize lactose to
monosaccharides, it is too late for the monosaccharides to be
absorbed.
• The best treatment is simply to avoid foods containing lactose.
Rehydration
• An effective rehydration strategy for both situations is to drink water
containing sodium and glucose.
• As sodium and glucose are absorbed by symport across the intestinal
epithelium, water follows by osmosis.
• As an added value, this strategy also replaces ions and provides an
immediate energy source
Rehydration
• Most sports drinks contain sodium and glucose, which efficiently
rehydrate the athlete.
• The same principle is used in oral rehydration therapy for severe
diarrhea.
• The World Health Organization estimates that millions of people in
third world countries die every year from severe diarrhea caused by
intestinal infections.
Rehydration
• Drinking a sodium and glucose solution is often sufficient to prevent
dehydration until the infection clears.
• Since oral rehydration therapy was adopted as a main strategy for
treating diarrhea, the annual number of deaths of children under 5
dropped worldwide from over 4 million in 1980 to about 1.5 million in
2000.
• Unfortunately, this simple, cheap treatment and the clean water it
requires are unavailable in many areas of exploding populations and
poor sanitary conditions.
Cystic Fibrosis
• Cystic fibrosis is a hereditary disorder; it is the most common lethal
genetic disorder among Caucasians.
• The most critical effects of the disease, accounting for 90% of the
deaths, are on the respiratory system. Several other problems occur,
however, in affected people.
• Because the disease is a disorder in a Cl− transport channel protein—
which affects chloride transport and, as a result, the movement of
water—all exocrine glands are affected.
Cystic Fibrosis
• The buildup of thick mucus in the pancreatic and hepatic ducts causes
blockage of the ducts, so that bile salts and pancreatic digestive
enzymes are prevented from reaching the duodenum.
• As a result, digestion is reduced, and fat-soluble vitamins are poorly
absorbed due to the lack of bile to form micelles.
• The person suffers from vitamin A, D, E, and K deficiencies, which
result in conditions such as night blindness, skin disorders, rickets,
and excessive bleeding.
• Therapy includes administering the missing vitamins to the person
and reducing dietary fat intake.
Systems Pathology
Diarrhea
Diarrhea
• Diarrhea is one of the most common complaints in clinical medicine.
• Diarrhea affects more than half the tourists in developing countries,
where it may result from eating food to which the digestive tract is
not accustomed or from ingesting food or water contaminated with
microorganisms.
• Diarrhea is any change in bowel habits involving increased stool
frequency or fluidity. It is not a disease in itself, but it can be a
symptom of a wide variety of disorders.
• Diarrhea that lasts less than 2–3 weeks is acute diarrhea; diarrhea
lasting longer is considered chronic.
Diarrhea
• Acute diarrhea is usually self-limiting, but some forms of diarrhea can
be fatal if not treated.
• Diarrhea results from either a decrease in fluid absorption in the
intestine or an increase in fluid secretion.
• It can also be caused by increased bowel motor activity that moves
chyme rapidly through the small intestine, so that more water enters
the colon.
• Normally, about 600 mL of fluid enter the colon each day, and all but
150 mL are reabsorbed. The loss of more than 200 mL of fluid per day
in the stool is considered abnormal.
Diarrhea
• Mucus secretion by the colon increases dramatically in response to
diarrhea.
• This mucus contains large quantities of bicarbonate ions, which come
from dissociation of carbonic acid into bicarbonate ions and hydrogen
ions within the blood supply to the colon.
• The bicarbonate ions enter the mucus secreted by the colon, whereas
the hydrogen ions remain in the circulation; as a result, the blood pH
decreases.
• Thus, a condition called metabolic acidosis can develop.
Diarrhea
• Diarrhea is usually caused by bacteria, viruses, amoebic parasites, or
chemical toxins.
• Symptoms can begin from as little as 1–2 hours after bacterial toxins
are ingested to as long as 24 hours or more for some strains of
bacteria.
• Nearly any bacterial species is capable of causing diarrhea. Some
types of bacterial diarrhea are associated with severe vomiting,
whereas others are not. Some bacterial toxins also induce fever.
• Identifying the causal organism usually requires laboratory analysis of
the food or stool but, in cases of acute diarrhea, the infectious agent
is seldom identified.
Diarrhea
• Treatment of diarrhea involves replacing lost fluids and ions. The diet
should be limited to clear fluids during at least the first day or so.
• Medicines that may help combat diarrhea include bismuth
subsalicylate, which increases mucus and HCO3− secretion and
decreases pepsin activity, and loperamide, which slows intestinal
motility.
• Patients should avoid milk and milk products. Breads, rice, and baked
fish or chicken can be added to the diet as the person’s condition
improves. A normal diet can be resumed after 2–3 days.
Diarrhea
Representative Diseases and Disorders: Digestive System
THANK YOU!
• REFERENCES:
• Seeley’s Essentials of Anatomy and Physiology 10th Edition By Cinnamon
VanPutte and Jennifer Regan and Andrew Russo, 2019
• Seeley’s Laboratory Manual Essentials of Anatomy & Physiology 8th Edition By
Kevin Patton

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Evolve.

MARK MAGBUHOS, RMT

Digestion and the Digestive System

Digestive System Functions

Digestive Tract Components

Layers of Digestive Tract Wall

Layers of Digestive Tract Wall

Regulation of Stomach Secretions

Regulation of Stomach Secretions

Regulation of Stomach Secretions

Parts of Small Intestine

Parts of Small Intestine

Mucosa of the Small Intestine

Mucosa of the Small Intestine

Secretions of the Small Intestine

Movement in the Small Intestine

Movement in the Small Intestine

Blood and Bile Flow Through the Liver

Functions of the Liver

Water and Minerals

Hepatitis, Cirrhosis, and Liver Damage

Hepatitis, Cirrhosis, and Liver Damage

Hepatitis, Cirrhosis, and Liver Damage

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