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Chapter 3

Digestive/ Gastrointestinal System

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Introduction

The digestive system also called the alimentary canal or gastrointestinal tract is a
series of hollow organs joined in a long, twisting tube from the mouth to the anus.

FUNCTIONS: The functions of the digestive system are three folds.

Digestion:The process of mechanical and chemical breakdown of

the complex food material into simpler substances.

Absorption: The process of absorbing valuable nutrients into blood

stream by passing through the walls of the small intestine.

Elimination:This is the process of eliminating the unabsorbed solid

waste materials (feces) from the GI tract through the anus.
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PARTS OF THE DIGESTIVE SYSTEM:

The alimentary canal begins with an oval-shaped oral

cavity or mouth. In the oral cavity there are many
structures, some of which are:

uvula
tongue (Combining form: gloss/o or lingu/o)
tonsils

2 functions:
● Mastication: chewing
● Deglutition: swallowing

If there is an infection in the oral cavity, the uvula may

or may not be involved.
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Pharynx:
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The pharynx or throat is a muscular tube, about 5 inches long, lined with a
mucous membrane that serves as a common passageway for air traveling
from the nose and the food traveling from the oral cavity.

A flap of cartilage called epiglottis prevents the entry of food into the trachea
(respiratory tract).

The pharynx has 3 structures/ openings:

● Nasopharynx
● Oropharynx
● Laryngopharynx
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Esophagus

Esophagus is a 9-10 inch muscular tube extending from the pharynx to

the stomach. Rhythmic contractions of the muscles in the wall of the
esophagus propels food toward the stomach (peristalsis).

Peristalsis: Rhythmic
alternate contraction
and relaxation of the
muscles which propel
the food in a forward.
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Stomach

Food passes from the esophagus into the stomach.

Rings of muscles called sphincters control the openings into and from the
stomach. The cardiac sphincters or lower esophageal sphincters (LES)
allows food into the stomach, whereas the pyloric sphincter keeps the food
until it has been sufficiently digested, then opens to allow it into the small
intestine.

The stomach contains digestive glands that produce hydrochloric acid. In the
stomach, the food is mechanically and chemically broken down for further
digestion and absorption in the bloodstream. Food leaves the stomach in 1-4
hours or longer, depending upon the amount and type of food eaten.
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Small Intestine (Small Bowel)

The small intestine extends from the pyloric sphincter to the first part
of the large intestine. It has 3 parts:
● duodenum
● jejunum
● ileum
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Large Intestine (Large Bowel)

Large intestine extends from the ileum to anus. The primary function of
the large intestine is to remove the undigested and unabsorbed food of
the small intestine to produce the waste product- feces or stool. It is
divided into:
● Cecum
● The appendix
● Ascending Colon
● Transverse colon
● Descending colon
● Sigmoid Colon
● Rectum, Anus/Anal canal

Note: Difference between Rectum and Anus: The anus is the opening
at the end of the digestive tract where stool leaves the body. The rectum
is the section of the digestive tract above the anus where stool is held
before it passes out of the body through the anus.
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OTHER ORGANS THAT HELP IN DIGESTION:

Liver (1): The liver is situated in the right upper quadrant

(RUQ). It produces a thick, yellowish-greenish fluid called
bile, which helps in digestion. After secretion the bile
travels to the (2) gallbladder (Combining form-
cholecyst/o) where it is stored for later use.

The bile contains a pigment called bilirubin. When the

liver is inflamed (Hepatitis) the amount of bilirubin in the
body increases causing the skin to become yellow-
Jaundice.
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(3) Pancreas: produces pancreatic juice, which is a mixture of amylase

(enzyme to digest carbohydrates), lipase (enzyme to digest fats), and
protease (enzyme to digest proteins). As an endocrine gland, it produces
insulin and glucagon both of which maintain the blood-glucose level in
the body.
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When a patient comes to the doctor, whatever problems or

complaints they say in their own language, are called
SYMPTOMS.

Symptoms related to the digestive system:

1. Abdominal pain: If the patient says “stomach pain” we MUST
substitute it for ABDOMINAL PAIN
2. Anorexia: Lack of appetite
3. Bloated: Abdominal distention with gas
3. Constipation: Difficult delayed elimination of feces.
4. Diarrhea: Loose, watery stools.
5. Dyspepsia : Difficulty digesting food.
6. Dysphagia: Difficult painful swallowing.
7. Flatus: Gas expelled through the anus.
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8. Heartburn: Burning sensation caused by the regurgitation of hydrochloric

acid from the stomach into the esophagus leading to its inflammation
(esophagitis). Also known as Gastroesophageal reflux disease (GERD)
9. Hematochezia: Bright red blood per rectum.
10. Jaundice: Yellow discoloration of the skin and mucous membrane
due to high levels of bilirubin in the blood.
11. Melena: Black, brown, tarry stools as a result of altered blood in stools.
12. Nausea: Unpleasant sensation prior to vomiting.
13. Hematemesis: Vomiting out the blood (emesis: vomiting)
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N.B: Important differences

1. Dysphagia vs Dysphasia: Dysphagia is defined as difficulty swallowing

any liquid (including saliva) or solid material. Dysphasia is defined as
speech disorders in which there is impairment of the power of expression by
speech, writing, or signs or impairment of the power of comprehension of
spoken or written language.

2. Reflux vs Reflex: the difference between reflux and reflex is that reflux is
the backwards flow of any fluid while reflex is an action that is performed as
a response to a stimulus and without conscious thought.
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PHYSICAL EXAMINATION (PE):

After the patient has described all their symptoms and stated the symptoms denied,
the doctor will then examine the patient. There are four steps to examination of any
system:

1. Inspection: The doctor LOOKS at the area for any abnormalities such as
swelling, discoloration, scars, etc.
2. Palpation: The doctor TOUCHES the patient to validate the inspection. Feels for
any swelling, mass, increase in organ size or shape.
3. Percussion: The doctor “TAPS” the patient to determine the consistency of the
abnormality. (Tapping on a hollow object has a different sound versus one filled
with fluid)
4. Auscultation: The doctor places a stethoscope to LISTEN for any sounds, both
normal and abnormal.
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Physical Examination (PE):

The abdomen lies in the abdominal cavity and is surrounded by a

membrane called peritoneum.
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PHYSICAL EXAMINATION (PE):

Whatever the doctor finds on any step of examination, is called a SIGN or a

FINDING.

In order to understand the location of organs, masses and pain, the abdomen is divided
into four quadrants, the right upper quadrant (RUQ), the right lower quadrant (RLQ), the
left upper quadrant (LUQ) and the left lower quadrant (LLQ).

For the Digestive System, the following Findings or Signs may be found:

● On Inspection: The patient is observed for the shape of the abdomen, any
discoloration, the shape of the umbilicus, etc.
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On palpation, we mostly see:

● Tenderness
● Mass
● Organomegaly (hepatomegaly, splenomegaly etc)

N.B. (Very important)

❖ What is tenderness: In medicine, tenderness is pain or discomfort when

an affected area is touched.

❖ Pain is a SYMPTOM that the patient complains of. When the doctor
examines the patient he finds TENDERNESS, meaning the patient is
sensitive (tender) to touch. Therefore tenderness is the SIGN or
FINDING for pain.
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Some tests or signs are elicited during palpation. If found

positive it may be indicative or certain diagnoses:

● Murphy’s sign: Found positive in acute cholecystitis.

● McBurney’s Point: Found positive in acute appendicitis
● Rebound tenderness: Indicative of acute appendicitis or
acute intestinal obstruction.
● Muscle Guarding/ Rigidity- When the muscles of the
abdomen experience severe pain for a prolonged period of
time, they contract to become hard.
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● On Percussion- to check if there is any fluid/ edema in the

abdomen.
● On Auscultation: To listen to the bowel sounds
❏ normal
❏ Hyperactive (in diarrhea)
❏ Hypoactive (in constipation)

● Rectal Exam: To evaluate rectum, prostate, and pelvic structures.

To obtain a specimen for Guaiac Test.
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After the patients symptoms have been discussed and physical examination by the
doctor has revealed corresponding signs, the doctor then makes a diagnosis:

1. Peptic Ulcer Disease- Formation of ulcers in the stomach.

2. Cholelithiasis: Stone in the gallbladder.
3. Irritable Bowel Syndrome(IBS): Syndrome means a group of symptoms. Here the patient has
diarrhea alternating with constipation, lower abdominal pain and bloating.

4. Inflammatory bowel disease(IBD) is a term for two conditions (Crohn's disease and
ulcerative colitis) that are characterized by chronic inflammation of the gastrointestinal tract.

● Crohn’s Disease

● Ulcerative colitis: (Please break down the word into its component parts and try to understand
the meaning.)
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5. Hernia: Abnormal protrusion of an organ through

its surrounding wall. There can be different types of
Hernias: Hiatal Hernia, Umbilical Hernia, etc

6. Hemorrhoids: Swollen veins in the rectal region

also known as piles, can be internal or external caused
by chronic constipation and straining.

7. Hepatitis: Inflammation of the liver commonly by

viruses such as HBV, HBD, HBC, HBA, HBE.

8. Cirrhosis of the liver: Chronic liver disease

9. Gastroenteritis- Inflammation of the stomach and

small intestine, commonly known as “upset stomach”

10. Gastroesophageal Reflux Disease (GERD): The

stomach contents flow backward into the esophagus.
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To confirm the diagnosis, the doctor may order some laboratory

investigations or test:

LABORATORY TESTS/
Investigations:

● Liver Function Tests:

○ ALT (alanine transaminase), AST(aspartate aminotransferase),
and ALP Enzyme levels are elevated when there is damage to
liver cells
○ Serum Bilirubin High levels of bilirubin in the blood produce a
jaundiced condition in the patient.
● Stool Culture Feces are placed in the growth medium to test for
abnormal microorganisms.
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● Stool guaiac or Hemoccult This is a test to determine the presence of

hidden blood in the feces which is an important screening test for colon
cancer.
● CT (CAT) scan of the abdomen Computed tomography (computed axial
tomography). Series of x-rays are taken to see an organ in depth.
● Abdominal ultrasonography Sound waves are beamed into the
abdomen, and a record is made of the echoes as they bounce off the
abdominal viscera.
1. Gastrointestinal endoscopy A fiber-optic tube is placed through the
mouth or anus to visualize parts of the gastrointestinal tract.
Examples:
i. esophagogastroduodenoscopy(EGD)/ Endoscopy
ii. colonoscopy
iii. sigmoidoscopy
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ABBREVIATIONS

ALT, AST: Alanine transaminase, aspartate aminotransferase.

BM: Bowel movement.

CT Scan Computed tomography (computed axial tomography)

EGD: Esophagogastroduodenoscopy.

GI: Gastrointestinal

IBD: Inflammatory bowel disease

FBS: Fasting blood sugar

GERD: Gastroesophageal Reflux Disease

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Medication List for GI Diseases: Anti-ulcerants

Generic Brand

esomeprazole Nexium
rabeprazole Aciphex
pantoprazole Protonix

calcium carbonate (Entacid) Tums

Medication List for GI Diseases: Anti-emetics

Generic Brand

ondansetron Zofran
domperidone
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Vocabulary

● Ascites: Accumulation of fluid/ edema (ascitic fluid) inside the

abdominal cavity.
● Amylase: Enzyme secreted by the pancreas to digest carbohydrates
● Anus: Opening of the digestive tract to the outside of the body.
● Appendix: Blind pouch hanging from the first part of the colon
(cecum).
● Bariatric surgery: Surgery on the stomach and/or intestines to help a
person with extreme obesity to lose weight.
● Bile: Digestive juice made in the liver and stored in the gallbladder. It
physically breaks up (emulsifies) large fat globules. It is composed of
bile pigments, cholesterol, and bile salts.
● Bilirubin: Pigment released by the liver in bile; produced from the
destruction of hemoglobin, a blood protein (globin). In the intestine,
bilirubin is degraded by bacteria to a variety of pigments that give stool
(feces) its brown color.
● Bowel: intestine.
● Cecum: First part of the large intestine.
● Colon: Large intestine
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● Defecation: Expulsion or passage of feces from the body through

the anus.
● Deglutition: Swallowing.
● Digestion: Breakdown of complex foods to simpler forms.
● Duodenum: First part of the small intestine.
● Enzyme: A chemical that speeds up a reaction between substances.
Digestive enzymes help in the breakdown of complex food to simpler
foods.
● Esophagus: Tube connecting the throat to the stomach.
● Feces: Solid wastes; stools.
● Gallbladder: Small sac under the liver; stores bile.
● Glucose: Simple sugar.
● Glycogen: Starch; glucose is stored in the form of glycogen in
liver cells.
● Uvula: Soft tissue hanging from the soft palate into the mouth
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● Hydrochloric acid: Substance produced by the stomach;

necessary for the digestion of food.
● Ileum: Third part of the small intestine.
● Insulin: Hormone produced by the endocrine cells of the
pancreas. It transports sugar into cells from the blood and
stimulates glycogen formation by the liver.
● Jejunum: Second part of the small intestine.
● Lipase: Pancreatic enzyme necessary to digest fats.
● Liver: A large organ located in the RUQ of the abdomen. The liver
secretes bile; stores sugar, iron, and vitamins; produces blood protein,
and destroys worn-out red blood cells.
● Lower esophageal sphincter: Ring of muscles between the
esophagus and
the stomach. Also called cardiac sphincter.
● Mastication: Chewing.
● Palate: Roof of the mouth. The hard palate is anterior to the soft
palate.
● Laparoscopy: The process of visual examination of the
abdominal cavity.
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● Pancreas: Organ under the stomach; produces insulin (for the transport
of sugar into cells) and enzymes (for digestion of foods)
● Pharynx: Throat, the common passageway for food from the mouth
and air from the nose.
● Polyp: Small growths that protrude from the mucous membrane. Eg.
Gastric and Intestinal polyps.
● Pyloric sphincter: Ring of muscle at the distal region of the stomach,
where it joins the duodenum.
● Rectum: Last section of the colon.
● Saliva: Digestive juice produced by salivary glands.
● Sigmoid Colon: Lower part of the colon; shaped like an S.
● Sphincter: Ring of muscles within a tube.
● Stomach: Muscular organ that received food from the
esophagus. It is divided into the fundus, body, antrum (distal
portion).
● Cholecystitis: Inflammation of the gallbladder
Thank you