13th -Continuing Nursing Education

DEPARTMENT OF MEDICAL SURICAL NURSIN

Th!"!#$Dig!sti%! dis!&u'i(iriu"-Nurs!s conc!rn$
Anato") and Ph)sio'og) o* U++!r Dig!sti%! s)st!"

Mrs,-,-a%itha,.M,Sc /N0
L!ctur!r
Facu't) o* Nursing
Sri Ra"achandra Uni%!rsit)
Dat!#12,34,15
Introduction


A'i"!ntar) cana'.also
calleddig!sti%! tract,

"outh.

+har)n6.

o!so+hagus

sto"ach

s"a'' int!stin!.

'arg! int!stin!. and

anus

Activities of the Digestive System
Overview of the Digestive System

Dig!sti%! s)st!" organs
*a'' into t7o "ain grou+s#

Th! a'i"!ntar) cana' or th!

gastroint!stina' /I0 tract.

Acc!ssor) dig!sti%! organs

th! t!!th.

tongu!.

ga''('add!r.

sa'i%ar) g'ands.

'i%!r. and

+ancr!as,
Secretions of the GI system
Normal GIT-pH
Layers of the alimentary canal
1,Mucosaisthe inn!r"ost. "oist. !+ith!'ia'
"!"(ran! that 'in!s th! !ntir! dig!sti%! tract, It

secretesmucus,digestiveenzymes,andhormones;

absorbsdigestiveendproductsintotheblood;and

protectsagainstinfectiousdisease.


1,Su("ucosa
connectivetissuelayercontaining('ood and ')"+hatic %!ss!'s. ')"+hoid *o''ic'!s. and n!r%!
*i(!rs,
ContainsthesubmucosalnerveplexusofMeissner,
regulatesglandsandmuscleofthemuscularismucosae
.
3,Muscu'aris !6t!rna
Smoothmuscle
peristalsisandsegmentation.
controlsmotilityoftheG.I.tract.
5,S!rosa,
theprotectiveouterlayerof
theintraperitonealorgans,

N!r%! su++') to th! a'i"!ntr) cana'

PARAS8MPAT9ETIC SUPPL8

VAGS N!"V!--ALI#!NTA"$ %ANAL

SA%"AL N!"V!-DISTAL &A"T '( TH! GI

T"A%T
EFFECTS OF

IN%"!AS!D #S%LA" A%TIVIT$

IN%"!AS!D &!"ISTALSIS

IN%"!AS!D A%TIVIT$ '( #$!NT!"I%

&L!)S

IN%"!AS!D GLANDLA" S!%"!TI'N

S8MPAT9ETIC SUPPL8

N#!"'S N!"V! THAT !#!"G!

("'# TH! S&INAL %'"D IN TH!
TH'"A%I% AND L#*A"
"!GI'NS

!!C"S#!

DECREASE #S%LA" A%TIVIT$

D!%"!AS! &!"ISTALSIS

L!SS STI#LATI'N '(

#$!NT!"I% &L!)S

IN%"!AS!D GLANDLA"
S!%"!TI'N
Anatomy of the Digestive System
$ Mouth
Th! 'i+s and ch!!:s

coreofs%eletalmusclecoveredexternallybys%in

helpsto%eepfoodbet&eentheteeth&hen&eche&

playsasmallroleinspeech.
Th! +a'at!

thehardpalateanteriorly

thesoftpalateposteriorly.
Mouth
$
Th! "outh -stratifieds'uamousepithelial
mucosa(linedcavity
#ralCavity)oundedby
$
'i+s ant!rior').
$
Oro+har)n6 +ost!rior')
$
Lat!ra'')muscles
ofthech!!:s
$
Su+!rior')bony
hardpalateand
muscularsoftpalate
Lips + %hee,s and Tongue

Li+s #Importantinmastication
andspeech

Ch!!:s#!acialmusclesactto
movelips

U%u'a#pro*ectsfromposterior
ofsoftpalate+alatinetonsils,
lateral&allsoffauces

Tongu!#-oluntarymuscular
structurethatoccupiesthe
floorofthemouth.
Tongue-*lood and nerve supply
;'ood su++'),xternalcarotid
artery
NER<E SUPPL8

"hehypoglossalnerve

.thC/(somatic
sensation,i.e.pain,tempand
touch

!acialandglossopharyngeal
nerves01th23th4,thenerves
oftaste
Functions o* th! tongu!

che&ing0mastication4

s&allo&ing
0deglutition4

speech

taste
Th! t!!th t!ar and grind *ood. (r!a:ing it
into s"a''!r +i!c!s,
T!!th T7o s!ts

Pri"ar),deciduous,
mil%,5ostduring
childhood

P!r"an!nt or
s!condar)#6dult0784
"ypes9Incisors,
canines,premolars
andmolars
Functions o* th! t!!th

"eethInvolvedinmastication
andspeech

"eethhavedifferentshapes
dependingontheirfunctions.

Incisorsandcanineteethare
thecuttingteeth(usedfor
bitingoffpiecesoffood,

+remolarandmolar
teeth,&ithbroad,flatsurfaces,
areusedforgrindingor
che&ing
Sa'i%ar) g'ands-
structur!

producesaliva,

cleansesthe
mouth,

dissolvesfood
chemicalsfortaste,

moistensfood,and

brea%do&nof
starches.
Sa'i%ar) g'ands
$
;'ood su++')

xternalcarotidarteries

-enousdrainageisintotheexternal
*ugularveins
$
Intrinsic(buccal
$
E6trinsic(parotid,submandibular,
sublingual
Co"+osition o* sa'i%a
$
:(:..litresof
saliva;daily
$
&ater(33..<
$
Mineralsalts=..<
0/a>,%>,cl>4
$
salivaryenzymes
$
mucus
$
lysozomes0bacterolyti
c4
$
Immunoglobulins6
$
)loodclottingfactors
S!cr!tion o* sa'i%a
$
6utonomicnervecontrol
$
+Sstimulation(profuse
secretionof&atery
saliva
$
Sympatheticstimulation(
secretionofsmall
amountofsaliva
$
!romsubmandibular
glands
Sa'i%ar) 'ands
1,-&arotid. largest- Serous- /ust
anterior to the ear- &arotid
duct enters the oral cavity
ad0acent to the 1 nd upper
molar
1-Su2mandi2ular. mi3ed+ 2ut
more serous than mucous-
Duct enters oral cavity on
either side of lingual frenulum
4-Su2lingual. smallest- #i3ed+
2ut primarily mucous- !ach
has 56- 51 ducts that enter the
floor of the oral cavity- Lingual
glands-
Functions o* th! sa'i%ar)
g'and

+roducesaliva

+reventsbacterialinfection

5ubrication

Containssalivaryamylasethatbrea%s
do&nstarchintodisaccharides,maltose
andisomaltose0givesstarchs&eettaste
inmouth4.

?elpstoformbolusfors&allo&ing

+arasympatheticinputcausessalivary
production
Phar)n6
&haryn3

oro+har)n6 and
'ar)ngo+har)n6

Passag! 7a) *or *ood.

*'uids. and air,
;'ood su++')

Facia' art!ri!s

<!nous drainag! into th!

*acia' %!in and th! int!rna'
=ugu'ar %!ins,
N!r%! su++')

PS> S)"+ath!tic-
Phar)ng!a' n!r%!

PS-'osso+harng!a' >
%agus n!r%!
Structur! o* th! O!so+hagus $
:=incheslong
$
pharynxtothestomach.
$
@oinsthepharynxatthe
sixthcervicalvertebraand
$
Aiaphragmatthetenth
thoracicvertebra.
$
+aralleltothe
larynx;trachea,
$
6rchoftheaortacross
thefrontofthe
oesophagusand
$
#esophagusentersthe
stomach.
Functions o* th! o!so+hagus
$
)olusoffoodcantravel
do&ntothestomach.
$
Bavesofcontractions
called+!rista'sis,

$
Smallamountof
secretioninthe
oesophagus,butits
basicallyallaboutmoving
stufftothestomach.
Art!ria' and <!nous su++')-
o!so+hagus
N!r%ous Su++')
$
Sympatheticandparasympatheticefferentand
afferentfibresviathevagiandsympathetic
trun%s.
$
6tthelo&erend(oesophagealnerveplexus.
L)"+h
$
Cpperthird,thedeepcervicalnodes
$
Middlethird(thesuperiorandposterior
mediastinalnodes,and
$
5o&erthird(celiacnodes.
S7allo7ing 8Deglutition9. Three phases
Sto"ach Anato") O+!nings
$
astro!so+hag!a'
0cardiac4,toesophagus
$
P)'oric,toduodenum
$
Parts9Cardiac9!undus
9)ody9+yloric,antrum
andcanal
$
r!at!r and '!ss!r
cur%atur!s# attachment
sitesforomenta
$
S+hinct!rs9Cardiac
0lo&eresophageal49
+yloric
?a''s o* th! Sto"ach
$
La)!rs9Serosaor
visceralperitoneum
$
Muscu'aris,threelayers
#uterlongitudinal,
Middlecircular,2Inner
obli'ue
$
Su("ucosa9Mucosa
Dugae,foldsinstomach
&henempty.Mucosa
andsubmucosa.
Functions o* th! sto"ach
$
T!"+orar) storag!
$
Ch!"ica' dig!stion
$
M!chanica' (r!a:do7nand +roduction o* ch)"!
$
A(sor+tion o* 7at!r,a'coho' and so"! *at-so'u('!
drugs
$
Non-s+!ci*ic d!*!ns!againstmicrobes
$
Pr!+aration o* ion fordigestionfurtheralongthetract
$
+roductionofintrinsicfactorneededfora(sor+tion o*
%ita"in ;11 in th! t!r"ina' i'!u"
$
Degulationofthe+assag! o* gastric cont!nts into
th! duod!nu"
astric =uic!
$ 6bout8litresofgastric
*uice;daily
$ Itconsistsof,

&ater2mineralsalts(secreted
bygastricglands

mucussecretedbymucous
cells

?C5andintrinsicfactor
(secretedbyparietalcells

inactiveenzymes
precursors,pepsinogens
secretedbychiefcellsinthe
gland
Functions o* th! gastric =uic!
$
Baterfurtherli'uefiesthefoods&allo&ed
$
?C5(acidifiesthefood,%illsingested
microbes2digestionofpepsin
$
+epsinogensareactivatedtopepsinby?C5
$
Intrinsicfactor(absorptionof-it):8from
theileum
$
Mucuspreventsmechanicalin*urytothe
stomach&all.
S!cr!tion o* gastric =uic!
"herearethreephasesofsecretionofgastric*uice;
1,C!+ha'ic Phas!
1,astric Phas!
3, Int!stina' Phas!
S"a'' Int!stin!
$
Siteofgreatestamountof
digestionandabsorption
ofnutrientsand&ater
Parts o* th! s"a''
int!stin!

Auodenum(first8.cm
beyondthe
pyloricsphincter.

@e*unum(8..m

Ileum(7..m.
+eyerspatchesorlymph
nodules
structur! o* th! s"a'' int!stin!

$ Duod!nu". =!=unu". and i'!u",

$ 6pproximatelyEminlength,
$ Fro" th! +)'oric s+hinct!r o*
th! sto"ach to th! i'!o-ca!ca'
%a'%!separatingtheileumfrom
thecaecum.
$ Duod!nu"istheproximalC(
shapedsectionthatcurvesaround
theheadofthepancreas.
C#/"I/...
$
Duod!nu"servesamixingfunctionasit
combinesdigestivesecretionsfromthe
pancreasandliver&iththecontentsexpelled
fromthestomach.

$
@!=unu" &herethema*orityofdigestionand
absorptionoccurs.
$
Th! i'!u". isthelongestsegmentandempties
intothecaecumattheileocaecal*unction.
Function o* th! s"a'' int!stin!
$ P!rista'sisisincreasedby
parasympatheticstimulation
$ S!cr!tion o* int!stina'
=uic!,increasedby
parasympatheticstimulation
$ Dig!stion o* C9O.+roti!n >*at
$ Prot!ction aganist in*!ction ()
"icro(!s
$ S!cr!tion o* th! hor"on!s
cho'!c)sto:inin/CC-0 and
s!cr!tin
$ A(sor+tion o* nutriti!nts
Ch!"ica' dig!stion - s"a''
int!stin!
Bhenacidch)"!
passesintothesmall
intestineitismixed&ith
+ancr!atic =uic! .(i'!
andint!stina' =uic!.and
isincontact&iththe
enterocytesofthevilli.

C?#arebro%endo&nto
monoaccharides

+roteinsarebro%endo&n
toaminoacids

!atsarebro%endo&nto
fattyacidsandglycerol
Pancr!atic =uic!
$
Secretedbyexocrine
pancreas
$
nterstheduodenum
$
Itconsistsof,

7at!r.

"in!ra' sa'ts .

!nA)"!s
/a")'as!.'i+as!>nuc'!as
!s0

inacti%! !nA)"!s
/tr)+sinog!n.ch)"otr)+si
nog!n0

+ancreatic*uiceisa
al%alinep?F
Functions o* th! +ancr!atic =uic!
1,Dig!stion o* +roti!ns

Tr)+sinog!n and ch)"otr)+sinog!n (

polypeptidestotripeptides,dipeptidesand
aminoacids
8.Dig!stion o* C9O

Pancr!atic a")'as!-polysaccharidesto
disaccharides
7.Dig!stion o* *ats

5ipaseconvertsfatstofattyacids
;i'!
$
;i'!.issecretedbythe'i%!r
$
Itpassesfromthehepatic
ducttothegallbladder
$
)ilehasa+9 o* around B
$
233-1333"'aresecreted
daily.
$
Itconsistsof,
7at!r."in!ra'
sa'ts."ucus.(i'! sa'ts.(i'!
+ig"!nts/(i'iru(in0.cho'!st
!ro'
Functions o* ;i'! Sa'ts
$
E"u'si*) *ats inthesmallintestine
$
Fat-so'u('! %ita"ins-r!adi') a(sor(!d
$
Uro(i'inog!n,&hichis7at!r-so'u('! .is
r!a(sor(!d and th!n !6cr!t!d in th!
urin!.butmostiscon%!rt!d to
st!rco(i'in and !6cr!t!d in th! *a!c!s,
$
St!rco(i'in co'ours and d!odoris!s
th! *a!c!s.
"elease from the gall 2ladder
$
Duod!nu"secretesthe
hormonessecretinandCCG
duringtheintestinalphase
$
Stimulatethecontraction o*
th! ga''('add!r and
r!'a6ation o* th!
h!+ato+ancr!atic s+hinct!r
$
Th! (i'! and th! +ancr!atic
=uic! to +ass through th!
duod!na' +a+i''a into th!
duod!nu"

INT!STINAL S!%"!TI'NS
$
Intestinalsecretionsare
91o."ucus and "in!ra'
sa'ts,
$
Itscontained!nA)"!s
-!nt!roc)t!softhe&allsof
thevilli.
$
AigestionofC9O.+roti!n
and *at
$
Chemicaldigestionoffoodat
thesurfaceoftheenterocytes
are,
+!+tidas!s.'i+as!.sucras!.
"a'tas! and 'actas!
Ch!"ica' dig!stion associat!d
7ith !nt!roc)t!s
$
Ent!ro:inas!(+o')+!+tid!s
to a"inoacids
$
Li+as!-*ats to *att) acids
and g')c!ro' in th! int!stin!
$ Sucras!."a'tas! and
'actas!- digestionofC9O ()
con%!rting disaccharid!s
suchasSucras!."a'tas!
and 'actas! to
"onosaccharid!s
A2sorption of nutrients
$ Through th! !nt!roc)t!s
.inc'uding
di**usion.os"osis.di**usion and
acti%! trans+ort
$ <ita"ins."in!ra's sa'ts and
7at!r ar! a'so a(sor(!d *ro"
th! s"a'' int!stin! into th! ('ood
ca+i''ari!s
$ Fat-so'u('! %ita"ins ar!
a(sor(!d into th! 'act!a's a'ong
7ith *att) acids and g')c!ro'
$ <ita"in;11 co"(in!s 7ith
intrinsic *actor in th! sto"ach
and is acti%!') a(sor(!d in th!
t!r"ina' i'!u"