13

CHAPTER Digestive System

Pretest
Multiple Choice. Select the best answer, and write the letter
of your choice to the left of each number. To check your
answers go to Appendix 11.

1. An organic catalyst is a(n)

a. enzyme
b. sugar
c. nucleic acid
d. saliva
2. The organ that carries food from the pharynx to the
stomach is the
a. trachea
b. larynx
c. esophagus
d. intestine
3. The word root for stomach is
a. hepat/o
b. ren/o
c. gastr/o
d. cardi/o
4. The word root enter/o refers to the
a. gallbladder
b. intestine
c. kidney
d. heart
5. The wave-like action that moves substances through
an organ is called
a. pulmonary
b. peristalsis
c. parotid
d. mastication
6. The process of moving digested nutrients from the
intestine into the circulation is called
a. lymphedema
b. digestion
c. egestion
d. absorption
7. The organ that secretes bile is the
a. kidney
b. spleen
c. liver
d. stomach
8. Cholecystitis is inflammation of the
a. gallbladder
b. throat
c. diaphragm
d. small intestine

9781284216837_CH13_Cohen.indd 424 12/11/19 5:42 PM

 Learning Objectives
After careful study of this chapter, you should be able to:

1 Describe the organs of the digestive tract, and give the 5 Define medical terms used in reference to the digestive
function of each. P426 system. P442
2 Describe the accessory organs of digestion and explain the 6 Interpret abbreviations used in referring to the
role of each. P429 gastrointestinal system. P449
3 Identify and use the roots pertaining to the digestive 7 Analyze the medical terms in case studies related to the
system and accessory organs. P432 digestive system. PP425, 456
4 Describe the major disorders of the digestive system. P436

Case Study: Abe’s Gastroesophageal Reflux Disease and Erosive Esophagitis

Chief Complaint normal limits. He describes his self-medication by taking

Abe is a 51 y/o businessman with over-the-counter (OTC) drugs including antacids, hista-
complaints of epigastric pain. He mine-2 receptor antagonists (H2 blockers), and the OTC
has a 10-year history of heartburn proton pump inhibitor (PPI) omeprazole. He notes the
that he notes has become worse latter helped “a little bit,” but he discontinued use after
over the last year. The heartburn 2 weeks, as noted in the packaging instructions. He has
occurs both after meals and at bedtime. His sleep has no history of smoking or alcohol abuse. He has an unre-
been interrupted by nighttime symptoms, and he feels markable past medical and family history.
generally fatigued. Intermittently he says he feels that
Clinical Course
things come back up into his throat, but he lacks clear
The physician explained to Abe that he is experiencing
signs of aspiration into the respiratory tract. He is aware
classic esophageal symptoms that are highly specific to
that gastroesophageal reflux disease (GERD) is a chronic
GERD, heartburn, and regurgitation. The physician also
condition and may be associated with a risk for compli-
informed him that GERD might be associated with erosive
cations that include serious morbidity and mortality. Due
esophagitis, which is best diagnosed on endoscopy via
to his required travel for business, he has put off making
esophagogastroduodenoscopy (EGD). Because Abe is
a doctor’s appointment but realizes he needs to see his
51 and has been experiencing heartburn for more than
physician. The heartburn has increased in frequency (daily
10 years with daily symptoms for the past year, he should
now) and severity, so he finally schedules an office visit.
be evaluated thoroughly. He has been referred for the
Examination endoscopy procedure, but the appointment is not for
Abe is seen by his primary care physician and describes 7 weeks. He is prescribed a PPI and is instructed to return
his daily episodes of discomfort. Abe is 6-foot-1-inch and to the office in approximately 4 weeks while still on ther-
weighs 230 pounds. The physician reviews a colonos- apy for assessment of symptoms prior to his appointment.
copy from last year with him that was normal. His blood
pressure and other physical examination findings at this Case Study Revisited: Once you complete this
visit are within normal ranges. Results of a complete blood chapter, please review the case follow-up on p. 449.
count, chemistry profile, and lipid profile are all within

Ancillaries At-A-Glance
Visit the web resource to access the following resources.

Chapter 13 ■ Digestive System 425

9781284216837_CH13_Cohen.indd 425 12/11/19 5:42 PM

 426 Part II ■ Body Systems

Learning Resources
■ eBook ■ TestPrep
■ A&P Module with Heart & Lung Sounds ■ Animations
■ Image Bank ■ Audio Pronunciation Glossary

Introduction through the digestive tract and also moves undigested waste
material out of the body. Also contributing to digestion are
The function of the digestive system is to prepare food for several accessory organs that release secretions into the
intake by body cells. Nutrients must be broken down by digestive tract.
mechanical and chemical means into molecules that are Enzymes are needed throughout the digestive process.
small enough to be absorbed into circulation. Within cells, These compounds are organic catalysts that speed the rate
the nutrients are used for energy and for rebuilding vital of food’s chemical breakdown. The names of most enzymes
cell components. The digestive system also stores undigested can be recognized by the ending -ase.
waste materials and then eliminates them from the body.

The Digestive Tract

Digestion The digestive tract, also known as the alimentary canal or
Digestion takes place in the digestive tract proper, which gastrointestinal (GI) tract, is essentially a long tube modified
extends from the mouth to the anus (FIG. 13-1). Peristalsis, into separate organs with special functions (see FIG. 13-1).
wave-like contractions of the organ walls, moves food BOX 13-1 summarizes the activities of the digestive organs

Mouth Salivary
glands
Teeth Pharynx
Tongue
Esophagus

Liver
Stomach
Duodenum Pancreas
(of small
intestine) Transverse
colon
Gallbladder
Descending
colon
Ascending
colon Small
intestine
Cecum Sigmoid colon
Rectum
Appendix Anus
FIGURE 13-1 Digestive system. Divisions of the gastrointestinal
tract are shown along with the accessory organs, the salivary glands,
liver, gallbladder, and pancreas.

9781284216837_CH13_Cohen.indd 426 12/11/19 5:42 PM

 Chapter 13 ■ Digestive System 427

FOR YOUR REFERENCE BOX 13-1

Organs of the Digestive Tract

Organ Digestive Actions

mouth Used to bite and chew food. Mixes food with saliva, which contains salivary amylase, an enzyme that begins
the digestion of starch. Shapes food into small portions, which the tongue pushes into the pharynx.

pharynx Swallows food by reflex action and moves it into the esophagus.

esophagus Moves food into the stomach by peristalsis.

stomach Stores food; churns to mix food with water and digestive juices. Secretes protein-digesting hydrochloric
acid (HCl) and the enzyme pepsin.

small intestine Secretes enzymes. Receives secretions from the accessory organs, which digest and neutralize food. Site of
13
most digestion and absorption of nutrients into the circulation.

large intestine Forms, stores, and eliminates undigested waste material.

described below. A large serous membrane, the peritoneum the mouth; the anterior portion (hard palate) is formed by
(per-ih-to-NE-um), covers the organs in the abdominal cav­ bone, and the posterior part (soft palate) is made of soft
ity, supporting and separating them. tissue. The fleshy uvula, used in speech production, hangs
from the soft palate. Dental hygienists help in care of the
mouth and teeth. BOX 13-2 has information on careers in
THE MOUTH TO THE STOMACH dental hygiene.
Digestion begins in the mouth (FIG. 13-2), also called the oral In the process of chewing, or mastication, the tongue,
cavity. Here, food is chewed into small bits by the teeth. lips, cheeks, and palate also help to break up food and mix
There are 32 teeth in a complete adult set, including inci­ it with saliva, a secretion that moistens the food and begins
sors and canines to bite food and molars for grinding. The starch digestion. The salivary glands (see FIG. 13-1) secrete
structural features of a molar tooth and its surrounding saliva into the mouth and are considered to be accessory
tissue are shown in FIGURE 13-3. The palate is the roof of digestive organs.

Upper lip
Gingiva (gum)

Cuspid Enamel
Premolars Hard palate Crown Dentin
Pulp
Pharynx Soft palate Gingiva
(gum)
Uvula
Palatine
tonsil Alveolar
bone
Molars Cementum
Root
Periodontal
ligament
Root canal
Lower lip
Artery
Vein
Nerve
Incisors
FIGURE 13-2 The mouth. The teeth, pharynx, tonsils, and other FIGURE 13-3 A molar tooth. The bony socket, gingiva, blood
structures in the oral cavity are shown. vessels, and nerve supply are shown as well as portions of the tooth.

9781284216837_CH13_Cohen.indd 427 12/11/19 5:42 PM

 428 Part II ■ Body Systems

HEALTH PROFESSIONS BOX 13-2

Dental Hygienist

Dental hygienists focus primarily on dental health mainte- Most dental hygiene programs award an associate degree;
nance and preventive dental care. They examine patients’ some offer bachelor’s or master’s degrees. The higher degrees
dentition and periodontium (supporting structures of the are required for research, teaching, or practice in public or
teeth); take radiographic images; and perform oral pro- school health facilities. The professional program requires 1 year
phylaxis using hand and ultrasonic instruments to remove of college-level prerequisite courses. The curriculum includes
deposits, such as calculus, stains, and plaque. They may also courses in radiography, dental anatomy, pharmacology, head
apply fluorides to prevent caries. They work independently and neck anatomy, and other health- and dental-related sci-
or along with a dentist to administer local anesthesia and ences. Additional material on the legal and ethical aspects
nitrous oxide sedation and to do oral screenings, polish of dental hygiene practice and extensive clinical training are
restorations, remove sutures, apply dental sealants, and included in the program. After graduation, dental hygienists
perform periodontal procedures. Dental hygienists must must be licensed in their states by passing clinical and written
be knowledgeable about safety concerning x-ray equip- examinations administered by the American Dental Associa-
ment, anesthesia, and infectious diseases. They wear safety tion’s (ADA) Joint Commission on National Dental Examinations.
glasses, surgical masks, and gloves to protect themselves Almost all hygienists work in dental offices. One advan-
and their patients. A major component of the dental hygien- tage of this field is scheduling flexibility and the opportunity
ist’s work is patient education for maintenance of good oral for part-time work. Job prospects are good; dental hygiene is
health. They may give instruction on nutrition and proper among the fastest growing occupations. Benefits vary with
oral care, such as brushing, flossing, and the use of antimi- place of employment. For additional information, contact the
crobial rinses. American Dental Hygienists’ Association at adha.org.

Portions of moistened food are moved toward the phar­ which break down proteins. The partially digested food
ynx (throat), where swallowing reflexes push them into the then passes through the stomach’s lower portion, the pylo­
esophagus. Peristalsis moves the food through the esopha­ rus, into the intestine.
gus and into the stomach. At its distal end, where it joins the
stomach, the esophagus has muscle tissue that contracts to
keep stomach contents from refluxing (flowing backward). THE SMALL INTESTINE
This lower esophageal sphincter (LES) is also called the Food leaving the stomach enters the duodenum, the first
“cardiac sphincter” because it lies above the cardia of the portion of the small intestine. As the food continues through
stomach, the region around its upper opening. the jejunum and ileum, the small intestine’s remaining sec­
In the stomach, food is further broken down as it is tions, digestion is completed. (Ileum sounds like ilium, a
churned and mixed with secretions containing the enzyme large bone of the pelvis. For information on these and other
pepsin and powerful hydrochloric acid (HCl), both of homonyms, see BOX 13-3.) The digestive substances active in

FOCUS ON WORDS BOX 13-3

Homonyms

Homonyms are words that sound alike but have different write the name as if it had some relation to the famous gam-
meanings. One must know the context in which they are used bling city in Nevada.
in order to understand the intended meaning. For example, Homonyms may have a more serious side as well. Drug
the ilium is the upper portion of the pelvis, but the ileum is the names may sound or look so similar that clinicians could con-
last portion of the small intestine. Different adjectives are pre- fuse them, leading to dangerous, potentially fatal, complica-
ferred for each—iliac for the first and ileal for the second. The tions. For example, a 50 y/o woman was hospitalized after she
word meiosis refers to the type of cell division that halves the took Flomax, which is used to treat symptoms for an enlarged
chromosomes to form the gametes, but miosis means abnor- prostate instead of Volmax, which is used to relieve broncho-
mal contraction of the pupil. Both words come from the Greek spasm. Another example involved two drugs used to treat
word that means a decrease. schizophrenia, clozapine and olanzapine; a young man was
Similar-sounding names lead to some funny misspell- given the wrong drug and suffered severe complications. The
ings. The large bone of the upper arm is the humerus, but FDA and the United States Adopted Names Council regulate
this bone is often written as “humorous.” The vagus nerve sound-alike or look-alike drug names. The World Health Orga-
(cranial nerve X) is named with a root that means “wander,” nization (WHO) has rejected many proposed names, and has
as in the words vague and vagabond, because this nerve even changed drug names after they have been marketed,
branches to many of the internal organs. Students often when they have led to medication errors.

9781284216837_CH13_Cohen.indd 428 12/11/19 5:42 PM

 Chapter 13 ■ Digestive System 429

Villus
Lumen
Mucosa
Lacteal
Villi
Epithelium
Mucous cells

Connective
Vein
13
tissue Capillary

Digestive glands Artery

Mucous glands
in submucosa

A B
FIGURE 13-4 Intestinal villi. A. Microscopic view of the small intestine’s lining showing villi and
glands that secrete mucus and digestive juices. The lumen is the central opening. B. An intestinal villus.
Each villus has blood vessels and a lacteal (lymphatic capillary) for nutrient absorption.

the small intestine include enzymes from the intestine itself pushed through the colon, water is reabsorbed, and stool or
and products from accessory organs that secrete into the feces is formed. This waste material passes into the S-shaped
duodenum. sigmoid colon and is stored in the rectum until eliminated
The digested nutrients, including water, minerals, and through the anus.
vitamins, are absorbed into the circulation, aided by small
projections in the intestinal lining called villi (FIG. 13-4).
Each villus has blood capillaries to absorb nutrients into the
bloodstream and lymphatic capillaries, or lacteals, to absorb
The Accessory Organs
small molecules of digested fats into the lymph. These fats The salivary glands, which secrete into the mouth, are
join the blood when lymph flows into the bloodstream near the first accessory organs to act on food (FIG. 13-5). They
the heart.

THE LARGE INTESTINE Parotid

duct
Any food that has not been digested, along with water
and digestive juices, passes into the large intestine. This
part of the digestive tract begins in the lower right region Parotid
gland Tongue
of the abdomen with a small pouch, the cecum, to which
the appendix is attached. (The appendix does not aid in Submandibular
digestion, but contains lymphatic tissue and may function Sublingual
duct
ducts
in immunity.) The large intestine continues as the colon, a
name that is often used alone to mean the large intestine, Submandibular Sublingual
gland gland
because the colon constitutes such a large portion of that
organ. The colon travels upward along the right side of the
abdomen as the ascending colon, crosses below the stomach
as the transverse colon, and then continues down the left FIGURE 13-5 Salivary glands. These accessory organs of digestion
side of the abdomen as the descending colon. As food is secrete into the mouth.

9781284216837_CH13_Cohen.indd 429 12/11/19 5:42 PM

 430 Part II ■ Body Systems

secrete an enzyme (salivary amylase) that begins starch

Diaphragm digestion. The remaining accessory organs are in the abdo­
men and secrete into the duodenum (FIG. 13-6). The liver is
a large gland with many functions. A major activity is to
process blood, removing toxins and converting nutrients
Liver into new compounds. A special circulatory pathway, the
hepatic portal system, carries blood to the liver from the
other abdominal organs. The liver functions in digestion
Gall- by secreting bile, which emulsifies fats, that is, breaks them
bladder down into smaller units. The gallbladder stores bile until
Pancreas it is needed in digestion. The common hepatic duct from
Common the liver and the cystic duct from the gallbladder merge
Cystic duct hepatic duct to form the common bile duct, which empties into the
duodenum.
Pancreatic duct The pancreas produces a mixture of digestive enzymes
that is delivered into the duodenum through the pancreatic
Duodenum Common bile duct
duct. It also secretes large amounts of bicarbonate, which
FIGURE 13-6 Accessory organs of digestion, which secrete neutralizes the strong stomach acid. BOX 13-4 summarizes
into the small intestine. The organs and ducts are shown. The the functions of the accessory organs.
diaphragm is shown for reference.

FOR YOUR REFERENCE BOX 13-4

The Accessory Organs

Organ Digestive Actions

salivary glands Secrete saliva, which moistens food and contains salivary amylase, an enzyme that begins the digestion
of starch.

liver Secretes bile salts that break down (emulsify) fats.

gallbladder Stores bile and releases it into the digestive tract when needed.

pancreas Secretes a variety of digestive enzymes. Also secretes bicarbonate to neutralize stomach acid and water
to dilute food.

Terminology Key Terms

The terms listed below are emphasized in this chapter. Knowing them will help you organize and prioritize your learning.
These boldface terms are also found, collectively, with all chapter key terms in the Glossary.
Normal Structure and Function
anus The distal opening of the digestive tract (root: an/o)
A-nus

appendix An appendage; usually means the narrow tube of lymphatic tissue attached to the cecum, the
ah-PEN-diks vermiform (worm-like) appendix

bile The fluid secreted by the liver that emulsifies fats and aids in their absorption (roots: chol/e, bili)

cecum A blind pouch at the beginning of the large intestine (root: cec/o)
SE-kum

colon The major portion of the large intestine; extends from the cecum to the rectum and is formed by
KO-lon ascending, transverse, and descending portions (roots: col/o, colon/o)

common bile duct The duct that carries bile into the duodenum; formed by the union of the cystic duct and the common
hepatic duct (root: choledoch/o)

9781284216837_CH13_Cohen.indd 430 12/11/19 5:42 PM

 Chapter 13 ■ Digestive System 431

Terminology Key Terms (Continued)

duodenum The first portion of the small intestine (root: duoden/o); also pronounced du-OD-eh-num
du-o-DE-num

enzyme An organic catalyst; speeds the rate of chemical reactions

EN-zime

esophagus The muscular tube that carries food from the pharynx to the stomach
e-SOF-ah-gus

feces The waste material eliminated from the intestine (adjective: fecal); stool
FE-seze

gallbladder A sac on the undersurface of the liver that stores bile (root: cholecyst/o)

hepatic portal system A special circulatory pathway that brings blood directly from the abdominal organs to the liver for 13
processing (also called simply the portal system); the vessel that enters the liver is the hepatic portal
vein (portal vein)

ileum The terminal portion of the small intestine (root: ile/o)

IL-e-um

intestine The portion of the digestive tract between the stomach and the anus; it consists of the small and large
in-TES-tin intestines; it functions in digestion, absorption, and elimination of waste (root: enter/o); the bowel
(BOW-el)

jejunum The middle portion of the small intestine (root: jejun/o)

jeh-JU-num

lacteal A lymphatic capillary in a villus of the small intestine; lacteals absorb digested fats into the lymph
lak-TELE

large intestine The terminal portion of the digestive tract, consisting of the cecum, colon, rectum, and anus; it stores
in-TES-tin and eliminates undigested waste material (feces)

liver The large gland in the upper right abdomen; in addition to many other functions, it secretes bile
LIV-er needed for digestion and absorption of fats (root: hepat/o)

lower esophageal Muscle tissue at the distal end of the esophagus (gastroesophageal junction) that prevents stomach
sphincter (LES) contents from refluxing into the esophagus; also called the cardiac sphincter
e-sof-ah-JE-al SFINK-ter

mastication Chewing
mas-tih-KA-shun

mouth The oral cavity; contains the tongue and teeth; used to take in and chew food, mix it with saliva, and
move it toward the throat to be swallowed

palate The roof of the mouth; the partition between the mouth and nasal cavity; consists of an anterior
PAL-at portion formed by bone, the hard palate, and a posterior portion formed of tissue, the soft palate
(root: palat/o)

pancreas A large, elongated gland posterior to the stomach; it produces hormones that regulate sugar
PAN-kre-as metabolism and also produces digestive enzymes (root: pancreat/o)

peristalsis Wave-like contractions of an organ’s walls; moves material through an organ or duct
per-ih-STAL-sis

peritoneum The large serous membrane that lines the abdominal cavity and supports the abdominal organs
per-ih-to-NE-um

pharynx The throat; a common passageway for food entering the esophagus and air entering the larynx
FAR-inks (root: pharyng/o)

pylorus The stomach’s distal opening into the duodenum (root: pylor/o); the opening is controlled by a ring of
pi-LOR-us muscle, the pyloric sphincter

rectum The distal portion of the large intestine; it stores and eliminates undigested waste (roots: rect/o,
REK-tum proct/o)

(continued)

9781284216837_CH13_Cohen.indd 431 12/11/19 5:42 PM

 432 Part II ■ Body Systems

Terminology Key Terms (Continued)

saliva The clear secretion released into the mouth that moistens food and contains a starch-digesting enzyme
sah-LI-vah (root: sial/o); saliva is produced by three pairs of glands: the parotid, submandibular, and sublingual
glands (see FIG. 13-1)

sigmoid colon Distal S-shaped portion of the large intestine located between the descending colon and the rectum

small intestine The portion of the intestine between the stomach and the large intestine; comprised of the duodenum,
in-TES-tin jejunum, and ileum; accessory organs secrete into the small intestine, and almost all digestion and
absorption occur there

stomach A muscular sac-like organ below the diaphragm that stores food and secretes juices that digest
STUM-ak proteins (root: gastr/o)

uvula The fleshy mass that hangs from the soft palate; aids in speech production (literally “little grape”)
U-vu-lah (root: uvul/o)

villi Tiny projections in the lining of the small intestine that absorb digested foods into the circulation
VIL-i (singular: villus)

Roots Pertaining to the Digestive System

See TABLES 13-1 to 13-3.

Table 13-1 Roots for the Mouth

Root Meaning Example Definition of Example
bucc/o cheek buccoversion turning toward the cheek
buk-ko-VER-zhun
dent/o, dent/i tooth, teeth edentulous without teeth
e-DEN-tu-lus
odont/o tooth, teeth periodontics dental specialty that deals with the study and
per-e-o-DON-tiks treatment of the tissues around the teeth
gingiv/o gum (gingiva) gingivectomy excision of gum tissue
jin-jih-VEK-to-me
gloss/o tongue glossoplegia paralysis (-plegia) of the tongue
glos-o-PLE-je-ah
lingu/o tongue orolingual pertaining to the mouth and tongue
or-o-LING-gwal
gnath/o jaw prognathous having a projecting jaw
PROG-nah-thus
labi/o lip labium lip or lip-like structure
LA-be-um
or/o mouth circumoral around the mouth
sir-kum-OR-al
stoma, stomat/o mouth xerostomia dryness (xero-) of the mouth
ze-ro-STO-me-ah
palat/o palate palatine pertaining to the palate (also palatal)
PAL-ah-tine
sial/o saliva, salivary gland, salivary sialogram radiograph of the salivary glands and ducts
duct si-AL-o-gram
uvul/o uvula uvulotome instrument (-tome) for incising the uvula
U-vu-lo-tome

9781284216837_CH13_Cohen.indd 432 12/11/19 5:42 PM

 Chapter 13 ■ Digestive System 433

Exercise 13-1
Complete the exercise. To check your answers go to Appendix 11.
Use the adjective suffix -al to write a word that has the same meaning as the following.
1. pertaining to the gums _____________________________________________
2. pertaining to the tongue _____________________________________________
3. pertaining to the teeth _____________________________________________
4. pertaining to the cheek _____________________________________________
5. pertaining to the lip _____________________________________________
6. pertaining to the mouth _____________________________________________
13
Fill in the blanks.
7. Dentistry (DEN-tis-tre) is the profession that studies, diagnoses, and treats the _____________________________ .
8. Micrognathia (mi-krog-NATH-e-ah) is excessive smallness of the ________________________________________ .
9. An orthodontist (or-tho-DON-tist) specializes in straightening (ortho-) of the _____________________________ .
10. The oropharynx is the part of the pharynx that is located behind ________________________________________ .
11. Stomatoplasty (STO-mah-to-plas-te) is any plastic repair of the __________________________________________ .
12. Hemiglossal (hem-e-GLOS-al) means pertaining to one half of the _______________________________________ .
13. A sialolith (si-AL-o-lith) is a stone formed in a(n) __________________________________________ gland or duct.

Define the following words.

14. buccopharyngeal (BUK-oh-far-in-je-al) _____________________________________________
15. gingivoplasty (jin-jih-vo-PLAS-te) _____________________________________________
16. sublingual (sub-LING-gwal) _____________________________________________
17. labiodental (la-be-o-DEN-tal) _____________________________________________
18. uvuloptosis (u-vu-lop-TO-sis) _____________________________________________
19. hypoglossal (hi-po-GLOS-al) _____________________________________________
20. palatorrhaphy (pal-at-OR-ah-fe) _____________________________________________

Table 13-2 Roots for the Digestive Tract (Except the Mouth)
Root Meaning Example Definition of Example
esophag/o esophagus esophageala pertaining to the esophagus
e-sof-ah-JE-al
gastr/o stomach gastroparesis partial paralysis (paresis) of the stomach
gas-tro-pah-RE-sis
pylor/o pylorus pyloroplasty plastic repair of the pylorus
pi-LOR-o-plas-te
enter/o intestine dysentery infectious disease of the intestine
DIS-en-ter-e
duoden/o duodenum duodenostomy surgical creation of an opening into the duodenum
du-o-deh-NOS-to-me
jejun/o jejunum jejunectomy excision of the jejunum
jeh-ju-NEK-to-me

(continued)

9781284216837_CH13_Cohen.indd 433 12/11/19 5:42 PM

 434 Part II ■ Body Systems

Table 13-2 Roots for the Digestive Tract (Except the Mouth) (Continued)
Root Meaning Example Definition of Example
ile/o ileum ileitis inflammation of the ileum
il-e-I-tis
cec/o cecum cecoptosis downward displacement of the cecum
se-kop-TO-sis
col/o, colon/o colon coloclysis irrigation (-clysis) of the colon
ko-lo-KLI-sis
sigmoid/o sigmoid colon sigmoidoscope an endoscope for examining the sigmoid colon
sig-MOY-do-skope
rect/o rectum rectocele hernia of the rectum
REK-to-sele
proct/o rectum proctopexy surgical fixation of the rectum
PROK-to-pek-se
an/o anus perianal around the anus
per-e-A-nal
a
Note addition of e before -al.

Exercise 13-2
Complete the exercise. To check your answers go to Appendix 11.
Use the adjective suffix -ic to write a word for the following definitions.
1. pertaining to the pylorus _____________________________________________
2. pertaining to the colon _____________________________________________
3. pertaining to the stomach _____________________________________________
4. pertaining to the intestine _____________________________________________

Use the adjective suffix -al to write a word for the following definitions.
5. pertaining to the rectum _____________________________________________
6. pertaining to the jejunum _____________________________________________
7. pertaining to the ileum _____________________________________________
8. pertaining to the cecum _____________________________________________
9. pertaining to the anus _____________________________________________

Write a word for the following definitions.

10. pertaining to the stomach and duodenum _____________________________________________
11. inflammation of the esophagus _____________________________________________
12. surgical creation of an opening in the intestine _____________________________________________
13. study of the stomach and intestines _____________________________________________
14. endoscopic examination of the stomach _____________________________________________
15. downward displacement of the pylorus _____________________________________________
16. inflammation of the jejunum and ileum _____________________________________________
17. excision of the ileum _____________________________________________
18. pertaining to the anus and rectum _____________________________________________

9781284216837_CH13_Cohen.indd 434 12/11/19 5:42 PM

 Chapter 13 ■ Digestive System 435

Exercise 13-2 (Continued)

Use the root col/o to write a word for the following definitions.

19. inflammation of the colon _____________________________________________

20. surgical creation of an opening into the colon _____________________________________________
21. surgical fixation of the colon _____________________________________________
22. surgical puncture of the colon _____________________________________________

Use the root colon/o to write a word for the following definitions.

23. any disease of the colon _____________________________________________

24. endoscopic examination of the colon _____________________________________________
13
Two organs of the digestive tract or even two parts of the same organ may be surgically connected by a passage
(anastomosis) after removal of damaged tissue. Such a procedure is named for the connected organs plus the ending
-stomy. Use two roots plus the suffix -stomy to write a word for the following definitions.

25. surgical creation of a passage between the esophagus and stomach ________________________________________
26. surgical creation of a passage between the stomach and intestine __________________________________________
27. surgical creation of a passage between two portions of the jejunum _______________________________________
28. surgical creation of a passage between the duodenum and the ileum _______________________________________
29. surgical creation of a passage between the sigmoid colon and the rectum (proct/o) ___________________________

Table 13-3 Roots for the Accessory Organs

Root Meaning Example Definition of Example
hepat/o liver hepatocyte a liver cell
HEP-ah-to-site
bili bile biliary pertaining to the bile or bile ducts
BIL-e-ar-e
chol/e, chol/o bile, gall cholestasis stoppage of bile flow
ko-le-STA-sis
cholecyst/o gallbladder cholecystogram radiograph of the gallbladder
ko-le-SIS-to-gram
cholangi/o bile duct cholangioma cancer of the bile ducts
ko-lan-je-O-mah
choledoch/o common bile duct choledochal pertaining to the common bile duct
KO-le-dok-al
pancreat/o pancreas pancreatotropic acting on the pancreas
pan-kre-at-o-TROP-ik

9781284216837_CH13_Cohen.indd 435 12/11/19 5:42 PM

 436 Part II ■ Body Systems

Exercise 13-3
Complete the exercise. To check your answers go to Appendix 11.
Use the suffix -ic to write a word for the following definitions.

1. pertaining to the liver _____________________________________________

2. pertaining to the gallbladder _____________________________________________
3. pertaining to the pancreas _____________________________________________

Use the suffix -graphy to write a word for the following definitions.

4. radiographic study of the liver _____________________________________________

5. radiographic study of the gallbladder _____________________________________________
6. radiographic study of the bile ducts _____________________________________________
7. radiographic study of the pancreas _____________________________________________

Use the suffix -lithiasis to write a word for the following definitions.

8. condition of having a stone in the common bile duct _____________________________________________

9. condition of having a stone in the pancreas _____________________________________________

Fill in the blanks.

10. Inflammation of the liver is called ___________________________________________________________________ .

11. The word biligenesis (bil-ih-JEN-eh-sis) means the formation of _________________________________________ .
12. A cholelith (KO-le-lith) is a(n) ______________________________________________________________________ .
13. Choledochotomy (ko-led-o-KOT-o-me) is incision of the ________________________________________________ .
14. Cholecystectomy (ko-le-sis-TEK-to-me) is removal of the _______________________________________________ .
15. Hepatomegaly (hep-ah-to-MEG-ah-le) is enlargement of the ____________________________________________ .
16. Cholangitis (ko-lan-JI-tis) is inflammation of a(n) _____________________________________________________ .
17. Pancreatolysis (pan-kre-ah-TOL-ih-sis) is dissolving of the ______________________________________________ .

Clinical Aspects of the avoid rupture and peritonitis, infection of the peritoneal
cavity.
Digestive System
Ulcers
DIGESTIVE TRACT An ulcer is a lesion of the skin or a mucous membrane marked
Infection by inflammation and tissue damage. Ulcers caused by the
A variety of organisms can infect the GI tract, from viruses damaging action of gastric juices, also called peptic juices, on
and bacteria to protozoa and worms. In the mouth, bacte­ the lining of the GI tract are termed peptic ulcers. Most peptic
rial infection contributes to tooth decay or caries. It may ulcers appear in the first portion of the duodenum. The origins
cause a mild gum infection (gingivitis) or more extensive of such ulcers are not completely known, although infection
involvement of the deeper tissues and bony support around with a bacterium, Helicobacter pylori, has been identified as
the tooth (periodontitis). Infections of the stomach or intes­ a major cause. Heredity and stress may be factors, as well as
tine may produce short-lived upsets with gastroenteritis, chronic inflammation and exposure to damaging drugs, such
nausea, diarrhea, and emesis (vomiting). Other infectious as aspirin and other NSAIDs, or to irritants in food and drink.
diseases of the GI tract, such as typhoid, cholera, and dysen­ Current ulcer treatment includes the administration of
tery, are more serious, even fatal. antibiotics to eliminate H. pylori infection and use of drugs
Appendicitis results from infection of the appendix, that inhibit gastric acid secretion. Ulcers may lead to hemor­
often secondary to its obstruction. Surgery is necessary to rhage or to perforation of the digestive tract wall.

9781284216837_CH13_Cohen.indd 436 12/11/19 5:42 PM

 Chapter 13 ■ Digestive System 437

13

FIGURE 13-7 Endoscopy. A patient undergoing gastroscopy is shown.

Ulcers can be diagnosed by endoscopy (FIG. 13-7, BOX 13-5) rank among the most frequent causes of cancer deaths in the
and by radiographic study of the GI tract using a contrast United States in both men and women. A diet low in fiber
medium, usually barium sulfate. A barium study can reveal and calcium and high in fat is a major risk factor in colorec­
a variety of GI disorders in addition to ulcers, including tal cancer. Heredity is also a factor, as is chronic inflamma­
tumors and obstructions. A barium swallow is used for the tion of the colon (colitis). Polyps (growths) in the intestine
study of the pharynx and esophagus; an upper GI series often become cancerous and should be removed. Polyps can
examines the esophagus, stomach, and small intestine. be identified and even removed by endoscopy.
One sign of colorectal cancer is bleeding into the intes­
Cancer tine, which can be detected by testing the stool for blood.
Cancer of the mouth generally involves the lips or tongue. Because this blood may be present in very small amounts, it
Smoking is a major risk factor in these cases. Leukoplakia, is described as occult (“hidden”) blood. Colorectal cancers
white patches on mucous membranes, often results from are staged according to Dukes classification, ranging from A
smoking or other irritants and is an early sign of cancer in up to C according to severity.
to 25% of cases. The most common sites for GI tract cancer Examiners can observe the intestine’s interior with var­
are the colon and rectum. Together, these colorectal cancers ious endoscopes named for the specific area in which they

CLINICAL PERSPECTIVES BOX 13-5

Endoscopy

Modern medicine has made great strides toward looking into endoscope, such as polyp removal from the colon or sphinc-
the body without resorting to surgery. The endoscope, an ter expansion. Endoscopy can also be used to examine and
instrument that is inserted through a body opening or small operate on joints (arthroscopy), the bladder (cystoscopy),
incision, has allowed the noninvasive examination of passage- respiratory passages (bronchoscopy), and the abdominal cavity
ways, hollow organs, and body cavities. The first endoscopes (laparoscopy).
were rigid, lighted telescopes that could be inserted only a A “virtual colonoscopy” uses computerized x-rays to gen-
short distance into the body. Today, physicians can navigate erate detailed images of the colon. This method can provide
the twists and turns of the digestive tract using long fiberoptic an adequate screening for most people, although a small per-
endoscopes composed of flexible, light-transmitting bundles centage might then need a standard colonoscopy for further
of glass or plastic. assessment or surgery. Capsular endoscopy, a recent tech-
Physicians can endoscopically detect structural abnor- nologic advance, has made examination of the GI tract even
malities, ulcers, inflammation, and tumors in the GI tract. easier. It uses a pill-sized camera that a patient can swallow!
In addition, they use endoscopes to remove fluid or tissue As the camera moves through the digestive tract, it transmits
samples for testing. Some surgery can even be done with an video images to a data recorder worn on the patient’s belt.

9781284216837_CH13_Cohen.indd 437 12/11/19 5:42 PM

 438 Part II ■ Body Systems

Polyp

B C
FIGURE 13-8 Colonoscopy. A. Sigmoidoscopy. The flexible fiberoptic endoscope is advanced
past the proximal sigmoid colon and then into the descending colon. B. Endoscopic image of the
cecum, the first portion of the large intestine. C. Endoscopic image of a colonic polyp.

are used, such as proctoscope (rectum), sigmoidoscope (sig- for elimination of waste. Such ostomy surgery (FIG. 13-9) is
moid colon), and colonoscope (colon) (FIG. 13-8). named for the organ involved, such as ileostomy (ileum)
In some cases of cancer, and for other reasons as well, or colostomy (colon). When an anastomosis (connection)
it may be necessary to surgically remove a portion of the GI is formed between two organs of the tract, both organs
tract and create a stoma (opening) on the abdominal wall are included in naming, such as gastroduodenostomy

A B C
FIGURE 13-9 Ostomy surgery. Various locations are shown. The shaded portions represent the bowel sections that have
been removed or are inactive. A. Sigmoid colostomy. B. Transverse colostomy. C. Ileostomy.

9781284216837_CH13_Cohen.indd 438 12/11/19 5:42 PM

 Chapter 13 ■ Digestive System 439

(stomach and duodenum) or coloproctostomy (colon and

rectum).
Esophagitis
Diaphragm
Obstructions Erosive
A hernia is the protrusion of an organ through an abnor­ esophagitis Incomplete
mal opening. The most common type is an inguinal hernia, Esophageal closure of
stricture lower
described in Chapter 15 (see FIG. 15-7). In a hiatal hernia, esophageal
part of the stomach moves upward into the chest cavity sphincter
through the space (hiatus) in the diaphragm through which
the esophagus passes (see FIG. 3-4). Often this condition pro­
duces no symptoms, but it may result in chest pain, dys­
phagia (difficulty in swallowing), or reflux (backflow) of
stomach contents into the esophagus. Stomach
In pyloric stenosis, the opening between the stomach
Acid reflux
and small intestine is too narrow. This usually occurs in
infants and in boys more often than in girls. A sign of pyloric 13
stenosis is projectile vomiting. Surgery may be needed to
FIGURE 13-11 Gastroesophageal reflux disease (GERD).
correct it.
A weak LES allows acidic stomach contents to flow backward into
Other types of obstruction include intussusception
(FIG. 13-10), slipping of an intestinal segment into a part
the lower portion of the esophagus causing pain and irritation.
below it; volvulus, twisting of the intestine (see FIG. 13-10B);
and ileus, intestinal obstruction often caused by lack of Gastroesophageal Reflux Disease
peristalsis. Gastroesophageal reflux disease (GERD) refers to reflux
Hemorrhoids are varicose veins in the rectum asso­ of gastric juices into the esophagus due to weakness at the
ciated with pain, bleeding, and, in some cases, rectal gastroesophageal junction, specifically the LES (FIG. 13-11).
prolapse. These acidic secretions irritate the lining of the esopha­
gus and even the throat and mouth if propelled upward
by regurgitation. A GERD symptom commonly known as
heartburn, an upward-radiating burning sensation behind
the sternum, does not involve the heart, but is experienced
in the area near the heart (see Abe’s opening case study).
GERD symptoms are more likely to occur when there is
A increased pressure in the stomach, such as after meals when
the stomach is full, when one is lying or bending down, and
with obesity and pregnancy. Hiatal hernia can also lead to
GERD. Treatment includes weight reduction if needed, ele­
vating the head of the bed 4 to 6 in, avoidance of irritating
foods, and drugs to reduce gastric acid secretion. Surgery to
repair an incompetent LES might be needed.
Persistent reflux esophagitis may cause injury to the
esophageal lining leading to Barrett syndrome or Barrett
esophagus. In this condition, the esophageal mucosa is grad­
ually replaced with epithelium resembling that of the stom­
B ach or intestines. Barrett esophagus frequently has no early
symptoms, but possible complications include esophageal
spasms, formation of scar tissue, esophageal strictures, and
increased risk of cancer.

Inflammatory Intestinal Disease

Two similar diseases are included under the heading of
inflammatory bowel disease (IBD):

■ Crohn disease is a chronic inflammation of the intesti­

nal wall, usually in the ileum and colon, causing pain,
diarrhea, abscess, and often formation of an abnormal
passageway, or fistula.
■ Ulcerative colitis involves a continuous inflammation of
FIGURE 13-10 Intestinal obstruction. A. Intussusception. the colon’s lining that begins in the rectum and extends
B. Volvulus, showing counterclockwise twist. proximally (FIG. 13-12).

9781284216837_CH13_Cohen.indd 439 12/11/19 5:42 PM

 440 Part II ■ Body Systems

FIGURE 13-12 Ulcerative colitis. Prominent erythema and

ulceration of the colon begin in the ascending colon and are most
severe in the rectosigmoid area.

Both forms of IBD occur mainly in adolescents and FIGURE 13-13 Lower gastrointestinal (GI) series. Barium
young adults and show a hereditary pattern. They originate enema shows lesions of enteritis (straight arrows) and thickened
with an abnormal immunologic response, perhaps to the mucosa (curved arrows).
normal intestinal flora, along with autoimmunity. Treat­
ment is with anti-inflammatory agents, immunosuppres­
food handlers, and in crowded, unsanitary conditions. It
sants, and frequently surgery to remove damaged portions
may also be acquired by eating contaminated food, espe­
of the colon.
cially seafood.
Celiac disease is characterized by the inability to absorb
foods containing gluten, a protein found in wheat and some ■ Hepatitis B virus (HBV) is spread by blood and other
other grains. It affects the upper part of the small intestine body fluids. It may be transmitted sexually, by sharing
and originates with an excess immune response to gluten. injection needles, and by close interpersonal contact.
Mucosal inflammation diminishes the intestinal villi and Infected individuals may become carriers of the disease.
interferes with absorption. Celiac disease is treated with a Most patients recover, but the disease may be serious,
gluten-free diet. even fatal, and may lead to liver cancer.
Diverticulitis most commonly affects the colon. Diver­ ■ Hepatitis C is spread through blood and blood products
ticula are small pouches in the intestinal wall that commonly or by close contact with an infected person. Drug treat­
appear with age. The presence of these pouches is termed ment is available to cure hepatitis C.
diverticulosis, which has been attributed to a diet low in
■ Hepatitis D, the delta virus, is highly pathogenic but
fiber. Collection of waste and bacteria in these sacs leads to
infects only those already infected with hepatitis B.
diverticulitis, which is accompanied by pain and sometimes
bleeding. Diverticula can be seen by radiographic studies ■ Hepatitis E, like HAV, is spread by contaminated food and
of the lower GI tract using barium as a contrast medium, water. It has caused epidemics in Asia, Africa, and Mexico.
a so-called barium enema (FIG. 13-13). Although there is no
cure, diverticulitis is treated with a high-fiber diet, stool The name hepatitis simply means “inflammation of the
softeners, and drugs (antispasmodics) to reduce motility. liver,” but this disease also causes necrosis (death) of liver
Diverticular infections are treated with antibiotics. cells. Other infections as well as drugs and toxins may also
cause hepatitis. Liver function tests performed on blood
serum are important in diagnosis.
ACCESSORY ORGANS Jaundice, or icterus, is a symptom of hepatitis and other
Hepatitis diseases of the liver and biliary system (FIG. 13-14). It appears
In the United States and other industrialized countries, hep­ as yellowness of the skin, whites of the eyes, and mucous
atitis is most often caused by viral infection. More than five membranes due to the presence of bile pigments, mainly bil­
types of hepatitis viruses have now been identified. Vaccines irubin, in the blood.
are available for hepatitis A and hepatitis B.
Cirrhosis
■ Hepatitis A virus (HAV) is the most common hepatitis Cirrhosis is a chronic liver disease characterized by hepato­
virus. It is spread by fecal–oral contamination, often by megaly, edema, ascites (fluid in the abdomen), and jaundice.

9781284216837_CH13_Cohen.indd 440 12/11/19 5:42 PM

 Chapter 13 ■ Digestive System 441

is characterized by biliary colic (pain) in the right upper

quadrant (RUQ), nausea, and vomiting.
Most gallstones are composed of cholesterol, an ingre­
dient of bile. They form more commonly in women than in
men and are promoted by conditions that increase estro­
gen, as this hormone raises the cholesterol level in bile.
These predisposing conditions include pregnancy, use of
oral contraceptives, and obesity. Oddly, the rapid weight
loss that follows stomach reduction surgery to treat mor­
bid obesity commonly leads to gallstones because of
changes in bile production and cholesterol precipitation
in the bile. Drugs may dissolve gallstones, but often the
cure is removal of the gallbladder in a cholecystectomy.
Originally, this procedure required an extensive incision,
but now the gallbladder is almost always removed lap­
aroscopically through a small abdominal slit. Following 13
FIGURE 13-14 Jaundice. Yellowish discoloration due to bile gallbladder removal, bile flows directly into the duodenum
pigments in the blood is seen in the eye. through the common bile duct.
Ultrasonography, radiography, and magnetic resonance
Disease progression leads to internal bleeding and brain imaging are used to diagnose gallstones (see FIG. 13-14).
damage caused by changes in the blood’s composition. One Endoscopic retrograde cholangiopancreatography (ERCP)
complication of cirrhosis is portal hypertension, increased (FIG. 13-16) is a technique for visualizing and correcting bil­
pressure in the hepatic portal system, the vessels that carry iary and pancreatic duct obstructions. Contrast medium is
blood from the other abdominal organs to the liver. Por­ injected into the biliary system from the duodenum before
tal hypertension causes splenomegaly and the formation of imaging.
varices (varicose veins) in the distal esophagus with possible
hemorrhage. The main cause of cirrhosis is the excess con­ Pancreatitis
sumption of alcohol. Pancreatitis, or inflammation of the pancreas, may result
from alcohol abuse, drug toxicity, bile obstruction, infec­
Gallstones tions, and other causes. Blood tests in acute pancreatitis
Cholelithiasis refers to the presence of stones in the gallblad­ show increased levels of the enzymes amylase and lipase.
der (FIG. 13-15) or bile ducts, which is usually associated with Glucose and bilirubin levels may also be elevated. Often the
cholecystitis, inflammation of the gallbladder. Cholelithiasis disease subsides with only symptomatic treatment.

Pigment stones
and mucus Gallbladder
wall

Gallbladder
lumen

Liver

A B
Thick, fibrotic gallbladder wall

FIGURE 13-15 Cholelithiasis (gallstones). A. Formation of gallstones (cholelithiasis) causes gallbladder inflammation (cholecystitis) and
bile obstruction. Numerous gallstones and a thickened gallbladder wall caused by chronic inflammation are evident in this figure. B. Sonogram
shows dense gallstones (curved arrows). Shadows appear (between the straight arrows) because the sound waves cannot penetrate the stones
(calculi).

9781284216837_CH13_Cohen.indd 441 12/11/19 5:42 PM

 442 Part II ■ Body Systems

Liver
Gallbladder

Biliary system

Fiberoptic
endoscope

Duodenal papilla Pancreatic

ductal system
FIGURE 13-16 Endoscopic retrograde cholangiopan-
creatography (ERCP). A contrast medium is injected into the
pancreatic and bile ducts in preparation for radiography.

Terminology Key Terms

The terms listed below are emphasized in this chapter. Knowing them will help you organize and prioritize your learning.
These boldface terms are also found, collectively, with all chapter key terms in the Glossary.
Disorders
appendicitis Inflammation of the appendix
ah-pen-dih-SI-tis

ascites Accumulation of fluid in the abdominal cavity; a form of edema; may be caused by
ah-SI-teze heart disease, lymphatic or venous obstruction, cirrhosis, or changes in blood plasma
composition

Barrett syndrome Condition resulting from chronic esophagitis, as caused by gastroesophageal reflux
BAH-ret disease; inflammatory injury can lead to esophageal spasms, scarring, strictures, and
increased risk of cancer; also called Barrett esophagus

biliary colic Acute abdominal pain caused by gallstones in the bile ducts
BIL-e-ar-e KOL-ik

bilirubin A pigment released in the breakdown of hemoglobin from red blood cells; mainly
bil-ih-RU-bin excreted by the liver in bile

caries Tooth decay

KAR-eze

celiac disease Inability to absorb foods containing gluten, a protein found in wheat and some other
SE-le-ak grains; caused by an excess immune response to gluten

cholecystitis Inflammation of the gallbladder

ko-le-sis-TI-tis

cholelithiasis The condition of having stones in the gallbladder; also used to refer to stones in the
ko-le-lih-THI-ah-sis common bile duct

cirrhosis Chronic liver disease with degeneration of liver tissue

sir-RO-sis

Crohn disease A chronic inflammatory disease of the gastrointestinal tract usually involving the ileum
krone and colon

9781284216837_CH13_Cohen.indd 442 12/11/19 5:42 PM

 Chapter 13 ■ Digestive System 443

Terminology Key Terms (Continued)

diarrhea The frequent passage of watery bowel movements
di-ah-RE-ah

diverticulitis Inflammation of diverticula (small pouches) in the wall of the digestive tract, especially in
di-ver-tik-u-LI-tis the colon

diverticulosis The presence of diverticula, especially in the colon

di-ver-tik-u-LO-sis

dysphagia Difficulty in swallowing

dis-FA-je-ah

emesis Vomiting
EM-eh-sis 13
fistula An abnormal passageway between two organs such as between the rectum and anus
FIS-tu-lah (anorectal fistula), or from an organ to the body surface

gastroenteritis Inflammation of the stomach and intestine

gas-tro-en-ter-I-tis

gastroesophageal reflux disease Condition caused by reflux of gastric juices into the esophagus resulting in heartburn,
(GERD) regurgitation, inflammation, and possible damage to the esophagus; caused by weakness
gas-tro-e-sof-ah-JE-al of the lower esophageal sphincter (LES) (see FIG. 13-11)

heartburn A warm or burning sensation felt behind the sternum and radiating upward; commonly
HART-bern associated with gastroesophageal reflux; medical name is pyrosis (pyr/o means “heat”)

hemorrhoids Varicose veins in the rectum associated with pain, bleeding, and sometimes rectal
HEM-o-roydz prolapse; piles

hepatitis Inflammation of the liver; commonly caused by a viral infection

hep-ah-TI-tis

hepatomegaly Enlargement of the liver

hep-ah-to-MEG-ah-le

hiatal hernia A protrusion of the stomach through the opening (hiatus) in the diaphragm through
hi-A-tal which the esophagus passes (see FIG. 3-4)

icterus Jaundice
IK-ter-us

ileus Intestinal obstruction; may be caused by lack of peristalsis (adynamic, paralytic ileus) or
IL-e-us by contraction (dynamic ileus); intestinal matter and gas may be relieved by insertion of a
drainage tube

intussusception Slipping of one intestinal segment into another part below it; occurs mainly in male infants
in-tuh-suh-SEP-shun in the ileocecal region (see FIG. 13-10A); may be fatal if untreated for more than 1 day

jaundice A yellowish color of the skin, mucous membranes, and whites of the eye caused by
JAWN-dis bile pigments in the blood (from French jaune meaning “yellow”); the main pigment is
bilirubin, a byproduct of erythrocyte destruction (see FIG. 13-14)

leukoplakia White patches on mucous membranes, as on the tongue or cheeks, often resulting from
lu-ko-PLA-ke-ah smoking or other irritants; may be precancerous

nausea An unpleasant sensation in the upper abdomen that often precedes vomiting; typically
NAW-zhah occurs in digestive upset, motion sickness, and sometimes early pregnancy

occult blood Blood present in such small amounts that it can be detected only microscopically or
o-KULT chemically; in the feces, a sign of intestinal bleeding (occult means “hidden”)

pancreatitis Inflammation of the pancreas

pan-kre-ah-TI-tis

(continued)

9781284216837_CH13_Cohen.indd 443 12/11/19 5:42 PM

 444 Part II ■ Body Systems

Terminology Key Terms (Continued)

peptic ulcer A lesion in the mucous membrane of the esophagus, stomach, or duodenum caused by
PEP-tik UL-ser the action of gastric juice

peritonitis Inflammation of the peritoneum, the membrane that lines the abdominal cavity and
per-ih-to-NI-tis covers the abdominal organs; may result from perforation of an ulcer, ruptured appendix,
or reproductive tract infection, among other causes

polyp A tumor that grows on a stalk and bleeds easily

POL-ip

portal hypertension An abnormal pressure increase in the hepatic portal system; may be caused by cirrhosis,
infection, thrombosis, or a tumor

pyloric stenosis Narrowing of the opening between the stomach and the duodenum; pylorostenosis
pi-LOR-ik

regurgitation A backward flowing, such as the backflow of undigested food

re-gur-jih-TA-shun

splenomegaly Enlargement of the spleen

sple-no-MEG-ah-le

ulcerative colitis Chronic ulceration of the rectum and colon; the cause is unknown, but may involve
UL-ser-ah-tiv ko-LI-tis autoimmunity

volvulus Twisting of the intestine resulting in obstruction; usually involves the sigmoid colon
VOL-vu-lus and occurs most often in children and in the elderly; may be caused by congenital
malformation, a foreign body, or adhesion; failure to treat immediately may result in
death (see FIG. 13-10B)

Diagnosis and Treatment

anastomosis A passage or communication between two vessels or organs; may be normal or
ah-nas-to-MO-sis pathologic or may be created surgically

barium study Use of barium sulfate as a liquid contrast medium for fluoroscopic or radiographic study
BAH-re-um of the digestive tract; can show obstruction, tumors, ulcers, hiatal hernia, and motility
disorders, among other conditions

cholecystectomy Surgical removal of the gallbladder

ko-le-sis-TEK-to-me

Dukes classification A system for staging colorectal cancer based on degree of bowel wall penetration and
lymph node involvement; severity is graded from A to C

endoscopic retrograde A technique for viewing the pancreatic and bile ducts and for performing certain
cholangiopancreatography (ERCP) techniques to relieve obstructions; contrast medium is injected into the biliary system
ko-lan-je-o-pan-kre-ah-TOG-rah-fe from the duodenum before radiographs are taken (see FIG. 13-16)

endoscopy Use of a fiberoptic endoscope for direct visual examination; GI studies include
en-DOS-ko-pe esophagogastroduodenoscopy, proctosigmoidoscopy (rectum and distal colon), and
colonoscopy (all regions of the colon) (see FIGS. 13-7 and 13-8)

Ostomy An opening into the body; generally refers to an opening created for elimination of body
OS-to-me waste; also refers to the operation done to create such an opening (see stoma)

stoma A surgically created opening to the body surface or between two organs (literally
STO-mah “mouth”) (see FIG. 13-9)

9781284216837_CH13_Cohen.indd 444 12/11/19 5:42 PM

 Chapter 13 ■ Digestive System 445

Terminology Enrichment Terms

The terms listed below expand on the key terms to increase your knowledge of this chapter topic.
Normal Structure and Function
bolus A mass, such as the rounded mass of food that is swallowed
BO-lus

cardia The part of the stomach near the esophagus, named for its closeness to the heart
KAR-de-ah

chyme The semiliquid partially digested food that moves from the stomach into the small intestine
kime

defecation The evacuation of feces from the rectum

def-eh-KA-shun 13
deglutition Swallowing
deg-lu-TISH-un

duodenal bulb The part of the duodenum near the pylorus; the first bend (flexure) of the duodenum
du-o-DE-nal

duodenal papilla The raised area where the common bile duct and pancreatic duct enter the duodenum
du-o-DE-nalpah-PIL-lah (see FIG. 13-16); papilla of Vater (FAH-ter)

greater omentum A fold of the peritoneum that extends from the stomach over the abdominal organs
o-MEN-tum

hepatic flexure The right bend of the colon, forming the junction between the ascending colon and the
heh-PAT-ik FLEK-shur transverse colon (see FIG. 13-1)

ileocecal valve A valve-like structure between the ileum of the small intestine and the cecum of the large
il-e-o-SE-kal intestine

mesentery The portion of the peritoneum that folds over and supports the intestine
MES-en-ter-e

mesocolon The portion of the peritoneum that folds over and supports the colon
mes-o-KO-lon

papilla of Vater See duodenal papilla

rugae The large folds in the stomach’s lining seen when the stomach is empty
RU-je

sphincter of Oddi The muscular ring at the opening of the common bile duct into the duodenum
OD-e

splenic flexure The left bend of the colon, forming the junction between the transverse colon and the
SPLEN-ik FLEK-shur descending colon (see FIG. 13-1)

Disorders
achalasia Failure of a smooth muscle to relax, especially the lower esophageal sphincter, so that food is
ak-ah-LA-ze-ah retained in the esophagus

achlorhydria Lack of hydrochloric acid in the stomach; opposite is hyperchlorhydria

a-klor-HI-dre-ah

anorexia Loss of appetite; anorexia nervosa is a psychologically induced refusal or inability to eat
an-o-REK-se-ah (adjectives: anorectic, anorexic)

aphagia Inability to swallow or difficulty in swallowing; refusal or inability to eat

ah-FA-je-ah

aphthous ulcer An ulcer in a mucous membrane, as in the mouth

AF-thus

(continued)

9781284216837_CH13_Cohen.indd 445 12/11/19 5:42 PM

 446 Part II ■ Body Systems

Terminology Enrichment Terms (Continued)

bruxism Clenching and grinding of the teeth, usually during sleep
BRUK-sizm

bulimia Excessive, insatiable appetite; a disorder characterized by overeating followed by induced

bu-LEME-e-ah vomiting, diarrhea, or fasting

cachexia Profound ill health, malnutrition, and wasting

kah-KEK-se-ah

cheilosis Cracking at the corners of the mouth, often caused by B vitamin deficiency (root cheil/o
ki-LO-sis means “lip”)

cholestasis Stoppage of bile flow; also pronounced ko-LES-tah-sis

ko-le-STA-sis

constipation Infrequency or difficulty in defecation and the passage of hard, dry feces
con-stih-PA-shun

dyspepsia Poor or painful digestion

dis-PEP-se-ah

eructation Belching
eh-ruk-TA-shun

familial adenomatous polyposis A hereditary condition in which multiple polyps form in the colon and rectum, predisposing
(FAP) one to colorectal cancer
fah-MIL-e-al ad-eh-NO-mah-tus
pol-ih-PO-sis

flatulence Condition of having gas or air in the GI tract

FLAT-u-lens

flatus Gas or air in the gastrointestinal tract; gas or air expelled through the anus
FLA-tus

hematemesis Vomiting of blood

he-mah-TEM-eh-sis

irritable bowel syndrome (IBS) A chronic stress-related disease characterized by diarrhea, constipation, and pain associated
with rhythmic intestinal contractions; mucous colitis; spastic colon

megacolon An extremely dilated colon; usually congenital but may occur in acute ulcerative colitis
meg-ah-KO-lon

melena Black tarry feces resulting from blood in the intestines; common in newborns; may also be a
MEL-e-nah sign of gastrointestinal bleeding

obstipation Extreme constipation

ob-stih-PA-shun

pernicious anemia A form of anemia caused by the stomach’s failure to secrete intrinsic factor, a substance
per-NISH-us needed for the absorption of vitamin B12

pilonidal cyst A dermal cyst in the sacral region, usually at the top of the cleft between the buttocks; may
pi-lo-NI-dal become infected and begin to drain

thrush Fungal infection of the mouth and/or throat caused by Candida; appears as mucosal white
patches or ulcers

Vincent disease Severe gingivitis with necrosis associated with the bacterium Treponema vincentii;
VIN-sent necrotizing ulcerative gingivitis; trench mouth

Diagnosis and Treatment

appendectomy Surgical removal of the appendix
ap-en-DEK-to-me

9781284216837_CH13_Cohen.indd 446 12/11/19 5:42 PM

 Chapter 13 ■ Digestive System 447

Terminology Enrichment Terms (Continued)

bariatrics The branch of medicine concerned with prevention and control of obesity and associated
bar-e-AT-riks diseases (from Greek baros, meaning “weight”)

bariatric surgery Surgery to reduce the size of the stomach and reduce nutrient absorption in the treatment
of morbid obesity; most common is gastric bypass surgery, which involves division of the
stomach and anastomosis of its upper part to the small intestine (jejunum) (FIG. 13-17); other
methods are gastric stapling, partitioning of the stomach with rows of staples, and gastric
banding, which involves laparoscopic placement of an adjustable loop (Lap-Band) that
reduces stomach capacity

Billroth operation Gastrectomy with anastomosis of the stomach to the duodenum (Billroth I) or to the jejunum
(Billroth II) (FIG. 13-18)

gavage Process of feeding through a nasogastric tube into the stomach 13

gah-VAHZH

lavage Washing out of a cavity; irrigation

lah-VAJ

manometry Measurement of pressure; pertaining to the GI tract, measurement of pressure in the portal
man-OM-eh-tre system as a sign of obstruction

Murphy sign Inability to take a deep breath when fingers are pressed firmly below the right arch of the
ribs (below the liver); signifies gallbladder disease

nasogastric (NG) tube Tube that is passed through the nose into the stomach (FIG. 13-19); may be used for emptying
na-zo-GAS-trik the stomach, administering medication, giving liquids, or sampling stomach contents

parenteral hyperalimentation Complete intravenous feeding for one who cannot take in food; total parenteral nutrition
pah-REN-ter-al (TPN)

percutaneous endoscopic Tube inserted into the stomach for long-term feeding (FIG. 13-20)
gastrostomy (PEG) tube

vagotomy Interruption of vagal nerve impulses to reduce stomach secretions in the treatment of a
va-GOT-o-me gastric ulcer; originally done surgically but may also be done with drugs

Drugs
antacid Agent that counteracts acidity, usually gastric acidity
ant-AS-id

antidiarrheal Drug that treats or prevents diarrhea by reducing intestinal motility or absorbing irritants
an-te-di-ah-RE-al and soothing the intestinal lining

antiemetic Agent that relieves or prevents nausea and vomiting

an-te-eh-MET-ik

antiflatulent Agent that prevents or relieves flatulence

an-te-FLAT-u-lent

antispasmodic Agent that relieves spasm, usually of smooth muscle

an-te-spas-MOD-ik

emetic An agent that causes vomiting

eh-MET-ik

histamine H2 antagonist Drug that decreases secretion of stomach acid by interfering with the action of histamine at
H2 receptors; used to treat ulcers and other gastrointestinal problems; H2-receptor–blocking
agent

laxative Agent that promotes elimination from the large intestine; types include stimulants,
LAK-sah-tiv substances that retain water (hyperosmotics), stool softeners, and bulk-forming agents

proton pump inhibitor (PPI) Agent that inhibits gastric acid secretion by blocking the transport of hydrogen ions
(protons) into the stomach

9781284216837_CH13_Cohen.indd 447 12/11/19 5:42 PM

 448 Part II ■ Body Systems

Duodenum Stomach

Afferent loop Jejunum

A

Nasogastric
tube

Splenic
impression
on descending
colon

B
FIGURE 13-19 A nasogastric (NG) tube. A. Diagram showing an
FIGURE 13-17 Gastric bypass. For treatment of morbid obesity, a NG tube in place. B. Abdominal radiograph showing an NG tube. The
small pouch is created in the stomach to limit food intake. The pouch filter (arrow) shown in the inferior vena cava is meant to trap emboli
is attached to the jejunum in a gastrojejunostomy to bypass the that might originate in the lower extremities and pelvis.
stomach and reduce nutrient absorption.

Stomach
Tubing clamp Plug-in adapter
Surgical External circle External
staples clamp crossbar

Stomach Mushroom Internal crossbar

wall cap catheter in contact with
mushroom catheter
FIGURE 13-18 Gastrojejunostomy (Billroth II operation). The FIGURE 13-20 Percutaneous endoscopic gastrostomy (PEG)
dotted lines show the portion removed. tube. The tube is shown in place in the stomach.

9781284216837_CH13_Cohen.indd 448 12/11/19 5:42 PM

 Chapter 13 ■ Digestive System 449

Terminology Abbreviations
The abbreviations listed below are emphasized in this chapter. These are also found, collectively, with all chapter
abbreviations in Appendix 2.
BE Barium enema (for radiographic study of the colon) HCl Hydrochloric acid

BM Bowel movement IBD Inflammatory bowel disease

CBD Common bile duct IBS Irritable bowel syndrome

EGD Esophagogastroduodenoscopy LES Lower esophageal sphincter

ERCP Endoscopic retrograde cholangiopancreatography NG Nasogastric (tube)

FAP Familial adenomatous polyposis N&V Nausea and vomiting

13
GERD Gastroesophageal reflux disease N/V/D Nausea, vomiting, and diarrhea

GI Gastrointestinal PEG Percutaneous endoscopic gastrostomy (tube)

HAV Hepatitis A virus PONV Postoperative nausea and vomiting

HBV Hepatitis B virus PPI Proton pump inhibitor

HCV Hepatitis C virus TPN Total parenteral nutrition

HDV Hepatitis D virus UGI Upper gastrointestinal (radiograph series)

HEV Hepatitis E virus

Case Study Revisited

Abe’s Follow-Up Study Abe’s appointment for his endoscopy is in 3 weeks.

When Abe returns after 4 weeks for his follow-up The physician emphasized that Abe continue his
appointment in primary care, he explains that he medication and go to his endoscopy appointment. Abe
started feeling better, so he stopped taking the medi- did follow the physician’s instructions and the results
cine after 3 weeks. Now his symptoms have returned. from the endoscopy indicate that he does indeed have
They are waking him up at night, and he also now moderate erosive esophagitis. There is a small hiatal
reports experiencing mild dysphagia. The physician hernia present as well.
explained that he must remain on his medication. Following the study, Abe is prescribed a PPI,
Medication nonadherence, when patients do not take 40 mg/day and encouraged to take it on a regular
their medications, is unfortunately fairly common basis. He is counseled to decrease the fat in his
especially among patients with chronic disease. The meals, avoid lying down for at least 2 hours after
physician knew this and educated Abe on understand- meals, and limit alcohol intake. He returns 6 weeks
ing the importance of following the directions that he later with marked improvement in compliance
was given on the prescription and from his previous and total control of his symptoms. He is instructed
appointment. Stopping a medication early, as Abe did, to continue the PPI and to return in 6 months for
caused his symptoms to return. reassessment.

9781284216837_CH13_Cohen.indd 449 12/11/19 5:42 PM