THE DIGESTIVE SYSTEM /GASTROINTESTINAL TRACT

FUNCTIONAL ANATOMY OF DIGESTIVE SYSTEM

Digestive system is made up of gastrointestinal tract (GI tract) or alimentary

canal and accessory organs, which help in the process of digestion and
absorption. GI tract is a tubular structure extending from the mouth up to anus,
with a length of about 30 feet. It opens to the external environment on both
ends.

GI tract is formed by two types of organs:

1. Primary digestive organs.

2. Accessory digestive organs.

The gastrointestinal tract is an organ system that enables us to ingest food via
the mouth, digest it by breaking it down, absorb it, and then expel the remaining
waste as faeces via the anus.

1. Primary Digestive Organs Primary digestive organs are the organs where
actual digestion takes place. Primary digestive organs are: i. Mouth ii. Pharynx
iii. Esophagus iv. Stomach v. Small intestine vi. Large intestine.

2. Accessory Digestive Organs Accessory digestive organs are those which help
primary digestive organs in the process of digestion. Accessory digestive organs
are: i. Teeth ii. Tongue iii. Salivary glands iv. Exocrine part of pancreas v. Liver
vi. Gallbladder.

WALL OF GASTROINTESTINAL TRACT : In general, wall of the GI tract

is formed by four layers which are from inside out: 1. Mucus layer 2. Submucus
layer 3. Muscular layer 4. Serous or fibrous layer.

1. MUCUS LAYER Mucus layer is the innermost layer of the wall of GI tract.
It is also called gastrointestinal mucosa or mucus membrane. It faces the cavity
of GI tract.
Mucosa has three layer of structures: i. Epithelial lining ii. Lamina propria iii.
Muscularis mucosa.

Epithelial Lining : Epithelial lining is in contact with the contents of GI tract.

The type of cells in this layer varies in different parts of GI tract. The inner
surface of mouth, surface of tongue, inner surface of pharynx and esophagus
have stratified squamous epithelial cells. However, mucus membrane lining the
other parts such as stomach, small intestine and large intestine has columnar
epithelial cells.

Lamina Propria : Lamina propria is formed by connective tissues, which contain

fibro blasts, macrophages, lymphocytes and eosinophils.

Muscularis Mucosa; Muscularis mucosa layer consists of a thin layer of smooth

muscle fibers. It is absent in mouth and pharynx. It is present from esophagus
onwards.

2. SUBMUCUS LAYER: Submucus layer is also present in all parts of GI

tract, except the mouth and pharynx. It contains loose collagen fibers, elastic
fibers, reticular fibers and few cells of connective tissue. Blood vessels,
lymphatic vessels and nerve plexus are present in this layer.

3. MUSCULAR LAYER Muscular layer in lips, cheeks and wall of pharynx

contains skeletal muscle fibers. The esophagus has both skeletal and smooth
muscle fibers. Wall of the stomach and intestine is formed by smooth muscle
fibers. Smooth muscle fibers in stomach are arranged in three layers: i. Inner
oblique layer ii. Middle circular layer iii. Outer longitudinal layer.

Smooth muscle fibers in the intestine are arranged in two layers: i. Inner
circular layer ii. Outer longitudinal layer.

. 4. SEROUS OR FIBROUS LAYER Outermost layer of the wall of GI tract

is either serous or fibrous in nature. The serous layer is also called serosa or
serous membrane and it is formed by connective tissue and mesoepithelial cells.
It covers stomach, small intestine and large intestine. The fibrous layer is
otherwise called fibrosa and it is formed by connective tissue. It covers pharynx
and esophagus.
Key facts

Functions Regulation of satiety and hunger, mechanical digestion

(mastication), swallowing and chemical digestion of
food; absorption of necessary nutrients, elimination of
unnecessary matter and waste

Components Primary organs: mouth, pharynx, esophagus, stomach,

small intestines (duodenum, jejunum, ileum), large
intestine (colon), rectum and anal canal
Accessory organs: salivary glands, liver, gall bladder,
pancreas

Mouth Contains structures that start digestion: teeth (choping

the food), salivary glands (secrete saliva that contain
enzymes that start chemical digestion of sugar and fats),
tongue (detects taste, pushes bolus towards the pharynx)

Pharynx Conducts the food to the esophagus

Esophagus Muscular tube that conduct the bolus to the stomach; It
has upper sphincter (opens with swallow reflex and
allows the bolus to enter the esophagus) and lower
sphincter (controls emptying of the esophagus content to
the stomach)

Stomach Function - secretion of gastric acid (hydrochloric acid +

sodium chloride + pepsine) that digests proteins and
converts bolus to chyme
Parts - cardia (where content of the esophagus empties
into stomach), fundus (upper curved part), body (main,
central region), pylorus (empties the chyme into the
duodenum)

Spleen Breaks down spent erythrocytes -> production of

bilirubin -> bilirubin sent to the liver -> secreted in the
bile

Liver Main functions: detoxication of metabolytes, synthesis

of proteins, production of biochemicals needed for
digestion -> regulation of body's metabolism and energy
storage

Gallbladder Stores the bile and empties it into the duodenum from
where it partially eliminates via defecation

Pancreas Secretes insulin when sugar levels are high, secretes

glucagon when sugar levels are low, secretes pancreatic
juice (tripsinogen, chymotripsinogen, elastase, amilase
etc.) into the duodenum where it digests the chyme

Small Duodenum - mixes chyme with bile, secretes

intestines bicarbonates to rise pH in order to activate pancreatic
enzymes which digest the chyme
 Jejunum - absorbs small nutrients that have been
previously digested in duodenum
Ileum - absorbs vitamin B12, bile salts and all necessary
materia that were not absorbed in jejunum
Cecum - a pouch that marks division between small and
large intestines -> connects the ileum with ascending
colon

Large intestine Ascending colon - absorbs water from content and

moves in to the transverse colon by peristalsis
Transverse colon - extends from hepatic flexure to the
splenic flexure; absorbs water and salts
Descending colon - extends from splenic flexure to the
sigmoid colon; stores feces that will be emptied into the
sigmoid colon
Sigmoid colon - contracts to increase pressure inside the
colon, causing the stool to move into the rectum

Rectum Holds the formed feces awaiting elimination via

defecation

Bowel Dow Jones Industrial Average Closing Stock Report

mnemonic (stands for duodenum, jejunum, ileum, appendix, colon,
sigmoid, rectum)

Anal canal Passage through which undigested food and exfoliated

mucosa exit the body

Vascularizatio Supplied by the branches of abdominal aorta:

n - Celiac trunk - supplies the liver, stomach, spleen,
upper 1/3 of duodenum, pancreas
- Superior mesenteric artery - supplies distal 2/3 of
duodenum, jejunum, ileum, cecum, appendix, ascending
colon, proximal 1/3 of transverse colon
- Inferior mesenteric artery - supplies distal 1/2 of
transverse colon, descending colon, sigmoid colon,
 rectum, anus

Innervation Parasympathetic supply - vagus nerve and pelvic

splanchnic nerves
Sympathetic supply - thoracic and lumbar splanchnic
nerves

The digestive system can be broken down into two major components:

 There is the primary digestive tract, which functions mainly as a conduit and
storage pathway. This portion is needed in order to move food contents along
the tract (peristalsis) so that absorption of nutrients and excretion of
undigested substances can occur. The tract also allows for segmentation of
food at different stages of digestion. This is important because some enzymes
produced in one part of the tract (e.g. pepsin in the stomach) will not function
optimally in another part of the tract (e.g. the jejunum).

 The other component is the accessory digestive tract. This group of organs
are responsible for the synthesis and secretion enzymes to facilitate chemical
digestion.

Functions of the digestive system

a. Trigger and initiation

The function of the digestive system truly begins within the brain. Whenever
the body’s energy stores (i.e. blood glucose, protein, or fat stores) fall below a
set point, the hunger centres of the hypothalamus are activated. These centres
regulate satiety (fullness) and appetite in order to maintain energy homeostasis.
This signals to the brain that there is a need to obtain food.

Monogastric organisms like humans have two kinds of digestive processes

occurring in the digestive tract – mechanical and chemical digestion. Once the
desired food is obtained, the digestive process begins in the mouth with
mechanical digestion. Here the teeth are used to cut, tear, and grind chunks of
food into smaller particles. This process of mastication involves the alternating
action of the muscles of mastication (namely, the superficial and deep masseter,
the pterygoids, and the temporalis muscles).

Mastication is actually a reflex action that is stimulated once food is present in

the mouth. At that point, there is inhibition of the muscles of mastication which
results in a fall of the mandible. This causes distention of the muscles of
mastication, resulting in reflex contraction of the muscle fibres; thus raising the
mandible. That action causes apposition of the upper and lower rows of teeth,
crushing the food that is between them. The cycle is repeated until the food
particles can be rolled into a bolus.

As the tongue rolls the chewed food into a bolus, the salivary glands secrete
saliva to moisten the bolus in order for it to pass smoothly to the stomach. Also
note that some amount of chemical digestion also occurs in the mouth, as saliva
contains the enzyme amylase, which breaks down some carbohydrates in the
mouth.

b. Swallowing and physical digestion

Once the bolus is prepared, then swallowing will be initiated. This is another
intricate reflex arc that involves the action of afferent and efferent tracts of
several cranial nerves being relayed to and from the nucleus tractus solitarius
and nucleus ambiguus of the brainstem.

The end result is that these nerves send motor signals to the tongue, which
moves the bolus against the hard and soft palate, then into the oropharynx
(which is also under brainstem regulation). The bolus then continues inferiorly
towards the laryngopharynx and the swallowing reflex is initiated at the
esophagus. All the actions of swallowing up to this point were under voluntary
control; however, the rest of the action is carried out by involuntary peristaltic
contractions that travel in a craniocaudal fashion. At the level of the pharynx:

 Superiorly, the bolus is prevented from entering the nasopharynx by the

actions of Passavant’s ridge. This structure is formed by the joint actions of
the palatopharyngeal sphincters, the superior constrictor muscles,
salpingopharyngeus and the muscles of the soft palate.
 The epiglottis closes off the larynx to prevent food from entering the airway.
The vocal cords are also adducted as an additional protective measure.

At the level of the esophagus:

 There is relaxation of the cricopharyngeal sphincter and the bolus enters the
proximal esophagus. The presence of the bolus causes distention of the
myenteric plexus within the walls of the esophagus, initiating the primary
esophageal peristaltic wave.
 The continued presence of the food stimulates the secondary peristaltic waves
in a craniocaudal direction.

These waves, along with the action of gravity, move the bolus toward the lower
esophageal sphincter at a rate of 4 cm/s. At rest, the sphincter has a high tone.
However, the presence of the bolus aids relaxation of the lower esophageal
sphincter, and food is able to enter the stomach. Here, the majority of the
chemical digestion will take place.

c. Chemical digestion

Once the bolus enters the stomach, there is regulated release of a variety of
enzymes that facilitate chemical digestion. Some of these enzymes also
stimulate the accessory digestive organs to release their enzymes to aid in
digestion. In addition to chemical digestion (particularly of proteins), the
stomach also functions as:

 A storage point, which gradually releases its contents into the small
intestines, to allow adequate time for further digestion and absorption.
 A mixer: the mode of contraction and arrangement of the stomach mucosa
results in further mixing of the food contents to form chyme.
 A conduit: essentially passing food from the esophagus to the small
intestines.
 Immunological defence: the acidic pH of the stomach aids in dissolving
invading pathogens before they are able to cause an infection.
 Other micronutrients: iron (Fe), vitamin B12 ,and folate absorption are
heavily regulated by the stomach.

The stomach can be functionally divided into proximal and distal motor pumps,
which stores food content and pumps chyme along the conduit, respectively.
Portions of chyme are passed into the pylorus and into the small intestines.
Once chyme has entered the first part of the duodenum, it activates the
neurohormonal axis which promotes the release of bile (from the liver and
gallbladder) and other enzymes from the pancreas. The peristaltic waves
continue to move the chyme along the intestinal tract. The intricate folding of
the intestines facilitates absorption of nutrients from the chyme. Majority of the
nutrients are absorbed within the small intestines. The remnants are passed
through the unidirectional ileocecal valve into the cecum.

As the peristaltic waves continue into the colon, the chyme continues to move
along the tract. Further absorption of electrolytes and water from the remaining
chyme occurs and the chyme is then converted into stool, which is stored in the
rectum. As the rectum becomes distended, the stretch receptors signal to the
brain that promotes defecation. While the internal anal sphincters are under
autonomic regulation, the external anal sphincters are under voluntary control.
Therefore the individual may resist the urge to defecate until an appropriate
time and place is identified.

ORGANS OF THE DIGESTIVE SYSTEM

The digestive tract is also referred to as the alimentary canal. It is a tubular

continuum that is segmented into dilated regions. These dilated regions are
often separated by thickened regions of the wall that form sphincters. This
prevents unintended mixing of the contents in the respective segments.

A. BUCCAL CAVITY/ MOUTH

Mouth is otherwise known as oral cavity or buccal cavity. It is formed by

cheeks, lips and palate. It encloses the teeth, tongue and salivary glands. Mouth
opens anteriorly to the exterior through lips and posteriorly through fauces into
the pharynx. Digestive juice present in the mouth is saliva, which is secreted by
the salivary glands.

FUNCTIONS OF MOUTH

1. Ingestion of food materials

2. Chewing the food and mixing it with saliva

3. Appreciation of taste of the food

4. Transfer of food (bolus) to the esophagus by swallowing

5. Role in speech

6. Social functions such as smiling and other expressions.

Major Salivary Glands Major glands are: 1. Parotid glands 2. Submaxillary

or submandibular glands 3. Sublingual glands.

1. Parotid Glands Parotid glands are the largest of all salivary glands, situated
at the side of the face just below and in front of the ear. Each gland weighs
about 20 to 30 g in adults. Secretions from these glands are emptied into the oral
cavity by Stensen duct. This duct is about 35 mm to 40 mm long and opens
inside the cheek against the upper second molar tooth .

2. Submaxillary Glands Submaxillary glands or submandibular glands are

located in submaxillary triangle, medial to mandible. Each gland weighs about 8
to 10 g. Saliva from these glands is emptied into the oral cavity by Wharton
duct, which is about 40 mm long. The duct opens at the side of frenulum of
tongue, by means of a small opening on the summit of papilla called caruncula
sublingualis.

3. Sublingual Glands Sublingual glands are the smallest salivary glands

situated in the mucosa at the floor of the mouth. Each gland weighs about 2 to 3
g. Saliva from these glands is poured into 5 to 15 small ducts called ducts of
Rivinus. These ducts open on small papillae beneath the tongue. One of the
ducts is larger and it is called Bartholin duct. It drains the anterior part of the
gland and opens on caruncula sublingualis near the opening of submaxillary
duct.
Composition Of Saliva : Mixed saliva contains 99.5% water and 0.5% solids.

FUNCTIONS OF SALIVA Saliva is a very essential digestive juice. Since it

has many functions, its absence leads to many inconveniences.

1. Preparation Of Food For Swallowing When food is taken into the mouth,
it is moistened and dissolved by saliva. The mucus membrane of mouth is also
moistened by saliva. It facilitates chewing. By the movement of tongue, the
moistened and masticated food is rolled into a bolus. Mucin of saliva lubricates
the bolus and facilitates swallowing.

2. Appreciation Of Taste Taste is a chemical sensation. By its solvent action,

saliva dissolves the solid food substances, so that the dissolved substances can
stimulate the taste buds. The stimulated taste buds recognize the taste.

3. Digestive Function Saliva has three digestive enzymes, namely salivary

amylase, maltase and lingual lipase

Salivary Amylase Salivary amylase is a carbohydrate-digesting (amylolytic)

enzyme. It acts on cooked or boiled starch and converts it into dextrin and
maltose. Though starch digestion starts in the mouth, major part of it occurs in
stomach because, food stays only for a short time in the mouth. Optimum pH
necessary for the activation of salivary amylase is 6. Salivary amylase cannot
act on cellulose.

Maltase Maltase is present only in traces in human saliva and it converts

maltose into glucose.

Lingual Lipase Lingual lipase is a lipid-digesting (lipolytic) enzyme. It is

secreted from serous glands situated on the posterior aspect of tongue. It digests
milk fats (pre-emulsified fats). It hydrolyzes triglycerides into fatty acids and
diacylglycerol
APPLIED PHYSIOLOGY

Hyposalivation: Reduction in the secretion of saliva is called

hyposalivation. It is of two types, namely temporary hyposalivation and
permanent hyposalivation. 1. Temporary hyposalivation occurs in: i. Emotional
conditions like fear. ii. Fever. iii. Dehydration. 2. Permanent hyposalivation
occurs in: i. Sialolithiasis (obstruction of salivary duct). ii. Congenital absence
or hypoplasia of salivary glands. iii. Bell palsy (paralysis of facial nerve).

Hypersalivation: Excess secretion of saliva is known as hypersalivation.

Physiological condition when hypersalivation occurs is pregnancy.
Hypersalivation in pathological conditions is called ptyalism, sialorrhea, sialism
or sialosis. Hypersalivation occurs in the following pathological conditions: 1.
Decay of tooth or neoplasm (abnormal new growth or tumor) in mouth or
tongue due to continuous irritation of nerve endings in the mouth. 2. Disease of
esophagus, stomach and intestine. 3. Neurological disorders such as cerebral
palsy, mental retardation, cerebral stroke and parkinsonism. 4. Some
psychological and psychiatric conditions. 5. Nausea and vomiting.

PHARYNX

Posterior to the oral cavity proper is the oropharynx. This is the middle part of
the pharynx that communicates superiorly with the nasopharynx and inferiorly
with the laryngopharynx. The walls of the oropharynx are formed by the
superior and middle pharyngeal constrictor muscles. Anterolaterally, the
palatopharyngeal folds form a demarcation between the oral cavity proper and
the oropharynx.

The base of the tongue also serves as another landmark in the anteroinferior
aspect of the oropharynx. The mucosa of the walls also contains numerous
mucosa associated lymphatic tissue (MALT). It can be separated from the
nasopharynx by the muscles of Passavant’s ridge and the supporting structures
of the soft palate during deglutition.

ESOPHAGUS

The tubular conduit responsible for transferring food from the oropharynx to the
stomach is the esophagus. It can be divided into three parts:
 cervical
 thoracic
 abdominal components

The total length of the muscular tube is 25 cm, commencing at the

cricopharyngeus at the lower border of the cricoid cartilage at the sixth cervical
vertebrae (C6). It journeys posteriorly to the trachea in the neck along its caudal
course. It then travels through the superior, then posterior mediastinum
alongside the thoracic vertebrae. It pierces the diaphragm at the tenth thoracic
vertebra (T10). The remaining 2.5 cm of the esophagus is the abdominal part. It
transitions into the stomach at the gastroesophageal junction, where the
physiological lower esophageal sphincter exists.

STOMACH

FUNCTIONAL ANATOMY OF STOMACH

Stomach is a hollow organ situated just below the diaphragm on the left side in
the abdominal cavity. Volume of empty stomach is 50 mL. Under normal
conditions, it can expand to accommodate 1 L to 1.5 L of solids and liquids.
However, it is capable of expanding still further up to 4 L.

Parts Of Stomach In humans, stomach has four parts: 1. Cardiac region 2.

Fundus 3. Body or corpus 4. Pyloric region.

1. Cardiac Region Cardiac region is the upper part of the stomach where
esophagus opens. The opening is guarded by a sphincter called cardiac
sphincter, which opens only towards stomach. This portion is also known as
cardiac end.

2. Fundus Fundus is a small domeshaped structure. It is elevated above the

level of esophageal opening.

3. Body or Corpus Body is the largest part of stomach forming about 75% to
80% of the whole stomach. It extends from just below the fundus up to the
pyloric region
4. Pyloric Region Pyloric region has two parts, antrum and pyloric canal. The
body of stomach ends in antrum. Junction between body and antrum is marked
by an angular notch called incisura angularis. Antrum is continued as the
narrow canal, which is called pyloric canal or pyloric end. Pyloric canal opens
into first part of small intestine called duodenum. The opening of pyloric canal
is guarded by a sphincter called pyloric sphincter. It opens towards duodenum.
Stomach has two curvatures. One on the right side is lesser curvature and the
other on left side is greater curvature.

Within the abdominal cavity, the esophagus enters the stomach. This is a
dilated area of the alimentary canal that participates in both mechanical and
chemical digestion. It is divided into four main parts, namely the:

 fundus
 body
 antrum
 pylorus

STRUCTURE OF STOMACH WALL Stomach wall is formed by four layers

of structures:

1. Outer serous layer: Formed by peritoneum

2. Muscular layer: Made up of three layers of smooth muscle fibers, namely

inner oblique, middle circular and outer longitudinal layers

3. Submucus layer: Formed by areolar tissue, blood vessels, lymph vessels and
Meissner nerve plexus.

4. Inner mucus layer: Lined by mucussecreting columnar epithelial cells. The

gastric glands are situated in this layer. Under resting conditions, the mucosa of
the stomach is thrown into many folds. These folds are called rugae. The rugae
disappear when the stomach is distended after meals. Throughout the inner
mucus layer, small depressions called gastric pits are present. Glands of the
stomach open into these pits. Inner surface of mucus layer is covered by 2 mm
thick mucus.
Glands Of Stomach – Gastric Glands Glands of the stomach or gastric glands
are tubular structures made up of different types of cells. These glands open into
the stomach cavity via gastric pits.

Classification Of Glands Of The Stomach Gastric glands are classified into

three types, on the basis of their location in the stomach:

1. Fundic glands or main gastric glands or oxyntic glands: Situated in body

and fundus of stomach 2. Pyloric glands: Present in the pyloric part of the
stomach 3. Cardiac glands: Located in the cardiac region of the stomach.

Functions Of Gastric Glands Function of the gastric gland is to secrete gastric

juice.

Composition Of Gastric Juice Gastric juice contains 99.5% of water and

0.5% solids. Solids are organic and inorganic substances.

FUNCTIONS OF GASTRIC JUICE „

1. Digestive Function Gastric juice acts mainly on proteins. Proteolytic

enzymes of the gastric juice are pepsin and rennin . Gastric juice also contains
some other enzymes like gastric lipase, gelatinase, urase and gastric amylase.

Pepsin Pepsin is secreted as inactive pepsinogen. Pepsinogen is converted into

pepsin by hydrochloric acid. Action of pepsin Pepsin converts proteins into
proteoses, peptones and polypeptides. Pepsin also causes curdling and digestion
of milk (casein).

Gastric Lipase Gastric lipase is a weak lipolytic enzyme when compared to

pancreatic lipase. It is active only when the pH is between 4 and 5 and becomes
inactive at a pH below

Protective Function – Function Of MucuS Mucus is a mucoprotein,

secreted by mucus neck cells of the gastric glands and surface mucus cells in
fundus, body and other parts of stomach. It protects the gastric wall by the
following ways: Mucus: i. Protects the stomach wall from irritation or
mechanical injury, by virtue of its high viscosity. ii. Prevents the digestive
action of pepsin on the wall of the stomach, particularly gastric mucosa

Functions Of Hydrochloric Acid Hydrochloric acid is present in the gastric

juice: i. Activates pepsinogen into pepsin ii. Kills some of the bacteria entering
the stomach along with food substances. This action is called bacteriolytic
action iii. Provides acid medium, which is necessary for the action of hormones.

Digestive enzymes of gastric juice Enzyme Activator Substrate End products

Pepsin Hydrochloric acid Proteins Proteoses, peptones and polypeptides Gastric
lipase Acid medium Triglycerides of butter Fatty acids and glycerols Gastric
amylase Acid medium Starch Dextrin and maltose (negligible action)
Gelatinase Acid medium Gelatin and collagen of meat Peptides Urase Acid
medium Urea Ammonia

FUNCTIONS OF STOMACH

1. Mechanical Function i. Storage Function Food is stored in the stomach for

a long period, i.e. for 3 to 4 hours and emptied into the intestine slowly. The
maximum capacity of stomach is up to 1.5 L. Slow emptying of stomach
provides enough time for proper digestion and absorption of food substances in
the small intestine.

ii. Formation of Chyme Peristaltic movements of stomach mix the bolus with
gastric juice and convert it into the semisolid material known as chyme.

2. Digestive Function

3. Protective Function

4. Excretory Function Many substances like toxins, alkaloids and metals are
excreted through gastric juice.
Applied Physiology

1. Gastritis Inflammation of gastric mucosa is called gastritis. It may be acute

or chronic. Acute gastritis is characterized by inflammation of superficial layers
of mucus membrane and infiltration with leukocytes, mostly neutrophils.
Chronic gastritis involves inflammation of even the deeper layers and
infiltration with more lymphocytes. It results in the atrophy of the gastric
mucosa, with loss of chief cells and parietal cells of glands. Therefore, the
secretion of gastric juice decreases.

Causes of Gastritis i. Infection with bacterium Helicobacter pylori ii. Excess

consumption of alcohol iii. Excess administration of Aspirin and other
nonsteroidal antiinflammatory drugs (NSAIDs) iv. Trauma by nasogastric tubes
v. Repeated exposure to radiation (rare).

2. Gastric Atrophy Gastric atrophy is the condition in which the muscles of

the stomach shrink and become weak. Gastric glands also shrink, resulting in
the deficiency of gastric juice.

Causes: Gastric atrophy is caused by chronic gastritis called chronic atrophic

gastritis. There is atrophy of gastric mucosa including loss of gastric glands.

3. Peptic Ulcer Ulcer means the erosion of the surface of any organ due to
shedding or sloughing of inflamed necrotic tissue that lines the organ. Peptic
ulcer means an ulcer in the wall of stomach or duodenum, caused by digestive
action of gastric juice. If peptic ulcer is found in stomach, it is called gastric
ulcer and if founfound in duodenum, it is called duodenal ulcer

Causes i. Increased peptic activity due to excessive secretion of pepsin in

gastric juice ii. Hyperacidity of gastric juice iii. Reduced alkalinity of duodenal
content iv. Decreased mucin content in gastric juice or decreased protective
activity in stomach or duodenum v. Constant physical or emotional stress vi.
Food with excess spices or smoking (classical causes of ulcers) v ii. Longterm
use of NSAIDs (see above) such as Aspirin, Ibuprofen and Naproxen viii.
Chronic inflammation due to Helicobacter pylori.
Features Most common feature of peptic ulcer is severe burning pain in
epigastric region. In gastric ulcer, pain occurs while eating or drinking. In
duodenal ulcer, pain is felt 1 or 2 hours after food intake and during night. Other
symptoms accompanying pain are: i. Nausea ii. Vomiting iii. Hematemesis
(vomiting blood) iv. Heartburn (burning pain in chest due to regurgitation of
acid from stomach into esophagus) v. Anorexia (loss of appetite) vi. Loss of
weight.

4. Zollinger-Ellison Syndrome ZollingerEllison syndrome is characterized by

secretion of excess hydrochloric acid in the stomach.

Causes This disorder is caused by tumor of pancreas. Pancreatic tumor

produces a large quantity of gastrin. Gastrin increases the hydrochloric acid
secretion in stomach by stimulating the parietal cells of gastric glands.

Features i. Abdominal pain ii. Diarrhea (frequent and watery, loose bowel
movements) iii. Difficulty in eating iv. Occasional hematemesis.

FUNCTIONAL ANATOMY OF SMALL INTESTINE:

Small intestine is the part of gastrointestinal (GI) tract, extending between the
pyloric sphincter of stomach and ileocecal valve, which opens into large
intestine. It is called small intestine because of its small diameter, compared to
that of the large intestine. But it is longer than large intestine. Its length is about
6 meter. Important function of small intestine is absorption. Maximum
absorption of digested food products takes place in small intestine. Small
intestine consists of three portions:

1. Proximal part known as duodenum

2. Middle part known as jejunum

3. Distal part known as ileum. Wall of the small intestine has all the four layers
as in stomach
a. The duodenum marks the beginning of the small intestines.

It is roughly 20 – 25 cm long, extending from the pylorus to the ligament of

Treitz. Not only is the duodenum the shortest part of the small intestines, but it
is also the widest.

It can be subdivided into four parts based on its geometrical orientation.

The first part is known as pars superioris (the superior part); it is roughly 2 – 3
cm long and travels above the head of the pancreas. The second part is pars
descendens which commences behind the neck of the gallbladder. It travels
about 8 – 10 cm lateral to the head to the pancreas.

The inferior duodenal flexure (where pars descendens begins to turn) marks the
transition of the second part of the duodenum to the third part – pars
horizontalis. It travels for roughly 10 cm before it begins to curve upwards into
the final segment of the duodenum, the pars ascendens (which is only 2.5 cm
long).

b. Jejunum

The transition from the duodenum to jejunum occurs at the ligament of Treitz.
The difference in the luminal diameter of the jejunum and duodenum is an
important distinguishing feature. The duodenum is significantly wider than the
jejunum.

However, it may be more challenging to distinguish between the jejunum and

ileum as there are no external anatomical landmarks to guide. The key
distinguishing features are as follows:

 The external diameter of the jejunum (4 cm) is greater than that of the ileum
(3.5 cm).
 The internal diameter of the ileum (2 cm) is also smaller than that of the
jejunum (2.5 cm).
 The walls of the jejunum appear thicker than that of the ileum.
 Additionally, the jejunum appears more hyperaemic than the ileum because it
has a more extensive vascular supply.
 The luminal surface of the jejunum is significantly folded into plicae
circulares that are more numerous and appear deeper than anywhere else
within the digestive tract. Furthermore, the plicae circulares become less
abundant distally within the ileum.
 Finally, the luminal mucosa of the ileum has more prominent mucosa-
associated lymphoid tissue (MALT) than the jejunum.

c. The ileum terminates at the ileocecal valve; which marks the

transition from the small intestines to the large intestines. The
ileocecal valve is a one way structure that prevents reflux of the
bolus from the large intestines to the small intestines.

Intestinal Villi And Glands Of Small Intestine:

Intestinal Villi: Mucous membrane of small intestine is covered by minute

projections called villi. The height of villi is about 1 mm and the diameter is less
than 1 mm. Villi are lined by columnar cells, which are called enterocytes. Each
enterocyte gives rise to hair-like projections called microvilli. Villi and
microvilli increasethe surface area of mucous membrane by many folds. Within
each villus, there is a central channel called lacteal, which opens into lymphatic
vessels. It contains blood vessels also

Epithelial cells lining the intestinal glands undergo division by mitosis at a

faster rate. Newly formed cells push the older cells upward over the lining of
villi. These cells which move to villi are called enterocytes. Enterocytes secrete
the enzymes. Old enterocytes are continuously shed into lumen along with
enzymes. Types of cells interposed between columnar cells of intestinal glands:
1. Argentaffin cells or enterochromaffin cells, which secrete intrinsic factor of
Castle 2. Goblet cells, which secrete mucus 3. Paneth cells, which secrete the
cytokines called defensins.

Properties And Composition Of Succus Entericus Secretion from small

intestine is called succus entericus.

Composition Of Succus Entericus Succus entericus contains water (99.5%)

and solids (0.5%). Solids include organic and inorganic substances. Bicarbonate
concentration is slightly high in succus entericus.
Functions Of Succus Entericus „

1. Digestive Function Enzymes of succus entericus act on the partially

digested food and convert them into final digestive products. Enzymes are
produced and released into succus entericus by enterocytes of the villi.

Proteolytic Enzymes Proteolytic enzymes present in succus entericus are the

peptidases, which are given in Fig. 41.2. These peptidases convert peptides into
amino acids.

Lactase, sucrase and maltase convert the disaccharides (lactose, sucrose and
maltose) into two molecules of monosaccharides. Dextrinase converts dextrin,
maltose and maltriose into glucose. Trehalase or trehalose glucohydrolase
causes hydrolysis of trehalose (carbohydrate present in mushrooms and yeast)
and converts it into glucose. Lipolytic Enzyme Intestinal lipase acts on
triglycerides and converts them into fatty acids.

2. Protective Function i. Mucus present in the succus entericus protects the

intestinal wall from the acid chyme, which enters the intestine from stomach;
thereby it prevents the intestinal ulcer. ii. Defensins secreted by paneth cells of
intestinal glands are the antimicrobial peptides. These peptides are called
natural peptide antibiotics because of their role in killing the phagocytosed
bacteria.

3. Activator Function Enterokinase present in intestinal juice activates

trypsinogen into trypsin. Trypsin, in turn activates other enzymes .

4. Hemopoietic Function Intrinsic factor of Castle present in the intestine plays

an important role in erythropoiesis. It is necessary for the absorption of vitamin
B12.

Functions Of Small Intestine „

1. Mechanical Function Mixing movements of small intestine help in the

thorough mixing of chyme with the digestive juices like succus entericus,
pancreatic juice and bile.
 2. Secretory Function Small intestine secretes succus entericus, enterokinase
and the GI hormones.

3. Hormonal Function Small intestine secretes many GI hormones such as

secretin, cholecystokinin, etc. These hormones regulate the movement of GI
tract and secretory activities of small intestine and pancreas

4. Digestive Function

Applied Physiology

1. Malabsorption Malabsorption is the failure to absorb nutrients such as

proteins, carbohydrates, fats and vitamins. Malabsorption affects growth and
development of the body. It also causes specific diseases

2. Malabsorption Syndrome Malabsorption syndrome is the condition

characterized by the failure of digestion and absorption in small intestine.
Malabsorption syndrome is generally caused by Crohn’s disease, tropical sprue,
steatorrhea and celiac disease.

3. Crohn’s Disease Or Enteritis Enteritis is an inflammatory bowel disease

(IBD), characterized by inflammation of small intestine. Usually, it affects the
lower part of small intestine, the ileum. The inflammation causes malabsorption
and diarrhea.

Causes Crohn’s disease develops because of abnormalities of the immune

system. The immune system reacts to a virus or a bacterium, resulting in
inflammation of the intestine.

Features i. Malabsorption of vitamin ii. Weight loss iii. Abdominal pain iv.
Diarrhea v. Rectal bleeding, anemia and fever vi. Delayed or stunted growth in
children.
LARGE INTESTINE

FUNCTIONAL ANATOMY OF LARGE INTESTINE

Large intestine or colon extends from ileocecal valve up to anus

Parts Of Large Intestine Large intestine is made up of the following parts:

1. Cecum with appendix

2. Ascending colon

3. Transverse colon

4. Descending colon

5. Sigmoid colon or pelvic colon

6. Rectum

7. Anal canal.

The proximal end of the large intestines – also known as the colon – is formed
by a dilated cul-de-sac known as the cecum. There is also a vermiform appendix
attached at variable parts of the cecum.

The colon is divided into:

 ascending
 transverse
 descending
 sigmoid parts
Externally, the colon has a segmented appearance due to the haustrations that
are present on the luminal surface of the conduit. The muscular layers of the
colon are concentrated into three muscular bands known as taenia coli; which
travel along the length of the colon. The three taenia are:

 Taenia libera is the free taenia that is found at the antimesenteric surface of
the colon; which is located on the anterior surface of the colon.
 Taenia omentalis is located posterolaterally and is attached to the omentum
of the large intestines.
 Taenia mesocolic is found at the midpoint between the taenia libera and the
mesenteric attachment on the colon.

Importantly, the cecum does not have the prominent haustrations seen on the
rest of the colon. As the ascending colon travels from the right iliac fossa
superiorly, it transitions to the transverse colon at the hepatic (right colic)
flexure. The transverse colon travels across from the left to the right
hypochondriac regions. It turns caudally at the splenic (left colic) flexure to
form the descending colon. As the descending colon travels from the left
hypochondrium to the left iliac fossa, it transitions into the sigmoid colon. This
distal segment enters the pelvic inlet and terminates at the rectosigmoid junction
at the level of the third sacral vertebra (S3).

Rectum

Unlike the preceding colon, the rectum is circumferentially walled by smooth

muscles. It does not have haustrations and is devoid of taenia coli. This distal
continuation of the large intestines functions of a reservoir for stool, prior to
excretion. It terminates at the level of the sacrococcygeal curvature. It passes
over the pelvic diaphragm to form the anorectal junction.

Anal canal

The final passageway through which undigested food and exfoliated mucosa
will exit the body is called the anal canal. It continues from the anorectal
junction and passes through the loop formed by the puborectalis muscle, which
swings the anal canal anteriorly. Distally, the mucosa of the anal canal
transitions from the columnar epithelium with goblet cells found throughout the
colon, to the squamous epithelium of the perianal skin. This point is referred to
as the anal verge.
Structure Of Wall Of Large Intestine: Wall of large intestine is formed by
four layers of structures like any other part of the gut.

1. Serous layer: It is formed by peritoneum

2. Muscular layer: Smooth muscles of large intestine are distributed in two

layers, namely the outer longitudinal layer and inner circular layer. The
longitudinal muscle fibers of large intestine are arranged in the form of three
long bands called tenia coli. The length of the tenia coli is less when compared
to the length of large intestine. Because of this, the large intestine is made into
series of pouches called haustra

3. Submucus layer: It is not well developed in large intestine 4. Mucus layer:

The crypts of Leiberkühn are present in mucosa of large intestine. But the villi,
which are present in mucus membrane of small intestine, are absent in the large
intestine. Only mucus-secreting glands are present in the mucosa of large
intestine

Functions Of Large Intestine „

1. Absorptive Function Large intestine plays an important role in the

absorption of various substances such as: i. Water ii. Electrolytes iii. Organic
substances like glucose iv. Alcohol v. Drugs like anesthetic agents, sedatives
and steroids.

2. Formation Of Feces After the absorption of nutrients, water and other

substances, the unwanted substances in the large intestine form feces. This is
excreted out.

3. Excretory Function Large intestine excretes heavy metals like mercury,

lead, bismuth and arsenic through feces.

4. Secretory Function Large intestine secretes mucin and inorganic substances

like chlorides and bicarbonates.
5. Synthetic Function Bacterial flora of large intestine synthesizes folic acid,
vitamin B12 and vitamin K. By this function, large intestine contributes in
erythropoietic activity and blood clotting mechanism.

Applied Physiology

DIARRHEA Diarrhea is the frequent and profuse discharge of intestinal

contents in loose and fluid form. It occurs due to the increased movement of
intestine. It may be acute or chronic.

Causes: Normally, when digested food passes through colon, large portion of
fluid is absorbed and only a semisolid stool remains. In diarrhea, the fluid is not
absorbed sufficiently, resulting in watery bowel discharge. Acute diarrhea may
be caused by temporary problems like infection and chronic diarrhea may be
due to disorders of intestinal mucosa. Thus, the general causes of diarrhea are:

APPENDICITIS Inflammation of appendix is known as appendicitis.

Appendix is a small, worm-like appendage, projecting from cecum of ascending
colon. It is situated on the lower right side of the abdomen. Appendix does not
have any function in human beings. But, it can create major problems when
diseased. Appendicitis can develop at any age. However, it is very common
between 10 and 30 years of age.

Causes: The cause for appendicitis is not known. It may occur by bacterial or
viral infection. It also occurs during blockage of connection between appendix
and large intestine by feces, foreign body or tumor.

Features 1. Main symptom of appendicitis is the pain, which starts around the
umbilicus and then spreads to the lower right side of the abdomen. It becomes
severe within 6 to 12 hours 2. Nausea 3. Vomiting 4. Constipation or diarrhea 5.
Difficulty in passing gas 6. Low fever 7. Abdominal swelling 8. Loss of
appetite.

If not treated immediately, the appendix may rupture and the inflammation will
spread to the whole body, leading to severe complications, sometimes even
death. Therefore, the treatment of appendicitis is considered as an emergency.
Usual standard treatment for appendicitis is appendectomy (surgical removal of
appendix).

ULCERATIVE COLITIS Ulcerative colitis is an inflammatory bowel

disease (IBD), characterized by the inflammation and ulcerative aberrations in
the wall of the large intestine. It is also known as colitis or proctitis. Rectum and
lower part of the colon are commonly affected. Sometimes, the entire colon is
affected. Ulcerative colitis can occur at any age. More commonly, it affects
people in the age group of 15 to 30 years. Rarely it affects 50 to 70 years old
people.
MOVEMENTS OF GASTROINTESTINAL TRACT

1. MASTICATION Mastication or chewing is the first mechanical process in

the gastrointestinal (GI) tract, by which the food substances are torn or cut into
small particles and crushed or ground into a soft bolus.

Significances Of Mastication

1. Breakdown of foodstuffs into smaller particles

2. Mixing of saliva with food substances thoroughly

3. Lubrication and moistening of dry food by saliva, so that the bolus can be
easily swallowed

4. Appreciation of taste of the food.

Muscles And The Movements Of Mastication

Muscles of Mastication 1. Masseter muscle 2. Temporal muscle 3. Pterygoid

muscles 4. Buccinator muscle.

Movements of Mastication 1. Opening and closure of mouth 2. Rotational

movements of jaw 3. Protraction and retraction of jaw.

Control Of Mastication Action of mastication is mostly a reflex process. It is

carried out voluntarily also. The center for mastication is situated in medulla
and cerebral cortex. Muscles of mastication are supplied by mandibular division
of 5th cranial (trigeminal) nerve.

2.DEGLUTITION Deglutition or swallowing is the process by which food

moves from mouth into stomach.
Stages of Deglutition Deglutition occurs in three stages:

I. Oral stage, when food moves from mouth to pharynx

II. II. Pharyngeal stage, when food moves from pharynx to
esophagus
III. III. Esophageal stage, when food moves from esophagus
to stomach.

Oral Stage Or First Stage Oral stage of deglutition is a voluntary stage. In this
stage, the bolus from mouth passes into pharynx by means of series of actions

Pharyngeal Stage Or Second Stage Pharyngeal stage is an involuntary stage.

In this stage, the bolus is pushed from pharynx into the esophagus. Pharynx is a
common passage for food and air. It divides into larynx and esophagus. Larynx
lies anteriorly and continues as respiratory passage. Esophagus lies behind the
larynx and continues as GI tract. Since pharynx communicates with mouth,
nose, larynx and esophagus, during this stage of deglutition, bolus from the
pharynx can enter into four paths: 1. Back into mouth 2. Upward into
nasopharynx 3. Forward into larynx 4. Downward into esophagus.
However, due to various coordinated movements, bolus is made to enter only
the esophagus

Esophageal Stage Or Third Stage Esophageal stage is also an involuntary

stage. In this stage, food from esophagus enters the stomach. Esophagus forms
the passage for movement of bolus from pharynx to the stomach. Movements of
esophagus are specifically organized for this function and the movements are
called peristaltic waves. Peristalsis means a wave of contraction, followed by
the wave of relaxation of muscle fibers of GI tract, which travel in aboral
direction (away from mouth). By this type of movement, the contents are
propelled down along the GI tract. When bolus reaches the esophagus, the
peristaltic waves are initiated. Usually, two types of peristaltic contractions are
produced in esophagus. 1. Primary peristaltic contractions 2. Secondary
peristaltic contractions.

After origin, the peristaltic contractions pass down through the rest of the
esophagus, propelling the bolus towards stomach. Pressure developed during
the primary peristaltic contractions is important to propel the bolus. Initially, the
pressure becomes negative in the upper part of esophagus. This is due to the
stretching of the closed esophagus by the elevation of larynx. But immediately,
the pressure becomes positive and increases up to 10 to 15 cm of H2O. 2.
Secondary Peristaltic Contractions If the primary peristaltic contractions are
unable to propel the bolus into the stomach, the secondary peristaltic
contractions appear and push the bolus into stomach. Secondary peristaltic
contractions are induced by the distention of upper esophagus by the bolus.
After origin, these contractions pass down like the primary contractions,
producing a positive pressure.

3.MOVEMENTS OF STOMACH Activities of smooth muscles of stomach

increase during gastric digestion (when stomach is filled with food) and when
the stomach is empty.

Types of movements in stomach 1. Hunger contractions 2. Receptive

relaxation 3. Peristalsis.

1. hunger contractions Hunger contractions are the movements of empty

stomach. These contractions are related to the sensations of hunger. Hunger
contractions are the peristaltic waves superimposed over the contractions of
gastric smooth muscle as a whole. This type of peristaltic waves is different
from the digestive peristaltic contractions. The digestive peristaltic contractions
usually occur in body and pyloric parts of the stomach. But, peristaltic
contractions of empty stomach involve the entire stomach. Hunger contractions
are of three types :type 1, type 11 and type 111

2. Receptive Relaxation Receptive relaxation is the relaxation of the upper

portion of the stomach when bolus enters the stomach from esophagus. It
involves the fundus and upper part of the body of stomach. Its significance is to
accommodate the food easily, without much increase in pressure inside the
stomach. This process is called accommodation of stomach.

3. Peristalsis When food enters the stomach, the peristaltic contraction or

peristaltic wave appears with a frequency of 3 per minute. It starts from the
lower part of the body of stomach, passes through the pylorus till the pyloric
sphincter. Initially, the contraction appears as a slight indentation on the greater
and lesser curvatures and travels towards pylorus. The contraction becomes
deeper while traveling. Finally, it ends with the constriction of pyloric sphincter.
Some of the waves disappear before reaching the sphincter. Each peristaltic
wave takes about one minute to travel from the point of origin to the point of
ending. This type of peristaltic contraction is called digestive peristalsis because
it is responsible for the grinding of food particles and mixing them with gastric
juice for digestive activities.

4.FILLING AND EMPTYING OF STOMACH

Filling Of Stomach While taking food, it arranges itself in the stomach in

different layers. The first eaten food is placed against the greater curvature in
the fundus and body of the stomach. The successive layers of food particles lie
nearer, the lesser curvature, until the last portion of food eaten lies near the
upper end of lesser curvature, adjacent to cardiac sphincter. The liquid remains
near the lesser curvature and flows towards the pyloric end of the stomach along
a V-shaped groove. This groove is formed by the smooth muscle and it is called
magenstrasse. But, if a large quantity of fluid is taken, it flows around the entire
food mass and is distributed over the interior part of stomach, between wall of
the stomach and food mass.

Emptying Of Stomach Gastric emptying is the process by which the chyme

from stomach is emptied into intestine. Food that is swallowed enters the
stomach and remains there for about 3 hours. During this period, digestion takes
place. Partly digested food in stomach becomes the chyme.

Chyme Chyme is the semisolid mass of partially digested food that is formed in
the stomach. It is acidic in nature. Acid chyme is emptied from stomach into the
intestine slowly, with the help of peristaltic contractions. It takes about 3 to 4
hours for emptying of the chyme. This slow emptying is necessary to facilitate
the final digestion and maximum (about 80%) absorption of the digested food
materials from small intestine. Gastric emptying occurs due to the peristaltic
waves in the body and pyloric part of the stomach and simultaneous relaxation
of pyloric sphincter. Gastric emptying is influenced by various factors of the
gastric content and food.

5. VOMITING Vomiting or emesis is the abnormal emptying of stomach and

upper part of intestine through esophagus and mouth.

Causes Of Vomiting 1. Presence of irritating contents in GI tract 2. Mechanical

stimulation of pharynx 3. Pregnancy 4. Excess intake of alcohol 5. Nauseating
sight, odor or taste 6. Unusual stimulation of labyrinthine apparatus, as in the
case of sea sickness, air sickness, car sickness or swinging 7. Abnormal
stimulation of sensory receptors in other organs like kidney, heart, semicircular
canals or uterus 8. Drugs like antibiotics, opiates, etc. 9. Any GI disorder 10.
Acute infection like urinary tract infection, influenza, etc. 11. Metabolic
disturbances like carbohydrate starvation and ketosis (pregnancy), uremia,
ketoacidosis (diabetes) and hypercalcemia.

Mechanism Of Vomiting

1. Nausea Vomiting is always preceded by nausea. Nausea is unpleasant

sensation which induces the desire for vomiting. It is characterized by secretion
of large amount of saliva containing more amount of mucus.

2. Retching Strong involuntary movements in the GI tract which start even

before actual vomiting. These movements intensify the feeling of vomiting.
This condition is called retching (try to vomit) and vomiting occurs few minutes
after this.

Act of Vomiting

Act of vomiting involves series of movements that takes place in GI tract.

Sequence of events:

1. Beginning of antiperistalsis, which runs from ileum towards the mouth

through the intestine, pushing the intestinal contents into the stomach within
few minutes. Velocity of the antiperistalsis is about 2 to 3 cm/second

2. Deep inspiration followed by temporary cessation of breathing

3.Closure of glottis

4. Upward and forward movement of larynx and hyoid bone

5. Elevation of soft palate

6. Contraction of diaphragm and abdominal muscles with a characteristic jerk,
resulting in elevation of intra-abdominal pressure

7. Compression of the stomach between diaphragm and abdominal wall leading

to rise in intragastric pressure

8. Simultaneous relaxation of lower esophageal sphincter, esophagus and upper

esophageal sphincter

9. Forceful expulsion of gastric contents (vomitus) through esophagus, pharynx

and mouth. Movements during act of vomiting throw the vomitus (materials
ejected during vomiting) to the exterior through mouth. Some of the movements
play important roles by preventing the entry of vomitus through other routes and
thereby prevent the adverse effect of the vomitus on many structuresDuodenum

6.MOVEMENTS OF SMALL INTESTINE Movements of small intestine are

essential for mixing the chyme with digestive juices, propulsion of food and
absorption.

Types of Movements of Small Intestine: 1. Mixing movements: i.

Segmentation movements ii. Pendular movements. 2. Propulsive
movements: i. Peristaltic movements ii. Peristaltic rush. 3. Peristalsis in
fasting – migrating motor complex 4. Movements of villi.

1. MIXING MOVEMENTS Mixing movements of small intestine are

responsible for proper mixing of chyme with digestive juices such as pancreatic
juice, bile and intestinal juice. The mixing movements of small intestine are
segmentation contractions and pendular movements.

2. PROPULSIVE MOVEMENTS Propulsive movements are the movements

of small intestine which push the chyme in the aboral direction through
intestine. The propulsive movements are peristaltic movements and peristaltic
rush.

3. PERISTALSIS IN FASTING – MIGRATING MOTOR COMPLEX

Migrating motor complex is a type of peristaltic contraction, which occurs in
stomach and small intestine during the periods of fasting for several hours. It is
also called migrating myoelectric complex. It is different from the regular
peristalsis because, a large portion of stomach or intestine is involved in the
contraction. The contraction extends to about 20 to 30 cm of stomach or
intestine. This type of movement occurs once in every 1½ to 2 hours. It starts as
a moderately active peristalsis in the body of stomach and runs through the
entire length of small intestine. It travels at a velocity of 6 to 12 cm/min. Thus,
it takes about 10 minutes to reach the colon after taking origin from the
stomach.

ORGANS OF THE ACCESSORY DIGESTIVE SYSTEM

a. Salivary glands

The organs of the accessory digestive system have the principal role of
synthesizing and secreting digestive enzymes to further break down food into
nutrients. The salivary glands are paired structures in the oral cavity that secrete
saliva and other enzymes that mix with the masticated food to form the bolus.
There are three major salivary glands in the oral cavity:

 Parotid glands
 Submandibular glands
 Sublingual glands

b. Liver

Another important accessory digestive organ is the liver. It is located in the right
upper quadrant of the abdomen, beneath the right hemidiaphragm. The liver has
two anatomical lobes, but eight functional segments. In addition to producing
bile to digest fats, all of the nutrients absorbed from the small intestines enter
the liver via the hepatic portal venous system.

c. Gallbladder

From the liver, the nutrients are integrated into various catabolic processes and
sent throughout the body. Most of the bile made by the liver is stored in the
gallbladder. This muscular, sac-like organ that resides on the posterior surface
of the liver drains its contents into the extrahepatic biliary tree following a fatty
meal.
 d. Pancreas

Finally, the pancreas is a retroabdominal organ that also provides enzymes for
digestion. The head of the pancreas is found within the C-shaped loop of the
duodenum. The body extends superolaterally, behind the gastric antrum. The
tail of the pancreas terminates at the hilum of the spleen.

NEUROVASCULAR SUPPLY AND VENOUS DRAINAGE

Arterial supply

The vast majority of the digestive system is supplied by the abdominal aorta. In
the abdominal cavity, the aorta gives off three major branches that, in
succession, supply the derivatives of the foregut, midgut and hindgut:

 Celiac trunk, which after a short course further splits three into major
branches; left gastric, common hepatic and splenic arteries. Via these
branches, the celiac trunk supplies the foregut, including the abdominal part
of the esophagus, stomach, upper 1/3 of the duodenum, liver, spleen, and
pancreas.
 Superior mesenteric artery, which gives off the inferior pancreaticoduodenal,
middle colic, right colic, ileocolic arteries, jejunal and ileal branches, and the
marginal artery of Drummond. These branches supply the midgut, which
includes the distal 2/3 of the duodenum, jejunum, ileum, cecum, appendix,
ascending colon and proximal 1/3 of the transverse colon.
 Inferior mesenteric artery, which gives off the left colic, sigmoid, and
superior rectal arteries. These branches provide blood to the hindgut,
supplying the distal 1/3 of the transverse colon, descending colon, sigmoid
colon, rectum and anus.

Innervation

The digestive system receives both sympathetic and parasympathetic

innervation. Sympathetic innervation stems from the abdominopelvic
splanchnic nerves. These nerves arise from the sympathetic trunk and include
the thoracic and lumbar splanchnic nerves. The splanchnic nerves synapse with
prevertebral ganglia (celiac, aorticorenal, superior mesenteric, and inferior
mesenteric ganglia) which project postganglionic fibers to innervate the organs
of the digestive system. Sympathetic innervation inhibits peristalsis, constricts
blood vessels and redirects blood from the digestive system to the skeletal
muscles and contracts the anal sphincters.

The parasympathetic supply to the digestive system stems from the vagus nerve
(CN X) and pelvic splanchnic nerves. The vagus nerve supplies the digestive
tract from the esophagus to the transverse colon, while the pelvic splanchnic
nerves supply the descending colon, sigmoid colon and rectum.
Parasympathetic innervation increases peristalsis, promotes secretion of
digestive juices, relaxes the internal anal sphincter and contracts the rectum.

Venous drainage

There are two venous systems that drain the organs of the digestive tract; portal
venous system and the systemic venous system.

In the portal venous system, the nutrient-rich blood from the digestive tract is
drained by the hepatic portal vein into the liver to be filtered and detoxified. The
hepatic portal vein is formed by the merger of the superior mesenteric vein and
the splenic vein.

After being processed by the liver, the blood is carried into the systemic venous
system by the hepatic veins, which drain into the inferior vena cava.

Conditions and Disorders

What are some common conditions that affect the digestive system?

There are temporary conditions and long-term, or chronic, diseases and

disorders that affect the digestive system. It’s common to have conditions such
as constipation, diarrhea or heartburn from time to time. If you are experiencing
digestive issues like these frequently, be sure to contact your healthcare
professional. It could be a sign of a more serious disorder that needs medical
attention and treatment.

Short-term or temporary conditions that affect the digestive system include:

 Constipation: Constipation generally happens when you go poop (have a bowel
movement) less frequently than you normally do. When you’re constipated,
your poop is often dry and hard and it’s difficult and painful for your poop to
pass.
 Diarrhea: Diarrhea is when you have loose or watery poop. Diarrhea can be
caused by many things, including bacteria, but sometimes the cause is unknown.
 Heartburn: Although it has “heart” in its name, heartburn is actually a digestive
issue. Heartburn is an uncomfortable burning feeling in your chest that can
move up your neck and throat. It happens when acidic digestive juices from
your stomach go back up your esophagus.
 Hemorrhoids: Hemorrhoids are swollen, enlarged veins that form inside and
outside of your anus and rectum. They can be painful, uncomfortable and cause
rectal bleeding.
 Stomach flu (gastroenteritis): The stomach flu is an infection of the stomach and
upper part of the small intestine usually caused by a virus. It usually lasts less
than a week. Millions of people get the stomach flu every year.
 Ulcers: An ulcer is a sore that develops on the lining of the esophagus, stomach
or small intestine. The most common causes of ulcers are infection with a
bacteria called Helicobacter pylori (H. pylori) and long-term use of anti-
inflammatory drugs such as ibuprofen.
 Gallstones: Gallstones are small pieces of solid material formed from digestive
fluid that form in your gallbladder, a small organ under your liver.

Common digestive system diseases (gastrointestinal diseases) and disorders

include:

 GERD (chronic acid reflux): GERD (gastroesophageal reflux disease, or

chronic acid reflux) is a condition in which acid-containing contents in your
stomach frequently leak back up into your esophagus.
 Irritable bowel syndrome (IBS): IBS is a condition in which your colon muscle
contracts more or less often than normal. People with IBS experience excessive
gas, abdominal pain and cramps.
 Lactose intolerance: People with lactose intolerance are unable to digest lactose,
the sugar primarily found in milk and dairy products.
 Diverticulosis and diverticulitis: Diverticulosis and diverticulitis are two
conditions that occur in your large intestine (also called your colon). Both share
the common feature of diverticula, which are pockets or bulges that form in the
wall of your colon.
 Cancer: Cancers that affect tissues and organs in the digestive system are called
gastrointestinal (GI) cancers. There are multiple kinds of GI cancers. The most
common digestive system cancers include esophageal cancer, gastric (stomach)
cancer, colon and rectal (colorectal) cancer, pancreatic cancer and liver cancer.
 Crohn’s disease: Crohn’s disease is a lifelong form of inflammatory bowel
disease (IBD). The condition irritates the digestive tract.
 Celiac disease: Celiac disease is an autoimmune disorder that can damage your
small intestine. The damage happens when a person with celiac disease
consumes gluten, a protein found in wheat, barley and rye.