The Digestive System

Gastroenterology study of the stomach & intestines

Gastrointestinal (GI) Tract

Tube that includes: Mouth, Pharynx, Esophagus, Stomach, Small intestine, Large intestine As you take a bite of food, what structures and accessories organs will it pass through 5-7 metres of intestines Accessory organs: teeth, tongue, salivary glands, liver, gallbladder, and pancreas

Figure 19.1

Overview- Operations
Ingestion: eating Secretion: release of water, enzymes & buffers Mixing & propulsion: movement along GI tract Digestion: mechanical and chemical breakdown of foods Absorption: getting it into the body enters the epithelial cells that line the hollow tube (lumen) circulate through blood and lymph Defecation: dumping waste products = defecation Feces: Waste products Emesis: Vomiting

Wall Layers- Everywhere

4 layers Just know there are 4 layers
Mucosa- epithelium (mucous membrane), connective layer,
glands, lymphatic nodules, muscularis mucosae

Submucosa- connective tissue, blood vessels, lymphatic

vessels, enteric nervous system

Muscularis- circular layer, longitudinal layer

In mouth, pharynx & upper esophagus skeletal muscle Also in external anal sphincter

Serosa or Visceral peritoneum

Figure 19.2

Peritoneum
Peritoneum-serous membrane
Largest in the body Parietal-lines the wall of the cavity Visceral-covers some of the organs in cavity Contains large folds
5 major folds Greater Omentum

Greater Omentum
Largest peritoneal fold
Covers the transverse colon and small intestine. Contains adipose tissuefatty apron Vascular Lymph nodes

Mouth
Formed by cheeks, hard & soft palate (allows you to chew and breathe at the same time) & tongue Soft palate at back includes a hangy down part = uvula
During swallowing uvula prevents entry into nasal cavity

Tongue - muscular accessory organ

maneuvers food for chewing Adjusts shape for speech & swallowing

Salivary Glands
3 pairs of salivary glands
Ducts empty into oral cavity

Parotid inferior & anterior to ears

Submandibular in floor of mouth, medial & inferior to mandible

Sublingual
Beneath tongue and superior to submandibular

Saliva contains 99.5% water, salivary amylase, mucus and other solutes
Dissolves food & starts digestion of starches

Figure 19.4

Teeth
Accessory organs in bony sockets of mandible & maxilla Primary teeth 4/6 months to a year 3 external regions:
Crown- above gums (visible portion) Root- 1 or more parts embedded in socket Neck between crown and root near gum line

3 layers of material
Enamel- covers crown (hardest substance in the body) Dentin- majority of interior of tooth Pulp cavity - nerve, blood vessel & lymphatic vessels

Figure 19.5

Digestion in the Mouth

Mechanical breakdown- chewing Mixed with saliva by tongue Salivary amylase chemically breaks down polysaccharides (starch) Rounds up food into a soft bolus for swallowing

Pharynx & Esophagus

On swallowing: Bolus of food oropharynx Laryngopharynx esophagus (25cm long)
Muscular contractions in pharynx help

Upper esophageal sphincter

Skeletal muscle controls entry to esophagus Vomiting after eating can mean issue with this structure

Cardiac or Lower esophageal sphincter

Smooth muscle- regulates entry to stomach

Figure 19.6a,b

Swallowing
Voluntary: bolus forced into oropharynx Triggers oropharyngeal stage
Involuntary breathing interrupted Soft palate move up - close nasopharynx Epiglottis seals off larynx Bolus moves into esophagus through UES

Esophageal stage toward stomach

peristalsis moves it

Figure 19.6c

Stomach
J- shaped enlargement of GI tract Serves as mixing chamber and holding reservoir Very elastic & muscular 4 regions
Cardia- surrounds superior opening Fundus- superior & to left of cardia (rounded portion) Body large central portion Pylorus- lower part leading to pyloric sphincter & duodenum

Figure 19.7

Stomach Wall
Mucosa:
Folds called rugae Epithelium- simple columnar-surface mucous cells Gastric glands lining gastric pits

Muscularis- 3 Layers: longitudinal, circular & oblique

Figure 19.8

Digestion & Absorption

Food entry

stretch & rise in pH

Nerve impulses secretion & mixing waves Food mixed with gastric juice Chyme Small amount pushed through pyloric sphincter Gastric emptying- Carb. foods fastest, lipids next & proteins slowest Entry in duodenum feedback inhibition of stomach activity Gastrin needs to be released for digestion to begin

Pepsin digests protein breaks them down into peptides Little absorption- water, ions & some drugs (aspirin) and alcohol.

Pancreas
Behind stomachProduces pancreatic juice in acinar cells (exocrine)
to duodenum via pancreatic duct

NaHCO3 solution (pH 7.1-8.2) 1000ml/day

Neutralize stomach acid and dilutes chyme

Pancreas- digestive enzymes

Pancreatic amylase - starch Pancreatic lipase - fats Nucleotidases RNAase & DNAase

Liver & Gall Bladder

Largest organ after the skin (3 lbs or 1.4 kg) Right hypochondriac region inferior to diaphragm Functional unit is lobule Hepatocytes around central vein Hepatocytes secrete

Bile canaliculi ducts Gall bladder cystic duct

hepatic duct common bile duct

Gall bladder =Pear-shaped organ on front & under liver(stores bile)-anterior inferior margin of liver.

Figure 19.11a

Bile
Bicarbonate, bile salts & waste. 1000 ml/day Important for emulsifying fats Pigment is bilirubin- from broken-down heme during RBC recycling
Digested to strecobilin- brown color in feces

Bile salts reabsorbed at end of small intestineileum Recycle to liver in portal circulation

Figure 19.10

Liver Function
Maintains blood glucose
Stores as glycogen

Uses absorbed sugars & converts amino acids

glucose

Lipid metabolism
Produces cholesterol & triglycerides, makes bile Makes lipoproteins for lipid transport

Excretion of bilirubin Processes drugs and other chemicals Store fat soluble vitamins (A, B12, D, E, K) Make active vitamin D

Small Intestine
3 parts: duodenum, jejunum, ileum Where most of the digestion occurs Essentially all of the nutrient absorption Begins at pyloric sphincter of the stomach and Ends in ileocecal sphincter

Figure 19.12a

Figure 19.12b

Wall Structure
Same 4 layers Epithelial- simple columnar
Absorptive cells with microvilli Goblet cells- secrete mucus

Intestinal glands- intestinal juice & hormones

Secretin, cholecystokinin (CCK), Glucose-dependentinsulinotrophic peptide (GIP)

Lymphatic tissue- defense

Peyers patches and MALT

Wall Structure (Cont.)

Duodenal glands- alkaline mucus
Helps neutralize stomach acid in the chyme

Circular folds- increase surface area Villi- finger like projections of mucosa
Increase surface area for absorption Include lacteals for lipid absorption

Microvilli
Increase surface area for absorption

Figure 19.13

Motility & Secretions

Secretions: alkaline, some enzymes
Peptidases-breaks small peptides Disaccharidases attached to wall Water and salt to balance osmolality ~2000 ml/day

Peristalsis for movement after most absorption completed- slow waves Segmentations-localized mixing contractions

Digestion & Absorption

Chyme enters with partially digested carbohydrates & proteins Bile + pancreatic juice + intestinal juice completes the job Absorption is of monosaccharides; amino acids; phosphate sugar & bases of DNA & RNA; fatty acids & monoglycerides

Large Intestine
Cecum, colon, rectum, anal canal Ileocecal canal large intestine anal canal
Below the cecum is the appendix

rectum

Colon- ascending, transverse, descending & sigmoid Standard 4 layers with mucus secretion
Few folds , little specialization for absorption

Muscularis: circular + bands of longitudinal muscle

Figure 19.15a

Figure 19.16

Digestion & Absorption

Slow emptying of ileum Slow peristalsis Bacterial digestion Produce some B-vitamins & Vit. K Produce gases= flatus Colon absorbs salt & water

Defecation Reflex
Stretch of rectum wall neural reflex contraction of longitudinal muscle (shortens the rectum) Combined pressure (w/in the rectum) + parasympathetic activity relaxing of internal anal sphincter (opens) External anal sphincter is voluntary
Relaxed feces expelled Contracted feces are held

Contraction of diaphragm & abdominal wall muscles aid defecation

Figure 19.15b

Aging
Decreased secretion, motility, strength of responses loss of taste, periodontal disease, hiatal hernia, gastritis & peptic ulcer disease Increased incidence of gall bladder problems, cirrhosis of liver, pancreatitis, constipation, hemorrhoids & diverticulitis

Diarrhea
Diarrhea insufficient removal of water by colon
Result: frequent, watery feces Causes: illness, lactose intolerance, stress, food poisoning Can cause dehydration & electrolyte imbalances

Constipation
Constipation too much water removed by colon-feces remain in the colon for long periods
Result: infrequent, dry, hard feces that are difficult to pass Causes: insufficient fiber or fluids in diet, lack of exercise, stress, drugs Give laxatives, fiber, drink more water

Jaundice
Yellowish color to skin and sclerae (whites of the eyes) caused by a buildup of bilirubin, can indicate liver disease Newborns-liver is not in full functioning capacity and disappears as the liver matures.
Treatment
Expose to light (blue light) Use bililights Converts the bilirubin into a substance that can be excreted by kidneys

Phototherapy or Bililights

Hepatitis
Hepatitis inflammation of the liver Hepatitis A spread by fecal contamination, mild Hepatitis B spread by sexual contact or contaminated blood, can cause cirrhosis or liver cancer Hepatitis C similar to hep. B (but no vaccine) Hepatitis D spread through sexual contact, must also have HepB to get it Hepatitis E Spread like HepA, but doesnt cause damage or cancer

Peptic ulcers
Craterlike lesions (sores) that develop in GI tract; can cause bleeding Causes:
Bacteria (H pylori) NSAIDS (esp. aspirin) Overproduction of HCl

Other disorders
Cirrhosis scarring of the liver
Causes: hepatitis, drugs, alcoholism, parasites

Gallstones can block flow of bile from gallbladder (CHOLECYSTECTOMY)

Treatment: drugs, lithotripsy, or surgery

Irritable bowel syndrome (IBS) pain and alternating bouts of diarrhea & constipation, possibly due to stress Inflammatory bowel disease (Crohns disease is one type) inflammation of any part of GI tract

Colorectal cancer
One of the leading causes of death from cancer, even though its slow-growing Begins as polyps (small growths) on inside of colon; some polyps turn cancerous Genetics plays a role Prevention: High-fiber, low-fat diet Signs: constipation, diarrhea, abdominal pain or cramping, rectal bleeding, blood in stool

Occult Blood
Occult blood is hidden-can not see it. The main diagnostic for colorectal cancer
Test feces or urine
Tests use reagents that change color when added to feces or urine.
Smear test Dip and read test