Anatomy and Physiology

Introduction: The digestive system provides fuel for daily cellular function and building
blocks for growth and repair. The digestive system works closely with lymphatic and
cardiovascular systems to distribute nutrients to tissues.

The digestive system (Fig. 1) is comprised of the
digestive tract (gastrointestinal tract, GI tract) (mouth, pharynx, esophagus, stomach,
small intestines, and large intestines)
and accessory organs (liver, pancreas, gall bladder, teeth, salivary glands).

















Functions of the Digestive System:
1. Digestion chemical break down of food by enzymatic, hydrolysis, or acids
Ingestion insert in mouth by conscious choice
2. Absorption movement across digestive epithelium to interstitial fluids
3. Excretion removal of wastes and indigestible residue
Defecation: the exit of materials (feces) from the digestive tract.

Histological Organization of the Digestive Tract: (Fig. 2)
Moving from the lumen on out.
1. Mucosa: mucous membrane (epithelium + lamina propria)
a. Stratified squamous epithelium lines the oral cavity, pharynx, and esophagus
for areas of stress;
Figure 1
b. Simple columnar epithelium + goblet cells (secrete mucus) line the stomach,
small intestines, and large intestines.
Some cells inthis layer secrete hormones and digestive enzymes

2. Submucosa: loose connective tissue with blood vessels, lymphatic exocrine glands
(secrete buffers and enzymes)
a. outer layer of submucosa has sensory neurons, parasympathetic ganglionic
neurons, and sympathetic postgangionic fibers, innervate mucosa and
submucosa.

3. Muscularis Externa: smooth muscle cells with inner circular layer and outer
longitudinal layer for mechanical processing and movement of materials.
a. Peristalsis (wavelike contraction) of muscularis externae propels materials
along the length of the digestive tract.

4. Serosa: serous membrane covering most digestive tract (covering the muscularis
externae of the stomach, small intestines and large intestines).
a. Visceral peritoneum and parietal peritoneum



















The Peritoneum
Peritoneal cavity - space between visceral and parietal peritoneum (serous
membranes).
Peritoneal fluid (serous fluid) 7 liters secreted and reabsorbed each day, minimizes
friction
Mesenteries: sheets of serous membranes that hold digestive tract in place, double layer
membranes with areolar tissue in between for blood vessels, nerves and lymphatic vessels.
Greater Omentum (Fig. 3): pouch of mesentery hangs from stomach between
small intestine and body wall fills with fat to cushion anterior and lateral
surfaces of abdomen.
Lesser Omentum is the mesentery that supports the stomach by connecting to
the liver
Figure 2

Peritonitis: inflammation of the peritoneal membrane. Inflammation may be a result of
physical damage, chemical irritation, or bacterial invasion (examples: rupturing of an infected
appendix, infection during surgical procedures). Peritonitis is painful, disrupts functions of
nearby organs, and it can be fatal.



















The Oral Cavity: (Buccal cavity): bound by the cheeks and lips (labia), the mouth opens
into oral cavity, start of the digestive tract
Functions:
1. Ingestion of food
Analysis of foods texture, taste, heat/cold sensory
2. Mechanical Processing (mastication) by teeth, tongue and palatal surfaces
3. Lubrication by mixing food with mucus and salivary secretions
Parotid salivary glands, Sublingual salivary glands, and Submandibular salivary
glands produce a watery saliva that contain mucins, buffers, lingual lipase and
salivary amylase.
Produce 1.0-1.5 liters of saliva each day. Saliva is 99.4 % water and the rest is
electrolytes, buffers, mucins (responsible for lubricating), antibodies, enzymes,
and waste products.
4. Moves the bolus (food) to the back of the throat to be swallowed (deglutition)


The Teeth
Deciduous teeth (20 baby teeth) temporary teeth of primary dentition
1
st
molars (1 and 2) appear around the age of six, after that deciduous teeth start to fall
out

Secondary dentition or permanent teeth (32 adult teeth): adult jaws are larger to
accommodate more teeth. Three additional molars appear on each side of the upper and
lower jaws. Third molars are wisdom teeth, which may not erupt before age 21. When
Figure 3
wisdom teeth fail to erupt they become impacted and need to be surgically removed to
prevent abscesses.
Dentin: mineralized matrix inside the tooth, similar to bone but acellular.
Crown: exposed portion of the tooth, you see enamel
Enamel: calcium phosphate compound hardest biologically substance. Need
calcium, phosphates and Vitamin D during childhood to build enamel.
Root: base of tooth, blood vessels and nerves enter the root canal through apical
foramen.
Cementum: layer of bony substance that covers the dentin in the root region and
anchors the tooth to the bone

Types
1. Incisors blade shaped teeth at the front of the mouth (8). Single root
2. Cuspids (canines) conical with a pointed tip (4). Single root
3. Bicuspids (premolars) flattened crowns that crush/grind (8). Single or double root
4. Molars large flattened crowns that excel at crush/grind (12). 3 or more roots.


Mastication: chewing. Teeth break down tough connective tissues in meat, break plant fibers,
and help saturate materials with salivary secretions and enzymes with side to side, up and
down movements.

The Pharynx: Movement of bolus through the pharynx is from contractions of the
pharyngeal muscles (push food to esophagus) and palatal muscles (elevate the soft palate), as
well as the elevation of the larynx.

Swallowing (deglutition) starts voluntary finishes involuntary
Bolus is pressed against the hard palate. The tongue retracts and pushes the bolus into
the pharynx (the soft palate lifts to isolate the nasal cavity).
The swallowing reflex is initiated by stimulus of the bolus in the back of the throat.
Larynx elevates and the epiglottis folds over the glottis so the bolus bypasses entry to
the trachea.
muscles of the pharynx contract and push bolus down to the esophagus. Peristaltic
waves push the bolus down the esophagus to the stomach.

The Esophagus: hollow muscular tube, 10-12 inches long, carries solids and liquids to
stomach.
Passes through the diaphragm to the stomach through the Esophagageal hiatus:
opening in the diaphragm, where the esophagus enters the abdominopelvic cavity.

Esophagitis: Inflammation of the esophagus. Due to weakened or permanently relaxed lower
esophageal sphincter. Stomach acids rise, epithelia erosion and inflammation cause
discomfort. Frequent episodes of acidic eruptions cause gastroesophageal reflux
disease (GERD) giving symptoms of heartburn.

The Stomach: expandable organ, muscular for churning, when full can contain 1-1.5 liters
of material. Simple columnar epithelium produces alkaline mucus; stomach epithelial is a
secretory sheet. Alkaline mucus protects epithelial from acids and enzymes in the lumen.




















Fundus superior to the junction of esophagus and stomach. The fundus contacts the
diaphragm
Body largest region of stomach, mixing tank, gastric glands secrete most of stomachs acids
and enzymes
Pylorus curve of the J, empties into the duodenum. Glands secrete mucus and hormones
Pyloric Sphincter regulates release of chyme into duodenum.

Chyme: Partially digested food mixed with stomach acids and secretions from glands. This
mixing of chyme produces a highly acidic, soupy mixture.

Rugae folds in stomach mucosa when stomach is empty, expandable feature as stomach
fills causing rugae to flatten out.

Gastric Glands within the stomach are secretory cells that make 1500 ml gastric juices per
day.
1. Some secrete secrete HCl (H
+
Cl
-
in the cytoplasm). Creates a pH of 1.5-2 in the
stomach.
Low pH functions:
1. Kills bacteria
2. Denatures proteins and inactivates enzymes in foods
3. Breaks down plant cell walls and connective tissues in meat
4. Need low pH to activate pepsin
2. Others produce Pepsin, an active protein-digesting enzyme. Optimal pH for Pepsin
to work is 1.5 2.0.


The Small Intestines
Small Intestines: 90% of nutrient absorption occurs in the small intestine, and most of the
rest occurs in the large intestine, average length is 6 m (20 ft). Mucosa production produces
few digestive enzymes; the liver and pancreas produce the bulk of buffers and bile salt
enzymes.
Plicae: permanent transverse folds of the digestive tract increase surface area.

Three subdivisions of the small intestines: (1) duodenum, (2) jejunum, and (3) the ileum.

1. Duodenum 25 cm (10 in) in length. Duodenum is most proximal segment, and
posterior to jejunum. The duodenum functions as a mixing bowl that mixes chyme and
digestive secretions from the pancreas and liver.

2. J ejunum 2.5 m (8 ft) in length. Bulk of chemical digestion and nutrient absorption
occurs in the jejunum. If cut out portions of jejunum, then weight is lost due to
decreased absorption; this is not healthy.

3. Ileum distal segment and longest segment, 3.5 m (12 ft) in length. Ends at the
ileocecal valve.

a. Ileocecal Valve controls flow of materials from ileum to cecum (large
intestines).

Plicae permanent folds of intestinal lining, roughly 800 plicae in the small intestine; their
presence greatly increases the surface area

Intestinal Villi fingerlike projections into the intestinal lumen. Coated with simple columnar
epithelium that is carpeted with microvilli (brush border). Between the plicae, intestinal villi,
and brush borders the lumen surface area increases from 3.6 ft
2
to 2200 ft
2
.

Intestinal Glands at the base of intestinal villi are holes that lead into intestinal glands.
These glands produce hormones that stimulate secretions that protect intestinal epithelium
from acids of chyme and buffers. The pH is therefore elevated to 7-8.
Intestinal J uice- 1.8 L per day. Moistens chyme, buffers acids, liquefies
digestive enzymes from pancreas so they are more effective.

Aggregate Lymphoid Nodules (Peyers Patches) - in distal ileum 20-30 aggregate lymphoid
nodules in lamina propria. Most abundant near the end of ileum where it meets the large
intestine. Prevents bacteria from large intestine growing into small intestine.

















Figure 5 Large Intestines
Figure 4a. Small Intestines
The Large Intestines: (large bowel) the large intestine consists of the cecum (pouch),
colon (largest section), and the rectum (last 6 inches). Frames the small intestine. The large
intestine is 1.5 m (5ft) long and 3 inches in width.

Functions of the Large Intestines:
1. Reabsorb water and compact materials into feces
2. Absorb vitamins produced by bacteria
3. Store fecal material prior to defecation

The Cecum ileum (small intestine) to ileocecal valve to cecum (large intestine). The cecum
starts compaction of fecal material.
Vermiform Appendix (appendix) - attached to cecum. Lymphoid nodules in mucosa
and submucosa, serve immunological functions by sampling large intestinal contents.

The Colon: Have a larger lumen diameter but a thinner wall than the small intestine. Four
regions of the colon are: ascending colon, transverse colon, descending colon, and sigmoid
colon.
Haustra is a series of pouches for expansion and tenia coli are the longitudinal bands of
muscle that run the length of colon that help with peristalsis

Physiology of the Large Intestine
Reabsorption of water, vitamins, urobilinogen, bile salts, and toxins go to the hepatic portal
circulation for detoxification. <10% of nutrients are absorbed in large intestine, 1500-2000
ml enters in form of food and drinks and only 150-200 ml is released as feces. Feces
consist of 75% H
2
O, 5% bacteria, and the rest is undigested material.

Bacteria in the colon produce Vitamin K (bacteria produce required, needed for 4
clotting factors), Biotin (water-soluble vitamin needed for glucose metabolism), and
Vitamin B
5
(pantothenic acid) (a water-soluble needed to make steroid hormones and
some neurotransmitters) also:
breaks down remaining peptides into ammonium ions (NH
4
+
) and indole and
skatole, two nitrogen-containing compounds that make feces smell; and
hydrogen sulfide (H
2
S), a gas that produces a rotten egg odor.

Flatus: Intestinal gas produced by bacteria (from indigestible carbohydrate
sources such as franks and beans) stimulate bacterial gas production.

Reflex moves materials from the ilium into the cecum while you eat. Distention of the stomach
and duodenum stimulates mass movements (strong peristaltic contractions) of materials from
the transverse colon through the rest of the large intestine and into the rectum. Muscular
sphincters control the passage of fecal material to the anus. The defecation reflex is
triggered by the distention of the rectal wall.

The Liver ( versatile metabolic and synthesis organ. Left lobe and right lobe (bigger) divided
by the falciform ligament. 1/3 of blood supply to liver from arterial blood supply (hepatic artery
proper) and 2/3 is venous blood from the hepatic portal vain. The liver samples and adjusts
nutrients by selective absorption and secretion.
Hepatic artery delivers oxygen and nutrients to liver cells
Hepatic portal veins deliver absorbed nutrients and compounds that were absorbed
by the digestive tract

Kupffer Cells fixed macrophages in liver sinusoids, engulf pathogens, cell debris,
store irons, stores lipids, store heavy metal (tin or mercury) absorbed in digestive
tract



Functions of the Liver















1. Metabolic Regulation
Carbohydrate metabolism maintains blood glucose at 90ml/dl. (insulin or glucagon)
Lipid Metabolism most lipids bypass hepatic portal system. Lipids levels would
have to be high for the liver to regulate it
Amino Acid metabolism removes excess AAs from the bloodstream
Removal of waste products neutralizes ammonia by converting it to urea for
excretion
Vitamin storage Fat-soluble vitamins (A,D,E,K) and B
12
stored there
Mineral storage convert iron to ferritin and stores it for later use
Drug inactivation removes and breaks down circulating drugs

2. Hematological Regulation
Phagocytosis and antigen presentation Kupffer cells engulf debris and old RBCs.
Kupffer cells stimulate an immune response through surface antigens
Synthesis of plasma proteins hematopocytes synthesize most plasma proteins
(albumins)
The removal of circulating hormones absorbs and recycles N, NE, Ins, T3, T4,
steroid hormones, and corticosteroids
The removal of antibodies breaks down antibodies and recycles AAs
The removal or storage of toxins - fat-soluble toxins stored or broken down and
excreted in bile
The synthesis and secretion of bile:

Functions of Bile
synthesized in liver, stored and concentrated in gallbladder. Bile made from water,
ions, bilirubin (orange-yellow pigment from HG), cholesterol, and other lipids.
Bile Salts steroid derivatives in bile; responsible for the emulsification of ingested
lipids.
o 90% of the bile salts are reabsorbed in the ileum and shuttled back to the
liver

Emulsification use of bile salts to break down lipid droplets.


The Gall Bladder - hollow pear shaped organ
stores and concentrates bile prior to its excretion into the small intestine
Liver creates ~1L bile/day. Flows into cystic duct to gallbladder for storage
Bile modification as H2O is removed, bile salts and other components become
increasingly concentrated
Hormones stimulate the release of bile when chime enters the duodenum



The Pancreas posterior to the stomach, extends from duodenum toward the spleen (spleen
on left). Primarily exocrine organ (secretes in the ducts).
Pancreatic Duct delivers pancreatic enzymes and buffers to duodenum.
Pancreatic Acini pockets of Pancreatic acinar cells (enzymes) and epithelium
(buffers) secrete pancreatic juice (1L per day): alkaline (pH 7.5-8.8) mixture of
digestive enzymes, water, and ions into the small intestines and this secretion also
contains bicarbonate and phosphate buffers.

Pancreatic Enzymes:
Carbohydrases (example pancreatic alpha-amylase) - similar to salivary
amylase, breaks down certain starches.
Pancreatic Lipase breaks down certain complex lipids, release fatty acids that
can be absorbed.
Nucleases break down of nucleic acids (DNA, RNA), protects from some viral and
bacterial species.
Proteolytic Enzymes break down certain proteins, 70 % pancreatic enzymes are
inactive proenzymes that get activated in the intestines.
Proteases enzymes that digest large protein complexes
Peptidases enzymes that digest peptide chains in amino acids



Digestion and Absorption
The Processing and Absorption of Nutrients a typical meal of food and liquids contains
proteins, carbohydrates, lipids, water, vitamins, and electrolytes. 1
st
is the physical breakdown,
2
nd
is the chemical breakdown, 3
rd
is the absorption, and 4
th
utilize nutrients for ATP production
and synthesize carbohydrates, proteins and lipids.
Hydrolysis: enzymes use water to break down substrates

Carbohydrate Digestion and Absorption:
Amylases (from pancreas and salivary glands) break down carbohydrates into tri and
disaccharides. Tri and disaccharides are further broken down into monosaccharides by
epithelial enzymes and then absorbed by the intestinal epithelium by facilitated diffusion (no
ATP, one at a time, gradient needed) or cotransport (ATP needed for homeostasis, more than
one at a time, no gradient needed).
Carbohydrases: maltose splits maltose into two glucose; sucrase breaks down
sucrose into glucose and fructose; lactase breaks down lactose into glucose and
galactose.

Lipid Digestion and Absorption:
Starts with lingual lipase and pancreatic lipase. Triglycerides emulsified into lipid droplets
containing fatty acids and monoglycerides. Fatty acids and monoglycerides are mixed with
bile salts and diffuse across the intestinal epithelium and are reconstructed into chylomicrons.
Chylomicrons enter the blood stream via lymphatic vessels Through lacteals.

Protein Digestion and Absorption
Pepsin (gastric enzyme) and pancreatic proteases break down proteins into amino acids in
the stomach and duodenum. The amino acids are absorbed and exported to intestinal fluid.
Trypsin activated by enterokinase, yield short chain of polypeptides.

Water Absorption
2000 ml (8 cups) of water is ingested each day + digestive secretions provide 7000 ml. Nearly
all of the water is reabsorbed by osmosis.
Important to have so enzymes can break food down better.

Vitamin and Ion Absorption
NaCl (broken down into Na and CL) and other ion movement into intestinal epithelium is
from diffusion, cotransport, and carrier mediated transport processes.
Water-soluble vitamins: C, Bs (except B
12
) diffuses across the digestive epithelium.
Fat-soluble Vitamins: A, D, K, E are incorporated into the lipid droplets and are
absorbed with the products of lipid digestion.

Malabsorption Syndromes: problem with absorption due to damage to the accessory glands
or damaged intestinal mucosa (ischemia, radiation exposure, toxic compounds or infections).
Lactose Intolerance Intestinal cells stop producing Lactase, an enzyme
responsible for breaking down milk sugar. Mostly a genetic disorder.