The Digestive Tract

 The GI tract
(gastrointestinal tract)
The muscular alimentary canal
 Mouth
 Pharynx
 Esophagus
 Stomach
 Small intestine
 Large intestine
 Anus

 The accessory
digestive organs
Supply secretions contributing
to the breakdown of food
 Teeth & tongue
 Salivary glands
 Gallbladder
 Liver
 Pancreas 2
 The Digestive Process
 Ingestion
 Taking in food through the mouth
 Propulsion (movement of food)
 Swallowing
 Peristalsis – propulsion by alternate
contraction &relaxation
 Mechanical digestion
 Chewing
 Churning in stomach
 Mixing by segmentation
 Chemical digestion
 By secreted enzymes: see later
 Absorption
 Transport of digested end products into
blood and lymph in wall of canal
 Defecation
 Elimination of indigestible substances from
body as feces 3
 Chemical digestion
 Complex food molecules (carbohydrates,
proteins and lipids) broken down into
chemical building blocks (simple sugars,
amino acids, and fatty acids and glycerol)
 Carried out by enzymes secreted by digestive
glands into lumen of the alimentary canal

4
Ways to divide….
The more common

Plus:
epigastric
periumbilical
suprapubic
flank5
 Histology of alimentary canal wall
Same four layers from esophagus to anal canal

1. Mucosa
2. Submucosa
3. Muscularis
externa
4. Serosa

from lumen (inside) out

6
Inner layer: the mucosa*
(mucous membrane)

Three sub-layers
* 1. Lining epithelium
2. Lamina propria
3. Muscularis
mucosae

7
 More about the mucosa
 Epithelium: absorbs nutrients, secretes mucus
 Continuous with ducts and secretory cells of intrinsic
digestive glands (those within the wall)
 Extrinsic (accessory) glands: the larger ones such as
liver and pancreas
 Lamina propria
 Loose connective tissue with nourishing and
absorbing capillaries
 Contains most of mucosa-associated lymphoid tissue
(MALT)
 Muscularis mucosae
 Thin layer of muscle producing only local8 movements
Second layer: the submucosa*

 Connective tissue
containing major
blood and
lymphatic vessels
* and nerves
 Many elastic fibers
so gut can regain
shape after food
passes

9
Next in, the muscularis externa*
(AKA just “muscularis”)

Two layers of smooth

muscle responsible
for peristalsis and
segmentation
 Inner circular layer
(circumferential)
*  Squeezes
 In some places forms
sphincters (act as
valves)
 Outer longitudinal
layer: shortens
10
gut
Last (outer), the serosa*
(the visceral peritoneum)

 Simple squamous
epithelium
(mesothelium)
 Thin layer of areolar
connective tissue
underneath
 Exceptions:
 Parts not in peritoneal
cavity have adventitia,
* lack serosa
 Some have both, e.g.
retroperitoneal organs

11
 Smooth muscle
Smooth muscle

•Muscles are spindle-shaped cells

•One central nucleus
•Grouped into sheets: often running
perpendicular to each other
•Peristalsis
•No striations (no sarcomeres)
•Contractions are slow, sustained and
resistant to fatigue
•Does not always require a nervous signal:
can be stimulated by stretching or hormones
6 major locations:
1. inside the eye 2. walls of vessels 3. respiratory tubes
4. digestive tubes 5. urinary organs 6. reproductive organs 12
 Nerves
 Enteric nervous system: the gut’s own
 Visceral plexuses within gut wall controlling the
muscles, glands and having sensory info
 Myenteric: in muscularis
 Submucosal
 100 million neurons! (as many as the spinal cord)
 Autonomic input: speeds or slows the system
 Parasympathetic
 Stimulates digestive functions
 Sympathetic
 Inhibits digestion
 Largely automatic
13
 Review of some definitions….

 Peritoneum: serous membranes of the

abdominopelvic cavity
 Visceral peritoneum: covers external
surfaces of most digestive organs
 Parietal peritoneum: lines body wall
 Peritoneal cavity: slit-like potential space
between visceral and parietal peritoneum
 Serous fluid – lubricating

14
 New definitions
 Mesentery
 Double layer of peritoneum
 Extends to digestive organs from body wall
 Hold organs in place
 Sites of fat storage
 Route by which circulatory vessels and nerves reach
organs
 Most are dorsal
 Extend dorsally from gut to posterior abdominal wall
 Ventral mesentery – from stomach and liver to anterior
abdominal wall
 Some mesenteries are called “ligaments” though not
technically such
15
 Mesenteries
 Note dorsal, ventral and formation of
retroperitoneal position

16
Mesenteries
 Two ventral mesenteries
 Falciform “ligament”
*  Binds anterior aspect of liver
to anterior abdominal wall
and diaphragm
 Lesser omentum (=“fatty
skin”) – see diagram*
 All other mesenteries are
dorsal (posterior)
17
 Mesenteries continued (all these are dorsal)

 Greater omentum
 Connects stomach to posterior abdominal wall – very roundabout
 Wraps around spleen: gastrosplenic ligament
 Continues dorsally as splenorenal ligament
 A lot of fat
 Limits spread of infection by wrapping around inflamed e.g. appendix
 “Mesentery” or mesentery proper
 Supports long coils of jejunum and ileum (parts of small intestine)
 Transverse mesocolon
 Transverse colon held to posterior abdominal wall
 Nearly horizontal sheet fused to underside of greater omentum
 Sigmoid mesocolon
 Connects sigmoid colon to posterior abdominal wall

see next slides for pics… 18

Note mesenteries: falciform ligament, lesser
omentum, greater omentum

19
Note: greater omentum, lesser omentum, falciform ligament,
transverse mesocolon, mesentery, sigmoid mesocolon

20
 Some organs are “retroperitoneal”
 Are “behind the peritoneum”
 Fused to posterior (dorsal) abdominal wall
 Lack a mesentery
 Include:
 Most of duodenum (1st part of small intestine)
 Ascending colon
 Descending colon
 Rectum
 Pancreas
 Tend to cause back pain, instead of abdominal pain

(This is as opposed to the organs which are intraperitoneal,

or just “peritoneal”)
21
 The Mouth

 Mouth = oral cavity

 Lining: thick
stratified squamous
epithelium
 Lips- orbicularis
oris muscle
 Cheeks –
buccinator muscle

22
 “Vermillion border” or red
border
 Between highly
keratinized skin of face
and mucosa of mouth
 Needs moisture
 Note frenulums (folds of
mucosa)
 Palate – roof of mouth
 Hard plate anteriorly
 Soft palate posterioly
 Uvula
23
 Tongue
 Mostly muscles
 Grip and reposition food
 Forms “bolus” of food (lump)
 Help in swallowing
 Speech – help form some consonants
 Note frenulum on previous slide: can be too tight
 Taste buds contained by circumvallate and fungiform papillae
 Lingual tonsil – back of tongue

24
 Teeth
 Called “dentition” (like dentist)

 Teeth live in sockets (alveoli) in the gum-

covered margins of the mandible and
maxilla

 Chewing: raising and lowering the

mandible and moving it from side to side
while tongue positions food between teeth
25
 Teeth
 Two sets
 Primary or deciduous
 “Baby” teeth
 Start at 6 months
 20 are out by about 2 years
 Fall out between 2-6 years
 Permanent: 32 total
 All but 3rd set of molars by
end of adolescence
 3rd set = “wisdom teeth”
– Variable
 Some can be “impacted”
(imbedded in bone) 26
Teeth are classified according to
shape and function
 Incisors: chisel-shaped for
chopping off pieces
incisor  Canines: cone shaped to
tear and pierce
canine
 Premolars (bicuspids) and
premolar  Molars - broad crowns
with 4-5 rounded cusps for
molar grinding
Cusps are surface bumps
27
 Tooth structure
 Two main regions
A. Crown (exposed)
A
B. Root (in socket)
C. Meet at neck
 Enamel C
 99% calcium crystals
 Hardest substance in
body B
 Dentin – bulk of the
tooth (bone-like but
harder than bone, with
collagen and mineral)
 Pulp cavity with vessels
and nerves
 Root canal: the part of the
pulp in the root 28
 Tooth structure
 Cementum – bone
A
layer of tooth root
 Attaches tooth to
periodontal ligament C

 Periodontal ligament
 Anchors tooth in boney
B
socket of the jaw
 Continuous with gingiva
(gums)
 Cavities or caries - rot
 Plaque – film of sugar,
bacteria and debris
29
 Salivary glands
(tuboalveolar glands)

 Intrinsic salivary glands

– within mucosa
 Secrete saliva all the time
to keep mouth moist
 Extrinsic salivary glands
 Paired (2 each)
 Parotid
 Submandibular
 Sublingual
 External to mouth
Saliva: mixture of water, ions, mucus, enzymes
keep mouth moist
 Ducts to mouth
dissolves food so can be tasted  Secrete saliva only right
moistens food before or during eating
starts enzymatic digestion
buffers acid 30
antibacterial and antiviral
 Extrinsic salivary glands
 Parotids* - largest (think mumps)
 Facial nerve branch at risk during surgery here
 Submandibular # - medial surface mandible
 Sublingual + - under tongue; floor of mouth

+
Compound = duct branches
Tubo = tubes
# Alveolar
31 = sacs
 Pharynx
___oropharynx  Oropharynx and
laryngopharynx
___laryngopharynx  Stratified squamous
epithelium

 Three constrictor
muscles*
 Sequentially squeeze
* bolus of food into
esophagus
*  Are skeletal muscles
 Voluntary action
 Vagus nerve (X)
*
32
 Esophagus
 Continuation of pharynx in
mid neck
 Muscular tube collapsed
when lumen empty Esophagus___________
 Descends through thorax
 On anterior surface of
vertebral column
 Behind (posterior to) trachea

33
 Esophagus continued
 Passes through “esophageal hiatus” in the diaphragm to
enter the abdomen
 Abdominal part only 2 cm long
 Joins stomach at cardiac orifice*
 Cardiac sphincter at cardiac orifice to prevent regurgitation (food
coming back up into esophagus)
 Gastroesophageal junction and GERD

___________________esophageal hiatus
(hiatus means opening)

34
 Microscopic anatomy of esophagus

Contains all 4
layers (see right)

 Epithelium: nonkeratinized stratified squamous epithelium

 At GE junction – thin simple columnar epithelium
 Mucus glands in wall
 Muscle (muscularis externa) changes as it goes down
 Superior 1/3 of esophagus: skeletal muscle (like pharynx)
 Middle 1/3 mixture of skeletal and smooth muscle
 Inferior 1/3 smooth muscle (as in stomach and intestines)
 When empty, mucosa and submucosa lie in longitudinal folds35
Esophagus histology

36
 Stomach
 J-shaped; widest part of alimentary canal
 Temporary storage and mixing – 4 hours
 Into “chyme”
 Starts food breakdown
 Pepsin (protein-digesting enzyme needing acid
environment)
 HCl (hydrochloric acid) helps kill bacteria
 Stomach tolerates high acid content but esophagus
doesn’t – why it hurts so much when stomach contents
refluxes into esophagus (heartburn; GERD)
 Most nutrients wait until get to small intestine to
be absorbed; exceptions are:
 Water, electrolytes, some drugs like aspirin and alcohol
(absorbed through stomach)
37
 Stomach
epigastrium
 Lies mostly in LUQ
 But pain can be epigastric or
lower
 Just inferior to (below)
diaphragm
 Anterior (in front of) spleen
and pancreas
 Tucked under left lower dome
margin of liver junction with
 Anchored at both ends but esophagus

mobile in between
contains pyloric
 Main regions in drawing to sphincter
right--------------------------------
 Capacity: 1.5 L food; max funnel shaped
capacity 4L (1 gallon) 38
39
 Stomach Regions
 Cardiac region
 Fundus (dome shaped)
 Body
 Greater curvature
 Lesser curvature dome

 Pyloric region junction with

esophagus

 Antrum contains pyloric

 Canal sphincter

 Sphincter funnel shaped

40
 Rugae: longitudinal folds
on internal surface (helps
distensibility)
 Muscularis: additional
innermost oblique layer
(along with circular and
longitudinal layers)

41
 Histology of
stomach
 Simple columnar
epithelium: secrete
bicarbonate-buffered
mucus
 Gastric pits opening
into gastric glands
 Mucus neck cells
 Parietal cells
 HCL
 Intrinsic factor (for
B12 absorption)
 Chief cells
 Pepsinogen
(activated to pepsin
with HCL)
 Stimulated by gastrin:
a stomach hormone

42
 Small intestine
 Longest part of alimentary canal (2.7-5 m)
 Most enzymatic digestion occurs here
 Most enzymes secreted by pancreas, not
small intestine
 Almost all absorption of nutrients
 3-6 hour process
 Runs from pyloric sphincter
to RLQ
Small intestine___________

43
 Small intestine has 3 subdivisions
Blood supply: superior
 Duodenum – 5% of length mesenteric artery;
 Jejunum – almost 40% Veins drain into hepatic
 Ileum – almost 60% portal vein

Duodenum is retroperitoneal (stuck down under peritoneum); others are loose

Duodenum receives
bile from liver and gallbladder via bile duct*
enzymes from pancreas via main pancreatic duct*

44 *
  Small intestine designed for absorption
 Huge surface area because of great length
 Structural modifications also increase absorptive area
 Circular folds (plicae circulares)
 Villi (fingerlike projections) 1 mm high – simple columnar epithelium: velvety
 Microvilli

Absorptivie cell
with microvilli to
increase surface
area & many
mitochondria:
nutrient uptake is
energy-
demanding
*

Lacteal*: network of blood

and lymph capillaries
-Carbs and proteins into blood to
liver via hepatic portal vein
-Fat into lymph: fat-soluble toxins
e.g. pesticides circulate
systemically before going to liver 45
for detoxification
 Intestinal crypts * (of Lieberkuhn) inbetween villi
 Cells here divide every 3-6 days to renew epithelium (most rapidly dividing cells of the
body)
 Secrete watery intestinal juice which mixes with chyme (the paste that food becomes after
stomach churns it)
 Intestinal flora – the permanent normal bacteria
 Manufacture some vitamins, e.g. K, which get absorbed

-have many
mitochondria:
Duodenal glands * *
nutrient uptake
is energy-
•Mucus to counteract acidity demanding
from stomach
•Hormones: * -produce
Cholecystokinin (stimulates GB mucus
to release stored bile, also pancreas)
Secretin (stimulates pancreatic 46
ducts to release acid neutralizer)
General histology of digestive tract

47
48
49
 Large intestine
Digested residue reaches it
Main function: to absorb water
and electrolytes

Subdivisions
Cecum
Appendix
Colon
Rectum
Anal canal

50
 1. Teniae coli (3 longitudinal
Three special muscle strips)
2. Haustra (puckering into sacs)
features 3. Epiploic appendages (omental
or fat pouches)

3.

2.

1.

51
 Colon has segments: ascending, transverse and descending colon; then sigmoid colon
Right angle turns: hepatic flexure* in RUQ and splenic flexure* in LUQ

*
*

Between ileum
and cecum

1st part S-shaped

Blind tube

Movement sluggish and weak except for a few “mass peristaltic

52
movements” per day to force feces toward rectum powerfully
 Rectum
 In pelvis
 No teniae
 Strong longitudinal muscle
layer
 Has valves
 Anal canal
 Pectinate line*
 Inferior to it: sensitive to
pain *
 Hemorrhoids (enlarged
veins)
 Superior to pectinate *
line: internal
 Inferior to pectinate line:
external
 Sphincters (close opening)
 Internal*
– smooth muscle
– involuntary
*
 External*
– skeletal muscle
– voluntary 53
 Defecation
1. Triggered by stretching of
wall, mediated by spinal
cord parasympathetic reflex
2. Stimulates contraction of
smooth muscle in wall and
relaxation of internal anal
sphincter
3. If convenient to defecate
voluntary motor neurons
stimulate relaxation of
external anal sphincter
(aided by diaphragm and
abdominal wall muscles
-called Valsalva maneuver)

54
Histology – large intestine

 No villi
 Fewer nutrients
absorbed
 “Columnar cells” in pic
= absorptive cells
 Take in water and
electrolytes
 A lot of goblet cells for
mucus
 Lubricates stool
 More lymphoid tissue
 A lot of bacteria in stool
55
 The Liver
 Largest gland in the body
(about 3 pounds)
 Over 500 functions
 Inferior to diaphragm in
RUQ and epigastric area
protected by ribs
 R and L lobes
 Plus 2 smaller lobes
 Falciform ligament
 Mesentery binding liver to
anterior abdominal wall
 2 surfaces
 Diaphragmatic
 Visceral
 Covered by peritoneum
 Except “bare area” fused to 56
diaphragm
 posterior

Fissure on visceral surface

Porta hepatis: major vessels and nerves anterior

enter and leave - see pics

Ligamentum teres: remnant of
umbilical vein in fetus, attaches to navel
– see next slide 57
Fetal circulation

Ligamentum
Umbilical vein ___________ teres__________
Navel_______

58
59
 Just some of the liver’s repertoire

 Produces bile
 Picks up glucose from blood
 Stores glucose as glycogen
 Processes fats and amino acids
 Stores some vitamins
 Detoxifies poisons and drugs
 Makes the blood proteins

60
 Liver histology
 Liver lobules (about one million of them)
 Hexagonal solid made of sheets of hepatocytes (liver
cells) around a central vein
 Corners of lobules have “portal triads”
(see next pic)

61
 Portal triad
 Portal arteriole
 Portal venule
 Branch of hepatic
portal vein
 Delivers substances
from intestines for
processing by
hepatocytes
 Bile duct
 Carries bile away
 Liver sinusoids
 Large capillaries
between plates of
hepatocytes
 Contribute to central
vein and ultimately to
hepatic veins and IVC
 Kupffer cells
 Liver macrophages
 Old blood cells and
microorganisms
removed
62
63
 Hepatocytes (liver cells)
 Many organelles
 Rough ER – manufactures blood proteins
 Smooth ER – help produce bile salts and detoxifies
blood-borne poisons
 Peroxisomes – detoxify other poisons, including
alcohol
 Golgi apparatus – packages
 Mitochondria – a lot of energy needed for all this
 Glycosomes - role in storing sugar and regulation of
blood glucose (sugar) levels
 Produce 500-1000 ml bile each day
 Secrete into bile canaliculi (little channels) then ducts
 Regeneration capacity through liver stem cells
64
 Gallbladder*
 Bile is produced in the liver
 Bile is stored in the gallbladder
 Bile is excreted into the
duodenum when needed (fatty
meal)
 Bile helps dissolve fat and
cholesterol
 If bile salts crystallize, gall
stones are formed
 Intermittent pain: ball valve
effect causing intermittent
obstruction
 Or infection and a lot of pain,
fever, vomiting, etc.

* 65
Lies in LUQ kind of behind stomach
Is retroperitoneal Pancreas
Has a head, body and tail
Head is in C-shaped curve of duodenum (exocrine and
Tail extends left to touch spleen
Main pancreatic duct runs the length of the endocrine)
pancreas, joins bile duct

66
67
one acinus
Pancreatic
exocrine function
 Compound acinar (sac-
like) glands opening into
large ducts (therefore
exocrine)
 Acinar cells make 22
kinds of enzymes
 Stored in zymogen
granules
 Grape-like arrangement
 Enzymes to duodenum,
where activated
68
 Pancreatic endocrine function
(hormones released into blood)

 Islets of Langerhans (AKA “islet cells”)

are the hormone secreting cells
 Insulin (from beta cells)
 Lowers blood glucose (sugar)
 Glucagon (from from alpha cells)
 Raises blood glucose (sugar)

(more later)
69
Endocrine cells:

70