LESSON 9

The Digestive System

TOPICS
1. Digestive Organs, Accessory, Structure and Function
2. Physiology of Digestion
3. Digestive Hormones, Enzymes, Juices and Functions

LEARNING OUTCOMES
At the end of the lesson, you should be able to:
1. Identify the structures comprising the digestive system and their functions.
2. Identify the principal digestive hormones, enzymes and juices and cite its function.
3. Discuss the process of chemical and mechanical digestion.

Lesson 9: The Digestive System

Digestive System
Composed of GI tract and accessory organs
Breaks down ingested food for use by the body
Digestion occurs by mechanical and chemical mechanisms
Excretes waste products or feces through process of defecation

Essential Terms

digestion
process of mechanically or chemically breaking down food

absorption
passage of small molecules into blood and lymph

TOPIC #1: DIGESTIVE ORGANS, ACCESSORIES, STRUCTURE & FUNCTIONS

Digestive Organs, Accessory, and Structure

organs which carry out process of digestion and absorption

metabolism
all the chemical reactions of the body

GI Tract / Alimentary Canal

Continuous tube from mouth to anus
Mouth
Pharynx

Esophagus
Stomach
Small intestine
Large intestine

Accessory Digestive Organs

Provide mechanical and chemical mechanisms to aid digestion
Teeth
Tongue
Salivary glands
Liver
Gallbladder
Pancreas
Functions of Digestive System
Ingestion
Secretion
Mixing and propulsion
Motility
Digestion
Mechanical and chemical
Absorption
Defecation

Layers of GI Tract
Same in all areas of GI tract
From deep to superficial:
Mucosa
Submucosa
Muscularis
Serosa

Layers of GI Tract
Mucosa
Epithelium
Type varies
Lamina propria – areolar connective tissue
MALT – mucus-associated lymphatic tissue
Muscularis mucosae – smooth muscle
Submucosa
Areolar connective tissue
Blood and lymphatic vessels
Neurons – submucosal plexus
Muscularis
Skeletal and smooth muscle
Neurons – myenteric plexus
Serosa
Areolar and simple squamous epithelium
Visceral peritoneum

Peritoneum
Mesothelium
Parietal peritoneum
Visceral peritoneum
Peritoneal cavity
Retroperitoneal
Folds of Peritoneum
Greater omentum
Adipose tissue
Falciform ligament
Liver to anterior abdominal wall
Lesser omentum
Mesentery
Small intestine to posterior abdominal wall
Mesocolon

Neural Innervation of GI Tract

Regulated by autonomic nervous system
Enteric division
Myenteric plexus / plexus of Auerbach
Submucosal plexus / plexus of Meissner
Able to function independently from rest of nervous system
Linked to CNS by extrinsic sympathetic and parasympathetic
nerves
Sympathetic nerves decrease GI secretions
& motility
Parasympathetic nerves increase GI
secretion and motility

Accessory Organs of the Head

Mouth Parts of Digestive System

Mouth formed by several parts:
Cheeks
Lips / labia
Labial frenulum
Orbicularis
Vestibule
Oral cavity proper
Fauces
Hard and soft palate
Uvula
Palatoglossal and palatopharyngeal arch
The digestive System

Tongue

Skeletal muscle and mucous

membrane
Helps form floor of oral cavity
Extrinsic muscles
Intrinsic muscles
Lingual frenulum

Papillae
Fungiform
Filiform
Circumvallate
Foliate

Lingual glands
Lingual lipase
Salivary Glands
Release saliva to oral cavity
3 pairs of salivary glands
Parotid
Submandibular
Sublingual

Composition of Saliva
99.5 % water
0.5% other solutes
Ions
Mucus
Immunoglobulin A
Enzymes
Salivation controlled by autonomic nervous system
Stimulated by various mechanisms

Teeth
External regions
Crown
Root
Neck

Internal components
Enamel
Dentin
Cementum
Pulp cavity
PulpRoot canals
Apical foramen

Dentitions
Deciduous teeth – first set (20 teeth)
Permanent teeth – secondary (32 teeth )

Carry out mechanical digestion by mastication

Creates bolus
Salivary amylase
Breakdown starch
Lingual lipase
Breakdown triglycerides

Swallowing

Pharynx
Composed of skeletal muscle
Lined by mucous membrane
Nasopharynx
Oropharynx

Laryngopharynx

Esophagus
Collapsible muscular tube through esophageal hiatus of diaphragm

Mucosa
Submucosa contains areolar connective tissue

Muscularis
Skeletal muscle
Upper and lower esophageal sphincter

Adventitia
Attaches esophagus to nearby structures
Secrets mucus and transports food
Deglutition

Stages of swallowing
Voluntary
Mouth to oropharynx
Pharyngeal
Deglutition center in medulla oblongata and pons
Closing of epiglottis
Involuntary
Esophageal
Involuntary
Peristaltic contractions

Stomach
Serves as mixing chamber and storage area for ingested food
Rugae allow for increased volume

4 main regions
Cardia
Fundus
Body
Pylorus

Pyloric antrum and canal

Pyloric sphincter
Lesser and greater curvatures

Stomach Histology
Mucosa
Surface mucous cells
Lamina propria

Muscularis mucosae
Gastric glands and pits
Parietal cells
Chief cells
G cells
Submucosa – areolar connective tissue
Muscularis
3 layers of smooth muscle
Serosa
Accessory Organs of the Abdomen

Pancreas
Produces secretions to aid digestion
Head
Body
Tail
Pancreatic duct /duct of Wirsung
Hepatopancreatic ampulla
Sphincter of the heatopancreatic ampulla (sphincter of (Oddi)
Regulates passage of pancreatic juice and bile
Accessory duct (duct of Santorini)

Histology of Pancreas
Glandular epithelial cells
99% exocrine clusters
Secrete pancreatic juice
Fluid and enzymes
Pancreatic islets (islets of Langerhans)
1% endocrine cells
Hormones
Glucagon
Insulin
Somatostatin
Pancreatic polypeptide
Pancreatic Juice
1200-1500 mL/day
pH 7.1-8.2
Water
Salts
Sodium bicarbonate
Enzymes
Pancreatic amylase
Trypsin
Entereokinase
Chymotrypsin
Carboxypeptidase
Elastase
Pancreatic lipase
Ribonuclease and deoxyribonuclease

Liver and Gallbladder

Liver
Largest gland at 1.4 kg (~3 lb)

Gallbladder
Closely associated with liver
Anatomy of Liver
Right and left lobe separated by falciform ligament
Quadrate lobe
Caudate lobe
Round ligament (ligamentum teres)
Remnant of umbilical vein
coronary ligaments
Lobule
Hepatocytes radiating from central vein
Sinusoids
Reticuloendothelial (Kupffer) cells
Stationary phagocytes
Bile Duct System
Bile secreted by hepatocytes
Bile canaliculi
Bile ducts
Right and left hepatic ducts
Common hepatic duct
Common bile duct
Gallbladder for temporary storage of bile
Cystic duct

Blood Supply of Liver

Hepatic artery provides oxygenated blood
Hepatic portal vein provides deoxygenated blood
Nutrients, drugs, toxins, microbes
Hepatic artery and vein carry blood to sinusoids
Substances exchanged by hepatocytes
Blood drains to central vein and eventually hepatic vein
Portal triad
Hepatic portal vein
Hepatic artery
Bile duct

Bile
800-1000 mL/day
pH 7.6 – 8.6
Water
Bile acids
Bile salts
Emulsification
Cholesterol
Lecithin
Bile pigments
Bilirubin
Stercobilin

Liver Functions
Metabolism of:
Carbohydrates
Lipids
Proteins
Process drugs and hormones
Excrete bilirubin
Synthesize bile salts
Storage
Glycogen
Vitamins
Minerals
Phagocytosis
Activate Vitamin D

The small intestine is an organ located within the gastrointestinal tract. It is approximately 6.5m
in the average person and assists in the digestion and absorption of ingested food.

It extends from the pylorus of the stomach to the ileocaecal junction, where it meets the large
intestine at the ileocaecal valve. Anatomically, the small bowel can be divided into three parts;
the duodenum, jejunum and ileum.

In this article, we shall examine the anatomy of the small intestine – its structure and neurovascular
supply, as well as some clinically important feature.

Fig 1 – The anatomical divisions of the small intestine.

The Duodenum

The most proximal portion of the small intestine is the duodenum. Its name is derived from the
Latin ‘duodenum digitorum’, meaning twelve fingers length. It
runs from the pylorus of the stomach to the duodenojejunal
junction.

The duodenum can be divided into four parts; superior,

descending, inferior and ascending. Together these parts
form a ‘C’ shape, that is around 25cm long, and which wraps
around the head of the pancreas.

Superior (Spinal level L1)

The first section of the duodenum is known as ‘the cap’. It ascends upwards from the pylorus of
the stomach, and is connected to the liver by the hepatoduodenal ligament. This area is most
common site of duodenal ulceration.

The initial 3cm of the superior duodenum is covered anteriorly and posteriorly by visceral
peritoneum, with the remainder retroperitoneal (only covered anteriorly).

Descending (L1-L3)

The descending portion curves inferiorly around the head of the pancreas. It lies posteriorly to
the transverse colon, and anterior to the right kidney.

Internally, the descending duodenum is marked by the major duodenal papilla – the opening at
which bile and pancreatic secretions to enter from the ampulla of Vater (hepatopancreatic
ampulla).
Inferior (L3)

The inferior duodenum travels laterally to the left, crossing over the inferior vena
cava and aorta. It is located inferiorly to the pancreas, and posteriorly to the superior mesenteric
artery and vein.

Ascending (L3-L2)

After the duodenum crosses the aorta, it ascends and curves anteriorly to join the jejunum at a
sharp turn known as the duodenojejunal flexure.

Located at the duodenojejunal junction is a slip of muscle called the suspensory muscle of the
duodenum. Contraction of this muscle widens the angle of the flexure, and aids movement of
the intestinal contents into the jejunum.

Jejunum and Ileum

The jejunum and ileum are the distal two parts of the small intestine. In contrast to the
duodenum, they are intraperitoneal.

They are attached to the posterior abdominal wall by mesentery (a double layer of peritoneum).

The jejunum begins at the duodenojejunal flexure. There is no clear external

demarcation between the jejunum and ileum – although the two parts are macroscopically
different. The ileum ends at the ileocaecal junction.

At this junction, the ileum invaginates into the cecum to form the ileocecal valve. Although it is
not developed enough to control movement of material from the ileum to the cecum, it
can prevent reflux of material back into the ileum (if patent, see below).

Histology of Small Intestine

Mucosa
Cell types
Absorptive
Goblet
Endocrine
Paneth
Lysozyme
Intestinal glands
S cells
Hormone secretin
CCK cells
Hormone – cholecystokinin (CCK)

The intestines are a long, continuous tube running

from the stomach to the anus. Most absorption of
nutrients and water happen in the intestines. The
intestines include the small intestine, large
intestine, and rectum.
The small intestine (small bowel) is about 20 feet
long and about an inch in diameter. Its job is to
absorb most of the nutrients from what we eat and
drink. Velvety tissue lines the small intestine,
which is divided into the duodenum, jejunum, and ileum.
The large intestine (colon or large bowel) is about 5 feet long and about 3 inches in diameter.
The colon absorbs water from wastes, creating stool. As stool enters the rectum, nerves there
create the urge to defecate.
The large intestine composes of 3 segments, ascending colon, transverse and descending colon,
that ends into the rectum.

TOPIC # 2: DIGESTIVE HORMONES,ENZYMES, JUICES AND FUNCTIONS

 TOPIC # 3: PHYSIOLOGY OF DIGESTION

( Mechanical and Chemical Digestion)

Mixing waves caused by peristaltic movement
Chyme released in process of gastric emptying
Proton pumps bring H+ into the lumen
Carbonic anhydrase forms carbonic acid to provide H+ and bicarbonate ions (HCO3-)
Chemical digestion stimulated by nervous system
Parasympathetic neurons release acetylcholine
Works with gastrin
HCl released in presence of histamine
Pepsin begins digestion of proteins
Stomach protected by alkaline mucus secretion
Gastric lipase digests triglycerides
Few molecules absorbed by stomach
Water, ions, short-chain fatty acids, alcohol