Anatomy & Physiology of The Digestive Tract

Dr. Ni Luh Putu Eka Sudiwati, SKp, MKes

 OBJECTIVES:
1. Discuss the general functions and
anatomy of the digestive tract
2. Describe the individual organs of the
system, including a discussion of the
gross and microscopic anatomy
 INTRODUCTION
Digestive System
1. Composed of GI tract and accessory organs
2. Breaks down ingested food for use by the
body
3. Digestion occurs by mechanical and
chemical mechanisms
4. Excretes waste products or feces through
process of defecation
 The GI tract (gastrointestinal
tract)
The muscular alimentary canal
1. Mouth
2. Pharynx
3. Esophagus
4. Stomach
5. Small intestine
6. Large intestine
7. Anus

The accessory digestive

organs
Supply secretions contributing
to the breakdown of food
1. Teeth & tongue
2. Salivary glands
3. Gallbladder
4. Liver
4
5. Pancreas
 THE DIGESTIVE PROCESS
1. Ingestion
Taking in food through the mouth
2. Propulsion (movement of food)
Swallowing
Peristalsis propulsion by alternate
contraction &relaxation
3. Mechanical digestion
Chewing
Churning in stomach
Mixing by segmentation
4. Chemical digestion
By secreted enzymes
5. Absorption
Transport of digested end products into
blood and lymph in wall of canal
6. Defecation
Elimination of indigestible substances
from body as feces 5
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

6
Ways to divide. The more common

Plus:
epigastric
periumbilical
suprapubic
flank 7
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

8
 HISTOLOGICAL ORGANIZATION

Tube made up of
four layers. 1
2

Modifications along
its length as
Muscularis
needed. 3 externa

4
INNER LAYER: THE MUCOSA*
(MUCOUS MEMBRANE)

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

10
 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 local movements 11
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

12
THE MUSCULARIS EXTERNA*
Two layers of smooth
muscle responsible for
peristalsis and
segmentation
Inner circular layer
(circumferential)
In some places forms
* sphincters (act as
valves)
Outer longitudinal
layer: shortens gut

13
 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

14
 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
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4. digestive tubes 5. urinary organs 6. reproductive organs
 NERVES
Enteric nervous system: the guts 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

16
 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
17
 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
18
 MESENTERIES
Note dorsal, ventral and formation of
retroperitoneal position

19
 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)
20
 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
21
NOTE MESENTERIES: FALCIFORM LIGAMENT,
LESSER OMENTUM, GREATER OMENTUM

22
Note: greater omentum, lesser omentum, falciform ligament,
transverse mesocolon, mesentery, sigmoid mesocolon

23
 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

24
 The Mouth

Mouth = oral cavity

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

25
The Mouth
Vermillion border or
red border
Between highly
keratinized skin of face
and mucosa of mouth
Needs moisture
frenulums (folds of
mucosa)
Palate roof of mouth
Hard plate anteriorly
Soft palate posterioly
Uvula

26
 Tongue
Mostly muscles
Grip and reposition food
Forms bolus of food (lump)
Help in swallowing
Speech help form some consonants
Taste buds contained by circumvallate and fungiform papillae
Lingual tonsil

27
 Teeth
Called dentition
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

28
 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
Some can be impacted
(imbedded in bone)

29
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 30
 Tooth structure
Two main regions
A. Crown (exposed)
B. Root (in socket) A

C. Meet at neck
Enamel C
99% calcium crystals
Hardest substance in body
Dentin bulk of the tooth B
(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
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 Tooth structure
Cementum bone layer of
tooth root A

Attaches tooth to periodontal

ligament C

Periodontal ligament
Anchors tooth in boney socket
of the jaw B

Continuous with gingiva

(gums)
Cavities or caries - rot
Plaque film of sugar,
bacteria and debris
32
Figure 23.5
 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 Ducts to mouth
keep mouth moist
dissolves food so can be tasted Secrete saliva only right before
moistens food or during eating
starts enzymatic digestion
buffers acid 34
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 = sacs 35
 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
 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)

*
37
 Deglutition
Stages of swallowing
Voluntary
Mouth to oropharynx
Pharyngeal
Deglutition center in medulla oblongata and pons
Closing of epiglottis
Involuntary
Esophageal
Involuntary
Peristaltic contractions
Figure 23.9a,b
 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

40
 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

 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 folds 42
Esophagus histology

43
Figure 23.9c
 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)

45
 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 doesnt
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)

46
 Stomach
Just inferior to (below) epigastrium

diaphragm
Anterior (in front of) spleen and
pancreas
Tucked under left lower margin
of liver
Anchored at both ends but
mobile in between dome

Main regions in drawing to right-- junction with

------------------------------ esophagus

Capacity: 1.5 L food; max contains pyloric

capacity 4L (1 gallon) sphincter

funnel shaped
47
48
 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

49
 Rugae: longitudinal folds on
internal surface (helps
distensibility)
Muscularis: additional
innermost oblique layer (along
with circular and longitudinal
layers)

50
 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

51
 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

Small intestine___________

52
 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*

* 53
 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 for detoxification 54
 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 from demanding
stomach
Hormones: * -produce mucus
Cholecystokinin (stimulates GB to
release stored bile, also pancreas)
55
Secretin (stimulates pancreatic ducts to
release acid neutralizer)
General histology of digestive tract

56
57
58
 Large intestine
Digested residue reaches it
Main function: to absorb water and
electrolytes
Subdivisions
Cecum
Appendix
Colon
Rectum
Anal canal

59
 1. Teniae coli (3 longitudinal muscle
strips)
Three special 2. Haustra (puckering into sacs)
features 3. Epiploic appendages (omental or fat
pouches)

3.

2.

1.

60
 Colon has segments: ascending, transverse, descending colon,
sigmoid colon

*
*

Between ileum and

cecum

1st part S-shaped

Blind tube

Movement sluggish and weak except for a few mass peristaltic movements per 61
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

62
 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)

63
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

64
 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 65
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
66
67
 Just some of the livers 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

68
 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)

69
 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

70
71
 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

72
 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.

* 73
Is retroperitoneal
Has a head, body and tail Pancreas
Head is in C-shaped curve of duodenum
Tail extends left to touch spleen (exocrine and
Main pancreatic duct runs the length of the pancreas,
joins bile duct endocrine)

74
75
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

76
 Pancreatic endocrine function
(hormones released into blood)
Islets of Langerhans are
the hormone secreting cells
Insulin (from beta cells)
Lowers blood glucose
(sugar)
Glucagon (from from alpha
cells)
Raises blood glucose (sugar)
(more later)

77