Anatomy d igestivechapter_017

Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 17Chapter 17

The Digestive System

Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.2

ObjectivesObjectives

• List in sequence each of the component parts or segments of the alimentary canal from the mouth to the anus and identify the accessory organs of digestion

• List and describe the four layers of the wall of the alimentary canal. Compare the lining layer in the esophagus, stomach, small intestine, and large intestine.


ObjectivesObjectives

• List and describe the major disorders of the digestive organs

• Discuss the basics of protein, fat, and carbohydrate digestion and give the end-products of each process

• Define and contrast mechanical and chemical digestion

• Define peristalsis, bolus, chyme, jaundice, ulcer, and diarrhea


The Digestive System The Digestive System

• Alimentary canal or GI tract– Extends from mouth to anus—9 m (29 feet) – Involved in digestion, absorption and metabolism

of nutrients• System includes main and accessory organs

– Main organs: mouth, pharynx, esophagus, stomach, small intestine, large intestine, rectum, and anal canal

– Accessory organs: teeth and tongue, salivary glands, liver, gallbladder, pancreas, and vermiform appendix



MouthMouth

• Also known as oral cavity—hollow chamber with a roof, floor, and walls

• Roof—formed by hard palate (parts of maxillary and palatine bones) and soft palate (an arch-shaped muscle separating mouth from pharynx)


MouthMouth

• Uvula—a downward projection of the soft palate – Uvula and soft palate prevent food and

liquid from entering nasal cavities– Assists in speech and swallowing

(deglutition)


MouthMouth

• Floor—formed by tongue and its muscles– Lingual frenulum—fold of mucous

membrane that helps anchor the tongue to the floor of the mouth

– Papillae—small elevations on mucosa of tongue

– Taste buds—found in many papillae



TeethTeeth

• Types of teeth—incisors, cuspids, bicuspids, and tricuspids– Deciduous (also known as baby or

primary) teeth—full set equals 20 teeth • First tooth erupts at about 6 months• Complete set in place at about 2 years of age


TeethTeeth

• Permanent teeth—full set equals 32 in most; 28 teeth is a normal variation in others – First permanent tooth erupts at about 6

years of age – Set complete between ages 17 and 24 years

• Structures of a typical tooth—crown, neck, and root




Disorders of the Mouth and TeethDisorders of the Mouth and Teeth

• Infections, cancer, congenital defects, and other disorders can cause serious complications including malnutrition – Infections and cancer of the mouth may

spread to other parts of the body • Leukoplakia—precancerous mouth tissue

– Snuff dipper’s pouch—from use of chewing tobacco – Squamous cell carcinoma—most common form of

mouth cancer




• Dental caries – Tooth disease resulting in permanent defect called

“cavity”– Infection may spread to other adjacent tissues or to

blood– Lost or diseased teeth may be replaced by dentures or

implants

• Gingivitis—gum inflammation or infection– Most cases result from poor oral hygiene– Can be a complication of diabetes, vitamin deficiency, or

pregnancy




• Thrush, or oral candidiasis—caused by yeastlike fungal organism

– Patches of “cheesy”-looking exudate form over an inflamed tongue and oral mucosa, which itches and bleeds easily

– Common in immunosuppressed individuals (AIDS) or after antibiotic therapy

• Periodontitis—inflammation of periodontal membrane

– Often a complication of advanced or untreated gingivitis– Leading cause of tooth loss among adults




• Cleft lip and cleft palate are most common types

– May occur alone or together– Caused by failure of mouth structures to fuse during

embryonic development



Salivary Glands Salivary Glands

• Three pairs of salivary glands – Secrete about 1 L of saliva/day

– Located outside of GI tract

– Convey secretions via ducts into tract lumen

• Parotid glands—largest of salivary glands – Located in front of ear at angle of jaw

– Ducts open into mouth opposite second molars

– Inflamed in mumps



Salivary GlandsSalivary Glands

• Submandibular glands—ducts open on either side of lingual frenulum

• Sublingual glands—ducts open into floor of mouth

• Saliva contains salivary amylase—begins digestion of carbohydrates


PharynxPharynx

• Muscular tube (throat) lined with mucous membrane

• Functions as part of both respiratory and digestive systems

• Subdivided into three anatomical segments



Wall of the Digestive Tract Wall of the Digestive Tract

• Lumen—hollow space within the “tube” of the digestive tract

• Tissue layers of the wall of the digestive tube from inside to outside– Mucosa—mucous epithelium– Muscularis—two layers of smooth muscle

that move food through the tube by rhythmic muscular waves known as peristalsis


Wall of the Digestive Tract Wall of the Digestive Tract

• Tissue layers (cont’d)– Serosa—serous membrane that covers the

outside of abdominal organs• Composed of visceral peritoneum in abdominal

cavity• It attaches the digestive tract to the wall of the

abdominopelvic cavity by forming folds called mesenteries



EsophagusEsophagus

• Muscular, mucus-lined tube about 25 cm (10 inches) long

• Connects pharynx with stomach• Muscular walls help push food toward stomach• Sphincters at each end of esophagus help keep

ingested material moving in one direction down the tube – Upper esophageal sphincter (UES) – Lower esophageal sphincter (LES)


EsophagusEsophagus

• GERD—gastroesophageal reflux disease– Backflow of acidic stomach contents into

esophagus causes symptoms of heartburn and indigestion

– Mild symptoms treated by nonsurgical measures include dietary changes, weight loss, acid-blocking or buffering medications, and drugs that strengthen LES


EsophagusEsophagus

• GERD– Severe and frequent episodes of GERD can

trigger asthma attacks, cause severe chest pain, bleeding, or narrowing and chronic irritation of esophagus (Figure 17-12)

– Untreated GERD may result in a precancerous condition called Barrett esophagus

– Common symptom of hiatal hernia




Stomach Stomach

• Pouch for food that lies in upper part of abdominal cavity just under diaphragm– The size of a large sausage when empty– Expands considerably after a large meal

• Contraction of muscular walls of stomach mixes food with gastric juice and breaks it down into chyme


Stomach Stomach

• Mucous membrane lines the stomach– Membrane lies in folds (rugae) when stomach is

empty– Many microscopic glands secrete gastric juice and

hydrochloric acid into stomach

• Divisions of stomach—fundus, body, and pylorus

• Pyloric sphincter muscle closes opening of pylorus (lower part of stomach) to retain food to facilitate partial digestion



Disorders of the StomachDisorders of the Stomach

• Gastroenterology—study of stomach and intestines and their diseases– Stomach is site of numerous diseases and

conditions – Gastric diseases often exhibit the following

signs or symptoms: gastritis (inflammation), anorexia (appetite loss), nausea (upset stomach), and emesis (vomiting)



• Pylorospasm—abnormal spasms of the pyloric sphincter– Common in infants– Pyloric stenosis is similar abnormality—obstructive

narrowing of the pyloric opening• Ulcers—open wounds caused by acid in gastric

juice– Often occurs in duodenum or stomach– Associated with infection by the bacterium

Helicobacter pylori and use of NSAIDs– Current treatment involves triple therapy



• Stomach cancer– Associated with consumption of alcohol or

preserved food and use of chewing tobacco

– No practical way to screen for early stages


Small Intestine Small Intestine

• About 7 m (20 feet) long but only 2 cm or so in diameter

• Divisions– Duodenum– Jejunum– Ileum

• Wall—contains smooth muscle fibers that contract to produce peristalsis


Small Intestine Small Intestine

• Lining—mucous membrane; many microscopic glands (intestinal glands) secrete intestinal juice; villi (microscopic finger-shaped projections from surface of mucosa into intestinal cavity) contain blood and lymph capillaries



Disorders of the Small IntestineDisorders of the Small Intestine

• Enteritis—intestinal inflammation

• Gastroenteritis—inflammation of stomach and intestines

• Malabsorption syndrome—group of symptoms resulting from failure to absorb nutrients properly (anorexia, abdominal bloating, cramps, anemia, and fatigue)


Liver and Gallbladder Liver and Gallbladder

• Liver– Size and location

• Liver is largest gland• Fills upper right section of abdominal cavity and

extends over into left side

– Classified as exocrine gland• Secretes bile• Has a variety of metabolic functions


Liver and Gallbladder Liver and Gallbladder

• Liver– Ducts

• Hepatic—drains bile from liver• Cystic—duct by which bile enters and leaves gallbladder• Common bile—formed by union of hepatic and cystic

ducts and drains bile from hepatic or cystic ducts into duodenum

• Gallbladder– Location—undersurface of the liver– Function—concentrates and stores bile produced

in the liver



Disorders of the Liver and Gallbladder


• Gallstones—calculi (stones) made of crystallized bile pigments and calcium salts– Cholelithiasis—condition of having

gallstones – Cholecystitis—inflammation of the

gallbladder; may accompany cholelithiasis– Stones can obstruct bile canals, causing

jaundice





• Hepatitis—liver inflammation– Characterized by liver enlargement,

jaundice, anorexia, discomfort, gray-white feces, and dark urine

– Caused by a variety of factors—toxins, bacteria, viruses, and parasites




• Cirrhosis—degeneration of liver tissue involving replacement of normal (but damaged) tissue with fibrous and fatty tissue

• Portal hypertension—high blood pressure in the hepatic portal veins caused by obstruction of blood flow in a diseased liver; may cause varicosities of surrounding systemic veins



Pancreas Pancreas

• Location—behind stomach • Functions

– Pancreatic cells secrete pancreatic juice into pancreatic ducts; main duct empties into duodenum

– Pancreatic islets (of Langerhans)—cells not connected with pancreatic ducts; secrete hormones glucagons and insulin into the blood


Pancreas Pancreas

• Pancreatic disorders– Pancreatitis—inflammation of pancreas

• Acute pancreatitis results from blocked ducts that force pancreatic juice to backflow

• Pancreatic enzymes digest the gland

– Cystic fibrosis—thick secretions block flow of pancreatic juice

– Pancreatic cancer is very serious—fatal in the majority of cases


Large Intestine Large Intestine

• Size and location—1.5 m long; forms lower, or terminal, portion of digestive tract

• Divisions– Cecum– Colon—ascending, transverse, descending, and

sigmoid– Rectum– Anal canal

• Opening to exterior—anus



Disorders of the Large Intestine Disorders of the Large Intestine

• Disorders of the large intestine often relate to abnormal motility (rate of movement of contents)– Diarrhea—results from abnormally increased

intestinal motility; may result in dehydration or convulsions

– Constipation—results from decreased intestinal motility

– Diverticulitis (inflammation of abnormal outpouchings called diverticula)—may cause constipation


Disorders of the Large IntestineDisorders of the Large Intestine

– Colitis—general name for any inflammatory condition of the large intestine

– Colorectal cancer—a common malignancy of the colon and rectum associated with colonic polyps; advanced age; low-fiber, high-fat diets; and genetic predisposition


Appendix and AppendicitisAppendix and Appendicitis

• Vermiform appendix is blind tube attached directly to cecum; no important digestive function in humans

• Appendicitis—inflammation or infection of appendix– If appendix ruptures, infectious material may

spread to other organs – Most common acute abdominal condition requiring

surgery– Affects 7% to 12% of population younger than 30

years


Peritoneum Peritoneum

• Description—large sheet of serous membrane– Parietal layer of peritoneum lines

abdominal cavity– Visceral layer of peritoneum covers

abdominal organs– Peritoneal space lies between parietal and

visceral layers


Peritoneum Peritoneum

• Extensions of peritoneum—largest are the mesentery and greater omentum – Mesentery—extension of parietal

peritoneum, which attaches most of small intestine to posterior abdominal wall

– Greater omentum, or “lace apron”—hangs down from lower edge of stomach and transverse colon over intestines



PeritoneumPeritoneum

• Peritonitis—inflammation of peritoneum resulting from infection or other irritant; often a complication of ruptured appendix

• Ascites—abnormal accumulation of fluid in peritoneal space, often causes bloating of abdomen



Digestion Digestion

• Definition—process that transforms food into a form that can be absorbed and used by cells – Mechanical digestion—chewing, swallowing, and

peristalsis break food into tiny particles, mix them well with digestive juices, and move them along the digestive tract

– Chemical digestion—breaks up large food molecules into compounds having smaller molecules; brought about by digestive enzymes


Digestion Digestion

• Enzymes and chemical digestion– Enzymes—protein molecules that act as

catalysts, speeding up chemical reactions– Chemical digestion—specific enzymes

speed up breakdown of specific molecules and no others

– Hydrolysis—enzymes speed up reactions that add water to break large molecules into smaller molecules


DigestionDigestion

• Carbohydrate digestion—mainly in small intestine– Pancreatic amylase—changes starches to

maltose– Intestinal juice enzymes

• Maltase—changes maltose to glucose• Sucrase—changes sucrose to glucose• Lactase—changes lactose to glucose


DigestionDigestion

• Protein digestion—starts in stomach; completed in small intestine– Gastric juice enzymes, rennin and pepsin,

partially digest proteins– Pancreatic enzyme, trypsin, completes

digestion of proteins to amino acids– Intestinal enzymes, peptidases, complete

digestion of partially digested proteins to amino acids


DigestionDigestion

• Fat digestion– Bile contains no enzymes but emulsifies

fats (breaks fat droplets into very small droplets)

– Pancreatic lipase changes emulsified fats to fatty acids and glycerol in small intestine


AbsorptionAbsorption

• Definition—digested food moves from intestine into blood or lymph

• Absorption site—foods and most water are absorbed from small intestine; some water also absorbed from large intestine

Education

Anatomy d igestivechapter_017