AnatomyoftheGITract[edit]

The GI tract is essentially a hollow tube connecting the mouth to the anus. The GI tract has a similar
layout through out its length:

An inner mucosal layer with an epithelial lining

A submucosal layer

A thin layer of muscle , the Muscularis Mucosa is at the junction of the mucosal and sub
mucosal layers, outside this are the nerves of the mucosal plexus

A muscular layer with an inner circular muscle layer and an outer longitudinal layer

Between the muscles are the nerves of the myenteric plexus

A serosal layer which is continuous with the mesentry

This is illustrated graphically here:

General Anatomy[edit]
Mucosa[edit]

Layers of Intestine as illustrated in the stomach

villi (from Grays anatomy)

The mucosal layer consists of a Epithelial layer, and its underlying suportive tissue, the Lamina
Propria. It is separated from the Submucosal layer by the Muscularis Mucosa. The epithelial layer
varies from section to section of the Gut. In the oesophagus it is anon-cornified stratified
squamous epithelium; in the stomach it is mainly mucosal cells; the small intestine and large
intestine are characterized by absorptive cells, with many mucous producing goblet cells. In the
absorptive sections of the intestine, the surface are for absorbtion is greatly increased by finger like
projections into the lumen called villi, and the absorptive cells themselves also have small
projections of microvilli giving them the appearence of a brush border when viewed with a light
microscope.
The lamina propria contains lymph and blood vessels which drain into larger vessels in the
submucosal layer. Also in the lamina propria, particularly in the absorptive layers are
numerous immune cells, wandering macrophages and lymphocytes, as well as agregations of
lymphoid tissue called called Peyers patches. By some estimates 80% of the body's lymphoid
tissue is in the intestine.
The cell to cell junctions are of the epithelia are mainly tight junctions. In the stomach there are
very little or no gaps between the epithelial cells, but in the absorptive sections there is a certain
amount of 'leakiness' so that water and some solutes can go between the cells rather than through
them. The degree of leakiness is variable and is to some extent under hormonal control.

Submucosa[edit]
The submucosa consists of connective tissue with larger blood and lymph vessels. It is separated
from the mucosa by the muscularis mucosa. Also in the the submucosal layer is the submucosal
plexus, part of the enteric nervous system. The muscularis mucosa probably acts to propel the
contents of the mucosal glandular lumens and crypts (see below) into the lumen and also to
enhance contact of the cells with the contents of the lumen.
Muscular Layers[edit]
Consists of an inner circular muscle, and an outer longitudinal musle. Between the two layers is
the mesenteric plexus', also part of theenteric nervous system. In the stomach there is also an
oblique layer of muscle fibers interior to these two. The musclar layers work in harmony to
produce peristaltic contractions and segmental contractions.
Serosa[edit]
The serosa is a continuation of the peritoneal membrane. It is useful to think of the gut as
being envaginated into the peritoneal membrane until it completely surrounds it. The double layer of
membrane as it attaches to the gut is called the mesentry, and contains the main vessels and the
non-intrinsic nerve supply to the gut.

Each section of the intestine has a variation on this theme. A brief review of the anatomy and
function of each section follows.

Mouth & Pharynx[edit]

anatomy of mouth and pharynx

Digestion starts in the oral cavity. Food is taken into the mouth and masticated by the teeth, being
mixed with saliva from the parotid, sub-mandibular, and sublingual glands. Saliva
contains amylase and lipase enzymes, and these are mixed with the food. As these enzymes are
deactivated on reaching the stomach, the more thoroughly food is masticated, the longer they have
to act. When mastication is complete, the food is swallowed, a three part process, only the first part
of which is under voluntary control. (see Motility). The epithelia lining of the mouth and pharynx is
non-cornifed squamous epithelium.

Plate from Grays anatomy showing Salivary glands

Esophagus[edit]

The esophagus extends from the pharynx to the stomach and is about ten inches in length. It
traverses three regional anatomical areas, the neck, the thorax, and the abdominal cavity. At the
upper and lower ends of the esophagus the musclar layers act like sphincters - they are in tonic
contraction, and these have been known as the esophageal and the cardiac sphincters. Although
the esophagus is outside the abdomen, and thus does not have a serosal layer, it has the same
basic layout as the rest of the system
The epithelium of the mucosal layer is non-cornified stratified squamous epithelium. The lamina
propria is not copious and contains aggregates of lymphoid tissue.

The oesophageal glands are scattered throughout the length of the esophagus and are located in
the submucosa. There are also cardiac glands - similar in microscopic appearance to those in the
stomach, but with no enzymes in their secretions - at the proximal and distal ends of the esophagus.
These glands are confined to the mucosal layer. The longitudinal rugae disappear on swallowing.
The sub-mucosal layer consists of loose fibrous tissue and elastic tissue allowing expansion. No
new digestive enzymes are added nor does absorption take place in the esophagus.
Clinical Note - Barrets esophagitis[edit]

Barrett's esophagus Alcian blue stain. The characteristic goblet cells are stained blue. Normal stratified squamous
epithelium is seen on the right of the image

In Barrets esophagitis the stratified squamous epithelium at the lower end of the esophagus is
replaced by intestinal-type lining (columnar epithelium), due to reflux esophagitis. It is considered a
pre-malignant condition as about 0.5% per year of patients will go on to develop esophageal cancer
(adenocarcinoma of the esophagus).

Stomach[edit]
Gross Anatomy[edit]

1. Body of stomach 2. Fundus 3. Anterior wall 4. Greater curvature 5. Lesser curvature 6. Cardia 9.
Pyloric sphincter 10. Pyloric antrum 11. Pyloric canal 12. Angular notch 13. Gastric Canal 14. Rugal
folds
Food enters the stomach from the esophagus at the at the cardia and passes into the stomach. In
the fasting state the stomach is kept in a state of contraction, but the presence of food causes it to
expand. The rugae of the stomach are folds in the mucosa seen in the fasting state, unlike the small
intestine they are not there to increase surface area for absorption. Numerous pores are seen, the
openings to the gastric glands which secrete enzyme pepsinogen and Hydrocloric Acid as well
as mucous. The Hydrochloric Acid produces a pH of about 2. This highly acidic environment serves
two purposes - to provide an environment hostile to bacteria and other pathogens; to denature
protein, causing it to unfold, and thus increasing the area that pepsins can attack (see digestion
below)

The stomach is divided into three parts, the fundus,; the main body; and the pyloric antrum.
Stored food is mixed with enzymes and HCl to form chyme. The muscles feed the the chyme down
to the pyloric anrum, where it is thoroughly mixed, and fed in small amounts into the small intestine
by relaxation of the pyloric valve.
The Arterial Supply to the stomach is from the Coeliac Artery. The venous drainage of the stomach
drains into the venous portal system
Microscopic Anatomy[edit]

The basic layout pattern holds true in the stomach, although the stomach has a third inner layer of
oblique muscle fibers. The mucosal layer has numerous pits opening into the lumen, the mouths of
the gastric glands. Some of these glands penetrate down into the submucosal layer.
Gastric Glands[edit]
The gastric glands secrete mucous, hydrochloric acid and enzymes into the stomach. They are
located for the most part in the mucosal layer of the stomach, but some of the deeper gland
penetrate into the submucosal layer, and secrete into the lumen via. ducts. Several different
secretory cells are found: mucous; parietal; chief cells; D cells; enterochafin cells; and G cells.
Mucous cells secrete both mucous and bicarbonate, substances that protect the stomach from autodigestion. Parietal cells secrete Hydrochloric acid, 1-3 liters a day which cause the pH in the
stomach to fall as low as 1. Chief cells secrete the enzyme pepsinogen, which is activated
to pepsin by the pH of the stomach. G cells produce gastrin, a hormone that promotes gastric acid
secretions and stimulates the growth of the gastric mucosa.

The composition of the gastric glands varies throughout the stomach. In the fundus, the glands are
more branched and contain all the different kinds of secretory cells. In the pyloric part of the stomach
the glands are deeper and contain more mucous cells. The Chief cells are only found in the fundus
of the stomach,G cells are found mainly in the Antrum, the other cells are found in all areas.
Not much absorption of nutrients take place in the stomach, although many fluids, particularly
alcohol, can be absorbed from here.

Small Intestine[edit]
The small intestine is divided into three sections, the duodenum, the jejunum, and the ilium. In is

Fundic glands
Cardiac glands (at cardia)

Pyloric glands (at pylorus)

(at fundus)

the area of the intstine where most of the absorption takes place. In all three sections the layers
follow the general pattern:

The surface for absorption is increased in many ways: the mucosa of the small intestine is thrown
into folds called rugae; the mucosa itself has numerous finger like projections called villi, and the
epithelial cells are also covered with numerous projections called microvilli. this later gives the
appearance of a 'brush' on light microscopy, hence the termbrush border. the following illustration
shows the anatomy of a

villi:
Mucous is secreted by numerous goblet cells, the other cells are specialized for absorption and are
known as absorptive cells. In the base of the crypts are numerous secretory cells which secrete the
digestive enzymes of the small intestine. Some of the cryts will penetrate into the submucosal layer
forming digestive glands which will communicate with the mucosa via. a secretory duct. The length
of the small intestine is about 12-13 ft. in the living adult, although after death, due to the loss of
longitudinal muscle tonicity, this length will double.

Duodenum[edit]

epithelia of duodenum

Release of chyme into the duodenum is controlled by a number of factors that ensure that there is a
controlled release into the small intestine for processing.
The duodenum is itself divided into three parts, the first, second, and third part. Small portions of
highly acidic chime is released into the first part of the duodenum. This part secretes the hormone
Secretin from the mucosal cells (as do the other parts of the doudenum)in response to the presence
of acidic chyme leaving the stomach. This stimulates the pancreas to secrete copious amounts to
neutralizing Sodium Bicarbonate, so the pH of the chyme is nearer 7 when it leaves the duodenum.
the digestive enzymes of the pancreas and small intestine operate maximally at this pH. This also
means that any pepsin from the stomach is also deactivated. The first part of the duodenum does
not have plicae and folds, indicating that this part is probably not important for absorption.
In the Second part of the duodenum bile and pancreatic enzymes are secreted via the common
duct into the lumen see (Biliary System & Pancreas) below. Absorption of food starts in the second
part of the duodenum.
Jejunum & Ilium[edit]

Transmission electron microscope image of a thin section cut through a human jejunum(segment of small intestine)
epithelial cell. Image shows apical end of absorptive cell with some of the densely packed microvilli that make up the
striated border. Each microvillus is approximately 1um long by 0.1um in diameter and contains a core of actin
microfilaments.

The jejunum comprises about the upper two fifths and the ilium the lower three fifths of the small
intestine past the duodenum. The jejunum and ilium are classified according to various anatomical
differences. These differences include the arrangement of the cascade of vessels in mesentry
mesentry; the distribution of Peyers patches - more numerous in the ilium; the mucosa is thicker and
has more blood supply in the jejunum; and the incidence of surface area increasing plicae are more
prevalent in the jejunum. Physiologically they have more or less the same functions, although
probably more digestive enzymes are produced in the proximal portions of the small intestine. In any
case, when we consider absorption and digestion we shall just consider them all 'small intestine'.

Epithelial Regeneration[edit]
Epithelial cells have a life-time of 5-7 days. New cells are continuously being generated in the crypts,
and migrate up the sides of the villi. These cells differentiate into either goblet cells (10-25%) or
absorptive cells. Old cells are shedded from the tips of the

villi.

Bilary System & Pancreas[edit]

From Grays Anatomy: The anterior part of the pancreas has been removed to show the pancreatic duct

Bile and bile salts are manufactured by the liver and fed into the second part of the duodenum via
the common duct. Bile salts are important in fat digestion.
The pancrease is a retro-peritoneal gland that is both an endocrine - producing the hormones insulin
and glucagon, and an exocrine gland - producing digestive enzymes. The enzymes are secreted in a
deactivated form - to prevent auto-digestion - and are activated in the lumen of the duodenum.
The following illustration indicates the relationships of the pancreas and bilary

systems.

Large Intestine[edit]
The large intestine extends from the ileo-caecal junction to the recum and anus. The microscopic
appearence is similar to that of the small intestine. In is divided into
the caecum,ascending, transverse, descending and sigmoid colon. In the colon electrolytes and
water are removed, and faeces are formed. These are propelled fowards by a form of movement
called mass movement. (see Motility). The colon is populated with bacteria, which usually operate
in a symbiotic mode. Any food that has not been processed may be digested by these bacteria, and
the products will then be absorbed by the Large Intestine.
The microscopic appearence is similar to the small intestine with the following exceptions:

Goblet cells are more numerous.

Villi are few or absent.

The muscularis mucosa has both a circular and a longitudinal layer.

The Crypts of Lieberkuhn are larger and do not branch.

The longitudinal muscle layer is condensed in the colonic portion of the Large Intestine into
three longitudinal bands called the teniae coli.

Rectum and Anus[edit]

Illustrating the Internal and External anal sphincters

The faeces are now passed to the rectum where they await elimination. The process of elimination is
controlled by two sphinctae, the Internal and external Anal sphinctae. The former is under
involuntary control, the latter under voluntary control. The functioning of these are discussed in the

section on motility

SplanchnicCirculation[edit]
This includes the blood supply and drainage - via. the portal system - of the Gut as well as the
pancreas, liver and spleen. The liver is drained by the hepatic vein.

Gastrointestinal blood supply[edit]

Blood supply comes from three arteries branching off the aorta:the coeliac artery; the superior
mesenteric artery; and the inferior mesenteric artery.
Coeliac Artery[edit]
Supplies blood to the stomach, liver, pancreas and spleen as well as the duodenum.

Superior Mesenteric Artery[edit]

Supplies blood to the small intestine as well as the superior part of the Colon. Notice the system of
arching anastemoses that is a feature of The splanchnic arteries.

Inferior Mesenteric Artery[edit]

Supplies blood to the Colon. Again notice the system of arching anastemoses.

Hepatic Portal System[edit]

The Hepatic Portal Vein

All the blood from the GI system below the esophagus drains into the Hepatic Portal Vein, the
Portal system also drains the spleen and pancreas. Blood is conveyed to the liver for processing
where it passes through millions of liver sinusoids. This allows thereticuloendothelial cells that
line the sinusoids to remove bacteria and other particulate matter. Blood finally leaves the liver via.
theHepatic vein where it drains into the Inferior Vena Cava.
The total blood flow to the liver is about 1.5 Liters per minute of which two-thirds is carried by the
portal vein. The Blood in the portal vein is more oxygen saturated than blood in the Systemic Venous
System - about 80-90% saturated, and provides about 70% of the oxygen requirements of the liver.