The Cardiovascular System

Your heart and circulatory system make up your cardiovascular system. Your heart works as
a pump that pushes blood to the organs, tissues, and cells of your body. Blood delivers
oxygen and nutrients to every cell and removes the carbon dioxide and waste products
made by those cells. Blood is carried from your heart to the rest of your body through a
complex network of arteries, arterioles, and capillaries. Blood is returned to your heart
through venules and veins. If all the vessels of this network in your body were laid end-to-
end, they would extend for about 60,000 miles (more than 96,500 kilometers), which is far
enough to circle the earth more than twice!

The one-way circulatory system carries blood to all parts of your body. This process of blood
flow within your body is called circulation. Arteries carry oxygen-rich blood away from your
heart, and veins carry oxygen-poor blood back to your heart.

In pulmonary circulation, though, the roles are switched. It is the pulmonary artery that
brings oxygen-poor blood into your lungs and the pulmonary vein that brings oxygen-rich
blood back to your heart.

In the diagram, the vessels that carry oxygen-rich blood are colored red, and the vessels
that carry oxygen-poor blood are colored blue.

Twenty major arteries make a path through your tissues, where they branch into smaller
vessels called arterioles. Arterioles further branch into capillaries, the true deliverers of
oxygen and nutrients to your cells. Most capillaries are thinner than a hair. In fact, many
are so tiny, only one blood cell can move through them at a time. Once the capillaries
deliver oxygen and nutrients and pick up carbon dioxide and other waste, they move the
blood back through wider vessels called venules. Venules eventually join to form veins,
which deliver the blood back to your heart to pick up oxygen
Heart Anatomy

The heart weighs between 7 and 15 ounces (200 to 425 grams) and is a little larger than the size of your
fist. By the end of a long life, a person's heart may have beat (expanded and contracted) more than 3.5
billion times. In fact, each day, the average heart beats 100,000 times, pumping about 2,000 gallons (7,571
liters) of blood.

Your heart is located between your lungs in the middle of your chest, behind and slightly to the left of your
breastbone (sternum). A double-layered membrane called the pericardium surrounds your heart like a sac.
The outer layer of the pericardium surrounds the roots of your heart's major blood vessels and is attached
by ligaments to your spinal column, diaphragm, and other parts of your body. The inner layer of the
pericardium is attached to the heart muscle. A coating of fluid separates the two layers of membrane, letting
the heart move as it beats, yet still be attached to your body.

Your heart has 4 chambers. The upper chambers are called the left and right atria, and the lower chambers
are called the left and right ventricles. A wall of muscle called the septum separates the left and right atria
and the left and right ventricles. The left ventricle is the largest and strongest chamber in your heart. The
left ventricle's chamber walls are only about a half-inch thick, but they have enough force to push blood
through the aortic valve and into your body.
The Heart Valves

Four types of valves regulate blood flow through your heart:

 The tricuspid valve regulates blood flow between the right atrium and right ventricle.
 
 The pulmonary valve controls blood flow from the right ventricle into the pulmonary arteries, which
carry blood to your lungs to pick up oxygen.
 
 The mitral valve lets oxygen-rich blood from your lungs pass from the left atrium into the left
ventricle.
 
 The aortic valve opens the way for oxygen-rich blood to pass from the left ventricle into the aorta,
your body's largest artery, where it is delivered to the rest of your body.
The Conduction System

Electrical impulses from your heart muscle (the myocardium) cause your heart to contract. This electrical
signal begins in the sinoatrial (SA) node, located at the top of the right atrium. The SA node is sometimes
called the heart's "natural pacemaker." An electrical impulse from this natural pacemaker travels through
the muscle fibers of the atria and ventricles, causing them to contract. Although the SA node sends electrical
impulses at a certain rate, your heart rate may still change depending on physical demands, stress, or
hormonal factors.

The Circulatory System

Your heart and circulatory system make up your cardiovascular system. Your heart works as a pump that
pushes blood to the organs, tissues, and cells of your body. Blood delivers oxygen and nutrients to every
cell and removes the carbon dioxide and waste products made by those cells. Blood is carried from your
heart to the rest of your body through a complex network of arteries, arterioles, and capillaries. Blood is
returned to your heart through venules and veins. If all the vessels of this network in your body were laid
end-to-end, they would extend for about 60,000 miles (more than 96,500 kilometers), which is far enough
to circle the earth more than twice!
The Heartbeat

A heartbeat is a two-part pumping action that takes about a second. As blood collects in the upper chambers
(the right and left atria), the heart's natural pacemaker (the SA node) sends out an electrical signal that
causes the atria to contract. This contraction pushes blood through the tricuspid and mitral valves into the
resting lower chambers (the right and left ventricles). This part of the two-part pumping phase (the longer
of the two) is called diastole.

The second part of the pumping phase begins when the ventricles are full of blood. The electrical signals
from the SA node travel along a pathway of cells to the ventricles, causing them to contract. This is called
systole. As the tricuspid and mitral valves shut tight to prevent a back flow of blood, the pulmonary and
aortic valves are pushed open. While blood is pushed from the right ventricle into the lungs to pick up
oxygen, oxygen-rich blood flows from the left ventricle to the heart and other parts of the body.

After blood moves into the pulmonary artery and the aorta, the ventricles relax, and the pulmonary and
aortic valves close. The lower pressure in the ventricles causes the tricuspid and mitral valves to open, and
the cycle begins again. This series of contractions is repeated over and over again, increasing during times
of exertion and decreasing while you are at rest. The heart normally beats about 60 to 80 times a minute
when you are at rest, but this can vary. As you get older, your resting heart rate rises. Also, it is usually
lower in people who are physically fit.

Your heart does not work alone, though. Your brain tracks the conditions around you—climate, stress, and
level of physical activity—and adjusts your cardiovascular system to meet those needs.

The human heart is a muscle designed to remain strong and reliable for a hundred years or longer. By
reducing your risk factors for cardiovascular disease, you may help your heart stay healthy longer.
Bundle Branch Block

Your heart has a natural "pacemaker" called the sinoatrial (SA) node. The SA node is a
specialized group of cells at the top of your heart's upper-right chamber (the right atrium).
Anywhere between 60 and 100 times a minute, the SA node sends an electrical impulse
throughout your heart to cause it to beat (contract).

When the SA node sends an electrical impulse, that impulse first travels through the heart's
upper chambers (the atria). It then passes through a small group of cells called the
atrioventricular (AV) node. The AV node checks the impulse and sends it along a track called the
bundle of His. The bundle of His divides into a right bundle branch and a left bundle branch,
which lead to your heart's lower chambers (the ventricles).
Sometimes the electrical impulse cannot travel throughout the heart because part of the heart's
conduction system is "blocked." If an impulse is blocked as it travels through the bundle
branches, you are said to have bundle branch block.

What causes bundle branch block?

For the left and right ventricles to contract at the same time, an electrical impulse must travel
down the right and left bundle branches at the same speed. If there is a block in one of these
branches, the electrical impulse must travel to the ventricle by a different route. When this
happens, the rate and rhythm of your heartbeat are not affected, but the impulse is slowed. Your
ventricle will still contract, but it will take longer because of the slowed impulse. This slowed
impulse causes one ventricle to contract a fraction of a second slower than the other.

The medical terms for bundle branch block are derived from which branch is affected. If the block
is located in the right bundle branch, it is called right bundle branch block. If the block is located
in the left bundle branch, it is called left bundle branch block.

The block can be caused by coronary artery disease, cardiomyopathy, or valve disease. Right
bundle branch block may also occur in a healthy heart.

What are the symptoms of bundle branch block?

If there is nothing else wrong with your heart, you probably will not feel any symptoms of bundle
branch block. In fact, some people may have bundle branch block for years and never know they
have the condition. In people who do have symptoms, they may faint (syncope) or feel as if they
are going to faint (presyncope).

So why should we worry about bundle branch block? Because it can be a warning sign of other,
more serious heart conditions. For example, it might mean that a small part of your heart is not
getting enough oxygen-rich blood. Also, researchers have found that people who have left bundle
branch block may be at greater risk for heart disease than are people who do not have the
condition.

How is bundle branch block diagnosed?

Doctors can use an electrocardiogram (EKG or ECG) machine to record the electrical impulses of
your heart. Bundle branch block shows up on the EKG tracing. The electrical patterns recorded by
the EKG machine can even show your doctor whether the block is located in the right or left
bundle branch.

How is bundle branch block treated?

In most cases, bundle branch block does not need treatment. But patients who have bundle
branch block along with another heart condition may need treatment. For example, if bundle
branch block develops during a heart attack, you may need a pacemaker. After a heart attack,
your heart is fragile, and bundle branch block may cause a very slow heart rhythm (bradycardia).
A pacemaker will help regulate the heart's rhythm after a heart attack.

For patients with both bundle branch block and dilated cardiomyopathy, a new type of pacing
called cardiac resynchronization treatment (CRT) may be used. Normally, pacemakers pace only
one of the lower heart chambers (the ventricles) at a time. But CRT re-coordinates the beating of
the two ventricles by pacing them at the same time. Recent studies have shown that CRT works
for certain patients with both bundle branch block and dilated cardiomyopathy.
The Coronary Arteries

Coronary Circulation

The heart muscle, like every other organ or tissue in your body, needs oxygen-rich blood to survive. Blood is
supplied to the heart by its own vascular system, called coronary circulation.

The aorta (the main blood supplier to the body) branches off into two main coronary blood vessels (also
called arteries). These coronary arteries branch off into smaller arteries, which supply oxygen-rich blood to
the entire heart muscle.

The right coronary artery supplies blood mainly to the right side of the heart. The right side of the heart is
smaller because it pumps blood only to the lungs.

The left coronary artery, which branches into the left anterior descending artery and the circumflex artery,
supplies blood to the left side of the heart. The left side of the heart is larger and more muscular because it
pumps blood to the rest of the body.
 Cardiovascular System Anatomy & Physiology

The heart is the pump responsible for maintaining adequate circulation of oxygenated blood around
the vascular network of the body. It is a four-chamber pump, with the right side receiving
deoxygenated blood from the body at low presure and pumping it to the lungs (the pulmonary
circulation) and the left side receiving oxygenated blood from the lungs and pumping it at high
pressure around the body (the systemic circulation).

The myocardium (cardiac muscle) is a specialised form of muscle, consisting of individual cells joined
by electrical connections. The contraction of each cell is produced by a rise in intracellular calcium
concentration leading to spontaneous depolarisation, and as each cell is electrically connected to its
neighbour, contraction of one cell leads to a wave of depolarisation and contraction across the
myocardium.

This depolarisation and contraction of the heart is controlled by a specialised group of cells localised in
the sino-atrial node in the right atrium- the pacemaker cells.

1. These cells generate a rhythmical depolarisation, which then spreads out over the atria
to the atrio-ventricular node.
2. The atria then contract, pushing blood into the ventricles.
3. The electrical conduction passes  via  the Atrio-ventricular node to the bundle of His,
which divides into right and left branches and then spreads out from the base of the
ventricles across the myocardium.
4. This leads to a 'bottom-up' contraction of the ventricles, forcing blood up and out into the
pulmonary artery (right) and aorta (left).
5. The atria then re-fill as the myocardium relaxes.

The 'squeeze' is called systole and normally lasts for about 250ms. The relaxation period, when the
atria and ventricles re-fill, is called diastole; the time given for diastole depends on the heart rate.

The ECG

The Electrocardiograph (ECG) is clinically very useful, as it shows the electrical activity within the
heart, simply by placing electrodes at various points on the body surface. This enables clinicians to
determine the state of the conducting system and of the myocardium itself, as damage to the
myocardium alters the way the impulses travel through it.

When looking at an ECG, it is often helpful to remember that an upward deflection on the ECG
represents depolarisation moving towards the viewing electrode, and a downward deflection
represents depolarisation moving away from the viewing electrode. Below is a normal lead II ECG.

 The P wave represents atrial depolarisation- there is little muscle in the atrium so the
deflection is small.
 The Q wave represents depolarisation at the bundle of His; again, this is small as there is little
muscle there.
 The R wave represents the main spread of depolarisation, from the inside out, through the
base of the ventricles. This involves large ammounts of muscle so the deflection is large.
 The S wave shows the subsequent depolarisation of the rest of the ventricles upwards from
 the base of the ventricles.
 The T wave represents repolarisation of the myocardium after systole is complete. This is a
relatively slow process- hence the smooth curved deflection.

The Coronary Circulation

The heart needs its own reliable blood supply in order to keep beating- the coronary circulation. There
are two main coronary arteries, the left and right coronary arteries, and these branch further to form
several major branches (see image). The coronary arteries lie in grooves (sulci) running over the
surface of the myocardium, covered over by the epicardium, and have many branches which
terminate in arterioles supplying the vast capillary network of the myocardium. Even though these
vessels have multiple anastomoses, significant obstruction to one or other of the main branches will
lead to ischaemia in the area supplied by that branch.

Anatomy & Physiology of the Respiratory System

The respiratory system is situated in the thorax,

and is responsible for gaseous exchange
between the circulatory system and the outside
world. Air is taken in via the upper airways (the
nasal cavity, pharynx and larynx) through the
lower airways (trachea, primary bronchi and
bronchial tree) and into the small bronchioles
and alveoli within the lung tissue.
Move the pointer over the coloured regions
of the diagram; the names will appear at
the bottom of the screen)

The lungs are divided into lobes; The left lung is

composed of the upper lobe, the lower lobe
and the lingula (a small remnant next to the
apex of the heart), the right lung is composed of
the upper, the middle and the lower lobes.

Mechanics of Breathing

To take a breath in, the external intercostal

muscles contract, moving the ribcage up and
out. The diaphragm moves down at the same
time, creating negative pressure within the
thorax. The lungs are held to the thoracic wall by the pleural membranes, and so expand outwards as
well. This creates negative pressure within the lungs, and so air rushes in through the upper and lower
airways.

Expiration is mainly due to the natural elasticity of the lungs, which tend to collapse if they are not
held against the thoracic wall. This is the mechanism behind lung collapse if there is air in the pleural
space (pneumothorax).
 Physiology of Gas Exchange

Each branch of the bronchial tree eventually sub-divides to

form very narrow terminal bronchioles, which terminate in
the alveoli. There are many millions of alveloi in each lung,
and these are the areas responsible for gaseous exchange,
presenting a massive surface area for exchange to occur
over.

Each alveolus is very closely associated with a network of

capillaries containing deoxygenated blood from the
pulmonary artery. The capillary and alveolar walls are very
thin, allowing rapid exchange of gases by passive diffusion
along concentration gradients.
CO2 moves into the alveolus as the concentration is much
lower in the alveolus than in the blood, and O2 moves out of
the alveolus as the continuous flow of blood through the
capillaries prevents saturation of the blood with O2 and allows
maximal transfer across the membrane.

Anatomy of the Central Nervous System

The brain can be subdivided into several distinct regions:

 The cerebral hemispheres form the largest part of the brain, occupying the anterior and
middle cranial fossae in the skull and extending backwards over the tentorium cerebelli.
They are made up of the cerebral cortex, the basal ganglia, tracts of synaptic connections,
and the ventricles containing CSF.
  The Diencephalon (not shown above) includes the thalamus, hyopthalamus, epithalamus
and subthalamus, and forms the central core of the brain. It is surrounded by the cerebral
hemispheres.
 The Midbrain (not shown) is located at the junction of the middle and posterior cranial
fossae.
 The Pons sits in the anterior part of the posterior cranial fossa- the fibres within the structure
connect one cerebral hemisphere with its opposite cerebellar hemisphere.
 The Medulla Oblongata is continuous with the spinal cord, and is responsible for automatic
control of the respiratory and cardiovascular systems.
 The Cerebellum overlies the pons and medulla, extending beneath the tentorium cerebelli
and occupying most of the posterior cranial fossa. It is mainly concerned with motor
functions that regulate muscle tone, coordination, and posture

Cerebral lobes

The cerebral hemispheres can be further divided into four lobes:

 Frontal (red)
 Parietal (yellow)
 Occipital (green)
 Temporal (blue)
 The frontal lobe is concerned with higher intellectual functions, such as abstract thought and
reason, speech (Broca's area in the left hemisphere only), olfaction, and emotion. Voluntary
movement is controlled in the precentral gyrus (the primary motor area).

 The parietal lobe is dedicated to sensory awareness, particularly in the postcentral gyrus
(the primary sensory area). It is also concernes with abstract reasoning, language
interpretation and formation of a mental egocentric map of the surrounding area.

 The occipital lobe is responsible for interpretation and processing of visual stimuli from the
optic nerves, and association of these stimuli with other nervous imputs and memories.

 The temporal lobe is concerned with emotional development and formation, and also
contains the auditory area responsible for processing and discrimination of sound. It is also
the area thought to be responsible for the formation and processing of memories
The cerebral hemispheres are supplied by three main arteries:

 anterior cerebral artery

 middle cerebral artery
 posterior cerebral artery

(the areas supplied by each artery can be seen by clicking on the names above)

Stenosis or occlusion in any of these arteries will have an effect on the area of brain they supply; the
effect will depend on the degree of occlusion, and where in the artery the occlusion is (if it is in one of
the terminal branches the effect may be fairly small, but if it is at the base of the artery the effect will
be very large).

Occlusion results in ischaemic damage to the cerebral tissues- this is called an 'ischaemic stroke'- and
will therefore affect whatever system that particular region controls, often leaving a permanent
residual deficit even if the cause of the ischaemia resolves.

Anterior cerebral artery

 Middle cerebral artery

Posterior cerebral artery

Renal System
The kidneys are essentially regulatory organs which maintain the volume and composition of body
fluid by filtration of the blood and selective reabsorption or secretion of filtered solutes.

the kidneys are retroperitoneal organs (ie located behind the peritoneum) situated on the posterior
wall of the abdomen on each side of the vertebral column, at about the level of the twelfth rib. The left
kidney is lightly higher in the abdomen than the right, due to the presence of the liver pushing the
right kidney down.

The kidneys take their blood supply directly from the aorta via the renal arteries; blood is returned to
the inferior vena cava via the renal veins. Urine (the filtered product containing waste materials and
water) excreted from the kidneys passes down the fibromuscular ureters and collects in the bladder.
The bladder muscle (the detrusor muscle) is capable of distending to accept urine without increasing
the pressure inside; this means that large volumes can be collected (700-1000ml) without high-
pressure damage to the renal system occuring.
When urine is passed, the urethral sphincter at the base of the bladder relaxes, the detrusor
contracts, and urine is voided via the urethra.

Structure of the kidney

 On sectioning, the kidney has a pale outer
region- the cortex- and a darker inner region-
the medulla.The medulla is divided into 8-18
conical regions, called the renal pyramids; the
base of each pyramid starts at the
corticomedullary border, and the apex ends in
the renal papilla which merges to form the
renal pelvis and then on to form the ureter. In
humans, the renal pelvis is divided into two or
three spaces -the major calyces- which in turn
divide into further minor calyces. The walls of
the calyces, pelvis and ureters are lined with
smooth muscle that can contract to force urine
towards the bladder by peristalisis.

The cortex and the medulla are made up of

nephrons; these are the functional units of the
kidney, and each kidney contains about 1.3
million of them

Structure of the Nephron

The nephron is the unit of the kidney responsible for ultrafiltration of the blood and reabsorption or
excretion of products in the subsequent filtrate. Each nephron is made up of:

 A filtering unit- the glomerulus. 125ml/min of filtrate is formed by the kidneys as blood is
filtered through this sieve-like structure. This filtration is uncontrolled.
  The proximal convoluted tubule. Controlled absorption of glucose, sodium, and other
solutes goes on in this region.
 The loop of Henle. This region is responsible for concentration and dilution of urine by
utilising a counter-current multiplying mechanism- basically, it is water-impermeable but can
pump sodium out, which in turn affects the osmolarity of the surrounding tissues and will
affect the subsequent movement of water in or out of the water-permeable collecting duct.
 The distal convoluted tubule. This region is responsible, along with the collecting duct
that it joins, for absorbing water back into the body- simple maths will tell you that the kidney
doesn't produce 125ml of urine every minute. 99% of the water is normally reabsorbed,
leaving highly concentrated urine to flow into the collecting duct and then into the renal pelvis.

Micrograph of Glomerulus

Key:

 AA- afferent arteriole

 EA- efferent arteriole
 BC- Bowman's capsule
 US- urinary space
 TP- tubular pole- first part of collecting system

As blood passes through the glomerulus from the afferent arteriole, the plasma is filtered through a
very fine physical mesh created by podocyte cells. This filtration process is entirely pressure- and
osmotically- driven, with no active transport involved at this stage.
 Micrograph of Proximal Convoluted Tubule

The proximal tubule carries out much of the

active reabsorption of solutes present in the
filtrate. The lumen of the tubule has many
microvilli (MV) which dramatically increase the
area available for membrane transfer. The cells
are also packed with mitochondria supplying
energy for the active transport processes; it has
been calculated that about 50% of the kidney's
energy needs go on the active transport of
sodium back out of the filtrate in the proximal
tubule.

Electron Micrograph of Loop of Henle

The loop of Henle has a flat thin lining epithelium with little specialization of the cytoplasm. It
acts to create an osmotic gradient in the surrounding tissues, allowing concentration of the
urine as it passes through the medulla.

Micrograph of Collecting ducts

Key:

 CD- collecting ducts

 I- interstitial tissues
 C- calyx

Many distal convoluted tubules join to a central collecting duct; these, in turn, merge together
until they emerge at the renal papilla and the highly concentrated urine is released into the
calyces.
 Anatomy of the Liver- front view

The liver is the largest organ in the body, normally weighing about 1.5kg (although this can increase
to over 10kg in chronic cirrhosis). The liver is the main organ of metabolism and energy production;
its other main functions include:

 Bile production
 Storage of iron, vitamins and trace elements
 detoxification
 conversion of waste products for excretion by the kidneys

The liver is functionally divided into two lobes, right and left. The external division is marked on the
front of the liver by the falciform ligament, which joins the coronary ligament at the superior margin of
the liver.
  The right lobe is separated from the other lobes by the gallbladder fossa and the fossa for
the inferior vena cava on the visceral surface of the liver.
 The left lobe includes the caudate and quadrate lobes. It is separated from these two lobes
by the attachment of the ligumentum teres, and the fissures for the ligumentum teres and
the ligamentum venosum.
 The caudate lobe lies between the fissure for the ligamentum venosum and the fossa for the
inferior vena cava.
 The quadrate lobe is partly covered by the gallbladder in normal patients; anatomically, it
lies between the fissure for the ligamentum teres and the gallbladder fossa.

Each lobe hs its own arterial and venous supply and its own billiary drainage. all the lobes perform the
same functions- there are no areas of specialisation.
 The Portal Circulation

The liver is unusual in that it has a double blood supply;

the right and left hepatic arteries carry oxygenated blood
to the liver, and the portal vein carries venous blood
from the GI tract to the liver.

The venous blood from the GI tract drains into the

superior and inferior mesenteric veins; these two vessels
are then joined by the splenic vein just posterior to the
neck of the pancreas to form the portal vein. This then
splits to form the right and left branches, each supplying
about half of the liver.
On entering the liver, the blood drains into the hepatic
sinusoids, where it is screened by specialised
macrophages (Kupffer cells) to remove any pathogens
that manage to get past the GI defences. The plasma is
filtered through the endothelial lining of the sinusoids
and bathes the hepatocytes; these cells contain vast
numbers of enzymes capable of braking down and metabolising most of what has been absorbed.

The portal venous blood contains all of the products of digestion absorbed from the GI tract, so all
useful and non-useful products are processed in the liver before being either released back into the
hepatic veins which join the inferior vena cava just inferior to the diaphragm, or stored in the liver for
later use.
 Surface Markings of the Liver

When examining a patient, it is important to recognise where the internal organs lie relative to the
surface anatomy you can see. The liver can essentially be visualised as a triangle, with its upper
margin below the nipples on either side of the chest, and the lower margin making a line from just
above the tenth rib on the right side to below the nipple on the left side. The superior surface of the
liver lies just below the diaphragm; this means that the lower margin of the liver will move downwards
on inspiration, and this can be palpated. As the liver is also a very dense organ, it is very dull to
percussion and you can easily percuss out the borders of the liver if palpation is unsuccessful.

The gallbladder area can be palpated around the tip of the right ninth rib. The normal gallbladder is
impalpable; it only becomes palpable when distended with stones or bile, and the area will become
very tender if there is inflammation present.

The GI System
The gastro-intestinal system is essentially a long tube running right through the body, with specialised
sections that are capable of digesting material put in at the top end and extracting any useful
components from it, then expelling the waste products at the bottom end. The whole system is under
hormonal control, with the presence of food in the mouth triggering off a cascade of hormonal actions;
when there is food in the stomach, different hormones activate acid secretion, increased gut motility,
enzyme release etc. etc.

Nutrients from the GI tract are not processed on-site; they are taken to the liver to be broken down
further, stored, or distributed.

The Oesophagus

Once food has been chewed and mixed with saliva in the mouth, it is swallowed and passes down the
oesophagus. The oesophagus has a stratified squamous epithelial lining (SE) which protects the
oesophagus from trauma; the submucosa (SM) secretes mucus from mucous glands (MG) which aid
the passage of food down the oesophagus. The lumen of the oesophagus is surrounded by layers of
muscle (M)- voluntary in the top third, progressing to involuntary in the bottom third- and food is
propelled into the stomach by waves of peristalisis.

The Stomach
The stomach is a 'j'-shaped organ, with two openings- the oesophageal and the duodenal- and four
regions- the cardia, fundus, body and pylorus. Each region performs different functions; the fundus
collects digestive gases, the body secretes pepsinogen and hydrochloric acid, and the pylorus is
responsible for mucus, gastrin and pepsinogen secretion.

The stomach has five major functions;

 Temporary food storage

 Control the rate at which food enters the duodenum
 Acid secretion and antibacterial action
 Fluidisation of stomach contents
 Preliminary digestion with pepsin, lipases etc.

The Stomach - Histology

Key:

 G- mucosa containing glandular tissue; different areas of the stomach contain different types
of cells which secrete compounds to aid digestion. The main types involved are:
o parietal cells which secrete hydrochloric acid
o chief cells which secrete pepsin
o enteroendocrine cells which secrete regulatory hormones.
 MM- muscularis mucosae
 SM- submucosa

The stomach contains three layers of involuntary smooth muscle which aid digestion
by physically breaking up the food particles;

o OM- inner oblique muscle

o CM- circular muscle
o LM- outer longditudional muscle

The Small Intestine (1)

The small intestine is the site where most of the chemical and mechanical digestion is carried out, and
where virtually all of the absorption of useful materials is carried out. The whole of the small intestine
is lined with an absorptive mucosal type, with certain modifications for each section. The intestine also
has a smooth muscle wall with two layers of muscle; rhythmical contractions force products of
digestion through the intestine (peristalisis). There are three main sections to the small intestine;

 The duodenum forms a 'C' shape around the head of the pancreas. Its main function is to
neutralise the acidic gastric contents (called 'chyme') and to initiate further digestion;
Brunner's glands in the submucosa secrete an alkaline mucus which neutralises the chyme
and protects the surface of the duodenum.
 The jejunum
 The ileum. The jejunum and the ileum are the greatly coiled parts of the small intestine, and
together are about 4-6 metres long; the junction between the two sections is not well-
defined. The mucosa of these sections is highly folded (the folds are called plicae), increasing
the surface area available for absorption dramatically.

The Small Intestine (2)

The micrograph above shows a section of the jejunum, and clearly shows the highly folded structure
of the mucosa of the small intestine. The epithelial surface of the plicae (P) is further folded to form
villi(V). These increase the surface area of the small intestine still further, and the surface of each
villus is covered in small microvilli to maximise surface area- the area available for absorption is vast.
Each villus has its own blood supply- the vessels can be seen in the submucosa (SM)- and blood
containing digestive products from the small intestine is taken to the liver via the hepatic portal
system. The double muscle layer (M) moves food through the intestine by peristalisis.

The Pancreas
The pancreas consists mainly of exocrine glands that secrete enzymes to aid in the digestion of food in
the small intestine. the main enzymes produced are lipases, peptidases and amylases for fats,
proteins and carbohydrates respectively. These are released into the duodenum via the duodenal
ampulla, the same place that bile from the liver drains into.
Pancreatic exocrine secretion is hormonally regulated, and the same hormone that encourages
secretion (cholesystokinin) also encourages discharge of the gall bladder's store of bile. As bile is
essentially an emulsifying agent, it makes fats water soluble and gives the pancreatic enzymes lots of
surface area to work on.
structurally, the pancreas has four sections; head, neck, body and tail; the tail stretches back to just
in front of the spleen.

The Large Intestine

By the time digestive products reach the large intestine, almost all of the nutritionally useful products
have been removed. The large intestine removes water from the remainder, passing semi-solid faeces
into the rectum to be expelled from the body through the anus. The mucosa (M) is arranged into
tightly-packed straight tubular glands (G) which consist of cells specialised for water absorption and
mucus-secreting goblet cells to aid the passage of faeces. The large intestine also contains areas of
lymphoid tissue (L); these can be found in the ileum too (called Peyer's patches), and they provide
local immunological protection of potential weak-spots in the body's defences. As the gut is teeming
with bacteria, reinforcement of the standard surface defences seems only sensible...