ANATOMY AND PHYSIOLOGY

A. Digestive System:

Function of the Digestive System

The function of the digestive system is digestion and absorption. Digestion is the
breakdown of food into small molecules, which are then absorbed into the body. The
digestive system is divided into two major parts:

• The gastrointestinal (GI) tract (alimentary canal) is a continuous tube with two
openings, the mouth and the anus. It includes the mouth, pharynx, esophagus,
stomach, small intestine, and large intestine. Food passing through the internal
 cavity, or lumen, of the GI tract does not technically enter the body until it is
absorbed through the walls of the GI tract and passes into blood or lymphatic
vessels.

• Accessory organs include the teeth and tongue, salivary glands, liver,
gallbladder, and pancreas.

Ingestion and Swallowing: Swallowing is a complex event that is coordinated by the

swallowing center in the lower portion of the brainstem. During this process, food
passes from the mouth to the pharynx and into the esophagus.

Mouth: Foodstuffs are broken down into small pieces mechanically by chewing and
saliva is added as a lubricant. Initially, the food bolus is moved to the back of the
tongue. This triggers swallowing, by stimulating touch receptors in the pharynx. Then,
the anterior of the tongue lifts to the hard palate and forces the bolus to the pharynx.

Pharyngeal phase: during the pharyngeal phase, the larynx is pulled forward and
upward under the tongue by muscular contraction. As the larynx rises, the epiglottis
moves backwards and downwards to seal off the glottis.

Esophagus: A simple conduit between the mouth and stomach - clearly important but
only marginally interesting compared to other regions of the tube. It is about 25 cm long
it is essential a passageway

After Pharyngeal phase, the food bolus is pushed through the esophagus by involuntary
muscle contractions called peristalsis.

Stomach: Where the real action begins - enzymatic digestion of proteins initiated and
foodstuffs reduced to liquid form. Foodstuffs entering the stomach have been, to at least
some extent, crushed and reduced in size by mastication, and impregnated with saliva.
The stomach provides four basic functions that assist in the early stages of digestion
and prepare the ingesta for further processing in the small intestine:

• It serves as a short-term storage reservoir, allowing a rather large meal to be

consumed quickly and deal with over an extended period.
 • It is in the stomach that substantial enzymatic digestion is initiated, particularly of
proteins.
• Vigorous contractions of gastric smooth muscle mix and grind foodstuffs with
gastric secretions, resulting in liquefaction of food, a prerequisite for delivery of
the ingesta to the small intestine.
• As food is liquefied in the stomach, it is slowly released into the small intestine for
further processing.

There are 2 basic types of muscular movements in the stomach: Mixing waves which
mix ingested materials with the gastric secretions; and Peristaltic waves that are more
powerful and force chyme towards the pyloric sphincter. Each peristaltic wave forces a
small amount of chyme thru the pylorus.

Secreted Abbreviat From

Effect
hormone ion cells

Gastrin (Primaril
G cells Secretion of gastric acid by parietal cells
y)

Stimulate appetite,
P/D1
Ghrelin
cells secretion of growth hormone from anterior
pituitary gland

increased food intake and decreased physical

Neuropeptide Y NPY
activity
Suppress release
of gastrin, cholecystokinin (CCK), secretin, motilin
, vasoactive intestinal peptide (VIP), gastric
inhibitory polypeptide (GIP), enteroglucagon
Somatostatin D cells
Lowers rate of gastric emptying Reduces smooth
muscle contractions and blood flow within the
intestine.

Histamine ECL cells stimulate gastric acid secretion

Endothelin X cells Smooth muscle contraction of stomach
Liver: The center of metabolic activity in the body - its major role in the digestive
process is to provide bile salts to the small intestine, which are critical for digestion and
absorption of fats. The liver is traditionally divided into 4 lobes: right, left, caudate, and
quadrate. The large left and right lobes are easily viewed anteriorly and are separated
by the falciform ligament. The caudate and quadrate lobes are smaller and best viewed
from the posteroinferior aspect. The gallbladder rests in a recess on the interior of the
right lobe. The liver is attached to the lesser curvature of the stomach via the lesser
omentum. The hepatic artery and hepatic portal vein run to the liver in the lesser
omentum and enter the liver at its hilum (the porta hepatis). The hepatic ducts along
with lymphatic vessels exit the liver at its hilum. The main digestive output of the liver is
bile. It exits the liver as follows:
1. Bile from the left and right sides of the liver leaves via the left and right hepatic
ducts respectively.
2. The left and right hepatic ducts fuse to form the common hepatic duct.
3. The common hepatic duct fuses with the cystic duct of the gallbladder to form the
common bile duct.
4. Common bile duct fuses with the pancreatic duct and enters the duodenum as
the hepatopancreatic ampulla.

Secreted hormone Abbrevia From cells Effect

tion

Insulin-like growth factor (or IGF Hepatocytes insulin-like effects

somatomedin) (Primarily)
regulate cell growth and
development
Angiotensinogen and angiotensi Hepatocytes vasoconstriction
n
release
of aldosterone from adrenal
cortex dipsogen.
Thrombopoietin Hepatocytes stimulates megakaryocytes
to produce platelets
Pancreas

Is mostly retroperitoneal and deep to the greater

curvature of the stomach. The head of the
pancreas sits next to the duodenum as it
emanates from and loops away from the
pylorus. The body extends behind the stomach
and its tail ends at the spleen. The pancreas
primarily consists of acini – small clusters of
enzyme secreting cells.
These acinar cells empty their secretion into
small pancreatic ducts. Small pancreatic
ultimately empty into the main pancreatic duct,
which runs centrally along the long axis of the pancreas. Recall that the main pancreatic
duct combines with the common bile duct to form the hepatopancreatic ampulla, which
empties into the duodenum at the major duodenal papilla. Sometime an accessory
pancreatic duct will branch from the main pancreatic duct and empty directly into the
duodenum,

The major function of the acinar and duct cells is the secretion of pancreatic juice
(1.5L/day). Acinar cells contribute digestive enzymes to the pancreatic juice including:
• Protein-digesting enzymes (a.k.a. proteases such as trypsinogen,
chymotrypsinogen, and procarboxypeptidase). These proteases are released in
an inactive form known as zymogens. The active forms are trypsin, hymotrypsin,
and carboxypeptidase.
• Fat-digesting enzymes such as pancreatic lipase.
• Carbohydrate-digesting enzymes such as pancreatic amylase.
• Nucleic acid-digesting enzymes such as nuclease.
• Duct cells contribute a watery bicarbonate-rich solution. The bicarbonate gives
pancreatic juice a slightly alkaline pH which helps neutralize the acidity of the
chyme.
When acidic, fatty chyme arrives, the duodenal enteroendocrine cells secrete secretin
and cholecystokinin (CCK). CCK travels in the blood to the pancreas where it primarily
stimulates the secretion of enzymes by the acinar cells. Secretin also travels to the
pancreas and stimulates the duct cells to release large amounts of the bicarbonate-rich
fluid. CCK also causes contraction of the gallbladder as well as relaxation of the
hepatopancreatic sphincter. During the cephalic and gastric phases of gastric secretion,
parasympathetic input to the pancreas via the vagus nerve also prompts pancreatic
juice release. Scattered amidst the pancreatic acini are the hormone-producing islets of
Langerhans.
Their major function is the regulation of blood glucose levels. Islets of Langerhans
consist of two primary cell types. Alpha cells secrete the hormone glucagon. Beta cells
secrete the hormone insulin. Glucagon is released in response to low plasma [glucose].
Glucagon acts to increase plasma [glucose]. Insulin is released in response to high
Plasma [glucose] and acts to lower plasma [glucose].Important roles as both an
endocrine and exocrine organ - provides a potent mixture of digestive enzymes to the
small intestine, which are critical for digestion of fats, carbohydrates and protein.

Secreted From cells Effect

hormone

Insulin (Primaril β Islet cells Intake

y) of glucose, glycogenesis and glycolysis in liver and
muscle from blood

intake of lipids and synthesis

of triglycerides in adipocytes Other anabolic effects
Glucagon (Also α Islet cells glycogenolysis and gluconeogenesis in liver
Primarily) increases blood glucose level
Somatostatin δ Islet cells Inhibit release of insulin

Inhibit release of glucagon Suppress the exocrine

secretory action of pancreas.
Pancreatic PP cells Self regulate the pancreas secretion activities and
polypeptide effect the hepatic glycogen levels.
 In addition to its role as an exocrine organ, the pancreas is also an endocrine
organ and the major hormones it secretes - insulin and glucagon - play a vital role in
carbohydrate and lipid metabolism. They are, for example, necessary for maintaining
normal blood concentrations of glucose.

Small Intestine: The most exciting place to be in the entire digestive system - this is
where the final stages of chemical enzymatic digestion occur and where almost all
nutrients are absorbed. The small intestine is the portal for absorption of virtually all
nutrients into blood. Accomplishing this transport entails breaking down large
supramolecular aggregates into small molecules that can be transported across the
epithelium

Large Intestine: Major differences among species in extent and importance - in

humans water is absorbed, bacterial fermentation takes place and feces are formed.
The colon is made up of six parts all working collectively for a single purpose. Their
purpose is ridding the body of toxins that have entered the body from food sources,
environmental poisons, or toxins produced within the body. The colons role is to transfer
nutrients into the bloodstream through the absorbent walls of the large intestine while
pushing waste out of the body. In this process, digestive enzymes are released, water is
absorbed by the stool, and a host of muscle groups and beneficial microorganisms work
to maintain the digestive system.

The colon is approximately 4.5 feet long, 2.5 inches wide, and is a muscular tube
composed of lymphatic tissue, blood vessels, connective tissue, and specialized
muscles for carrying out the tasks of water absorption and waste removal. The tough
outer covering of the colon protects the inner layer of the colon with circular muscles for
propelling waste out of the body in an action called peristalsis. Under the outer muscular
layer is a sub-mucous coat containing the lymphatic tissue, blood vessels, and
connective tissue. The innermost lining is highly moist and sensitive, and contains the
villi- or tiny structures providing blood to the colon.

The colon is actually just another name for the large intestine. The shorter of the two
intestinal groups, the large intestine, consists of parts with various responsibilities. The
names of these parts are the transverse colon, ascending colon, appendix, descending
colon, sigmoid colon, and the rectum and anus.

Ileocecal and Cecum Valves

The ileocecal valve is located where the small and large intestines meet. This valve is
an opening between the small intestine and large intestine allowing contents to be
transferred to the colon. The cecum follows this valve and is an opening to the large
intestine.

Rectum and Anus

The rectum is a chamber that begins at the end of the large intestine, immediately
following the sigmoid colon, and ends at the anus. Ordinarily, the rectum is empty
because stool is stored higher in the descending colon. Eventually, the descending
colon becomes full, and stool passes into the rectum, causing an urge to move the
bowels (defecate). Adults and older children can withstand this urge until they reach a
bathroom. Infants and young children lack the muscle control necessary to delay bowel
movement.

The anus is the opening at the far end of the digestive tract through which stool leaves
the body. The anus is formed partly from the surface layers of the body, including the
skin, and partly from the intestine. The anus is lined with a continuation of the external
skin. A muscular ring (anal sphincter) keeps the anus closed until the person has a
bowel movement.

B. Cardiovascular System and Circulatory system

A. Cardiovascular System

The cardiovascular system comprises of the heart, blood, blood vessels and lymphatic
system.

Heart
 The function of the heart is to
pump blood around the body.
The heart is a hollow,
muscular organ divided by a
vertical wall called the
septum. These two chambers
are further divided into the thin
walled atrium above, and a
thick walled ventricle below,
making four chambers.
Between each pair of
chambers are valves
preventing any back flow of
blood. Blood vessels leaving
the heart generally carry
oxygenated blood through
vessels known as arteries. These are large, hollow elastic tubes with thick muscular
walls that are designed to withstand the high pressure with the blood leaving the heart.
Their size gradually diminishes as they spread throughout the body, ultimately reaching
fine, hair-like vessels known as capillaries. Blood vessels that return blood to the heart
are known as veins, which generally carry de-oxygenated blood to the heart. They are
elastic tubes containing valves to help prevent back flow of blood. Blood is forced
through arteries by the pressure from the heart whereas venous flow is aided by
muscular contraction.

The only two exceptions to the above are the pulmonary artery, which carries de-
oxygenated blood from the heart to the lungs, and the pulmonary vein, which carries
oxygenated blood from the lungs to the heart. The circulation is divided into two
principle systems known as the general or systemic circulation, that is the circulation
around the body, and the pulmonary circulation to and from the lungs.

Pumping Action of the Heart

 The pumping action starts with the simultaneous contraction of the two atria. This
contraction serves to give an added push to get the blood into the ventricles at the end
of the slow-filling portion of the pumping cycle called "diastole." Shortly after that, the
ventricles contract, marking the beginning of "systole." The aortic and pulmonary valves
open and blood is forcibly ejected from the ventricles, while the mitral and tricuspid
valves close to prevent backflow. At the same time, the atria start to fill with blood again.
After a while, the ventricles relax, the aortic and pulmonary valves close, and the mitral
and tricuspid valves open and the ventricles start to fill with blood again, marking the
end of systole and the beginning of diastole. It should be noted that even though equal
volumes are ejected from the right and the left heart, the left ventricle generates a much
higher pressure than does the right ventricle.

Electrical Activity of the Heart

When vertebrate muscles are excited, an electrical signal (called an "action

potential") is produced and spreads to the rest of the muscle cell, causing an increase in
the level of calcium ions inside the cell. The calcium ions bind and interact with
molecules associated with the cell's contractile machinery, the end result being a
mechanical contraction. Even though the heart is a specialized muscle, this
fundamental principle still applies.

One thing that distinguishes the heart from other muscles is that the heart muscle is a
"syncytium," meaning a meshwork of muscle cells interconnected by contiguous
cytoplasmic bridges. Thus, an electrical excitation occurring in one cell can spread to
neighboring cells. Another defining characteristic is the presence of pacemaker cells.
These specialized muscle cells can generate action potentials rhythmically.

Under normal circumstances, a wave of electrical excitation originates in the pacemaker

cells in the sino-atrial (S-A) node, located on top of the right atrium. Specialized muscle
fibers transmit this excitation throughout the atria and initiate a coordinated contraction
of the atrial walls. Meanwhile, some of these fibers excite a group of cells located at the
border of the left atrium and ventricle known as the atrioventricular (A-V) node. The A-V
node is responsible for spreading the excitation throughout the two ventricles and
causing a coordinated ventricular contraction.

Blood

The fluid that surrounds tissue cells throughout the body is called interstitial fluid and is
serviced by blood transporting oxygen and nutrients to it whilst lymph removes toxins
and waste products. Blood forms about 79% of the body weight consisting of Plasma,
Corpuscles and Platelets. Erythrocyte (red blood cells) transport oxygen and carbon
dioxide, leucocytes (white blood cells), produced in red bone marrow (myeloid tissue),
and lymphocytes fight infection and thrombocyte (platelet) are essential to blood clotting
at the site of an injury. Plasma is a clear slightly alkaline yellow fluid in which the
following are dissolved - blood, proteins, salts, waste materials, gases, enzymes,
hormones and vitamins. The blood has three main functions, transport, regulation, and
protection.

Transports

• oxygen from the lungs to the cells

• carbon dioxide from the cells to the lungs
• nutrients from the intestines to the cells
• waste material from the cells
• hormones from the endocrine glands to the cells
• heat from various cells

Regulates

• pH (concentration of hydronium ions)

• body temperature
• salts
• water content in the cells

Protection

• Blood prevents loss by clotting and combats toxins

B. Circulatory system

Circulatory system

The circulatory system is an organ system that passes nutrients (such as amino
acids and electrolytes), gases, hormones, blood cells, etc. to and from cells in the body
to help fight diseases and help stabilize body temperature and pH to
maintain homeostasis.

This system may be seen strictly as a blood distribution network, but some consider the
circulatory system as composed of the cardiovascular system, which distributes blood,
and the lymphatic system, which distributes lymph. While humans, as well as other
vertebrates, have a closed cardiovascular system (meaning that the blood never leaves
the network of arteries, veins and capillaries), some invertebrate groups have an open
cardiovascular system. The most primitive animal phyla lack circulatory systems. The
lymphatic system, on the other hand, is an open system.

Two types of fluids move through the circulatory system: blood and lymph. The blood,
heart, and blood vessels form the cardiovascular system. The lymph, lymph nodes, and
lymph vessels form the lymphatic system. The cardiovascular system and the lymphatic
system collectively make up the circulatory system.

Pulmonary circulation

The Pulmonary circulation is the portion of the cardiovascular system which

transports oxygen-depleted blood away from the heart, to the lungs, and returns
oxygenated blood back to the heart.

Oxygen deprived blood from the vena cava enters the right atrium of the heart and flows
through the tricuspid valve into the right ventricle, from which it is pumped through
the pulmonary semilunar valve into the pulmonary arteries which go to the lungs.
Pulmonary veins return the now oxygen-rich blood to the heart, where it enters the left
atrium before flowing through the mitral valve into the left ventricle. Then, oxygen-rich
blood from the left ventricle is pumped out via the aorta, and on to the rest of the body.

Systemic circulation
Systemic circulation is the portion of the cardiovascular system which transports
oxygenated blood away from the heart, to the rest of the body, and returns oxygen-
depleted blood back to the heart. Systemic circulation is, distance-wise, much longer
than pulmonary circulation, transporting blood to every part of the body.

Coronary circulation

The coronary circulatory system provides a blood supply to the heart. As it provides
oxygenated blood to the heart, it is by definition a part of the systemic circulatory
system.