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SLIDE 1 ANATOMY AND PHYSIOLOGY OF THE GASTROINTESTINAL SYSTEM Introduction to the gastrointestinal system The gastrointestinal tract (GIT)

consists of a hollow muscular tube starting from the oral cavity, where food enters the mouth, continuing through the pharynx, esophagus, stomach and intestines to the rectum and anus, where food is expelled. There are various accessory organs that assist the tract by secreting enzymes to help break down food into its component nutrients. Thus the salivary glands, liver, pancreas and gall bladder have important functions in the digestive system. Food is propelled along the length of the GIT by peristaltic movements of the muscular walls.

SLIDE 2

The primary purpose of the gastrointestinal tract is to break food down into nutrients, which can be absorbed into the body to provide energy. First food must be ingested into the mouth to be mechanically processed and moistened. Secondly, digestion occurs mainly in the stomach and small intestine where proteins, fats and carbohydrates are chemically broken down into their basic building blocks. Smaller molecules are then absorbed across the epithelium of the small intestine and subsequently enter the circulation. The large intestine plays a key role in reabsorbing excess water. Finally, undigested material and secreted waste products are excreted from the body via defecation (passing of feces).

SLIDE 3 Basic structure The gastrointestinal tract is a muscular tube lined by a special layer of cells, called epithelium. The contents of the tube are considered external to the body and are in continuity with the outside world at the mouth and the anus. Although each section of the tract has specialized functions, the entire tract has a similar basic structure with regional variations.

SLIDE 4 The wall is divided into four layers as follows: Mucosa The innermost layer of the digestive tract has specialized epithelial cells supported by an underlying connective tissue layer called the lamina propria. The lamina propria contains blood vessels, nerves, lymphoid tissue and glands that support the mucosa. Depending on its function, the epithelium may be simple (a single layer) or stratified (multiple layers). Areas such as the mouth and esophagus are covered by a stratified squamous (flat) epithelium so they can survive the wear and tear of passing food. Simple columnar (tall) or glandular epithelium lines the stomach and intestines to aid secretion and absorption. The inner lining is constantly shed and replaced, making it one of the most rapidly dividing areas of the body. Beneath the lamina propria is the muscularis mucosa. This comprises layers of smooth muscle which can contract to change the shape of the lumen.

Submucosa The submucosa surrounds the muscularis mucosa and consists of fat, fibrous connective tissue and larger vessels and nerves. At its outer margin there is a specialized nerve plexus called the submucosal plexus or Meissner plexus. This supplies the mucosa and submucosa. Muscularis externa This smooth muscle layer has inner circular and outer longitudinal layers of muscle fibers separated by the myenteric plexus or Auerbach plexus. Neural innervations control the contraction of these muscles and hence the mechanical breakdown and peristalsis of the food within the lumen. Serosa/Mesentery The outer layer of the GIT is formed by fat and another layer of epithelial cells called mesothelium.

SLIDE 5 Individual components of the gastrointestinal system Oral cavity The oral cavity or mouth is responsible for the intake of food. It is lined by a stratified squamous oral mucosa with keratin covering those areas subject to significant abrasion, such as the tongue, hard palate and roof of the mouth. Mastication refers to the mechanical breakdown of food by chewing and chopping actions of the teeth. The tongue, a strong muscular organ, manipulates the food bolus to come in contact with the teeth. It is also the sensing organ of the mouth for touch, temperature and taste using its specialized sensors known as papillae. In salivation refers to the mixing of the oral cavity contents with salivary gland secretions. The mucin (a glycoprotein) in saliva acts as a lubricant. The oral cavity also plays a limited role in the digestion of carbohydrates. The enzyme serum amylase, a component of saliva, starts the process of digestion of complex carbohydrates. The final function of the oral cavity is absorption of small molecules such as glucose and water, across the mucosa. From the mouth, food passes through the pharynx and esophagus via the action of swallowing.

Salivary glands Three pairs of salivary glands communicate with the oral cavity. Each is a complex gland with numerous acini lined by secretory epithelium. The acini secrete their contents into specialized ducts. Each gland is divided into smaller segments called lobes. Salivation occurs in response to the taste, smell or even appearance of food. This occurs due to nerve signals that tell the salivary glands to secrete saliva to prepare and moisten the mouth. Each pair of salivary glands secretes saliva with slightly different compositions.

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Parotids The parotid glands are large, irregular shaped glands located under the skin on the side of the face. They secrete 25% of saliva. They are situated below the zygomatic arch (cheekbone) and cover part of the mandible (lower jaw bone). An enlarged parotid gland can be easier felt when one clenches their teeth. The parotids produce a watery secretion which is also rich in proteins. Immunoglobins are secreted help to fight microorganisms and a-amylase proteins start to break down complex carbohydrates. Submandibular The submandibular glands secrete 70% of the saliva in the mouth. They are found in the floor of the mouth, in a groove along the inner surface of the mandible. These glands produce a more viscid (thick) secretion, rich in mucin and with a smaller amount of protein. Mucin is a glycoprotein that acts as a lubricant. Sublingual The sublinguals are the smallest salivary glands, covered by a thin layer of tissue at the floor of the mouth. They produce approximately 5% of the saliva and their secretions are very sticky due to the large concentration of mucin. The main functions are to provide buffers and lubrication.

SLIDE 7 Esophagus The esophagus is a muscular tube of approximately 25cm in length and 2cm in diameter. It extends from the pharynx to the stomach after passing through an opening in the diaphragm. The wall of the esophagus is made up of inner circular and outer longitudinal layers of muscle that are supplied by the esophageal nerve plexus. This nerve plexus surrounds the lower portion of the esophagus. The esophagus functions primarily as a transport medium between compartments.

Once food has been chewed and mixed with saliva in the mouth, it is swallowed and passes down the esophagus. The esophagus has a stratified squamous epithelial lining (SE) which protects the esophagus from trauma; the submucosa (SM) secretes mucus from mucous glands (MG) which aid the passage of food down the esophagus. The lumen of the esophagus 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 peristalsis.

SLIDE 8 Stomach The stomach is a J shaped expanded bag, located just left of the midline between the esophagus and small intestine. It is divided into four main regions and has two borders called the greater and lesser curvatures. The first section is the cardia which surrounds the cardial orifice where the esophagus enters the stomach. The fundus is the superior, dilated portion of the stomach that has contact with the left dome of the diaphragm. The body is the largest section between the fundus and the curved portion of the J. This is where most gastric glands are located and where most mixing of the food occurs. Finally the pylorus is the curved base of the stomach. Gastric contents are expelled into the proximal duodenum via the pyloric sphincter. The inner surface of the stomach is contracted into numerous longitudinal folds called rugae. These allow the stomach to stretch and expand when food enters. The stomach can hold up to 1.5 liters of material. With two openings- the esophageal 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 Fluidization of stomach contents Preliminary digestion with pepsin, lipases etc.

SLIDE 9

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 o o

OM- inner oblique muscle CM- circular muscle LM- outer longditudional muscle

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The Small Intestine 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 (peristalsis). 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 neutralize the acidic gastric contents (called 'chyme') and to initiate further digestion; Brunner's glands in the submucosa secrete alkaline mucus which neutralizes 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 meters 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.

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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 maximize 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 peristalsis.

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Large intestine The large intestine is horse-shoe shaped and extends around the small intestine like a frame. It consists of the appendix, cecum, ascending, transverse, descending and sigmoid colon, and the rectum. It has a length of approximately 1.5m and a width of 7.5cm. The cecum is the expanded pouch that receives material from the ileum and starts to compress food products into fecal material. Food then travels along the colon. The wall of the colon is made up of several pouches (haustra) that are held under tension by three thick bands of muscle (taenia coli). The rectum is the final 15cm of the large intestine. It expands to hold fecal matter before it passes through the anorectal canal to the anus. Thick bands of muscle, known as sphincters, control the passage of feces. The mucosa of the large intestine lacks villi seen in the small intestine. The mucosal surface is flat with several deep intestinal glands. Numerous goblet cells line the glands that secrete mucous to lubricate fecal matter as it solidifies. The functions of the large intestine can be summarized as: 1. The accumulation of unabsorbed material to form feces. 2. Some digestion by bacteria. The bacteria are responsible for the formation of intestinal gas. 3. Reabsorption of water, salts, sugar and vitamins.

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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 feces into the rectum to be expelled from the body through the anus. The mucosa (M) is arranged into tightlypacked straight tubular glands (G) which consist of cells specialized for water absorption and mucus secreting goblet cells to aid the passage of feces. 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 defenses.

SLIDE 14 Accessory Glands 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 pancreas is a lobular, pinkish-grey organ that lies behind the stomach. Its head communicates with the duodenum and its tail extends to the spleen. The organ is approximately 15cm in length with a long, slender body connecting the head and tail segments. The pancreas has both exocrine and endocrine functions. Endocrine refers to production of hormones which occurs in the Islets of Langerhans. The Islets produce insulin, glucagon and other substances and these are the areas damaged in diabetes mellitus. The exocrine (secretory) portion makes up 80-85% of the pancreas and is the area relevant to the gastrointestinal tract. Gall bladder The gallbladder is a hollow, pear shaped organ that sits in a depression on the posterior surface of the liver's right lobe. It consists of a fundus, body and neck. It empties via the cystic duct into the biliary duct system. The main functions of the gall bladder are storage and concentration of bile. Bile is a thick fluid that contains enzymes to help dissolve fat in the intestines. Bile is produced by the liver but stored in the gallbladder until it is needed. Bile is released from the gall bladder by contraction of its muscular walls in response to hormone signals from the duodenum in the presence of food. Liver The liver is a large, reddish-brown organ situated in the right upper quadrant of the abdomen. It is surrounded by a strong capsule and divided into four lobes namely the right, left, caudate and quadrate lobes. The liver has several important functions. It acts as a mechanical filter by filtering blood that travels from the intestinal system. It detoxifies several metabolites including the breakdown of bilirubin and estrogen. In addition, the liver has synthetic functions, producing albumin and blood clotting factors. However, its main roles in digestion are in the production of bile and metabolism of nutrients. All nutrients absorbed by the intestines pass through the liver and are processed before traveling to the rest of the body. The bile produced by cells of the liver, enters the intestines at the duodenum. Here, bile salts break down lipids into smaller particles so there is a greater surface area for digestive enzymes to act.

SLIDE 15 Appendix

Scientists considered the appendix a leftover vestigial organ, meaning an organ previously more fully developed in the human species that currently serves no function. Studies prove otherwise. Appendix function warrants further research, but strong evidence substantiates this body part and its role in health and development. a. Features A finger size, slimy, dead-end sac, the appendix measures between 2 and 8 inches long and a half-inch wide. The appendix is longest in childhood and gradually shrinks throughout adult life. The wall of the appendix is composed of all layers typical of the intestine, but it is thickened and contains a concentration of lymphoid tissue. b. Fetal Development The appendix assists in fetal development. As quickly as 11 weeks after conception, the appendix starts making endocrine cells for the developing fetus. Endocrine cells secrete useful chemicals, such as hormones, and the appendix endocrine cells secrete amines and peptide hormones that help with biological checks and balances as the fetus grow. c. Immune Function The appendix helps create and train white blood cells. Acting as a lymphoid organ after birth, the appendix wards against disease. Lymphoid organs, with their lymphoid tissue, make white blood cells and antibodies. The appendix, by virtue of its lymphoid tissue, is part of a complicated chain that makes B lymphocytes (one variety of white blood cells) and a class of antibodies known as immunoglobulin A antibodies. The location of the appendix exposes white blood cells to a bounty of drugs, viruses and bacteria that cells learn how to fight. Chemicals also originate in the appendix that dispatches white cells to needed locations throughout the body. SLIDE 16 Spleen The human spleen is an organ that creates lymphocytes for the destruction and recycling of old redblood cells. The spleen is also a blood reservoir. The spleen is shaped like a loose fist and is tucked under the left side of the diaphragm. The average weight of an adult spleen is 0.44 lbs. During and after digestion, the size of the spleen increases. If the increase in size is significant, the spleen can rupture. The spleen is the soft, purplish-red organ tucked just under the rib cage on the left side of the abdomen. It is about the size of the heart and is made up of a spongy material that can hold up to three gallons of blood. When a child experiences a sudden blood loss, the body signals the spleen to contract, forcing replacement blood into the circulation. A second important function of the spleen is to filter worn-out

red and white blood cells, and platelets from the blood. A third job of the spleen is to store platelets and a large percentage of the body's platelets normally found there, ready to be sent where needed. Digestion Digestion is the process by which the gastrointestinal system retrieves important nutrients for the body and chemically changes the unused food into waste. Mastication, or the chewing of food in the mouth, is the first step of digestion. Proteins, fats and carbohydrates are chemically broken down into their basic building blocks in the stomach and absorbed in the small intestine. The large intestine plays a key role in reabsorbing excess water. Finally, undigested material and secreted waste products are excreted from the body via defecation (passing of feces). Transcript Digestion is the process by which the gastrointestinal system retrieves important nutrients for the body and chemically changes the unused food into waste. Mastication, or the chewing of food in the mouth, is the first step of digestion. Saliva initiates digestion and changes the chewed food into a soft mass, or bolus. Saliva makes the bolus slippery, making it easier to be swallowed and slide down the back of the throat and esophagus. The bolus passes through the esophageal sphincter before it enters the stomach. Inside the stomach, hydrochloric acid is released, breaking down large food molecules into smaller ones and liquefying the bolus. SLIDE 17 The liquefied bolus, now called chyme, then passes through the pyloric sphincter and enters the duodenum, the first section of the small intestine. It is here that enzymes released from the pancreas, liver, and gallbladder further breakdown chyme into elements that can be easily absorbed and used by the body. The small intestine is lined with a heavily folded inner mucosa and small fingerlike projections called villi. The villi enable digested food to enter the bloodstream. It is here, in the small intestine, where all nutrients and vitamins are absorbed. Chyme can travel through up to 20 feet of small intestine before it passes through the ileocecal valve to enter the large intestine. Very little digestion occurs in the large intestine. Undigested chyme that enters the large intestine is considered waste. The waste becomes more and more solid as it passes through the large intestine because water is continuously being reabsorbed from the waste. Waste collects in the rectum, or end of the large intestine, until the brain signals for it to be expelled from the body.

Introduction: Our digestive system is made up of the body parts that change raw food into nutrients that the body can use and waste. It also moves the nutrients and waste through our body. It is made up of the mouth including the teeth, jaws, tongue and salivary glands, esophagus, stomach, liver, gall bladder, bile duct, pancreas, pancreatic duct, small intestine including the duodenum, jejunum and ileum, large intestine, rectum and anus. The Mouth: When a person eats any food such as an apple, digestion starts when the jaws use the teeth to bite into the apple. This begins to break down the food by dividing it into bite sized pieces. Then the teeth and jaws chew the apple to break the bite sized pieces into smaller pieces. This is to make the pieces small enough to fit through the esophagus and to make less work for the stomach. While the food is still in the mouth, the salivary glands produce saliva containing an enzyme which starts off the digestive process. The Esophagus: The food is then swallowed which takes the food from the mouth to the esophagus. The esophagus is the tube that connects the mouth to the stomach. Food moves through the esophagus by peristalsis, which is a wave of muscle contractions that pushes the food down the tube. At the end of the esophagus is the lower esophageal sphincter (LES), which closes to prevent food from re-entering the esophagus. Sometimes, when something gets in the stomach that the stomach doesnt like, the stomach muscles contract and force anything that is in your stomach up through the lower esophageal sphincter. The LES is trying to stay closed but the contractions create more pressure than your LES can hold. When this happens, the stomach contents go back up through the esophagus and come out through the mouth. We call this "throwing up". The Stomach: After food has left the esophagus it enters the stomach. The stomach provides four basic functions that assist in the early stages of digestion and prepare the food for further processing in the small intestine: The stomach is a temporary storage container which can hold a large meal for a long time.This is where chemical and enzymatic digestion starts. There are natural chemicals in your stomach that we call digestive juices. They are acids that dissolve food down into smaller pieces so it can be absorbed into the blood stream. The muscles around the stomach squeeze the stomach and food in the stomach like mixing pancake batter in a plastic bag. Just like you need to put water in the bag to get a smooth mix, the stomach

makes juices to mix with the food to liquefy it which is a requirement for the food to go to the small intestine. As food is liquefied in the stomach, it is slowly released into the small intestine for further processing. The Liver: The liver has hundreds of functions. One of its main functions is to process fat and other nutrient-rich liquefied food that drains from the small intestine so it can be used. Another important function of the liver is that it produces sugars from proteins and fatty substances; and it secretes albumin which helps to keep fluid within the blood vessels. The liver also converts poisons in the blood into materials which can be safely excreted from the body. The liver uses calcium to reduce the amount of acid in the body waste. This allows us to go to the bathroom without pain or body damage. It also secretes bile which is a substance containing fatty materials. These help in the digestion, as well as the absorption of fatty products. The Gall Bladder: The gall bladder is a pouch-shaped organ which lies near the liver. It accepts bile from the liver, and stores it. When food is digested, the gallbladder releases bile into the small intestine where it is able to help dissolve fats. The Pancreas: The pancreas makes and delivers digestive juices through a tube called the pancreatic duct to the upper part of the small intestine. The Small Intestine: The small intestine is approximately 20 feet long and is divided into 3 segments - the duodenum, jejunum, and ileum. The duodenum begins just beyond the stomach and curves around the head of the pancreas and the entrance of the common bile duct, in a C-shaped formation. At the spot where the stomach and duodenum meet, is a muscle called the pyloric sphincter which prevents the regurgitation of material back into the stomach. The duodenum is responsible for further processing the material from the stomach (called chyme), by secreting enzymes which aid indigestion. Bile and pancreatic juice also enter the duodenum around its midpoint, and by moving the chyme in a shaking kind of motion, the duodenum mixes the chyme with these enzymes within its lumen, further aiding digestion. The jejunum is the next portion of the small intestine, and it has a lining which is specialized in the absorption of carbohydrates and proteins. The proteins have been broken down in the stomach by enzymes called pepsin and acid into amino acids. The carbohydrates are broken down in the duodenum by enzymes from the pancreas and liver into sugars. Fats are broken down in the duodenum by "lipase"

from the pancreas into fatty acids. Amino acid, sugar, fatty acid particles, vitamins, minerals, electrolytes and water are small enough to soak into the villi of the jejunum and drop into the blood stream. The blood takes all these nutrients to all the other parts of the body to provide fuel to do their jobs. The ileum is the last portion of the small intestine, and it is responsible for absorption of fats, and bile salts which are a component of bile. The pores in the ileum are slightly bigger than those in the jejunum and allow vitamin B12, vitamins dissolved in fatty liquids, electrolytes, bile salts and water to soak through the walls and into the blood stream. Where the ileum joins the large intestine is a valve, called the ileocecal valve, which prevents the back flow of materials into the small intestine. By the time material reaches this point, it has a rather pasty consistency. The Large Intestine: The parts of the food that cant be digested get pushed into the large intestine, also called the colon. It is about 5 feet long. Its function is to move the waste from the small intestine on to the rectum. The material first passes through the ascending colon and then through the transverse colon. Throughout this process, it absorbs more water. By the time the waste reaches the segment called the sigmoid, it is quite firm. The sigmoid colon is designed to slow down this movement of the waste until it is ready to be eliminated. The lowermost segment of the large intestine is called the rectum. It stores the firm waste until you are ready to get rid of it by "going to the bathroom". It has a specialized muscle, called the anal sphincter, which prevents the body waste from escaping until the appropriate time.

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