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Diseases Digestive System

At its simplest, the digestive system is a tube running from mouth to anus. Its chief goal is to break down huge macromolecules (proteins, fats and starch), which cannot be absorbed intact, into smaller molecules (amino acids, fatty acids and glucose) that can be absorbed across the wall of the tube, and into the circulatory system for dissemination throughout the body.

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The digestive system can be divided into two main parts: the alimentary tract and accessory organs. The alimentary tract of the digestive system is composed of the mouth, pharynx, esophagus, stomach, small and large intestines, rectum and anus. Associated with the alimentary tract are the following accessory organs: salivary glands, liver, gallbladder, and pancreas.

Alimentary Tract

Mouth

The mouth, or oral cavity, is the first part of the digestive tract. It is adapted to receive food by ingestion, break it into small particles by mastication, and mix it with saliva. The lips, cheeks, and palate form the boundaries. The oral cavity contains the teeth and tongue and receives the secretions from the salivary glands.

Pharynx

The pharynx is a fibromuscular passageway that connects the nasal and oral cavities to the larynx and esophagus. It serves both the respiratory and digestive systems as a channel for air and food. The upper region, the nasopharynx, is posterior to the nasal cavity. It contains the pharyngeal tonsils, or adenoids, functions as a passageway for air, and has no function in the digestive system. The middle region posterior to the oral cavity is the oropharynx. This is the first region food enters when it is swallowed. The opening from the oral cavity into the oropharynx is called the fauces. Masses of lymphoid tissue, the palatine tonsils, are near the fauces. The lower region, posterior to the larynx, is the laryngopharynx, or hypopharynx. The laryngopharynx opens into both the esophagus and the larynx.

Food is forced into the pharynx by the tongue. When food reaches the opening, sensory receptors around the fauces respond and initiate an involuntary swallowing reflex. This reflex action has several parts. The uvula is elevated to prevent food from entering the nasopharynx. The epiglottis drops downward to prevent food from entering the larynx and trachea in order to direct the food into the esophagus. Peristaltic movements propel the food from the pharynx into the esophagus.

Esophagus

The esophagus is a collapsible muscular tube that serves as a passageway between the pharynx and stomach. As it descends, it is posterior to the trachea and anterior to the vertebral column. It passes through an opening in the diaphragm, called the esophageal hiatus, and then empties into the stomach. The mucosa has glands that secrete mucus to keep the lining moist and well lubricated to ease the passage of food.

The muscular layers of the esophagus are normally pinched together at both the upper and lower ends by muscles called sphincters. When a person swallows, the sphincters relax automatically to allow food or drink to pass from the mouth into the stomach. The muscles then close rapidly to prevent the swallowed food or drink from leaking out of the stomach back into the esophagus or into the mouth. These sphincters make it possible to swallow while lying down or even upside-down. When people belch to release swallowed air or gas from carbonated beverages, the sphincters relax and small amounts of food or drink may come back up briefly; this condition is called reflux. The esophagus quickly squeezes the material back into the stomach. This amount of reflux and the reaction to it by the esophagus are considered normal.

Stomach

The stomach, which receives food from the esophagus, is located in the upper left quadrant of the abdomen. The stomach is divided into the fundic, cardiac, body, and pyloric regions. The lesser and greater curvatures are on the right and left sides, respectively, of the stomach.

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Gastric Secretions

The mucosal lining of the stomach is simple columnar epithelium with numerous tubular gastric glands. The gastric glands open to the surface of the mucosa through tiny holes called gastric pits. Four different types of cells make up the gastric glands:

  • Mucous cells
  • Parietal cells
  • Chief cells
  • Endocrine cells

The secretions of the exocrine gastric glands - composed of the mucous, parietal, and chief cells - make up the gastric juice. The products of the endocrine cells are secreted directly into the bloodstream and are not a part of the gastric juice. The endocrine cells secrete the hormone gastrin, which functions in the regulation of gastric activity.

Regulation of Gastric Secretions

The regulation of gastric secretion is accomplished through neural and hormonal mechanisms. Gastric juice is produced all the time but the amount varies subject to the regulatory factors. Regulation of gastric secretions may be divided into cephalic, gastric, and intestinal phases. Thoughts and smells of food start the cephalic phase of gastric secretion; the presence of food in the stomach initiates the gastric phase; and the presence of acid chyme in the small intestine begins the intestinal phase.

Note: Chyme is the semifluid mass of partly digested food expelled by the stomach into the duodenum.

Stomach Emptying

Relaxation of the pyloric sphincter allows chyme to pass from the stomach into the small intestine. The rate of which this occurs depends on the nature of the chyme and the receptivity of the small intestine.

Small Intestine

The small intestine extends from the pyloric sphincter to the ileocecal valve, where it empties into the large intestine. The small intestine finishes the process of digestion, absorbs the nutrients, and passes the residue on to the large intestine. The liver, gallbladder, and pancreas are accessory organs of the digestive system that are closely associated with the small intestine.

The small intestine is divided into the duodenum, jejunum, and ileum. The small intestine follows the general structure of the digestive tract in that the wall has a mucosa with simple columnar epithelium, submucosa, smooth muscle with inner circular and outer longitudinal layers, and serosa. Exocrine cells in the mucosa of the small intestine secrete mucus, peptidase, sucrase, maltase, lactase, lipase, and enterokinase. Endocrine cells secrete cholecystokinin and secretin.

The most important factor for regulating secretions in the small intestine is the presence of chyme. This is largely a local reflex action in response to chemical and mechanical irritation from the chyme and in response to distention of the intestinal wall. This is a direct reflex action, thus the greater the amount of chyme, the greater the secretion.

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Large Intestine

The large intestine is larger in diameter than the small intestine. It begins at the ileocecal junction, where the ileum enters the large intestine, and ends at the anus. The large intestine consists of the colon, rectum, and anal canal.

The wall of the large intestine has the same types of tissue that are found in other parts of the digestive tract but there are some distinguishing characteristics. The mucosa has a large number of goblet cells but does not have any villi. The longitudinal muscle layer, although present, is incomplete. The longitudinal muscle is limited to three distinct bands, called teniae coli, that run the entire length of the colon. Contraction of the teniae coli exerts pressure on the wall and creates a series of pouches, called haustra, along the colon. Epiploic appendages, pieces of fat-filled connective tissue, are attached to the outer surface of the colon.

Unlike the small intestine, the large intestine produces no digestive enzymes. Chemical digestion is completed in the small intestine before the chyme reaches the large intestine. Functions of the large intestine include the absorption of water and electrolytes and the elimination of feces.

Rectum and Anus

The rectum continues from the sigmoid colon to the anal canal and has a thick muscular layer. It follows the curvature of the sacrum and is firmly attached to it by connective tissue. The rectum and ends about 5 cm below the tip of the coccyx, at the beginning of the anal canal.

The last 2 to 3 cm of the digestive tract is the anal canal, which continues from the rectum and opens to the outside at the anus. The mucosa of the rectum is folded to form longitudinal anal columns. The smooth muscle layer is thick and forms the internal anal sphincter at the superior end of the anal canal. This sphincter is under involuntary control. There is an external anal sphincter at the inferior end of the anal canal. This sphincter is composed of skeletal muscle and is under voluntary control.

Accessory Organs

The salivary glands, liver, gallbladder, and pancreas are not part of the digestive tract, but they have a role in digestive activities and are considered accessory organs.

Salivary Glands

Three pairs of major salivary glands (parotid, submandibular, and sublingual glands) and numerous smaller ones secrete saliva into the oral cavity, where it is mixed with food during mastication. Saliva contains water, mucus, and enzyme amylase. Functions of saliva include the following:

  • It has a cleansing action on the teeth.
  • It moistens and lubricates food during mastication and swallowing.
  • It dissolves certain molecules so that food can be tasted.
  • It begins the chemical digestion of starches through the action of amylase, which breaks down polysaccharides into disaccharides.
Liver

The liver is located primarily in the right hypochondriac and epigastric regions of the abdomen, just beneath the diaphragm. It is the largest gland in the body. On the surface, the liver is divided into two major lobes and two smaller lobes. The functional units of the liver are lobules with sinusoids that carry blood from the periphery to the central vein of the lobule.

The liver receives blood from two sources. Freshly oxygenated blood is brought to the liver by the common hepatic artery, a branch of the celiac trunk from the abdominal aorta. Blood that is rich in nutrients from the digestive tract is carried to the liver by the hepatic portal vein.

The liver has a wide variety of functions and many of these are vital to life. Hepatocytes perform most of the functions attributed to the liver, but the phagocytic Kupffer cells that line the sinusoids are responsible for cleansing the blood.

Liver functions include the following:

  • secretion
  • synthesis of bile salts
  • synthesis of plasma protein
  • storage
  • detoxification
  • excretion
  • carbohyrate metabolism
  • lipid metabolism
  • protein metabolism
  • filtering
Gallbladder

The gallbladder is a pear-shaped sac that is attached to the visceral surface of the liver by the cystic duct. The principal function of the gallbladder is to serve as a storage reservoir for bile. Bile is a yellowish-green fluid produced by liver cells. The main components of bile are water, bile salts, bile pigments, and cholesterol.

Bile salts act as emulsifying agents in the digestion and absorption of fats. Cholesterol and bile pigments from the breakdown of hemoglobin are excreted from the body in the bile.

Pancreas

The pancreas has both endocrine and exocrine functions. The endocrine portion consists of the scattered islets of Langerhans, which secrete the hormones insulin and glucagon into the blood. The exocrine portion is the major part of the gland. It consists of pancreatic acinar cells that secrete digestive enzymes into tiny ducts interwoven between the cells. Pancreatic enzymes include anylase, trypsin, peptidase, and lipase. Pancreatic secretions are controlled by the hormones secretin and cholecystokinin.

 

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