ANATOMY AND PHYSIOLOGY

The treatment of food in the digestive system involves the following seven processes: 1. Ingestion is the process of eating.

2. Propulsion is the movement of food along the digestive tract. The major means of propulsion is peristalsis, a series of alternating contractions and relaxations of smooth muscle that lines the walls of the digestive organs and that forces food to move forward. 3. Secretion of digestive enzymes and other substances liquefies, adjusts the pH of, and chemically breaks down the food. 4. Mechanical digestion is the process of physically breaking down food into smaller pieces. This process begins with the chewing of food and continues with the muscular churning of the stomach. Additional churning occurs in the small intestine through muscular constriction of the intestinal wall. This process, called segmentation, is similar to peristalsis, except that the rhythmic timing of the muscle constrictions forces the food backward and forward rather than forward only. 5. Chemical digestion is the process of chemically breaking down food into simpler molecules. The process is carried out by enzymes in the stomach and small intestines. 6. Absorption is the movement of molecules (by passive diffusion or active transport) from the digestive tract to adjacent blood and lymphatic vessels. Absorption is the entrance of the digested food into the body. 7. Defecation is the process of eliminating undigested material through the anus.

The digestive tract consists of the digestive tract, a tube extending from the mouth to the anus, plus the associated organs, which secrete fluids into the digestive tract. The term gastrointestinal tract technically only refers to the stomach and intestine but is often used as a synonym for the digestive tract. The inside of the digestive tract is continuous with the outside environment, where it

opens at the mouth and anus. Nutrients cross the wall of the digestive tract to enter the circulation. The digestive tract consists of the oral cavity, pharynx, esophagus, stomach, small intestine, large intestine, and anus. Accessory glands are associated with the digestive tract. The salivary glands empty into the oral cavity and the liver and pancreas are connected to the small intestine. Various parts of the digestive tract are specialized for different functions, but nearly all parts consist of four layers or tunics the mucosa, sub mucosa, muscularis, and serosa or adventitia.

Digestive Tract Histology

The innermost tunic, the mucosa, consists of mucous epithelium, a loose connective tissue called the lamina propria, and a thin smooth muscle layer, the muscularis mucosa. The epithelium in the mouth, esophagus and anus resists abrasion, and epithelium in the stomach and intestine absorbs and secretes.

The sub mucosa lies just outside the mucosa. It is a thick layer of loose connective tissue containing nerves, blood vessels, and small glands. An extensive network of nerve cell processes forms a plexus (network). The plexus is innervated by autonomic nerves. The muscularis which in most part of the digestive tube consists of an inner layer of circular smooth muscle and an outer layer of longitudinal smooth muscle. Another nerve plexus, also innervated by autonomic nerves, lies between the two muscle layers. Together the nerve plexuses of the sub mucosa and muscularis compose the enteric plexus. This plexus is extremely important in the control of movement and secretion within the tract. The fourth, or outermost, layer of the digestive tract is either a serosa or an adventitia. Some regions of the digestive tract are covered by peritoneum and other regions are not. The peritoneum, which is a smooth epithelial layer, and its underlying connective tissue are referred to histologically as the serosa. In regions of the digestive tract not covered by peritoneum, the digestive tract is covered by a connective tissue layer called the adventitia, which is continuous with the surrounding connective tissue. Peritoneum and Mesenteries

The body wall of the abdominal cavity and the abdominal organs are covered with serous membranes. The serous membrane that covers the organs is the

visceral peritoneum, or serosa. The serous membrane that lines the wall of the abdominal cavity is the parietal peritoneum. Many of the organs of the abdominal cavity are held in place by connective tissue sheets called mesenteries. The mesenteries consist of two layers of serous membranes with a thin layer of loose connective tissue between them. Specific mesenteries are given names. The mesentery connecting the lesser curvature of the stomach to the liver and diaphragm is the lesser omentum, and the mesentery connecting the greater curvature of the stomach to the transverse colon and posterior body wall is the greater omentum. The greater omentum is unusual in that it is a long, double fold of mesentery that extends inferiorly from the stomach before looping back to the transverse colon to create a cavity or pocket, called the omental bursa. Fat accumulates in the greater omentum, giving it the appearance of a fat-filled apron that covers the anterior surface of the abdominal viscera. Mesentery is a general term referring to the serous membrane attached to the abdominal organs. The term is also used specifically to refer to the mesentery that attaches the small intestine to the posterior abdominal wall. This mesentery is also called the mesentery proper. Other abdominal organs lie against the abdominal wall, have no mesenteries, and are described as retroperitoneal. The retroperitoneal organs include the duodenum, pancreas, ascending colon, descending colon, rectum, kidneys, adrenal glands and urinary bladder.

PARTS OF DIGESTIVE SYSTEM Stomach A hollow, sac-like organ connected to the esophagus and the duodenum (the first part of the small intestine), the stomach consists of layers of muscle and

nerves that continue the breakdown of food which begins in the mouth. It is also a storage compartment, which enables us to eat only two or three meals a day. If this weren't possible, we would have to eat about every twenty minutes. The average adult stomach stretches to hold from two to three pints and produces approximately the same amount of gastric juices every twenty-four hours. The stomach has several functions: (1) as a storage bin, holding a meal in the upper portion and releasing it a little at a time into the lower portion for processing; (2) as a food mixer, the strong muscles contract and mash the food into a sticky, slushy mass; (3) as a sterilizing system, where the cells in the stomach produce an acid which kills germs in "bad" food; (4) as a digestive tub, the stomach produces digestive fluid which splits and cracks the chemicals in food to be distributed as fuel for the body. The process of digestion is triggered by the sight, smell or taste of food, so that the stomach is prepared when the food arrives. If the stomach is not filled, these gastric juices begin eroding the stomach lining itself. Small Intestine

If the small intestine were not looped back and forth upon itself, it could not fit into the abdominal space it occupies. It is held in place by tissues which are attached to the abdominal wall and measures eighteen to twenty-three feet in the average adult, which makes it about four times longer than the

person is tall. It is a three-part tube of about one and one-half to two inches in diameter and is divided into three sections: (1) the duodenum, a receiving area for chemicals and partially digested food from the stomach; (2) the jejunum, where most of the nutrients are absorbed into the blood and (3) the ileum, where the remaining nutrients are absorbed before moving into the large intestine. The intestines process about 2.5 gallons of food, liquids and bodily waste every day. In order for enough nutrients to be absorbed into the body, it must come in contact with large numbers of intestinal cells which are folded like gathered skirts. Each of these cells contain thousands of tiny finger-like projections called "villi," and each villus contains microscopic "microvilli". In one square inch of small intestine, there are about 20,000 villi and ten billion microvilli. Each villus brings in fresh, oxygenated blood and sends out nutrient-enriched blood. The villi sway constantly to stir up liquefied food and remove the nutrients which can be absorbed and then passed through the membranes of the villi into the blood and lymph vessels. The fatty nutrients go to the lymph vessels, and glucose and amino acids go to the blood and on to the liver. The muscles which encircle this tube constrict about seven to twelve times a minute to move the food back and forth, to churn it, knead it, and to mix it with gastric juices. The small intestine also makes waves which move the food forward, but these are usually weak and infrequent to allow the food to stay in one place until the nutrients can be absorbed. If a toxic substance enters the small intestine, these movements may be strong and rapid to expel the poisons quickly. Large Intestine

The

large

intestine,

or

colon,

consists

of

ascending,

transverse,

descending, and sigmoid portions. The ascending portion extends from the cecum superiorly along the right abdominal wall to the inferior surface of the liver and bends sharply at a right angle to the left at a curve called the hepatic flexure. From there, it crosses the abdominal cavity as the transverse colon to the left abdominal wall at the splenic flexure and begins the descending colon which traverses inferiorly along the left abdominal wall to the pelvic region. The colon then forms an angle medially from the pelvis to form an s-shaped curve called the sigmoid colon. The last few inches of the colon is the rectum which is a storage site for solid waste which leaves the body by way of an external opening called the anus, controlled by muscles called sphincters. Substances which have not been absorbed in the small intestine enter the large intestine in the form of liquid and fiber. The large intestine or "bowel" is sometimes called the "garbage dump" of the body, because the materials that reach it are of very small use to the body and are sent on to be disposed of. The first half of the colon absorbs fluids and recycles them into the blood stream. The second half compacts the wastes into feces, secretes mucus which binds the substances, and lubricates it to protect the colon and ease its passage. Of the two to two and one-half gallons of food and liquids taken in by the average adult, only about twelve ounces of waste enters the large intestine.

Feces are comprised of about three quarters water. The remainder is protein, fat, undigested food roughage, dried digestive juices, cells shed by the intestine, and dead bacteria. A common disorder of the large intestine is inflammation of the appendix, or appendicitis. Waste that accumulates in the appendix cannot be moved easily by peristalsis since the appendix has only one opening. The symptoms of appendicitis include muscular rigidity, localized pain in the right lower quarter of the abdomen, and vomiting. The chief danger of appendicitis is that is may rupture and empty its contents of fecal matter and waste into the abdominal cavity producing an extremely serious condition called peritonitis.

Gallbladder

The gallbladder is an active storage shed, which absorbs mineral salts and water received from the liver and converts it into a thick, mucus substance called "bile," to be released when food is present in the stomach. The gallbladder is a small, pear-shaped sac which is situated just below the liver and is attached to it by tissues. It stores bile and then releases it when food passes from the stomach to the duodenum (the first part of the small intestine) to help in the process of digestion. It has a capacity of around one and one-half fluid ounces. When food leaves the stomach, a secretion causes the gallbladder to

contract and expel its contents into the duodenum, where the bile disperses the fats in the food into liquid. Liver

Thirty percent of the blood pumped through the heart in one minute passes through the body's chemical factory, which is called the liver. The liver cleanses the blood and processes nutritional molecules, which are distributed to the tissues. The liver also receives bright red blood from the lungs, filled with vital oxygen to be delivered to the heart. The only part of the body which receives more blood than the liver is the brain. The liver is located at the top of the abdomen, just below the diaphragm and has two main lobes. It is the largest gland in the body, weighing 2.5 to 3.3 pounds. When we eat, more blood is diverted to the intestines to deal with digestive processes; when not eating, three-fourths of the blood supply to the liver comes from the intestines. It also produces about two and one-half pints of bile in its ducts, which is delivered to the gallbladder through a small tube called the "cystic duct" for storage. "Liver" is probably an appropriate name for this gland, which makes the important decision as to whether incoming substances are useful to the body or

whether they are waste. The liver is an extremely important organ and has multiple functions. The liver detoxifies blood cells by mixing them with bile and by chemical alteration to less toxic substances, such as the alteration of ammonia to urea. Many chemical compounds are inactivated by the liver through modification of chemical structures. The liver converts glucose to a storage form of energy called glycogen, and can also produce glucose from sugars, starches, and proteins. The liver also synthesizes triglycerides and cholesterol, breaks down fatty acids, and produces plasma proteins necessary for the clotting of blood, such as clotting factors I, III, V, VII, IX and XI. The liver also produces bile salts and excretes bilirubin. A "lily-livered coward" was someone whose liver contained no blood. Pancreas Function The pancreas can also be thought of as having different functional components, the endocrine and exocrine parts. Tumors can arise in either part. However, the vast majority arise in the exocrine (also called non-endocrine) part. Since the parts have different normal functions, when tumors interfere with these functions, different kinds of symptoms will occur.

Islets

of

These are the endocrine (endo= within) cells of the pancreas that produce and secrete hormones into the bloodstream. The pancreatic hormones, insulin and glucagon, work together to

Langerhans

maintain the proper level of sugar in the blood. The sugar, glucose, is used by the body for energy.

These are the exocrine (exo= outward) cells of the pancreas that produce and transport chemicals that will exit the body through Acinar cells the digestive system. The chemicals that the exocrine cells produce are called enzymes. They are secreted in the duodenum where they assist in the digestion of food. What function does the pancreas serve?

The pancreas is an integral part of the digestive system. The flow of the digestive system is often altered during the surgical treatment of pancreatic cancer. Therefore it is helpful to review the normal flow of food before reading about surgical treatment. Food is carried from the mouth to the stomach by the esophagus. This tube descends from the mouth and through an opening in the diaphragm. (The

diaphragm is a dome shaped muscle that separates the lungs and heart from the abdomen and assists in breathing.) Immediately after passing through the diaphragm's opening, the esophagus empties into the stomach where acids that break down the food are produced. From the stomach, the food flows directly into the first part of the small intestine, called the duodenum. It is here in the duodenum that bile and pancreatic fluids enter the digestive system.

What is bile?

Bile is a greenish-yellow fluid that aids in the digestion of fats. After being produced by cells in the liver, the bile travels down through the bile ducts which merge with the cystic duct to form the common bile duct. The cystic duct runs to the gallbladder, a small pouch nestled underneath the liver. The gallbladder stores extra bile until needed. The common bile duct actually enters the head of

the pancreas and joins the pancreatic duct to form the ampulla of Vater which then empties into the duodenum. Flow of bile indicated by green arrows.

What is pancreatic fluid?

Instead of carrying bile, the pancreatic duct carries the pancreatic fluid produced by the acinar cells (exocrine) of the pancreas. The pancreatic duct runs the length of the pancreas and joins the common bile duct in the head of the pancreas. These ducts join to form the ampulla of Vater which then empties into the duodenum. Flow of pancreatic fluid indicated by dark yellow arrow. The food, bile and pancreatic fluid travels through many more feet of continuous intestine including the rest of the duodenum, jejunum and ileum which comprise the small intestine, then through the cecum, large intestine, rectum, and anal canal.