GASTROINTESTINAL SYSTEM

The human gastrointestinal tract refers to the stomach and intestine,[1] and sometimes to all the structures from the mouth to the anus.[2] (The "digestive system" is a broader term that includes other structures, including the accessory organs of digestion).[3] In an adult male human, the gastrointestinal (GI) tract is 5 metres (20 ft) long in a live subject, or up to 9 metres (30 ft) without the effect of muscle tone, and consists of the upper and lower GI tracts. The tract may also be divided into foregut, midgut, and hindgut, reflecting the embryological origin of each segment of the tract. The GI tract always releases hormones to help regulate the digestion process. These hormones, including gastrin, secretin, cholecystokinin, and grehlin, are mediated through either intracrine or autocrine mechanisms, indicating that the cells releasing these hormones are conserved structures throughout evolution.[4]

UPPER GASTROINTESTINAL TRACT

Upper and Lower human gastrointestinal tract

The upper gastrointestinal tract consists of the esophagus, stomach, and duodenum.[5] The exact demarcation between "upper" and "lower" can vary. Upon gross dissection, the duodenum may appear to be a unified organ, but it is often divided into two parts based upon function, arterial supply, or embryology.

LOWER GASTROINTESTINAL TRACT

The lower gastrointestinal tract includes most of the small intestine and all of the large intestine. According to some sources, it also includes the anus present in human body.

Bowel or intestine o Small intestine, which has three parts: Duodenum - Here the digestive juices from pancreas (digestive enzymes) and gallbladder (bile) mix together. The digestive enzymes break down proteins and bile emulsifies fats into micelles. Duodenum contains Brunner's glands which produce bicarbonate and pancreatic juice contains bicarbonate to neutralize hydrochloric acid of stomach Jejunum - It is the midsection of the intestine, connecting duodenum to ileum. Contain plicae circulares, and villi to increase surface area. Ileum - It has villi, where all soluble molecules are absorbed into the blood (capillaries and lacteals). o Large intestine, which has three parts: Cecum (the vermiform appendix is attached to the cecum). Colon (ascending colon, transverse colon, descending colon and sigmoid flexure). The main function of colon is to absorb water, but it also contains bacteria that produce beneficial vitamins like Vitamin K. Rectum in human body Anus

The ligament of Treitz is sometimes used to divide the upper and lower GI tracts.[7]

THE BRAIN AND THE MOUTH :

Many people spend a third of their time consciously trying to control how to get food into their digestive tracts and another third thinking about how that food is doing when it gets into their digestive tracts and another third of their time consciously trying to control how to get their food intake out of their digestive tracts. However, once food is swallowed, the conscious ability to

control the passage of food is almost completely lost. When the food reaches the point of elimination some conscious control is again reestablished in the digestive system. The gastrointestinal track or as people call it, the digestive system, has the main purpose of break down food, both solid and fluid into sustenance for the various tissues and systems in the body. A normal digestive tract squeezes the utmost benefit from what it eats. Feces are the products left over when the body has selected everything that is of use from the food that has been eaten. The digestive system distance ranges from the mouth to the bottom of the trunk, which when we look at it, seems like no more than two or three feet, but is really about 30 feet and like a railway station consisting of signals, checkpoints, and control devices in a turning, zigzagging, coiling track system. From the moment the three main types of food-carbohydrates, fats and proteins-enter the mouth, they are exposed to chemical and mechanical actions that begin to break them apart so that they can be absorbed through the intestinal walls into the circulatory system.

THE OESOPHAGUS:
Anatomically and functionally, the esophagus is the least complex section of the digestive tube. Its role in digestion is simple: to convey boluses of food from the pharynx to the stomach. The esophagus begins as an extension of the pharynx in the back of the oral cavity. It then courses down the neck next to the trachea, through the thoracic cavity, and penetrates the diaphragm to connect with the stomach in the abdominal cavity.

Like other parts of the digestive tube, the esophagus has four tunics, but important differences exist in the composition of these tunics in comparison to more distal sections of the tube. First, instead of the muscular tunic being entirely smooth muscle, as it is in the stomach and intestines, the wall of the esophagus contains a variable amount of striated muscle. In dogs, cattle and sheep, its entire length is striated muscle, whereas in cats, horses and humans, the proximal esophagus has striated muscle and the distal esophagus smooth muscle. Second, instead of the esophagus being free as it courses through the thoracic cavity, it is embedded in the connective tissue; thus, its outer tunic is referred to as adventitia instead of serosa.

In its role as the first conduit in the digestive tube, the esophagus is routinely exposed to rough and abrasive foodstuffs, like fragments of bone, fibrous plant leaves and Doritos. Its surface should therefore be resistant to trauma, and indeed, the esophagus is lined with stratified squamous epithelium, as seen below in an image from a cat's esophagus:

Absorption in the esophagus is virtually nil. The mucosa does contain mucous glands that are expressed as foodstuffs distend the esophagus, allowing mucus to be secreted and aid in lubrication.

The body of the esophagus is bounded by physiologic sphincters known as the upper and lower esophageal sphincters. The upper sphincter is composed largely of a muscle that is closely associated with the larynx. When relaxed, as it is during swallowing, this muscle pulls the larynx forward and aids in routing food into the esophagus instead of the larynx. The lower esophageal sphincter is the muscle that surrounds the esophagus just as it enters the stomach.

Normally, the upper and lower sphincters are closed except during swallowing, which prevents constant entry of air from the oral cavity or reflux of stomach contents. In humans, common disorders involving the esophagus include heartburn and gastroesophageal reflux disease (GERD). In both cases, the lower sphincter does not close properly, allowing acid from the stomach to reflux back into the esophagus, causes a burning sensation in the chest or throat (heartburn) or additional signs such as coughing, coughing or a sensation of choking.

An associated problem is acid indigestion, which occurs when refluxed stomach acid is tasted. Occasional heartburn is very common, but if it occurs more than a time or two each week, it could signify a more serious problem that requires treatment, usually with dietary managment and drugs that suppress secretion of gastric acid.

DISORDERS OF OESOPHAGUS:
"Acid reflux" redirects here. Acid reflux may also refer to Laryngopharyngeal reflux. Gastroesophageal reflux disease (GERD), gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease is a chronic symptom of mucosal damage caused by stomach acid coming up from the stomach into the esophagus.[1] A typical symptom is heartburn.

GERD is usually caused by changes in the barrier between the stomach and the esophagus, including abnormal relaxation of the lower esophageal sphincter, which normally holds the top

of the stomach closed; impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. These changes may be permanent or temporary ("transient").

Another kind of acid reflux, which causes respiratory and laryngeal signs and symptoms, is called laryngopharyngeal reflux (LPR) or "extraesophageal reflux disease" (EERD). Unlike GERD, LPR is unlikely to produce heartburn, and is sometimes called silent reflux. Signs and symptoms: AdultsThe most-common symptoms of GERD are:

Heartburn Regurgitation Trouble swallowing (dysphagia) Less-common symptoms include:

Pain with swallowing (odynophagia) Increased salivation (also known as water brash) Nausea Chest pain GERD sometimes causes injury of the esophagus. These injuries may include:

Reflux esophagitis necrosis of esophageal epithelium causing ulcers near the junction of the stomach and esophagus. Esophageal strictures the persistent narrowing of the esophagus caused by reflux-induced inflammation. Barrett's esophagus intestinal metaplasia (changes of the epithelial cells from squamous to intestinal columnar epithelium) of the distal esophagus.[3] Esophageal adenocarcinoma a rare form of cancer.[2]

Several other atypical symptoms are associated with GERD, but there is good evidence for causation only when they are accompanied by esophageal injury. These symptoms are:

Chronic cough Laryngitis (hoarseness, throat clearing) Asthma Erosion of dental enamel Dentine hypersensitivity Sinusitis and damaged teeth[4] Pharyngitis Some people have proposed that symptoms such as sinusitis, recurrent ear infections, and idiopathic pulmonary fibrosis are due to GERD; however, a causative role has not been established.

Children GERD may be difficult to detect in infants and children, since they cannot describe what they are feeling and indicators must be observed. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems such as wheezing. Inconsolable crying, refusing food, crying for food and then pulling off the bottle or breast only to cry for it again, failure to gain adequate weight, bad breath, and belching or burping are also common. Children may have one symptom or many; no single symptom is universal in all children with GERD.

It is estimated that of the approximately 4 million babies born in the U.S. each year, up to 35% of them may have difficulties with reflux in the first few months of their life, known as spitting up. One theory for this is the "4th trimester theory" which notes that most animals are born with significant mobility, but humans are relatively helpless at birth, and suggests that there may have accommodate the development of larger heads and brains and allow them to pass through the birth canal and this leaves them with partially undeveloped digestive systems.

Most children will outgrow their reflux by their first birthday. However, a small but significant number of them will not outgrow the condition. This is particularly true where there is a family history of GERD present.

THE STOMACH:
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects (mid-gut), and molluscs. It is involved in the second phase of digestion, following mastication (chewing).

The stomach is located between the esophagus and the small intestine. It secretes proteindigesting enzymes and strong acids to aid in food digestion, (sent to it via oesophageal peristalsis) through smooth muscular contortions (called segmentation) before sending partially digested food (chyme) to the small intestines.

The word stomach is derived from the Latin stomachus which is derived from the Greek word stomachos, ultimately from stoma, "mouth". The words gastro- and gastric (meaning related to the stomach) are both derived from the Greek word gaster. Bolus (masticated food) enters the stomach through the oesophagus via the oesophageal sphincter. The stomach releases proteases (protein-digesting enzymes such as pepsin) and hydrochloric acid, which kills or inhibits bacteria and provides the acidic pH of two for the proteases to work. Food is churned by the stomach through muscular contractions of the wall reducing the volume of the fundus, before looping around the fundus[3] and the body of stomach as the boluses are converted into chyme (partially digested food). Chyme slowly passes through the pyloric sphincter and into the duodenum, where the extraction of nutrients begins. Depending on the quantity and contents of the meal, the stomach will digest the food into chyme anywhere between forty minutes and a few hours. The stomach lies between the oesophagus and the duodenum (the first part of the small intestine). It is on the left upper part of the abdominal cavity. The top of the stomach lies against the diaphragm. Lying behind the stomach is the pancreas. The greater omentum hangs down from the greater curvature.

Greater omentum and stomachTwo sphincters keep the contents of the stomach contained. They are the esophageal sphincter (found in the cardiac region, not an anatomical sphincter) dividing the tract above, and the Pyloric sphincter dividing the stomach from the small intestine.

StomachThe stomach is surrounded by parasympathetic (stimulant) and orthosympathetic (inhibitor) plexuses (networks of blood vessels and nerves in the anterior gastric, posterior, superior and inferior, celiac and myenteric), which regulate both the secretions activity and the motor (motion) activity of its muscles.

In adult humans, the stomach has a relaxed, near empty volume of about 45 ml. Because it is a distensible organ, it normally expands to hold about one litre of food,[4] but can hold as much as two to three litres. The stomach of a newborn human baby will only be able to retain about 30 ml.

DISORDER OF STOMACH:
In the digestive system, an ulcer is an area where tissue has been destroyed by gastric juices and stomach acid. Peptic ulcer disease is a general term for ulcers that occur in the stomach or duodenum (upper part of the small intestine).

A peptic ulcer is an erosion or sore in the wall of the gastrointestinal tract. The mucous membrane lining the digestive tract erodes and causes a gradual breakdown of tissue. This breakdown causes a gnawing or burning pain in the upper middle part of the belly (abdomen). Although most peptic ulcers are small, they can cause a considerable amount of discomfort.

Peptic Ulcers Causes When you eat, your stomach produces hydrochloric acid and an enzyme called pepsin to digest the food.

The food is partially digested in the stomach and then moves on to the duodenum to continue the process. Peptic ulcers occur when the acid and enzyme overcome the defense mechanisms of the gastrointestinal tract and erode the mucosal wall. In the past it was throught that ulcers were caused by lifestyle factors such as eating habits, cigarette smoking, and stress.

Now it is understood that people with ulcers had an imbalance between acid and pepsin coupled with the digestive tract's inability to protect itself from these harsh substances. Research done in the 1980s showed that ulcers are caused by infection with a bacterium named Helicobacter pylori, usually called H pylori. Not everyone who gets an ulcer is infected with H pylori. Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) can cause ulcers if takes place.

Some types of medical therapy can contribute to ulcer formation. The following factors can weaken the protective mucosal barrier of the stomach increasing the chances of getting an ulcer and slows healing of existing ulcers.

Aspirin, nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen), and newer anti-inflammatory medications (such as celecoxib [Celebrex]) Alcohol Stress: physical (severe injuries or burns, major surgery) or emotional Caffeine Cigarette smoking Radiation therapy:-used for diseases such as canceren regularly.

The bacteria are found in the stomach, where they are able to penetrate and damage the lining of the stomach and duodenum.

Many people who are exposed to the bacteria never develop ulcers. People who are newly infected usually develop symptoms within a few weeks. Researchers are trying to discover what is different about the people who develop ulcers.

Ulcers can be linked with other medical conditions.

People who worry excessively are usually thought to have a condition called generalized anxiety disorder. This disorder has been linked with peptic ulcers. A rare condition called Zollinger-Ellison syndrome causes peptic ulcers as well as tumors in the pancreas and duodenum.

THE LIVER:
Liver: An organ in the upper abdomen that aids in digestion and removes waste products and worn-out cells from the blood. The liver is the largest solid organ in the body. The liver weighs about three and a half pounds (1.6 kilograms). It measures about 8 inches (20 cm) horizontally (across) and 6.5 inches (17 cm) vertically (down) and is 4.5 inches (12 cm) thick. The liver has a multitude of important and complex functions. Some of these functions are to:

Manufacture (synthesize) proteins, including albumin (to help maintain the volume of blood) and blood clotting factors Synthesize, store, and process (metabolize) fats, including fatty acids (used for energy) and cholesterol Metabolize and store carbohydrates, which are used as the source for the sugar (glucose) in blood that red blood cells and the brain use Form and secrete bile that contains bile acids to aid in the intestinal absorption (taking in) of fats and the fat-soluble vitamins A, D, E, and K.

Eliminate, by metabolizing and/or secreting, the potentially harmful biochemical products produced by the body, such as bilirubin from the breakdown of old red blood cells and ammonia from the breakdown of proteins

DISORDERS OF LIVER:
Liver disease is any disturbance of liver function that causes illness. The liver is responsible for many critical functions within the body and should it become diseased or injured, the loss of those functions can cause significant damage to the body. Liver disease is also referred to as hepatic disease.

Liver disease is a broad term that covers all the potential problems that may occur to cause the liver to fail to perform its designated functions. Usually, more than 75% or three quarters of liver tissue needs to be affected before decrease in function occurs.

The liver the largest solid organ in the body; and is also considered a gland because among its many functions, it makes and secretes bile. The liver is located in the upper right portion of the abdomen protected by the rib cage. It has two main lobes that are made up of tiny lobules. The liver cells have two different sources of blood supply. The hepatic artery supplies oxygen rich blood that is pumped from the heart, while the portal vein supplies nutrients from the intestine and the spleen.

Normally, veins return blood from the body to the heart, but the portal vein allows chemicals from the digestive tract to enter the liver for "detoxification" and filtering prior to entering the general circulation. The portal vein also efficiently delivers the chemicals and proteins that liver cells need to produce the proteins, cholesterol, and glycogen required for normal body activities.

As part of its function, the liver makes bile, a fluid that contains among other substances, water, chemicals, and bile acids (made from stored cholesterol in the liver). Bile is stored in the gallbladder and when food enters the duodenum (the first part of the small intestine), bile is secreted into the duodenum, to aid in digestion of food.

The liver is the only organ in the body that can easily replace damaged cells, but if enough cells are lost, the liver may not be able to meet the needs of the body. The liver can be considered a factory; and among its many functions include the: production of bile that is required in the digestion of food, in particular fats;conversion of the extra glucose in the body into stored glycogen in liver cells; and then converting it back into glucose when the need arises;production of blood clotting factors; production of amino acids (the building blocks for making proteins), including those used to help fight infection;the processing and storage iron necessary for red blood cell production;manufacture of cholesterol and other chemicals required for fat transport; conversion of waste products of body metabolism into urea that is excreted in the urine; andmetabolization medications into their active ingredient in the body. Cirrhosis is a term that describes permanent scarring of the liver. Normal liver cells are replaced by scar tissue that cannot perform any liver function.

Acute liver failure may or may not be reversible, meaning that is there is a treatable cause and the liver is able to recover and resume its normal functions.

THE PANCREAS:
A fish-shaped spongy grayish-pink organ about 6 inches (15 cm) long that stretches across the back of the abdomen, behind the stomach. The head of the pancreas is on the right side of the abdomen and is connected to the duodenum (the first section of the small intestine). The narrow end of the pancreas, called the tail, extends to the left side of the body. The pancreas makes pancreatic juices and hormones, including insulin. The pancreatic juices are enzymes that help digest food in the small intestine. Insulin controls the amount of sugar in the blood.

As pancreatic juices are made, they flow into the main pancreatic duct. This duct joins the common bile duct, which connects the pancreas to the liver and the gallbladder. The common bile duct, which carries bile (a fluid that helps digest fat), connects to the small intestine near the stomach.

The pancreas is thus a compound gland. It is "compound" in the sense that it is composed of both exocrine and endocrine tissues. The exocrine function of the pancreas involves the synthesis and secretion of pancreatic juices. The endocrine function resides in the million or so cellular islands (the islets of Langerhans) embedded between the exocrine units of the pancreas. Beta cells of the islands secrete insulin, which helps control carbohydrate metabolism. Alpha cells of the islets secrete glucagon that counters the action of insulin.

DISORDERS OF PANCREAS:
The pancreas is a large gland located behind the stomach and next to the duodenum (the first section of the small intestine). The pancreas has two primary functions:

1.To secrete powerful digestive enzymes into the small intestine to aid the digestion of carbohydrates, proteins, and fat. 2.To release the hormones insulin and glucagon into the bloodstream. These hormones are involved in blood glucose metabolism, regulating how the body stores and uses food for energy. Pancreatitis is a disease in which the pancreas becomes inflamed. Pancreatic damage occurs when the digestive enzymes are activated before they are secreted into the duodenum and begin attacking the pancreas. There are two forms of pancreatitis: acute and chronic.

Acute pancreatitis

Acute pancreatitis is a sudden inflammation that occurs over a short period of time. In the majority of cases, acute pancreatitis is caused by gallstones or heavy alcohol use. Other causes include medications, infections, trauma, metabolic disorders, and surgery. In about 10% to 15% of people with acute pancreatitis, the cause is unknown.

The severity of acute pancreatitis may range from mild abdominal discomfort to a severe, lifethreatening illness. However, the majority of people with acute pancreatitis (more than 80%) recover completely after receiving the appropriate treatment.

In very severe cases, acute pancreatitis can result in bleeding into the gland, serious tissue damage, infection, and cyst formation. Severe pancreatitis can also create conditions which can harm other vital organs such as the heart, lungs, and kidneys.

Chronic pancreatitis Chronic pancreatitis occurs most commonly after an episode of acute pancreatitis and is the result of ongoing inflammation of the pancreas.

In about 45% of people, chronic pancreatitis is caused by prolonged alcohol use. Other causes include gallstones, hereditary disorders of the pancreas, cystic fibrosis, high triglycerides, and certain medicines. Damage to the pancreas from excessive alcohol use may not cause symptoms for many years, but then the person may suddenly develop severe pancreatitis symptoms, including severe pain and loss of pancreatic function, resulting in digestion and blood sugar abnormalities.

THE GALLBLADDER:
A pear-shaped organ just below the liver that stores the bile secreted by the liver. During a fatty meal, the gallbladder contracts, delivering the bile through the bile ducts into the intestines to help with digestion. Abnormal composition of bile leads to formation of gallstones, a process termed cholelithiasis. The gallstones cause cholecystitis, inflammation of the gallbladder.

DISORDERS OF GALLBLADDER:
Gallstones are solid stones formed in the gall bladder from cholesterol, bile salts and calcium. They can vary in size from a few millimetres to a few centimetres. Gallstones are formed when bile contains too much cholesterol. The excess cholesterol forms crystals from which gallstones are made. Gallstones are seen in all age groups but they are rare in the young. The possibility of developing gallstones increases with age. The following groups are considered to be at increased risk:

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people who have relatives with gallstones obese people people with a high blood cholesterol level. women who take drugs containing oestrogen, eg contraceptive pills people with diseases such as chronic intestinal inflammation (Crohn's disease and ulcerative colitis).

Not all gallstones cause symptoms and those detected during a scan performed for other reasons do not usually require treatment. This, however, should be discussed with your doctor.

Symptoms can be extremely variable, but usually present in one of three ways.

Chronic cholecystitis (biliary colic) This is a long-term inflammation of the gall bladder and causes:

sporadic pains in the middle of the upper abdomen, or just below the ribs on the right side pain which becomes worse over an hour and then stays the same pain that may spread to the right shoulder or between the shoulder blades pain that can be accompanied by nausea and vomiting and sometimes excessive wind. An attack can last from a few minutes to two to three hours before getting better.

The frequency and severity of attacks is very variable.

Attacks can be triggered by eating fatty foods such as chocolate, cheese or pastry.

It can be difficult to distinguish the pain from other diseases such as gastric ulcer, back problems, heart pains, pneumonia and kidney stones.

SMALL INTESTINE AND LARGE INTESTINE:

The small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to describe the entire intestine. This article is primarily about the human gut, though the information about its processes is directly applicable to most placental mammals. The primary function of the small intestine is the absorption of nutrients and minerals found in food. The average length of the small intestine in an adult human male is 22 feet 6 inches (6.9 m), and in the adult female 23 feet 4 inches (7.1 m). However, it can vary greatly, from as short as 15 feet (4.6 m) to as long as 32 feet (9.8m).[3][4] It is approximately 2.53 cm in diameter.

The small intestine is divided into three structural parts: Duodenum Jejunum Ileum

The small intestine is where most chemical digestion takes place. Most of the digestive enzymes that act in the small intestine are secreted by the pancreas and enter the small intestine via the pancreatic duct. The enzymes enter the small intestine in response to the hormone cholecystokinin, which is produced in the small intestine in response to the presence of nutrients. The hormone secretin also causes bicarbonate to be released into the small intestine from the pancreas in order to neutralize the potentially harmful acid coming from the stomach.

The three major classes of nutrients that undergo digestion are proteins, lipids (fats) and carbohydrates:

Proteins and peptides are degraded into amino acids. Chemical breakdown begins in the stomach and continues in the large intestine. Proteolytic enzymes, including trypsin and

chymotrypsin, are secreted by the pancreas and cleave proteins into smaller peptides. Carboxypeptidase, which is a pancreatic brush border enzyme, splits one amino acid at a time. Aminopeptidase and dipeptidase free the end amino acid products. Lipids (fats) are degraded into fatty acids and glycerol. Pancreatic lipase breaks down triglycerides into free fatty acids and monoglycerides. Pancreatic lipase works with the help of the salts from the bile secreted by the liver and the gall bladder. Bile salts attach to triglycerides to help emulsify them, which aids access by pancreatic lipase. This occurs because the lipase is water-soluble but the fatty triglycerides are hydrophobic and tend to orient towards each other and away from the watery intestinal surroundings. The bile salts are the "main man" that holds the triglycerides in the watery surroundings until the lipase can break them into the smaller components that are able to enter the villi for absorption. Some carbohydrates are degraded into simple sugars, or monosaccharides (e.g., glucose). Pancreatic amylase breaks down some carbohydrates (notably starch) into oligosaccharides. Other carbohydrates pass undigested into the large intestine and further handling by intestinal bacteria. Brush border enzymes take over from there. The most important brush border enzymes are dextrinase and glucoamylase which further break down oligosaccharides. Other brush border enzymes are maltase, sucrase and lactase. Lactase is absent in most adult humans and for them lactose, like most poly-saccharides, are not digested in the small intestine. Some carbohydrates, such as cellulose, are not digested at all, despite being made of multiple glucose units. This is because the cellulose is made out of beta-glucose, making the inter-monosaccharidal bindings different from the ones present in starch, which consists of alpha-glucose. Humans lack the enzyme for splitting the beta-glucose-bonds, something reserved for herbivores and bacteria from the large intestine. Digested food is now able to pass into the blood vessels in the wall of the intestine through the process of diffusion. The small intestine is the site where most of the nutrients from ingested food are absorbed. The inner wall, or mucosa, of the small intestine is lined with simple columnar epithelial tissue. Structurally, the mucosa is covered in wrinkles or folds called plicae circulares, which are considered permanent features in the wall of the organ. They are distinct from rugae which are considered non-permanent or temporary allowing for distention and contraction. From the plicae circulares project microscopic finger-like pieces of tissue called villi (Latin for "shaggy hair"). The individual epithelial cells also have fingerlike projections known as microvilli. The function of the plicae circulares, the villi and the microvilli is to increase the amount of surface area available for the absorption of nutrients.

Each villus has a network of capillaries and fine lymphatic vessels called lacteals close to its surface. The epithelial cells of the villi transport nutrients from the lumen of the intestine into these capillaries (amino acids and carbohydrates) and lacteals (lipids). The absorbed

substances are transported via the blood vessels to different organs of the body where they are used to build complex substances such as the proteins required by our body. The food that remains undigested and unabsorbed passes into the large intestine.

Absorption of the majority of nutrients takes place in the jejunum, with the following notable exceptions:

Iron is absorbed in the duodenum. Vitamin B12 and bile salts are absorbed in the terminal ileum. Water and lipids are absorbed by passive diffusion throughout the small intestine. Sodium Bicarbonate is absorbed by active transport and glucose and amino acid co-transport. Fructose is absorbed by facilitated diffusion

The large intestine (or "large bowel") is the third-to-last part of the digestive system in vertebrate animals. Its function is to absorb water from the remaining indigestible food matter, and then to pass useless waste material from the body.[1] This article is primarily about the human gut, though the information about its processes are directly applicable to most mammals.

The large intestine consists of the cecum and colon. It starts in the right iliac region of the pelvis, just at or below the right waist, where it is joined to the bottom end of the small intestine. From here it continues up the abdomen, then across the width of the abdominal cavity, and then it turns down, continuing to its endpoint at the anus.

The large intestine is about 4.9 feet (1.5 m) long, which is about one-fifth of the whole length of the intestinal canal.

In Terminologia Anatomica the large intestine includes the cecum, colon, rectum, and anal canal. However, some sources exclude the anal canal.

The large intestine takes about 16 hours to finish up the remaining processes of the digestive system. Food is no longer broken down at this stage of digestion. The colon absorbs vitamins which are created by the colonic bacteria - such as vitamin K (especially important as the daily ingestion of vitamin K is not normally enough to maintain adequate blood coagulation), vitamin B12, thiamine and riboflavin. It also compacts feces, and stores fecal matter in the rectum until it can be discharged via the anus in defecation.

The large intestine differs in physical form from the small intestine in being much wider and in showing the longitudinal layer of the muscularis have been reduced to 3 strap-like structures known as the taeniae coli. The wall of the large intestine is lined with simple columnar epithelium. Instead of having the evaginations of the small intestine (villi), the large intestine has invaginations (the intestinal glands). While both the small intestine and the large intestine have goblet cells, they are abundant in the large intestine.

The appendix is attached to its inferior surface of the cecum. It contains the least of lymphoid tissue. It is a part of mucosa-associated lymphoid tissue, which gives the appendix an important role in immunity. Appendicitis is the result of a blockage that traps infectious material in the lumen. The appendix can be removed with no apparent damage or consequence to the patient. The large intestine extends from the ileocecal junction to the anus and is about 4.9 ft long. On the surface, bands of longitudinal muscle fibers called taeniae coli, each about 1/5 in wide, can be identified. There are three bands, and they start at the base of the appendix and extend from the cecum to the rectum. Along the sides of the taeniae, tags of peritoneum filled with fat, called epiploic appendages (or appendices epiploicae) are found. The sacculations, called haustra, are characteristic features of the large intestine, and distinguish it from the small intestine.

DISORDERS OF SMALL AND LARGE INTESTINES:

Gastroenteritis is an inflammation of the intestines. It is the most common disease of all the intestines. Ileus is a blockage of the intestines. Ileitis is an inflammation of the ileum.

Colitis is an inflammation of the large intestine. Appendicitis is inflammation of the vermiform appendix located at the caecum. This is a potentially fatal disease if left untreated; most cases of appendicitis require surgical intervention. Coeliac disease is a common form of malabsorption, affecting up to 1% of people of northern European descent. An autoimmune response is triggered in intestinal cells by digestion of gluten proteins. Ingestion of proteins found in wheat, barley and rye, causes villous atrophy in the small intestine. Life-long dietary avoidance of these foodstuffs in a gluten-free diet is the only treatment. Crohn's disease and ulcerative colitis are examples of inflammatory bowel disease. While Crohn's can affect the entire gastrointestinal tract, ulcerative colitis is limited to the large intestine. Crohn's disease is widely regarded as an autoimmune disease. Although ulcerative colitis is often treated as though it were an autoimmune disease, there is no consensus that it actually is such. (See List of autoimmune diseases). Enteroviruses are named by their transmission-route through the intestine (enteric meaning intestinal), but their symptoms aren't mainly associated with the intestine. Irritable bowel syndrome (IBS) is the most common functional disorder of the intestine. Functional constipation and chronic functional abdominal pain are other disorders of the intestine that have physiological causes, but do not have identifiable structural, chemical, or infectious pathologies. They are aberrations of normal bowel function but not diseases.[3] Diverticular disease is a condition that is very common in older people in industrialized countries. It usually affects the large intestine but has been known to affect the small intestine as well. Diverticulosis occurs when pouches form on the intestinal wall. Once the pouches become inflamed it is known as diverticulitis. Endometriosis can affect the intestines, with similar symptoms to IBS. Bowel twist (or similarly, bowel strangulation) is a comparatively rare event (usually developing sometime after major bowel surgery). It is, however, hard to diagnose correctly, and if left uncorrected can lead to bowel infarction and death. (The singer Maurice Gibb is understood to have died from this.) Angiodysplasia of the colon Chronic functional abdominal pain Colorectal cancer Constipation

Diarrhea Hirschsprung's disease (aganglionosis) Intussusception Polyp (medicine) (see also Colorectal polyp) Pseudomembranous colitis Ulcerative colitis and toxic megacolon.

AMITY INSTITUTE OF BEHAVOURAL HEALTH AND SCIENCES

GASTORINTESTINAL DISORDERS

MODERATOR: MR. ATUL KUMAR VERMA

BY: SANJANA GUHA ROY B.A. + M.A. CLINICAL PSYCHOLOGY(IMA-2)