The

Digestive
System
Chapter 23
Overview of the Digestive System

Alimentary canal or
gastrointestinal (GI)) or digestive
tract: open tube 5 7 meters
Mouth, pharynx, and esophagus
Stomach, small intestine, and large intestine
Contains food material until digested and
absorbed or eliminated

Accessory digestive organs help in

digestion (food never passes
through)
Teeth, tongue, gallbladder, salivary glands,
liver, and pancreas
Connected to GI tract by ducts: secretions help
with chemical breakdown of food

Gastroenterology
Proctology
The GI Tract and Accessory
Digestive Organs

Mouth (oral cavity) Parotid gland

Tongue Sublingual gland Salivary glands
Submandibular
gland

Esophagus Pharynx

Stomach
Pancreas
(Spleen)
Liver
Gallbladder

Transverse colon
Duodenum Descending colon
Small intestine Jejunum Ascending colon
Ileum
Cecum
Large intestine
Sigmoid colon
Rectum
Anus Vermiform appendix
Anal canal

Figure 23.1
Digestion: Six Basic Processes
Ingestion: taking food and liquid into the mouth

Secretion: cells of the GI wall and accessory

organs secrete ~7 liters of water, acid, buffers
and enzymes into tract lumen

Mixing and propulsion: alternating contraction

and relaxation of smooth muscle in the walls of
the GI tract
Mix food and secretions propelling them toward the anus
Motility: ability of GI tract to mix and move material
along its length
 Functions of the Digestive
System
Digestion: breakdown of ingested food into small
molecules
Mechanically: cutting/grinding by teeth; churning of
stomach/small intestine
Chemically: carbohydrates, proteins, lipids, proteins, nucleic
acids broken down into smaller molecules by digestive enzymes

Absorption: passage of digested products into the

epithelial cells lining the lumen of the GI tract
Blood and lymph

Defecation: elimination of waste products as feces

Indigestible substances, bacteria, cells shed from the GI tract
 Ingestion
Digestive Processes Mechanical
Food
digestion
Pharynx
Chewing (mouth) Esophagus
Propulsion
1. Ingestion Churning (stomach)
Segmentation Swallowing
(small intestine)
2. Secretion Chemical
(oropharynx)

digestion Peristalsis
3. Mixing and propulsion (esophagus,
stomach,
small intestine,
4. Digestion large intestine)

5. Absorption Stomach
Absorption
6. Defecation
Lymph
vessel

Small
intestine
Large Blood
intestine vessel
Mainly H2O
Feces

Defecation Anus
Peristalsis

Major means of propulsion

Adjacent segments of the

canal relax and contract

Figure 23.3a
Segmentation

Rhythmic local contractions

of the intestine
Mixes food with digestive juices

Figure 23.3b
 Abdominal Regions

Four lines divide abdominal wall

into nine regions
Midclavicular lines: vertical lines of grid
Subcostal plane: superior horizontal line
connects inferior points of costal margin
Transtubercular plane: inferior horizontal
line connects tubercles of iliac crests

Right Left
Abdominal quadrants: simpler Epigastric
hypochondriac hypochondriac
method of sectioning abdominal region
region region
wall
Right Left
Right upper quadrant Umbilical
lumbar lumbar
region
Left upper quadrant region region
Right lower quadrant Right iliac
HypogastricLeft iliac
Left lower quadrant (inguinal) (pubic) (inguinal)
region region region
(a) Nine regions delineated by four planes
Nine Regions of Anterior
Abdominal Surface
How regions relate to abdominal viscera

Liver Diaphragm

Gallbladder Stomach

Ascending colon Transverse colon

of large intestine of large intestine
Small intestine Descending colon
of large intestine
Cecum
Initial part of
Appendix sigmoid colon
Urinary bladder

(b) Anterior view of the nine regions showing the

superficial organs
Figure 23.4b
The Peritoneal Cavity and
Peritoneum
Peritoneum: serous
membrane
Visceral peritoneum surrounds
digestive organs
Parietal peritoneum lines the body
wall
Peritoneal cavity slit-like potential
space

Mesenterya double layer of

peritoneum
Holds organs in place
Sites of fat storage
Provides a route for circulatory
vessels and nerves
Parietal Periotenum

Peritonitis: acute
inflammation of the peritoneum
Contamination by infectious
microbes
From wounds (accidental or surgical)
in the abdominal wall
Or from perforation (rupture) of
abdominal organs
Mesenteries

Falciform ligame
Liver Liver
Gallbladder Gallbladder
Lesser omentum
Spleen
Stomach Stomach
Duodenum
Ligamentum t
Transverse colon
Greater omentu
Small intestine
Small intestin

Cecum
Cecum
Urinary bladder
(b)

Figure 23.6a
Mesenteries
Greater omentuma fatty apron of peritoneum

Liver
Greater omentum Lesser omentum
Pancreas
Transverse colon
Stomach
Duodenum
Transverse Transverse
mesocolon mesocolon
Transverse colon
Descending colon
Mesentery
Jejunum
Mesentery Greater omentum
Sigmoid Jejunum
mesocolon Ileum
Sigmoid colon Visceral peritoneum
Parietal peritoneum
Ileum
Urinary bladder
Rectum

Figure 23.6
Retroperitoneal Organs /
Peritoneal Organs
Retroperitoneal Organs: behind the peritoneum
Peritoneal Organs: digestive organs that keep their
mesentery
Secondarily Retroperitoneal Organs: initially formed
within peritoneum
Become retroperitoneal: fuse to posterior abdominal wall
The Peritoneal Cavity and
Peritoneum
Abdominope Alimentary Alimentary canal
Liver
lvic Alimentary Ventral canal organ organ in a
cavity canal organ mesentery retroperitoneal
position

Parietal
peritoneum
Visceral
peritoneum
Peritoneal Dorsal mesentery Mesentery
cavity Vertebra
Resorbed and
(a) Schematic abdominal cavity illustrating the peritonea and lost
mesenteries
Anterior Visceral (c) Some organs lose their mesentery
Falciform and become retroperitoneal during
ligament peritoneum development.

Liver Peritoneal
cavity (with
serous fluid)
Stomach
Parietal
peritoneum Kidney
(retroperitoneal)
Posterior Wall of body
trunk
(b) Peritonea in a cross section through the superior abdomen, inferior view
Figure 23.5
Layers of the GI Wall and the
Omentum
Basic arrangement of 4 layers from deep to superficial
Mucosa,submucosa, muscularis, serosa

Parts of the peritoneum include:

Mesentery and greater omentum
Layers of the GI Wall Mucosa
1. Mucous membrane: inner lining of the tract
Epithelium: direct contact with contents of the GI tract
Nonkeratinized stratified squamous: mouth, pharynx, esophagus,
anal canal
Simple columnar in stomach and small intestine (secretion and
absorption)
Exocrine cells secrete mucus and fluid into the lumen
Enteroendocrine cells secrete hormones
Lamina propria: areolar CT with blood and lymphatic vessels
Contains lymphatic nodules: mucosa-associated lymphoid tissue
(MALT)
Muscularis mucosae: thin layer of smooth muscle fibers
Increases surface area (folding of the stomach and small intestine )
Movements ensure all absorptive cells exposed to contents in the GI
tract
Layers of the GI Wall Submucosa

2.Connective tissue: collagenous fibers,

nerves, BVs
Areolar CT binds mucosa to the muscularis
Highly vascular: BVs and lymphatic vessels receive
absorbed food molecules
Contains submucosal plexus: enteric nervous system
controls secretions
Subjected to regulation by the ANS
 Layers of the GI Wall Muscularis

3.Thick layer of muscle

Skeletal muscle: mouth, pharynx, superior and middle
esophagus, external anal sphincter
Produces voluntary swallowing
Voluntary control of defecation
Involuntary smooth muscle in rest of tract
Inner circular layer and outer longitudinal layer
Contains myenteric plexus (second major plexus of
the ENS)
Controls motility (frequency / strength of contractions)
Layers of the GI Wall Serosa

4. Superficial layer: serous membrane

Areolar CT and simple squamous epithelium
(mesothelium)
Epithelial portion aka visceral peritoneum
Serous fluid: lubicating
Serous membrane protects from abrasion
Esophagus lacks a serosa has a single layer of
areolar CT (adventitia)
Histology of the Alimentary Canal
Intrinsic nerve plexuses
Myenteric nerve plexus
Submucosal nerve plexus

Glands in submucosa

Mucosa
Epithelium
Lamina propria
Muscularis mucosae

Submucosa

Muscularis externa
Longitudinal muscle
Circular muscle
Serosa
Epithelium
Connective tissue
Nerve
Artery Gland in mucosa Lumen
Vein Duct of gland outside Mucosa-associated
Mesentery Lymphatic vessel alimentary canal lymphoid tissue
(a) Longitudinal and cross-sectional views through the small intestine
Figure 23.7a
Smooth Muscle
Primarily found in walls of viscera: elongated fibers,
central nucleus

Grouped into sheets:

Longitudinal layer: parallel to long axis of organ)
Crcular layer: deeper layer, fibers run around circumference of
organ

Longitudinal layer (shows

smooth muscle fibers in
cross section, 145)

Small intestine
Mucosa
(a) Location and plane of (b) Cross section of the intestine showing the Circular layer (shows longitudin
section shown in (b) smooth muscle layers (circular and longitudinal) views of smooth muscle
running at right angles to each other fibers, 145)
Smooth Muscle Contraction

Myofilaments operate by interaction with cytoskeleton

Dense bodiescorrespond to Z-discs of skeletal
muscle
Intermediate Caveolae Gap junctions
filament

Nucleus Dense bodies

(a) Relaxed smooth muscle fiber (note that adjacent fibers
are connected by gap junctions)

Nucleus
Dense bodies

(b) Contracted smooth muscle fiber

Figure 23.9
Innervation of Smooth Muscle

Innervated by ANS: few fibers per sheet innervated

Sheet of smooth muscle contracts as a unit
Exceptions: iris of eye; arrector pili muscles in skin

Varicosities

Autonomic nerve Smooth

fibers muscle cell
Innervate most
smooth
muscle fibers

Synaptic Varicosities release their

Mitochondrion
vesicles neurotransmitters
into a wide synaptic cleft (a
 The Mouth and Associated Organs
Soft palate
The mouth: oral cavity Palatoglossal arch Uvula

Mucosal layer: stratified

squamous epithelium on a Hard palate
Oral cavity
lamina propria
Palatine
tonsil
The lips and cheeks: Tongue
Formed from orbicularis orisOropharynx
Lingual tonsil
and buccinator muscles
Epiglottis
Hyoid bone
Laryngopharynx

Esophagus

Trachea
(a) Sagittal section of the oral cavity and pha
 Mouth (Oral or Buccal Cavity)

Covered externally by skin and internally by

mucous membrane
Labial and Lingual frenulum: fold of mucuous
membrane
Oral vestibule: space bounded by the cheeks and
lips (outside), gums, teeth (inside)
Fauces: opening to the oropharynx
Palate: septum separates oral cavity from nasal
cavity)
Hard palate: maxillae and palatine bones covered by
a mucous membrane
Soft palate: muscular partition lined with a mucous
membrane
Uvula: muscular extension blocks food from
nasopharynx
Palatoglossal arch and palatopharyngeal arch
Anatomy of the Mouth

The labial frenulum connects lips to gum

Upper lip
The palate forms the roof Gingivae
(gums) Superior labial
frenulum
of the mouth Palatine
raphe Palatoglossal
Hard palate arch
Palatopharyngeal
Soft palate
arch
Uvula
Palatine Posterior wall
tonsil of oropharynx
Tongue
Sublingual Lingual frenulum
fold with
openings of Opening of
sublingual submandibular
ducts duct
Gingivae (gums)
Vestibule
Inferior labial
Lower lip frenulum
Figure 23.11b
(b) Anterior view
 The Tongue
Interlacing fascicles of skeletal muscle
Grips food and repositions it
Helps form some consonants
Intrinsic muscles: within the tongue
Extrinsic muscles: external to the tongue
Lingual frenulum: secures tongue to floor of
mouth
 The Superior Surface of the
Tongue
Epiglottis Tongue papillae
Palatopharyngeal Filiform papillaeno taste buds
arch
Palatine tonsil Fungiform papillae
Lingual tonsil Circumvallate papillae
Palatoglossal
arch Sulcus terminalis: marks
Terminal sulcus
border between mouth and
Vallate papilla
pharynx
Midline groove Posterior one-third of
of tongue
tongue lies in oropharynx
Fungiform papilla Lined with lingual tonsil
Filiform papilla
 The Teeth
Deciduous teeth20 teeth
Permanent teeth32 teethIncisors
Central (7 yr)
Dental formulashorthandLateral (8 yr)
Number and position of teeth Canine
(eyetooth)
2I, 1C, 2P, 3M (11 yr)
Premolars
(bicuspids)
First premolar
(11 yr)
Incisors Second premolar
Central (68 mo) (1213 yr)
Lateral (810 mo) Molars
Canine (eyetooth) First molar
(1620 mo) (67 yr)
Molars Second molar
First molar (1213 yr)
(1015 mo) Deciduous Third molar Permanent
Second molar (milk) teeth (wisdom tooth) teeth
(about 2 yr) (1725 yr)

Figure 23.13a
Teeth
Incisors (8): cutting
Cuspids (canines) (4): tearing
Premolars (8): crushing/grinding
Molars (12): crushing/grinding
Deciduous Teeth and Permanent
Teeth

Deciduous teeth Permanent teeth

Figure 23.13b
Teeth or Dentes

Accessory organs in bony sockets of the mandible and maxilla

Sockets covered by gingivae (gums) and lined with the
Periodontal ligament (dense fibrous CT) anchors teeth to gums

External regions:
Crown: above gums;
Root: region embedded in socket
Neck: between crown and root near gum line

Composed of:
Enamel: hardest substance;
Dentin: calcified CT;
Cementum: bonelike substance covers dentin attaching it to peridontal
ligament
Pulp cavity filled with pulp (CT with BVs, nerves and lymphatic vessels)
Clinical Connection Root Canal
Therapy
Removes pulp tissue Ename
lDentin
CROWN
Hole drilled in tooth Gingival
Root canals filed out and sulcus
Gingiva
NECK
irrigated to remove (gum)
Pulp in
bacteria pulp
cavity
Canals treated with Cementu
m
medication Root
canal
Sealed tightly ROOT Alveolar
bone
Crown repaired Periodont
al
ligament
Apical
foramen
Nerv
e
Blood
Sagittal section of a mandibular supply
(lower) molar
 Salivary Glands
Exocrine glands produce saliva receive both
sympathetic and parasympathetic innervation
Released into ducts that empty into the oral cavity

Saliva: 99.5% water and 0.5% solutes

Water dissolves food so it can be tasted and reactions can
occur
Salivary amylase begins digestion of carbohydrates
Lysozyme, enzyme that kills bacteria
Lingual lipase and mucus secreted by lingual glands

Major salivary glands

Parotid: largest; inferior and anterior to ears
Submandibular: floor of the mouth; medial and inferior to
mandible
Sublingual: inferior to tongue and superior to submandibular
 The Extrinsic Salivary Glands

Tongue

Teeth Parotid
gland
Ducts of
sublingual Parotid duct
gland
Masseter muscle
Frenulum
of tongue Body of mandible
(cut)
Sublingual
gland Posterior belly of
digastric muscle
Mylohyoid Submandibular
muscle (cut) duct
Anterior belly of Submandibular
digastric muscle gland Mucous cells Serous cells
forming
(a) (b) demilunes

Figure 23.15
 Pharynx
Mastication (chewing) tongue manipulates food, teeth
grind it and is mixed with salvia
Food is reduced to a bolus that is easily swallowed into the
pharynx

Pharynx: funnel-shaped tube extends from the internal

nares to the esophagus
Composed of skeletal muscle and lined by mucous membrane
Nasopharynx involved only in respiration
Oropharynx and laryngopharynx both digestive and respiratory functions
Muscular contractions help propel swallowed food into the
esophagus

Deglutition: swallowing
Mechanism that moves food from the mouth to the stomach
 Three Stages of Deglutition
Voluntary stage: bolus of food oropharynx
Forces bolus into the oropharynx by movement of the tongue

Pharyngeal (involuntary) stage: oropharynx

esophagus
Breathing is interrupted when the soft palate and uvula move
upward to close off the nasopharynx
Epiglottis moves down sealing off the nasopharynx and
larynx

Esophageal stage: esophagus stomach

By a process called peristalsis by smooth muscle contraction
Esophagus
Mucosa
Long collapsible muscular tube
Lies posterior to the trachea
Travels through the esophageal hiatus
Transports food and secretes mucus
Submucosa
Ends: muscularis forms two
Muscularis
sphincters (circular
Upper esophageal sphincter (UES): layer)
skeletal muscle
Controls entry esophagus
Muscularis
Lower esophageal (gastroesophageal (longitudinal
or cardia) sphincter (LES): smooth layer
muscle
Controls entry stomach Vagus
nerve
Gastroesophageal reflux
disease (GERD) (b) Anterosuperior view of step
dissection of esophagus
 Deglutition

Tongue rises against the palate nasopharynx closed off larynx

rises epiglottis seals off larynx bolus passes into the esophagus
 Esophageal Stage Peristalsis

1.Circular muscle fibers above

bolus contract
Constricts esophageal wall
squeezing bolus downward
2.Longitudinal muscle fibers at
the bottom of the bolus contract
Shortens esophageal section below
the bolus pushing the walls outward
3.Bolus moves into new section,
circular muscles above
contract, cycle repeats

Bolus reaches the end, LES

relaxes
Bolus moves into the stomach
 Microscopic Structure of the
Esophagus

Mucosa
(contains a stratified
squamous epithelium)
Submucosa (areolar
connective tissue)
Lumen

Muscularis externa
Circular layer
Longitudinal layer

Adventitia (fibrous
connective tissue)
(a) Cross section through esophagus (5) (b) Gastroesophageal
junction, longitudinal
section (85)
Figure 23.16
The Stomach

Site where food is churned Cardia

Fundus
into chyme
Esophagus
Muscularis externa Serosa
Food remains in stomach for Longitudinal layer
Circular layer
about 4 hours Oblique layer Body

Lumen
Lesser
Regions of the stomach: curvature Rugae of
mucosa
Cardia: surrounds upper opening
Fundus: superior and left of Greater
cardia curvature

Body: large central portion Pyloric Pyloric

Duodenum canal antrum
Pylorus: connects to duodenum Pyloric sphincter (valve)
at pylorus
Pyloric antrum and pyloric canal
 The Stomach
Liver Fundus
(cut)
Body

Spleen

Lesser
curvature

Greater
curvature

(b)

Figure 23.17b
 Stomach Wall: Four Layers

1. Mucosa empty stomach lies in folds called rugae

Surface mucous cells: surface layer of simple columnar
epithelial cells extend downward to form columns of
secretory cells
Gastric glands that line channels called gastric pits
Secretions flow into gastric pits lumen of the stomach
Gastric glands contain three types of exocrine secretory
cells
Mucous neck cells mucus
Chief cells pepsinogen (inactive enzyme)
Parietal cells HCl and intrinsic factor
These secretions collectively called gastric juice
Gastric Glands
Gastric pit
Surface mucous
Surface mucous cell (secretes
cells mucus)
Gastri
Lamina Mucous neck cell
c pit
propria (secretes mucus)

SEMabout Parietal cell

1000x mucosa
Stomach (secretes HCl and
intrinsic factor)
Gastric
glands Chief cell
(secretes
pepsinogen and
gastric lipase)

Muscularis G cell (secretes

mucosae the hormone
gastrin)
Submucosa
(b) Sectional view of the stomach mucosa showing gastric glands and cell types
 Stomach Wall: Four Layers

2. Submucosa: areolar CT connects mucosa to the

muscularis

3. Muscularis: three layers of smooth muscle instead of

two
Outer longitudinal layer
Middle circular layer
Inner oblique layer (provides efficient gastric contractions)

4. Serosa (serous membrane) is composed of

Simple squamous epithelium (mesothelium)
Visceral peritoneum covers organs (extensions include greater
omentum and mesentry)
Areolar connective tissue
Copyright 2010, John Wiley & Sons,
Inc.
 Functions of the Stomach
Mechanical digestion: stretching of stomach wall
nerve impulses stimulate flow of gastric juices
Secretions + mixing waves food mixed with juices chyme

Chemical digestion:
Pepsin (pepsinogen + HCl) digests protein peptides (small
chains of amino acids)
Gastric lipase

Gastric emptying through pyloric sphincter

Carbohydrates fastest, proteins next, fats last
Once in duodenum feedback inhibition of stomach
Functions of the Stomach

1. Mixes saliva, food, gastric juice to form chyme

2. Serves as a reservoir for food before release into small
intestine
3. Secretes gastric juice, contains HCl (kills bacteria, denatures
proteins), pepsin (begins protein digestion), intrinsic factor
(vit B12), and gastric lipase
4. Secretes gastrin into blood
Stomach Absorption
Stomach epithelial cells impermeable to most materials
Mucous cells absorb some water, ions, short-chain fatty
acids, and some drugs (especially aspirin) and alcohol
Clinical Connection Vomiting
Forcible expulsion of the contents of the upper GI tract
(stomach and sometimes duodenum) through the
mouth
Strongest stimuli irritation and excessive distension of
the stomach
Other stimuli unpleasant sights, general anesthesia,
dizziness, and some drugs (morphine)
Prolonged vomiting in infants and elderly can be
serious
Due to loss of acidic gastric juice alkalosis (higher than normal
blood pH)
Dehydration
Damage to the esophagus and teeth
 Peptic Ulcers
Bacteria

Mucosa
layer of
stomach

(a) A gastric ulcer lesion (b) H. Pylori bacteria

Figure 23.28
 Peptic Ulcers
Are erosions of the mucosa of a region of the
alimentary canal
Gastric ulcers: occur in pyloric region of the stomach
Duodenal ulcers: occur in duodenum of the small
intestine
Caused by Helicobacter pylori (H. pylori)
Acid-resistant
Binds to gastric epithelium induces oversecretion of acid and
Bacteria
inflammation

Mucosa
layer of
stomach

(a) A gastric ulcer lesion (b) H. Pylori bacteria

 Protein Digestion in
Stomach
Interactions Animation
Protein Digestion in the Stomach

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Copyright 2012, John Wiley & Sons,
Inc.
Small Intestine

From pylorus of stomach to cecum of large intestine

2.5cm in diameter and ~10 feet long in a living person
~21 ft in a cadaver
Ends in ileocecal sphincter (in RLQ)

Three major regions:

Duodenum (12), jejunum (empty), ileum (twisted)

Function: most digestion and absorption of

nutrients

Within 2 4 hours after eating stomach empties

contents into the small intestine
 Intestinal Wall Structure
Same four layers but with modifications
Epithelial layer in mucosa is a simple columnar epithelium
Absorptive cells with microvilli digest and absorb nutrients in
chyme
Goblet cells secrete mucus

Mucosa intestinal glands secrete intestinal juice

Enzymes that complete digestion
Hormones secreted by: S cells (secretin), CCK cells
(cholecystokinin (CCK), K cells (glucose-dependent insulinotropic
peptide (GIP)

Mucosa lamina propria contains areolar CT with an

abundance of lymphatic tissue
Defense against potential pathogens in food
 Small IntestineMicroscopic
Anatomy
Modifications for absorption
Circular folds (plicae circulares): transverse ridges of
mucosa and submucosa
Villi: finger-like projections of the mucosa
Covered with simple columnar epithelium
Microvilli: further increase surface area for absorption

Histology:
Absorptive cells: uptake digested nutrients
Goblet cells: secrete mucus that lubricates chyme
Enteroendocrine cells: secrete hormones
Intestinal crypts: epithelial cells secrete intestinal juice
 Vein carrying
blood to
The Small Intestine
hepatic portal
vessel Structural Features
Muscle
layers Lumen
Circular Microvilli
folds (brush
Absorptive border)
Villi cells
Lacteal
Goblet
cell
Blood Absorptive cells
Vilus
capillaries
(a)
Mucosa Goblet
associated cells
lymphoid Villi
tissue
Intestinal Enteroendocrine
crypt cells
Muscularis Venule
mucosae Lymphatic vessel
Duodenal
(b) Submucosa
gland

(c) Intestinal crypt

Figure 23.20
 Digestion in the Small
Intestine
Mechanical digestion
Segmentation: localized contractions slosh chyme
back and forth mixing it with digestive juices
Peristalsis (slow waves) of the stomach pushes
chyme to the duodenum
Chemical digestion: 2 L/day of secretions
Alkaline chyme due to bicarbonate from pancreas and
alkaline mucus from small intestine
Enzymes produced by cells on villi
Maltase maltose into 2 glucose molecules
Sucrase sucrose into a glucose and fructose molecules
Lactase lactose into a glucose and galactose molecules
Peptidases proteins into amino acids, dipeptides,
tripeptides
 Absorption in the Small
Intestine
Chyme enters small intestine carrying partially
digested carbohydrates and proteins
Intestinal juice (composed of bile, pancreatic juice,
intestinal juice) completes digestion
90% of absorption of products of digestion occurs
in the small intestine (10% in the stomach and
large intestine)
Carbohydrates absorbed as monosaccharides
Dietary proteins into amino acids, di/tripeptides absorbed
mainly in duodenum and jejunum
Half come from digestive juices and dead cells from mucosa
Triglycerides into fatty acids and monoglycerides
Phosphate sugar, and bases of DNA, RNA
 Absorption of Products of
Digestion
By diffusion, facilitated diffusion, osmosis and
active transport
Carbohydrates monosaccharides
Via portal system (blood) to liver

Proteins (jejunum + ileum) amino acids

Via portal system (blood) to liver

Lipids
Short-chained fatty acids or monoglycerides or blood in
villi
Larger lipids coated by proteins in chlyomicrons lacteals
lymphatics (lymph) then blood
 Absorption of Products of
Digestion
Water and ions (salt)
Primarily osmotic movement that accompanies
other nutrients
Vitamins
Fat-soluble (A, D, E, K) absorbed with fat
Water-soluble (Bs, C) with simple diffusion
B12
Combines with intrinsic factor for transport through
duodenum and jejunum
Finally can be absorbed by active transport in ileum

Copyright 2010, John Wiley & Sons,

Inc.
Absorption of digested nutrients in the
small intestine
Mechanisms for movement of nutrients
through absorptive epithelial cells of
the villi
 Large Intestine
~6.5 cm (2.5in) and ~1.5 m (5 ft) extends from
ileum to the anus and contains four regions
Cecum
Ileocecal sphincter allows materials to pass into the
large intestine
Appendix twisted coiled tube of lymphatic nodules
Colon (food passage)
Ascending, transverse, descending and sigmoid
Rectum
Anal canal with sphincters
Internal sphincter of smooth (involuntary) muscle
External sphincter of skeletal (involuntary) muscle
Opening of anal canal to the exterior is the anus
 TRANSVERSE COLON

Left colic
Right colic (splenic) flexure
(hepatic)
flexure
Teniae coli
ASCENDING
COLON
DESCENDING COLON

Teniae
Omental
coli
Ileum appendices
Mesoappendix

Haustra
Ileocecal
sphincter
(valve)

SIGMOID
COLON
CECUM RECTUM
VERMIFORM APPENDIX ANAL CANAL
ANUS

(a) Anterior view of large intestine showing

major regions
Large Intestine Wall Standard 4
Layers
Mucosa simple columnar epithelium form intestinal glands
Absorptive cells (ion and water)
Goblet cells (mucus) that form intestinal glands
Muscularis incomplete longitudinal layer
 Digestion and Absorption in the
Large Intestine
Ileocecal sphincter limits rate of emptying of ileum
Peristalsis occurs at a slower rate
Mass peristalsis drives colonic contents into the
rectum
Triggered by presence of food in the stomach
Wastes move from mid-colon rectum

Bacterial digestion final stage of digestion

Produce some B-vitamins + vitamin K
Break down remaining proteins to amino acids and decompose
bilirubin stercobilin (brown color)
Ferment any remaining carbohydrates releasing H 2, CO2, and
methane gases that contribute to flatus (flatulence when
excessive)
Colon absorbs salt + water
Functions of the Large Intestine
Haustral churning, peristalsis, and mass peristalsis drive contents
into rectum
Bacteria in the large intestine convert proteins to amino acids,
break down amino acids, produce some B vitamins and vitamin K
Some water, ions, and vitamins are absorbed
Feces are formed
Defecation (emptying of the rectum) occurs
Clincial Connection Polyps in the
Colon
Polyps in the colon
Generally slow-developing benign
growths
Arise from the mucosa of the large
intestine

Often asymptomatic
If they occur include diarrhea, blood
in the feces, mucus discharged from
the anus

Removed by colonoscopy
Gross Anatomy of Large Intestine

Rectal valve
Rectum
Hemorrhoidal
veins
Levator ani muscle

Anal canal

External anal
sphincter

Internal anal
sphincter
Anal columns
Anal valves

Pectinate line
Anal sinuses
Anus
Figure 23.21b
 Vessels and Nerves of the
Large Intestine
First half of large intestine
Arterial supplysuperior mesenteric artery
Innervation:
Sympathetic innervationsuperior mesenteric and celiac
ganglia
Parasympathetic innervationvagus nerve
Distal half of large intestine
Arterial supplyinferior mesenteric artery
Innervation
Sympathetic innervationinferior mesenteric and hypogastric
plexuses
Parasympathetic innervationpelvic splanchnic nerves
Impulses from
Defecation Reflex
cerebral cortex
(conscious
control)

Sensory
nerve fibers

1 Distension, or stretch, of
Voluntary motor the rectal walls due to
nerve to external movement of feces into the
anal sphincter rectum stimulates stretch
Sigmoid receptors there. The
colon receptors transmit signals
along afferent fibers to spinal
cord neurons.
Stretch receptors in wall
2 A spinal reflex is initiated in which
parasympathetic motor (efferent) fibers
stimulate contraction of the rectal walls
and relaxation of the internal anal
Rectum sphincter.
External anal Involuntary motor nerve
sphincter (parasympathetic division)
(skeletal muscle)
Internal anal sphincter
(smooth muscle)

3 If it is convenient to defecate, voluntary motor

neurons are inhibited, allowing the external anal
sphincter to relax so that feces may pass.
Figure 23.22
Overview of the GI Organs

Table 23.2
Overview

Table 23.2 (continued)

The Acessory Organs

Right and left

hepatic ducts
of liver
Common hepatic
duct
Cystic duct
Bile duct and sphincter
Accessory pancreatic duct

Mucosa
with folds Tail of pancreas
Pancreas
Gallbladder
Jejunum
Major duodenal
papilla
Main pancreatic duct and
Hepatopancreatic
sphincter
ampulla and
sphincter Duodenum Head of pancreas

Figure 23.19
 Pancreas Exocrine and
Endocrine Gland
Made up of small clusters of glandular epithelial cells
Most are arranged in clusters called acini (exocrine) produce
pancreatic juice
1% are endocrine cells in clusters called pancreatic islets
(islets of Langerhans) (secrete hormones: insulin,
glucagon, somatostain, PP)

Secretions that help digestion

Sodium bicarbonate (NaHCO3) maintain pH of 7.1-8.2
Pancreatic lipase: fat-digesting
Pancreatic amylase: starch-digesting
Proteases: protein-digesting (made in an inactivated form)
Activated by enterokinase from small intestine
Chymotrypsinogen, trypsinogen, carboxypeptidase
RNAase and DNAase: nucleic-digesting
 Clinical Connection
Pancreatic Cancer
Affects more males then females
Usually occurs in individuals over 50
Typically few symptoms and often asymptomatic until
metastasis occurs (lymph nodes, liver, or lungs)
Nearly always fatal
Fourth most common cause of death from cancer in
the US
Lifestyle: linked to fatty foods, high alcohol
consumption, genetic factors, smoking, and chronic
pancreatitis
 Liver and Gallbladder
Liver: largest internal organ (~1.4 kg (3 lb) )
Falciform ligament divides right and left lobes + caudate and
quadrate lobes
Free border of the falciform is the Ligamentum teres (umbilical vein)
Coronary ligaments: extensions of parietal peritoneum suspend liver from
the diaphargm

Gallbladder: pear-shaped sac on inferior surface of the liver, 7

10 cm
Fundus, body, and neck regions
 The Gallbladder
Stores and concentrates bile
Bile emulsifies fats
Expels bile into duodenum

Cholecystokininreleased from
enteroendocrine cells in response to fatty chyme
Liver and Gallbladder
Caudate Inferior vena cava
lobe
Coronary ligament
Hepatic portal vein
Right lobe Common bile duct
Left lobe Common hepatic duct
Cystic duct
Hepatic artery Gallbladder
Quadrate lobe Neck
Falciform ligament Body
Fundus
Round ligament

PATH OF BILE FLOW FROM THE LIVER INTO THE DUODENUM

Hepatocytes Bile capillaries Small bile ducts Right and left hepatic ducts
Common hepatic duct Common bile duct (or cystic duct for storage in gallbladder)
Hepatopancreatic ampulla (ampulla of Vater)
Clinical Connection Hepatitis
Inflammation of the liver can be caused by viruses,
drugs, and chemicals, including alcohol
Hepatitis A (infectious hepatitis) spread via fecal
contamination (fecal-oral route); mild; loss of appetite, malaise,
nausea, diarrhea, fever, chills
Eventually jaundice appears but does not cause lasting liver damage
Most recover in 4 6 weeks
Hepatitis B spread primarily by sexual contact and
contaminated syringes and transfusion equipment also by saliva
and tears
Can be present for years or even a lifetime
Can produce cirrhosis and possibly cancer of the liver
Individual who harbor active virus become carriers
Vaccines available produced through recombinant DNA technology
(recombivax HB)
 Hepatitis
Hepatitis C clinically similar to B
Causes cirrhosis and possibly liver cancer
Donated blood is screened for hepatitis B and C

Hepatitis D is transmitted like B

A person must be co-infected with hepatitis B before
contracting hepatitis D
Results in severe liver damage, has a higher fatality rate
than B alone

Hepatitis E is spread like A

Does not cause chronic liver disease but has a very high
mortality rate among pregnant women
 Histology of the Liver and
Gallbladder
Hepatocytes: major functional cells perform a wide
array of metabolic, secretory, and endocrine functions
Arranged in rows called hepatic laminae
Bordered by endothelial-lined vascular spaces called hepatic
sinusoids
Grooves in the cell membranes between hepatocytes provide
spaces for bile canaliculi into which hepatocytes secrete bile
Bile: yellow, brownish, or olive-green liquid secreted by hepatocytes

Bile canilculi bile ductules bile ducts

Merge to form right and left hepatic ducts which unite and exit as
the common hepatic duct joins the cystic duct (gallbladder) to
form
The common bile duct bile enters the small intestine
(duodenum)
Small intestine empty sphincter closes the common duct and bile
backs up into the cystic duct to the gallbladder for storage
Histology of the Liver
Hepatic
sinusoids Bile canaliculi
Central To hepatic
vein vein
Portal triad:
Bile duct

Branch of hepatic
portal vein
Branch of
hepatic artery
Hepatic laminae
Hepatocyte
Stellate
reticuloendothelial
(Kupffer) cell

Connective
Hepatic sinusoid tissue
(b) Details of histological components of liver
 Liver Histology
Hepatic sinusoids: highly permeable blood
capillaries between hepatic laminae
Receive oxygenated blood from hepatic artery and nutrient-
rich deoxygenated blood from hepatic portal vein
Sinusoids converge and deliver blood into a central vein
hepatic veins inferior vena cava
Bile flows in the opposite direction
Stellate reticuloendothelial (Kupffer) cells that destroy
worn-out WBCs and RBCs, bacteria, and any foreign matter

Portal triad a bile duct, a branch of the hepatic

artery, and abranch of the hepatic vein
 Liver
Hepatic lobule: functional
unit of the liver
Each shaped like a hexagon
with a portal triad at its corners
Consists of hepatocytes in rows
radiating around a central vein
Portal lobule emphasizes
exocrine function
Bile duct is the center

Hepatic acinus: smallest

structural and functional unit
of the liver
Hepatocytes are arranged into
three zones
Hepatic Portal Nutrient-rich,
Oxygenated blood
System from hepatic
deoxygen-ated
blood from hepatic
artery portal vein

Liver sinusoids

Central vein

Hepatic vein

Inferior vena cava

Right atrium of
heart
 Liver Functions
1. Carbohydrate metabolism maintains normal blood
glucose
Polysaccharide stored in liver as glycogen
blood glucose breakdown glycogen blood glucose
Converts fructose, galactose, lactic acid, amino acids to
glucose
blood glucose glucose into glycogen and triglycerides
2. Lipid metabolism
Breaks down fatty acids ATP
Makes lipoproteins for transport of fatty acids, cholesterol, and
triglycerides
Synthesize and uses cholesterol to make bile salts
3. Protein metabolism removes NH2 from amino acids
Used to produce ATP or converted to carbohydrates or fats
Convert toxic ammonia (NH3) urea to kidneys (urine)
Synthesize most plasma proteins
 Liver Functions
4. Processing of drugs and hormones
Detoxifies substances such as alcohol
Inactivates steroid hormones(estrogens, aldosterone) and thyroid
hormones
Secretes some drugs (penicillin, erythromycin, sulfonamides) into
bile

5. Excretion of bilirubin (derived from heme)

Absorbed from the blood and secreted into bile
Metabolized in the small intestine by bacteria feces

6. Synthesis of bile salts

Emulsification and absorption of lipids, choleserol, phospholipids,
and lipoproteins

7. Storage of fat-soluble vitamins and minerals

A, D, E, K and iron, copper

8. Activation of vitamin D skin, liver and kidneys synthesize

active vitamin D3
 Clinical Connection Liver
Function Tests
Blood tests used to evaluate and monitor liver
disease or damage
Tests for the presence of liver enzymes and proteins

Common causes ofliver enzymes:

Excessive use of NSAIDs or some herbal supplements
(kava, comfrey, pennyroyal, dandelion root, skullcap,
ephedra)
Also cholesterol-lowering medications, some antibiotics,
and alcohol
Diabetes, infection (viral hepatitis and mononucleosis),
gallstones, liver tumors
 Disorders of the Digestive
System
Intestinal obstruction
Mechanical obstructions adhesions, tumors, or foreign
objects
Nonmechanical obstruction halt in peristalsis
Trauma or intestines touched during surgery

Inflammatory bowel disease: inflammation of

intestinal wall
Crohns disease and ulcerative colitis

Viral hepatitis: jaundice and flu-like symptoms

Cystic fibrosis and the pancreas
Pancreatic ducts become blocked with mucus
Clogged ducts prevent pancreatic juices from entering
small intestine
Leads to malabsorption of fats and other nutrients
Embryonic Development of the
Digestive System
Alimentary canal formed in week 3 encloses tubular
portion of yolk sac
Vitelline duct: landmark dividing into three regions
Forgut; midgut; hindgut

Lung bud
Stomodeum
Brain
Foregut
Oral Liver Stomach
membrane Site of liver
Heart development
Spinal cord Bile
Vitelline Midgut duct
duct in
Primitive
yolk sac Gall- Dorsal
Allantois intestinal loop
bladder pancreatic
Cloacal Hindgut bud
Cystic
membrane Proctodeum duct
Body Ventral Duodenum
Endoderm covered
stalk pancreatic bud
with splanchnic
(a) 3-week embryo (b) 5-week embryo
mesoderm
Figure 23.29
 Aging and the Digestive
System
Middle agegallstones and ulcers

Old ageactivity of digestive organs decline

Fewer digestive juices and enzymes produced
Absorption is less efficient
Dehydration of fecal mass leads to constipation
Diverticulosis and cancer of digestive organs
Decreased GI secretion, motility, strength of responses
Loss of taste, increased risk for periodontal disease,
difficulty swallowing, hiatal hernia, gastritis, peptic ulcer
disease
Increased risk for gallbladder problems, cirrhosis of liver,
pancreatitis, constipation, hemorrhoids, diverticulitis

Copyright 2010, John Wiley & Sons,

Inc.