Digestive System

Anatomy and Physiology

Mouth – pharynx – esophagus – stomach – small intestine – large intestine – elementary canal

Digestion – break down of complex food molecules into small molecules.

4 layers of tract – mucosa, submucosa, muscularis, serosa/adventitia

Accessory glands – salivary glands, pancreas, liver, gallbladder.

Oral cavity:

Cheek - buccal

Upper lip – labium superioris

Lower lip – labium inferioris

Hard palate – anterior portion of the roof of the mouth

Soft palate – muscular, posterior portion of the roof of the mouth

Rugae – irregular ridges in the mucous membrane covering the anterior portion of hard palate.

Uvula – small, soft tissue projection, hangs from the soft palate. It aids production of sounds and
speech.

Tongue: voluntary muscle. It helps in mastication (chewing) and deglutition (swallowing).

Small tiny projections on upper surface of tongue – papillae – consists of sensory receptor cells – taste
buds.

Linguo - tongue

Tonsils- two small lymphatic tissue near both sides of oropharynx. They produce lymphocytes (type of
WBC’s). They fight with bacteria.

Gums (gingiva) – Fleshy tissue surrounding the sockets of the teeth.

Anatomy of tooth:

Crown – visible part of tooth

Root – invisible part of tooth

Tooth is formed by dentin – is covered by strong whitish layer called as enamel (hardest substance in
the body) – outermost protective layer of crown.

Root is covered by cementum – covers, protects, and supports dentin in the root.

Periodontal membrane – surrounds the cementum and holds the tooth in place in the tooth socket.

Pulp – lies underneath the dentin. Soft and delicate tissue, fills the center of the tooth.

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Blood vessels, nerve endings, connective tissue, and lymphatic vessels are within the pulp canal (root
canal).

Base of root canal – apical foramen

Teeth:

Child – 20 temporary teeth

Adult - 32 permanent teeth

2 incisors, 1 canine, 2 premolars, and 3 molars

Incisors and canine – cutting and tearing

Premolars and molars – chewing and grinding

Salivary Glands: exocrine glands

3 pairs – parotid (near the ear); submandibular (mandible); sublingual (under the tongue)

These exocrine glands produce saliva

Composition of saliva: produce about 1.5 liters of saliva daily.

Water, mucus, mineral salts, salivary amylase, lysozyme.

Function of oral cavity: mastication (chewing) and swallowing (deglutition)

Chewed food – bolus

Pharynx (throat):

This is a muscular tube, about 5 inches long, lined with a mucous membrane. It serves as a passageway
both for air and food.

When deglutition occurs, a cartilaginous flap of tissue, epiglottis, covers the trachea.

Esophagus: 9-10 inch muscular tube extending from pharynx to the stomach.

Peristalsis – involuntary, progressive, rhythmic contraction of muscles in the wall of esophagus

propelling a bolus down toward the stomach.

Stomach: 3 parts

Fundus – upper portion

Body – middle section

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Antrum – lower portion

Sphincter – open and close to prevent backflow of the food.

Lower esophageal sphincter – relaxes and contracts to move food from the esophagus into the
stomach.

Pyloric sphincter – allows food to leave the stomach when it is ready.

Folds of the stomach – rugae – which expands during digestion.

Gastric glands – secretes gastric juice, HCl, pepsin.

Chyme – partially digested food in stomach.

Small intestine (small bowel):

Duodenum

Jejunum

Ileum

Liver and gallbladder (bile) and Pancreas (pancreatic juice) and chyme – through pyloric sphincter –
duodenum – jejunum – ileum.

Villi – tiny microscopic projections, lines the walls of small intestine.

The tiny capillaries in the villi absorb the digested nutrients into the bloodstream and lymph vessels.

Large intestine:

Appendicitis – inflammation of appendix

Appendectomy – surgical removal of appendix

Cecum: First part of large intestine. Cecum is a pouch on the right side that connects to the ileum at
the ileocecal valve.

Appendix: Blind pouch hanging from the cecum.

Colon: Portion of large intestine consisting of ascending, transverse, descending, and sigmoid colon.

Ascending colon: It extends from the cecum to the undersurface of the liver where it turns to the right
hepatic flexure to become transverse colon.

Transverse colon: It passes horizontally to the left toward the spleen and then turns downward (splenic
flexure) into the descending colon.

Sigmoid colon: Shaped like an “S,” begins at the distal end of the descending colon and leads into the
rectum.

Rectum: the rectum terminates in the lower opening of GI tract, the anus.

Anus: terminal end or opening of the digestive tract to the outside of the body.

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Defecation (bowel movement): elimination of feces from the digestive tract through the anus.

Liver, Gallbladder, and Pancreas

Liver: RUQ

Glycogenolysis: liver converts stored glycogen back into glucose.

Gluconeogenesis: liver convert proteins and fats into glucose.

Pancreas: acts as both exocrine and endocrine organs.

Exocrine: it produces enzymes to digest starch such as amylase, to digest fat such as lipase, and to
digest proteins such as protease.

Endocrine – the pancreas secrete insulin.

Pathway of food through the gastrointestinal tract:

Food enters the oral cavity – pharynx – esophagus – stomach – duodenum – jejunum – ileum – cecum
– ascending colon – hepatic flexure – transverse colon – splenic flexure – descending colon – sigmoid
flexure – sigmoid colon – rectum – anus.

Terminology:
Ano – anus Entero – intestines

Appendo – appendix Esophago – esophagus

Bucco – cheek Facio – face

Ceco – cecum Gastro – stomach

Celio – belly, abdomen Gingivo – gums

Cheilo – lip Glosso (or) linguo – tongue

Cholecysto – gallbladder Hepato – liver

Choledocho – common bile duct Ileo – ileum

Colo (or) colono – colon Jejuno – jejunum

Denti (or) Odonto- tooth Laparo – abdomen

Duodeno – duodenum Mandibulo – lower jaw, mandible

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Odonto – tooth Bilirubino – bilirubin

Oro (or) stomato – mouth Chole – bile, gall

Palato – palate Chlorhydro – hydrochloric acid

Pancreato – pancreas Gluco (or) glycol – sugar

Peritoneo – peritoneum Glycogeno – glycogen

Pharyngo – throat Lipo – fat, lipid

Procto – anus and rectum Litho – stone

Pyloro – pyloric sphincter Proteo – protein

Recto – rectum Pyo – pus

Sialadeno – salivary gland Steato – fat

Sigmoido – sigmoid colon Ase- enzyme

Uvulo – uvula Chezia – defecation

Amylo – starch iasis – abnormal condition

Bili – bile, gall Prandial – meal

Pathology of Digestive System

Etiology – cause

Idiopathic - unknown

Signs and Symptoms

1. Anorexia – lack of appetite.

2. Ascites – abnormal accumulation of fluid in the abdomen.
3. Borborygmus – rumbling or gurgling noise produced by the movement of gas, fluid, or both
in the GI tract.
4. Constipation – difficulty in passing stools (feces).
5. Diarrhea – frequent passage of loose, water stools.
6. Dysphagia – difficulty in swallowing.
7. Eructation - gas expelled from the stomach through the mouth. Eructation produced a
characteristic sound and also is called belching.
8. Flatus – gas expelled through the anus. Flatulence is the presence of excessive gas in the
stomach and intestines.
9. Hematochezia – passage of fresh, bright red blood from the rectum.
10. Jaundice (icterus) - yellow-orange coloration of the skin and whites of eyes caused by high
levels of bilirubin in the blood (hyperbilirubinemia).
11. Melena – black, tarry stools; feces containing digested blood.
12. Nausea – Unpleasant sensation in the stomach associated with a tendency to vomit.
13. Steatorrhea – fat in the feces; frothy, foul-smelling fecal matter.

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Pathologic Conditions

Oral Cavity and Teeth

Aphthous stomatitis: Inflammation of the mouth with small, painful ulcers. The ulcers associated with
this condition are commonly called canker sores.

Dental caries: Tooth decay.

Herpetic stomatitis: Inflammation of the mouth caused by infection with the herpesvirus. Painful
fluid-filled blisters on the lips, palate, and tongue, commonly called fever blisters or cold sores.

Oral leukoplakia: White plaques or patches on the mucosa of the mouth.

Periodontal disease: Inflammation and degeneration of gums, teeth, and surrounding bone.

Upper Gastrointestinal Tract

Achalasia: Failure of the lower esophagus sphincter muscle to relax.

Esophageal cancer: Malignant tumor of the esophagus. Long-term irritation of the esophagus caused
by gastric reflux is a premalignant condition called “Barrett esophagus.”

Esophageal varices: swollen, varicose veins at the lower end of the esophagus.

Gastric cancer: malignant tumor of stomach.

Gastroesophageal reflux disease (GERD): Solids and fluids return to the mouth from the stomach.

Hernia: Protrusion of an organ or part through the tissues and muscles normally containing it.

Rrhaphy – suture

Peptic ulcer: caused by bacterium called Helicobacter pylori.

Open sore in the lining of the stomach or duodenum.

Lower Gastrointestinal Tract (small and large intestines)

Anal fistula: Abnormal tube-like passageway near the anus.

Colonic polyps: Polyps protrude from the mucous membrane of the colon.

2 types of polyps: pedunculated (attached to the membrane by a stalk) and sessile (sitting directly on
the mucous membrane).

Colorectal cancer: Adenocarcinoma of the colon or rectum, or both.

Crohn disease: Chronic inflammation of the intestinal tract. It is a form of IBD (inflammatory bowel
disease).

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Diverticulosis: Abnormal outpouchings (diverticula) in the intestinal wall of the colon.

Dysentery: Painful, inflamed intestines commonly caused by bacterial infection.

Hemorrhoids: Swollen, twisted, varicose veins in the rectal region.

Ileus: Loss of peristalsis with resulting obstruction of the intestines.

Inflammatory bowel disease (IBD): Inflammation of the colon and small intestine.

Intussusception: telescoping of intestines.

Irritable bowel syndrome (IBS): Group of GI symptoms (abdominal pain, bloating, diarrhea,
constipation), but without abnormalities in the intestines.

Ulcerative colitis: chronic inflammation of the colon with presence of ulcers.

Volvulus: Twisting of the intestine on itself.

Liver, Gallbladder, and Pancreas

Cholelithiasis: Gallstones in the gallbladder.

Cirrhosis: Chronic degenerative disease of the liver.

Pancreatic cancer: Malignant tumor of pancreas.

Pancreatitis: Inflammation of pancreas.

Viral hepatitis: Inflammation of liver caused by a virus.

Ectasia – dilation, widening

Emesis – vomiting

Pepsia – digestion

Phagia – eating, swallowing

Plasty – surgical repair

Ptysis- spitting

Rrhage, rhhagia – bursting forth (of blood)

Rrhaphy – suture

Rrhea – flow, discharge

Spasm – involuntary contraction of muscles

Stasis – stopping, controlling

Stenosis – narrowing, tightening

Tresia – opening

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Laboratory Tests

Amylase and lipase tests: Tests for the levels of amylase and lipase enzymes in the blood.

Liver function tests (LFTs): Tests for the presence of enzymes and bilirubin in blood.

Stool culture: Test for microorganisms present in feces.

Stool guaiac test or hemoccult test: Test to detect occult blood in feces.

Clinical Procedures:
Lower gastrointestinal series (barium enema): X-ray images of the colon and rectum obtained after
injection of the barium into the rectum.

Upper gastrointestinal series: X-ray images of the esophagus, stomach, and small intestine obtained
after administering barium by mouth.

Cholangiography: X-ray examination of the biliary system performed after injection of contrast into
the bile ducts.

ERCP- endoscopic retrograde cholangiopancreatography.

Computed tomography (CT): A series of x-ray images are taken in multiple views.

Ultrasound examinations

Abdominal ultrasonography: Sound waves beamed into the abdomen produce an image of abdominal
viscera.

Endoscopic ultrasonography: Use of an endoscope combined with ultrasound to examine the organs
of the gastrointestinal tract.

Magnetic Resonance

Magnetic resonance imaging (MRI): Magnetic waves produce images of organs and tissues in all planes
of the body.

Nuclear Medicine Test

HIDA (hepatobiliary iminodiacetic acid) scan (or) cholescintigraphy: Radioactive imaging procedure
that tracks the production and flow of bile from the liver and gallbladder to the intestine.

Procedures
Gastric bypass or bariatric surgery: Reducing the size of the stomach and diverting food to the jejunum
(gastrojejunostomy).

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Gastrointestinal endoscopy: Visual examination of the gastrointestinal tract using an endoscope.

Laparoscopy: Visual examination of the abdomen with a laparoscope inserted through small incisions
in the abdomen

Liver biopsy: removal of liver tissue for microscopic examination.

Nasogastric intubation: Insertion of tube through the nose into the stomach.

Paracentesis (abdominocentesis): surgical puncture to remove fluid from the abdomen.

Abbreviations of DS

1. NG tube: nasogastric tube

2. GERD: gastroesophageal reflux disease
3. IBD: inflammatory bowel disease
4. EUS: endoscopic ultrasonography
5. ALT: alanine transaminase
6. AST: aspartate transaminase
7. Alk phos: alkaline phosphatase
8. IBS: irritable bowel syndrome

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