KEBBI STATE COLLEGE OF NURSING SCIENCES, BIRNIN KEBBI

ANATOMY AND PHYSIOLOGY I

MID 112 UNIT IX

FOR SET 2024 BASIC MIDWIVES

ANATOMY OF DIGESTIVE SYSTEM

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The digestive system has two anatomical subdivisions, the digestive tract and the accessory organs.

 The digestive tract (alimentary canal) is a muscular tube extending from mouth to anus. It measures
about 5 m (16 ft) long in a living person.. It includes the:

1. Mouth

2. Pharynx

3. Esophagus

4. Stomach

5. small intestine

6. Large intestine.

The accessory organs are the:

1. Teeth

2. Tongue

3. salivary glands

4. liver

5. gallbladder

6. pancreas

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Functions of digestive system

1. Ingestion: Food enters through the mouth.

2. Mechanical Digestion: Chewing and stomach contractions break down food into smaller pieces.

3. Chemical Digestion: Enzymes (saliva, stomach acid, pancreas, bile) break down food molecules
into absorbable components.

4. Absorption: Small intestine absorbs nutrients (carbs, proteins, fats, vitamins, minerals) into the
bloodstream.

5. Elimination: Undigested material passes through the large intestine, water is reabsorbed, forming
feces.

6. Secretion: Digestive organs produce fluids like saliva, gastric juices, pancreatic enzymes, and bile to
aid digestion

MOUTH

The mouth, also known as the oral or buccal cavity, serves as the initial segment of the digestive system. Its
primary functions include receiving food, initiating digestion by breaking down solid particles through
mastication (chewing) and saliva mixing, and playing roles in speech and sensory reception. It is enclosed
by the cheeks, lips, palate, and tongue.

This cavity is lined with stratified squamous epithelium. The anterior opening is called the oral fissure,
while the posterior leads to the throat (fauces). Its boundaries consist of muscles and bones: anteriorly by the
lips, posteriorly connected to the oropharynx, laterally by cheek muscles, superiorly by the hard and soft
palate, and inferiorly by the tongue and the oral floor.

The mouth includes the vestibule (the space between gums and cheeks) and the oral cavity proper. The
palate, dividing the mouth's roof, comprises the hard palate (formed by maxilla and palatine bones) and the
soft palate (a muscular structure curving downwards from the hard palate's rear). The lips, formed mainly by
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the orbicularis oris muscle and connective tissue, have skin covering their outer surface, with less
keratinization at the edges, giving them a reddish appearance.

TONGUE

The tongue, a large muscular organ within the oral cavity, is primarily attached posteriorly, while its front
section remains relatively free. It is linked to the floor of the mouth by a thin tissue called the lingual
frenulum.

Its muscles fall into two categories:

 Intrinsic muscle, residing within the tongue and responsible for altering its shape,
 Extrinsic muscle, located outside the tongue but connected to it, involved in protrusion, retraction,
lateral movement, and shape modification.

The tongue is divided by a groove, the terminal sulcus, into anterior and posterior sections. The front two-
thirds contain papillae housing taste buds, while the back one-third lacks papillae, holding lymphatic tissue
forming the lingual tonsil. The surface of the tongue is covered by moist stratified squamous epithelium.

Functions of the tongue

 The tongue moves food in the mouth and, in cooperation with the lips and gums, holds the food in
place during mastication.
 It also plays a major role in swallowing.

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  In addition, the tongue is a major sensory organ for taste and one of the primary organs of speech.
 It manipulates food between the teeth while it avoids being bitten
 it can extract food particles from the teeth after a meal, and it is sensitive enough to feel a stray hair
in a bite of food.

TEETH

Teeth, collectively known as dentition, play a vital role in chewing and digesting food by breaking it into
smaller pieces, making digestion easier and faster. Adults typically have 32 teeth, evenly split between the
upper (maxilla) and lower (mandible) jaws, consisting of 2 incisors, 1 canine, 2 premolars, and 3 molars on
either side (the third molars are often called wisdom teeth because they usually appear in the late teens or
early twenties, when a person is old enough to have acquired some wisdom.)

The teeth are classified in to:

 Permanent or secondary teeth

 Deciduous, primary or milk teeth

Adult teeth, termed permanent or secondary teeth, replace the deciduous or primary teeth, also known as
milk teeth, lost during childhood. Children have 20 temporary teeth, erupting between 6 months and 24
months, which are gradually replaced by permanent teeth from around 5 years old, with this process usually
completed by about 21 years.

The structure of each tooth includes

 a crown (above the gum),

 a root (embedded in the bone), and
 a neck (where crown and root meet).

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At the centre of each tooth, there's a pulp cavity filled with blood vessels, nerves, and connective tissue
called pulp. Dentin, a calcified tissue, surrounds the pulp cavity. Enamel, a hard substance also covers the
dentin, protecting the tooth from wear and acid exposure.

SALIVARY GLAND

The salivary glands, vital for saliva production, release their secretions through ducts into the mouth. There
are three main pairs: parotid, submandibular, and sublingual glands, along with smaller scattered glands
within the oral cavity.

 Parotid Glands: These are the largest salivary glands, located below and in front of the ears. Each
gland weighs around 20 to 30 grams in adults. Saliva from the parotid glands enters the oral cavity
through the Stensen duct, about 35 to 40 mm long, opening inside the cheek near the upper second
molar tooth.

 Submandibular (submaxillary) Glands: Situated in the submandibular triangle, medial to the

mandible, these glands weigh approximately 8 to 10 grams each. Saliva is released into the oral
cavity via the Wharton duct, around 40 mm long, opening at the side of the tongue's frenulum on a
small papilla called the caruncula sublingualis.

 Sublingual Glands: These are the smallest glands found in the mucosa at the mouth's floor,
weighing about 2 to 3 grams each. Saliva from these glands is discharged through 5 to 15 small ducts
called ducts of Rivinus, which open on small papillae under the tongue. The Bartholin duct, larger
than the others, drains the anterior part of the gland and opens on the caruncula sublingualis, near the
opening of the submandibular duct.

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Composition of saliva

Saliva is a hypotonic solution primarily composed of water, comprising 97% to 99.5%, with a pH range of
6.8 to 7.0. It consists of secretions from salivary glands and small mucus-secreting glands, containing
various solutes:

 Mucus: Provides binding and lubrication for the food bolus, aiding in swallowing.

 Electrolytes: Includes salts of sodium (Na+), potassium (K+), chloride (Cl–), phosphate, and
bicarbonate.

 Lysozyme: An enzyme present in saliva with antibacterial properties, effectively killing bacteria.

 Immunoglobulin A (IgA): An antibacterial antibody that helps fight against pathogens.

 Salivary Amylase: An enzyme responsible for initiating starch digestion in the mouth by breaking
down carbohydrates.

 Lingual Lipase: An enzyme contributing to fat digestion in the mouth, primarily activated after food
swallowing.

Functions of saliva

1. Chemical digestion of polysaccharides through the enzyme amylase.

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 2. Lubrication of food for easier swallowing.

3. Cleaning and moistening the mouth to prevent damage to the mucous membrane.

4. Non-specific defense against microbes with components like lysozyme and immunoglobulins.

5. Enhancement of taste perception by activating taste buds with dissolved chemical substances.

PHARYNX

The pharynx, positioned behind the mouth, serves as a passage connecting the nasal and oral cavities to the
larynx and esophagus.

Structurally divided into three sections:

1. Nasopharynx: Located above the soft palate, connecting to the nasal cavity and facilitating air
passage during breathing. It houses the auditory tubes linking to the middle ears.

2. Oropharynx: Situated behind the mouth, extending from the soft palate to the upper border of the
epiglottis. It acts as a pathway for both food moving downward from the mouth and air traveling
between the nasal cavity.

3. Laryngopharynx: Positioned below the oropharynx, extending from the upper border of the
epiglottis to the lower border of the larynx's cricoid cartilage. It functions as a passage to the
esophagus.

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The epiglottis, covering the larynx's opening, prevents food and liquid from entering the respiratory tract.
The walls of the oropharynx and laryngopharynx consist of three stacked muscles (superior, middle, and
inferior pharyngeal constrictors).

ESOPHAGUS

The esophagus is a straight, collapsible tube, roughly 25 cm long and 2 cm in diameter, positioned centrally
in the thorax. It lies in front of the vertebral column, behind the trachea and heart, connecting the pharynx
above to the stomach below. Joining the stomach just below the diaphragm through the esophageal hiatus, it
passes behind the diaphragm's central tendon near the 10th thoracic vertebra.

Upon passing through the diaphragm, it curves upward before entering the stomach. This sharp angle helps
prevent the backflow (regurgitation) of gastric contents into the esophagus. Sphincters close both the upper
and lower ends of the esophagus: the upper cricopharyngeal sphincter prevents air intake during breathing
and the aspiration of esophageal contents. Just before joining the stomach, the lower esophageal sphincter,
or Cardiac sphincter, formed by increased sympathetic muscle tone in circular muscle fibers, remains
contracted, closing the entrance to the stomach. This prevents stomach contents from regurgitating into the

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esophagus. When peristaltic waves push food towards the stomach, these muscle fibers briefly relax to allow
the swallowed food to enter the stomach.

Mucous glands within the esophageal submucosa secrete fluids that moisten and lubricate the inner lining of
the tube, aiding in the passage of food and protecting the esophagus from damage by stomach acids. The
coordinated actions of sphincters and muscle fibers help regulate the flow of food and prevent the backflow
of stomach contents, facilitating smooth digestion.

Process of swallowing

Swallowing, also known as deglutition, is a complex process that allows food and liquids to move from the
mouth to the esophagus and eventually into the stomach. It involves several stages:

1. Oral (Voluntary) Phase: This is the voluntary phase where food is chewed (masticated) in the
mouth. Saliva mixes with the food to moisten it and begin the digestive process. Once the food is
ready to be swallowed, the tongue moves the chewed food or liquid to the pharynx.

2. Pharyngeal Phase: This phase is involuntary and involves the initiation of swallowing reflexes. The
soft palate blocks the nasal passage to prevent food from entering the nasal cavity. The larynx
elevates and the epiglottis closes over the trachea to prevent food from entering the airway.

3. Esophageal Phase: Once the epiglottis closes over the trachea, the food bolus moves down the
esophagus through a series of coordinated muscle contractions called peristalsis. Peristalsis helps
push the food towards the stomach. At the lower end of the esophagus, the lower esophageal
sphincter (LES) opens to allow the food bolus to enter the stomach. The LES then closes to prevent
the contents of the stomach from flowing back into the esophagus (reflux).

STOMACH

The stomach is a hollow J-shaped dilated portion of the alimentary tract situated in the epigastric, umbilical
and left hypochondriac regions of the abdominal cavity. Its shape and size vary from person to person, even
within the same individual from time to time, depending on food content and body posture. It has an internal
volume of about 50 mL when empty and 1.0 to 1.5 L after a typical meal. When extremely full, it may hold
up to 4 L and extend nearly as far as the pelvis.

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Structure of the stomach

The stomach is relatively vertical in tall people and more nearly horizontal in short people. The lesser
curvature of the stomach is the margin that extends for the short distance (about 10 cm) from esopha gus to
duodenum along the medial to superior aspect, facing the liver; the greater curvature is the longer margin
(about 40 cm) from esophagus to duodenum on the lateral to inferior aspect.

The stomach is divided into four regions:

 The cardiac region (cardia): is a small area within about 3 cm of the cardiac orifice.

 The fundic region (fundus) is the dome superior to the esophageal attachment. It is a temporary
storage area and sometimes fills with swallowed air. This produces a gastric air bubble, which may
be used as a landmark on a radiograph of the abdomen

 The body (corpus) is the greatest part distal to the cardiac orifice, is located between the fundic and
pyloric portion.

 The pyloric region is a slightly narrower pouch at the inferior end; it is subdivided into a funnel-like
antrum and a narrower pyloric canal. The pyloric canal terminates at the pylorus, a narrow passage
into the duodenum. The pylorus is surrounded by a thick ring of smooth muscle, the pyloric or
gastroduodenal sphincter, which regulates the passage of chyme into the duodenum. When the
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 stomach is inactive the pyloric sphincter is relaxed and open, and when the stomach contains food
the sphincter is closed.

Microscopic Anatomy

The stomach wall has tissue layers similar to those of the remaining parts of alimentary canal, with some
variations. The mucosa is covered with a simple columnar glandular epithelium. The mucosa and submucosa
are flat and smooth when the stomach is full, but as it empties, these layers form conspicuous longitudinal
wrinkles called gastric rugae. The lamina propria is almost entirely occupied by tubular glands. The
muscular layer has three layers, rather than two: outer longitudinal, middle circular and inner oblique layers.

The stomach is lined with simple columnar epithelium. The epithelium forms numerous, tubelike gastric
pits, which are the openings for the gastric glands. The epithelial cells of the stomach are of five types.

The first type:

 surface mucous cells, are found on the surface and lining the gastric pit. Surface mucous cells
protect the stomach wall from being damaged by acid and digestive enzymes. These cells produce an
alkaline mucus on their surface that neutralizes the acid and is a barrier to the digestive enzymes. The
surface mucous cells are connected by tight junctions, which provide an additional barrier that
prevents acids and enzymes from reaching deeper tissues. In addition, when surface mucous cells are
damaged, they are rapidly replaced.

The remaining four cell types are in the gastric glands. They are:

 mucous neck cells, which produce mucus

 parietal cells, which produce hydrochloric acid and intrinsic factor

 chief cells, which produce pepsinoge

 endocrine cells, which produce regulatory hormones and paracrine factors.

The mucous neck cells are located near the openings of the glands, whereas the parietal, chief, and endocrine
cells are interspersed in the deeper parts of the glands.

Stomach secretions include

 mucus

 hydrochloric acid
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  gastrin

 histamine

 intrinsic factor, and

 pepsinogen. Pepsinogen is the inactive form of the protein-digesting enzyme pepsin.

Blood supply

 Arterial supply to the stomach is by the left gastric artery, a branch of the coeliac artery, the right
gastric artery and the gastroepiploic arteries.

 Venous drainage is through veins of corresponding names into the portal vein.

Secretion of gastric juice

Approximately 2–3 L of gastric secretions (gastric juice) are produced each day. The amount and type of
food entering the stomach and small intestine dramatically affect the quantity of gastric secretions, but up to
700 mL are secreted as a result of a typical meal. There is always a small quantity of gastric juice present in
the stomach, even when it contains no food. This is known as fasting juice. Secretion reaches its maximum
level about 1 hour after a meal then declines to the fasting level after about 4 hours

It occurs in three main phases: cephalic, gastric, and intestinal phases.

1. Cephalic Phase: This phase is triggered by the sight, smell, taste, or thought of food. The sensory
inputs, primarily through the vagus nerve, stimulate the brain to send signals to the stomach,
initiating the secretion of gastric juices. Acetylcholine, released by the vagus nerve, stimulates the
release of gastric juices such as hydrochloric acid and pepsinogen. This phase prepares the stomach
for the arrival of food and primes the digestive system.

2. Gastric Phase: Once food enters the stomach, this phase is activated. Distension of the stomach
walls due to the presence of food initiates stretch receptors, signaling the release of more gastric
juices. Additionally, food in the stomach triggers the release of gastrin, a hormone that further
stimulates the secretion of gastric juices. Gastrin is produced by G cells in the stomach lining and
enhances the production of hydrochloric acid, promoting the breakdown of food particles.

3. Intestinal Phase: When partially digested food (chyme) moves into the small intestine, this phase
begins. It involves feedback mechanisms to moderate the rate of gastric emptying and secretion. The
entrance of acidic chyme into the small intestine triggers hormonal signals, such as the release of
secretin and cholecystokinin (CCK), which act to reduce gastric secretion. These hormones inhibit

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 gastric motility and reduce the release of gastric juices, slowing down the emptying of the stomach to
match the intestine's ability to digest and absorb nutrients

Gastric emptying

Stomach emptying duration depends on food type and volume. Liquids exit within 1½–2½ hours; a typical
meal empties in 3–4 hours. The pyloric sphincter usually remains slightly closed, allowing peristaltic
contractions to push small amounts of chyme into the duodenum—termed the pyloric pump. Increased
motility quickens emptying. An empty stomach can have strong contractions causing hunger pangs due to
low blood glucose, starting 12–24 hours post-meal. Pangs peak at 3–4 days without food, then weaken
progressively.

Functions of stomach

 Storage: Temporarily holds food before gradual release into the small intestine.
 Mechanical Digestion: Mixes and churns food, breaking it down into smaller particles.
 Chemical Digestion: Produces gastric juices containing acids and enzymes that break down proteins.
 Production of Intrinsic Factor: Secretes a glycoprotein necessary for vitamin B12 absorption.
 Protection Against Pathogens: Creates an acidic environment to kill ingested pathogens.
 Regulates Food Entry: Controls the release of partially digested food (chyme) into the small
intestine.
 Hormone Production: P roduces hormones like gastrin that regulate stomach functions.

SMALL INTESTINE

The small intestine is a long, coiled tube that extends from the stomach to the large intestine which
is about 6 metres (20 feet) long and folds many times to fit in the abdomen. It's divided into three parts:
the duodenum, jejunum, and ileum.

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Duodenum

This is the first part of the small intestine, and it's where most of the digestion takes place. It's about 10
inches long and receives partially digested food from the stomach. The duodenum receives bile from the
liver and gallbladder, as well as digestive enzymes from the pancreas, to further break down food. The
wall of the duodenum contains glands that secrete large amounts or mucus to protect the small intestine
from the strongly acid chyme entering from the stomach

Jejunum

The jejunum is the middle section of the small intestine, roughly 8 feet long. It's where the majority of
nutrient absorption occurs. The walls of the jejunum have finger-like projections called villi, which
increase the surface area for absorption.

Ileum

The ileum is the final section of the small intestine, about 12 feet long. It connects to the large intestine
at the ileocecal valve. The ileum continues the process of nutrient absorption, particularly vitamins
(mostly vit B12) and minerals that were not absorbed in the jejunum. It also absorbs bile salts to be
recycled back to the liver.

The inner lining of the small intestine is covered with mucosa, which contains millions of tiny, finger-
like projections called villi. Villi are lined with even smaller hair-like structures called microvilli. These
structures greatly increase the surface area of the small intestine, facilitating absorption of nutrients into
the bloodstream.

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Blood Supply

The small intestine receives its blood supply from branches of the superior mesenteric artery. Nutrients
absorbed through the small intestine are carried away by the bloodstream to nourish the body's cells.

Lymphatic drainage

The small intestine also has an extensive network of lymphatic vessels called lacteals, which absorb
dietary fats and fat-soluble vitamins. These nutrients are transported through the lymphatic system
before entering the bloodstream.

LARGE INTESTINE

The large intestine, also known as the colon, is wider in diameter but shorter in length compared to the
small intestine. It's about 5 to 6 feet long. Like the small intestine, the large intestine is lined with
mucosa, but it lacks the extensive villi found in the small intestine. Instead, it has numerous mucous-
secreting glands that lubricate the passage of feces. It is divided into several sections: the cecum,
ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.

Cecum

The cecum is the pouch-like structure that marks the beginning of the large intestine. It's located in the
lower right abdomen and receives material from the small intestine through the ileocecal valve. The
appendix is attached to the cecum.

Colon

The colon can be further divided into four main parts:

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  Ascending Colon: This portion of the colon travels upward on the right side of the abdomen
from the cecum.

 Transverse Colon: The colon then turns horizontally across the abdomen from the right to
the left side, known as the transverse colon.

 Descending Colon: After the transverse colon, the descending colon descends vertically on
the left side of the abdomen.

 Sigmoid Colon: The sigmoid colon is an S-shaped curve that leads into the rectum.

Rectum

The rectum is the final straight portion of the large intestine, located just before the anus. It serves as a
temporary storage site for feces before they are expelled from the body. Enlargement of the veins in this
area constitutes haemorrhoids.

Functions of the large intestine

While the primary function of the small intestine is nutrient absorption, the large intestine absorbs water
and electrolytes from the remaining indigestible food matter. It also plays a crucial role in the
fermentation of undigested carbohydrates by bacteria, resulting in the production of certain vitamins
(like vitamin K and some B vitamins) and gases.

Large quantities of mucus, but no enzymes, are secreted by the large intestine. At intervals, usually after
meals, the involuntary muscles within the walls of the large intestine propel solid waste material, called
feces or stool, toward the rectum. This material is then eliminated from the body by both voluntary an
involuntary muscle actions, a process called defecation

Blood Supply

The large intestine receives its blood supply from branches of the superior and inferior mesenteric
arteries.

Nerve Supply

The large intestine is innervated by the enteric nervous system, which regulates its motility and
secretion. It also receives input from the autonomic nervous system

LIVER

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The liver is a reddish-brown organ with a smooth texture. . It's the largest internal organ in the human
body weighs about 1.5kg. It's surrounded by a tough fibrous capsule called Glisson's capsule. Internally,
the liver is made up of hepatic lobules, which are tiny functional units consisting of hepatocytes. The
liver is located in the upper right quadrant of the abdomen, beneath the diaphragm and above the
stomach. The liver is divided into two main lobes: the right lobe and the left lobe. The right lobe is larger
and is further divided into smaller lobes known as the caudate lobe and the quadrate lobe.

Blood Supply

The liver has a dual blood supply:

 Hepatic Artery: Oxygen-rich blood is supplied to the liver via the hepatic artery, which
branches off from the celiac artery.

 Hepatic Portal Vein: The majority of the blood supply to the liver comes from the hepatic
portal vein, which carries nutrient-rich blood from the digestive organs (such as the stomach
and intestines) to the liver for processing.

Functions of the liver

The main digestive function of the liver is the production of bile. The salts contained in bile act like a
detergent to emulsify fat, that is, to break up fat into small droplets that can be acted on more effectively

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by digestive enzymes. Bile also aids in the absorption of fat from the small intestine. Bile leaves the
lobes of the liver by two ducts that merge to form the common hepatic duct. After collecting bile from
the gallbladder, this duct, now called common bile duct, delivers bile into the duodenum

1. [Link] of glucose (simple sugar) in the form of glycogen, in animal starch. When the blood sugar
level falls below normal, liver cells convert glycogen to glucose and release it into the bloodstream;
this serves to restore the normal concentration of blood sugar.

2. The formation of blood plasma proteins, such as albumin, globulins, and clotting factors

3. The synthesis of urea, a waste product of protein metabolism. Urea is released into the blood and
transported to the kidneys for elimination.

4. The modification of fats, so cells all over the body can use them more efficiently

5. The manufacture of bile

6. The destruction of old red blood cells. The pigment released from these cells in both the liver and the
spleen is eliminated in the bile. This pigment (bilirubin) gives the stool its characteristic dark color.

7. The detoxification (removal of the poisonous properties) of harmful substances such as alcohol and
certain drugs

8. The storage of some vitamins (A,D,E,K) and iron

9. Regeneration, The liver has remarkable regenerative abilities. It can regenerate lost or damaged
tissue, making it unique among major organs in the human body.

GALLBLADDER

The gallbladder is a muscular sac on the inferior surface of the liver that serves as a storage pouch for
bile. Although the liver may manufacture bile continuously, the body is likely to need it only a few times
a day. Consequently, bile from the liver flows into the hepatic ducts and then up through the cystic duct
connected with the gallbladder. When chyme enters the duodenum, the gallbladder contracts, squeezing
bile through the cystic duct and into the common bile duct leading to the duodenum.

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PANCREAS

The pancreas is situated deep within the abdomen, behind the stomach. It lies horizontally across the
upper abdomen, with its head nestled within the curve of the duodenum and its tail extending toward the
spleen.

Structure:

 Head: The head of the pancreas is the widest part and is located adjacent to the duodenum.

 Body: The body of the pancreas extends horizontally behind the stomach.

 Tail: The tail of the pancreas tapers toward the spleen.

 Islets of Langerhans: Within the pancreas, scattered throughout the tissue, are clusters of cells
called islets of Langerhans. These contain different types of cells, including alpha cells (which
produce glucagon), beta cells (which produce insulin), and delta cells (which produce somatostatin).
These hormones play roles in regulating blood sugar levels and other metabolic processes.

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Blood Supply

The pancreas receives its blood supply from branches of the celiac artery and the superior mesenteric
artery.

Exocrine Function:

 The pancreas functions as an exocrine gland, producing digestive enzymes and bicarbonate ions.

 These enzymes are released into the duodenum via the pancreatic duct, where they aid in the
digestion of carbohydrates, proteins, and fats in the small intestine.

 The bicarbonate ions help neutralize the acidic chyme (partially digested food) that enters the
duodenum from the stomach, creating a more favorable environment for enzyme activity.

Endocrine Function:

 In addition to its exocrine function, the pancreas also serves as an endocrine gland.

 The islets of Langerhans produce hormones such as insulin, glucagon, and somatostatin, which are
released directly into the bloodstream.

 Insulin helps lower blood sugar levels by facilitating the uptake of glucose into cells, while glucagon
helps raise blood sugar levels by promoting the release of glucose from glycogen stores in the liver.

 Somatostatin regulates the secretion of both insulin and glucagon, as well as other digestive
processes.

PHYSIOLOGY OF DEFECATION

Defecation is the process by which solid waste, known as feces or stool, is expelled from the body
through the anus. It involves coordinated actions of several organs and muscles in the digestive and
pelvic regions.

Formation and storage of Feces:

After digestion and absorption of nutrients in the small intestine, indigestible materials, fiber, and waste
products pass into the large intestine (colon). In the colon, water and electrolytes are absorbed, and the
remaining material becomes more solid, forming feces.

Feces are then temporarily stored in the rectum, until it is time for defecation. The rectum acts as a
reservoir, accommodating fecal material without causing an immediate need for defecation.

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Initiation of Defecation Reflex:

When fecal material accumulates in the rectum, stretch receptors in the rectal wall are stimulated,
sending signals to the spinal cord. In response to these signals, the spinal cord initiates the defecation
reflex, which triggers a series of coordinated muscular contractions.

Relaxation of Internal Anal Sphincter:

The internal anal sphincter, which is composed of smooth muscle, normally remains contracted to
prevent involuntary passage of feces. During the defecation reflex, the internal anal sphincter relaxes in
response to nerve signals, allowing feces to move into the anal canal.

External Anal Sphincter

While the internal anal sphincter relaxes involuntarily, the external anal sphincter, composed of skeletal
muscle, remains under voluntary control. When the individual is ready to defecate, conscious effort is
exerted to relax the external anal sphincter, allowing expulsion of feces from the body. Failure to
consciously relax the external anal sphincter can lead to difficulty in defecation, known as fecal retention
or constipation.

Assistance from Abdominal and pelvic floor Muscles:

Contraction of the abdominal muscles, including the diaphragm, transversus abdominis, and rectus
abdominis, helps increase intra-abdominal pressure, aiding in the expulsion of feces
(Valsalva maneuver).

The pelvic floor muscles, including the puborectalis, external anal sphincter, and levator ani muscles,
play an important role in supporting the rectum and controlling defecation. Relaxation of these muscles
allows the anus to open, facilitating the passage of feces.

Once feces are expelled from the body, the internal and external anal sphincters contract again to prevent
leakage of stool between bowel movements

PHYSIOLOGY FLATULENCE

Production of gas

Flatulence composed of gases produced during the digestive process. When we eat or drink, we also
swallow air, which can contribute to the gas in our digestive system. Additionally, bacteria in the colon
ferment undigested carbohydrates, fibers, and certain other compounds, producing gases such as
hydrogen, methane, carbon dioxide, and sometimes trace amounts of other gases like hydrogen sulfide.

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As food moves through the digestive tract, gases produced during digestion are also transported along
with it. Gases can accumulate and become trapped in various parts of the gastrointestinal tract, including
the stomach and intestines.

Rectal Storage:

As gases accumulate in the intestines, they may eventually reach the rectum, the final portion of the
large intestine. The rectum serves as a storage area for feces and gas until they are expelled from the
body.

Release of Gas:

When the pressure of gas in the rectum exceeds a certain threshold, the body initiates the process of
passing gas. Flatulence often makes a sound, as the flatus passes through the tight anal sphincter. The
speed the gas is passed at, the tightness of the sphincter and other factors such as water and body fat
content, determine the type and pitch of the sound. Flatulence can occur voluntarily which involves the
conscious relaxation of the external anal sphincter muscles to release gas or accidentally when intra-
abdominal pressure is suddenly raised due to coughing, sneezing, sexual intercourse or laughing, for
example.

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