Human

Digestive System
KHUSHAL KHAN
DEMONSTRATOR CARDIOLOGY
KHYBER MEDICAL UNIVERSITY – INSTITUTE OF PARAMEDICAL SCIENCES
  The digestive system consists of;
 Alimentary Canal or Gastrointestinal tract (GIT)
 Accessory organs of digestion
 Alimentary Canal or Gastrointestinal tract (GIT)
 begins at the mouth
 passes through the thorax, abdomen and pelvis

Digestive  ends at the anus

 Accessory organs of digestion
System  They are:
1. Teeth
2. Tongue
3. Salivary glands
4. Pancreas They are ducted organs –
connected to the alimentary
5. Liver and biliary tract
canal.
  Ingestion
 Taking of food into the alimentary tract, i.e. eating and drinking.
 Secretion
 Secretion of mucous and enzymes i.e. digestive enzymes.
 Propulsion (Peristalsis)
 Mixing and movement of food along the alimentary tract.
 Digestion
1) Mechanical digestion - breakdown of food by, e.g. Mastication
Functions (chewing).
2) Chemical digestion - conversion of food into small molecules by enzymes.
 Absorption
 Passage of digested food substances through the walls of the alimentary
canal into the blood and lymph capillaries like alcohol, nutrients,
vitamins, water and electrolytes.
 Elimination
 The removal of undigested and non absorbable food from the
alimentary canal.
 Defaecation - the discharge of faeces from the body.
  The digestive system consists of;
1) The gastrointestinal tract (GI tract, digestive tract,
alimentary canal)
2) Accessory organs of digestion
1) Alimentary canal
Physiologica  Alimentary canal also known as the gastrointestinal (GI)
tract.
l Anatomy  This is a long tube through which food passes (about 9
meters).
 It starts at the mouth and terminates at the anus.
 It consists of;
 Mouth, pharynx, oesophagus, stomach, small
intestine, large intestine, rectum and anal canal.
2) Accessory Organs of digestion
 These organs helps primary digestive organs in the
process of digestion.
 The organs and glands are linked physiologically as
well as anatomically to the alimentary canal.
 They consist of:
 Teeth
 Tongue
 Three pairs of salivary glands
 Pancreas
 Liver and biliary tract
  The basic structure of the walls of the alimentary tract (GIT)
are formed by 4 layers of tissue:
1) Adventitia or The Serosa
2) The Muscle Layer
3) The Submucosa

Layers of 4) The Mucosa

Gastrointestin
al Tract
  This is the outermost layer.
 In thorax - it consists of loose fibrous tissue
 In the abdomen - the organs are covered by a
1- Serosa serous membrane (serosa) called peritoneum.
 The peritoneum serves to support the organs of
the abdomen and acts as a conduit for the
passage of nerves, blood vessels, and
lymphatics.
  The largest serous membrane of the body.
 It is a closed sac, containing a small amount of serous fluid,
Peritoneum within the abdominal cavity.
 It has two layers:
 Parietal peritoneum - lines the abdominal wall.
 Visceral peritoneum - covers the organs (viscera) within the abdominal
and pelvic cavities.
 It is richly supplied with blood and lymph vessels, and
contains many lymph nodes.
 It provides a physical barrier to local spread of infection,
and can isolate an infective focus such as appendicitis,
preventing involvement of other abdominal structures.
 Peritoneal Cavity – space between visceral and parietal
peritoneum.
 Contains peritoneal fluid – secreted by peritoneal cells
 Prevent friction between two layers of peritoneum.
  The muscle layer consists of two layers of smooth
(involuntary) muscle.
 The muscle fibres of the outer layer are arranged
longitudinally.
 The muscle of inner layer encircle the wall of the
tube.
 Between these two muscle layers are blood
vessels, lymph vessels and a plexus (network)
2-Muscle of sympathetic and parasympathetic nerves,
called the myenteric plexus (Auerbach’s plexus).
layer  The Myenteric Plexus (Auerbach’s Plexus)
 Neurons of this plexus regulate peristaltic waves
that move digestive products from the oral to the
anal opening.
 Myenteric neurons control local muscular
contractions that are responsible for stationary
mixing and churning.
 These nerves supply the adjacent smooth muscle
and blood vessels.
Myenteric
Plexus
  The sub-mucosal layer consists of loose areolar connective
tissue.
 It contains collagen and elastic fibres, which binds the
muscle layer to the mucosa.
 The submucosal layer contains;
 blood vessels
3-  nerves plexuses - Meissner’s plexus
 lymph vessels
Submucosa  lymphoid tissue
 Meissner’s plexus
 Meissner's plexus, a neural network located within the
submucosa.
 It transmits sensory (afferent) stimuli to the central
nervous system through both parasympathetic and
sympathetic pathways.
Meissner’s
Plexus
  The mucosa consists of 3 layers of tissue:
1)Mucous Membrane
 The innermost layer - formed by columnar epithelium
 It has three main functions: protection, secretion and
absorption
2)Lamina Propria
4-Mucosa 

It consists of loose connective tissue.
It supports the blood vessels that nourish the inner
epithelial layer, and lymphoid tissue that has a protective
function.
3) Muscularis Mucosa
 It is the thin, outer layer of smooth muscle.
 It provides involutions of the mucosa layer, e.g. gastric
glands, villi.
Enteric
Nervous
System
  The gastrointestinal tract has a nervous system all its own
called the enteric nervous system.
 It lies entirely in the wall of the gut, beginning in the
esophagus and extending all the way to the anus.
Enteric  The number of neurons in the enteric system is greater than
100 million.
Nervous  Its plays a vital role in controlling gastrointestinal
System movements and secretion.
 The enteric nervous system is composed mainly of two
plexuses;
1. Myenteric plexus or Auerbach’s plexus
2. Submucosal plexus or Meissner’s plexus
Enteric
Nerve
Plexus
 Myenteric plexus Submucosal plexus

 also known as  also known as

Auerbach’s plexus. Meissner’s plexus.
 It lies between the  It lies in the
longitudinal and submucosa.
circular muscle  The submucosal plexus
layers. controls mainly
 The myenteric plexus gastrointestinal
controls mainly the secretion and local
gastrointestinal blood flow.
movements.
 Parasympathetic
Supply Sympathetic Supply
1) Vagus Nerves 1) Celiac Ganglion

Sympathetic 2) Sacral Nerves 2) Superior Mesenteric

Ganglion
& 3) Inferior Mesenteric
 The effects of Ganglion
Parasympath parasympathetic  The effects of sympathetic
etic Nerve stimulation are:
 Increased peristalsis -
stimulation are:
 decreased peristalsis -
Supply to GIT through increased
activity of the
because there is less
stimulation of the
myenteric plexus myenteric plexus
 increased glandular  decrease glandular
secretion - through secretion - as
increased activity of stimulation of the
the submucosal submucosal plexus is
plexus reduced
Splanchnic
Circulation
  The term ‘splanchnic circulation’ describes the
blood flow to the abdominal gastrointestinal
organs including the stomach, liver, spleen,
pancreas, small intestine, and large intestine.

Splanchnic  It comprises 3 major branches of the abdominal

aorta;
Circulation 1. Celiac artery
2. Superior mesenteric artery (SMA)
3. Inferior mesenteric artery (IMA)

 The hepatic portal circulation delivers the

majority of the blood flow to the liver.
Components
of
Digestive
System
  The mouth – also called oral cavity (buccal cavity).
 Parts:
 Vestibule - part of the mouth between the gums and the cheeks
 Uvula - curved fold of muscle, hanging down from middle of soft
palate
 The oral cavity is lined with mucous membrane -
Mouth stratified squamous epithelium
 Borders:
 Anterior – the lips.
 Posterior – it is continuous with the oropharynx.
 Lateral – muscles of the cheeks.
 Superior – bony hard palate and muscular soft palate.
 Inferior – muscular tongue and soft tissues of the floor of
the mouth.
  The tongue is a voluntary muscular structure.
 Occupies the floor of the mouth.
 Attachments:
 Hyoid bone
Tongue  Frenulum
 Superior surface consists - papillae (little projections).
 Papillae contain sensory receptors (specialised nerve
endings) for the sense of taste in the taste buds.
  The tongue plays an important part in:
 Chewing (mastication)
Functions  Swallowing (deglutition)
 Speech
 Taste
  The teeth are embedded in the alveoli or sockets
of the alveolar ridges
 The mandible and the maxilla
 Babies are born with two sets of teeth
(dentitions)
 Temporary teeth (Deciduous teeth)
Teeth  There are 20 temporary teeth, 10 in each jaw.
 Begin to erupt about 6 months, and complete by 24
months of age.
 Permanent teeth
 The permanent teeth replace the deciduous teeth
in the 6th year of age.
 This dentition, consisting of 32 teeth, is usually
complete by the 21st year.
  Teeth have different shapes depending on their
functions.
 Incisors and canine (cutting teeth) - used for
Functions biting off pieces of food.
 Premolar and molar teeth - used for grinding or
chewing food.
  Salivary glands make saliva, which aids in
digestion.
 It keeps the mouth moist and supports healthy
teeth.
Salivary  Salivary glands release their secretions into
Glands ducts that lead to the mouth.
 There are three main pairs:
1) Parotid Glands
2) Submandibular Glands
3) Sublingual Glands
  Chemical digestion of polysaccharides
 Saliva contains the enzyme amylase that begins the
breakdown of complex sugars, including
starches, reducing them to the disaccharide
maltose.
 The optimum pH for the action of salivary amylase is
6.8 (slightly acid).
Functions  Enzyme action continues during swallowing until
terminated by the strongly acidic pH (1.5 to 1.8)
of the gastric juices, which degrades the amylase.
 Lubrication of food
 The high water content means that dry food
entering the mouth is moistened and lubricated
by saliva before it can be made into a bolus ready for
swallowing.
 Cleaning and lubricating the mouth
 An adequate flow of saliva is necessary to clean the
mouth, and to keep it soft, moist and pliable.
 It helps to prevent damage to the mucous
membrane by rough or abrasive food.
 Non-specific defence
 Lysozyme, immunoglobulins and clotting factors
present in saliva combat invading microbes.
 Taste
 The taste buds are stimulated only by chemical
substances in solution and therefore dry foods only
stimulate the sense of taste after thorough
mixing with saliva.
 The senses of taste and smell are closely linked
and involved in the enjoyment of food.
  The pharynx is hollow tube inside the neck that
starts behind the nose and ends at the top of
the trachea (windpipe) and oesophagus.
 It is divided into three parts;
 Nasopharynx
 Oropharynx

Pharynx  Laryngopharynx
 The oropharynx and laryngopharynx are
passages common to both the respiratory and
the digestive systems.
 Food passes from the oral cavity into the pharynx
then to the oesophagus below, with which it is
continuous.
 The walls of the pharynx consist of three layers of
tissue.
 Inner Layer - (mucosa)
 Provide lining of the mouth - stratified squamous
epithelium
 Stratified epithelial tissue provides a lining well suited
to the wear and tear of swallowing.
 Middle layer
 Made of connective tissue
 contains blood and lymph vessels and nerves
 Outer Layer
 consists of involuntary muscles - involved in
swallowing
 When food reaches the pharynx swallowing is
no longer under voluntary control.
  The oesophagus is a hollow, muscular tube that
carries food and liquid from throat to the
stomach.
 Also called: Food pipe or gullet
 It is about 25 cm (10 inch) long and about 2 cm
in diameter.

Oesophagu  It begins at the back of the mouth, passing

downward through the rear part of the
s mediastinum, through the diaphragm, and into the
stomach.
 Location:
 It lies in the median plane in the thorax
 in front of the vertebral column
 behind the trachea and the heart
 It is continuous with the pharynx above and just
below the diaphragm it joins the stomach.
 The oesophagus is one of the upper parts of the
digestive system.
 The oesophagus starts around the level C-6 behind
the cricoid cartilage of the trachea, enters the
diaphragm at about the level of T-10, and ends at
the cardia of the stomach, at the level of T-11.
 The wall of the oesophagus consists of;
 Outer layer of connective tissue
 Muscular layer
 Submucosa (connective tissue)
 Mucosa
 Sphincters:
 The upper and lower ends of the oesophagus are
closed by sphincters.
 Upper oesophageal sphincter
(cricopharyngeal)
 prevents air passing into the oesophagus
during inspiration
 prevents the aspiration of oesophageal
contents
 The cardiac or lower oesophageal sphincter
 Physiological – (not anatomical) i.e. no
thickening of the circular muscle
 prevents the reflux of acid gastric contents
into the oesophagus
  The stomach is a J-shaped dilated portion of the
alimentary tract.
 It is situated in the epigastric, umbilical and left
hypochondriac regions of the abdominal cavity.
 Organs associated with the stomach
Stomach  Anteriorly – left lobe of liver and anterior abdominal wall
 Posteriorly – abdominal aorta, pancreas, spleen, left kidney &
adrenal gland
 Superiorly – diaphragm, oesophagus and left lobe of liver
 Inferiorly – transverse colon and small intestine
 To the left – diaphragm and spleen
 To the right – liver and duodenum
 The stomach is continuous with the oesophagus
at the cardiac sphincter and with the duodenum
at the pyloric sphincter.
 Curvatures
 It has two curvatures.

1) Lesser Curvature
 short, lies on the posterior surface of the stomach
 It is the downward continuation of the posterior wall of
the oesophagus.
2) Greater Curvature
 Where the oesophagus joins the stomach the anterior
region angles acutely upwards
 Curves downwards forming the greater curvature and
then slightly upwards towards the pyloric sphincter.
 Regions
 The stomach is divided into four regions:
1) Cardia – entry of food
2) Fundus – storage of food
3) Body – chemical digestion + mixing of food
4) Pylorus – emptying of food
 At the distal end of the pylorus is the pyloric
sphincter, guarding the opening between the
stomach and the duodenum.
 When the stomach is inactive the pyloric
sphincter is relaxed and open, and when the
stomach contains food the sphincter is closed.
 Walls of the Stomach
 The four layers of tissue that comprise the basic structure
of the alimentary canal are found in the stomach but with
some modifications.
 Muscle layer
 This consists of 3 layers of smooth muscle fibres:
1. an outer layer - longitudinal fibres
2. a middle layer - circular fibres
3. an inner layer - oblique fibres
 This arrangement allows for the churning motion -
characteristic of gastric activity, as well as peristaltic
movement.
 Circular muscle is strongest in the pylorus and pyloric
sphincter.
 Mucosa of the stomach
 When the stomach is empty the mucous
membrane lining is thrown into longitudinal folds or
rugae.
 When the stomach is full the rugae are pressed and
the surface has a smooth, velvety appearance.
 Numerous gastric glands are situated below the
surface in the mucous membrane and open on to
it.
 They consist of specialised cells that secrete
gastric juice into the stomach.
 1. Temporary storage of food
 Allowing time for the digestive enzymes, pepsins, to act

2. Chemical digestion
Functions  Pepsins convert proteins to polypeptides

3. Mechanical breakdown
 The three smooth muscle layers enable the stomach to act
as a churn, gastric juice is added and the contents are
liquefied to chyme.
  The small intestine is continuous with the stomach at the
pyloric sphincter.
 The small intestine is about 5 metres long.
 It leads into the large intestine at the ileocaecal valve.
Small  It lies in the abdominal cavity surrounded by the large
Intestine intestine.
 The small intestine comprises three parts:
 Duodenum
 Jejunum
 Ileum
 3 Parts of small intestine;
1) Duodenum
 1st part of small intestine
 about 25 cm long, curves around the head of the
pancreas
 Secretions from the gall bladder and pancreas merge in
a common structure – the hepatopancreatic
ampulla – and enter the duodenum at the duodenal
papilla.
 The duodenal papilla is guarded by a ring of smooth
muscle, the hepatopancreatic sphincter (of Oddi).
2) Jejunum
 middle part, about 2 meters long

3) Ileum
 about 3 metres long, ends at the ileocaecal valve
  The walls of the small intestine are composed of the four
layers of tissue.
 Some modifications occurs at peritoneum and mucosa
and described as;
 Peritoneum – (Mesentery)
 Short, fan shaped
Structure of  A double layer of peritoneum
Small  Attaches the jejunum and ileum to the posterior
abdominal wall.
intestine  The large blood vessels and nerves lie on the posterior
abdominal wall and the branches to the small
intestine pass between the two layers of the mesentery.
 Mucosa
 The surface area of the small intestine mucosa is
greatly increased by permanent circular folds, villi
and microvilli.
 The permanent circular folds, unlike the rugae of
the stomach, are not smoothed out when the
small intestine is distended.
 They promote mixing of chyme as it passes along.
  Chemical Digestion
 In the small intestine the chemical digestion of food is
completed.
Functions  Absorption
 Absorption of most nutrients takes place in small intestine.
  The large intestine is about 1.5 metres long.
 It begins at the caecum in the right iliac fossa and
terminate at the rectum and anal canal deep in
the pelvis.
 Its lumen is about 6.5 cm in diameter, larger than
Large that of the small intestine.
 It forms an arch round the coiled-up small
Intestine intestine.
 The large intestine is divided into;
 Caecum
 Colon
 Rectum
 Anal canal
  Caecum is the first part of the large intestine.
 It is a dilated region and is continuous with the
ascending colon. Just below the junction of the
two the ileocaecal valve opens from the ileum.
 Vermiform Appendix
 a fine tube, closed at one end, which leads from the
caecum.
 It is usually about 8 to 9 cm long.
Caecum  It has the same structure as the walls of the large
intestine but contains more lymphoid tissue.
  The colon has four parts;
 Ascending colon
 This passes upwards from the caecum to the level of the
liver where it curves acutely to the left at the hepatic
flexure to become the transverse colon.
 Transverse colon
 This is a loop of colon that extends across the abdominal
cavity in front of the duodenum and the stomach to the
Colon area of the spleen where it forms the splenic flexure and
curves acutely downwards to become the descending
colon.
 Descending colon
 This passes down the left side of the abdominal cavity
then curves towards the midline. After it enters the true
pelvis it is known as the sigmoid colon.
 Sigmoid colon
 This part describes an S-shaped curve in the pelvis that
continues downwards to become the rectum.
  This is a slightly dilated section of the large
intestine about 13 cm long.
Rectum  It leads from the sigmoid colon and terminates in
the anal canal.
  This is a short passage about 3.8 cm long in the
adult.
 It leads from the rectum to the exterior.
 Two sphincter muscles control the anus;

1. Internal sphincter
Anal canal  It consists of smooth muscle.
 It is under the control of the autonomic nervous
system.

2. External sphincter
 It is formed by skeletal muscle.
 It is under voluntary control.
  Absorption
 absorption of water - by osmosis, until semisolid consistency of
faeces is achieved.
 Mineral salts, vitamins and some drugs are also absorbed.
 Microbial activity
 Escherichia coli, Enterobacter aerogenes, Streptococcus
faecalis, Clostridium perfringens - synthesise vitamin K and
folic acid

Function  Mass movement

 a wave of strong peristalsis sweep along the transverse colon
forcing its contents into the descending and sigmoid colons –
mass movement
 Defaecation
 Thus defaecation involves involuntary contraction of the muscle
of the rectum and relaxation of the internal anal sphincter.
 Contraction of the abdominal muscles and lowering of the
diaphragm increase the intra-abdominal pressure (Valsalva’s
manoeuvre) and so assist the process of defaecation.
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