Gastroenterology- medical specialty that deals
with the structures, functions, diagnosis, and
treatment of diseases of the stomach and
intestines
Proctology- medical
specialty that deals with the
diagnosis and treatment of
disorders of the lower portion
of the large intestine, rectum,
and anus
Diseases/Conditions:
Diverticulosis- diverticula
(outpouchings of the large
intestine) form, usually in the
sigmoid colon. May become
infected, inflamed, painful, and
bleed
The organs of the digestive tract
can be divided into 2 groups: 1.
digestive tract- continuous muscular
tube that extends from the mouth to
anus 2. accessory digestive organs-
organs that assist in digestion
The digestive system performs 6 basic processes
1. Ingestion- process of taking food and liquid into
mouth 2. Mechanical digestion- crushing and churning
that makes materials easier to propel along digestive
tract 3. Chemical Digestion- chemical breakdown of
ingested food into small molecules that can be absorbed
4. Secretion- cells lining the digestive tract and
accessory digestive organs release water, acid, enzymes,
buffers, salts, and hormones into the lumen of the tract
5. Absorption- passage of products of digestion across
epithelial cells that line the digestive tract, and then into
the interstitial fluid of the digestive tract 6.
Defecation/Egestion- elimination of feces through anus
The digestive tract has a four-layered arrangement of tissues
1. Mucosa- mucous membrane that forms the inner lining of the digestive tract.
Composted of two layers: digestive epithelium- includes cells that protect the walls,
secrete substances, and absorb small molecules. And lamina propria- connective
tissue containing small blood and lymphatic capillaries which are the routes by
which nutrients that are absorbed by the epithelium travel to the body cells 2.
Submucosa- connective tissue that binds the mucosa to the muscularis, it contains
blood and lymphatic vessels 3. Muscularis mucosae- main muscular layer of
digestive tract 4. Visceral peritoneum- superficial layer of the digestive tract
The peritoneum is the largest serous
membrane of the body. It is divided
into 2 parts: visceral peritoneum-
covers the outer surface of the
digestive tube and the surface of the
abdominal organs. The parietal
peritoneum- lines the wall of the
abdominopelvic cavity
Peritonitis- an acute
inflammation of the peritoneum
that can be caused by accidental
or surgical wounds followed by
microbial contamination, or by
rupture of the appendix
Oral Cavity has 3
important structures:
tongue, salivary
glands, and teeth
Tongue- composed of
skeletal muscle covered
with mucous membrane.
Assists in mechanical
processing of food by
compression. Secretes
watery fluid and enzyme
lingual lipase
Salivary Glands- release saliva in the mouth which includes
water, ions, antibodies, and enzymes. Functions of saliva
include: lubricating the mouth, providing a medium for
dissolving foods, buffers acidic foods, antibodies and the
enzyme lysozyme help control oral bacteria, and salivary
calculi : development of stones in the salivary glands
Teeth-
hardest
structures
in the
body and
highly
calcified
Chemical digestion is based on 2 enzymes:
salivary amylase- initiates the breakdown of
polysaccharides into disaccharides. Lingual
lipase- initiates the breakdown of
triglycerides into fatty acids and
monoglycerides
Deglutition
(swallowing)
occurs in 3 stages:
buccal stage,
pharyngeal stage,
and esopharyngeal
stage
Buccal stage-
the tongue
compresses the
bolus against
the palate and
then forces the
bolus into the
oropharynx
Pharyngeal
stage- involuntary
passage of bolus
through the
pharynx into the
esophagus
Esopharyngeal
stage- involuntary
passage of bolus
through the
esophagus into the
stomach
The stomach is a J-shaped
enlargement of the digestive
tract that connects the
esophagus to the small
intestine. A hiatus hernia
may occur when the
stomach protrudes through
the opening in the
diagpharm
Mechanical digestion-several
minutes after food enters the
stomach, peristaltic
movement called mixing
waves pass over the stomach
every 15-25 seconds. This
creates a soupy liquid called
chyme
Chemical digestion- cells lining the stomach
secrete about 1.5 L of gastric juice in a day.
They cells are found in shallow depressions
called gastric pits they include:
1. Mucous cells- secrete mucus into
the lumen of the gastric pit 2. Parietal
cells- secrete hydrochloric acid 3.
Chief cells- secrete pepsinogen an
inactive proenzyme which is
converted into the enzyme pepsin by
the acid in the lumen of the stomach
4. G cells- secrete gastrin
Events in gastric digestion occur in 3 phases: 1. Cephalic
phase- prepares stomach for the arrival of food 2. Gastric
phase- begins with the arrival of food in the stomach 3.
Intestinal phase- controls the rate of chime entry into the
duodenum to give time for the duodenum to deal with the
arriving acids
Caffeine and alcohol stimulate gastric secretions and motility
Stomach absorbs
very little
including ions,
water, aspirin,
some antibodies,
and alcohol
Vomiting
(emesis)- forcible
expulsion of
contents of the
upper digestive
tract through the
mouth
The acinar cells
of the pancreas
produce about 1L
of pancreatic
juice per day
Pancreatic juice includes: 1.Sodium bicarbonate 2. Enzymes
including pancreatic amylase, pancreatic lipase, nucleases (digest
nucleic acids into nucleotides), and trypsinogen- and inactive
proenzyme which is converted into the enzyme trypsin in small
intestine. Trypsin continues the digestion of proteins into short
peptides
Gallstones- form when bile
contains insufficient bile salts or
excessive cholesterol. Bile
becomes saturated with
cholesterol which precipitates
out of solution to form crystals
and gallstones. They may
partially or completely obstruct
the flow of bile from the
gallbladder into the duodenum
The walls of the small intestine have 3 structures that increase surface
area: 1. Plicae circulares- ridges that extend out from the small
intestine 2. Intestinal villi- fingerlike projections of the mucosa 3.
Microvilli- hairlike projections on the free side of the plasma
membrane of absorptive cells
Two types of
movement occur in
small intestine: 1.
Segmentation-
localized, mixing
contractions 2.
Peristalsis-
contractions that
move chime along
Brush border enzymes
finally digestive
disaccharides into
monosaccharaides. These
enzymes include: maltase-
breaks down maltose into
two glucoses. Sucrase-
breaks down into glucose
and fructose. Lactase-
breaks down lactose into
glucose and galactose
Lactose intolerance-
mucosal cells of the
small intestine fail to
produce lactase
Pancreatic lipase completes the breakdown of triglycerides
into fatty acids and monoglycerides. As fatty acids and
monoglycerides are released,, the interact with bile salts in
chime to form small lipid/bile salt complexes called micelles
Absorption- all mechanical and chemical phases of digestion are
directed towards changing foods into forms that can
pass through the epithelial cells lining the mucosa
and into the underlying blood and lymphatic vessels
Normally all carbohydrates are absorbed
except cellulose and fibers. Normally
95-98% of proteins are absorbed.
Normally 95% of lipids are absorbed
All nutrients are absorbed into the blood go directly to the liver through the hepatic portal
system. Blood capillaries of the small intestine make their way via the hepatic portal veins to
the livers hepatic portal system. The liver acts as a filter of absorbed material before it enters
the general circulation through the hepatic portal system via the hepatic veins
Functions of liver: maintaining metabolism of blood levels of
carbohydrates, proteins, and lipids. Storage of iron, glycogen, lipids,
vitamins, processing of drugs and hormones, synthesis of bile and
plasma proteins, excretion of bilirubin, kupffer cells- phagocytosis of
pathogens
Hepatitis- disease of the liver caused by
viruses. Hepatocytes- are destroyed due to
drugs and alcohol, viral infections, inadequate
blood supply, blocked hepatic ducts
Large Intestine- terminal portion of
digestive tract which extends from the
ileocecal valve to the anus
Haustral churning mass
peristalsis- drives the contents of
the second half of the colon into
the rectum by strong waves
Bacteria also breaks down remaining proteins and amino
acids into simpler compounds, including ammonia, hydrogen
sulphide, indole, and skatole
When chime has remained in the large intestine for about 3-10 hours it
becomes solid because of water absorption. It is now called feces
which consists of: water, bacteria, unabsorbed digestive material,
ingestible parts of food, sloughed off epithelial cells, products of
bacterial decomposition
Defecation Reflex- when the stretch receptors detect distension of
the rectum as fecal material is moved by peristalsis into the rectum
from the sigmoid colon, the defecation reflex is initiated which
involves 2 reflexes: the involuntary internal anal sphincter to relax,
feces now moves into anal canal. The second reflex causes the
contraction of the external anal sphincter under voluntary control
Hemorrhoids- venous pressures in
the lamina propria and submucosa in
the anal canal become too high
causing veins to become distended
Diarrhea- excessive amounts of
fecal material and fluid contents is
eliminated from the body due to
enhanced peristaltic activity and
decreased absorption
Constipation- infrequent or difficult defecation due to decreased motility