What are the components of the

digestive tract?

How long is the GI tract?

What are the nine main actions of

the digestive tract?

Oral cavity, esophagus, stomach, small

intestine, large intestine, anus
Associated glands = salivary glands,
liver, and pancreas

9 meters

1. Ingestion = of food and liquid into the oral cavity

2. Mastication = chewing; divides solid food into digestible pieces
3. Motility = muscular movements of material through the tract
4. Secretion = of lubricating and protective mucus, digestive
enzymes, acidic and alkaline fluids, and bile
5. Hormone release = for local control of motility and secretion
6. Chemical digestion = enzymatic degradation of large
macromolecules in food into smaller molecules and their subunits
7. Absorption = of small molecules into blood and lymph
8. Elimination = of indigestible, unabsorbed components of food
9. Protective barrier

What are the 4 main layers of the

gut wall (from inner to outer)?

1. Mucosa
2. Submucosa
3. Muscularis
4. Serous / Adventitia

What are the 3 components of the

mucosa layer of the gut wall?

1. Epithelial lining
2. Lamina propria
3. Muscularis mucosae

What does the lamina propria of

the mucosa layer of the gut wall
contain?

What is the muscularis mucosae?

Loose connective tissue rich in blood

vessels (capillaries), lymphatics,
lymphocytes, smooth muscle cells, and
often small glands

A thin layer of smooth muscle that

separates the mucosa from the
submucosa and allows local
movements of the mucosa

What does the submucosa of the

gut wall contain?

1. Denser connective tissue

2. Larger blood and lymph vessels
3. Submucosal (Meissner) plexus of
autonomic nerves
4. Glands
5. Lymphoid tissue

What are the layers of the

muscularis externa (from inner to
outer)?

1. Circular smooth muscle layer

2. Connective tissue layer containing
blood and lymph vessels and the
myenteric (Auerbach) nerve plexus of
autonomic neurons aggregated into
small ganglia
3. Longitudinal smooth muscle layer

What are the two components of

the enteric nervous system?

1. Submucosal (Meissner) plexus

2. Myenteric (Auerbach) plexus

What does the serosa layer of the

gut wall contain?

Describe the outermost layer of

the gut tube in areas outside of the
abdominal cavity (such as the
esophagus).

What immune components are

present in the lamina propria?

What is Hirschsprung disease?

How does Chagas disease affect

the GI tract?

Loose connective tissue rich in blood

vessels, lymphatics, and adipose tissue
Has a simple squamous covering
epithelium, or mesothelium, that is
continuous with the mesenteries in the
abdominal cavities

Serosa is replaced by a thick

adventitia, a connective tissue
layer that merges with the
surrounding tissues and lacks
mesothelium
Macrophages
Plasma cells producing IgA
antibodies (epithelial cells produce
the secretory protein for transport
of IgA into the intestinal lumen)

Congenital aganglionic megacolon

Absence of the plexuses in the digestive
tract's enteric nervous system
Disturbs digestive tract motility and
produces dilations in some areas

Trypanosomiasis (infection with the

protozoan Trypanosoma cruzi)
Severely injures the digestive tract's
enteric nervous system, disturbing
normal motility and producing dilations
in some areas

What percentage of the body's

total immune cells are located in
the gut?

What are the 3 types of movement

in the esophagus?

What are the 5 types of movement

in the stomach?

What are the 5 types of movement

in the small intestine?

What are the 4 types of movement

in the large intestine?

70%

1. Peristalsis = Contraction of the tube behind the foodstuff,

moving the bolus of food downward through the tube
2. Secondary peristalsis = In the event that the bolus gets stuck or
moves slower than the primary peristaltic wave (as can happen
when it is poorly lubricated), stretch receptors in the esophageal
lining are stimulated and a local reflex response causes a
secondary peristaltic wave around the bolus, forcing it further
down the esophagus.
3. Retroperistalsis = important in vomiting

Receptive relaxation = smooth muscle in muscularis externa relaxes to

allow entry of food
Pyloric grind = located at pyloric sphincter; contracts to cause
retropulsion; sends stomach contents back up and around the stomach;
causes mixing
Migrating motor (myoelectric) complex (MMC) = every 90 minutes there is
a sweep from the stomach to the ileal-cecal junction; cleanout function;
pushes everything left in the hose out of this section
Mucosal squeeze = up and down motion of epithelium caused by
muscularis mucosa smooth muscle
Musosal flutter = horizontal wave movement of epithelium caused by
muscularis mucosa

Peristalsis = forward motion of food

Segmentation = local mixing back and forth
MMC = big sweep every 90 minutes
Mucosal squeeze = up and down movement of
epithelium caused by muscularis mucosa smooth
muscle
Mucosal flutter = horizontal movement of
epithelium caused by muscularis mucosa smooth
muscle
Peristalsis
Segmentation = local mixing; larger chunks; haustra
are important in the segmentation process
Mass movements = 1-3 movements per day;
consolidation of foodstuffs into large chunks (large
bolus of feces)
Mucosal squeeze = important for water
reabsorption

How do sympathetic fibers reach

the GI tract?

Presynaptic fibers travel from the spinal cord --> white

rami communicantes --> sympathetic chain -->
splanchnic nerves --> synapses in prevertebral ganglia
(celiac, superior mesenteric, inferior mesenteric,
hypogastric ganglia)
Postsynaptic fibers travel from prevertebral ganglia to
the gut wall and synapse in the myenteric or submucosal
plexus

How do parasympathetic fibers

reach the GI tract?

Presynaptic fibers travel in the vagus nerve or in

pelvic splanchnic nerves all the way to the gut
wall and synapse in the intrinsic gut plexuses
Postsynaptic fibers are located in the intrinsic gut
plexuses (myenteric and submucosal plexuses)

What do diffuse neuroendocrine

system (DNES) cells do?

Regulate motility
Regulate secretions
Produce neurotransmitter-like peptides
that affect contractile cells and secretory
cells in a paracrine manner

Describe the epithelium of the

esophagus.

Nonkeratinized stratified
squamous epithelium; forms
interdigitations with the lamina
propria

What do melanocytes in the

esophageal epithelium do?

Detox function; neutralize free

radicals and free oxygen species

What is the turnover rate for cells

of the esophageal epithelium?

Describe the glands of the

esophagus.

Describe the muscularis of the

esophagus. Is it striated or
smooth? Voluntary or involuntary?

15 days

Esophageal glands = small mucus-secreting

glands located in the submucosa; empty via ducts
onto the luminal surface; lubricate and protect
the mucosa
Esophageal cardiac glands = group of glands in
the mucosa near the stomach that secrete
additional mucus
Upper 1/3 of esophagus = muscularis is
exclusively striated, voluntary skeletal muscle
Middle 1/3 of esophagus = combination of
skeletal and smooth muscle fibers
Distal 1/3 of esophagus = muscularis is
exclusively smooth, involuntary muscle

About 25 cm long

How long is the esophagus? How

much of it is covered by serosa?

Only the distal 1-2 cm of the esophagus

that is within the abdominal cavity is
covered by serosa; the rest is enclosed
by the loose CT of the adventitia, which
blends into the surrounding tissue
Skeletal muscle but not really under conscious
control

Describe the upper esophageal

sphincter.

Prevents air from entering into the esophagus

during breathing
Prevents reflux of esophageal contents into the
pharynx to guard airway aspiration

Smooth muscle

Describe the lower esophageal

sphincter.

Antireflux barrier protecting the

esophagus from the gastric contents
Functional but not anatomical

What is the gastroesophageal

junction called? Where does it
occur?

What are esophageal varices?

What underlying issue can cause
them?

What is GERD? What can happen if

it goes untreated?

What are the main functions of the

stomach?

Z-line
Occurs at the distal limit of the
lower esophageal sphincter and
the proximal limit of the gastric
rugae
Dilated veins in the esophageal wall
(especially in the deep submucosa);
veins may burst and cause bleeding in
the lower 1/3 of the esophagus
Usually result from portal hypertension
due to some type of liver disease
Gastroesophageal reflux disease
An incompentent inferior esophageal sphincter
allows stomach acid to move up into the esophagus,
produce chronic heartburn, and lead to erosion of
the esophageal mucosa. Untreated GERD can
produce metaplastic changes in the stratified
squamous epithelium of the esophageal mucosa, a
condition called Barrett esophagus.
1. To continue digestion of carbohydrates initiated
by the amylase of saliva
2. To add an acidic fluid to the ingested food
3. To mix food and fluid into a viscous mass called
chyme via the churning activity of its muscularis
4. To begin digestion of triglycerides by a secreted
lipase
5. To promote the initial digestion of proteins with
the enzyme pepsin

What are the four major regions of

the stomach?

Cardia, fundus, body, pylorus

The cardiac and pylorus regions of

the stomach are primarily involved
in what?

Mucus production

The fundus and body regions of

the stomach are the sites of what?

Gastric glands releasing acidic

gastric juice

Which layers of the stomach wall

form rugae?

The mucosa and submucosa of the

empty stomach form large,
longitudinally directed folds called
rugae, which flatten when the
stomach fills with food.

Where can ulcers occur? What are

potential causes?

Gastric and duodenal ulcers = erosive lesions of the mucosa that

occur anywhere btw the lower esophagus and the jejunum
Potential causes:
1. Bacterial infections with Helicobacter pylori
2. Effects of nonsteroidal anti-inflammatory drugs
3. Overproduction of HCl or pepsin
4. Lowered production or secretion of mucus or bicarbonate

Describe the epithelium of the

stomach.

Simple columnar epithelium that

invaginates deeply into the lamina
propria; the invaginations form millions
of gastric pits that lead down to long,
branched, tubular glands that extend
through the full thickness of the lamina
propria
Surface mucous cells

What type of cell lines the stomach

lumen and the lumen of the gastric
pits? What do these cells secrete?

Where do stem cells for the

stomach epithelium exist?

What is the turnover time of

surface mucous cells?

What are the 4 major types of

secretory epithelial cells of the
gastric glands?

Secrete a thick, adherent, and highly viscous

mucous layer that is rich in bicarbonate ions
and protects the mucosa from both abrasive
effects of intraluminal food and the corrosive
effects of stomach acid

Stem cells for the epithelium that lines

the glands, pits, and stomach lumen are
found in a narrow segment (isthmus)
between each gastric pit and the gastric
glands. Multiple gastric glands are
formed by branching at the isthmus of
each gastric pit.

4-7 days

1. Mucous neck cells

2. Parietal cells
3. Chief (zymogenic) cells
4. Enteroendocrine cells

Describe mucous neck cells. What

do they secrete?

Present in clusters or singly among other cells in the

necks of gastric glands; include many progenitor and
immature surface mucous cells; less columnar than
surface mucous cells lining the gastric pits; rounded
nuclei and apical secretory granules
Secrete mucus that is less alkaline than that of the
surface epithelial mucous cells

Where are parietal cells located?

Parietal cells are present among

the mucous neck cells and
throughout the deeper parts of
gastric glands.

Describe the ultrastructure of

parietal cells.

Parietal cells are large cells, usually appearing

rounded or pyramidal, each with one (or sometimes
two) central, round nucleus. The cytoplasm is
intensely eosinophilic due to the high density of
mitochondria. An active parietal cell has a deep
circular invagination of its apical plasma membrane
that forms an intracellular canaliculus with a large
surface area produced by thousands of microvilli.

What two main products do

parietal cells secrete?

1. Hydrochloric acid, HCl

2. Intrinsic factor, a glycoprotein
required for uptake of vitamin B12
in the small intestine

Describe the enzymes and

transporters involved in HCl
production and secretion by
parietal cells.

Carbonic anhydrase converts H2O and CO2 to H+ and HCO3inside the parietal cell.
Apical surface:
H+/K+ ATPase (pumps H+ out of the cell in exchange for K+)
K+ and Cl- diffuse across the apical membrane and Cl- combines
with the protons in the lumen of the gastric gland to form HCl.
Basolateral surface:
Na+/K+ ATPase
Cl-/HCO3- exchange (Cl- into cell, HCO3- out of cell)

Describe the pH of the mucosa.

What stimulates parietal cell

secretory activity?

Contrast a resting parietal cell and

an active parietal cell.

Where are chief (zymogenic) cells

found?

Describe the ultrastructure of chief

cells.

Gastric secretions become acidic due to

HCl produced by parietal cells, but the
mucosa itself remains at a more neutral
pH because of the bicarbonate released
into the lamina propria by the parietal
cells.

1. Parasympathetic innervation
2. Paracrine release of histamine
and the polypeptide gastrin from
enteroendocrine cells

Resting cell: a number of tubulovesicular structures are below the

apical plasmalemma; the cell has few microvilli and only a short
intracellular canaliculus
Active cell: tubular vesicles fuse with the cell membrane to form
the large intracellular canaliculus and microvilli, thus providing a
generous increase in the surface of the cell membrane for
diffusion and ion pumps

Chief cells predominate in the

lower regions of the gastric glands.
They are found in clusters.

All the characteristics of active

protein-secreting cells:
Abundant RER, numerous apical
secretory granules, basal nuclei,
and basophilic cytoplasm

What two major products do chief

cells secrete?

1. Pepsinogens = inactive precursors which are

converted in the acidic environment of the
stomach into active pepsins (endoproteinases
with broad specificity and maximal activity in the
pH range 1.8-3.5; initate hydrolysis of ingested
protein)
2. Gastric lipase = digests many lipids

What are the different ways that

enteroendocrine cells are named?

Enterochromaffin (EC) cells and argentaffin cells = alternative

names based on whether these cells stained with chromium or
silver salts in TEM tissue treatments
APUD cells = collective term that refers to the "amine precursor
uptake and decarboxylation" activity of these cells
Naming with initial letter of the main hormone they produce

Give the major location and

hormone product (with major
actions) of D cells.

Major location = pylorus, duodenum,

pancreatic islets
Hormone produced = somatostatin
Major action of somatostatin = inhibits
secretion from other DNES cells nearby

Give the major location and

hormone product (with major
actions) of EC cells.

Major location = stomach (fundus basal

lamina), small intestine, large intestine
Hormones produced = serotonin and
substance P
Major action of hormones = promote
increased gut motility

Give the major location and

hormone product (with major
actions) of G cells.

Major location = pylorus

Hormone produced = gastrin
Major action of gastrin = promotes
gastric acid secretion

Give the major location and

hormone product (with major
actions) of I cells.

Major location = small intestine

Hormone produced = cholecystokinin
(CCK)
Major actions of cholecystokinin =
promotes pancreatic enzyme secretion
and gallbladder contraction; inhibits
gastric acid secretion

Give the major location and

hormone product (with major
actions) of K cells.

Major location = duodenum and

jejunum
Hormone produced = gastric
inhibitory polypeptide (GIP)
Major action of GIP = inhibits gastric
acid secretion

Give the major location and

hormone product (with major
actions) of L cells.

Major location = ileum and colon

Hormones produced = glucagon-like peptide (GLP-1)
and peptide YY
Major actions of GLP-1 = promotes insulin secretion;
inhibits gastric acid secretion and inhibits hunger
Major actions of Peptide YY = promotes H2O and
electrolyte absorption in the large intestine; inhibits
gastric acid secretion

Give the major location and

hormone product (with major
actions) of Mo cells.

Location = small intestine

Hormone produced = motilin
Major action of motilin = promotes
increased gut motility

Give the major location and

hormone product (with major
actions) of N cells.

Major location = ileum

Hormone produced = neurotensin
Major action of neurotensin = inhibits
gastric acid secretion

Give the major location and

hormone product (with major
actions) of S cells.

What are carcinoids?

Major location = small intestine

Hormone produced = secretin
Major actions of secretin = promotes
pancreatic and biliary bicarbonate and
water secretion; inhibits gastric acid
secretion and stomach emptying
Tumors which arise from enteroendocrine EC
cells
Responsible for clinical symptoms caused by
overproduction of serotonin, which increases
gut motility and can produce mucosal
vasoconstriction and tissue damage when
present in high levels

What are the 2 classes of cells of

the digestive tract DNES?

Closed type = cellular apex is covered by

neighboring epithelial cells
Open type = constricted apical end of
the cell contacts the lumen and bears
chemoreceptors that sample the
lumen's contents

What types of glands are present

in the cardia and pylorus regions of
the stomach?

Cardia --> cardial glands

Pylorus --> pyloric glands

Describe cardial and pyloric glands.

Cardia and pylorus mucosa contains

tubular glands with long pits that
branch into coiled secretory portions
(cardial and pyloric glands). These
glands lack both parietal and chief cells
and primarily secrete abundant mucus.

What are the 3 layers of smooth

muscle in the stomach muscularis?
Which layer thickens to form the
pyloric sphincter?

What are leiomyomas?

What are the functions of each of

the 3 regions of the small
intestine?

1. Outer longitudinal layer

2. Middle circular layer --> thickens
to form the pyloric sphincter
3. Innermost oblique layer
Benign tumors of smooth muscle cells
Most common type of tumor in the
stomach and small intestine
May become large
Muscularis of the stomach may include
leiomyomas in up to 50% of the
population older than 50
Duodenum = digestion; absorption of
proteins and carbohydrates
Jejunum = absorption; fat digestion
Ileum = absorption; immune response

About how long is the small

intestine?

5m

What are the permanent circular

or semilunar folds of mucosa and
submucosa in the small intestine?

Plicae circulares
(Best developed in the jejunum)

What are the short mucosal

outgrowths that densely cover the
entire mucosa of the small
intestine and project into the
lumen?

Describe the epithelium of the

small intestine. What are the two
main cell types?

What does each villus contain?

Villi
0.5-1.5 mm in length

Simple columnar epithelium

Cytokeratin-positive
Enterocytes = absorptive cells
Goblet cells = mucus-producing cells
interspersed among the enterocytes

Each villus has a core of loose connective tissue

that extends from the lamina propria and
contains fibroblasts, smooth muscle fibers,
lymphocytes (IgA, IgG, IgM), plasma cells,
fenestrated capillaries, and a central lymphatic
called a lacteal.

What is Celiac disease (celia

sprue)?

Disorder of the small intestine mucosa that

causes malabsorption and can lead to damage or
destruction of the villi; caused by an immune
reaction against gluten or other proteins in wheat
and certain other types of grain; resulting
inflammation affects enterocytes, leading to
reduced nutrient absorption

What are located between villi of

the small intestine?

Openings of short tubular glands

called intestinal glands or crypts (or
crypts of Lieberkuhn) with an
epithelium continuous with the villi

What are located in the intestinal

crypts?

Differentiating cells and pluripotent

stem cells for all the cell types of
the small intestine

What are the 5 cell types of the

small intestine epithelium?

1. Enterocytes
2. Goblet cells
3. Paneth cells
4. Enteroendocrine cells
5. M (microfold) cells

Describe the ultrastructure of

enterocytes.

Tall columnar cells

Oval nucleus located basally
Apical end has a brush border, which is
a layer of densely packed microvilli (1
um long) covered by glycocalyx through
which nutrients are absorbed

How many microvilli does a single

enterocyte have? How many are
on a square millimeter of the
mucosal surface?

Each enterocyte = 3000 microvilli

1 square mm = 200 million
microvilli

By how much do the plicae

circulares, villi, and microvilli
increase surface area? What is the
total surface area of the small
intestine?

Plicae circulares = increase SA 3-fold

Villi = increase SA 10-fold
Microvilli = increase SA 20-fold
Total SA = over 200 square meters

Describe the basic mechanisms of

carbohydrate and protein
absorption.

Describe the basic order of events

in lipid absorption.

What do goblet cells produce?

What is their function?

Disaccharidases and peptidases secreted by

the enterocytes are located in the glycocalyx
and hydrolyze disaccharides and dipeptides
to monosaccharides and amino acids. These
monomers are then easily absorbed by active
transport and immediately released on the
basolateral side for uptake by the capillaries.
1. Ingested fats are emulsified by bile acids to form a suspension
of lipid droplets
2. Lipases digest lipids from lipid droplets into glycerol, fatty acids,
and monoglycerides
3. The products of hydrolysis diffuse passively across the microvilli
membranes
4. In the SER, lipid subunits are reesterified into triglycerides
5. The TAGs are complexed with apoproteins in the Golgi
apparatus to produce chylomicrons
6. Chylomicrons are released from the cell's basolateral surface for
uptake by the lacteal

Goblet cells are interspersed among the

absorptive enterocytes. They secrete
glycoprotein mucins that are hydrated to
form mucus that functions to protect
and lubricate the lining of the intestine.

Location = basal portion of the intestinal crypts below

the stem cells

Where are Paneth cells found?

What is their role?

Role = exocrine cells with large eosinophilic secretory

granules in their apical cytoplasm; release lysozyme,
phospholipase A2, and defensins, all of which break
down membranes of microorganisms and bacterial cell
walls; important role in innate immunity and in
regulating the microenvironment of the intestinal crypts

Location = mucosa of the ileum overlying the lymphoid follicles of

Peyer patches

Where are M cells? Describe their

ultrastructure and function.

Ultrastructure = basal membrane invaginations or pockets

containing intraepithelial lymphocytes and APCs
Function = M cells selectively endocytose antigens and transport
them to the underlying lymphocytes and dendritic cells, which
then migrate to lymph nodes for an appropriate immune
response

What are located in the mucosa

and submucosa of the proximal
part of the duodenum?

Where are Peyer patches found?

What is Crohn disease?

Large clusters of branched tubular mucous glands, the

duodenal (or Brunner) glands with small excretory ducts
opening among the intestinal crypts
Mucus from these glands is distinctly alkaline, which
neutralizes chyme entering the duodenum from the
pylorus, protecting the mucous membrane and bringing
the intestinal contents to the optimum pH for pancreatic
enzyme action.

Lamina propria and submucosa of

the ileum

Chronic inflammatory bowel disease that occurs

most commonly in the ileum or colon; results
from a poorly understood combination of
immune, environmental, and genetic factors;
excessive lymphocytic activity and inflammation
occur in any or all layers of the tract wall,
producing pain, localized bleeding,
malabsorption, and diarrhea
Lacks villi and, except for in the rectum, has no major
folds

Describe the mucosa of the large

intestine.

What are the columnar absorptive

cells of the large intestine called?

Penetrated by tubular intestinal glands; glands and

lumen are lined by goblet and absorptive cells with a
small number of enteroendocrine cells; goblet cells
become more numerous along the length of the colon
and in the rectum; epithelial stem cells are located in
the bottom third of each gland

Colonocytes
These cells have irregular microvilli
and dilated intercellular spaces
indicating active absorption.

What is colorectal cancer?

What are hemorrhoids?

How does the epithelium change

at the rectoanal junction?

What are the anal columns?

What is diverticulosis?

An adenocarcinoma that develops initially from

benign adenomatous polyps in the mucosal
epithelium; such polyps usually occur in the
epithelium of the rectum, sigmoid colon, or distal
descending colon and are more common in
individuals with low-fiber diets, which reduce the
bulk of fecal material, prolonging contact of the
mucosa with toxins in feces

Swollen blood vessels in the mucosa or

submucosa of the anal canal; typically
results from a low-fiber diet,
constipation, prolonged sitting, or
straining at defecation, all of which
produce increased pressure on these
blood vessels

Simple columnar mucosal lining of

the rectum is replaced by stratified
squamous epithelium

Longitudinal folds formed by the

mucosa and submucosa in the anal
canal; the lamina propria and
submucosa in the anal columns include
sinuses of the rectal venous plexus

A condition in which the mucosa and submucosa

of the colon can herniate out between the teniae
coli, forming bulges (diverticula); this disorder
can result from structural defects in the colon
wall or from high intraluminal pressure or
constipation; fecal material can become
immobilized in the diverticula and cause localized
inflammation, or diverticulitis.