07/11/2019

GASTROINTESTINAL SYSTEM

Dr Paterne S. KARUME, MBBS, MSc, Mmed (PS)

OUTLINE

1. DIGESTIVE PROCESS AND GENERAL ANATOMY

2. THE MOUTH AND THE OESOPHAGUS

3. THE STOMACH

4. THE SMALL INTESTINE

5. THE LARGE INRESTINE

6. ACCESSORY GLANDS OF DIGESTION

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LEARNING OBJECTIVES
At the end of this lecture students should be able to:
• Identify the functions and major process of the digestive system
• State the names and locations of the salivary glands
• Describe the gross anatomy and histology of the digestive system
• Explain how the stomach is protected from digesting itself
• contrast the mucosa of the colon with that of the small intestine
• Describe the gross and microscopic anatomy of the liver and the
pancreas
• Describe the function of the liver, the pancreas and gallbladder

OUTLINE
1. DIGESTIVE PROCESS AND GENERAL ANATOMY
2. THE MOUTH AND THE OESOPHAGUS
3. THE STOMACH
4. THE SMALL INTESTINE
5. THE LARGE INTESTINE
6. ACCESSORY GLANDS OF DIGESTION

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DIGESTIVE PROCESS AND GENERAL ANATOMY

• GENERAL ANATOMY
• Two anatomical subdivision:
1. Digestive tract: muscular tube (about 9m) from mouth to anus
• Includes: oral cavity, pharynx, oesophagus, stomach, small intestine
and large intestine
• Gastrointestinal (GI) tract=stomach and intestines

2. Accessory organs: teeth, tongue, salivary glands, liver, gallbladder,

pancreas

DIGESTIVE PROCESS AND GENERAL ANATOMY

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DIGESTIVE PROCESS AND GENERAL ANATOMY

• Histology : 4 layers
1. Mucosa
• Epithelium
• Lamina propria
• Muscularis mucosae
2. Submucosae
3. Muscularis externa
• Circular layer
• Longitudinal layer
4. Serosa
• Areolar tissue
• mesothelium

DIGESTIVE PROCESS AND GENERAL ANATOMY

• innervation:
• Somatic nerves from cranial nerves (tongue mouvements,
mastication, swallowing):
• Autonomic innervation
• Parasympathetic system (vagus nerve mainly)
• Sympathetic system (through coeliac ganglion, sup mesenteric ganglion and
inf mesenteric ganglion)
Enteric nervous system : two networks (submucosal plexus: Meissner;
myenteric plexus: Auerbach)

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DIGESTIVE PROCESS AND GENERAL ANATOMY

• CIRCULATION
• oesophageal arteries
• Celiac trunk
• Superior mesenteric arteries
• Inferior mesenteric arteries

• Hepatic portal vein

DIGESTIVE PROCESS AND GENERAL ANATOMY

• RELATIONSHIP TO THE PERITONEUM
• The GIT is loosely suspended on the abd wall by the mesenteries.
• Mesentery, mesocolon, greater omentum, lesser omentum

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DIGESTIVE PROCESS AND GENERAL ANATOMY

• FUNCTIONS:
1. Ingestion
2. Digestion
3. Absorption
4. Compaction
5. Defecation

OUTLINE
1. DIGESTIVE PROCESS AND GENERAL ANATOMY
2. THE MOUTH AND THE OESOPHAGUS
3. THE STOMACH
4. THE SMALL INTESTINE
5. THE LARGE INTESTINE
6. ACCESSORY GLANDS OF DIGESTION

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THE MOUTH AND THE OESOPHAGUS

• ORAL CAVITY
• Functions: ingestion, taste, chewing,
swallowing, speech, respiration
• Enclosed by the cheeks, lips, palate
and tongue
• The palate separate oral cavity from
nasal cavity
• composed of two separate regions,
the vestibule, the area between the
cheeks, teeth, and lips, and the oral
cavity proper
• Anteriorly, the roof forms by the
hard palate and posteriorly by the
soft palate

THE MOUTH AND THE OESOPHAGUS

• ORAL CAVITY
• Tongue:
• highly muscular organ covered by a
mucous membrane
• functions:
• speech
• manipulation and positioning of
food
• tasting
• swallowing
• cleansing of oral cavity

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THE MOUTH AND THE OESOPHAGUS

• ORAL CAVITY
• Tongue:
• Parts:
• root: posterior ⅓ (in oropharynx)
• body: anterior ⅔ (in oral cavity
proper) ends anteriorly in apex (tip) of
tongue
• dorsum: superior roughened surface
• inferior (sublingual) surface: faces floor
of oral cavity proper, covered with thin,
transparent mucosa
• right/left margins: separate dorsum
and inferior surface

THE MOUTH AND THE OESOPHAGUS

• Tongue:
• Dorsal suface:
• Divided into ant 2/3 and post 1/3 by
a V-shaped sulcus terminalis.
• The apex of the sulcus is marked by
a pit called the foramen cecum
• Posterior one third: No papillae but
shows nodular surface because of
underlying lymphatic nodules, the
lingual tonsils

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THE MOUTH AND THE OESOPHAGUS

• Tongue:
• Dorsal suface:
• Anterior two third: mucosa is rough,
shows three types of papillae:
• Filliform
• Foliate
• Fungiform
• Vallate
• They contain taste buds for
gustation

THE MOUTH AND THE OESOPHAGUS

• Tongue:
• Muscles:
• The tongue is composed of two types
of muscles:
• Intrinsic: Longitudinal fibers, Transverse
fibers, Vertical fibers
• Function: Alter the shape of the tongue
• Extrinsic: Include:
• Palatoglossus
• Genioglossus
• Hyoglossus
• Styloglossus
• Function: Help in movements of the
tongue

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THE MOUTH AND THE OESOPHAGUS

• Tongue:
• Movements
• Protrusion, Retraction, Depression,
Elevation
• Nerve supply:
• Hypoglossal nerve (motor)
• Lingual nerve, glossopharyngeal
nerve, chorda tympani, internal
laryngeal nerve (sensitive)

THE MOUTH AND THE OESOPHAGUS

• Tongue:
• taste zones

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THE MOUTH AND THE OESOPHAGUS

• SALIVARY GLANDS
• three paired major salivary glands
(parotid, submandibular, and
sublingual)
• More than 100 minor salivary glands
• exocrine glands that produce saliva
through a system of ducts
• saliva facilitate mastication and
swallowing, and amylase begin the
digestion of starches

THE MOUTH AND THE OESOPHAGUS

• TEETH
• Each tooth is composed of
connective tissue, the pulp, covered
by three calcified tissues: dentin(e),
enamel, and cement(um)
• Function:
• Masticate the food:
• smaller pieces that easier to swallow

• More surface area exposed to the

action if digestive enzymes

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THE MOUTH AND THE OESOPHAGUS

• TEETH
• children have 20 deciduous (primary,
milk) teeth. in each half of maxillary and
mandibular dental arches there are 5
teeth: 2 incisors, 1 canine, 2 molars
• adults have 32 permanent (secondary)
teeth. in each half of maxillary and
mandibular dental arches there are 8
teeth: 2 incisors, 1 canine, 2 premolars,
3 molars

THE MOUTH AND THE OESOPHAGUS

• OESOPHAGUS
• 25 cm long muscular tube
• From the pharynx to the stomach
• C6 to T11
• Anatomically divided into three parts
• Cervical : 4-5cms
• Thoracic(notch to hiatus)
• abdominal
• 2 sphincters:
• Upper end sphincter
• Lower end sphincter

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THE MOUTH AND THE OESOPHAGUS

• OESOPHAGUS
• histology
• 4 LAYERS
• Mucosa
• stratified squamous epithelium
• Lamina propria
• Muscularis mucosa
• Submucosa- containing brenners glands
• Muscularis propria- inner circular and
outer longitudinal muscle fibres
• Adventitial layer

THE MOUTH AND THE OESOPHAGUS

• OESOPHAGUS
• Functions
• transport masticated and swallowed
material (a bolus) through the
mediastinum from the pharynx to the
stomach
• Made of muscles that contract to move
food to the stomach. This process is
called peristalsis

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OUTLINE
1. DIGESTIVE PROCESS AND GENERAL ANATOMY
2. THE MOUTH AND THE OESOPHAGUS
3. THE STOMACH
4. THE SMALL INTESTINE
5. THE LARGE INTESTINE
6. ACCESSORY GLANDS OF DIGESTION

THE STOMACH
• GROSS ANATOMY
• Most dilated part of GIT
• Occupies in the epigastric, umbilical &
left hypochondral areas
• Roughly J Shaped at rest
• Size and Shape varies
• 2 openings (cardia and pylorus)
• 2 surfaces (antéro sup and postero inf) ,
• 2 borders (greater and lesser curvature)

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THE STOMACH
• GROSS ANATOMY
• Blood supply:
• Left gastric artery
• Rt gastric artery
• Lt & Rt gastro epiploic artery
• Short gastric artery
• Nerves
• Right and left Vagus N.

THE STOMACH
• HISTOLOGY
• 4 layers
• Mucosa
• Sub mucosa
• Muscularis externa
• Serosa

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THE STOMACH
• HISTOLOGY
• Mucosa
• Epithelium
• Appears as honey combed due to small
gastric pits (foveola). They receive
gastric glands which extend deep into
lamina propria
• simple columnar mucous cells

THE STOMACH
• HISTOLOGY
• Mucosa
• Epithelium
• Three glands types:
• Principal : Found In body & fundus
• Viaroius cells
• Cardiac glands : Situated near the cardia
• Pyloric glands : numerous mucous

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THE STOMACH
• HISTOLOGY
• Sub mucosa
• Loose connective tissue
• Collagen, elastin,sub mucosal plexus of
stomach
• Muscularis externa
From within outwards layers are:
Oblique fibres
Circular
longitudinal
• Serosa:

THE STOMACH
• FUNCTIONS

• Temporary storage for food, which passes from the esophagus to the
stomach where it is held for 2 hours or longer.

• Mixing and breakdown of food by contraction and relaxation of the muscle

layers in the stomach.

• Digestion of food.

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OUTLINE
1. DIGESTIVE PROCESS AND GENERAL ANATOMY
2. THE MOUTH AND THE OESOPHAGUS
3. THE STOMACH
4. THE SMALL INTESTINE
5. THE LARGE INTESTINE
6. ACCESSORY GLANDS OF DIGESTION

THE SMALL INTESTINE

• GROSS ANATOMY

• LENGTH : 3 - 8.5 m in adult

• duodenum 20-25 cms, jejunum 120-400 cms, ileum
330 – 500 cms

• EXTENT

• duodenum – pylorus to duodenojejunal flexure

• jejunum – upper 40%

• ileum –lower 60%

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THE SMALL INTESTINE

• GROSS ANATOMY
• blood supply
• Duodenum: Superior
pancreaticoduodenal artery and Inferior
pancreaticoduodenal artery
• Jejunum & ileum: branches of superior
mesenteric artery
• Superior mesentery vein
• Innervation: Vagus nerve and
splanchnic nerves

THE SMALL INTESTINE

• HISTOLOGY

• large circular folds of mucosa (plicae

circulares or valvulae conniventes)

• Intestinal villi

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THE SMALL INTESTINE

• HISOLOGY

• Mucosa

• Submucosa

• Muscularis propria

• Serosa

THE SMALL INTESTINE

• FUNCTION

• digestion and absorption: 90% of the

digestion and absorption of food

• immune function and

• endocrine function:
• gastrin, Cholecystokinin, secretin

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OUTLINE
1. DIGESTIVE PROCESS AND GENERAL ANATOMY
2. THE MOUTH AND THE OESOPHAGUS
3. THE STOMACH
4. THE SMALL INTESTINE
5. THE LARGE INTESTINE
6. ACCESSORY GLANDS OF DIGESTION

THE LARGE INTESTINE

• GROSS ANATOMY
• consists of the cecum, colon (4
segments), rectum, and anal canal
• Lenght: 1.5m,
• diameter: 4.8 cm (mean)
• Vermiform appendix
• Two flexures
• Haustrations
• Tenia coli & appendices epiploicae

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THE LARGE INTESTINE

• GROSS ANATOMY
• Blood supply
• The arterial supply is derived from both
the superior and the inferior mesenteric
arteries
• The venous drainage is primarily into
the portal vein via the superior
mesenteric and inferior mesenteric
veins

THE LARGE INTESTINE

• HISTOLOGY
• 4 layers:
• mucosa,
• villi and circular folds are absent and the
glands (crypts) are longer.
• submucosa,
• muscular (inner circular and outer
longitudinal) and
• serosa;

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THE LARGE INTESTINE

THE LARGE INTESTINE

• FUNCTION
• absorbing water and electrolytes,
• producing and absorbing vitamins, and
• forming and propelling feces toward the rectum for
elimination

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OUTLINE
1. DIGESTIVE PROCESS AND GENERAL ANATOMY
2. THE MOUTH AND THE OESOPHAGUS
3. THE STOMACH
4. THE SMALL INTESTINE
5. THE LARGE INTESTINE
6. ACCESSORY GLANDS OF DIGESTION

LIVER & GALLBLADDER

• GROSS ANATOMY
• located in the upper right-hand
portion of the abdominal cavity
• an overall wedge shape
• Surfaces
• Diaphragmatic/antero superior
• Visceral/postero inferior
• Lobes :
• ◦ Major lobes
• Right & Left

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LIVER & GALLBLADDER

• GROSS ANATOMY
• Accessory lobes
• Caudate
• Quadrate
• Border
• Inferior Border
• Surfaces:
• Diaphragmatic
• visceral
• Attached to diaphragm by
• falciform and coronary ligaments
• Left and right triangular ligaments

LIVER & GALLBLADDER

• GROSS ANATOMY
• The gallbladder is a flask-shaped,
blind-ending diverticulum attached
to the bile duct by the cystic duct
• firmly attached to the inferior
surface of the right lobe of the liver
• fundus, body and neck
• continuous with the cystic duct,
leading into the biliary tree

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LIVER & GALLBLADDER

• GROSS ANATOMY
• blood supply
• Two sources provide blood to the
liver
• Hepatic artery
• Celiac trunk of aorta
• Portal vein
• Blood exits the liver via the hepatic
vein

LIVER & GALLBLADDER

• HISTOLOGY
• structural unit of the liver is the
lobule
• Between the rows of hepatocytes
are sinusoids which supply blood
• hepatocytes are arranged mainly in
plates - or cords,
• Bile secreted by the hepatocytes is
collected in a
• network of minute tubes (canaliculi).

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LIVER & GALLBLADDER

• FUNCTIONS
• LIVER:
• Bile production and secretion
• Detoxification
• Storage of glycogen
• Protein synthesis
• Production of heparin and bile pigments
• Erythropoiesis (in fetus)
• GALLBLADDER : concentrate and store bile which is
produced by the liver

THE PANCREAS
• GROSS ANATOMY
• elongated, tapered organ located
across the back of the belly, behind
the stomach.
• in the upper left abdomen
• surrounded by other organs including
the small intestine, liver, and spleen
• 4 parts: head, neck, body and tail
• single main and a single accessory
pancreatic duct

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THE PANCREAS
• GROSS ANATOMY
• Blood supply
• arterial supply via branches from the
coeliac trunk and superior mesenteric
artery
• Vein drain into splenic, superior
mesenteric and portal veins

THE PANCREAS
• HISTOLOGY
• composed of exocrine (98%) and
endocrine tissues
• The exocrine pancreas is a branched
acinar gland
• secrete digestive enzymes, water and
bicarbonate
• Pancreatic islets (of Langerhans)
constitute the endocrine component
• Secrete insulin and glucagon

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THE PANCREAS
• FUNCTION

THE SPLEEN
• GROSS ANATOMY
• large, encapsulated, complex mass
of vascular and lymphoid tissue
• situated in the upper left quadrant of
the abdominal cavity
• usually 9–14 cm long, 6–8 cm wide
and 3–5 cm thick
• largest organ of the lymphatic
system

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THE SPLEEN
• GROSS ANATOMY
• Blood supply
• Splenic artery
• splenic vein

THE SPLEEN
• HISTOLOGY
• white pulp (ab 5-20%) and
• red pulp (ab 90%)
• connective tissue capsule

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THE SPLEEN
• FUNCTION
• Early hematopoesis
• Mechanical filtration of senescent erythrocytes
• Infection control:
-Pathogens within RBCs: Malaria, Bartonella
-Clearance on unopsonized, noningested bacteria from circulation
-Microorganisms without specific host antibody

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