DIGESTIVE SYSTEM

DIGESTIVE SYSTEM ORGANS

The easiest way to understand the digestive system is to divide

its organs into two main categories. The first group is the organs
that make up the alimentary canal. Accessory digestive organs
comprise the second group and are critical for orchestrating the
breakdown of food and the assimilation of its nutrients into the
body. Accessory digestive organs, despite their name, are critical
to the function of the digestive system.

ALIMENTARY CANAL ORGANS

Also called the gastrointestinal (GI) tract or gut, the

alimentary canal (aliment- = “to nourish”) is a one-way
tube about 7.62 meters (25 feet) in length during life and
closer to 10.67 meters (35 feet) in length when measured
after death, once smooth muscle tone is lost. The main
function of the organs of the alimentary canal is to
nourish the body. This tube begins at the mouth and
terminates at the anus. Between those two points, the
canal is modified as the pharynx, esophagus, stomach,
and small and large intestines to fit the functional needs of
the body. Both the mouth and anus are open to the
external environment; thus, food and wastes within the
alimentary canal are technically considered to be outside
the body. Only through the process of absorption do the
nutrients in food enter into and nourish the body’s “inner
space.”

ACCESSORY STRUCTURES

Each accessory digestive organ aids in the breakdown of

food. Within the mouth, the teeth and tongue begin
mechanical digestion, whereas the salivary glands begin
chemical digestion. Once food products enter the small
intestine, the gallbladder, liver, and pancreas release
secretions—such as bile and enzymes—essential for
digestion to continue. Together, these are called accessory
organs because they sprout from the lining cells of the
developing gut (mucosa) and augment its function;
indeed, you could not live without their vital
contributions, and many significant diseases result from
their malfunction. Even after development is complete,
they maintain a connection to the gut by way of ducts.

HISTOLOGY OF THE ALIMENTARY CANAL

Throughout its length, the alimentary tract is composed of

the same four tissue layers; the details of their structural
arrangements vary to fit their specific functions. Starting
from the lumen and moving outwards, these layers are the
mucosa, submucosa, muscularis, and serosa, which is
continuous with the mesentery.

Layers of the Alimentary

Canal. The wall of the alimentary canal has four basic
tissue layers: the mucosa, submucosa, muscularis, and
serosa.

The mucosa is referred to as a mucous membrane,

because mucus production is a characteristic feature of
gut epithelium. The membrane consists of epithelium,
which is in direct contact with ingested food, and the
lamina propria, a layer of connective tissue analogous to
the dermis. In addition, the mucosa has a thin, smooth
muscle layer, called the muscularis mucosa.

Epithelium—In the mouth, pharynx, esophagus, and anal

canal, the epithelium is primarily a non-keratinized,
stratified squamous epithelium. In the stomach and
intestines, it is a simple columnar epithelium. Notice that
the epithelium is in direct contact with the lumen, the
space inside the alimentary canal. Interspersed among its
epithelial cells are goblet cells, which secrete mucus and
fluid into the lumen, and enteroendocrine cells, which
secrete hormones into the interstitial spaces between cells.
Epithelial cells have a very brief lifespan, averaging from
only a couple of days (in the mouth) to about a week (in
the gut). This process of rapid renewal helps preserve the
health of the alimentary canal, despite the wear and tear
resulting from continued contact with foodstuffs.

Lamina propria—In addition to loose connective tissue,

the lamina propria contains numerous blood and
lymphatic vessels that transport nutrients absorbed
through the alimentary canal to other parts of the body.
The lamina propria also serves an immune function by
housing clusters of lymphocytes, making up the mucosa-
associated lymphoid tissue (MALT). These lymphocyte
clusters are particularly substantial in the distal ileum
where they are known as Peyer’s patches. When you
consider that the alimentary canal is exposed to foodborne
bacteria and other foreign matter, it is not hard to
appreciate why the immune system has evolved a means
of defending against the pathogens encountered within it.

Muscularis mucosa—This thin layer of smooth muscle is

in a constant state of tension, pulling the mucosa of the
stomach and small intestine into undulating folds. These
folds dramatically increase the surface area available for
digestion and absorption.

As its name implies, the submucosa lies immediately

beneath the mucosa. A broad layer of dense connective
tissue, it connects the overlying mucosa to the underlying
muscularis. It includes blood and lymphatic vessels
(which transport absorbed nutrients), and a scattering of
submucosal glands that release digestive secretions.
Additionally, it serves as a conduit for a dense branching
network of nerves, the submucosal plexus.

The third layer of the alimentary canal is the muscalaris

(also called the muscularis externa). The muscularis in the
small intestine is made up of a double layer of smooth
muscle: an inner circular layer and an outer longitudinal
layer. The contractions of these layers promote
mechanical digestion, expose more of the food to
digestive chemicals, and move the food along the canal.
In the most proximal and distal regions of the alimentary
canal, including the mouth, pharynx, anterior part of the
esophagus, and external anal sphincter, the muscularis is
made up of skeletal muscle, which gives you voluntary
control over swallowing and defecation. The basic two-
layer structure found in the small intestine is modified in
the organs proximal and distal to it. The stomach is
equipped for its churning function by the addition of a
third layer, the oblique muscle. While the colon has two
layers like the small intestine, its longitudinal layer is
segregated into three narrow parallel bands, the tenia coli,
which make it look like a series of pouches rather than a
simple tube.

The serosa is the portion of the alimentary canal

superficial to the muscularis. Present only in the region of
the alimentary canal within the abdominal cavity, it
consists of a layer of visceral peritoneum overlying a
layer of loose connective tissue. Instead of serosa, the
mouth, pharynx, and esophagus have a dense sheath of
collagen fibers called the adventitia. These tissues serve
to hold the alimentary canal in place near the ventral
surface of the vertebral column.

NERVE SUPPLY

As soon as food enters the mouth, it is detected by

receptors that send impulses along the sensory neurons of
cranial nerves. Without these nerves, not only would your
food be without taste, but you would also be unable to
feel either the food or the structures of your mouth, and
you would be unable to avoid biting yourself as you chew,
an action enabled by the motor branches of cranial nerves.

Intrinsic innervation of much of the alimentary canal is

provided by the enteric nervous system, which runs from
the esophagus to the anus, and contains approximately
100 million motor, sensory, and interneurons (unique to
this system compared to all other parts of the peripheral
nervous system). These enteric neurons are grouped into
two plexuses. The myenteric plexus (plexus of
Auerbach) lies in the muscularis layer of the alimentary
canal and is responsible for motility, especially the
rhythm and force of the contractions of the muscularis.
The submucosal plexus (plexus of Meissner) lies in the
submucosal layer and is responsible for regulating
digestive secretions and reacting to the presence of food.

Extrinsic innervations of the alimentary canal are

provided by the autonomic nervous system, which
includes both sympathetic and parasympathetic nerves. In
general, sympathetic activation (the fight-or-flight
response) restricts the activity of enteric neurons, thereby
decreasing GI secretion and motility. In contrast,
parasympathetic activation (the rest-and-digest response)
increases GI secretion and motility by stimulating neurons
of the enteric nervous system.

THE PERITONEUM

The digestive organs within the abdominal cavity are held

in place by the peritoneum, a broad serous membranous
sac made up of squamous epithelial tissue surrounded by
connective tissue. It is composed of two different regions:
the parietal peritoneum, which lines the abdominal wall,
and the visceral peritoneum, which envelopes the
abdominal organs. The peritoneal cavity is the space
bounded by the visceral and parietal peritoneal surfaces.
A few milliliters of watery fluid act as a lubricant to
minimize friction between the serosal surfaces of the
peritoneum.
The Peritoneum. A cross-section of the abdomen shows
the relationship between abdominal organs and the
peritoneum.

alimentary canal organs

I. Mouth

Mouth, also called Oral Cavity, or Buccal Cavity, in

human anatomy, orifice through which food and air
enter the body. The mouth opens to the outside at the
lips and empties into the throat at the rear; its
boundaries are defined by the lips, cheeks, hard and soft
palates, and glottis. It is divided into two sections: the
vestibule, the area between the cheeks and the teeth,
and the oral cavity proper. The latter section is mostly
filled by the tongue, a large muscle firmly anchored to
the floor of the mouth by the frenulum linguae. In
addition to its primary role in the intake and initial
digestion of food, the mouth and its structures are
essential in humans to the formation of speech.

The chief structures of the mouth are the teeth, which

tear and grind ingested food into small pieces that are
suitable for digestion; the tongue, which positions and
mixes food and also carries sensory receptors for taste;
and the palate, which separates the mouth from the
nasal cavity, allowing separate passages for air and for
food. All these structures, along with the lips, are
involved in the formation of speech sounds by
modifying the passage of air through the mouth.

The oral cavity and vestibule are entirely lined by

 mucous membranes containing numerous small glands
that, along with the three pairs of salivary glands, bathe
the mouth in fluid, keeping it moist and clear of food
and other debris. Specialized membranes form both the
gums (gingivae), which surround and support the teeth,
and the surface of the tongue, on which the membrane
is rougher in texture, containing many small papillae
that hold the taste buds. The mouth’s moist
environment and the enzymes within its secretions help
to soften food, facilitating swallowing and beginning
the process of digestion.

II. Pharynx

The pharynx is a muscular tube that connects the oral

and nasal cavity to the larynx and oesophagus.

It begins at the base of the skull, and ends at the inferior

border of the cricoid cartilage (C6). The pharynx is
comprised of three parts (superior to inferior):

➢ Nasopharynx
➢ Oropharynx
➢ Laryngopharynx.

1. Nasopharynx

The nasopharynx is found between the base of the

skull and the soft palate. It is continuous with the
nasal cavity, and performs a respiratory function by
conditioning inspired air and propagating it into the
larynx.

This part of the pharynx is lined with respiratory

epithelium; ciliated pseudostratified columnar
epithelium with goblet cells.

The posterosuperior nasopharynx contains the

adenoid tonsils, which enlarge between 3-8 years of
age and then regress.
2. Oropharynx

The oropharynx is the middle part of the pharynx,

located between the soft palate and the superior
border of the epiglottis.

It contains the following structures:

• Posterior 1/3 of the tongue.

• Lingual tonsils – lymphoid tissue at the base of
the tongue.
• Palatine tonsils – lymphoid tissue located in the
tonsillar fossa (between the palatoglossal and
palatopharyngeal arches of the oral cavity).
• Superior constrictor muscle

Waldeyer’s ring is the ring of lymphoid tissue in the

naso- and oropharynx formed by the paired palatine
tonsils, the adenoid tonsils and lingual tonsil.

The oropharynx is involved in the voluntary and

involuntary phases of swallowing.

3. Laryngopharynx

The most distal part of the pharynx, the

laryngopharynx is located between the superior
border of the epiglottis and inferior border of the
cricoid cartilage (C6). It is continuous inferiorly with
the oesophagus.

It is found posterior to the larynx and communicates

with it via the laryngeal inlet, lateral to which one can
find the piriform fossae.

The laryngopharynx contains the middle and inferior

pharyngeal constrictors.

III. Esophagus
 The esophagus is a muscular tube connecting the
throat (pharynx) with the stomach. The esophagus is
about 8 inches long, and is lined by moist pink tissue
called mucosa. The esophagus runs behind the
windpipe (trachea) and heart, and in front of the
spine. Just before entering the stomach, the
esophagus passes through the diaphragm.

The upper esophageal sphincter (UES) is a bundle of

muscles at the top of the esophagus. The muscles of
the UES are under conscious control, used when
breathing, eating, belching, and vomiting. They keep
food and secretions from going down the windpipe.

The lower esophageal sphincter (LES) is a bundle of

muscles at the low end of the esophagus, where it
meets the stomach. When the LES is closed, it
prevents acid and stomach contents from traveling
backwards from the stomach. The LES muscles are
not under voluntary control.

IIII. Stomach

The stomach is a muscular organ located on the left

side of the upper abdomen. The stomach receives
food from the esophagus. As food reaches the end of
the esophagus, it enters the stomach through a
muscular valve called the lower esophageal sphincter.

The stomach secretes acid and enzymes that digest

food. Ridges of muscle tissue called rugae line the
stomach. The stomach muscles contract periodically,
churning food to enhance digestion. The pyloric
sphincter is a muscular valve that opens to allow food
to pass from the stomach to the small intestine.

V. Small intestine

The small intestine is an organ located within the

gastrointestinal tract. It is approximately 6.5m in the
average person and assists in the digestion and
absorption of ingested food.

It extends from the pylorus of the stomach to the

ileocaecal junction, where it meets the large intestine
at the ileocaecal valve. Anatomically, the small bowel
can be divided into three parts; the duodenum,
jejunum and ileum.

1. The Duodenum

The most proximal portion of the small intestine is

the duodenum. Its name is derived from the Latin
‘duodenum digitorum’, meaning twelve fingers
length. It runs from the pylorus of the stomach to
the duodenojejunal junction.

The duodenum can be divided into four parts;

superior, descending, inferior and ascending.
Together these parts form a ‘C’ shape, that is
around 25cm long, and which wraps around the
head of the pancreas.

• Superior (Spinal level L1)

The first section of the duodenum is known as ‘the

cap’. It ascends upwards from the pylorus of the
stomach, and is connected to the liver by the
hepatoduodenal ligament. This area is most
common site of duodenal ulceration.

The initial 3cm of the superior duodenum is

covered anteriorly and posteriorly by visceral
peritoneum, with the remainder retroperitoneal
(only covered anteriorly).

• Descending (L1-L3)

The descending portion curves inferiorly around

the head of the pancreas. It lies posteriorly to the
 transverse colon, and anterior to the right kidney.

Internally, the descending duodenum is marked by

the major duodenal papilla – the opening at which
bile and pancreatic secretions to enter from the
ampulla of Vater (hepatopancreatic ampulla).

• Inferior (L3)

The inferior duodenum travels laterally to the left,

crossing over the inferior vena cava and aorta. It is
located inferiorly to the pancreas, and posteriorly
to the superior mesenteric artery and vein.

• Ascending (L3-L2)

After the duodenum crosses the aorta, it ascends

and curves anteriorly to join the jejunum at a sharp
turn known as the duodenojejunal flexure.

Located at the duodenojejunal junction is a slip of

muscle called the suspensory muscle of the
duodenum. Contraction of this muscle widens the
angle of the flexure, and aids movement of the
intestinal contents into the jejunum.

2. Jejunum and Ileum

The jejunum and ileum are the distal two parts of

the small intestine. In contrast to the duodenum,
they are intraperitoneal.

They are attached to the posterior abdominal wall

by mesentery (a double layer of peritoneum).

The jejunum begins at the duodenojejunal

flexure. There is no clear external demarcation
between the jejunum and ileum – although the two
parts are macroscopically different. The ileum ends
at the ileocaecal junction.
 At this junction, the ileum invaginates into the
cecum to form the ileocecal valve. Although it is
not developed enough to control movement of
material from the ileum to the cecum, it can
prevent reflux of material back into the ileum.

it is often necessary to be able to distinguish

between the jejunum and ileum of the small
intestine:

Jejunum Ileum
Located in upper left Located in lower right
quadrant quadrant
Thick intestinal wall Thin intestinal wall
Longer vasa recta (straight Shorter vasa recta
arteries)
Less arcades (arterial More arcades
loops)
Red in color Pink in color

VI. Large intestine ( the colon)

The colon (large intestine) is the distal part of the

gastrointestinal tract, extending from the cecum to
the anal canal. It receives digested food from the
small intestine, from which it absorbs water and
electrolytes to form faeces.

Anatomically, the colon can be divided into four parts

– ascending, transverse, descending and sigmoid.
These sections form an arch, which encircles the
small intestine.

❖ Anatomical Position
The colon averages 150cm in length, and can be
divided into four parts (proximal to distal):
ascending, transverse, descending and sigmoid.

• Ascending Colon

The colon begins as the ascending colon, a

retroperitoneal structure which ascends
superiorly from the cecum.

When it meets the right lobe of the liver, it turns

90 degrees to move horizontally. This turn is
known as the right colic flexure (or hepatic
flexure), and marks the start of the transverse
colon.

• Transverse Colon

The transverse colon extends from the right colic

flexure to the spleen, where it turns another 90
degrees to point inferiorly. This turn is known as
the left colic flexure (or splenic flexure). Here,
the colon is attached to the diaphragm by the
phrenicocolic ligament.

The transverse colon is the least fixed part of the

colon, and is variable in position (it can dip into
the pelvis in tall, thin individuals). Unlike the
ascending and descending colon, the transverse
colon is intraperitoneal and is enclosed by the
transverse mesocolon.

• Descending Colon

After the left colic flexure, the colon moves

inferiorly towards the pelvis – and is called the
descending colon. It is retroperitoneal in the
majority of individuals, but is located anteriorly
to the left kidney, passing over its lateral border.
 When the colon begins to turn medially, it
becomes the sigmoid colon.

• Sigmoid Colon

The 40cm long sigmoid colon is located in the

left lower quadrant of the abdomen, extending
from the left iliac fossa to the level of the S3
vertebra. This journey gives the sigmoid colon
its characteristic “S” shape.

The sigmoid colon is attached to the posterior

pelvic wall by a mesentery – the sigmoid
mesocolon. The long length of the mesentery
permits this part of the colon to be particularly
mobile.

Paracolic Gutters

The paracolic gutters are two spaces between the

ascending/descending colon and the posterolateral
abdominal wall.

These structures are clinically important, as they

allow material that has been released from inflamed
or infected abdominal organs to accumulate
elsewhere in the abdomen.

The accessory digestive structures

i. Liver

The liver is located in the upper right-hand portion

of the abdominal cavity, beneath the diaphragm,
and on top of the stomach, right kidney, and
intestines.

Shaped like a cone, the liver is a dark reddish-

brown organ that weighs about 3 pounds.
 There are 2 distinct sources that supply blood to the
liver, including the following:

• Oxygenated blood flows in from the hepatic

artery

• Nutrient-rich blood flows in from the hepatic

portal vein

The liver holds about one pint (13%) of the body's

blood supply at any given moment. The liver
consists of 2 main lobes. Both are made up of 8
segments that consist of 1,000 lobules (small
lobes). These lobules are connected to small ducts
(tubes) that connect with larger ducts to form the
common hepatic duct. The common hepatic duct
transports the bile made by the liver cells to the
gallbladder and duodenum (the first part of the
small intestine) via the common bile duct.

ii. Gallbladder

The gallbladder is a gastrointestinal organ located

within the right hypochondrial region of the
abdomen. This intraperitoneal, pear-shaped sac lies
within a fossa formed between the inferior aspects
of the right and quadrate lobes of the liver.

The primary function of the gallbladder is to

concentrate and store bile which is produced by the
liver. As part of the gustatory response, the stored
bile is then released from the gallbladder in
response to cholecystokinin.

Anatomical Structure
 The gallbladder has a
storage capacity of 30-50ml and, in life, lies
anterior to the first part of the duodenum. It is
typically divided into three parts:

• Fundus – the rounded, distal portion of the

gallbladder. It projects into the inferior surface of
the liver in the mid-clavicular line.
• Body – the largest part of the gallbladder. It lies
adjacent to the posteroinferior aspect of the liver,
transverse colon and superior part of the
duodenum.
• Neck – the gallbladder tapers to become
continuous with the cystic duct, leading into the
biliary tree.
The neck contains a mucosal fold, known as
Hartmann’s Pouch. This is a common location for
gallstones to become lodged, causing cholestasis.

iii. Pancreas

The pancreas is an elongated, tapered organ located

across the back of the belly, behind the stomach.
The right side of the organ—called the head—is
the widest part of the organ and lies in the curve of
the duodenum, the first division of the small
intestine. The tapered left side extends slightly
upward—called the body of the pancreas—and
ends near the spleen—called the tail.

The pancreas is made up of 2 types of glands:

 • Exocrine. The exocrine gland secretes
digestive enzymes. These enzymes are
secreted into a network of ducts that join the
main pancreatic duct. This runs the length of
the pancreas.

• Endocrine. The endocrine gland, which

consists of the islets of Langerhans, secretes
hormones into the bloodstream

Reference
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