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Table Of Contents:
What’s included: Ready-to-study anatomy, physiology and pathology notes of the
gastrointestinal system presented in succinct, intuitive and richly illustrated downloadable PDF
documents. Once downloaded, you may choose to either print and bind them, or make
annotations digitally on your iPad or tablet PC.

File List:

• Brief GI System Summary

• Detailed GI System Summary
• GI Tract Secretions
• GI Motility & Function
• Absorption of Carbohydrates & Proteins
• Absorption of Lipids & Drug Metabolism
• Nutrition & Nutritional Assessment
• Accessory Structures of the GIT
• Metabolism In The Liver
• Anal Fissures
• Anal Fistulae
• Appendicitis
• Bowel Obstructions
• Carcinoid Syndrome
• Cholangitis
• Coeliac Disease
• Congenital Pancreatic Abnormalities
• Constipation
• Cystic Fibrosis
• Diverticulosis & Diverticulitis
• Dysphagia & Achalasia
• Endocrine Pancreatic Tumours
• Familial Liver Diseases
• Gallstones & Cholecystitis
• Gastric Cancer
• Gastrinoma, Zollinger Ellison Syndrome
• Gastritis & Peptic Ulcer Disease
• Gastroenteritis
• GORD, Barret's & Cancer
• Haemorrhoids
• Helicobacter Pylori
• Hepatitis
• Hiatus Hernia
• Hirschprungs Disease
• Inflammatory Bowel Diseases
• Irritable Bowel Syndrome
• Ischaemic Bowel
• Jaundice
• Liver Abscesses & Cysts
• Liver Cancers
• Liver Failure & Cirrhosis
• Mallory Weiss Tear
• Meckel's Diverticulum
• Miscellaneous GI Tumours
• Oesophageal Varices
• Oesophagitis
• Pancreatic Cancer
• Pancreatitis
• Parasitic Gut Infections
• Pilonidal Sinus
• Polyps & Colon Cancer
• Pseudomembranous Colitis
• Radiation Enteritis
• Rectal Bleeding DDX
• Secondary Liver Diseases
• The Acute Abdomen - Surgical Approach
• TORONTO - Gastroenterology
• TORONTO - General Surgery
 BASIC A&P
GASTROINTESTINAL SYSTEM

Functions:
Ingestion (via mouth)
Mechanical breakdown
Propulsion swallowing
o Initiated voluntarily
o Continued via peristalsis
Contractile waves of smooth muscle
Chemical Digestion
o Molecular breakdown
o Via enzymes + acids
Secretion (mucus/bile/alkaline)
Absorption
o Passage of nutrients from GI into blood/lymph
Excretion/Defecation
o Elimination of indigestible substances

Oesophagus:
- Macro Anatomy:
o Approx 25cm long
o Pierces the diaphragm at the oesophageal hiatus to enter abdomen
o S hi c e Ga - e hagea Ca diac (Malfunction GORD)
- Histology:
o Oesophagus: Stratified Squamous
o Oesophago-Gastric Junction (Z-Line): Transition to Cuboidal Gastric Epithelium
o Upper 1/3 = striated muscle
o Lower 2/3 = smooth muscle

Stomach:
- Macro Anatomy:
o See Picture
- Histology:
o Gastric Pits
o Simple Cuboidal (Protected by Mucus & Alkaline Secretion) + Goblets
o + Parietal Cells Secrete Acid + Intrinsic Factor (for B12 Absorption)
o + Chief Cells Secrete Pepsinogen (Precursor to Pepsin Digests Collagen)
o + Endocrine Cells (G-Cells Stimulate Parietal Cells; D-Cells Inhibit G-Cells)

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Duodenum:
- Macro Anatomy:
o C-Shaped part of SI from Stomach Jejunum
o H a a c a cS c S c Odd D d a A aA a Va
- Histology:
o Microvilli & Crypts of Lieberkuhn
o S C b da G b C B Ga d S c A a M c

- Physiology
o Motility:
Peristalsis Oesophagus (5-10sec), Stomach (1-3hrs).
Combination of Segmentation & Pendular Contraction.
Segmentation
o Contractions of circular muscle
Pendular
o Contractions of longitudinal muscles
o Shortens & lengthens tube.
Migrating Motor Complex Small Intestines (7-9hrs)
Mass Movement Large Intestines (25-30hrs)
Defecation Reflex Rectum & Anus (After 40hrs)

o Digestion Phases & Enzymes:

Mechanical Digestion:

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 Chewing
Stomach
Chemical Digestion:
Saliva Salivary Amylase (Simple Carb Digestion)
Stomach Acid + Pepsin (Protein Digestion)
Liver Bile (Fat Emulsification)
Pancreatic Amylase (Carb Digestion)
Pancreatic Lipase (Fat Digestion)
Pancreatic Proteases (Protein Digestion)
Pancreatic Nucleases (DNA/RNA Digestion)
Intestinal Absorption:
Fluid + Nutrients Blood Vessels
Fluid + Fats Lymph Vessels

o Hormonal Control of
Gastric Acid Secretion:
Cephalic Phase
o Gastric Secretion Before a Meal Stimulated by taste/smell/thought:
G-Cells Gastrin Secretion
Pa a -Cell HCl Secretion
C -Cell Pepsin Secretion
Gastric Phase
o Food has entered & distended the stomach.
Distension of Stomach Further Gastrin Secretion
Low Acidity Stimulates G-Cells Gastrin
Intestinal Phase
o Acidic Chyme enters Duodenum Release of 3 local Hormones:
Secretin Stimulates Pancreas Bicarbonate Secretion
Cholecystokinin Stimulates Gallbladder Bile Secretion
Vasoactive Intestinal Peptide (VIP) Ga c Ac d P d c

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 Gastric Emptying:
Regulated by the Duodenum
Fatty Foods/Alcohol/Caffeine/Smoking Delayed Gastric Emptying

o Maintaining Luminal Homeostasis & Integrity

A ac e
Acid: Parietal Cells HCl + Intrinsic Factor
Pepsinogen: Chief Cells Pepsinogen Pepsin
Defe de
Mucous: Goblet Cells Mucin mucous Barrier from Acid + Lubrication.
Tight Junctions: Prevents Leakage of Mucous/Acid & Infection.
High Cell Turnover: Stem-Cell Regeneration in Gastric Pits
Alkaline Fluid: B Ga d D d Secrete Alkaline Fluid
Bile: Hepatocytes Bile Salts (Emulsifiers) + Alkaline
Pancreatic Bicarb: Exocrine Pancreatic Cells Bicarb Secretion Neutralises

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Anatomy:
- Small Intestine:
o Macro:
Duodenum C-shaped
Jejunum High surface area (plicae, villi & microvilli) Nutrient Absorption.
Ileum Lower surface area (fewer plicae, villi & microvilli) Fluid Absorption
Ileo-cecal Junction/Valve: empties into Cecum of large intestine.

o Micro:
Viliated Simple Columnar Epithelium + Goblet Cells + Basal Stem Cells

- Large Intestine:
o Macro:
Ileocecal valve Cecum + Appendix
Ascending Colon Right Colic Flexure
Transverse Colon Left Colic Flexure
Descending Colon
Sigmoid Colon
Rectum Anal Canal
NB: Teniae Coli bb c a c
NB: Haustra Sections slows down the movement of wastes
o Micro:
Simple Columnar Epithelium + Goblet Cells

Physiology:
- Motility:

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 o Small Intestine:
Pe i a i Migrating Motor Complex”
Initiated by pacemaker cells in smooth muscle layer
12-14 contractions / minute
Initiates peristalsis in duodenum lasts for about 50-70cm then dies out.
Successive waves are a d a a H c a
Takes approx 2 hrs for waves to reach Ileocecal valve.
Process then repeats itself sweeps food remnants, bacteria, etc.
o Large Intestine:
Pe i a i Mass Movements
Inactive most of the time
When presented with food colon becomes motile
Long, slow-moving, but powerful contractile waves.
Move over large areas of colon
3x Daily
Force contents towards rectum
o Rectum:
Defecation Reflex
Rectum wall stretches initiates defecation reflex:
Force on anal canal signals brain
Sigmoid-Colon & Rectum contracts + Internal Anal Sphincter relaxes
- Secretions:
o Mouth 1500mLs:
Saliva
o Stomach 2500mLs:
Acid + Pepsin Solution
Mucous
o Liver 500mLs:
Bile (Bicarbonate + Bile Salts + Cholesterol)
o Pancreas 1500mLs:
Bicarbonate Neutralises Acidity
Amylase, Lipase, Proteases, Nucleases
o Intestines 1000mLs:
Intestinal Juice Slightly Alkaline
D de B e Ga d
Bicarbonate Neutralises Acidity
Mucous
o Colon - Negligible:
Mucous
o NB: Plus 2000mLs Drinking Water, Total = 9000mLs
- Absorption:
o Intestines 7000mLs
NB: VitB12 & Bile Salts Absorbed by specific transporters in Terminal Ileum
(:. Malabsorption of these can occur in Ileal Resection)
o Colon 1500mLs
o NB: 500mLs Faeces @ 80% water.
- Defences:
o Physical Mucous, Mucosal Shedding, Constant Movement of Contents
o Chemical Lysozyme, Defensins, Mucosal IgA, B-Cells, T-Cells, Commensal Bacteria

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Anatomy of Small Intestine:

1. Duodenum C-shaped
2. Jejunum High surface area Maximum nutrient absorption (many plicae, villi & microvilli)
3. Ileum Lower surface area Absorption of fluids (fewer plicae, villi & microvilli)
4. Ileo-cecal Junction/Valve: empties into Cecum of large intestine.

Intestinal Wall

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Anatomy of Large Intestine:
Absorbs H2O from indigestible food
Temporarily stores waste
Eliminates semisolid faeces

Important Structures
Ileocecal valve
Cecum
Appendix
Ascending Colon
Right Colic Flexure
Transverse Colon
Transverse Mesocolon
Left Colic Flexure
Descending Colon
Sigmoid Colon
Rectum
Anal Canal

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Unique Structures
o Teniae Coli bb c a c
Causes the large-intestine wall to form segments (Haustra)
o Haustra slows down the movement of wastes.
Aid in packing and compacting
o Epiploic Appendages fatty pouches of visceral peritoneum (purpose unknown)

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Histology of Large Intestine & Rectum:

Anatomy of Rectum & Anus:

Important Structures:
o Levator Ani Muscle
o Anal Canal
o External anal Sphincter - voluntary
o Internal anal Sphincter involuntary
o Anus

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www.MedStudentNotes.com
MICROSCOPIC ANATOMY
4 Layers of GIT Lining (Histology & Function):
1. Mucosa
Folds (plicae)
Epithelium (simple columnar + goblet)
Lamina Propria (loose areola tissue)
Muscularis mucosae (smooth muscle)
Secretion of mucin, digestive enzymes
& hormones
Absorption of nutrients & fluids.
Protection from:
o Acid
o Bacteria
o Mechanical stresses
2. Submucosa
Dense conn. Tissue
Nerves
Blood vessels
Glands
Vasculates & innervates GI tract wall
3. Muscularus
Circular smooth muscle
Longitudinal smooth muscle
Responsible for peristalsis
Forms sphincters (valves) control passage of food
4. Serosa/Peritoneum
Areolar Connective Tissue
Mesothelium (single layered squamous epithelium)
(Dual layered peritoneum = mesentery)
Lubrication, vasculation, innervations & support of GI organs.

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 System: Gastrointestinal

Overview:
The Alimentary Canal (9m approx)
o Mouth
o Pharynx
o Oesophagus
25 cm long
Stratified Squamous
Upper 1/3 = striated muscle
Lower 2/3 = smooth muscle
o Stomach
o Small intestine
Duodenum
Jejunum
Ileum
o Large intestine
Vermiform appendix
Cecum
Ascending Colon
Transverse Colon
Descending Colon
Sigmoid Colon
Rectum
o Anus
Accessory Digestive Organs
o Teeth
o Tongue
o Salivary Glands
Parotid
Sublingual
Submandibular
o Glandular Organs
Liver
Pancreas
o Gallbladder

Abdominal Cavity:
Boundaries:
o Diaphragm of lungs (thoracic diaphragm)
o Broad Ligament of Pelvis
Layers of Abdominal Wall
o Skin
o Superficial Fascia
Fatter Layer
Membranous Layer
o 3 Muscle Layers Separated by Deep Fascia
Deep Fascia
External Oblique Muscle
Deep Fascia
Internal Oblique Muscle
Deep Fascia
Transverse Abdominal Muscle
Trasversalis Fascia
o Parietal Peritoneum

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SURFACE ANATOMY:
Abdominal Cavity:
Boundaries:
o Diaphragm of lungs (thoracic diaphragm)
o Broad Ligament of Pelvis
Muscles

Layers of Abdominal Wall

o Skin
o Superficial Fascia
Fatter Layer
Membranous Layer
o 3 Muscle Layers Separated by Deep Fascia
Deep Fascia
External Oblique Muscle
Deep Fascia
Internal Oblique Muscle
Deep Fascia
Transverse Abdominal Muscle
Trasversalis Fascia
o Parietal Peritoneum

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Regions:

Placement of Abdominal Organs

Placement of Accessory Structures

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Referred Pain:
o Pain felt at a site away from the location of affected organ
o Due to lack of dedicated sensory pathways from internal organs.
o Pain is relayed to areas of skin and muscle instead.
o K a i ce a- ma ic c e ge ce

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Embryonic Development of GIT:
Week 3:
o 3 Primary Germ Layers:
Ectoderm
Mesoderm
Endoderm
Week 3 4:
o GIT develops from the Endoderm & Mesoderm:
Endoderm:
The epithelial lining of the primitive gut (alimentary tube)
Mesoderm:
The rest of the wall:
o Submucosa
o Muscularis Externa
Week 4 8:
o Openings of GIT:
Mouth:
The end of the foregut merges with the ectoderm on the head of the embryo at
the s omode m
Forms the oral membrane later breaks to form the mouth opening.
Anus:
The end of the hindgut merges with the ectoderm on the tail of the embryo at the
proc ode m (procto = anus)
Forms the cloacal membrane later breaks through to form the anus.
o Budding of Glandular Organs:
Salivary Glands - foregut
Liver - midgut
Pancreas midgut
Glands retain their connections, which later become ducts to GIT.
o Stomach Appears
Different rates of growth causes rotation & greater/lesser curvatures

o Respiratory Diverticulum
o Dorsal Tube Oesophagus
Rapidly lengthens with
descent of heart & lungs

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Anatomy of the Oesophagus:
Important Structures
o Approx 25cm long
o Pierces the diaphragm at the oesophageal hiatus to enter abdomen
o Joins the stomach at the cardiac orifice
o Sphincter Gastro-oesophageal Cardiac
Malfunction of this sphincter heartburn
Histology:
o Mucosa:
Epithelium
Upper 1/3 = stratified squamous
Lower 2/3 = simple columnar

Anatomy of Stomach:
Histology:
o Gastric Pits
Surface Epithelium
o Gastric Glands
Mucous Neck Cells
Parietal Cells HCl producers.
Chief Cells Pepsinogen producers (protein digesting enzyme when mixed with acid)

Anatomy of Duodenum:
Important Structures:
o Gallbladder
Cystic Duct
o Hepatic ducts of liver
Common Hepatic Duct
o Bile Duct
o Pancreas
o Pancreatic Duct
o Major Duodenal Papilla
o Jejunum

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Anatomy of Small Intestine:
1. Duodenum C-shaped
2. Jejunum High surface area Maximum nutrient absorption (many plicae, villi & microvilli)
3. Ileum Lower surface area Absorption of fluids (fewer plicae, villi & microvilli)
4. Ileo-cecal Junction/Valve: empties into Cecum of large intestine.

Anatomy of Large Intestine:

Absorbs H2O from indigestible food
Temporarily stores waste
Eliminates semisolid faeces
Unique Structures
o Teniae Coli ibb f h cle al g he c l e i e le g h
Causes the large-intestine wall to form segments (Haustra)
o Haustra slows down the movement of wastes.
Aid in packing and compacting
o Epiploic Appendages fatty pouches of visceral peritoneum (purpose unknown)

Anatomy of Rectum & Anus:

Important Structures:
o Levator Ani Muscle
o Anal Canal
o External anal Sphincter - voluntary
o Internal anal Sphincter involuntary
o Anus

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The Peritoneum:
The slippery serous membrane of the abdomio-pelvic cavity:
o Visceral Peritoneum
Covers external surfaces of most digestive organs
o Parietal Peritoneum
Lines the body cavity wall
Mesenteries:
o Sheets of double-layered peritoneum
o Connects digestive organs to the body wall
o Contains blood vessels, nerves & lymphatics
o Lesser Omentum
Lesser Curvature of Stomach
o Greater Omentum
Greater Curvature of Stomach
o Transverse Mesentery
Transverse Colon
o Mesocolon
Ascending Colon
Descending Colon
o Mesentery Proper
Jejunum
Ileum
Intra Vs. Retro Peritoneal Organs:
o Intra: Inside the peritoneal cavity & suspended by mesentery.
Stomach
Gallbladder
Jejunum
Ileum
Cecum
Transverse Colon
Sigmoid Colon
o Retro: Posterior to (outside) the peritoneal cavity adhered to the dorsal abdominal wall.
Parts of duodenum
Most of pancreas
Ascending & Descending Colon
Rectum

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Greater & Lesser Sacs
Greater Sac
o Supracolic Compartment
o Infracolic Compartment
Lesser Sac
o Omental Bursa

Intra Vs. Retro Peritoneal Organs:

o Intra: Inside the peritoneal cavity & suspended by mesentery.
Stomach
Gallbladder
Jejunum
Ileum
Cecum
Transverse Colon
Sigmoid Colon
o Retro: Posterior to (outside) the peritoneal cavity adhered to the dorsal abdominal wall.
Parts of duodenum
Most of pancreas
Ascending & Descending Colon
Rectum

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ABDOMINAL INFRASTRUCTURE
The 3 Gut Segments:
Each give rise to specific gut structures during foetal development.
Structures derived from the gut proper develop as swellings/dilations of the primitive gut.
Gut-related structures develop as outpouchings of the primitive gut.
1. Foregut:
Arterial Supply: Celiac Trunk.

Pharynx
Oesophagus
Stomach
Upper Duodenum
Respiratory tract (incl. Lungs)
Liver
Gallbladder
Spleen
½ of Pancreas
2. Midgut:
Arterial Supply: Superior Mesenteric Artery

½ of Pancreas
Lower duodenum
Jejunum
Ileum
Cecum
Appenix
Ascending colon
1st 2/3 of transverse colon
3. Hindgut:
Arterial Supply: Inferior Mesenteric Artery

Last 1/3 of transverse colon

Descending colon
Sigmoid colon
Rectum
Upper anal canal

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Arterial Supply of GIT:
Foregut:
Celiac Trunk
Midgut:
Superior Mesenteric
Hindgut:
Inferior Mesenteric

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Venous Drainage of GIT
Foregut:
1. Portal Vein Liver
2. Left Gastric Portal
3. Right Gastric Portal
4. Splenic Vein Portal
Midgut:
o Superior Mesenteric Portal
Hindgut:
o Inferior Mesenteric Splenic Portal

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Lymphatic Drainage of the GIT:

Mesentric Lymph Nodes Lymph Nodes of Large Intestine

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Innervation of GIT:
Extrinsic Innervation:
o From Sympathetic Splanchnic nerves
o From Parasympathetic Vagus (CNS)

Referred Pain:
o Pain felt at a site away from the location of affected organ
o Due to lack of dedicated sensory pathways from internal organs.
o Pain is relayed to areas of skin and muscle instead.
o K a i ce a- a ic c e ge ce

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