IV.

ANATOMY AND PHYSIOLOGY

DIGESTIVE SYSTEM

The digestive system comprises the gastrointestinal tract and accessory organs. The gastrointestinal tract consists of the oral cavity, pharynx,
esophagus, stomach, small intestine, and large intestine. The accessory organs are the teeth, tongue, and glandular organs such as salivary glands,
liver, gallbladder, and pancreas.

The digestive system functions to provide mechanical processing, digestion, absorption of food, secretion of water, acids, enzymes, buffer,
salt, and excretion of waste products. The function of the digestive system is to digest and absorb food and then excrete the waste products with the
help of the liver, gallbladder, pancreas, small intestine, large intestine, and rectum. Each of these organs plays a specific role in the digestive system.
The Oral Cavity

Functions to Provide

 sensory analysis of food material before swallowing

Starting with the oral mucosa, which is lined by both keratinized (seen in the superior surface of the tongue and the hard palate) and
nonkeratinized squamous epithelial cells (seen in cheeks, lips, and inferior surface of the tongue), these cells are not known to absorb molecules
except for the mucosa inferior to the tongue.

Functions of the tongue include mechanical processing by compression, abrasion, and distortion; manipulation to assist in chewing and
prepare material for swallowing; sensory analysis by touch, temperature, and taste receptors; and secretion of mucins and lingual lipase. The lingual
lipase has a broad pH and breaks down lipids (mainly triglyceride). The pH of 3.5 to 6 allows lingual lipase to work even in the acid environment of
the stomach.

Within the oral cavity, there are three pairs of salivary glands. The first pair is the parotid salivary glands located inferior to the zygomatic arch
and posterolateral to the mandible. The parotid glands produce serous secretions containing a large amount of salivary amylase, which breaks down
carbohydrate complexes. Next are the sublingual salivary glands located on the floor of the mouth. The sublingual glands produce a mucous
secretion that serves as both a buffer and lubricant. The third is the submandibular salivary glands, located at the floor of the mouth within the
mandibular groove. They function by secreting a mixture of buffers, glycoproteins called mucins, and salivary amylase.

Altogether, these glands produce 1.0 to 1.5 liters of saliva each day.[2] Close to 99.4% of the saliva produced is water, and the remaining
0.6% consists of electrolytes, buffers, glycoproteins (mucins), antibodies, enzymes, and waste products. These function to lubricate the mouth to
prevent friction between the mucosa of the oral cavity and the food material; moisten the food material for easy swallowing process; and initiation of
lipid and carbohydrate complex digestion.

The teeth provide a mechanical breakdown of food materials; for instance, the connective tissue of meat and plant fibers in vegetables. This
process also saturates the salivary secretions and enzymes within the food material for better digestion.

The pharynx serves as a passageway of food material to the esophagus although it also has a respiratory function for air movement into the
lung. During swallowing, closure of the nasopharynx and larynx occurs to maintain the proper direction of food. This process is achieved by cranial
nerves IX and X. From the pharynx, food material goes to the esophagus.

The esophagus's primary function is to empty food materials into the stomach via waves of contraction of its longitudinal and circular muscle
known as peristalsis. The upper one-third of the esophagus is predominantly skeletal muscle. The middle one-third is a mixture of both the skeletal
muscle and smooth muscle. The lower one-third is mainly smooth muscle. However, during the act of deglutition, the buccal phase is the only
voluntary phase where one can still control the swallowing process. The skeletal muscles found in the pharynx and upper esophagus are all under
the control of the swallow reflex; hence the pharyngeal and esophageal phases of swallowing are under involuntary control help of afferent and
efferent fibers of glossopharyngeal and vagus nerves. The smooth muscles of the esophagus are arranged in a circular and longitudinal fashion and
aid in peristaltic movement during swallowing.
 Once the food material arrives in the stomach, it can be temporarily stored and mechanically and chemically broken down by the actions of
stomach acids and enzymes. The secretion of intrinsic factor produced by the stomach helps with the proper absorption of vitamin B12.[5] The ability
of the stomach to store food stems from its compliance and ability to change size. On average, the lesser curvature of the stomach has a length of
approximately 10cm, and the larger curvature has a length of approximately 40cm. The stomach typically spans from vertebrae T7 and L3, giving it
the ultimate ability to hold on to a large amount of food.

The stomach's function in breaking down food materials mechanically is due to its sophisticated muscular dimensions. The stomach has 3
muscular layers: an inner oblique layer, a middle circular layer, and an external longitudinal layer. The contraction and relaxation of these 3 muscular
layers of the stomach assist in the mixing and churning activities essential in the formation of chyme. Then the chemical breakdown of food material
in the stomach is propagated by the gastric glands produced majorly by the parietal cells, the chief cells, G-cells, the foveolar cells, and the mucous
neck cells. The parietal cells secrete intrinsic factors and hydrochloric acid. The intrinsic factor produced is essential in the absorption of vitamin B12.
It binds to B12, allowing for proper absorption at the ileum of the small intestine.The hydrochloric acid produced by the parietal cell keeps the
stomach pH between 1.5 to 2.0. The acidity of the stomach brought on by hydrochloric acid destroys most of the microorganisms ingested with food,
denatures protein and breaks down plant cell walls, and is essential for the activation and function of pepsin, a protein-digesting enzyme secreted by
chief cells. The chief cells produce a zymogen called pepsinogen, which gets activated at pH between 1.5 to 2 to become pepsin. Pepsin is a protein-
digesting enzyme. The foveolar cells and mucous neck cells produce mucous, which protects the gastric epithelium from acidic corrosion.The G cells
are abundant within the pyloric section of the stomach. They produce gastrin which stimulates secretions from the parietal and chief cells. Within the
pyloric section of the stomach, D cells produce somatostatin, which inhibits gastrin release.
 The small intestine is the next location where digestion takes place. But unlike the stomach, which has minor absorptive property, 90% of food
absorption occurs in the small intestine. The small intestine has three segments: the duodenum, the jejunum, and the ileum. The duodenum receives
chyme from the stomach as well as digestive material from the pancreas and the liver. The jejunum is where the bulk of chemical digestion and
absorption occur. The ileum also has digestion and absorption functions. The ileum is the last segment of the small intestine and has the ileocecal
valve, a sphincter that controls the flow of material from the ileum to the cecum of the large intestine. The small intestine mucosa has villi, and each
villus has multiple microvilli; thereby increasing the surface area exponentially for optimal absorption. There are extensive networks of capillaries
within the villi that carry absorbed nutrients to the hepatic portal circulation. Also, a vast quantity of lymphatic capillaries called lacteals aid in
chylomicron transportation to the venous circulation. The intestine has both endocrine and exocrine glands that produce hormones, enzymes, and
alkaline mucinous material. The hormones released by the small intestine include

 Gastrin produced by G-cells in the upper small intestine (but mostly found in the stomach)
 Cholecystokinin (CCK) produced by I-cells in the upper small intestine;

secretin produced by the S-cells in the upper small intestine in response to decreased upper intestine pH;

 Gastric inhibitory peptide (GIP) produced by K-cells in the upper small intestine in response to fat, amino acids, and glucose
 Pro-glucagon produced by the L-cells in the distal ileum and colon in response to glucose and fat
 Somatostatin produced by D-cells in the small intestine, including the stomach and pancreas
 Vasoactive intestinal polypeptide (VIP) produced by parasympathetic ganglia in the small intestine in response to distention
 Motilin produced by M-cells in the upper small intestine

The enzymes produced by the small intestine include lipase for fats digestion, peptidase for peptide breakdown, sucrase, maltase, and lactase for
sucrose, maltose, and lactose breakdown, respectively. Then there are the Brunner glands mostly found in the duodenum that produce bicarbonate
for acid neutralization. Within the duodenum, accessory digestive organs such as the liver and the pancreas release digestive secretions.
 The liver is the largest internal organ and the largest gland in the human body. It has numerous functions, but as an accessory organ of the
digestive system, it produces bile which emulsifies fats and various lipids for optimal digestion. Bile produced in the liver is stored in the gallbladder.
The gallbladder contracts to release bile into the duodenum when fat-containing food is present.

The pancreas also has exocrine glands that are essential for the food digestion process. The exocrine glands of the pancreas produce
multiple enzyme precursors and enzymes, which include trypsinogen, chymotrypsinogen, and procarboxypeptidase, which are activated by
enteropeptidase in the small intestine; active alpha-amylase; lipases and colipase, which act on triglycerides and phospholipids; and several other
enzymes like ribonuclease, elastase, and collagenase.
 The unabsorbed and undigested food material progresses to the large intestine. At this point, it is called feces. The large intestine is about 6
feet long and starts with the cecum, ascending colon, transverse colon, descending colon, and sigmoid colon. The large intestine absorbs water and
electrolytes. Also, due to the trillions of microbes that live in the large intestine, these organisms can break down the undigested food material. In
addition, nutrients such as vitamin K are produced and absorbed in the large intestine. The peristaltic movement of the large intestine moves the
feces into the rectum. In the rectum, stretch receptors signal for the defecation process to start, which includes a reflexive relaxation of internal anal
sphincter smooth muscle and conscious relaxation of the external anal sphincter skeletal muscle.