Digestive System (1)

Let's munch on some Anatomy!

The Digestive System consists of two groups of organs:

Gastrointestinal tract (GIT or alimentary canal):

A continuous tube from the oral cavity to the anus, with six main parts: mouth,
pharynx, esophagus, stomach, small intestine, and large intestine.
Accessory Digestive Organs:
Salivary Glands (Parotid, Submandibular, and Sublingual), Liver, Gallbladder, Pancreas.
Note: There are also minor salivary glands that are scattered in the mucosa of the
mouth.

The gastrointestinal tract can be categorised into two primary sections. These sections can
be used to classify diseases of the GIT:

1. Upper GIT:
Mouth (oral cavity)
Pharynx
Esophagus
Stomach
Duodenum, which is the first part of the small intestine
2. Lower GIT:
Rest of the small Intestine, including jejunum and Ileum
Large Intestine
 The Mouth (Oral Cavity)

The oral cavity is the space that stretches from the lips anteriorly (Oral fissure) to the
pharynx posteriorly.

The boundary between the oral cavity and the oropharnyx is the palatoglossal arch,
which is a fold of mucous membrane that covers the palatoglossus muscle.

The oral cavity contains the tongue and the teeth and is composed of two main regions:

Vestibule:
The area between the lips and cheeks externally and teeth and gum internally.
It contains the opening of the parotid duct (parotid papilla), which opens opposite to
the 2nd upper molar tooth.
Divides into sulci: labial (2: upper and lower) and buccal (4: upper and lower, right and
left)
Oral cavity proper:
Surrounded by teeth and contains the tongue. It is bounded by:
Roof: Hard palate, which is formed by the palatine process of maxilla and the
horizontal plate of palatine bone.
The soft palate is a mucosal fold containing muscles that is attached to the
posterior end of the hard palate.
Floor: Reflection of the mucous membrane under the tongue.
Anteriorly: Communicates with the vestibule.
Posteriorly: Communicates with the oropharynx through the palatoglossal arch.
 The Teeth (Dentes)

Deciduous (primary) teeth:

5 in each quadrant (20 teeth in total)

Begin eruption at around 6 months and fully emerge by 2 years
Central incisors → lateral incisors → first molar → canine (longest root) → second molar
The mandibular teeth erupt before the maxillary teeth

Permanent teeth:

8 in each quadrant (32 teeth in total)

Begin eruption at around the age of 6 years.
The first teeth to erupt is the lower first molar.
Fully erupted by 12 years old (with the exception of the 3rd molar, known as the wisdom
tooth).

The Tongue

The Tongue is a mobile muscular organ consisting of a group of skeletal and striated muscles
that are lined with a mucous membrane.

It is divided into two parts based on location:

Oral part: anterior two-thirds

Pharyngeal part: posterior one-third
The surface of the tongue can be divided into two parts:

Dorsum of The Tongue:

It has a V-shaped ridge called the Sulcus terminalis, which separates between the oral
and pharyngeal parts of the tongue.
Foramen Cecum: A blind opening at the apex of the sulcus terminalis.
Lingual Papillae, which are projections on the dorsal surface of anterior two thirds of
tongue that increase the surface area and contain taste buds:
i. Filiform: the smallest and most numerous. They are keratinised and do not contain
taste buds.
ii. Fungiform (like a mushroom): found on the dorsum, tip, and margins. They are non-
keratinised and therefore contain taste buds.
iii. Vallate (Circumvallate): 8-12 in front of the sulcus terminalis. They are non-
keratinised and therefore contain taste buds.
iv. Foliate: located on the sides near the tongue base. They are non-keratinised and
therefore contain taste buds.
Lingual Tonsil: An aggregation of lymphatic nodules forming the posterior third.

Ventral Surface of The Tongue: Covered by a smooth and thin mucous membrane.
a. Frenulum: A fold of mucous membrane that connects the ventral surface of the
tongue with the floor of the mouth.
b. Deep Lingual Artery & Vein: Positioned deep to the mucous membrane.
Muscles of the Tongue

The tongue muscles can be categorised into two types:

Intrinsic muscles:
These muscles are not connected to bone.
They run in three directions: longitudinal, transverse, and vertical.
Their action involves altering the shape of the tongue.
Extrinsic muscles:
These muscles originate from bones and insert into the tongue.
Their function is to move the tongue.
There are four of these muscles: Genioglossus (from genial tubercles of the mandible),
Hyoglossus, Styloglossus, and Palatoglossus.
Genioglossus muscle is the most important one of them, because it protracts the
tongue, preventing it from moving backward and obstructing the airway.

The Pharynx

The pharynx is a muscular tube that starts at the base of the skull and connects with the
esophagus at the level of C6 (at the level of cricoid cartilage).

It is divided into three parts:

1. Nasal (Nasopharynx): contains the 2 openings of the auditory tubes at each side, which
connect the nasopharynx with the middle ear, in addition to the pharyngeal tonsils
(Adenoids) at the roof of the nasopharynx.
2. Oral (Oropharynx), which contains the palatine tonsils, which are located between the
palatoglossal fold anteriorly and the palatopharyngeal fold posteriorly.
Superior constrictor muscle forms the bed upon which the palatine tonsils rest.
3. Laryngeal (Laryngopharynx).
Muscles of the Pharynx

1. Six longitudinal muscles: Stylopharyngeus, Salpingopharynygeus, and Palatopharyngeus.

2. Three constrictor muscles that are lined with a mucous membrane. These muscles are
called superior, middle, and inferior constrictor muscles. The successive contraction of
these muscles lead to swallowing.
Inferior part of the Inferior constrictor muscle, which is called the cricopharyngeus
muscle, works as a physiological sphincter to allow food into the esophagus.

The Esophagus

The Esophagus a muscular tube located posterior to the trachea, running through the
superior mediastinum and then through the posterior mediastinum from the level of C6 to
the stomach.

Approximately 25-30 cm in length.

It is divided into cervical, thoracic, and abdominal parts. The abdominal part is only 2 cm
long and joins the stomach at the level of T11.
Function: To carry food into the stomach.
It passes through the esophageal opening of the diaphragm, which lies at the level of
T10.
 The Stomach

Stomach is a J-shaped enlargement of the gastrointestinal tract located at the upper left
quadrant of the abdomen (Intraperitoneal).

Functions:

Digestion of carbohydrates, proteins, and fats

Acts as a holding reservoir

The Stomach can be divided into 4 regions:

Cardia: surrounds the opening of the esophagus. The angle formed between the cardia
and the fundus is called the cardiac notch. The cardia is the part of the stomach that lies
above an imaginary horizontal line starting at the cardiac notch.
Fundus: topmost part (dome-shaped)
Body: central and largest part
Pylorus: consists of pyloric antrum and canal

When empty, the stomach's mucosa forms large folds called rugae.
Connections:

Cardiac orifice: Esophagus to Stomach (Physiological sphincter)

Pyloric sphincter: regulates the passage from the stomach to the duodenum (Anatomical
sphincter)

Curves:

1. Greater curvature (left): which starts at the cardiac notch and ends at the pyloric
sphincter.
2. Lesser curvature (right): starts at the gastroesophageal junction and ends at the pyloric
sphincter.
Angular incisure (notch) marks the junction between the body and the pylorus on the
lesser curvature

Wall Layers:

Inner mucosal layer.

Middle muscular layer, which consists of three muscular layers: inner oblique, middle
circular, and outer longitudinal.
Outer layer consists of connective tissue called serosa.