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Digestive System
(GIT)
Explained by: Mohammad Taleb
Edited by: Nada Mohammad Ali
Topics :
1- Oral Cavity
a- Lips
b- Tongue
c- Teeth
d- Salivary enzymes
2- Pharynx
3- Esophagus
Oral Cavity
Lips: which used to take the food into the mouth
cavity.
Tongue: which used to speech, analyze food (by the
taste buds), mastication (chewing), and compress
food form bolus for swallowing (deglutition).
Mastication (Chewing): Digestion of food starts in the
mouth (oral cavity), by 1. the Teeth are admirably
designed for chewing, the anterior teeth (incisors and
canines) providing a strong cutting action, and the
posterior teeth (premolars and molars) providing a
grinding action.
Mastication (Chewing)
Most of the jaw muscles of chewing are innervated by the motor
branch of the fifth cranial nerve, and the chewing process is
controlled by nuclei in the brain stem.
Chewing is important for digestion of all foods, but especially important
for most fruits and raw vegetables because these have indigestible
cellulose membranes around their nutrient portions that must be broken
before the food can be digested
(Note// Humans can't digest cellulose as they don't have cellulase enzymes).
Mastication (Chewing)
Also, chewing aids the digestion of food for still another simple
reason: Digestive enzymes act only on the surfaces of food
particles; therefore, the rate of digestion is absolutely dependent
on the total surface area exposed to the digestive secretions.
In addition, grinding the food to a very fine particulate consistency prevents
excoriation of the gastrointestinal tract and increases the ease with which
food is emptied from the stomach into the small intestine, then into all
succeeding segments of the gut.
Salivary Glands and Saliva
By 2. the Salivary enzymes like the digestion of starch takes place
in the mouth (oral cavity) and in the small intestine.

About 40% of starch that is a carbohydrate is partially digested by ptyalin

(salivary amylase) while the remaining 60% starch is digested by pancreatic
amylase secretion of the pancreas.
Classification the salivary glands according to the size and amount of
secretion (salivation) into : Major & Minor Salivary Glands
Salivary Glands and Saliva
-Major salivary glands (Three pairs) are:
1- Parotid glands: largest salivary glands, located just
in front of the ears, its rich in amylase (25% of saliva).
2- Submandibular glands: under the lower jaw, its
watery secretion, high in buffers (5% of saliva).
3- Sublingual glands: smallest salivary glands, located
under the tongue. its buffers, mucin, amylase (70% of
saliva).
-Minor salivary glands: Buccal, Lingual, Palatine, Labial
The secretions of alimentary
tract glands :
Several types of glands provide the different types of alimentary
tract secretions.
First, on the surface of the epithelium in most parts of the
gastrointestinal tract are billions of single-cell mucous glands called
simply mucous cells or sometimes goblet cells
They function mainly in response to local
irritation of the epithelium: They extrude
mucus directly onto the epithelial surface to
act as a lubricant that also protects the
surfaces from excoriation and digestion.
The secretions of alimentary
tract glands :
Second, many surface areas of the gastrointestinal tract are lined by
pits that represent invaginations of the epithelium into the
submucosa.
In the small intestine, these pits, called crypts of Lieberkühn, are
deep and contain specialized secretory cells.
Third, in the stomach and upper duodenum are large
numbers of deep tubular glands.
Fourth, also associated with the alimentary tract are several complex
glands_the salivary glands, pancreas, and liver_that provide secretions for
digestion or emulsification of food.
The Simple & Compund Glands
The salivary glands and the pancreas are compound acinous
glands
The gland may be simple or compound distinction is based on duct shape.
A simple gland has an unbranched duct, contains only a single secretory
unit (acinus or alveolus),examples include sweat glands, gastric glands,
intestinal crypts, and uterine glands.

A compound gland has a branching duct, contain many individual secretory

units (acini), Salivary glands and pancreas are familiar examples.
The secretions of alimentary
tract glands :
Classified the salivary glands according to the nature of secretion
into three types;
❑ mucous glands (such as palatine glands),
❑ serous glands (such as parotid gland produce a secretion rich in
water, electrolytes, and enzymes from serous cells like ptyalin ),
❑ mixed glands (mucoserous such as submandibular and sublingual
glands.
Saliva
Salivary glands produce 800-1500 ml daily (average 1 L).
Saliva
Regulation (control) of Salivary Secretion : By Neural Reflexes;
1- Afferent signals from sensory receptors for example
taste, and tactile in the mouth.
2- Salivary center in the superior and inferior salivatory
nuclei in the brain stem.
3- Stimulation or inhibition of Parasympathetic nerve bundle
and Sympathetic nerve (efferent)
4- Salivary glands secretions (as shown in the figure).
Read More in Guyton & Hall Physiology | Chapter 65 (Secretory Functions of the Alimentary Tract) | Page 810
NERVOUS REGULATION OF SALIVARY SECRETION
Pharynx
Is the passageway for food and air.
A small flap of skin called the epiglottis closes over the pharynx to
prevent food from entering the trachea (prevent choking).
Swallowing (Deglutition):
Swallowing is a complex reflex initiated when
epithelial swallowing receptors in the walls of the
pharynx (lie in a ring around the pharyngeal opening)
are stimulated by a food or drink forced into the rear
of the mouth by the tongue.
Pharynx
These receptors send afferent impulses to the swallowing center
(in the brain stem medulla oblongata). Then this center elicits
swallowing via efferent fibers send to the pharynx and esophagus
muscles as well as to the respiratory muscles.
Pharynx
In general, swallowing reflexes can be divided into three
stages :

1- Oral (voluntary) stage: Bolus moves from oral cavity,

into the oropharynx; voluntary process.

2- Pharyngeal stage: Bolus moves from the oropharynx,

into the esophagus; involuntary process.

3- Esophageal stage: Bolus moves through the esophagus,

into the stomach; involuntary process.
Esophagus
Is a muscular conducting tube provides a passageway for
food from the pharynx to the stomach.
There are two types of muscles;
1. Skeletal m. (act as sphincter; upper esophageal
sphincter).
2. Smooth m. (result the peristaltic wave to push the
bolus, and form the lower esophageal sphincter).

In the upper esophagus sphincter (called the

pharyngoesophageal), prevents mucosal
excoriation by newly entering food,
Esophagus
Whereas at the lower esophageal
sphincter (called the gastroesophageal),
protect the esophageal wall from the
digestion of acidic gastric juices (like
esophagus reflux cases) that reflex from
the stomach into the lower esophagus
(disorder in this sphincter cause a peptic
ulcer or Heart burn).
This sphincter normally remains tonically constricted, it acts as a valve that
normally keeps food and stomach acid in the stomach, and prevents the
stomach's contents from regurgitating back into the esophagus.
Esophagus
Otherwise, every time we walked, coughed, or breathed hard,
we might expel stomach acid into the esophagus, at this point in
the esophagus, in contrast to the mid portion of the esophagus,
which normally remains relaxed.

When a peristaltic swallowing wave passes down the esophagus, there is

“receptive relaxation” of the lower esophageal sphincter ahead of the
peristaltic wave, which allows easy propulsion of the swallowed food into
the stomach.
Esophagus
Rarely, the sphincter does not relax satisfactorily, resulting in a
condition called achalasia.
The stomach secretions are highly acidic and contain many
proteolytic enzymes.
The esophageal mucosa, is not capable of
resisting for long the digestive action of
gastric secretions.
Fortunately, the tonic constriction of the
lower esophageal sphincter helps to prevent
significant reflux of stomach contents into the
esophagus except under abnormal
conditions.
Esophagus
The esophagus normally exhibits two types of peristaltic
movements : primary peristalsis and secondary peristalsis.
Primary peristalsis is simply continuation of the peristaltic wave that begins
in the pharynx and spreads into the esophagus during the pharyngeal stage
of swallowing.
Secondary peristaltic waves result
from distention of the esophagus itself
by the retained food; these waves
continue until all the food has emptied
into the stomach.
Esophagus
The secondary peristaltic waves are initiated partly by intrinsic
neural circuits in the myenteric nervous system and partly by
reflexes that begin in the pharynx and are then transmitted
upward through vagal afferent fibers to the medulla and back
again to the esophagus through glossopharyngeal and vagal
efferent nerve fibers.
The musculature of the pharyngeal wall and upper third of the esophagus
is striated muscle. Therefore, the peristaltic waves in these regions are
controlled by skeletal nerve impulses from the glossopharyngeal and
vagus nerves.
Esophagus
In the lower two thirds of the esophagus, the musculature is
smooth muscle, but this portion of the esophagus is also strongly
controlled by the vagus nerves acting through connections with
the esophageal myenteric nervous system.
When the vagus nerves to the esophagus are cut, the myenteric nerve
plexus of the esophagus becomes excitable enough after several days
to cause strong secondary peristaltic waves even without support from
the vagal reflexes.
Esophagus
Therefore, even after paralysis of the brain stem swallowing
reflex, food fed by tube or in some other way into the esophagus
still passes readily into the stomach.
The esophageal secretions are entirely mucous and mainly provide
lubrication for swallowing.
The esophagus body lined with many simple mucous glands, while at
the gastric end of the esophagus, there are many compound mucous
glands more than the beginning of the esophagus.
Esophagus
The mucus secreted by the compound glands in the upper
esophagus prevents mucosal excoriation by newly entering
food, whereas the compound glands located near the
esophagogastric junction protect the esophageal wall from
digestion by acidic gastric juices that often reflux from the
stomach back into the lower esophagus.

Despite this protection, a peptic ulcer at times can

still occur at the gastric end of the esophagus.
Disorders of Swallowing and
the Esophagus
1- Gastroesophageal Reflux Disease (GERD): The most common
esophageal disorder occurs when the lower esophageal sphincter doesn’t
close properly.
As a result, stomach acid and contents flow backward into your esophagus.
GERD is the condition in which excessive stomach
acid moves back into the esophagus (acid reflux),
causing Reflux esophagitis, heartburn, and
dysplastic changes(cancerous) or Barrett
esophagus (normal tissue lining the esophagus
resembles tissue lining of the intestine).
Disorders of Swallowing and
the Esophagus
2- Achalasia and Megaesophagus : Achalasia is a condition in which
the lower esophageal sphincter fails to relax during swallowing.
As a result, food swallowed into the esophagus then fails to pass from the
esophagus into the stomach.
Pathological studies have shown damage in the
neural network of the myenteric plexus in the lower
two thirds of the esophagus.
As a result, the musculature of the lower esophagus
remains spastically contracted and the myenteric
plexus has lost its ability to transmit a signal
Disorders of Swallowing and
the Esophagus
The myenteric plexus has lost its ability to transmit a signal to cause
“receptive relaxation” of the gastroesophageal sphincter as food
approaches this sphincter during swallowing.
When achalasia becomes severe, the esophagus often cannot empty
the swallowed food into the stomach for many hours, instead of the
few seconds that is the normal time.
Over months and years, the esophagus becomes tremendously
enlarged until it often can hold as much as 1 liter of food, which often
becomes putridly infected during the long periods of esophageal stasis.
Disorders of Swallowing and
the Esophagus
The infection may also cause ulceration of the esophageal mucosa,
sometimes leading to severe substernal pain or even rupture and
death.
Considerable benefit can be achieved by stretching the lower end
of the esophagus by means of a balloon inflated on the end of a
swallowed esophageal tube.
Antispasmotic drugs (drugs that relax smooth muscle) can also be helpful.
Disorders of Swallowing and
the Esophagus
3- Paralysis of the Swallowing Mechanism: Damage to the 5, 9, or
10 cerebral nerves can cause paralysis of the swallowing muscles,
as occurs in muscle dystrophy or in failure of neuromuscular
transmission, can also prevent normal swallowing.
One of the most serious instances of paralysis of the
swallowing mechanism occurs when patients are
under deep anesthesia.
Disorders of Swallowing and
the Esophagus
Often, while on the operating table, they vomit large quantities of
materials from the stomach into the pharynx; then, instead of swallowing
the materials again, they simply suck them into the trachea because the
anesthetic has blocked the reflex mechanism of swallowing.

As a result, such patients occasionally choke to death on their own

vomitus.
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