Transcribed by Janki Gajera!

April 3, 2014

Digestive Tract 2
(Histology)
Slide 1 - DIGESTIVE TRACT 2 2014 Dr. Harvey Wishe - OK, we might as well continue. Has everybody noticed that the best time to use the bathroom facilities on this floor is early in the morning? Once you pass a certain time, they become very odiferous and you have to watch where youre stepping. You have to use the facility Nevermind. So now were going to finish up the digestive tract, and were starting off with the small intestine which includes the duodenum, jejunum, and ileum. And overall, this is a good 25 feet long. The duodenum is the smallest part, about 10-12 inches. The remaining part, the jejunum takes up 2/5 and ileum takes up 3/5. The function of the small intestine are to receive food from stomach - dont forget in the stomach, HCl was released - and the HCl actually exerts an effect on the enzymes released by the chief cells - pepsinogen which gets activated by the acids, and the pepsin which is the actual act of forming the enzyme. So in the stomach you have some breakdown of protein, some minor breakdown of lipids, but basically the stomach is like a pounder - the muscularis externa, instead of having two layers of smooth muscle has three layers: inner oblique, middle circular, and outer longitudinal. So those three layers collectively produce a very thick muscularis mucosa, and when it contracts it literally pounds and squeezes the food down to a chemical mush known as chyme. So the chyme is moved to the duodenum. In the small intestine, the food is broken down by various enzymes from the small intestine and pancreas. You wind up with amino acids and glucose, which are absorbed into the vascular system of the small intestine. Fats are broken down into fatty acids, but the fatty acids are short or long-chained. The smaller fatty acids (10 C or less) will pass into circulation, but anything with more than 10 carbon unites get absorbed into the lymphatic system, and well look at that momentarily as well. Slide 2 - GUH Unit XII CH 65 FIG 64-5 PLICAE CIRCULARES Dr. Harvey Wishe - As you look at the small intestine, this is a perfect picture. You see these folds. They are known as your plicae circularis, or valves of conniventes. They are circular folds, thats what that terminology means. So in essence, what Im doing to this paper, thats your circular folds projecting into the lumen, whereas this is a longitudinal fold. These circular folds go around the lumen for maybe 2/3 of the distance, 1/2 of 2/3. Usually the upper part of the duodenum depending on the species, may be not so well developed. The jejunum has the most developed plicae circularis, and along with the plicae circularis, the jejunum also has the most highly developed villi. So each part of these folds is a plicae circularis. These little structures coming off are surface villi. Thats two ways to increase surface area: plicae circularis and villi. And the villi essentially represent the mucosa. [alarm-sounding noise started water running? passage of electricity through your seats? i dont know haha] So sandwiched within

Transcribed by Janki Gajera!

April 3, 2014

each villus, you have areolar CT, muscularis mucosa, and then this lilac color, the NYU color, represents the submucosa. So we can say that these plicae circularis are circular folds involving both mucosa and submucosa. Then of course you have your muscularis externa and serosa on the outside. With any of the folds, whether were dealing with the esophagus, small or large intestine, they can never be completely smoothed out. In other words, youre always going to have a little ridge existing. They basically flatten out, but theres always something left over. Slide 3 - J FIG. 15-20 SMALL INTESTINE Villi Dr. Harvey Wishe - Then we see some part of the small intestine. What we are looking at are the villi. And then the region between the villi happen to be known as your Crypts of Lieberkuhn, and why? Thats where you find your mitotic germ cells. As you look at the villi, you can see all these little white oval spaces - those are the goblet cells. Between the goblet cells, youre going to find simple columnar cells which function in releasing enzymes or absorbing break-down products, depending on their location. So the lamina propia, muscularis mucosa, submucosa, muscularis externa, all follow our general discussion that we started off with in the beginning. As we look at these simple columnar cells winding these villi, sometimes you see the term enterocytes, if you go to a specialist who deals with these problems of the gut, they are called enterologists or gastrologists, but a gastrologist is someone who concentrates more on the stomach whereas the enterologist concentrate on the small intestine. But so far we have seen two modifications to increase surface area: plicae circularis and villi. There is a third way to increase surface area: if you look at one of these simple columnar cells, you find microvilli. Anyone remember the name of the microvilli associated with the gut? Probably not. Striated border. When you look at a typical picture, what youre seeing is a thickened apical border. You cant see the little hair-like projections. The microvilli are nothing more than an extension of the cell cytoplasm. They increase surface area, and when you put them together, you get 600-fold increase in surface area for digestion and absorption to take place. These cells are also held together by desmosomes, and within the cell youre going to get actin and myosin filaments. Dont forget this whole villus apparatus moves back and forth. Thats how food is pushed down - an increase in surface area allows this part of the gut to do its job in the digestive process. Areolar CT alias lamina propia in the core of the villus. In the villus you also find muscularis mucosa. Slide 4 - J FIG. 15-24 SMALL INTESTINE Villi Dr. Harvey Wishe - Heres a picture showing you the small intestine, and here are all of the villi projecting into the lumen, and this particular area is the Crypts of Lieberkuhn? they are between the bases of two villi. This picture shows you two different types of cells. In essence the villus is lined by your simple columnar epithelium and your goblet cells. You learned about goblet cells in epithelium - single, unicellular glands releasing secretion for lubrication. Then as you look at the Crypts of Lieberkuhn, youre going to find mitotic cells to give rise to more cells to replace those that are dying or damaged. Then you find these cells really at the base of the Crypts of Lieberkuhn called Paneth cells - these are serous cells, enzyme-producing cells that

Transcribed by Janki Gajera!

April 3, 2014

produce enzymes to break down proteins. There are enzymes produced by your lysosomes that allow the Paneth cells to act like macrophages and destroy foreign material. And then we have these cells, which are argentaffin cells, cells that stain metallic silver or brownish with chromium stains. These are cells we discussed already in terms of the stomach. Like the G cells. What cell you find prominent here are EC cells. They make up the largest cell population of this group and releases serotonin. You have nerve fibers which stimulate muscularis mucosa which then squeezes the cells in germinative Crypts of Lieberkuhn, and the EC cells release serotonin which continues the stimulus of whole villus to get the various enzymes out. This is going to affect the absorption and digestion rate. Well find a couple of G cells that carry over from the stomach, whether they exert any effect on the villi etc. - no one really talks about that. There are other cells which the professor doing the physiology lectures. I dont remember his name. Whats his name? Pavlov, thats a name I should not forget. How were those lectures? Alright, there goes my course assessments. So we have an I cell which is one of these ridgophil cells, which releases something called cholecystokinin. The purpose of me mentioning it is that it has a stimulatory effect on gallbladder, causing gallbladder to release bile. The bile comes from the liver, temporarily stored in gallbladder, and release through common bile duct which empties into the duodenum, the first part of the small intestine. Slide 5 - J FIG. 15-33 VILLI Vasculature Dr. Harvey Wishe - Nice picture showing three villi. In this one (first one) you see the vasculature in the villi. You can see the capillaries, etc. Again, the Crypts of Lieberkuhn. This represents lamina propia. The second villus shows you a single vessel - a lymphatic capillary which eventually drains into your lymphatic system which eventually winds up back in the thoracic duct by the heart. So this is the vessel that picks up the larger chain fatty acids - 10-15 carbon units. The last villus is showing you the muscularis mucosa or interna extending into the villus, you can see very easily how these villi extend back and forth, creating a current to bring back to the area and then all the modifications increase digestion in terms of breakdown and absorption. Im going to show you some mucosa down here, here is the submucosal plexus, myenteric plexus, Meissners plexus. Of course, using the word myenteric isnt too good - some books use it for both Auerbachs and Meissners plexus? I mean they function the same way but there are stimulating different things. So I like to call Meissners submucosal and Auerbachs between two layers of smooth muscle. Slide 6 - J FIG. 15-42 STOMACH vs. SMALL INTESTINE Dr. Harvey Wishe - This is meant to illustrate mitosis. In the stomach, this is where you have your stem cells. More cells are produced. They move up and move down to replace worn out cells. In terms of the small intestine, the mitotic cells are in the base of the Crypts of

Transcribed by Janki Gajera!

April 3, 2014

Lieberkuhn. That means they have only one direction to move, so you see this arrow going in an upward direction. So thats a major different between mitosis in two different organs. Slide 7 - ARGENTAFFIN CELLS Dr. Harvey Wishe - These are the cells I mentioned, the EC cells produce serotonin and stimulate muscularis mucosa. We have GL cells also present, releasing glucagon - so throughout the tract you have cells releasing glucagon, but what role they play in controlling glucose, Im not sure. Dr. Pavlov may go into that. This is just an I cell, releasing cholecystokinin. These are just two cells, the MO cells release motilin - these are hormones that act to increase motility. I mean there is more than one thing increasing motility, just like theres more than one thing increasing surface area. These cells will be related to pancreatic function. Slide 8 - G&H FIG. 17-13 COMPONENTS OF SMALL INTESTINE Dr. Harvey Wishe - Diagrammatic view of small intestine - that purple area is villi. Youre looking at your Crypts of Lieberkuhn. Theyre just trying to show you different cells present in two different areas. Technically, from here down, is your Crypts of Lieberkuhn, so again youre going to find Paneth cells, mitotic cells, and your ridgophil or argentaffin cells. Some people use the term endocrine cells because some of the products they produce are endocrine in nature. Slide 9 - N Plate 252 ABDOMINAL CAVITY Dr. Harvey Wishe - Here you have a picture of the upper part of the tract with the stomach and greater momentum. Here the greater omentum is lifted up like an apron and you can see the small intestine and the large intestine alias the colon. We should say a few words about each part of the small intestine before rushing into the colon. Duodenum, whats characteristic of the duodenum - presence of glands and submucosa. And I never mentioned before, but I will now, they are called Brunners glands. They release a small amount of secretion for lubrication. They also begin the digestive process by emulsifying fats. They begin to neutralize the acid chyme that comes from the stomach. They begin the whole chemical process of the small intestine. It just starts the process going, but the bile is released from the gallbladder does most of the work, and then the pancreatic mucosa and enzymes of the small intestine do most of the digestion. Also what happens in the Brunners glands and is continued in the bile from the gallbladder, is the food becomes emulsified. Its broken down and separated a little bit, making the process of digestion easier. I mentioned earlier that if you have gastritis, you have ulcers, you can eat your way through the wall, and the pancreas could be attacked, vascularity in the area could be attacked. There are two types of ulcers: gastric and duodenal. Acid could drip down into the duodenum and do damage there as well as the stomach; you have to shut down the release of acid, it may even require surgery to seal up the holes. Jejunum has the most developed plicae circularis and villi, we already mentioned that. When you compare the jejunum to the ileum, the jejunum is a bit shorter than the ileum. Jejunum has greater diameter, it is thicker, and greater digestive surface. When you look at the villi in the jejunum, it gives a Christmas tree-like appearance, like a pine tree. Thats the way it spreads out. Whats done in the jejunum is the digestive process -

Transcribed by Janki Gajera!

April 3, 2014

the chemical digestion of carbs, proteins, and fats. And towards the end of the jejunum, closer to the ileum, we have absorption taking place. What is characteristic of the ileum is the presence of Pyers patches. Here we see a picture of the duodenum, it is sort of C-shaped, maybe 10-12 inches. Most of the duodenum is retro-peritoneal, its only this part of the duodenum that is continuous with the rest of the small intestine which is intra-peritoneal. Very below the duodenum, literally embedded in it is the pancreas. Here is the head of the pancreas, narrows down to become and neck and body. It doesnt really show you the tail, but the tail lies against curvature of the spleen. This particular picture shows you the presence of a lot of plicae circularis, although in the beginning there tends to be an absence and there is a gradual build up. When it comes to the jejunum, there is a much more developed region of plicae circularis. Here you can see part of the pyloric sphincter. This is a piece of the pyloric portion of the stomach. Down here, the lining of the lumen is epithelium, then youll have your lamina propia and muscularis mucosa. Slide 10 - N PLATE 262 DUODENUM Dr. Harvey Wishe - Then this happens to be showing you the submucosa - all these bumps are supposed to represent the duodenum with the Brenners glands. Then you have your two layers of muscle, and finally the organ should be covered by adventitia by the most part. Slide 11 - G FIG. 2.22B DUODENUM Dr. Harvey Wishe - Here is a hand-drawn version of what were looking at, again the C-shaped duodenal loop. Here you get the full view of the pancreas: the head, neck, body, and tail. Its backed up against the curvature of the spleen. Slide 12 - GH PLATE 14-4 FIG. 1A DUODENUM Dr. Harvey Wishe - This is an actual histological picture. Here you see the villi, a lot of goblet cells, lamina propia with areolar CT. See the MM? Thats the muscularis mucosa. Underneath that is part of the submucosa and that is the Brenners glands. The glands that are in the submucosa have to have ducts so their secretions can be carried to the surface to the lumen of this portion of the system. Slide 13 - GH PLATE 14-4 FIG. 2 DUODENUM Dr. Harvey Wishe - This is showing again the other part of the duodenum, were catching the end of the Brenners glands, showing some submucosa without glands and this represents muscularis externa. AP is Auerbachs plexus between the two layers of the smooth muscle. Slide 14 - GH PLATE 14-5 FIG. 3 JEJUNUM Dr. Harvey Wishe - This is showing you plicae circularis. This whole bulge and this whole bulge is plicae, and then all of these structures lined up are your villi. This is a low power so you cant see much detail, but if you look at the bottom villi you can tell theres some substances there: lamina propia, muscularis mucosa. And then all of this tissue here is your submucosa. So again, the plicae is a combination of mucosa and submucosa.

Transcribed by Janki Gajera!

April 3, 2014

Slide 15 - GH PLATE 14-5 FIG. 2 JEJUNUM Paneth Cells Dr. Harvey Wishe - Here were looking at the Crypts of Lieberkuhn, showing you all these cells with zymogenic granules, these are your Paneth cells. When you see something like this or that, those are mitotic cells, stem cells, proliferative cells. Slide 16 - GH PLATE 14-5 FIG. 4 ILEUM Dr. Harvey Wishe - Now we come to the ileum, which has its own characteristics, and thats Payers patches and solitary lymph nodes. Now the lymph nodes could start in the submucosa and could extend into the lamina propia. Now the villus on the right doesnt have an extension of the lymph node material into this. Slide 17 - GH PLATE 9-1 FIG 2 PEYERS PATCH Dr. Harvey Wishe - But here is a nice shot - you can see what I mean by the extensive nature. This is part of the submucosa as is this, Pyers patches going all the way into the lamina propia. Under this set of circumstances would you say the villi are functional in terms of absorption and break down of products? No. Because all of these lymphocytes are blocking the pathway. There are certain specialized cells right up here called M cells. Not found any place else than the mucosa of the digestive tract. The M cells are supposed to recognize foreign substances and transporting messages to the immune system in a way, they are like Langerhans cells. Slide 18 - N PLATE 254 COLON Dr. Harvey Wishe - Here we are looking at the colon, which consists of your ascending, transverse, descending, and sigmoid colon and your anal canal. As we look at this picture, we see this structure here, extending completely into the colon. One of the characteristics of the colon is that you have a thickened outer longitudinal layer of the muscularis externa. There are three bands. They are more or less equidistant from each other; the regions of the bands between the colon almost bulge out like you see all over. Almost like little pockets. What else you can see - obviously this is much wider than the small intestine. Then you notice this structure down here - the cecum. The terminal part of the cecum is the appendix. That gives us a lot of the problems. The appendix becomes filled with infectious material, and it could rupture as a result of cavity, become very bad. People have died of appendicitis because it was not caught in time. So this is an important consideration. If you go to doctor complaining of pain in the lower right abdomen, hes going to suspect that its your appendix and see if thats the problem. Slide 19 - GH PLATE 14-6 FIG. 3 APPENDIX Dr. Harvey Wishe - Here is a picture of the appendix, which has a epithelia, lamina propia, muscularis mucosa, submucosa, muscularis externa. What are the dark nuclei? These are lymphocytes. Its difficult sometimes to distinguish where the muscularis mucosa begins and ends. So the presence of all these lymphocytes designed to protect you are the lumen, which could become obliterated if the appendix becomes infected. And then of course the appendix could burst.

Transcribed by Janki Gajera!

April 3, 2014

Slide 20 - G&H TEXT FIG. 17-22 COLON Dr. Harvey Wishe - This is a section of the colon. There are no plicae circularis or villi. But you do have rectangular columns of mucosa, it is sort of reminiscent of the villi. Again, these columns have your lamina propia, muscularis mucosa coming in, so the fibers will come into this area. And most of the cells of the colon have goblet cells - as you look into this area, you see all these goblet, oval-shaped cells, making their first appearance in the duodenum - they are not found before. The maximum number of goblet cells are found in the colon. Crypts of Lieberkuhns still exist, and they are located at the bottom. In the Crypts of Lieberkuhns, youll find argentaffin cells, like your EC cells. Youll find your regenerative cells also. But the only other two cells are simple columnar, called absorptive cells. When you come to colon, absorption doesnt really take place except by Vitamin B12, and thats brought about by gastro-intrinsic factor released by the stomach. Slide 21 - GH PLATE 14-6 FIG. 1 COLON Dr. Harvey Wishe - Here we have a picture of the colon. We have seen this before. We use this for epithelium, goblet cells, lamina propia, and your muscularis mucosa. So this is your muscularis mucosa, we still have two layers: inner circular and outer longitudinal. Theres your submucosa. You tend to have a lot of fat cells - adipocytes. We mentioned the colon, it is wider and shorter in length than the jejunum or ileum. It has the presence of Taeniae coli, everyone spells it differently, those are the thickenings of the outer longitudinal layer, and there are three of them. Coming off the colon are patches of tissue called epiploicae appendages or appendages epiploicae, doesn't matter how you do it. They are nothing more than thick accumulations of fat. Again, no villi, no goblet cells. There are modifications - there are folds, which we don't have to concentrate on and those are called plicae semilunaris. The entire digestive tract has modifications in some kind of folds to increase surface area. Slide 22 - GH PLATE 14-6 FIG. 2 COLON Dr. Harvey Wishe - This is just a high power. One of the sections probably had to ID this as smooth muscle on the conference exam. So to finish up on the colon, it has the same layers as the rest of the tract, but things begin to change. You get appearance of more lymph nodules, more goblet cells, the muscularis interna changes from smooth muscle to skeletal muscle at the anal canal. So part of the contractile forces are involuntary, and at the end they are voluntary in nature. In terms of the outermost covering, part of the colon is intra-peritoneal, part is retro-peritoneal. And retro-peritoneal organs: pancreas, kidney, adrenal gland, aorta, IVC. Areas like most of the small intestine, stomach, small part of esophagus are intra-peritoneal. So the function of this organ is to absorb water. It is doing that to absorb Vitamin B12. Since there are so many goblet cells, there is a lot of mucous released as a lubricant makes it easier to eliminate waste products. At the end of the colon, when you enter your rectum, the epithelium changes from simple columnar to stratified squamous. Also the submucosa has a very vascular plexus called the hemorrhoidal plexus, you tend to be constipated and do a lot of squeezing - youre putting a lot of pressure on the simple columnar epithelium. It wears it away and exposes the underlying connective tissue, and

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April 3, 2014

erupts along the blood vessels, and you get your hemorrhoid bleeding. If its early enough, plop your butt into your tub, soak your rear in lukewarm water for 15-20 minutes several times a day, itll go away. If you need additional treatment, there is Preparation H. If its really bad, it requires surgery to remove it. You can tell someone whos had surgery on this, you see them sitting literally on a tube so their rear doesnt touch anything. Its just a surrounding part thats dealing with that.