THE DIGESTIVE SYSTEM

ANATOMY & PHYSIOLOGY

The Digestive System

The organs of the digestive system

are specialized for the digestion

and absorption of food.
The principal function of digestive
system is to prepare food for
cellular utilization.

The Digestive System

Digestive system can be divided

into a tubular gastrointestinal tract

(GI tract), or digestive tract, and
accessory digestive organs.
The GI tract, which extends from
the mouth to the anus, is a
continuous tube approximately 9
m (30 ft) long.
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Functional Activities
Ingestion taking of food into the

mouth
Mastication chewing movements to
pulverize food and mix it with saliva
Deglutition swallowing of food to
move it from the mouth to the pharynx
and into the esophagus
Digestion mechanical and chemical
breakdown of food material to prepare it
for absorption
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Functional Activities
Absorption passage of molecules of

food through the mucous membrane of

the small intestine and into the blood or
lymph for distribution to cells
Peristalsis rhythmic, wavelike
intestinal contractions that move food
through the GI tract
Defecation discharge of indigestible
wastes, called feces, from the GI tract
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The Mouth
The function of the mouth
Ingests food
Receives saliva
Grinds food and mixes it with saliva
Initiates digestion of carbohydrates
Forms and swallows soft mass of
chewed food called bolus
The mouth can also assist the
respiratory system in breathing air
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Pharynx
Posterior to the mouth.
Aa common passageway for both

the respiratory and digestive

systems.
Divided into 3 parts:
Nasopharynx
Oropharynx
Laryngopharynx
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Function
Receives bolus from oral cavity.
Autonomically continues

deglutition of bolus to esophagus

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Teeth
Deciduous (milk)

& permanent
teeth
Type of teeth:
Incisors for cutting
and shearing food
Canines for
holding and
tearing
Premolars and
molars for
crushing and

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Tongue
Tongue functions:
Move food around in the mouth
during mastication
Assist in swallowing food
Producing speech
Taste the food
The tongue is a mass of skeletal

muscle covered with a mucous

membrane.
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Salivary Gland
The salivary glands are accessory

digestive glands that produce a

fluid secretion called saliva.
Saliva functions as a solvent in
cleansing the teeth and dissolving
food molecules.
Major & minor salivary glands

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Esophagus
Collapsible tubular organ.
Approximately 25 cm (10 inc) long.
Originating at the larynx and lying

posterior to the trachea.

Located within the mediastinum.
Passes through the diaphragm just
above the opening into the
stomach.
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Anatomic
sphincter

Physiologic
sphincter

Prevent the
stomach contents
from regurgitating
into the esophagus

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Function
Transports bolus to stomach by

peristalsis.
Lower esophageal sphincter
restricts backflow of food.

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Swallowing Mechanism
Voluntary stage
Initiates the swallowing process

Pharyngeal stage
Involuntary and constitutes passage of food
through the pharynx into the esophagus

Esophageal stage
Another involuntary phase that transports
food from the pharynx to the stomach

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Stomach (Gaster)
Most distensible part of the GI

tract.
Located in the upper left
abdominal quadrant, immediately
below the diaphragm.
J-shaped when empty.
Continuous with esophagus
superiorly and empties into
duodenum .
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Cell

Function

Goblet cells

Secrete protective mucus

Parietal cells

Secrete HCl

Principal cells (chief

cells)

Secrete pepsin

Agretaffin cells

Secrete serotonin, histamine, and autocrine

regulators.

Endocrine cells (G cells)

Secrete hormone gastrin into the blood

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Function
Receives bolus from esophagus.
Churns bolus with gastric juice.
Initiates digestion of proteins.
Carries out limited absorption.
Moves mixture of partly digested food and

secretions (chyme) into duodenum and

prohibits backflow of chyme.
Regurgitates when necessary.
Generates hunger pangs.
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Mechanics of Vomiting

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Small Intestine
The small intestine is that portion

of the GI tract between the pyloric

sphincter of the stomach and the
ileocecal valve that opens into the
large intestine.
Divided into three parts:
Doudenum
Jejunum
Ileum
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Function
Receives chyme from stomach and

secretions from liver and pancreas.

Chemically and mechanically breaks
down chyme.
Absorbs nutrients.
Transports wastes through peristalsis to
large intestine.
Prohibits backflow of intestinal wastes
from large intestine.
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Large Intestine
Receives undigested wastes from

small intestine
Absorbs water and electrolytes
Forms feces

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Rectum & Anus

Forms, stores, and expels feces

when activated by a defecation

reflex

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Liver
The largest internal organ of the

body.
Weighing about 1.3 kg in an adult.
Reddish brown color is due to its
great vascularity.
The liver has four lobes
Liver lobule functional unit
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Function
Carbohydrate, protein, and fat metabolism.
Breakdown of erythrocytes and defence

against microbes.
Detoxification of drugs and noxious
substances.
Metabolism of ethanol.
Inactivation of hormones.
Synthesis of vitamin A from carotene.
Production of heat.
Secretion of bile.
Storage.
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Pancreas
Pancreas has both exocrine and

endocrine functions.
The endocrine function is performed by
the pancreatic islets (islets of
Langerhans). The islet cells secrete the
hormones insulin and glucagon into the
blood.
As an exocrine gland, the pancreas
secretes pancreatic juice through the
pancreatic duct, which empties into the
duodenum.
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To be Continued

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GASTRITIS

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Definition
Gastritis should be used to denote

conditions in which there is

histologic evidence of
inflammation.
Gastropathy should be used to

denote conditions in which there is

epithelial or endothelial damage
without inflammation.
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Classification
Acute gastritis

A.
B.
.
.
.
.
.
.
.
.

Acute H. pylori infection

B. Other acute infectious gastritides
Bacterial (other than H. pylori)
Helicobacter helmanni
Phlegmonous
Mycobacterial
Syphilitic
Viral
Parasitic
Fungal

Chronic atrophic
gastritis

A. Type A: Autoimmune, body- predominant

B. Type B: H. pylorirelated, antralpredominant
C. Indeterminant

Uncommon forms of
gastritis

A.
B.
C.
D.
E.

Lymphocytic
Eosinophilic
Crohn's disease
Sarcoidosis
Isolated granulomatous gastritis
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Clinical Feature
The correlation between the

histologic findings of gastritis, the

clinical picture of abdominal pain
or dyspepsia, and endoscopic
findings noted on gross inspection
of gastric mucosa is poor.
Tthere is no typical clinical
manifestation of gastritis.
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Clinical Feature
Dyspepsia refers to acute, chronic,

or recurrent pain or discomfort

centered in the upper abdomen.
The discomfort may be
characterized by or associated
with upper abdominal fullness,
early satiety, burning, bloating,
belching, nausea, retching, or
vomiting.
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Treatment
Depend on the etiology
Proton pump inhibitor
Histamin 2 receptor blockers
Antacid
Sucralfate
Prostaglandin analogue

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PEPTIC ULCER DISEASE

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Introduction
Peptic ulcer disease (PUD) refers to

disorders of the upper GI tract

caused by the action of acid and
pepsin.
Spectrum of peptic ulcer disease is
broad, including undetectable
mucosal injury, erythema,
erosions, & ulceration.
Correlation of severity of
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symptoms to objective evidence
of

Introduction
Encompasses both gastric and

duodenal ulcers.
Ulcers are defined as breaks in the
mucosal surface >5 mm in size,
with depth to the submucosa.

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Epidemiology
United States:

4 million individuals affected per

year
12% in men and 10% in women
15,000 deaths per year occur as
a consequence of complicated
PUD

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Etiology of Ulcer
Helycobacter pylori
NSAID
Infection
Cytomegalovirus, HSV, Helicobacter heilmanni

Drug/Toxin
Bisphosphonates, Chemotherapy, Clopidogrel,
Glucocorticoids, Mycophenolate mofetil,

Miscellaneous

Myeloproliferative disease, Duodenal obstruction,

Infiltrating disease, Ischemia, Radiation, Sarcoidosis,
Crohn's disease, Idiopathic hypersecretory state
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Pathogenesis
Injurious Factor

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Injurious Factor
Endogenous agents include acid,

pepsin, bile acids, and other smallintestinal contents.

Exogenous agents include ethanol,
aspirin, other nonsteroidal
antiinflammatory drugs, and
Helicobacter pylori infection.

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Clinical Feature
Abdominal (pigastric) pain
Dyspepsia
Occult bleeding
Upper GI bleedeng (hematemesis &

melena)
Perforation
Obstruction
Anemia
Anorexia
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PUD Related Complications

Gastrointestin

al bleeding
Perforation
Gastric outlet
obstruction

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Diagnostic Study
Endoscopy
Barium meal
Test for detection of H. pylori
Culture, serolugy, urease test, UBT

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Endoscopy demonstrating: A. a benign duodenal ulcer; B. a benign gastric ulcer.

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Treatment
Treatment for PUD
Treatment for eradication of H.

pylori

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DIARRHEA

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Diarrhea
Worlwide, more than 1 billion

individuals suffer one or more

episodes of acute diarrhea each
year.
Acute infectious diarrhea remains
one of most common causes of
mortality in developing countries,
particularly among children.
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Diarrhea
Normal stool frequency ranges

from three times a week to three

times a day.
Diarrhea can be defined as an
increase in the fluidity, frequency,
and volume of daily stool output.

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Diarrhea
Acute diarrhea

< than 14 days

Chronic or persistent diarrhea
> than 14 days

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Major Mechanism of
Diarrhea
Osmotic diarrhea
Secretory diarrhea
Inflammatory diarrhea
Abnormal intestinal motility

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Osmotic Diarrhea

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Secretory Diarrhea
Diarrhea > 1 L per day results from

secretion of fluid across intestinal

mucosa.
Stimulation of active secretion and
partial inhibition of intestinal
absorption.
The intestinal mucosa is intact and
has normal histologic findings.
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Features of Secretory
Diarrhea
Stool volume is usually large
Stools are watery in consistency.
Stools do not contain pus or blood.
Diarrhea continues while the

patient fasts.
Close to the plasma osmolality.

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Inflammatory Diarrhea
Mucus, blood,
and pus leak
into the
lumen
Inflammation

Prostaglandins

increased
osmotic load

Impaired absorption
of ions, solutes, and
water

large-volume
diarrhea

stimulate secretion

increase bowel
motility
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Motility Disturbance
Increased motility of the small

intestine
Decreased motility of the small
intestine
Increased colonic motility
Anal sphincter dysfunction

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Acute Infectious Diarrhea

Virus
Bacteria
Protozoa

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Clinical Feature
Diarrhea
Nausea
Vomiting
Dehydration
Shock
Fever
Abdominal pain
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SYMPTOM

Symptom Associated with

Dehydration
MINIMAL OR NO

MILD TO MODERATE

DEHYDRATION

DEHYDRATION

(<3% LOSS OF BW)

(39% LOSS OF BW)

Fatigued or restless,

SEVERE DEHYDRATION
(>9% LOSS OF BW)

Mental status

Alert

Thirst

Drinks normally

Thirsty;eager to drink

Heart rate

Normal

Normal to increased

Quality of pulses

Normal

Normal to decreased

Weak, thready, or impalpable

Breathing

Normal

Normal;fast

Deep

Eyes

Normal

Slightly sunken

Deeply sunken

Tears

Present

Decreased

Absent

Mouth and tongue

Moist

Dry

Parched

Skinfold

Instant recoil

Recoil in <2 sec

Recoil in >2 sec

Capillary refill

Normal

Prolonged

Prolonged;minimal

Extremities

Warm

Cool

Cold;mottled;cyanotic

Urine output

Normal to decreased

Decreased

Minimal

irritable

Apathetic, lethargic, unconscious

Drinks poorly; unable to drink
Tachycardia, with bradycardia in most severe
cases

Treatment
Fluid administration (ORS or IV)
Continued feeding
Antibiotics (for bacterial infection)
Symptomatic
Antipyretic (fever)
Prokinetic agent (vomiting)
Antidiarrhea (not recommended for children)

Zinc suplementation
Correct the complications
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ACUTE APPENDICITIS

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Introduction
Appendicitis is the most common

abdominal surgical emergency.

Peak incidence of acute
appendicitis is in the second and
third decades of life.
Primary cause of the abdominal
right lower quadrant pain.

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Pathophysiology

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Clinical Feature
Abdominal pain
(Right lower quadrant McBurney point)

Fever
Nausea & vomiting
Anorexia
Change of bowel habit
Leucocytosis
Rovsing sign
Obturator sign
Psoas sign
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Complications
Perforated appendicitis
Chronic appendicitis
Periappendicular Infiltrate
Appendiceal abscess
Peritonitis

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Treatment
Appendectomy
Antibiotics
Symptomatic

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PERITONITIS

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Introduction
Peritonitis is inflammation of the

peritoneum and peritoneal cavity.

Due to a localized or generalized
infection.

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Classification
Primary (spontaneus) peritonitis results

from bacterial, chlamydial, fungal, or

mycobacterial infection in the absence
of perforation of the gastrointestinal
tract
Secondary peritonitis occurs in the
setting of gastrointestinal perforation.
Frequent causes of secondary peritonitis
include peptic ulcer disease, acute
appendicitis, colonic diverticulitis, and
pelvic inflammatory disease. 116

Clinical feature
Generalized abdominal pain
Fever
Peritoneal sign
Muscular rigidity
Nausea & vomiting
Anorexia
Change of bowel habit
Leucocytosis
Shock
GI bleeding
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Treatment
Surgical treatment
Antibiotics
Symptomatic

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Matur Sembah Nuwun

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