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The digestive system is the organ system that processes food, extracts
nutrients from it, and eliminates the residue. It does this in
five stages:
1. ingestion, the selective intake of food;
2. digestion, the mechanical and chemical breakdown of food
into a form usable by the body;
3. absorption, the uptake of nutrients into the blood and lymph;
4. compaction, absorbing water and consolidating the
indigestible residue into feces; and finally
5. defecation, the elimination of feces.
General Anatomy
The digestive system has two anatomical subdivisions, the digestive
tract and the accessory organs (fig. 24.1). The digestive tract is a
muscular tube extending from mouth to anus, measuring about 9 m
(30 ft) long in the cadaver. It is also known as the alimentary2 canal
or gut. It includes the mouth, pharynx, esophagus, stomach, small
intestine, and large intestine. Part of it, the stomach and intestines,
constitutes the gastrointestinal (GI) tract. The accessory organs are
the teeth, tongue, salivary glands, liver, gallbladder, and pancreas.
The digestive tract is open to the environment at both ends.
Most of the material in it has not entered any body tissues and is
considered to be external to the body until it is absorbed by epithelial
cells of the alimentary canal. In the strict sense, defecated food
residue was never in the body.
Most of the digestive tract follows the basic structural plan
shown in figure 24.2, with a wall composed of the following tissue
layers, in order from the inner to the outer surface:
Mucosa
Epithelium
Lamina propria
Muscularis mucosae
Submucosa
Muscularis externa
Circular layer
Longitudinal layer
Serosa
Areolar tissue
Mesothelium
Slight variations on this theme are found in different regions of
the tract.
The mucosa (mucous membrane), which lines the lumen, consists
of an inner epithelium, a loose connective tissue layer called
the lamina propria, and a thin layer of smooth muscle called the
muscularis mucosae (MUSS-cue-LAIR-is mew-CO-see). The epithelium
is simple columnar in most of the digestive tract, but the
mouth, pharynx, esophagus, and anal canal differ. These upper and
lower ends of the digestive tract are subject to more abrasion than
the stomach and intestines, and thus have a stratified squamous
epithelium. The muscularis mucosae tenses the mucosa, creating grooves and ridges that enhance
its surface area and contact with
food. This improves the efficiency of digestion and nutrient absorption.
The mucosa often exhibits an abundance of lymphocytes
and lymphatic nodulesthe mucosa-associated lymphatic tissue
(MALT) (see p. 646).
The submucosa is a thicker layer of loose connective tissue containing
blood vessels, lymphatic vessels, a nerve plexus, and in some
places, mucous glands. The MALT also extends into the submucosa
in some parts of the GI tract.
The muscularis externa consists of usually two layers of smooth
muscle near the outer surface. Cells of the inner layer encircle the
tract and those of the outer layer run longitudinally. In some places,
the circular layer is thickened to form valves (sphincters) that regulate
the passage of material through the digestive tract. The muscularis
externa is responsible for the motility that propels food and
residue through the tract.
The serosa is composed of a thin layer of areolar tissue topped
by a simple squamous mesothelium. It begins in the lower 3 to 4
cm of the esophagus and ends just before the rectum. The pharynx,
most of the esophagus, and the rectum are surrounded by a fibrous
connective tissue layer called the adventitia (AD-ven-TISH-ah),
which blends into the adjacent connective tissues of other organs.
Innervation
Tongue movements, mastication, and the initial actions of swallowing
employ skeletal muscles innervated by somatic motor fibers
from six of the cranial nerves (V, VII, and IXXII) and from the
ansa cervicalis; these muscles and their innervation are detailed in
table 11.3 (p. 304). The salivary glands are innervated by sympathetic
fibers from the superior cervical ganglion and parasympathetic
fibers from cranial nerves VII and IX (see figs. 15.31, p. 457;
15.33, p. 458; and 16.4, p. 472).
From the lower esophagus to the anal canal, most of the muscle
is smooth muscle (the external anal sphincter is the only exception),
and therefore receives only autonomic innervation. Parasympathetic
innervation dominates the digestive tract and comes
mainly from the vagus nerves, which supply all of the tract from
esophagus to transverse colon. The descending colon and rectum
receive their parasympathetic innervation from pelvic nerves arising
from the inferior hypogastric plexus (see fig. 16.7, p. 476). The
parasympathetic nervous system relaxes sphincter muscles and
stimulates gastrointestinal motility and secretion. Thus, in general,
it promotes digestion.
joint called a gomphosis between the tooth and bone (fig. 24.7). The
alveolus is lined by a periodontal (PERR-ee-oh-DON-tul) ligament,
a modified periosteum whose collagen fibers penetrate into the bone
on one side and into the tooth on the other. This anchors the tooth
firmly in the alveolus, but allows for a slight amount of movement
under the pressure of chewing. The gum, or gingiva (JIN-jih-vuh),
covers the alveolar bone. Regions of a tooth are defined by their relationship
to the gingiva: the crown is the portion above the gum, the
root is the portion inserted into the alveolus below the gum, and the
neck is the line where the crown, root, and gum meet. The space between
the tooth and gum is the gingival sulcus. The hygiene of this
sulcus is especially important to dental health (see Insight 24.1).
Most of a tooth consists of hard yellowish tissue called dentine,
covered with enamel in the crown and cementum in the root.
Dentine and cementum are living connective tissues with cells or
cell processes embedded in a calcified matrix. Cells of the cementum
(cementocytes) are scattered more or less randomly and occupy
tiny cavities similar to the lacunae of bone. Cells of the dentine
(odontoblasts) line the pulp cavity and have slender processes that
travel through tiny parallel tunnels in the dentine. Enamel is not a
tissue but a cell-free secretion produced before the tooth emerges
above the gum. Damaged dentine and cementum can regenerate,
but damaged enamel cannotit must be artificially repaired.
Internally, a tooth has a dilated pulp cavity in the crown and
upper root, and a narrow root canal in the lower root. These spaces
are occupied by pulpa mass of loose connective tissue, blood and
lymphatic vessels, and nerves. These nerves and vessels enter the
tooth through a pore, the apical foramen, at the inferior end of
each root canal.
Tooth and Gum Disease
Food leaves a sticky residue on the teeth called plaque, composed
mainly of bacteria and sugars. If plaque is not thoroughly removed by
brushing and flossing, bacteria accumulate, metabolize the sugars, and
release lactic acid and other acids. These acids dissolve the minerals of
enamel and dentine, and the bacteria enzymatically digest the collagen
and other organic components. The eroded cavities of the tooth are
known as dental caries.12 If not repaired, caries may fully penetrate the
dentine and spread to the pulp cavity. This requires either extraction
of the tooth or root canal therapy, in which the pulp is removed and
replaced with inert material.
When plaque calcifies on the tooth surface, it is called calculus
(tartar). Calculus in the gingival sulcus wedges the tooth and gum
apart and allows bacterial invasion of the sulcus. This leads to gingivitis,
or gum inflammation. Nearly everyone has gingivitis at some time. In
some cases, bacteria spread from the sulcus into the alveolar bone and
begin to dissolve it, producing periodontal disease. About 86% of people
over age 70 have periodontal disease, and many suffer tooth loss as a
result. This accounts for 80% to 90% of adult tooth loss.
The meeting of the teeth when the mouth closes is called occlusion
(ah-CLUE-zhun), and the surfaces where they meet are called
the occlusal surfaces. The occlusal surface of a premolar has two
rounded bumps called cusps; thus the premolars are also known as
bicuspids. The molars have four to five cusps. Cusps of the upper
and lower premolars and molars mesh when the jaws are closed and
slide over each other as the jaw makes lateral chewing motions. This
grinds and tears food more effectively than if the occlusal surfaces
were flat.
Teeth develop beneath the gums and erupt (emerge) in predictable
order. Twenty deciduous teeth (milk teeth or baby teeth)
erupt from the ages of 6 to 30 months, beginning with the incisors
(fig. 24.6a). Between 6 and 25 years of age, these are replaced by 32
permanent teeth. As a permanent tooth grows deep to a deciduous
tooth (fig. 24.8), the root of the deciduous tooth dissolves and
leaves little more than the crown by the time it falls out. The third
molars (wisdom teeth) erupt around ages 17 to 25, if at all. Over
the course of human evolution, the face became flatter and the jaws
shorter, leaving little room for the third molars. Thus, they often
remain below the gum and become impactedso crowded against
neighboring teeth and bone that they cannot erupt.
The Salivary Glands
Saliva moistens the mouth, digests a small amount of starch and
fat, cleanses the teeth, inhibits bacterial growth, dissolves molecules
so they can stimulate the taste buds, and moistens food and binds
particles together to aid in swallowing. It is a solution of 97.0% to
99.5% water and the following solutes:
salivary amylase, an enzyme that begins starch digestion in
the mouth;
lingual lipase, an enzyme that is activated by stomach acid
and digests fat after the food is swallowed;
mucus, which binds and lubricates the food mass and aids in
swallowing;
lysozyme, an enzyme that kills bacteria;
immunoglobulin A (IgA), an antibody that inhibits bacterial
growth; and
electrolytes, including sodium, potassium, chloride,
phosphate, and bicarbonate salts.
There are two kinds of salivary glands, intrinsic and extrinsic. The
Gross Anatomy
The small intestine is a coiled mass filling most of the abdominal
cavity inferior to the stomach and liver. It is divided into three regions:
the duodenum, jejunum, and ileum (fig. 24.14).
The duodenum (dew-ODD-eh-num or DEW-oh-DEE-num)
constitutes the first 25 cm (10 in.). It begins at the pyloric sphincter,
arcs around the head of the pancreas and passes to the left, and ends
at a sharp bend called the duodenojejunal flexure. Its name refers
to its length, about equal to the width of 12 fingers.19 The first 2 cm
of the duodenum is intraperitoneal, but the rest is retroperitoneal,
along with the pancreas.
Internally, the duodenum exhibits transverse to spiral ridges,
up to 10 mm high, called circular folds (plicae circulares) (see fig.
24.20). They cause the chyme to flow on a spiral path along the mucosa,
slowing its progress, causing more contact with the mucosa, and
promoting thorough mixing, digestion, and nutrient absorption.
Adjacent to the head of the pancreas, the duodenal wall has
a prominent wrinkle called the major duodenal papilla where
the bile and pancreatic ducts open into the intestine. This papilla
marks the boundary between the foregut and midgut. In most people,
there is a smaller minor duodenal papilla a little proximal to
this, which receives an accessory pancreatic duct.
The duodenum receives and mixes the stomach contents, pancreatic
juice, and bile. Stomach acid is neutralized here by bicarbonate