BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

Gastrointestinal Anatomy and (Patho)Physiology

Introduction
The digestive system is extremely important, functioning to provide the fuel
which is needed by our body to ensure that our cells function properly, grow,
and are repaired where necessary.
This system consists of the gastrointestinal tract (in its simplest terms, a tube
which starts at the oral cavity and ends at the anus) and the accessory organs
which include the salivary glands, gall bladder, liver and pancreas.
Digestive processes involve ingestion, processing, digestion, secretion,
absorption and excretion, and all of the different elements of the GI system
play specific and important roles in this process.
Case studies are designed to enhance your understanding of basic physiology
covered in lectures and to provide an insight into pathological changes which
may occur in organs or systems, together with their symptoms.
This session is also designed to help you to understand the basic anatomy and
physiology of the human gastrointestinal system, using a virtual cadaver
(Anatomage Table) to explore the spatial and functional relationships between
the structures and organs of the GI tract.
We will use a variety of methods including microscope sections, pathological
specimens, and video clips to demonstrate a range of normal physiological and
pathological aspects of the GI system.

Learning Objectives
By the end of the session you will:
Be familiar with the basic anatomy of the human gastrointestinal system;
Be able to correctly identify the major organs and structures in the
human gastrointestinal tract;
Use physiological knowledge to differentiate between possible
pathophysiological conditions;
Understand how knowledge of plasma enzyme concentrations can aid
diagnosis;
Correlate knowledge of physiological mechanisms with the management
of the patient;
Abstract and summarise data;
Consider how advice on lifestyle, which may be unwelcome, may be
given to patients

Preparation:

Before the tutorial you should:

Read the worksheets carefully;
Use your notes, electronic and library resources and textbooks to answer
the questions as fully as you can;
Bring your completed worksheets to the tutorial/Anatomage session,
where you will discuss the general anatomy, the case study, the
questions and the answers.

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

1. Oral cavity & salivary glands

Introduction
The oral cavity is classed as the start of the digestive tract, receiving food prior
to it passing into the body. The oral cavity has several functions:
to sense and analyse material before allowing it to pass into the body
to mechanical process the food (teeth, tongue, hard & soft palate)
to lubricate material to a consistency suitable for swallowing
to begin the digestive breakdown of food using salivary enzymes.

ANATOMAGE:
View: salivary glands parotid, submandibular and sublingual

LABEL THE DIAGRAM BELOW

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

Complete the tables below:

GLAND

Structure & location

Types of
secretion

Percentage of
saliva
production

Largest salivary gland; located

anterior and inferior to ears;
duct opens into vestibule near
second molar
Located inferior to the floor of
the oral cavity; duct opens
lateral to the lingual frenulum
Smallest salivary gland; located
inferior to tongue; ducts open
into floor of oral cavity

Saliva characteristics
Production rate
Solute components pH range &
composition
.. litres per day

..

Slightly .

..

pH

..

% water

Ions:
..

% solutes

..

..

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

(McKinley, OLoughlin & Bidle: Anatomy & Physiology: An Integrative Approach)

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

2. Swallowing & oesophagus

Introduction
The oral cavity is connected to the stomach by the PHARYNX and OESOPHAGUS
The pharynx is a passageway for both air (to lungs) and food, while the
oesophagus is connected directly to the stomach.
The process of swallowing involves a complex sequence of integrated muscular
movements designed to propel food and fluids from the mouth to the stomach,
whilst avoiding contamination of the airways.
See this link for a demonstration of the mechanism of swallowing
(deglutition): http://www.youtube.com/watch?v=wqMCzuIiPaM

Phases of swallowing:
a.

PHASE

As food is moved around the mouth, the tongue

and teeth work together to begin to break down
the food and to combine it with saliva to form a
bolus (mass).
The tongue moves this bolus along its midline
to the rear of the mouth. At this stage, the
airways are open, allowing air from the nose
past the larynx to the lungs. The upper
oesophageal sphincter is closed.

b.
PHASE
As the bolus is moved to the back of the mouth,
the nasopharynx is closed off by the soft
palate, to inhibit breathing and to avoid the
food travelling upwards. The bolus moves into
the pharynx.

c.

PHASE

Once the food begins to move down through

the pharynx, towards the oesophagus, the
epiglottis falls back and down to cover the
larynx, stopping the bolus from travelling into
the trachea/airways. The glottis (larynx) also
closes to provide a further barrier and to inhibit
respiration.
The constrictor muscles of the oesophagus
push the bolus into the oesophagus as the
upper oesophageal sphincter relaxes, and the
bolus then continues down the oesophagus by
peristaltic movements of the oesophageal
muscles, to the stomach.

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

3. Stomach
Introduction
The stomach is a J-shaped organ containing numerous gastric folds on its
interior surface, which allow the stomach to expand when filled. Within the
stomach, mechanical and chemical digestion of food continues (the digestion of
proteins and fats begins in the stomach).
Label the diagram:

See this link for a demonstration of the

mechanism of peristalsis in the gastric
antrum: http://www.youtube.com/watch?
v=hpS5kMn_B0I

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

4. Intestines
Small intestine: Divided into three segments, it is approximately 6m in
length in a cadaver (shorter in the living body due to muscle tone). The small
intestine extends from the pylorus of the stomach to the cecum of the large
bowel and so occupies a large portion of the abdominal cavity.
a.
: extends approx. 0.25m from the pyloric sphincter.
b.
: extends approx. 2.5m and is the primary region for
chemical digestion and nutrient absorption.
c.
: extends approx. 3.5m to the cecum.
Duodenal peristaltic waves (not human): http://www.youtube.com/watch?
v=jn0QIlaDVYs&feature=relmfu

Large intestine:

Extends approximately 1.5m from the iliocecal junction to the anus. Specialised
longitudinal bundles of smooth muscle known as
can be
seen on the colon, which when contracted, act like draw-strings to bunch up
the colon in its characteristic sacs.
a.
: the ileum is connected to a relatively small sac (cecum),
the base (closed end) of which extends into the lower right quadrant of
the abdomen. The appendix can be found at the bottom end of the
cecum. The top of the cecum, at the level of the ileocecal junction,
becomes the colon.
b.
: portioned into 4 sections which form an inverted U shape.
Consists of the ascending colon; transverse colon; descending colon;
sigmoid colon
c.
: muscular tube which expands to store faecal matter prior
to defecation.
Peristalsis in the large bowel: http://www.youtube.com/watch?
v=Ujr0UAbyPS4

Blood supply of the GI tract:

Main arterial
vessel

Branches

Supplies:

Venous drainage from:

Stomach
Spleen
Transverse colon

Branches

Stomach
Spleen
Liver
Transverse colon
Ascending colon
Small intestines
Cecum & appendix
Transverse colon
Descending colon
Sigmoid colon
Rectum

Main venous
drainage

BIS4009-B Human Physiology

Ascending colon
Small intestines
Cecum & appendix
Descending colon
Sigmoid colon
Rectum

Tutorial/Anatomage Session 1: GI system

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

Use the Anatomage Table to study the structures and positions of the intestines
and their blood supply:
LABEL THE DIAGRAMS

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

5. LIVER
The liver is the largest internal organ, and is comprised of 2 major lobes right
(larger) and left. It has many important functions, but in relation to digestive
processes, its most important role is in the production of bile.
BASIC ANATOMY OF THE LIVER

MICROANATOMY OF THE LIVER

The liver is formed from thousands of units known as
the structural and functional units of the liver.

these are

A
C

Photomicrograph showing a liver lobule (left) and a portal triad (right). A) bile ductule; B) branch o

LIVER PATHOLOGY CIRRHOSIS

Cirrhosis is the result of the destruction of healthy liver cells, and their
replacement with scar tissue. The formation of the scar tissue may also
compress the blood vessels (resulting in
) and bile ducts,
impeding bile flow.
Cirrhosis may be caused by liver diseases such as hepatitis, chronic alcoholism,
or specific drugs/toxins.
The image below shows the difference between the surface anatomy of a
healthy liver and a specimen with cirrhosis.

BIS4009-B Human Physiology

Hepatic blood supply

Tutorial/Anatomage Session 1: GI system

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

6. GALL BLADDER
The gall bladder is attached to the surface of the liver and stores, concentrates
and releases the bile produced by the liver, which is then used in the digestion
of fats.

7. PANCREAS

The pancreas has a number of different endocrine and exocrine functions.

cells (acinar cells) produce digestive chemicals (pancreatic juice)
cells produce and secret hormones such as insulin and glucagon.

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

Case Study: Introduction

Pancreatitis is an inflammation of the pancreas. It can arise from blockage of
excretory ducts, viral or bacterial infection or from the adverse actions of
alcohol on the pancreatic exocrine cells.
Alcohol consumption is increasing among young people; the incidence of
pancreatitis can also be expected to increase. The damaged cells release
enzymes which begin autodigestion; this affects surrounding ceils which are
also damaged and a chain reaction starts. If only a portion of the pancreas is
involved, the condition calms down in a few days (acute pancreatitis).
However, in a minority of patients the condition persists and may eventually
destroy the pancreatic tissue (chronic pancreatitis).

Part 1: History
A 22 year oId woman was admitted to hospital because of nausea, vomiting,
fever and severe abdominal pain. She stated that she had felt well until 3 days
prior to hospitalisation, when her symptoms came on acutely. The patient
stated that she routinely consumed large quantities of alcohol and that she had
drunk more than usual during the preceding 2 weeks. In addition, she reported
that a man whom she had dated several months before had recently been
hospitalised for hepatitis.
A tentative diagnosis of acute infectious hepatitis was made. However, on
physical examination, the patient did not appear to be jaundiced, and a urine
specimen was normal in colour. The bile duct and gall bladder appeared normal
and there was no history of peptic ulcer. Biochemical tests were performed in
the laboratory and the serum amylase activity was found to be markedly
increased above normal, as was the serum lipase. Plasma biIirubin was not
increased above normal values, and the serum levels of several liver enzymes
were also within normal ranges.
Significant physical findings were limited to the abdomen, which was rigid to
palpation. There was tenderness (pain) when the epigastrium was firmly
pressed: when the examiners hand was suddenly removed, the pain was
momentarily increased (rebound tenderness). The patient was admitted, with
orders that she be given nothing by mouth. An intravenous catheter was
inserted, and she was given a solution of glucose and saline intravenously.

Questions
1. Which digestive enzymes are normally produced by the pancreas?

2. How would digestion and absorption be affected if the enzymes

normally produced by the pancreas were lacking?

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

3. Why was the patient given nothing by mouth?

4. What hormones are normally produced by the pancreas?

5. Why was a solution of glucose and saline given intravenously?

Part 2
The diagram (below) shows the time course of change in concentration of two
pancreatic enzymes in blood during acute pancreatitis. Note that the
concentrations of the two enzymes in the blood do not return towards normal
at the same rate, changes in amylase concentration are particularly prominent.

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

Questions
6. What are the major ionic components of pancreatic secretion?

7. What factors normally control pancreatic exocrine and endocrine

secretion?

8. Why do you think the blood amylase and lipase concentration was
increased during this illness?

9. From the case history presented in Part 1 and the diagram above,
make a summary of the points which suggest the patient was
suffering from pancreatitis rather than hepatitis.

BIS4009-B Human Physiology

Tutorial/Anatomage Session 1: GI system

Part 3
Patients who have an isolated, though severe, attack of pancreatitis usually
make a full recovery
Questions
10. What advice would you give the patient to promote health and
reduce the probability of a further attack of pancreatitis?

11. If the pancreas is damaged and there is only partial recovery of

function, what treatment may the patient require?

REFERENCES:
McKinley, OLoughlin & Bidle (2013) Anatomy & Physiology: An Integrated
Approach. McGraw-Hill, chapter 26; p 1014-1061
Montgomery, Dryer, Conway & Spector (1980) Biochemistry: A case oriented
approach; Mosby Press, 3rd edition, 140-142