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HumandigestivesystemWikipedia

Humandigestivesystem
FromWikipedia,thefreeencyclopedia

Thehumandigestivesystemconsistsofthegastrointestinaltractplustheaccessoryorgansofdigestion(the
tongue,salivaryglands,pancreas,liver,andgallbladder).Inthissystem,theprocessofdigestionhasmany
stages,thefirstofwhichstartsinthemouth(oralcavity).Digestioninvolvesthebreakdownoffoodintosmaller
andsmallercomponents,untiltheycanbeabsorbedandassimilatedintothebody.Thesecretionofsalivahelps
toproduceaboluswhichcanbeswallowedtopassdowntheesophagusandintothestomach.

Humandigestivesystem

Salivaalsocontainsacatalyticenzymecalledamylasewhichstartstoactonfoodinthemouth.Another
digestiveenzymecalledlinguallipaseissecretedbysomeofthelingualpapillaeonthetongueandalsofrom
serousglandsinthemainsalivaryglands.Digestionishelpedbythemasticationoffoodbytheteethandalsoby
themuscularactionsofperistalsisandsegmentationcontractions.Gastricjuiceinthestomachisessentialforthe
continuationofdigestionasistheproductionofmucusinthestomach.
Peristalsisistherhythmiccontractionofmusclesthatbeginsintheesophagusandcontinuesalongthewallof
thestomachandtherestofthegastrointestinaltract.Thisinitiallyresultsintheproductionofchymewhich
whenfullybrokendowninthesmallintestineisabsorbedaschyleintothelymphaticsystem.Mostofthe
digestionoffoodtakesplaceinthesmallintestine.Waterandsomemineralsarereabsorbedbackintotheblood
inthecolonofthelargeintestine.Thewasteproductsofdigestion(faeces)aredefecatedfromtheanusviathe
rectum.
Humandigestivesystem

Contents
1 Components
1.1 Mouth
1.1.1 Salivaryglands
1.1.1.1 Saliva
1.1.2 Tongue
1.1.2.1 Taste
1.1.3 Teeth
1.1.4 Epiglottis
1.2 Pharynx
1.3 Esophagus
1.4 Diaphragm
1.5 Stomach
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Details
Identifiers
Latin Systemadigestorium
MeSH D004064(https://www.nlm.nih.gov/cgi/mes
h/2011/MB_cgi?mode=&term=Digestive+S
ystem)
TA

05.0.00.000(http://www.unifr.ch/ifaa/Publi
c/EntryPage/TA98%20Tree/Entity%20TA9
8%20EN/5.0.00.000%20Entity%20TA98%
20EN.htm)
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2
3
4
5
6

1.5 Stomach
1.6 Spleen
1.7 Liver
1.7.1 Bile
1.7.2 Gallbladder
1.8 Pancreas
1.9 Lowergastrointestinaltract
1.9.1 Smallintestine
1.9.2 Cecum
1.9.3 Largeintestine
Bloodsupply
Nervesupply
Clinicalsignificance
4.1 Inpregnancy
Seealso
References

FMA 7152(http://xiphoid.biostr.washington.edu/
fma/fmabrowserhierarchy.html?fmaid=715
2)
Anatomicalterminology
[editonWikidata]

Components
Thereareseveralorgansandothercomponentsinvolvedinthedigestionoffood.Theorgansknownastheaccessorydigestiveglandsaretheliver,gallbladder
andpancreas.Othercomponentsincludethemouth,salivaryglands,tongue,teethandepiglottis.
Thelargeststructureofthedigestivesystemisthegastrointestinaltract(GItract).Thisstartsatthemouthandendsattheanus,coveringadistanceofaboutnine
(9)metres.[1]
ThelargestpartoftheGItractisthecolonorlargeintestine.Waterisabsorbedhereandremainingwastematterisstoredpriortodefecation.[2]
Mostofthedigestionoffoodtakesplaceinthesmallintestine.
Amajordigestiveorganisthestomach.Withinitsmucosaaremillionsofembeddedgastricglands.Theirsecretionsarevitaltothefunctioningoftheorgan.
TherearemanyspecialisedcellsoftheGItract.Theseincludethevariouscellsofthegastricglands,tastecells,pancreaticductcells,enterocytesandmicrofold
cells.

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Historicaldepictionofthedigestive
system,17thcenturyPersia

Mouth
Themouthisthefirstpartofthegastrointestinaltractandisequippedwithseveralstructuresthatbeginthefirstprocessesofdigestion.[3]Theseincludesalivary
glands,teethandthetongue.Themouthconsistsoftworegions,thevestibuleandtheoralcavityproper.Thevestibuleistheareabetweentheteeth,lipsand
cheeks,[4]andtherestistheoralcavityproper.Mostoftheoralcavityislinedwithoralmucosa,amucousmembranethatproducesalubricatingmucus,ofwhich
onlyasmallamountisneeded.Mucousmembranesvaryinstructureinthedifferentregionsofthebodybuttheyallproducealubricatingmucus,whichiseither
secretedbysurfacecellsormoreusuallybyunderlyingglands.Themucousmembraneinthemouthcontinuesasthethinmucosawhichlinesthebasesofthe
teeth.Themaincomponentofmucusisaglycoproteincalledmucinandthetypesecretedvariesaccordingtotheregioninvolved.Mucinisviscous,clear,and
clinging.Underlyingthemucousmembraneinthemouthisathinlayerofsmoothmuscletissueandthelooseconnectiontothemembranegivesititsgreat
elasticity.[5]Itcoversthecheeks,innersurfacesofthelips,andfloorofthemouth.[6]:1186
Theroofofthemouthistermedthepalateanditseparatestheoralcavityfromthenasalcavity.Thepalateishardatthefrontofthemouthsincetheoverlying
mucosaiscoveringaplateofboneitissofterandmorepliableatthebackbeingmadeofmuscleandconnectivetissue,anditcanmovetoswallowfoodand
liquids.Thesoftpalateendsattheuvula.[7]Thesurfaceofthehardpalateallowsforthepressureneededineatingfood,toleavethenasalpassageclear.[8]Thelips
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arethemouth'sfrontboundaryandthefauces(thepassagewaybetweenthetonsils,alsocalledthethroat),[6]:686markitsposteriorboundary.Ateithersideofthe
softpalatearethepalatoglossusmuscleswhichalsoreachintoregionsofthetongue.Thesemusclesraisethebackofthetongueandalsoclosebothsidesofthe
faucestoenablefoodtobeswallowed.[6]:1208Mucushelpsinthemasticationoffoodinitsabilitytosoftenandcollectthefoodintheformationofthebolus.
Salivaryglands
Therearethreepairsofmainsalivaryglandsandbetween800and1,000minorsalivaryglands,allofwhichmainlyservethe
digestiveprocess,andalsoplayanimportantroleinthemaintenanceofdentalhealthandgeneralmouthlubrication,without
whichspeechwouldbeimpossible.[9]Themainglandsareallexocrineglands,secretingviaducts.Alloftheseglands
terminateinthemouth.Thelargestofthesearetheparotidglandstheirsecretionismainlyserous.Thenextpairare
underneaththejaw,thesubmandibularglands,theseproducebothserousfluidandmucus.Theserousfluidisproducedby
serousglandsinthesesalivaryglandswhichalsoproducelinguallipase.Theyproduceabout70%oftheoralcavitysaliva.
Thethirdpairarethesublingualglandslocatedunderneaththetongueandtheirsecretionismainlymucouswithasmall
percentageofsaliva.
Withintheoralmucosa(amucousmembrane)liningthemouthandalsoonthetongueandpalatesandmouthfloor,arethe
minorsalivaryglandstheirsecretionsaremainlymucousandareinnervatedbythefacialnerve(theseventhcranialnerve).[10]
Theglandsalsosecreteamylaseafirststageinthebreakdownoffoodactingonthecarbohydrateinthefoodtotransformthe
starchcontentintomaltose.Thereareotherglandsonthesurfaceofthetonguethatencircletastebudsonthebackpartofthe
tongueandthesealsoproducelinguallipase.Lipaseisadigestiveenzymethatcatalysesthehydrolysisoflipids(fats).These
glandsaretermedVonEbner'sglandswhichhavealsobeenshowntohaveanotherfunctioninthesecretionofhistatinswhich
Oralcavity
offeranearlydefense(outsideoftheimmunesystem)againstmicrobesinfood,whenitmakescontactwiththeseglandson
thetonguetissue.[9][11]Sensoryinformationcanstimulatethesecretionofsalivaprovidingthenecessaryfluidforthetongueto
workwithandalsotoeaseswallowingofthefood.
Saliva

Salivafunctionsinitiallyinthedigestivesystemtomoistenandsoftenfoodintotheformationofabolus.Thebolusisfurtherhelpedbythelubricationprovided
bythesalivainitspassagefromthemouthintotheesophagus.Alsoofimportanceisthepresenceinsalivaofthedigestiveenzymesamylaseandlipase.Amylase
startstoworkonthestarchincarbohydrates,breakingitdownintothesimplesugarsofmaltoseanddextrosethatcanbefurtherbrokendowninthesmall
intestine.Salivainthemouthcanaccountfor30%ofthisinitialstarchdigestion.Lipasestartstoworkonbreakingdownfats.Lipaseisfurtherproducedinthe
pancreaswhereitisreleasedtocontinuethisdigestionoffats.Thepresenceofsalivarylipaseisofprimeimportanceinyoungbabieswhosepancreaticlipasehas
yettobedeveloped.[12]

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Aswellasitsroleinsupplyingdigestiveenzymes,salivahasacleansingactionfortheteethandmouth.[13]Italsohasanimmunologicalroleinsupplying
antibodiestothesystem,suchasimmunoglobulinA.[14]Thisisseentobekeyinpreventinginfectionsofthesalivaryglands,importantlythatofparotitis.
SalivaalsocontainsaglycoproteincalledhaptocorrinwhichisabindingproteintovitaminB12.[15]Itbindswiththe
vitamininordertocarryitsafelythroughtheacidiccontentofthestomach.Whenitreachestheduodenum,pancreatic
enzymesbreakdowntheglycoproteinandfreethevitaminwhichthenbindswithintrinsicfactor.
Tongue
Foodentersthemouthwherethefirststageinthedigestiveprocesstakesplace,withtheactionofthetongueandthe
secretionofsaliva.Thetongueisafleshyandmuscularsensoryorgan,andtheveryfirstsensoryinformationisreceived
viathetastebudsonitssurface.Ifthetasteisagreeablethetonguewillgointoaction,manipulatingthefoodinthe
mouthwhichstimulatesthesecretionofsalivafromthesalivaryglands.Theliquidqualityofthesalivawillhelpinthe
softeningofthefoodanditsenzymecontentwillstarttobreakdownthefoodwhilstitisstillinthemouth.Thefirstpart
ofthefoodtobebrokendownisthestarchofcarbohydrates.Thetongueisattachedtothefloorofthemouthbya
ligamentousbandcalledthefrenum[16]andthisgivesitgreatmobilityforthemanipulationoffood(andspeech)the
rangeofmanipulationisoptimallycontrolledbytheactionofseveralmusclesandlimitedinitsexternalrangebythe
stretchofthefrenum.Thetongue'stwosetsofmuscles,arefourintrinsicmusclesthatoriginateinthetongueandareinvolvedwithitsshaping,andfourextrinsic
musclesoriginatinginbonethatareinvolvedwithitsmovement.
Taste

Tasteisaformofchemoreceptionthattakesplaceinthespecialisedtastereceptors,containedinstructurescalledtastebuds
inthemouth.Tastebudsaremainlyontheuppersurface(dorsum)ofthetongue.Thefunctionoftasteperceptionisvitalto
helppreventharmfulorrottenfoodsfrombeingconsumed.Therearealsotastebudsontheepiglottisandupperpartofthe
esophagus.Thetastebudsareinnervatedbyabranchofthefacialnervethechordatympani,andtheglossopharyngeal
nerve.Tastemessagesaresentviathesecranialnervestothebrain.Thebraincandistinguishbetweenthechemical
qualitiesofthefood.Thefivebasictastesarereferredtoasthoseofsaltiness,sourness,bitterness,sweetness,andumami.
Thedetectionofsaltinessandsournessenablesthecontrolofsaltandacidbalance.Thedetectionofbitternesswarnsof
Crosssectionofcircumvallatepapilla
poisonsmanyofaplant'sdefencesareofpoisonouscompoundsthatarebitter.Sweetnessguidestothosefoodsthatwill
showingarrangementofnervesand
supplyenergytheinitialbreakdownoftheenergygivingcarbohydratesbysalivaryamylasecreatesthetasteofsweetness
tastebuds
sincesimplesugarsarethefirstresult.Thetasteofumamiisthoughttosignalproteinrichfood.Sourtastesareacidic
whichisoftenfoundinbadfood.Thebrainhastodecideveryquicklywhetherthefoodshouldbeeatenornot.Itwasthe
findingsin1991,describingthefirstolfactoryreceptorsthathelpedtoprompttheresearchintotaste.Theolfactoryreceptorsarelocatedoncellsurfacesinthe
nosewhichbindtochemicalsenablingthedetectionofsmells.Itisassumedthatsignalsfromtastereceptorsworktogetherwiththosefromthenose,toforman
ideaofcomplexfoodflavours.[17]
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Teeth
Teetharecomplexstructuresmadeofmaterialsspecifictothem.Theyaremadeofabonelikematerialcalleddentin,whichiscoveredbythehardesttissueinthe
bodyenamel.[18]Teethhavedifferentshapestodealwithdifferentaspectsofmasticationemployedintearingandchewingpiecesoffoodintosmallerand
smallerpieces.Thisresultsinamuchlargersurfaceareafortheactionofdigestiveenzymes.Theteetharenamedaftertheirparticularrolesintheprocessof
masticationincisorsareusedforcuttingorbitingoffpiecesoffoodcanines,areusedfortearing,premolarsandmolarsareusedforchewingandgrinding.
Masticationofthefoodwiththehelpofsalivaandmucusresultsintheformationofasoftboluswhichcanthenbeswallowedtomakeitswaydowntheupper
gastrointestinaltracttothestomach.[19]Thedigestiveenzymesinsalivaalsohelpinkeepingtheteethcleanbybreakingdownanylodgedfoodparticles.
Epiglottis
Theepiglottisisaflapthatismadeofelasticcartilageandattachedtotheentranceofthelarynx.Itiscoveredwithamucous
membraneandtherearetastebudsonitslingualsurfacewhichfacesintothemouth.[20]Itslaryngealsurfacefacesintothe
larynx.Theepiglottisfunctionstoguardtheentranceoftheglottis,theopeningbetweenthevocalfolds.Itisnormallypointed
upwardduringbreathingwithitsundersidefunctioningaspartofthepharynx,butduringswallowing,theepiglottisfolds
downtoamorehorizontalposition,withitsuppersidefunctioningaspartofthepharynx.Inthismanneritpreventsfoodfrom
goingintothetracheaandinsteaddirectsittotheesophagus,whichisposterior.Duringswallowing,thebackwardmotionof
thetongueforcestheepiglottisovertheglottis'openingtopreventanyfoodthatisbeingswallowedfromenteringthelarynx
whichleadstothelungsthelarynxisalsopulledupwardstoassistthisprocess.Stimulationofthelarynxbyingestedmatter
producesastrongcoughreflexinordertoprotectthelungs.

Pharynx
Thepharynxisapartoftheconductingzoneoftherespiratorysystemandalsoapartofthedigestivesystem.Itisthepartof
thethroatimmediatelybehindthenasalcavityatthebackofthemouthandabovetheesophagusandlarynx.Thepharynxis
madeupofthreeparts.Thelowertwopartstheoropharynxandthelaryngopharynxareinvolvedinthedigestivesystem.The
laryngopharynxconnectstotheesophagusanditservesasapassagewayforbothairandfood.Airentersthelarynxanteriorly
butanythingswallowedhaspriorityandthepassageofairistemporarilyblocked.Thepharynxisinnervatedbythe
pharyngealplexusofthevagusnerve.[21]Musclesinthepharynxpushthefoodintotheesophagus.Thepharynxjoinstheesophagusattheoesophagealinlet
whichislocatedbehindthecricoidcartilage.

Esophagus
Theesophaguscommonlyknownasthegullet,isanorganwhichconsistsofamusculartubethroughwhichfoodpassesfromthepharynxtothestomach.The
esophagusiscontinuouswiththelaryngealpartofthepharynx.Itpassesthroughtheposteriormediastinuminthethoraxandentersthestomachthroughaholein
thethoracicdiaphragmtheesophagealhiatus|,atthelevelofthetenththoracicvertebra(T10).Itslengthaverages25cm,varyingwithheight.Itisdividedinto
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cervical,thoracicandabdominalparts.Thepharynxjoinstheesophagusattheesophagealinletwhichisbehindthecricoidcartilage.
Atresttheesophagusisclosedatbothends,bytheupperandloweresophagealsphincters.Theopeningoftheuppersphincteristriggeredbytheswallowing
reflexsothatfoodisallowedthrough.Thesphincteralsoservestopreventbackflowfromtheesophagusintothepharynx.Theesophagushasamucous
membraneandtheepitheliumwhichhasaprotectivefunctioniscontinuouslyreplacedduetothevolumeoffoodthatpassesinsidetheesophagus.During
swallowing,foodpassesfromthemouththroughthepharynxintotheesophagus.Theepiglottisfoldsdowntoamorehorizontalpositionsoastopreventfood
fromgoingintothetrachea,insteaddirectingittotheesophagus.
Onceintheesophagus,thebolustravelsdowntothestomachviarhythmiccontractionandrelaxationofmusclesknownasperistalsis.Theloweresophageal
sphincterisamuscularsphinctersurroundingthelowerpartoftheesophagus.Thejunctionbetweentheesophagusandthestomach(thegastroesophageal
junction)iscontrolledbytheloweresophagealsphincter,whichremainsconstrictedatalltimesotherthanduringswallowingandvomitingtopreventthecontents
ofthestomachfromenteringtheesophagus.Astheesophagusdoesnothavethesameprotectionfromacidasthestomach,anyfailureofthissphinctercanleadto
heartburn.Theesophagushasamucousmembraneofepitheliumwhichhasaprotectivefunctionaswellasprovidingasmoothsurfaceforthepassageoffood.
Duetothehighvolumeoffoodthatispassedovertime,thismembraneiscontinuouslyrenewed.

Diaphragm
Thediaphragmisanimportantpartofthebody'sdigestivesystem.Thediaphragmseparatesthethoraciccavityfromtheabdominalcavitywheremostofthe
digestiveorgansarelocated.Thesuspensorymuscleattachestheascendingduodenumtothediaphragm.Thismuscleisthoughttobeofhelpinthedigestive
systeminthatitsattachmentoffersawiderangletotheduodenojejunalflexurefortheeasierpassageofdigestingmaterial.Thediaphragmalsoattachestothebare
areaoftheliver,whichitanchors.TheesophagusenterstheabdomenthroughaholeinthediaphragmatthelevelofT10.

Stomach
Thestomachisamajororganofthegastrointestinaltractanddigestivesystem.ItisaconsistentlyJshapedorganjoinedtotheesophagusatitsupperendandto
theduodenumatitslowerend.Gastricacid(informallygastricjuice),producedinthestomachplaysavitalroleinthedigestiveprocess,andmainlycontains
hydrochloricacidandsodiumchloride.Apeptidehormone,gastrin,producedbyGcellsinthegastricglands,stimulatestheproductionofgastricjuicewhich
activatesthedigestiveenzymes.Pepsinogenisaprecursorenzyme(zymogen)producedbythegastricchiefcells,andgastricacidactivatesthistotheenzyme
pepsinwhichbeginsthedigestionofproteins.Asthesetwochemicalswoulddamagethestomachwall,mucusissecretedbyinnumerablegastricglandsinthe
stomach,toprovideaslimyprotectivelayeragainstthedamagingeffectsofthechemicals.
Atthesametimethatproteinisbeingdigested,mechanicalchurningoccursthroughtheactionofperistalsis,wavesofmuscularcontractionsthatmovealongthe
stomachwall.Thisallowsthemassoffoodtofurthermixwiththedigestiveenzymes.Gastriclipasesecretedbythechiefcellsinthefundicglandsinthegastric
mucosaofthestomach,isanacidiclipase,incontrastwiththealkalinepancreaticlipase.Thisbreaksdownfatstosomedegreethoughisnotasefficientasthe
pancreaticlipase.

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Thepylorus,thelowestsectionofthestomachwhichattachestotheduodenumvia
thepyloriccanal,containscountlessglandswhichsecretedigestiveenzymes
includinggastrin.Afteranhourortwo,athicksemiliquidcalledchymeis
produced.Whenthepyloricsphincter,orvalveopens,chymeenterstheduodenum
whereitmixesfurtherwithdigestiveenzymesfromthepancreas,andthenpasses
throughthesmallintestine,wheredigestioncontinues.Whenthechymeisfully
digested,itisabsorbedintotheblood.95%ofabsorptionofnutrientsoccursinthe
smallintestine.Waterandmineralsarereabsorbedbackintothebloodinthecolon
ofthelargeintestine,wheretheenvironmentisslightlyacidic.Somevitamins,such
asbiotinandvitaminKproducedbybacteriainthegutfloraofthecolonarealso
absorbed.

Theparietalcellsinthefundusofthestomach,produceaglycoproteincalledintrinsicfactorwhichisessentialforthe
absorptionofvitaminB12.VitaminB12(cobalamin),iscarriedto,andthroughthestomach,boundtoaglycoprotein
secretedbythesalivaryglandstranscobalaminIalsocalledhaptocorrin,whichprotectstheacidsensitivevitaminfrom
theacidicstomachcontents.Onceinthemoreneutralduodenum,pancreaticenzymesbreakdowntheprotective
glycoprotein.ThefreedvitaminB12thenbindstointrinsicfactorwhichisthenabsorbedbytheenterocytesinthe
ileum.
Thestomachisadistensibleorganandcannormallyexpandtoholdaboutonelitreoffood.[22]Thisexpansionis
enabledbyaseriesofgastricfoldsintheinnerwallsofthestomach.Thestomachofanewbornbabywillonlybeable
toexpandtoretainabout30ml.

Spleen
Thespleenbreaksdownbothredandwhitebloodcellsthatarespent.Thisiswhyitissometimesknownasthe'graveyardofredbloodcells'.Aproductofthis
digestionisthepigmentbilirubin,whichissenttotheliverandsecretedinthebile.Anotherproductisiron,whichisusedintheformationofnewbloodcellsin
thebonemarrow.[5]Westernmedicinetreatsthespleensolelyasbelongingtothelymphaticsystem,thoughitisacknowledgedthatthefullrangeofitsimportant
functionsisnotyetunderstood.[23]Incontrasttothisview,traditionalChinesemedicineseesthespleentobeofcentralimportanceinthedigestivesystem.The
roleofthespleenisseentoaffectthehealthandvitalityofthebodyinitsturningofdigestedmaterialfromthestomachintousablenutrientsandenergy.
Symptomsthatincludepoorappetite,indigestion,bloatingandjaundice,areseentobeindicationsofanimbalanceinthespleen.Thespleenisfurtherseentoplay
apartinthemetabolismofwater,inriddingthebodyofexcessfluid.[24]Inthewest,thespleenisseentobepairedwiththestomachbutinChinesemedicine,
referenceismadetothespleensystem,whichinvolvesthepancreas.FluidsinthebodyareseenintraditionalChinesemedicinetobeunderthecontrolofthe
spleen.Fluidsincludedigestiveenzymes,saliva,mucus,fluidinthejoints,tears,sweatandurine.Theyarecategorisedasthinandthickandtogethertheyareseen
asnourishingalltissuesandorgans.Inacupuncturetwowidelyusedacupuncturepointsthestomach,(closetotheknee)andthespleen,(halfwaydownfromthe
knee)havelongbeenseentobeconnectedandinvolvedindigestiveissues.
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Liver
Theliveristhesecondlargestorgan(aftertheskin)
andisanaccessorydigestiveglandwhichplaysarole
inthebody'smetabolism.Theliverhasmany
functionssomeofwhichareimportanttodigestion.
Thelivercandetoxifyvariousmetabolitessynthesise
proteinsandproducebiochemicalsneededfor
digestion.Itregulatesthestorageofglycogenwhichit
canformfromglucose(glycogenesis).Thelivercan
alsosynthesiseglucosefromcertainaminoacids.Its
digestivefunctionsarelargelyinvolvedwiththe
breakingdownofcarbohydrates.Italsomaintains
proteinmetabolisminitssynthesisanddegradation.In
lipidmetabolismitsynthesisescholesterol.Fatsare
alsoproducedintheprocessoflipogenesis.Theliver
synthesisesthebulkoflipoproteins.Theliverislocatedintheupperrightquadrantoftheabdomenandbelowthediaphragmtowhichitisattachedatonepart,
Thisistotherightofthestomachanditoverliesthegallbladder.Theliverproducesbile,animportantalkalinecompoundwhichaidsdigestion.
Bile
Bileproducedbytheliverismadeupofwater(97%),bilesalts,mucusandpigments,1%fatsandinorganicsalts.[25]Bilirubinisitsmajorpigment.Bileacts
partlyasasurfactantwhichlowersthesurfacetensionbetweeneithertwoliquidsorasolidandaliquidandhelpstoemulsifythefatsinthechyme.Foodfatis
dispersedbytheactionofbileintosmallerunitscalledmicelles.Thebreakingdownintomicellescreatesamuchlargersurfaceareaforthepancreaticenzyme,
lipasetoworkon.Lipasedigeststhetriglycerideswhicharebrokendownintotwofattyacidsandamonoglyceride.Thesearethenabsorbedbyvillionthe
intestinalwall.Iffatsarenotabsorbedinthiswayinthesmallintestineproblemscanariselaterinthelargeintestinewhichisnotequippedtoabsorbfats.Bile
alsohelpsintheabsorptionofvitaminKfromthediet.Bileiscollectedanddeliveredthroughthecommonhepaticduct.Thisductjoinswiththecysticductto
connectinacommonbileductwiththegallbladder.Bileisstoredinthegallbladderforreleasewhenfoodisdischargedintotheduodenumandalsoafterafew
hours.[26]
Gallbladder
Thegallbladderisahollowpartofthebiliarysystemthatsitsjustbeneaththeliver,withthegallbladderbodyrestinginasmalldepression.[27]Itisasmallorgan
wherethebileproducedbytheliverisstored,beforebeingreleasedintothesmallintestine.Bileflowsfromtheliverthroughthebileductsandintothegall
bladderforstorage.Thebileisreleasedinresponsetocholecystokinin(CKK)apeptidehormonereleasedfromtheduodenum.TheproductionofCKK(by
endocrinecellsoftheduodenum)isstimulatedbythepresenceoffatintheduodenum.[28]
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Itisdividedintothreesections,afundus,bodyandneck.Thenecktapersandconnectstothebiliarytreeviathecysticduct,whichthenjoinsthecommonhepatic
ducttoformthecommonbileduct.AtthisjunctionisamucosalfoldcalledHartmann'spouch,wheregallstonescommonlygetstuck.Themuscularlayerofthe
bodyisofsmoothmuscletissuethathelpsthegallbladdercontract,sothatitcandischargeitsbileintothebileduct.Thegallbladderneedstostorebileina
natural,semiliquidformatalltimes.Hydrogenionssecretedfromtheinnerliningofthegallbladderkeepthebileacidicenoughtopreventhardening.Todilute
thebile,waterandelectrolytesfromthedigestionsystemareadded.Also,saltsattachthemselvestocholesterolmoleculesinthebiletokeepthemfrom
crystallising.Ifthereistoomuchcholesterolorbilirubininthebile,orifthegallbladderdoesn'temptyproperlythesystemscanfail.Thisishowgallstonesform
whenasmallpieceofcalciumgetscoatedwitheithercholesterolorbilirubinandthebilecrystallisesandformsagallstone.Themainpurposeofthegallbladderis
tostoreandreleasebile,orgall.Bileisreleasedintothesmallintestineinordertohelpinthedigestionoffatsbybreakingdownlargermoleculesintosmaller
ones.Afterthefatisabsorbed,thebileisalsoabsorbedandtransportedbacktotheliverforreuse.

Pancreas
Thepancreasisamajororganfunctioningasanaccessorydigestiveglandinthe
digestivesystem.Itisbothanendocrineglandandanexocrinegland.[29]The
endocrinepartsecretesinsulinwhenthebloodsugarbecomeshighinsulinmoves
glucosefromthebloodintothemusclesandothertissuesforuseasenergy.The
endocrinepartreleasesglucagonwhenthebloodsugarislowglucagonallows
storedsugartobebrokendownintoglucosebytheliverinordertorebalancethe
sugarlevels.Thepancreasproducesandreleasesimportantdigestiveenzymesinthe
pancreaticjuicethatitdeliverstotheduodenum.Thepancreasliesbelowandatthe
Actionofdigestivehormones
backofthestomach.Itconnectstotheduodenumviathepancreaticductwhichit
joinsneartothebileduct'sconnectionwhereboththebileandpancreaticjuicecan
actonthechymethatisreleasedfromthestomachintotheduodenum.Aqueous
pancreaticsecretionsfrompancreaticductcellscontainbicarbonateionswhicharealkalineandhelpwiththebileto
neutralisetheacidicchymethatischurnedoutbythestomach.

Pancreas,duodenumandbileduct

Thepancreasisalsothemainsourceofenzymesforthedigestionoffatsandproteins.SomeofthesearereleasedinresponsetotheproductionofCKKinthe
duodenum.(Theenzymesthatdigestpolysaccharides,bycontrast,areprimarilyproducedbythewallsoftheintestines.)Thecellsarefilledwithsecretory
granulescontainingtheprecursordigestiveenzymes.Themajorproteases,thepancreaticenzymeswhichworkonproteins,aretrypsinogenand
chymotrypsinogen.Elastaseisalsoproduced.Smalleramountsoflipaseandamylasearesecreted.ThepancreasalsosecretesphospholipaseA2,
lysophospholipase,andcholesterolesterase.Theprecursorzymogens,areinactivevariantsoftheenzymeswhichavoidstheonsetofpancreatitiscausedby
autodegradation.Oncereleasedintheintestine,theenzymeenteropeptidasepresentintheintestinalmucosaactivatestrypsinogenbycleavingittoformtrypsin
furthercleavageresultsinchymotripsin.

Lowergastrointestinaltract

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Thelowergastrointestinaltract(GI),includesthesmallintestineandallofthelargeintestine.[30]Theintestineisalsocalledthebowelorthegut.ThelowerGI
startsatthepyloricsphincterofthestomachandfinishesattheanus.Thesmallintestineissubdividedintotheduodenum,thejejunumandtheileum.Thececum
marksthedivisionbetweenthesmallandlargeintestine.Thelargeintestineincludestherectumandanalcanal.[2]
Smallintestine
Foodstartstoarriveinthesmallintestineonehourafteritiseaten,and
aftertwohoursthestomachhasemptied.Untilthistimethefoodistermed
abolus.Itthenbecomesthepartiallydigestedsemiliquidtermedchyme.
Inthesmallintestine,thepHbecomescrucialitneedstobefinely
balancedinordertoactivatedigestiveenzymes.Thechymeisveryacidic,
withalowpH,havingbeenreleasedfromthestomachandneedstobe
mademuchmorealkaline.Thisisachievedintheduodenumbythe
additionofbilefromthegallbladdercombinedwiththebicarbonate
secretionsfromthepancreaticductandalsofromsecretionsof
bicarbonaterichmucusfromduodenalglandsknownasBrunner'sglands.
Thechymearrivesintheintestineshavingbeenreleasedfromthestomach
throughtheopeningofthepyloricsphincter.Theresultingalkalinefluid
mixneutralisesthegastricacidwhichwoulddamagetheliningofthe
intestine.Themucuscomponentlubricatesthewallsoftheintestine.

Duodenum

Whenthedigestedfoodparticlesarereducedenoughinsizeandcomposition,theycanbeabsorbedbytheintestinalwalland
carriedtothebloodstream.Thefirstreceptacleforthischymeistheduodenalbulb.Fromhereitpassesintothefirstofthe
threesectionsofthesmallintestine,theduodenum.(Thenextsectionisthejejunumandthethirdistheileum).The
duodenumisthefirstandshortestsectionofthesmallintestine.Itisahollow,jointedCshapedtubeconnectingthestomach
tothejejunum.Itstartsattheduodenalbulbandendsatthesuspensorymuscleofduodenum.Theattachmentofthe
suspensorymuscletothediaphragmisthoughttohelpthepassageoffoodbymakingawiderangleatitsattachment.
LowerGItract3)Small
intestine5)Cecum6)Large
intestine

Mostfooddigestiontakesplaceinthesmallintestine.Segmentationcontractionsacttomixandmovethechymemoreslowly
inthesmallintestineallowingmoretimeforabsorption(andthesecontinueinthelargeintestine).Intheduodenum,
pancreaticlipaseissecretedtogetherwithacoenzyme,colipasetofurtherdigestthefatcontentofthechyme.Fromthis
breakdown,smallerparticlesofemulsifiedfatscalledchylomicronsareproduced.Therearealsodigestivecellscalled
enterocytesliningtheintestines(themajoritybeinginthesmallintestine).Theyareunusualcellsinthattheyhavevilliontheirsurfacewhichinturnhave
innumerablemicrovilliontheirsurface.Allthesevillimakeforagreatersurfacearea,notonlyfortheabsorptionofchymebutalsoforitsfurtherdigestionby
largenumbersofdigestiveenzymespresentonthemicrovilli.
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Thechylomicronsaresmallenoughtopassthroughtheenterocytevilliandintotheirlymphcapillariescalledlacteals.Amilkyfluidcalledchyle,consisting
mainlyoftheemulsifiedfatsofthechylomicrons,resultsfromtheabsorbedmixwiththelymphinthelacteals.Chyleisthentransportedthroughthelymphatic
systemtotherestofthebody.
ThesuspensorymusclemarkstheendoftheduodenumandthedivisionbetweentheuppergastrointestinaltractandthelowerGItract.Thedigestivetract
continuesasthejejunumwhichcontinuesastheileum.Thejejunum,themidsectionofthesmallintestinecontainscircularfolds,flapsofdoubledmucosal
membranewhichpartiallyencircleandsometimescompletelyencirclethelumenoftheintestine.Thesefoldstogetherwithvilliservetoincreasethesurfacearea
ofthejejunumenablinganincreasedabsorptionofdigestedsugars,aminoacidsandfattyacidsintothebloodstream.Thecircularfoldsalsoslowthepassageof
foodgivingmoretimefornutrientstobeabsorbed.
Thelastpartofthesmallintestineistheileum.ThisalsocontainsvilliandvitaminB12bileacidsandanyresiduenutrientsareabsorbedhere.Whenthechymeis
exhaustedofitsnutrientstheremainingwastematerialchangesintothesemisolidscalledfeces,whichpasstothelargeintestine,wherebacteriainthegutflora
furtherbreakdownresidualproteinsandstarches.[31]
Cecum
Thececumisapouchmarkingthedivisionbetweenthesmallintestineandthelargeintestine.[32]Thececumreceives
chymefromthelastpartofthesmallintestine,theileum,andconnectstotheascendingcolonofthelargeintestine.At
thisjunctionthereisasphincterorvalve,theileocecalvalvewhichslowsthepassageofchymefromtheileum,
allowingfurtherdigestion.Itisalsothesiteoftheappendixattachment.
Largeintestine
Inthelargeintestine,[2]thepassageofthedigestingfoodinthecolonisalotslower,takingfrom12to50hoursuntilit
isremovedbydefecation.Thecolonmainlyservesasasiteforthefermentationofdigestiblematterbythegutflora.
Cecumandbeginningofascendingcolon
Thetimetakenvariesconsiderablybetweenindividuals.Theremainingsemisolidwasteistermedfecesandisremoved
bythecoordinatedcontractionsoftheintestinalwalls,termedperistalsis,whichpropelstheexcretaforwardtoreachthe
rectumandexitviadefecationfromtheanus.Thewallhasanouterlayeroflongitudinalmuscles,thetaeniaecoli,andaninnerlayerofcircularmuscles.The
circularmusclekeepsthematerialmovingforwardandalsopreventsanybackflowofwaste.Alsoofhelpintheactionofperistalsisisthebasalelectricalrhythm
thatdeterminesthefrequencyofcontractions.[33]Thetaeniaecolicanbeseenandareresponsibleforthebulges(haustra)presentinthecolon.MostpartsoftheGI
tractarecoveredwithserousmembranesandhaveamesentery.Othermoremuscularpartsarelinedwithadventitia.

Bloodsupply
Thedigestivesystemissuppliedbytheceliacartery.Theceliacarteryisthefirstmajorbranchfromtheabdominalaorta,andistheonlymajorarterythat
nourishesthedigestiveorgans.
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Therearethreemaindivisionstheleftgastricartery,
thecommonhepaticarteryandthesplenicartery.

Bloodsupplytothedigestiveorgans[34]

Theceliacarterysuppliestheliver,stomach,spleenand
theupper1/3oftheduodenum(tothesphincterof
Oddi)andthepancreaswithoxygenatedblood.Mostof
thebloodisreturnedtotheliverviatheportalvenous
systemforfurtherprocessinganddetoxificationbefore
returningtothesystemiccirculationviathehepatic
portalvein.

Arteriesandveinsaroundthe
pancreasandspleen

Thenextbranchfromtheabdominalaortaisthesuperiormesentericartery,whichsuppliestheregionsofthedigestivetract
derivedfromthemidgut,whichincludesthedistal2/3oftheduodenum,jejunum,ileum,cecum,appendix,ascendingcolon,andtheproximal2/3ofthetransverse
colon.
Thefinalbranchwhichisimportantforthedigestivesystemistheinferiormesentericartery,whichsuppliestheregionsofthedigestivetractderivedfromthe
hindgut,whichincludesthedistal1/3ofthetransversecolon,descendingcolon,sigmoidcolon,rectum,andtheanusabovethepectinateline.

Nervesupply
Theentericnervoussystemconsistsofsomeonehundredmillionneurons[35]thatareembeddedintheperitoneum,theliningofthegastrointestinaltractextending
fromtheesophagustotheanus.[36]Theseneuronsarecollectedintotwoplexusesthemyenteric(orAuerbach's)plexusthatliesbetweenthelongitudinalandthe
smoothmusclelayers,andthesubmucosal(orMeissner's)plexusthatliesbetweenthecircularsmoothmusclelayerandthemucosa.[37][38][39]
Parasympatheticinnervationtotheascendingcolonissuppliedbythevagusnerve.Sympatheticinnervationissuppliedbythesplanchnicnervesthatjointhe
celiacganglia.Mostofthedigestivetractisinnervatedbythetwolargeceliacganglia,withtheupperpartofeachganglionjoinedbythegreatersplanchnicnerve
andthelowerpartsjoinedbythelessersplanchnicnerve.Itisfromthesegangliathatmanyofthegastricplexusesarise.

Clinicalsignificance
Eachpartofthedigestivesystemissubjecttoawiderangeofdisordersmanyofwhichcanbecongenital.Mouthdiseasescanalsobecausedbybacteria,viruses
andfungi.Mouthdiseasesincludetonguediseasesandsalivaryglanddiseases.Acommongumdiseaseinthemouthisgingivitiswhichiscausedbybacteriain
plaque.Themostcommonviralinfectionofthemouthisgingivostomatitiscausedbyherpessimplex.Anothercommoninfectionwhichisfungaliscandidiasis
commonlyknownasthrushwhichaffectsthemucousmembranesofthemouth.

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ThereareanumberofesophagealdiseasessuchasthedevelopmentofSchatzkiringsthatcanrestrictthepassageway,
causingdifficultiesinswallowing.Theycanalsocompletelyblocktheesophagus.[40]
Stomachdiseasesareoftenchronicconditionsandincludegastroparesis,gastritis,andpepticulcers.
Anumberofproblemsincludingmalnutritionandanemiacanarisefrommalabsorption,theabnormalabsorptionof
nutrientsintheGItract.Malabsorptioncanhavemanycausesrangingfrominfection,toenzymedeficienciessuchas
exocrinepancreaticinsufficiency.Itcanalsoariseasaresultofothergastrointestinaldiseasessuchascoeliacdisease.
Coeliacdiseaseisanautoimmunedisorderofthesmallintestine.Thiscancausevitamindeficienciesduetothe
improperabsorptionofnutrientsinthesmallintestine.Thesmallintestinecanalsobeobstructedbyavolvulus,aloop
ofintestinethatbecomestwistedenclosingitsattachedmesentery.Thiscancausemesentericischemiaifsevereenough.
Acommondisorderofthebowelisdiverticulitis.Diverticulaaresmallpouchesthatcanforminsidethebowelwall,
whichcanbecomeinflamedtogivediverticulitis.Thisdiseasecanhavecomplicationsifaninflameddiverticulum
burstsandinfectionsetsin.Anyinfectioncanspreadfurthertotheliningoftheabdomen(peritoneum)andcause
potentiallyfatalperitonitis.[41]
Crohn'sdiseaseisacommonchronicinflammatoryboweldisease(IBD),whichcanaffectanypartoftheGItract,[42]
butitmostlystartsintheterminalileum.

Dietaryliferules,Japan,Edoperiod.

Ulcerativecolitisanulcerativeformofcolitis,istheothermajorinflammatoryboweldiseasewhichisrestrictedtothe
colonandrectum.BothoftheseIBDscangiveanincreasedriskofthedevelopmentofcolorectalcancer.UlcerativecoliltisisthemostcommonoftheIBDs[43]
Irritablebowelsyndrome(IBS)isthemostcommonofthefunctionalgastrointestinaldisorders.TheseareidiopathicdisordersthattheRomeprocesshashelpedto
define.[44]
GiardiasisisadiseaseofthesmallintestinecausedbyaprotistparasiteGiardialamblia.Thisdoesnotspreadbutremainsconfinedtothelumenofthesmall
intestine.[45]Itcanoftenbeasymptomatic,butasoftencanbeindicatedbyavarietyofsymptoms.Giardiasisisthemostcommonpathogenicparasiticinfectionin
humans.[46]
TherearediagnostictoolsmostlyinvolvingtheingestionofbariumsulphatetoinvestigatedisordersoftheGItract.[47]Theseareknownasuppergastrointestinal
seriesthatenableimagingofthepharynx,larynx,oesophagous,stomachandsmallintestineandlowergastrointestinalseriesforimagingofthecolon.

Inpregnancy
Gestationcanpredisposeforcertaindigestivedisorders.Gestationaldiabetescandevelopinthemotherasaresultofpregnancyandwhilethisoftenpresentswith
fewsymptomsitcanleadtopreeclampsia.
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Seealso
Gastrointestinalphysiology
Gutbrainaxis
Neurogastroenterology

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