DIGESTIVE SYSTEM

BY ACHMAD AMINUDDIN
 FUNCTIONS

 INGESTION:
taking food into the mouth.
 SECRETIO:
release of water,acid, buffer, and enzymes i
nto the lumen of the GI tract.
 MIXING AND PROPULSION:
churning and propulsion of food through the
GI tract.
 CONTINUATION

 DIGESTIO:
mechanical and chemical breakdown of food
 ABSORPTION:
passage of digested products from the GI tr
act into the blood and lymph.
 DEFECATION:
the elimination of feces from the GI tract.
 ORAL REGION

 INCLUDES :
– THE ORAL CAVITY
– TEETH
– GINGIVAE
– TONGUE
– PALATE
– THE REGION OF THE PALATINE
– TONSILS
 ORAL CAVITY

 CONSIST OF
– THE ORAL VESTIBULE
– THE ORAL CAVITY PROPER
 IS WHERE FOOD IS INGESTED AND PRE
PARED FOR DIGESTION
 THE TEETH AND SALIVA FASILITATE TH
E FORMATION OF A MANAGEABLE FOO
D BOLUS
 THE ORAL VESTIBULE

 IS THE SLIT LIKE SPACE BETWEEN THE

LIPS AND CHEEKS SUPERFICIALLY.
 COMMUNICATES WITH THE EXTERIOR T
HROUGH THE ORAL FISSURE ( ORIFI CE
OF MOUTH )
 THE SIZE OF THIS OPENING IS CONTRO
LED BY THE ORBICULARIS ORIS M.
 THE ORAL CAVITY PROPER

 BOUNDARIES
– LATERAL AND ANTERIOR
 THE MAXILLARY AND MANDIBULAR ALVEOLAR ARCHES H
OUSING THE TEETH.
– POSTERIOR
 THE TERMIAL GROOVE OF THE TONGUE.
 PALATOGLOSSAL ARCHES.
– THE ROOF
 THE PALATE.
– POSTERIORLY COMMUNICATES WITH
 THE OROPHARYNX.
 ORAL VESTIBULE

 CONTAIN
 ORBICULARIS M.
 SUPERIOR AND INFERIOR LABIAL M.
 VESSELS AND NERVES.
 ARE COVERED BY
 SKIN.
 MUCOUS MEMBRANE
 PHILTRUM.
 THE VERMILLION BORDER.
 THE GINGIVAE

 COMPOSED OF FIBROUS TISSUE COVE

RED WITH MUCOUS MEMBRANE.
 FIRMLY ATTACH TO THE ALVEOLAR PR
OCESSES OF THE JAWS AND THE NECK
S OF THE TEETH.
 TEETH

 SET IN THE ALVEOLI OF THE UPPER AND LOWER JA

WS.
 CHILDREN HAVE 20 DECIDUOUS ( PRI MARY ) TEETH.
 THE FIRST TOOTH USUALLY ERUPS AT 6 TO 8 MONT
H OF AGE AND THE LAST TOOTH BY 20 TO 24 MONTH
OF AGE.
 THE PERMANENT TEETH NORMALLY 16 INEACH JAW,
3 MOLARS, 2 PREMOLARS,1 CA NINE AND 2 INCISORS
, USUALLY IS COMPLE TE BY THE MIDTEENS EXCEPT
FOR THE 3rd MOLAR, WICH USUAL LY ERUP DURING T
HE LATE TEENS OR EARLY TWETIES
 TEETH

 CONSIST OF,
– THE CROWN
 PROJECTS FROM THE GINGIVA
– THE NECK
 THE PART OF THE TOOTH BETWEEN THE CROW
N AND ROOT.
– THE ROOT
 IS FIXED IN THE ALVEOLUS BY A FIBROUS PERI
ODONTAL MEMBRANE.
COMPOSITION OF THE TOOTH

 DENTIN is covered by
 ENAMEL over the crown
 CEMENT over the root
 PULP CAVITY, contain
– CONNECTIVE TISSUE.
– BLOOD VESSELS.
– NERVES.
 ROOT CANAL transmits the nerves and vessels to
and from the pulp cavity
 SALIVA

 SALIVARY AMYLASE
source ; salivary glands.
substrates : starches ( polysacharides ).
products : maltose ( disaccharide ).
maltotriose ( trisaccharide ).
a-dextrins.
 LINGUAL LIPASE
source : lingual glands in the tongue.
substrates : triglycerides ( fats and oils ) and
other lipids.
products : fatty acids and diglycerides.
 PALATE

 THE HARD PALATE

– SEPARATES THE AMTERIOR PART OF THE
ORAL CAVITY FROM THE NASAL CAVITY.
 THE SOFT PALATE
– SEPARATES THE POSTERIOR PART OF THE
ORAL CAVITY FROM THE NASOPHARYNX S
UPERIOR
 THE PALATINE TONSIL

 LIES IN A TONSILAR SINUS ( FOSSA ), B

OUNDED BY,
– PALATO GLOSSAL ARCH.
– PALATOPHARYNGEAL ARCH.
– TONGUE.
 PHARYNX

 EXTENDS FROM THE CRANIAL BASE TO

THE INFERIOR BORDER OF THE CRICOI
D CARTILAGE ANTERIORLY AND THE IN
FERIOR BORDER OF THE C6 VERTEBRA
POSTERIORLY.
 INTERIOR OF THE PHARYNX
- NASOPHARYNX.
- OROPHARYNX.
- LARYNGOPHARYNX
 ESOPHAGUS

 A MUSCULAR TUBE THAT EXTENDS FROM TH

E PHARYNX TO THE STOMACH
 DESCENDS THROUGH THE POSTERIOR MEDI
ASTINUM, ESOPHAGEAL HIATUS IN THE DIAP
HRAGM JUST JUST TO THE LEFT OF MEDIAN
PLANE AT THE LEVEL OF VT 10 , ENTER THE
STOMACH THROGH CARDIAL ORIFICE TO THE
LEFT OF MID LINE AT THE LEVEL OF THE 7 T
H LEFT COSTAL CARTILAGE AND VT 11
 ESOPHAGUS
 Pharyngoesophageal junction – cardia.
 Striated muscle ( voluntary ) – upper third.
 Smooth muscle ( involuntary – lower third.
 Mixture -- in between.
 Cervical eophagus
- upper third.
- begin posterior to and at the level of the
inferior border of the cricoid cartilage / C6
vertebra.
- Pharyngoesophageal junction is the superior
esophageal shincter is produced by the cricopharyngeal
part of the inferior constrictor muscle.
- lie between the trachea and the cervical vertebral column.
- the recurrent laryngeal n.lie in the tracheoesophageal groove.
 ESOPHAGUS

 The esophagus descends in to the posterior media

stinum from the superior mediastinum passing pos
terior and to the right of the arch of the aorta.
 Passes through the esophageal hiatus in the diaph
ragm at the level of the T10 vertebra anterior to th
e aorta.
 Three constrictions
- the arch of the aorta.
- the left main bronchus.
- the diaphragm.
NERVES OF THECERVICAL ESOP
HAGUS
 Somatic motor and sensorik – upper half.
 Parasympathetic, sympathetic
and visceral sensory -- lower half.
 The cervical esiphagus receives
- somatic fibers via branches from the
recurrent laryngeal nerve.
- vasomotor fibers from the cervical
sympathetic trunk.
VESSELS OF THE CERVICAL E
SOPHAGUS

 Branches of the inferior thyroid arteries.

 Tributaries of the inferior thyroid veins.
 Paratracheal lymp nodes.
 Inferior deep cervical lymph nodes.
 DEGLUTITION

 THE MOVEMENT OF FOOD FROM THE MOUTH

INTO THE STOMACH.
 FACILITATED BY THE SECRETION OF SALIVA
AND MUCUS AND INVOLVES THE MOUTH,PHA
RYNX AND ESOPHAGU
 THREE STAGES;
- the voluntary stage, the bolus is passed in
to the oropharynx.
- the pharyngeal stages.
- the esophageal stage.
 STAGE I : VOLUNTARY

 THE BOLUS IS COMPRESSED AGAINST

THE PALATE AND PUSHED FROM THE M
OUTH IN TO THE OROPHARYNX, MAINL
Y BY MOVEMENTS OF THE MUSCLES O
F THE TONGUE AND SOFT PALATE
Fig 8.39 A , B
STAGE 2 INVOLUNTAY AND RAPI
D
 THE SOFT PALATE IS ELEVATED, SEALI
NG OFF THE NASOPHARYNX FROM THE
OROPHARYNX AND LARYNGOPHARYNX.
 THE PHARYNX WIDENS AND SHORTENS
TO RECEIVE THE BOLUS OF FOOD AS T
HE SUPRAHYOID MUSCELS AND LONGI
TUDINAL PHARYNGEAL MUSCLES CONT
RACT, ELEVATING THE LARYNX
 STAGE 3 ; INVOLUNTARY

 SEQUENTIAL CONTRACTION OF ALL TH

REE CONSTRICTOR MUSCLES FORCES
THE FOOD BOLUS INFERIORLY IN TO TH
E ESOPHAGUS
 STOMACH

 A FOOD BLENDER.
 RESERVOIR.
 CHIEF FUNCTION , ENZYMATIC DIGESTI
ON, GASTRIC JUICE CONVERTS A MASS
OF FOOD IN TO A LIQUID MIXTURE – CH
YME – THAT PASSES IN TO DUODENUM.
 STOMACH

 HAS 4 PARTS AND 2 CURVATURES,

– CARDIA.
– FUNDUS.
– BODY.
– PYLORIC PART.
– LESSER CURVATURE.
– GREATER CURVATURE.
 FUNCTIONS OF THE STOMACH

 MIXES SALIVA, FOOD AND GASTRIC JUICE TO

FORM CHYME.
 SERVES AS RESERVOIR FOR FOOD BEFORE
RELEASE INTO SMALL INTESTINE.
 SECRETE GASTRIC JUICE, WHICH CONTAIN H
Cl ( kills bacteria and denatures protein ), PEPSIN
( begins the digestion of proteins ), INTRINSIC FA
CTOR ( aids absorption of vit. B12 ), AND GASTRI
C LIPASE ( aids digestion of triglycerides ).
 SECRETES GASTRIN INTO BLOOD.
VISCERAL REFERED PAIN
 SMALL INTESTINE

 EXTENDS FROM THE PYLORUS TO THE

ILEOCECAL JUNCTION.
 THE PRIMARY SITE OF ABSORPTION OF
NUTRIEN FROM INGESTED MATERIAL.
 CONSIST OF DUODENUM, JEJUNUM AN
D ILEUM.
 DUODENUM

 SUPERIOR PART.
 DESCENDING PART.
 HORIZONTAL PART.
 ASCENDING PART.
 JEJUNUM AND ILIEUM

 6 – 7 METERS.
 JEJUNUM , two – fifth.
 ILEUM , three – fifth.
 THE MESENTERY
– ATTACHES THE JEJUNUM AND ILEUM TO THE POS
TERIOR ABDOMINAL WALL.
– THE ROOT OF THE MESENTERY, EXTENDS FROM T
HE DUODENOJEJUNAL JUNCTION ON THE LEFT DI
DE OF V.L. 2 TO THE ILEOCOLIC JUNCTION AT THE
RIGHT SACROILIAC JOINT ( 15 CM LONG ).
LARGE INTESTINE

 CONSIST OF
– CECUM.
– COLON
 ASCENDING.
 TRANSVERSE.
 DESCENDING.
 SIGMOID.
– RECTUM.
– ANAL CANAL.
 COLON CAN BE DISTINGUISE
D FROM SMALL INTESTINE,

 TENIA COLI (excep appendix and rectum ).

 HAUSTRA.
 OMENTAL APPENDICES.
 CALIBER.
 CECUM

 THE FIRST PART OF THE LARGE INT

ESTINE.
 INTRA PERITONEALLY.
 HAS NO MESENTERY.
 THE ILEUM ENTER THE CECUM ,
– ILEOCECAL ORIFICE.
– ILEO CECAL VALVE.
 APPENDIX

 EXTENDS FROM THE POSTEROMEDIAL

ASPECT OF THE CECUM, INFERIOR TO
THE ILEOCECAL JUNCTION/
 HAS THE MESOAPPENDIX.
 USUALLY RETROCECAL.
 ITS BASE MOST OFTENLIES DEEP TO M
c. BURNEY POINT.
 THE ASCENDING COLON

 FROM THE CECUM TO THE RIGHT COLI

C FLEXURE.
 RETROPERITONEAL ( 25 0/0 has a short
mesentery ).
THE TRANSVERSE COLON

 THE LARGEST AND MOST MOBILE.

 FROM THE RIGHT FLEXURE TO THE L
EFT COLIC FLEXURE.
 DESCENDING COLON

 RETRO PERITONEALLY.
 FROM THE LEFT COLIC FLEXURE IN TO
THE LEFT ILIAC FOSSA.
 IN THE ILIAC FOSSA HAS A SHORT MES
ENTERY ( 33 0/0 ).
 THE SIGMOID COLON

 S SHAPED LOOP.
 FROM THE ILIAC FOSSA TO THE THIRD
SACRAL.
 HAS ASIGMOID MESOCOLON.
 THE ROOT OF THE SIGMOID COLON HA
S AN INVERTED V SHAPED ATTACHME
NT.
RECTUM AND ANAL CANAL

 THE FIXED TERMINAL PART OF THE

LARGE INTESTINE.
 CONTINUOUS INFERIORLY WITH TH
E ANAL CANAL.
RECTUM

fig 3.33 429

 RECTUM

 The rectosigmoid junction lies anterior to the S3 ve

rtebra. At this point , the taenia of the sigmoid colo
n spread out to form a continuous outer longitudin
al layer of smooth muscle, and the fatty omental a
ppendices are discontinued.
 The sacral flexure of the rectum
 The rectum ends anteroinferior to the tip of the coc
cyx, immediately before the anorectal flexure of th
e anal canal, that occur as the gut perforates the p
elvic diaphragm
fig 241 272
 RECTUM

 The roughly 80° the anorectal flexure is an i

mportant mechanism for fecal continence, b
eing maintained during the resting stage by t
he tonus of the puborectalis muscle and by i
ts contraction during peristaltic contraction if
defecation is not to occur.
 The ampula of the rectum receives and hold
s an accumulating fecal mass until it is expel
led during defcation
fig 3.8 372
 RECTUM

 Peritonium covers the anterior and lateral su

rface of the superior third of the rectum, only
the anterior surface of the middle third, and
no surface of the inferior third because it is s
ubperitoneal.
 Rectovesical pouch.
 Rectouterine pouch.
 Pararectal fosae
fig 3.34 430
ARTERIL SUPPLY OF THE RECTU
M
 The superior rectal artery, the continuation of the i
nferior meenteric aretry, supply the proximal part o
f the rectum.
 The right and left middle rectal arteies, arising fro
m the inferior vesical arteries, supply the middle a
nd inferior parts of the rectum
 The inferior rectal arteries, arising from the pudend
al arteries, supply hte anorectal junction and anal
canal.
 Anastomosis betwen these arteries provide potenti
al colateral circulation
 VENOUS DRAINAGE

 The superior , middle and inferior rectal veins.

 The superior rectal vein drains into the portal veno
us system.
 The middle and inferior rectal veins drains into sys
temic system
 The rectal venous plexus
- the internal rectal venous plexus.
- the externsl rectal venous plexus
 LYMPHATIC DRAINAGE

 From the superior half of the rectum pass to

the pararectal l.n , and then to the inferior m
esenteric l.n , -- lumbar l.n.
 From the inferior half of the rectum drains dir
ectly to sacral l.n.
 From distal ampulla , drains into the internal
iliac l.n.
FIG 3,35 431
 INNERVATION OF THE RECTUM

 The sympathetic supply is from the lumbar spinal c

ord, conveyed via lumbar splanchnic nerves and t
he hypogastric / pelvic plexuses and through the p
eriarterial plexus of the inferior mesenteric and sup
erior rectal arteri
 The parasympathetic supply is from the S2 – S4 s
pinal cord level, passing via the pelvic splanchnic
nerves and the left and right inferior hypogastric pl
exuses to the rectal plexus.
 All visceral afferent fibers follow the parasympathe
tic fibers retrogradely to the S2 – S4 spinal sensor
y ganglia.
INNERVATION OF THE RECTUM

fig 3.36 432

 ANAL CANAL

 Anal canal extends from the superior aspec

t of the pelvic giaphragm to the anus.
 Surrounded by internal and axternal anal sp
hincters, descends posteroinferiorly betwee
n the anococcygeal ligament and the perine
al body
FIG 3.42 B
FIG 3.43
THE INTERNAL ANALSPHINCTER

 IAS, is an involuntary sphincters surroundin

g the superior two third of the anal canal
 It contraction ( tonus ) is stimulated and mai
ntained by sympathetic fibers from the super
ior rectal ( periarterial ) and hypogastric plex
uses ; its contraction is inhibited by parasym
pathetic fiber stimulatin
 THE EXTERNAL ANAL SPHINCTE
R
 EAS , is a large voluntary sphincter that forms a br
oad band on each side of the inferior two thirds of t
he anal canal
 EAS , is attached anteriorly to the perineal body a
nd posteriorly to the to the coccyx via the anococc
ygeal ligament; it blends superiorly with the pubore
ctalis muscle.
 EAS , is supplied mainly by S4 through the inferior
rectal nerve, although its deep part also receives fi
bers from the nerve to the levator ani
 ANAL CANAL

 Extends from the superior aspect of the pelv

ic diaphragm to the anus
 Surroumded by internal and external anal sp
hincter,descends posteroinferiorly between t
he anococcygeal ligamentum and the perine
al body.
 Anal column
- contain the terminal branches of the
superior rectal artery and vein
fig 3.45
ARTERIAL SUPPLY OF THE ANAL
CANAL
 The superior rectal arteriy supplies the anal
canal superior to the pectinate line.
 The two inferir rectal arteries supply the infer
ior part of the anal canal as well as the surro
unding muscles and perianal skin.
 The middle rectal arteries assist with the blo
od supply to the anal canal by forming anast
omses with the superior and inferior rectal ar
teries.
VENOUS DRAINAGE OF THE ANA
L CANAL
 Superior to the pectinate line, the internal rectal pl
exus drains chiefly into the superior rectal vein ( tri
butary of the IMV ).
 Inferior to the pectinate line, thr internal rectal plex
us drains into the inferior rectal vein ( tributary of t
he caval venous system ) around the margin of the
external anal sphincter .
 The middle rectal veins ( tributary of the internal ili
ac veins ) mainly drain the muscularis externa of t
he ampula and form anastomoses with hte superio
r and inferior rectal veins
LYMPHATIC GRAINAGE OF THE A
NAL CANAL
 Superior to the pectinata line, the lymphatic
vessels drain deeply into the internal iliac ly
mph nodes ---- the common iliac and lumbar
lymph nodes.
 Inferior to the pectinata line , the lymphatic v
essels drain superficially into the superficial i
nguinal lymph nodes
INNERVATION OF THE ANAL CAN
AL
 Seuperior to the pectinate line is visceral inn
ervation from the inferior hypogastric plexus,
involving sympathetic, parasympathetic, and
visceral afferent fibers Sympathetic fibers m
aintain the tonus of the internal sphincter
Parasympathetic fibers inhibit the tonus of th
e internal sphincter and evoke peristaltic con
traction for defecation.
INNERVATION OF THE ANAL CAN
AL
 All visceral afferent travel with the parasymp
athetic fibers to spinal sensory ganglia S2 –
S4.
 The nerve supply of the anal canal Inferior t
o the pectinate line, is somatic innervation d
erived from the inferior anal ( rectal ) nerves,
branches of the pudendal nerve.
 Somatic efferent fibers stimulate contraction
of the voluntary external anal sphincter.