The Components of the Digestive System

Your Digestive System and How it Works

Why is digestion important?

How is food digested?

How is the digestive process controlled

The Digestive System

Digestive tract:
A series of hollow organs Joined in a long, twisted tube from: the mouth to the anus

and other organs

Functions:

help the body break down food absorb food.

Total length 30ft(9 meters).

Digestive tract
Hollow Organs:
Mouth

Esophagus
Stomach Small and large intestine

Rectum and anus

Solid Organs:
Liver Pancreas Gall bladder Liver

Functions of the Digestive System

Ingestion Mechanical

processing Digestion Secretion Absorption Excretion

The Mouth Opens Into the Oral Opening or Buccal Cavity

Its functions include:
Analysis of material before swallowing Mechanical processing by the teeth, tongue, and palatal

surfaces
Lubrication Limited digestion Sensory analysis for temperature, touch and taste(tongue)

The Pharynx
Common passageway for food,

liquids, and air

Lined with a special lining

Pharyngeal muscles assist in

swallowing: 1. Pharyngeal constrictor muscles 2. Palatal muscles

The Swallowing Process

Movement of Digestive Materials

Visceral Smooth Muscle Shows Rhythmic Cycles of Activity:
Pacemaker cells

Peristalsis :
Waves that move a bolus

Segmentation :
Churn and fragment a bolus

The Esophagus

The Stomach

Functions Of The Stomach

Bulk storage of undigested food

Mechanical breakdown of food

Breakdown of foods via acids and enzymes

Regions Of The Small Intestine

The Small Intestine

Important digestive and absorptive functions:
Secretions and buffers provided by:
1. 2. 3.

pancreas liver gall bladder

Three subdivisions:
duodenum jejunum ileum

Ileocecal sphincter
Transition between:
1. 2.

small large intestine

Peristalsis Food Movement

Intestinal Juices
Moisten chyme Help buffer acids

Maintain digestive material in solution

What Organs Are Involved in Digestion?

The Pancreas

The Liver

The Gallbladder

The Pancreas

The pancreas
Pancreatic duct penetrates duodenal wall:
Endocrine functions: 1. Insulin and 2. Glucagons Exocrine functions: 1. Majority of pancreatic secretions 2. Pancreatic juice secreted into small intestine:
a. b. c.

d.

Carbohydrates Lipases Nucleases Proteolytic enzymes

The Anatomy of The Liver

The liver
Performs metabolic process

Hematological regulation

Produces bile

The Gallbladder
Structure: Hollow organ
Pear-shaped organ

Functions: Stores
Modifies and concentrates bile

The Large Intestine

Functions of The Large Intestine

Reabsorb water and compact material into feces

Absorb vitamins produced by bacteria

Store fecal matter prior to defecation

The Rectum
Last portion of the digestive tract

Terminates at the anal canal

Internal and external anal sphincters

What My Stomach is Telling Me

Abdominal Pain
Location Work-up Acute pain syndromes Chronic pain syndromes

Location of Pain

Localizing Pain Right Upper Quadrant (RUQ)

Hepatitis Cholecystitis Cholangitis RLL (right lower lobe) pneumonia Subdiaphragmatic abscess

Localizing Pain Right Lower Quadrant RLQ

Appendicitis Inguinal hernia Nephrolithiasis IBD (irritable bowel

syndrome) Salpingitis (inflammation of Fallopian tubes- females) Ectopic pregnancy Ovarian pathology

Localizing Pain Left Upper Quadrant LUQ

Splenic infarct Splenic abscess

Gastritis/PUD

Localizing Pain Left Lower Quadrant LLQ

Diverticulitis

Inguinal hernia
Nephrolithiasis IBD Salpingitis Ectopic pregnancy Ovarian pathology

Localizing Pain - Epigastric

PUD

Gastritis
Pancreatitis GERD Cardiac:
1. 2. 3.

MI Pericarditis etc

Localizing Pain - Periumbilical

Pancreatitis

Obstruction
Early appendicitis Small bowel pathology Gastroenteritis

Localizing Pain - Pelvic

UTI

Prostatitis
Bladder outlet obstruction

PID
Uterine pathology

Localizing Pain -Diffuse

Gastroenteritis Ischemia Obstruction DKA IBS Others:
1. 2. 3.

4.

FMF AIP Vitamin D deficiency Adrenal insufficiency

Acute Abdominal Pain - Syndromes

Generally present for less than a couple weeks:
1. 2.

Usually days to hours old Dont forget about the chronic pain that has acutely worsened

More immediate attention is required

Common Acute Pain Syndromes

Appendicitis

Acute diverticulitis
Cholecystitis Pancreatitis

Perforation of an ulcer
Intestinal obstruction Ruptured AAA

Pelvic disorders

APPENDICITIS
Inflammatory disease of wall of

appendix Diagnosis based on history and physical Symptoms:

1.
2.

3.

Abdominal pain Followed by pain over appendix and Low grade fever

Pain pattern in acute appendicitis

Example: McBurneys point in late appendicitis

DIVERTICULITIS
Results from
Stagnation of fecal material in single diverticulum

leading to:
1. 2.

pressure necrosis of mucosa and inflammation

Clinical presentation:
Mild to moderate aching Abdominal pain - usually Left Lower Quadrant May have Fever and Leukocytosis

CHOLECYSTITIS
Results from:
Obstruction of cystic or common bile duct by large

gallstones

Presents as :
Colicky pain with progression to constant pain in RUQ

that may radiate to R scapula Physical findings: Tender to palpation RUQ

PANCREATITIS
History :
Majority cases have gallstones

and/or alcohol abuse Presentation of pain : Pain steady and boring - unrelieved by position change Abdominal pain LUQ with radiation to back Other presentations: Nausea Vomiting

Physical findings:
Acutely ill with abdominal distention

BS

PEPTIC ULCER PERFORATION

Life-threatening complication of peptic ulcer disease : More common with Small Intestine than Stomach

Predisposing factors
Helicobacter pylori infections NSAIDs (Motrin)

SMALL BOWEL OBSTRUCTION

Presentation: Abdominal distention Causes: Sudden onset of crampy pain usually in umbilical area of epigastrium Symptoms: Vomiting occurs early with small bowel Vomiting occurs late with large bowel

Ruptured Aortic Aneurism

Abdominal Aortic Aneurism (AAA):
AAA is abnormal dilation of abdominal aorta forming

aneurysm May rupture and cause exsanguinations (bleeding) into stomach cavity More frequent in elderly Presents as Sudden Onset of Excruciating Pain: May be felt in chest or abdomen May radiate to legs and back

Chronic abdominal pain

Generally present for months to years
Generally not immediately life threatening Outpatient work-up is prudent

Chronic Pain Syndromes

Irritable bowel syndrome
Chronic pancreatitis Diverticulosis Gastroesophageal reflux disease (GERD) Inflammatory bowel disease Duodenal ulcer Gastric ulcer

Irritable Bowel Syndrome

GI condition classified as:
Functional No identifiable structural Biochemical abnormalities

Affects :
14%-24% of females and 5%-19% of males

Onset: Late adolescence Early adulthood

Rare :
to see onset > 50 yrs old

Pain described as:

Nonradiating Intermittent

Irritable Bowel Syndrome Symptoms

Crampy located lower abdomen

Onset:
Usually worse 1-2 hrs after meals

Exacerbated :
By stress

Relieved by:
BM (bowel movement)

Does not:
Interrupt sleep

Pain is critical to diagnosis of IBS

IBS Diagnosis
Rome Diagnostic Criteria:
3 month minimum of following symptoms in continuous or recurrent pattern: abdominal pain or discomfort relieved by BM & associated with either: 1. change in frequency of stools and/or 2. change in consistency of stools

IBS Diagnosis Continuation

Rome Diagnostic Criteria:
2 or more of following symptoms on 25% of occasions/days:
altered stool frequency >3 BMs daily or <3BMs/week altered stool form lumpy/hard or loose/watery

altered stool passage straining

urgency or feeling of incomplete evacuation passage of mucus feeling of bloating abdominal distention

IBS MANAGEMENT
Goals of management:
Exclude presence of underlying organic disease Provide support & reassurance Dietary modification Pharmacotherapy Alternative therapies

Chronic Pancreatitis
Causes:
alcohol major cause

malnutrition - outside US
patients >40 yrs with pancreatic dysfunction must be

evaluated for pancreatic cancer dysfunction between 20 to 40 yrs old R/O cystic fibrosis 50% of pts with chronic pancreatitis die within 25 yrs of diagnosis

Chronic Pancreatitis - Symptoms

Pain :
may be absent or severe recurrent

may be constant

Location of pain:
usually abdominal

sometimes referred upper back, anterior chest, flank

Presentation:
weight loss

diarrhea
oily stools N, V, or abdominal distention less reported

Presents as:

DIVERTICULOSIS

uncomplicated disease, presenting either

asymptomatic or symptomatic

Considered :
a deficiency disease of 20th century Western

civilization

Rare:
in first 4 decades

Occurs :
in later years

Incidence :
50% to 65% by 80 years

Diverticulosis Symptoms
Symptoms:
80% - 85% remain symptomless - found by diagnostic

study for other reason irregular defecation intermittent abdominal pain bloating or excessive flatulence change in stool recurrent bouts of steady or crampy pain may mimic IBS except older age

Diverticulosis Management
DO: increased fiber intake

Avoid:
popcorn
corn nuts

seeds

Presentation:

Diverticulitis

Pain LLQ, constant, associated with

fever, Mainly obstipation (severe and obstinate constipation) May be some blood with small amount of stool

Labs :
show leukocytosis imaging shows colon thickening with

diverticuli, pericolonic fat stranding, possible abscess

Treatment :
antibiotics

Impact upon :

Gastro Esophageal Reflux Disease GERD

Movement of gastric contents from stomach to

esophagus May produce S & S within esophagus, pharynx, larynx, respiratory tract

Prevalence:
Most prevalent condition affecting GI tract
About 15% of adults use antacid > 1x/wk

Presentations: Heartburn - most common Burning, gnawing in mid-epigastrium May irradiate to the back Water brash (appearance of salty-tasting fluid in mouth because stimulate saliva secretion) Occurs: After eating Alleviated: May be relieved with antacids (occurs within 1 hr of eating - usually large meal of day)

GERD - Symptoms

GERD - Triggers
Foods that may precipitate heartburn: high fat or sugar chocolate, coffee, & onions citrus, tomato-based, spicy cigarette smoking alcohol aspirin NSAIDS potassium pills heavy and spicy meal of day

GERD Diagnosis
Presentation:
History of heartburn without other symptoms of

serious disease

Treatment: Empiric trial of medication Testing for those who do have persistent or unresponsive heartburn or signs of tissue injury Tests: H. pylori antibody Barium swallow Endoscopy for severe or atypical symptoms

Lifestyle changes:

GERD Management

smoking cessation reduce ETOH consumption reduce dietary fat decreased meal size

weight reduction
elevate head of bed 6 inches

GERD Medications
Antacids with lifestyle changes may be sufficient
H2-histamine receptor antagonists in divided

doses(zantac) Proton pump inhibitor(prilosec,nexium,prevacid)

Chronic Inflammatory Bowel Diseases

What is Chronic IBS?
Chronic inflammatory condition involving intestinal

tract with periods of remission and exacerbation colitis

Two types
Ulcerative colitis (UC) Crohns disease (CD)

Ulcerative Colitis (UC) & Crohn's Disease (CD) Similarities and Differences
Incidence: Annual incidence of UC & Crohns similar Onset and Distribution: similar in both age of onset & worldwide distribution Gender Differences: about 20% more men have UC about 20% more women have Crohns Peak onset: peak age of onset - between 15 & 25 yrs Presentation: chronic inflammatory condition involving intestinal tract with periods of remission and exacerbation - colitis

Ulcerative Colitis (UC) & Crohn's Disease (CD) Similar Symptomatology

Presentation: both have similar presentations abdominal pain - intermittent for years abdominal pain and diarrhea present in most pts pain diffuse or localized to RLQ-LLQ cramping sensation - intermittent or constant

Ulcerative Colitis (UC) & Crohn's Disease (CD) Physical Examination

Physical Presentation: may be in no distress oral ulcers tender lower abdomen hyperactive bowel sounds stool for blood need to look for fistulas & abscesses perianal lesions

Ulcerative Colitis (UC) & Crohn's Disease (CD) Laboratory Diagnosis

Blood work

Flexible sigmoidoscopy
Colonoscopy

Colonoscopy with biopsy

Ulcerative Colitis (UC) & Crohn's Disease (CD) MANAGEMENT

Should be managed GI
5-aminosalicylic acid products Corticosteroids Immunosuppressives medications Surgery

DUODENAL ULCERS
Incidence: Increasingly secondary to increasing use of NSAIDs H. pylori infections Causes: Imbalance in amount of acid-pepsin production

Duodenal Ulcer Risk Factors

Stress
Cigarette smoking COPD Alcohol Chronic ASA Chronic NSAID use

Duodenal Ulcer Incidence

Facts: about 16 million individuals will have during lifetime more common than gastric ulcers peak incidence; 5th decade for men, 6th decade for women 75%-80% recurrence rate within 1yr of diagnosis without maintenance therapy >90% of duodenal ulcers caused by H.pylori

Duodenal Ulcer Symptoms

Pain: epigastric pain sharp, burning, aching, gnawing pain occurring 1 hrs after meals or in middle of night Pain Alleviated: Pain relieved with antacids or food Recurrences: Symptoms recurrent lasting few days to months Not uncommon: Weight gain -3

GASTRIC ULCERS
Causes: infection with H. pylori identified in 65% to 75% of patients with non-NSAID use 5% - 25% of patients taking ASA/NSAID develop gastric ulcers malignancy

Gastric Ulcer Other Risk Factors

Caffeine/coffee

Alcohol

Smoking

First-degree relative with gastric ulcer

Gastric Ulcer Symptoms

Pain: Pain similar to duodenal but may be increased by food Location - LUQ radiating to back Bloating, belching, nausea, vomiting, weight loss NSAID-induced ulcers usually painless - discovered secondary to black stools or iron deficiency anemia