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Chapter 1. Introduction to Digestive System

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12 views20 pages

Chapter 1. Introduction to Digestive System

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selaneth11
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Chapter 1: Introduction to

Digestive System
Dr. Prom Vireak, MD
Deputy Dean for Clinical Affairs, Faculty of Medicine
• 61-year-old woman came to hospital because of the consistent discomfort
and significant weight loss. She complaint of the tarry stool in the early
morning which she has never experienced before.
• She presented with a 2-month hisotry of burning pain in the epigastric
abdomen and chest which radiated toward her back.
• Her pain worsened after taking aspirine and drinking coffee, and was
relieved after taking anti-acids.
• She has previously lost 10kg in 2 months due to decreased intake caused by
the feeling of bloating, early fullness and stomachaches between meals.
• She also had nausea and vomiting. She also reported doubling her NSAID
intake to ease her increased knee pain. She looked pale and exhausted
when she entered the clinic.
• History: Gastritis with Helicobacter Pyloric (H. pylori) infection, diagnosed 5
years ago. Resolved with pharmacotherapy, frequent recurrence.
Diagnosis: Peptic Ulcere
1. What cause the burning senstation in the epigastric abdomen?
2. Why her pain is worsened after taking aspirine?
3. Why patient has stomachache between meals?
4. What cause her nausea and vomiting?
5. What make her pale appearance?
6. Why the pain is better with antiacid?
Introduction
• Digestion: Process by which food is broken down into simple
chemical susbstances that can be absorbed and use as nutrients by
the body.
• Digestive process is accomplished by mechanical and enzymatic
breakdown of food into simpler chemical compounds.
• Young healthy adult
• Consuming about 1kg of solid food and 1-2L of liquid daily.
• Digestive systems plays the major roles in the digestion and
absorption of food substances.
Introduction
• Functions include:
1. Ingestion of food substances
2. Breaking them into small particles
3. Transport of small particles to different areas of the digestive tract
4. Secretion of necessary enzymes and other substance for digestion
5. Digestion of food particles
6. Absorption of digestive products (nutritents)
7. Removal of unwanted substances from the body.
Functional Anatomy of Digestive System
• Digestive System = Gastrointestinal tract (GI) + Accessory Organs
• GI tract = Mouth to anus
• Length of GI tract = 30 feet (~ 9m)

• GI tract is divided into


• Upper GI tract
• Lower GI tract
GI tract: Accessory organs:

1. Mouth 1. Teeth
2. Pharynx 2. Tongue
3. Esophagus 3. Salivary glands
4. Stomach 4. Exocrine part of
5. Small Intestine pancreas
6. Large intestine 5. Liver
6. Gallbladder
Gastrointestinal Tract
• The wall of GI tract is formed by four layers which are from inside out:
• Mucus layer (mucosa)
• Submucus layer (submucosa)
• Muscular layer
• Serious layer (serosa)
• Mucus layer:
• The innermost layer of GI wall
• It has three layers:
• Epithelial lining/mucus epithelium:
• Stratified squamous epithelial cells are for the inner
surface of mouth, tongue, pharynx and esophagus.
• Columna epithelia cells are for the stomach, small and
large intestine.
• Lamina propria:
• formed by connective tissues ( fibroblasts, macrophages,
lymphocytes and esoinophils)
• Muscularis mucosa:
• thin layer of smooth muscles fibers. It is present from
oesophagus onward.
• Its main function is to:
• Secreting the gastric juice and other intestinal juices,
hormones and enzymes.
• Protect tissue through mucus secretion
Muscular layer
• Submucus layer
• Blood vessels, lympatic vessels and submucosal plexus
(Meissner plexus), connective tissues and type of fibers.
• Its main functions:
• To nourish and to communicate the GI tract
• Muscular layer
• Having the myenteric plexus (Auerbach Plexus)
• Skeletal muscles fibers: lips, cheeks and wall of pharynx
• Smooth muscle fibers: stomach and intestine
• Smooth mucles fibers in stomach are arranged in 3 layers:
• Inner oblique layer
• Middle circular layer
• Outer longitudinal layer
• Smooth muscle fibers in intestine are arranged in 2 layers:
• Inner circular layer
• Outer longitudinal layer
• Both muscles and skeletal muscle fibers: oesophagus Between circular and longitudinal has
• It main function: Auerbach Nerve Plexus
• To contract and relax, producing the peristalsis.
• Serous or fibrious layer (Adventitia)
• Outermost layer of GI tract
• It is formed by the connective tissues and mesoepithelial cells (peritoneum)
• Serious layer/membrane = serosa
• Covering stomach, small and large intestine
• Fibrous layer = Fibrosa
• Covering pharynx and esophagus
• It has two layers:
• Visceral layer = covering the organs
• Parietal layer = covering the abdominal cavity
Nerves Supply to GI tract
• GI tract has two types of
nerve supply:
• Instrinsic nerve supply
• Forming enteric nervous system
• Controls all the secretions and
movements of GI tracts
• Extrinsic nerve supply
• Sympathetic and
parasympathetic innervation
from peripheral
• The enteric nervous system is
controled by extrinsic nerves
Intrinsic Nerve Supply- Enteric Nervous System

• Presenting from esophagus to anus


• The nerve fibers of this system are interconnected and formed two major
networks:
• Auerbach Plexus
• Meissner Plexus
Auerbach’s Plexus ( Myenteric nerve plexus)
• Located between inner circular muscle and
outer longitunidal muscle layer
• Functions:
• Regulate the movements of GI tract (+++)
• Accelerating the movements ( excitatory
neurotransmitters: Acetylcholine, serotonin and
substance P.)
• Inhibit the GI motility ( Inhibitory
neurotransmitters: vasoactive intestinal
polypeptide (VIP), neurotensin and enkephalin
Meissner Plexus (Submucus nerver plexus)
• Located in submucosal layer of GI tract.
• Functions:
• Regulation of secretory functions of GI tract.
• Causing constrition of blood vessels of GI tract
Extrinsic Nerve Supply
• Extrinsic nerves that control the enteric nervous system are from
autonomic nervous system (ANS).
• ANS à GI tract innervation
• Sympathetic NS
• Parasympathetic NS
Questions for Study

1. What is the difference between digestion and digestive process?


2. What are the digestive system?
3. What are the 4 layers of gastric intestinal tract?
4. How many important plexuses of the enteric nervous system? What
are they? Where they are located? What are their functions?
5. The enteric nervous system is controlled by which system?

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