The Digestive System

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The Abdomen
 Hold GI, part of urinary and reproductive
viscera
 Divided into 9 regions by two vertical & two
transverse planes
 Transverse planes- through the lower border
of 10th rib (subcostal plane) and through the
two iliac tubercles (intertubercular plane)
 Vertical planes:- right and left planes
through mid of clavicle & inguinal ligament
Regions of the abdominal wall
a. Right and left hypochondrium
b. Epigastric region
c. Right and left lumbar or flank regions
d. Umbilical region
e. Right and left inguinal or iliac regions
f. Hypogastric or pubic region
For clinical descriptions,
we will classify into four
quadrants (right and left
upper and lower
quadrants) by the
transverse
transumbilical plane
and the vertical median
plane
 Peritoneum
• Largest serous membrane of the body.
Parietal peritoneum – lines wall of
abdominal cavity.
Visceral peritoneum - covers some organs
and constitutes their serosa.
Peritoneal cavity
• Potential space b/n the parietal and visceral
portions of peritoneum.

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 Peritoneal cavity cont…
• Contains serous fluid
Extra fluid in the peritoneal cavity results
in ascites.
The cavity is completely closed in males;
however, there is a communication pathway in
females to the exterior of the body through the
uterine tubes, uterine cavity, and vagina.
• a potential pathway of infection from the
exterior

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Based on the peritoneal covering
• Intraperitoneal organs stomach, liver, gall
bladder, spleen, jejunum, ileum, transverse
colon, sigmoid colon, uterus and ovaries
(essentially mobile organs “slung” in mesentery)
• Retroperitoneal organs
• Kidneys, adrenal glands, aorta, IVC, bladder,
vagina, rectum, descending and ascending
colon, duodenum and pancreas

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H Ye. G 10
Mesentery- a part of peritonium
• Outward fold of the serous coat of the
small intestine.
• Attached to the posterior abdominal wall
• Binds the small intestine to the posterior
abdominal wall.
Mesocolon
• Binds the large intestine to the posterior
body wall
• It also carries blood vessels and lymphatic
to the intestine.

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 Omentum
• Double layered peritoneum that passes from
stomach and proximal duodenum to adjacent
abdominal organs. Two parts
1. Greater Omentum greater stomach
curvature inferiorly and back up to anterior
surface of transverse colon.
• Functions to seal off local infected areas of
parietal peritoneum, and conveys blood vessels
and nerves from the posterior abdominal wall to
the stomach.
• Abdominal policeman can wrap itself around
inflamed areas to wall them off and prevent
spread of infection adhesions!
 Parts of greater omentum
 Gastrophrenic stomach to inferior
diaphragm
 Gastrosplenic stomach to spleen
 Gastrocolic stomach to transverse colon
2. Lesser Omentum- from the lesser curvature of
the stomach and proximal part of duodenum to
the liver.
Parts of lesser omentum
 Gastrohepatic  liver to stomach
 Hepatoduodenal liver to duodenum
 Organization of digestive organs
The organs of digestion are divided into
1. Gastrointestinal (GI) tract (Alimentary Canal)
• Continuous tube running through the ventral body
cavity.
• Extends from the mouth to anus.
• Its length in cadaver is about 9 meters.
• It composes the mouth, pharynx, esophagus,
stomach, small intestine, and large intestine.
2. Accessory structures - it consists of teeth, tongue,
salivary gland, liver, gallbladder, and pancreas.

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 Mouth /Oral/ Buccal cavity

Formed by Cheeks, hard & soft palates, & tongue

Cheeks
• Forms lateral walls of oral cavity
• Muscular structures externally covered with skin
• Anterior portion terminates in the superior and inferior
lips
Hard palate
• Anterior portion of the roof of the mouth
• Formed by the maxillary and palatine bones
• Covered by mucous membrane, and forms a bony
portion b/n the oral and nasal cavities.

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Soft palate
• Forms posterior portion of the roof of mouth
• An arch-shaped muscular portion b/n the oropharynx
and nasopharynx and lined by mucus membrane
Tongue
• Forms floor of the oral cavity
• Accessory structure of the digestive system composed
of skeletal muscle covered with mucus membrane.
• It is attached inferiorly to the hyoid bone.

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The tongue consists of
Extrinsic muscles
• Originate outside the tongue & insert into it.
• In includes hyoglossus, genioglossus, styloglossus
and palatoglossus
• Moves tongue from side to side and in and out.
• The movement food for chewing, shape the food,
and force the food to the back of the mouth for
swallowing.
Intrinsic muscles
• Originate and insert within the tongue.
• Alters shape & size of tongue for speech &
swallowing.
• It includes longitudinal superior and inferior,
transverses lingual, and verticalis lingual. 21
 Salivary glands
• Saliva is a fluid that is continuously secreted into the
mouth for moistening, lubrication, dissolving and
chemical breaking down of food.
• There are three pairs of major salivary glands.
1. The parotid glands: located inferior and anterior to
the ears b/n the skin and the masseter muscle.
2. The sub-mandibular glands: - found beneath the base
of the tongue in the posterior part of the floor of the
mouth.
3. Sablingual glands:- are located superior to the
submandibular glands.

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Salivary Glands

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Pharynx or throat
• It is a funnel shaped tube that starts at the internal
nares and extends the pathway down the neck.
 Pharynx is pathway for air and food
 Has 3 parts
1. Nasopharynx: connects with the two internal nares and
has two openings that lead in to auditory (eustachian)
tubes.
 The posterior wall contains the pharyngeal tonsils.
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2. Oropharynx: opens in to the mouth and nasopharynx.

 Two pairs of tonsils, the palatine tonsils and lingual

tonsils are found in oropharynx.

3. Laryngopharynx: connects with both the esophagus

(food tube) and the larynx (voice box).

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H Ye. G 26
 Esophagus
• Begins in the neck as a continuation of the pharynx at
the level of C6 and terminate at esophagogastric
junction (T10), where it enters the cardial orifice of the
stomach
• 25 cm long with a diameter of 2 cm with three parts
(cervical, thoracic and abdominal)
• Conveys food from the pharynx to the stomach
The esophagus normally has three constrictions
1. Cervical constriction (upper esophageal
sphincter): at its beginning at the pharyngo
esophageal junction, approximately 15 cm from the
incisor teeth; caused by the cricopharyngeus muscle.
Esophagus cont…
2. Thoracic (broncho-aortic) constriction: a compound
constriction where it is crossed by the arch of the aorta,
22.5 cm from the incisor teeth, and
• Where it is crossed by the left main bronchus, 27.5 cm
from the incisor teeth;
3. Diaphragmatic constriction: where it passes through
the esophageal hiatus of the diaphragm, approximately
40 cm from the incisor teeth
• The esophagus is attached to the margins of the
esophageal hiatus in the diaphragm by the phrenico-
esophageal ligament.
 Stomach
• The stomach is the expanded part of the digestive
tract between the esophagus and small intestine.
• The shape of the stomach resembles the letter J
• It is specialized for the accumulation of ingested
food.
• The stomach acts as a food blender and reservoir.
• The gastric juice gradually converts a mass of
food into a semiliquid mixture called chyme.
• It is capable of considerable expansion and can
hold 2–3 L of food.
• The stomach is divided into four areas: cardia,
fundus, body and pylorus.
• Cardia - surrounds the lower esophageal
sphincter.
• Fundus - the rounded portion above and to
the left of the cardia.
• Body - is largest central portion of the
stomach.
• Pylorus - it is the narrow, inferior region of
the stomach.

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Anatomy of the Stomach

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 Hiatal Hernia
• Protrusion of a part of the stomach into
mediastinum thru esophageal hiatus
• Occurs most often due to weakening of
muscular part of diaphragm.
• Subtypes: paraesophageal & sliding hiatal
hernia.

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 Hiatal Hernias cont…
In paraoesphageal hiatal hernia:
• Cardia of stomach remains in normal position
• A pouch of peritoneum, containing part of the
fundus of the stomach, extends through the
esophageal hiatus.
• No regurgitation of gastric contents occurs
In sliding hiatal hernia:
• Abdominal part of esophagus, cardia & fundus
of stomach slide superior to esophageal hiatus in
the thorax.
• Regurgitation of stomach contents occur.
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 Small Intestine
• Extends from pyloric sphincter  ileocecal
valve
• Major portion of digestion and absorption
• Averagely 2.5cm in diameter and about 6.33m
in length.
• Regions
• Duodenum
• Jejenum
• Ileum

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Duodenum- the widest and most fixed part.
Begins at the pylorus on the right side and ends at the
duodenojejunal junction on the left side.
 Four parts of the duodenum: superior (1st ) part,
descending (2nd ) part, horizontal (3rd ) part and
ascending (4th ) part.
Descending (2nd) part: The bile duct and main
pancreatic ducts via the hepatopancreatic ampulla enter
its posterior medial wall
• Duodenal (Peptic) Ulcers- mostly posterior wall of the
superior part of the duodenum
• perforates the duodenal wall and produce peritonitis.
 Jejunum and Ileum
• The jejunum begins at the duodenojejunal junction and
the ileum ends at the ileocecal junction, the union of
the terminal ileum and cecum.
Jejunum
• The jejunum is about 2.5m long & represents proximal
two-fifths.
• It is mostly in the left upper quadrant of the abdomen
• Is larger in diameter and has a thicker wall than the
ileum.
• less prominent arterial arcades & longer vasa recta
(straight arteries), compared to those of ileum.
Ileum
• It is about 4m long & makes up distal three-
fifths of small intestine
• It is mostly in the right lower quadrant.
• Compared to jejunum, ileum has thinner walls,
shorter vasa recta, more arterial arcades & more
mesenteric fat
• Ileum opens into large intestine
 Large Intestine
• Consists of the cecum, Appendix, colon (ascending,
transverse, descending, and sigmoid), rectum, and
anal canal.
• The large intestine can be distinguished from the
small intestine by:
Teniae coli: three thickened bands of
longitudinal muscle fibers.
Haustra: sacculations or pouches of the colon
between the teniae.
Omental appendices: small, fatty appendices
(projections) of colon.
Caliber: the internal diameter is much larger.
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 The Appendix
• The appendix is a narrow, hollow, blind
intestinal diverticulum
• Contains masses of lymphoid tissue in its walls.
Positions of appendix
• It may have: Anterior & Posterior positions:
1. Anterior position:
a. Ileal / preileal - 1%:
This is anterior to terminal ileum, possibly
contacting the body wall.
b. Pelvic (32%):
 This is suspended over pelvic brim in a pelvic
or descending position;
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Positions of appendix cont…
2. Posterior position:
a. Retrocaecal (retrocolic): posterior to the
cecum:  64% (most common)
b. Subcaecal (2%): below the cecum
c. postileal (0.5%): posterior to the terminal ileum
• Surface projection of base of appendix is at
junction of lateral 1/3rd & middle 2/3rd of a line
from Rt anterior superior iliac spine to umbilicus
(McBurney's point).
• People with appendicular problems may
describe pain near this location.

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The colon

1. The ascending colon

• passes superiorly from cecum to the right
lobe of the liver and it turns to the left as the
right colic flexure (hepatic flexure).
• lies retroperitoneally along the right side of
the posterior abdominal wall.
2. The transverse colon- the largest and most
mobile part of the large intestine
◦ crosses the abdomen from the right colic
flexure to the left colic flexure, where it bends
inferiorly to become the descending colon.
3. The descending colon - passes retroperitoneally
from the left colic flexure into the left iliac fossa,
where it is continuous with the sigmoid colon.
4. The sigmoid colon- S-shaped; extends from the
iliac fossa to the third sacral segment, where it
joins the rectum
◦ termination of the teniae coli indicates the
recto sigmoid junction.
• Rectum and Anal Canal
• The rectum, the fixed terminal part of the large
intestine, is continuous with the sigmoid colon at
the level of the S3 vertebra.
• The junction is at the lower end of the mesentery
of the sigmoid colon.
• The rectum is continuous inferiorly with the anal
canal
 The Liver
• Liver is the largest gland in the body  It
normally weighs about 1.5kg.
• Accounts for about one-fortieth of the body
weight in the adult.
• At birth, it represents one-twentieth of weight of
the body
• In the adult, it is concealed under the costal
margin and cannot be felt or palpated.
• Its sharp inferior border does not normally
extend below the right costal margin  unless
it is enlarged.

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 The Liver cont…
• The liver lies mainly in the right upper quadrant
of the abdomen, where it is protected by the
thoracic (rib) cage and the diaphragm.
• The normal liver lies deep to ribs 7–11 on the
right side and crosses the midline toward the left
nipple.
•4 Lobes
Major: Left and right
Minor: Caudate and quadrate

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Surfaces marking of liver
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 The Liver: Blood Supply
Has a dual blood supply: hepatic artery and portal vein
• The portal vein brings 75-80% of the blood to the liver.
Portal vein carries all nutrient absorbed from
alimentary tract to sinusoids of liver except lipids, which
pass via the lymphatic system.
• Hepatic artery from celiac trunk, accounting for only
20-25%
• The hepatic veins - open into the IVC just inferior to the
diaphragm
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 Functions of the Liver

1.Synthesis & secretion of bile

2.Metabolic activities: CH2O, protein, fat
metabolism
3.Filtration of blood

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 Secretion of bile
Bile is secreted by hepatocytes in the liver for
two purposes
1. It facilitates fat digestion and absorption of
fat
2. Serves as a means of excretion of waste
products (bilirubin and cholesterol)

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 The Gallbladder
• Gall bladder (7-10 cm long) lies in the
Gallbladder fossa on visceral surface of the Liver
• The Gall bladder fossa lies at junction of Rt &
Lt Liver.
• Has a Fundus, Body & Neck
• Gall bladder varies greatly in size, can holds
about 50 ml of bile.
• Stores & concentrates bile & excretes bile
back thru cystic duct to join common hepatic
duct & form the bile duct.

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 Pancreas Anatomy
• The pancreas is a feather shaped gland.

• Extend across the left side of the abdomen from

the spleen to the C shaped duodenum.
• The pancreas is an accessory digestive organ that
produces pancreatic juice.

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Histology
• Pancreatic cells are made up of Islets of
langerhans (1%) - endocrine portion which have
• Alpha - glucagon
• Beta - insulin
• Delta - somatostatin
• Acini (99%) - exocrine portions - secrets
pancreatic juice