Overview of the Digestive System

Introduction

In the digestive system, the process of digestion has many stages, the first of which starts in the
mouth (oral cavity). Digestion involves the breakdown of food into smaller and smaller
components which can be absorbed and assimilated into the body. The secretion of saliva helps
to produce a bolus which can be swallowed to pass down the oesophagus and into the stomach.

In this study session, you will be learning about the digestive system, Gerontological changes in
the GIT and assessment of the abdomen

Learning Outcome for Study Session

At the end of this study session, you should be able to:

Highlight the functions of Digestive system

Discuss the Gerontological changes in the GIT

Explain how to assess the abdomen

Functional Anatomy of the Digestive System

The Organs fall into two groups: alimentary canal and accessory digestive organs.

Alimentary canal: Mouth, pharynx, oesophagus, stomach, small intestine, large intestine, anus.

Accessory organs: tongue, teeth, gall bladder, salivary glands, glands of the large intestine, liver,
pancreas.

GIT extends from the mouth, oesophagus, stomach, intestines to the anus.
 Figure 11.1: Anatomy of the GIT

Mouth: A cavity lined by mucosa (oral or buccal cavity). Boundaries: anteriorly- lips, laterally-
cheeks, superiorly- palate, inferiorly- tongue, posteriorly- continuous with the oropharynx.

Lined with thick stratified squamous epithelium. Withstands considerable friction. Epithelium
on the gum, hard palate, dorsum of the tongue is slightly keratinized for extra protection against
abrasion during eating.

The oral mucosa responds to injury by producing antimicrobial peptides defensins, which
explains how the mouth remains healthy despite teeming disease causing microbes

Figure 1.2: Anterior view of Buccal Cavity

Tongue- Occupies the floor of the mouth, fills most of the oral cavity when the mouth is closed.
Composed of interlacing bundles of skeletal muscle fibres. During chewing, it grips the food and
constantly repositions it between the teeth, mixes food with saliva to form a blos, initiates
swallowing by pushing the bolus posteriorly into the pharynx. Intrinsic and extrinsic skeletal
muscle fibres.

Intrinsic muscles: confined in the tongue and NOT attached to bone. Fibres run along several
planes, allows the tongue to change its shape (but not position), becoming thicker, thinner, longer
or shorter as needed for speech and swallowing.

Extrinsic muscles: (Genioglossus, hyoglossus, styloglossus). Extends from the point of origin on
bones of the skull (mandible, hyoid bone, styloid process of the temporal bone respectively) or
soft palate. These muscles protrude, retract and move it side by side.

The lingual frenulum: secures the tongue to the floor of the mouth and limits posterior movement
of the tongue.

Filiform papillae: peg-like projections of the underlying mucosa. Provides the tongue with
roughness that aids in licking semi solid foods such as ice cream and provides friction for
manipulating food in the mouth.

Fungiform papillae: widely scattered on the surface of the tongue

Circumvallate: located in a V-shaped row at the back of the tongue

Foliate papillae: on lateral aspect of the posterior tongue

The fungiform, circumvallate and foliate hose the taste buds, but those on the foliate papillae
function in taste in infancy and early childhood.

Figure 1.3: The Papillae of the Tongue

Salivary Glands

Functions: Cleanses the mouth, dissolves food chemical so that they can be tasted, moistens food
and aids in compacting it into a bolus, contains enzymes that begin chemical breakdown of
starchy foods.

Types

 Intrinsic salivary or buccal glands: scattered throughout the oral cavity

 Extrinsic glands: Paired, compound, tubular glands. they include:
 Parotid glands: lies anterior to the ear. The parotid duct parallels the zygomatic arch,
pierces the buccinators muscle and opens into the vestibule next to the 2 nd molar.
Branches of the facial nerve runs through the parotid gland ( surgery on the gland can
result in facial paralysis)
 Inflammation of the parotid gland (mumps) occurs commonly in children. It is caused
by mumps virus (Myxovirus). Spreads through saliva
 Mumps in adult males carry a 25% risk that the testes may become infected as well,
resulting in sterility.

Salivary Glands

Submandibular gland: About size of walnut. Lies along the medial aspect of the mandible.
Duct runs beneath the mucosa of the floor of the mouth. Opens at the base of the lingual
frenulum.

Sublingual gland: lies anterior to the submandibular, under the tongue. Opens via 10-12 ducts
into the floor of the mouth.

Cells of the Salivary Glands

Two types of secretory cells:

Serous cells: produce watery secretions containing enzymes, ions, tiny bits of mucin.

Mucous cells: produce mucus.

 The parotid glands contain only serous cells. Submandibular and buccal glands have equal
number of serous and mucous cells. The sublingual contain mostly mucous cells.

Composition of Saliva

Largely water, therefore hypo osmotic. Osmolarity depends on the precise glands that are active
and nature of the stimulus for salivation. Saliva is slightly acidic (pH 6.75 to 7.00). Solutes
include: electrolytes: Na, K, Cl, PO4 and HCO3)

Digestive enzyme: salivary amylase and lingual lipase (both optimally active at an acid pH).
Protein (mucin), lysozyme, IgA, metabolic waste (urea and uric acid) when dissolved in water,
the glycoprotein mucin forms thick mucus that lubricates the oral mucosa and food

Protective Function of Saliva

Protection is provided by: immunoglobulin A (IgA) antibodies; lysozymes: a bactericidal

enzyme that inhibits bacterial growth in the mouth, may help prevent tooth decay.

A cyanide compound defensins functions as a cytokine to call defensive cells (lymphocytes,

neutrophils etc.) into the mouth for battle.

Friendly bacteria that live on the back of the tongue convert food–derived nitrates in saliva into
nitrites which, in turn are converted to nitric oxide in an acid environment. This transition occurs
around the gum where acid-producing bacteria tend to cluster, and in the HCl-rich secretions of
the stomach.

The highly toxic nitric oxide is believed to act as a bactericidal agent in these areas.

ESOPHAGUS: a muscular tube extending from the pharynx to the stomach. Two openings:
upper oesophageal sphincter at the cricopharyngeal muscle; lower oesophageal sphincter (LES)
or cardiac sphincter (normally remains closed and opens only to pass food into the stomach)

STOMACH: a hollow distensible muscular pouch. Located in the Left Upper Quadrant, below
the diaphragm and between the liver and the spleen. Consist of 3 anatomic areas: the fundus,
body (corpus) and antrum (pylorus). Stores, churns and digest food.

SPHINCTERS: The LES: Allows food to enter the stomach, prevents reflux into the
oesophagus

Pyloric sphincter: regulates flow of stomach content (Chyme) into the small intestine.

SMALL INTESTINE: a coiled tube. Extends from the pyloric sphincter to the ileocecal valve
at the large intestine. Has 3 sections: Duodenum, jejunum, and ileum.

LARGE INTESTINE: a shorter, wider tube (approximately 6.ocm), length 1.4m. Begins at
ileocecal valve (in the RLQ) and ends at the anus. Consist of 3 sections:

1. The cecum: a blind pouch that extends from the ileocecal valve to the vermiform
appendix
2. The colon: main portion of the large intestine. Divided into 4 parts: ascending,
transverse, descending and sigmoid.
3. The rectum: extends from the sigmoid colon to the rectum.

THE ILEOCECAL VALVE: Prevents the return of faeces from the cecum into the small
intestine.

The appendix: Collects lymphoid tissue. Arises from the cecum

LARGE INTESTINE: The large intestine consists of the caecum; ascending, transverse,
descending, and sigmoid colon; and the rectum. In adults, it extends about 1.5 m and has a
diameter ranging from 8 cm in the caecum to 2 cm in the sigmoid colon.
 Figure 10.4: Anterior view of the Large intestine

Source: American Society of Clinical Oncology

The function of the large intestine is to receive 500 to 2,000 mL of ilea contents per day.
Absorption of fluid and solutes occurs in the right colon or the segments proximal to the middle
of the transverse colon, with movement and storage of faecal material in the left colon and distal
segments of the colon.

Mucus secretion from goblet cells into the intestinal lumen lubricates the mucosal surface and
facilitates movement of the dehydrated faeces. It also serves to protect the luminal wall from
bacteria and colonic irritants such as bile acids.

Four major tissue layers, from the lumen outward, form the large intestine: the mucosa,
submucosa, muscularis externa and serosa.
Lymphatic channels do not extend into the mucosa. The muscularis externa consists of circular
smooth muscle and three outer longitudinal smooth muscle bands. The outermost layer of the
colon, the serosa, secretes a fluid that allows the colon to slide easily over nearby structures
within the peritoneum.

The serosa covers only the anterior and lateral aspects of the upper third of the rectum. The lower
third lies completely extra peritoneal and is surrounded by fibro-fatty tissue as well as adjacent
organs and structures.

Layers of the GIT

4 layers from within outward:

 Inner mucosal layer: lubricates and protects the inner surface of the tract
 Submucosa: responsible for secreting digestive enzymes.
 Muscles: Circular, Longitudinal & oblique muscles
 Outer serosa (peritoneum): composed parietal and visceral peritoneum

Functions of the GIT

 Ingestion and propulsion of food

 Digestion
 Absorption
 Elimination

Digestion- Begins in the mouth with chewing and action of ptyalin (salivary enzyme) that breaks
starch. Swallowed food passes through the oesophagus to the stomach. Process of digestions
continues in the stomach: secretion of gastric juices, HCl and enzyme pepsin and lipase (and
renin in infants)

Absorption: Mixing and churning through peristaltic action. From pylorus, the Chyme passes
into the duodenum through pyloric valve. Food digestion is completed in the small intestine.
Most nutrients absorption occurs. Pancreatic and intestinal enzymes (trypsin, lipase, amylase,
lactase, maltase, and sucrase) and bile are involved in digestion.
Elimination- Waste products: through the anus. Water and electrolytes are absorbed at the
cecum and ascending colon. Rectum stores faeces for elimination

Movement in the GIT

There are 2 types of movement in the GIT, they are:

Segmentation: mixing;

Propulsion: peristalsis.

SECRETIONS OF THE GIT:

Enzymes and hormones: digestion;

Mucus: lubrication and protection;

Water and electrolyte

Activity 1.1

Reading Assignment: Detailed Structure and Function of the GI Organs, Physiology of

Digestion.

Gerontologic Changes in the GIT

Abdomen- aging alters abdominal appearance. Accumulation of fat in the supra pubic areas in
females at middle age (decreased oestrogen levels). In male, fat deposits resulting in ‘spare tyre’
or bay window.’

Fat redistribution away from face and extremities to abdomen and hips (with further ageing).
Relaxed abdominal musculature.

GIT: decreased salivation: dry mouth and decreased sense of taste

Mouth: atrophy of soft tissues and thinning of epithelium (cheek and tongue): loss of taste.
Atrophic tissues ulcerate easily: risk of oral moniliasis. Abrading of the tooth surface, gum begin
to recede, teeth erode at the gum line.

A smooth V-shaped cavity forms around the neck of the tooth, exposing the nerve (resulting in
hypersensitive tooth). Some tooth loss due to bone reabsorption (osteoporosis) which decreases
the inner tooth structure and its outer support. Poor oral hygiene, tooth decay exacerbates tooth
loss. When tooth loss occurs, remaining teeth drift causing malocclusion. Mal-occluded teeth
cause stress during chewing and other problems:

1. Excessive bone resorption with further tooth loss

2. Muscle imbalance (maxilla and mandible out of alignment)
3. Spasms and tenderness of muscles of mastication
4. Chronic headache
5. Temporomandibular joint stress

Delayed oesophageal emptying: risk of aspiration if fed in supine position, Decreased gastric
acid secretion causing pernicious anaemia (interferes with vitamin B12 absorption), iron
deficiency anaemia and malabsorption of calcium.

Increased incidence of gall stones

Liver decreases in size (function may remain normal).Drug metabolism by liver is impaired
(particularly after 80yrs) and blood flow to the liver decreases by ½ by age 85. Liver metabolism
responsible for enzymatic oxidation, reduction and hydrolysis of drugs decreases.

Prolonged liver metabolism increases side effects of the drugs. Examples: acetaminophen,
barbiturates, diazepam. Ibuprofen, lidocaine, propranolol, quinidine, salicylates, warfarin etc.

Constipation: slowed passage in the distal colon and delayed rectal emptying.

Assessment of the Abdomen

Physical examination- Four quadrants: Right upper quadrant (RUQ), Left Upper quadrant
(LUQ), Right lower quadrant (RLQ), Left lower quadrant (LLQ)

Quadrants are determined by imaginary vertical line (midline) from the tip of the sternum, thru
the umbilicus to the symphysis pubis. The line is bisected perpendicularly by the lateral line
which runs thru the umbilicus across the abdomen.
 Figure 10.5: Abdominal Regions and Quadrants

Source: http://commons.wikimedia.org/wiki/File:Abdominal_Quadrant_Regions.jpg

Locating Structures by Quadrants

History of Symptoms RUQ: Ascending and transverse colon, duodenum, gall bladder, hepatic
flexure of the liver, liver, pancreatic head, pylorus, Rt adrenal gland, upper pole of right kidney,
Rt urethra.

RLQ: appendix, ascending colon, cecum, Rt Kidney (lower pole), Rt Ovary and tube, Rt ureter,
Rt spermatic cords

LUQ: left adrenal gland, left kidney (upper pole), left ureter, pancreas (body and tail), spleen,
splenic flexure of colon, stomach, transverse descending colon

LLQ: left kidney (lower pole), Lt Ovary, left ureter, left spermatic cord, descending and sigmoid
colon.

Use the mnemonic COLDSPA

C –character
O-onset

L-location

D- Duration

S- Severity

P- Pattern

A- Associated factors.

Example:

• Are you experiencing abdominal pain?

• How would you describe the pain?
• How bad is the pain on a scale of 1 to 10, with 10n being the worst?

Sources of Abdominal Pain

Quality and character of pain may suggest origin.

Abdominal pain may be: visceral, parietal or referred.

Visceral pain: Visceral pain is directly related to the organ involved. The majority of organs do
not have an abundance of nerve fibres, so the patient might experience mild or less severe pain
that is poorly localized. It’s important to understand this does not mean the patient is
experiencing a mild or less severe condition.

Parietal pain: Parietal pain occurs when there is an irritation of the peritoneal lining. The
peritoneum has a higher number of sensitive nerve fibres, so the pain is generally more severe
and easier to localize. The patient will typically present in a guarded position with shallow
breathing. This minimizes the stretch of the abdominal muscles and limits the downward
movement of the diaphragm, which reduces pressure on the peritoneum and helps ease the pain.

Referred pain: Referred pain is visceral pain that is felt in another area of the body and occurs
when organs share a common nerve pathway. For this reason, it is poorly localized but generally
constant in nature. An example is a patient with liver problems that experiences referred pain in
the neck or just below the scapula.

Summary

In this study session, you have learnt the following:

1. Alimentary canal: Mouth, pharynx, oesophagus, stomach, small intestine, large intestine,
anus while Accessory organs: tongue, teeth, gall bladder, salivary glands, glands of the
large intestine, liver, pancreas.
2. Quadrants are determined by imaginary vertical line (midline) from the tip of the
sternum, thru the umbilicus to the symphysis pubis. The line is bisected perpendicularly
by the lateral line which runs thru the umbilicus across the abdomen.
3. There are 4 layers of the GIT from within outward:

• Inner mucosal layer: lubricates and protects the inner surface of the tract
• Submucosa: responsible for secreting digestive enzymes.
• Muscles: Circular, Longitudinal & oblique muscles
• Outer serosa (peritoneum): composed parietal and visceral peritoneum

Self-Assessment Questions (SAQs) for Study Session

Now that you have completed this study session, you can assess how well you have achieved its
Learning Outcomes by answering these questions. Write your answers in your Study Diary and
discuss them with your Tutor at the next Study Support Meeting. You can check your answers
with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 1.1

Describe the function of the GIT

SAQ 1.2

List 5 effects of gerontology on the teeth

SAQ 1.3

Name the organs in each four quadrants of the abdomen

Note on SAQs

SAQ 1.1

Digestion- Begins in the mouth with chewing and action of ptyalin (salivary enzyme) that breaks
starch. Swallowed food passes through the oesophagus to the stomach. Process of digestions
continues in the stomach: secretion of gastric juices, HCL and enzyme pepsin and lipase (and
renin in infants)

Absorption: Mixing and churning through peristaltic action. From pylorus, the chyme passes
into the duodenum through pyloric valve. Food digestion is completed in the small intestine.
Most nutrients absorption occurs. Pancreatic and intestinal enzymes (trypsin, lipase, amylase,
lactase, maltase, and sucrase) and bile are involved in digestion.

Elimination- Waste products: through the anus. Water and electrolytes are absorbed at the
cecum and ascending colon. Rectum stores faeces for elimination

SAQ 1.2

1. Excessive bone resorption with further tooth loss

2. Muscle imbalance (maxilla and mandible out of alignment)

3. Spasms and tenderness of muscles of mastication

4. Chronic headache
5. Temporomandibular joint stress

SAQ 1.3

RUQ: Ascending and transverse colon, duodenum, gall bladder, hepatic flexure of the liver,
liver, pancreatic head, pylorus, Rt adrenal gland, upper pole of right kidney, Rt urethra.

RLQ: appendix, ascending colon, cecum, Rt Kidney (lower pole), Rt Ovary and tube, Rt ureter,
Rt spermatic cords

LUQ: left adrenal gland, left kidney (upper pole), left ureter, pancreas (body and tail), spleen,
splenic flexure of colon, stomach, transverse descending colon

LLQ: left kidney (lower pole), Lt Ovary, left ureter, left spermatic cord, descending and sigmoid
colon.