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PMS1 1/26/05 10:52 AM Page 1

Anatomy and Physiology

of the Bowel and
Urinary Systems
1
Anthony McGrath

INTRODUCTION
The aim of this chapter is to increase the reader’s under-
standing of the small and large bowel and urinary system as
this will enhance their knowledge base and allow them to
apply this knowledge when caring for patients who are to
undergo stoma formation.

LEARNING OBJECTIVES
By the end of this chapter the reader will have:

❏ an understanding of the anatomy and physiology of the

small and large bowel;
❏ an understanding of the anatomy and physiology of the
urinary system.

GASTROINTESTINAL TRACT
The gastrointestinal (GI) tract (Fig. 1.1) consists of the mouth,
pharynx, oesophagus, stomach, duodenum, jejunum, small
and large intestines, rectum and anal canal. It is a muscular
tube, approximately 9 m in length, and it is controlled by the
autonomic nervous system. However, while giving a brief
outline of the whole system and its makeup, this chapter will
focus on the anatomy and physiology of the small and large
bowel and the urinary system.
The GI tract is responsible for the breakdown, digestion and
absorption of food, and the removal of solid waste in the form
of faeces from the body. As food is eaten, it passes through each
section of the GI tract and is subjected to the action of various

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1 Anatomy and Physiology of the Bowel and Urinary Systems

Fig. 1.1 The digestive system. Reproduced with kind permission of Coloplast
Ltd from An Introduction to Stoma Care 2000

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Gastrointestinal Tract 1
digestive fluids and enzymes (Lehne 1998). The salivary
glands switch into action as soon as food enters the mouth, and
as the food continues on its journey, enzymes found in the
stomach, small intestine, the pancreas and the liver continue
the process. It is this secretion of fluids that helps maintain the
function of the tract (Tortora & Grabowski 2001).

Lining of the GI tract

Throughout the GI tract, the walls are made up of mucous
membrane, constructed in such a way that the various parts
can act independently of each other. The walls of the GI tract
consist of four layers. These are the:
• adventitia;
• muscularis;
• submucosa;
• mucosa.

Adventitia
The adventitia or outer layer consists of a serous membrane
composed of connective tissue and epithelium. In the
abdomen it is called the visceral peritoneum. It forms a part
of the peritoneum, which is the largest serous membrane of
the body (Thibodeau & Patton 2002).

Peritoneum
The peritoneum is the serous membrane that lines the ab-
dominal and pelvic cavities, and covers most abdominal
viscera. It is a large closed sac of thin membrane which has
two layers:
• the parietal peritoneum, which lines the abdominal and
pelvic cavities;
• the visceral peritoneum which covers the external surfaces
of most abdominal organs, including the intestinal tract.
The serous membrane is made up of simple squamous
epithelium and a supporting layer of connective tissue. The

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1 Anatomy and Physiology of the Bowel and Urinary Systems

potential space between the visceral and parietal layers is

known as the peritoneal cavity and contains serous fluid. In
some diseases, such as liver disease, the peritoneal cavity can
fill up with serous fluid called ascites. Some organs protrude
into the abdominal cavity but are not encased in the visceral
peritoneum. The kidneys lie in this type of position and are
said to be ‘retroperitoneal’.
The folds of the peritoneum bind the organs to the cavity
walls and to each other. The folds include the mesentery,
the lesser omentum, the greater omentum and the faciform
ligament. These folds contain the nerve, blood and lymph
supply to the abdominal organs. The mesentery is attached
to the posterior abdominal wall and this binds the small
intestine to the abdominal wall. The lesser omentum
arises from the lesser curvature of the stomach and extends
to the liver. The greater omentum is given off from the
greater curvature of the stomach, forms a large sheet that
lies over the intestines, and then converges into parietal
peritoneum. The falciform ligament attaches the liver to the
anterior abdominal wall and to the diaphragm (Ross et al.
2001).

Muscularis
The muscularis mostly consists of two layers of smooth
muscle, which contract in a wave-like motion. The exceptions
can be found in the mouth, pharynx and the upper oesopha-
gus, which are made of skeletal muscle that aids swallowing.
The two smooth muscle layers consist of longitudinal fibres in
the outer layer and circular fibres in the inner layer. The con-
traction of these two layers of muscle assists in breaking down
the food, mixing it with the digestive secretions and propelling
it forward. This action is referred to as peristalsis. Peristaltic
action looks like an ocean wave moving through the muscle.
The muscle constricts and then propels the narrowed portion
slowly down the length of the organ forcing anything in front
of the narrowing to move forward.

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Small Intestine 1
Between the two muscle layers the blood vessels, lymph
vessels and the major nerve supply to the GI tract can be
found. The nerve supply is called the mesenteric or Auerbach’s
plexus, and it consists of both sympathetic and parasympa-
thetic nerves. It is mostly responsible for GI motility, which is
the ability of the GI tract to move spontaneously (Tucker 2002;
Martini 2004).

Submucosa
The submucous layer is highly vascular as it houses plexuses
of blood vessels, nerves and lymph vessels, and tissue. It con-
sists of connective tissue and elastic fibres. It also contains the
submucosal or Meissner’s plexus, which is important in con-
trolling the secretions in the GI tract (Martini 2004).

Mucosa
The mucosa is a layer of mucous membrane that forms the
inner lining of the GI tract. It is made up of three layers:

• a lining layer of epithelium, which acts as a protective layer

in the mouth and oesophagus, and has secretory and
absorptive functions throughout the rest of the tract;
• the lamina propria, which supports the epithelium by
binding it to the muscularis mucosae and is made up of
loose connective tissue that contains blood and lymph
vessels;
• the muscularis mucosae layer, which contains smooth
muscle fibres (Siegfried 2002).

SMALL INTESTINE
The small intestine begins at the pyloric sphinter and coils its
way through the central and lower aspects of the abdominal
cavity and joins the large intestine (colon) at the ileocaecal
valve. The small intestine is divided into three separate seg-
ments: the duodenum, jejunum and ileum. The nerve supply
for the small bowel is both sympathetic and parasympathetic.

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1 Anatomy and Physiology of the Bowel and Urinary Systems

It is approximately 6.5 m long and has a diameter of approxi-

mately 2.5 cm. The walls of the small intestine consist of the
same four layers as the rest of the GI tract, however, both the
mucosal and submucosal layers are modified. The mucosal
layer consists of many glands called intestinal glands. These
glands are lined with glandular epithelium, and they secrete
intestinal juice. The submucosa in the duodenum contains
glands that secrete mucus which is alkaline, this is designed
to protect the small intestine walls from the acid in chyme and
prevent the enzymes from acting on the walls. The small
intestine is further modified in that throughout its length the
epithelium covering the lining and the mucosa is made up of
simple columnar epithelium. This contains both absorptive
and goblet cells. If you were to examine the small intestine
using a powerful microscope you would note that the absorp-
tive cells actually contain projections described as ‘finger-like’.
The projections are known as microvilli and allow the small
intestine to deal with larger amounts of digested nutrients,
having simply increased the surface area for digestion
(Thibodeau & Patton 2002; Ellis 2004).
The mucosa has a velvety appearance because its surface is
made up by a series of villi. There are approximately 20–40
villi per square millimetre and these also increase the absorp-
tive and digestive surface of the small intestine. They are about
0.5–1 mm long and their walls are made up of columnar
epithelial cells with tiny microvilli. The cells enclose a network
of blood and lymphatic capillaries. The lymphatic vessels are
known as lacteals. Nutrients pass via the blood capillaries
and lacteals into the cardiovascular and lymphatic systems
(Tortora & Grabowski 2002).
The surface area of the small intestine is further increased
by the presence of circular folds about 10 mm high. These are
unlike the rugae in the stomach that flatten out, in that they
remain in place. They cause the chyme to twist around as it
moves through the small intestine. This assists the digestive
and absorptive processes. Throughout the mucous membrane

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Small Intestine 1
in the small intestine numerous lymph nodes occur at
irregular intervals. The nodes are known as either solitary or
aggregated lymphatic follicles (Peyer’s patches) that occur in
groups, and they are found mostly in the ileum (Watson 2000;
Ross et al. 2001).
Thus, the main function of the small intestine is digestion
and absorption and its makeup is designed to help this
process. The chyme is broken into small molecules that can
be transported across the epithelium and into the blood
stream. This occurs in the presence of pancreatic enzymes
and bile, which are important in the digestive process.
The small intestine absorbs most of the water, electrolytes
(sodium, chloride, potassium) and glucose (amino acids and
fatty acid) from the chyme. The small intestine not only pro-
vides nutrients to the body but also plays a critical role in
water and acid–base balance (Tortora & Grabowski 2002;
Martini 2004).
The chyme from the stomach moves along the small intes-
tine at approximately 1 cm/min. As the small intestine is about
6.4 m in length, chyme can remain in the small intestine for up
to eight hours. The chyme is moved along by peristaltic move-
ments, which are controlled by the autonomic nervous system.
Digestion is completed in the small intestine with the aid of
juices from the liver and pancreas. Waste is then transported
to the large intestine for disposal.
The superior mesenteric artery supplies the whole of the
small intestine and venous blood is drained by the superior
mesenteric vein that links with other veins to form the hepatic
portal vein (Watson 2000; Ross et al. 2001).

Duodenum
This is approximately 25 cm in length and it curves around
the head of the pancreas. In the mid-section of the duo-
denum there is an opening from both the pancreas and the
common bile duct. This opening is controlled by the sphincter
of Oddi.

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1 Anatomy and Physiology of the Bowel and Urinary Systems

Jejunum
This is approximately 2.5 m in length and extends to the ileum.

Ileum
This is the terminal part of the small intestine that ends at the
ileocaecal valve. It measures about 3.5 m in length. The ileum
will usually empty approximately 1.5 litres of fluid into the
colon each day.

Pancreas
The pancreas is attached to the duodenum and lies posterior
to the greater curvature of the stomach. When chyme enters
the duodenum the hormone secretin is released and this
stimulates the pancreas to secrete its juices. The pancreatic
juices pass through the pancreatic ducts into the duodenum to
aid digestion by neutralising the acid to continue the digestive
process (Ross et al. 2001).

Liver and gall bladder

The liver is situated in the right hypochondrium and extends
into the epigastric region. Bile, which is produced in the liver,
passes from the hepatic ducts into the cystic duct prior to
entering the gall bladder for storage. When fatty foods are
detected in the duodenum the hormone cholecystokinin is
secreted. This causes the gall bladder to contract thus pushing
the bile into the duodenum to emulsify the fatty food (Kumar
& Clark 1998; Page 2001).

LARGE INTESTINE
The large intestine is so called because of its ability to distend.
It forms a three-sided frame around the small intestine leaving
its inferior area open to the pelvis. It is designed to absorb
water from the contents of the small intestine that pass into it.
Although the small intestine absorbs some water this process
is intensified in the large intestine until the familiar semisolid
consistency of faeces is achieved. The large intestine is

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Large Intestine 1
approximately 1.5 m in length and extends from the ileum to
the anus. Its size decreases gradually from the caecum, where
it is approximately 7 cm in diameter, to the sigmoid, where it
is approximately 2.5 cm in diameter (Keshav 2003). The large
intestine has four segments: the caecum, colon, rectum and
anal canal. The colon is divided into four sections: the ascend-
ing colon, transverse colon, descending colon and sigmoid
colon.
The large intestine also houses a variety of bacteria. These
bacteria, known as commensals, live happily in the bowel and
generally do not cause any problems. In fact, they play an
important part in digestion – they ferment carbohydrates and
release hydrogen, carbon dioxide and methane gas. The bac-
teria also synthesise a number of vitamins such as vitamin K
and some B vitamins. They are also responsible for breaking
down the bilirubin into urobilinogen, which gives the faeces
its characteristic brown colour. However, outside the bowel
the bacteria can cause illness and even death.
The blood supply to the large intestine is mainly by the
superior and inferior mesenteric arteries. The internal iliac
arteries supply the rectum and anus. Venous drainage is
mainly by the superior and inferior mesenteric veins, and the
rectum and anus are drained by the internal iliac veins. The
nerves supplying the large intestine are via the sympathetic
and parasympathetic nerves. The external anal sphincter is
under voluntary control and is supplied by motor nerves from
the spinal cord (Siegfried 2002; Ellis 2004).

Caecum
The small intestine terminates at the posteromedial aspect of
the caecum. The caecum is fixed to the right side near the iliac
crest. At the opening to the caecum there is a fold of mucous
membrane known as the ileocaecal valve, which allows the
passage of materials from the small intestine into the large
intestine and prevents the reflux of contents from the colon
back into the ileum. The contents of the colon are heavily

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1 Anatomy and Physiology of the Bowel and Urinary Systems

colonised by bacteria whereas the small intestine is relatively

free of microbes. The caecum is a dilated portion and has been
described as a blind pouch approximately 6 cm in width and
8 cm in length. It is continuous with the ascending colon su-
periorly and has a blind end inferiorly. Attached to the caecum
is a coiled tube closed at one end called the vermiform appen-
dix. It is usually 8–13 cm in length although this can vary from
2.5 cm to 23 cm and has the same structure as the walls of the
colon; however, it contains more lymphatic tissue (Moore &
Dalley 1999).

Colon

Ascending colon
The ascending colon is approximately 15 cm long and joins the
caecum at the ileocaecal junction. The ascending colon is
covered with peritoneum anteriorly and on both sides,
however, its posterior surface is devoid of peritoneum. It
ascends on the right side of the abdomen to the level of the
liver where it bends acutely to the left. At this point it forms
the right colic or hepatic flexure and then continues as the
transverse colon (Thibodeau & Patton 2002).

Transverse colon
This is a loop of colon approximately 45 cm long that con-
tinues from the left hepatic flexure across to the left side of
the abdomen to the left colic flexure. It passes in front of the
stomach and duodenum and then curves beneath the lower
part of the spleen on the left side as the left colic or splenic
flexure and then passes acutely downward as the descending
colon (Watson 2000).

Descending colon
This section of the colon passes downwards on the left side of
the abdomen to the level of the iliac crest. It is approximately

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Large Intestine 1
25 cm in length. The descending colon is narrower and more
dorsally situated than the ascending colon.

Sigmoid colon
The sigmoid colon begins near the iliac crest and is approxi-
mately 36 cm long. It ends at the centre of the mid-sacrum,
where it becomes the rectum at about the level of the third
sacral vertebra. It is mobile and is completely covered by
peritoneum and attached to the pelvic walls in an inverted V
shape.

Rectum
The rectum is approximately 13 cm in length and begins where
the colon loses its mesentery. It lies in the posterior aspect of
the pelvis and ends 2–3 cm anteroinferiorly to the tip of the
coccyx, where it bends downwards to form the anal canal
(Tortora & Grabowski 2002).

Anal canal
This is the terminal segment of the large intestine and is
approximately 4 cm in length opening to the exterior as the
anus. The mucous membrane of the anal canal is arranged in
longitudinal folds that contain a network of arteries and veins.
The anus remains closed at rest. The anal canal corresponds
anteriorly to the bulb of the penis in males and to the lower
vagina in females and posteriorly it is related to the coccyx.
The internal anal sphincter is composed of smooth muscle and
is the lower of the two sphincters. It is about 2.5 cm long and
can be palpated during rectal examination. It controls the
upper two-thirds of the anal canal. The external sphincter is
made up of skeletal muscle and is normally closed except
during elimination of faeces. The nerve supply is from the
perineal branch of the fourth sacral nerve and the inferior
rectal nerves (Martini 2004).

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1 Anatomy and Physiology of the Bowel and Urinary Systems

Fig. 1.2 The urinary system. Reproduced with kind permission of Coloplast
Ltd from An Introduction to Stoma Care 2000

URINARY SYSTEM
The urinary system consists of the kidneys, ureters, bladder
and urethra (Fig. 1.2). It has three major functions:

• excretion;
• elimination;
• homoeostatic regulation of the solute concentration of the
blood plasma.

Kidneys
The kidneys are situated on either side of the vertebral column
and they lie retroperitoneally between the 12th thoracic and

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Urinary System 1
3rd lumbar vertebrae. The left kidney lies slightly superior to
the right kidney and it is also slightly longer.
The kidneys are bean-shaped, and approximately 10–12 cm
in length, 5–7 cm wide and 2–5 cm thick. The blood supply,
nerves and lymphatic vessels enter and exit at the hilum.
The superior surface of the kidney is capped by the adrenal
gland. Each kidney is surrounded by three layers.

(1) Renal capsule: this is a layer of collagen fibres that covers

the outer surface of the entire organ.
(2) Fat: this keeps the kidney in place and surrounds the renal
capsule.
(3) Renal fascia: this is a dense fibrous outer layer that also
secures the kidney to the posterior abdominal wall and to
the surrounding structures (Ross et al. 2001).

The kidney itself is made up of two layers, the cortex and

the medulla. The cortex is the outer layer and the medulla is
the inner layer. Within the medulla there are 8–18 distinct
conical or triangular structures called the renal pyramids. The
base of each pyramid is turned towards the cortex and the tip
of the pyramid is directed towards the renal sinus. The tips of
the pyramids are referred to as the renal papillae. The pyra-
mids are separated from each other by bands of cortical tissue
called the renal columns. The renal cortex and the pyramids
together make up the parenchyma. The parenchyma consists
of approximately 1.25 million nephrons, which are the func-
tional units of the kidney as they form urine and help regulate
the composition of the blood (Raferty 2000; Tucker 2002;
Martini 2004)

Nephron
The nephron is the functional unit of the kidney. It is respon-
sible for filtration of the blood and for the re-absorption of
water and salts and the absorption of glucose. About 1.25
million nephrons can be found in the cortex. The nephron
consists of a renal tubule and a renal corpuscle. The tubule is

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1 Anatomy and Physiology of the Bowel and Urinary Systems

approximately 50 mm in length and consists of the convoluted

tubule and the loop of Henle. The renal corpuscle is made up
of the Bowman’s capsule and the capillary network of the
glomerulus (Tucker 2002).

Blood and nerve supply of the kidney

The right and left renal arteries transport about 20–25% of
the total cardiac output and approximately 1200 ml will pass
through the kidney each minute. As the renal artery enters the
renal sinus, it divides into the five segmental arteries, which
then subdivide into a series of interlobar arteries that radiate
outwards and between the renal columns. At the base of the
renal pyramids the arteries arch between the medulla and the
cortex and are known as the arcuate arteries. These divide
again to form the interlobular arteries. The interlobular
arteries enter the renal cortex and become efferent arterioles
which deliver blood to the capillaries known as peritubular
capillaries.
Blood exits the kidney via the peritubular venules which
then join the interlobular veins. These drain through the
arcuate veins into the interlobar veins, which, in turn, join the
segmental veins. The segmental veins join the renal vein which
leaves the kidney at the hilum (Ellis 2004).

Nerve supply of the kidney

The nerve supply to the kidneys is from the renal nerves,
which are derived from the renal plexus of the sympathetic
division of the autonomic nervous system. The nerves enter
the kidney at the hilum and run alongside the blood supply
to reach the individual nephrons. The nerves regulate the cir-
culation of blood in the kidneys by controlling the size of the
arterioles (Martini 2004).

Ureters
The ureters are muscular tubes that link the kidneys to the
bladder. They are approximately 30 cm in length and 3 mm in

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Urinary System 1
diameter. They consist of three layers: an inner layer of transi-
tional epithelium, a middle layer made up of longitudinal and
circular bands of smooth muscle and an outer layer of connec-
tive tissue which is continuous with the renal capsule. There are
slight differences in the ureters in men and women as they have
to accommodate the position of the reproductive organs.
The ureters transport urine from the kidneys to the bladder.
Urine is forced along the ureter due to peristaltic action. The
ureters enter the bladder on the posterior wall and pass into
the bladder at an oblique angle. This prevents backflow when
the bladder contracts (Ross et al. 2001).

Bladder
The bladder is a hollow, muscular organ that collects and
stores urine. It is situated in the lower part of the abdomen and
is lined with a membrane called the urothelium. The cells of
this membrane are called transitional cells or urothelial cells.
The bladder wall has three layers: mucosa, submucosa and
muscularis. The muscularis is made up of layers of longitudi-
nal smooth muscle with a circular layer sandwiched in
between. This muscle layer is known as the detrusor muscle,
and it is this mucle that contracts to expel urine from the
bladder and into the urethra.
The bladder initally stores urine, however, afferent fibres in
the pelvic nerves carry impulses to the spinal cord, which, in
turn, sends messages to the thalamus and then along projec-
tion fibres to the cerebral cortex. At this point you become
aware that your bladder requires emptying. The muscle of the
bladder can then be contracted to force urine out of the body
through a tube called the urethra (Ellis 2004).

Urethra
The urethra extends from the neck of the bladder to the exte-
rior of the body. In women, the urethra is a very short tube, in
front of the vagina, approximately 4 cm in length. In men, the
tube is considerably longer, 18–20 cm long; it needs to be

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1 Anatomy and Physiology of the Bowel and Urinary Systems

longer as it has to pass through the prostate gland and the

length of the penis. It is made up of stratified epithelium (Ross
et al. 2001; Thibodeau & Patton 2002; Martini 2004).

REFERENCES
Ellis, H. (2004) Clinical Anatomy. A Revision and Applied Anatomy for
Clinical Students. Blackwell Science, Oxford.
Keshav, S. (2003) The Gastrointestinal System at a Glance. Blackwell
Science, Oxford.
Kumar, P. & Clark, M. (1998) Clinical Medicine, 4th edn. W.B. Saunders,
Edinburgh.
Lehne, T. (1998) The mouth and salivary glands. In: D.J. Weatherall,
J.G. Ledingham & D.A. Warrell, eds. Oxford Textbook of Medicine, 3rd
edn. Oxford University Press, Oxford.
Martini, F.H. (2004) Fundamentals of Anatomy and Physiology. Benjamin
Cummings, San Fransisco.
Moore, K. & Dalley, A.F., eds. (1999) Clinically Orientated Anatomy.
Lippincott Williams & Wilkins, Philadelphia.
Page, M., ed. (2001) The Human Body. Dorling Kindersley, London.
Raferty, A.T., ed. (2000) Applied Science for Basic Surgical Training.
Churchill Livingstone, Edinburgh.
Ross, J.S., Wilson, R.J.W., Waugh, A. & Grant, A. (2001) Ross and Wilson
Anatomy and Physiology in Health and Illness, 10th edn. Churchill
Livingstone, Edinburgh.
Siegfried, D.R. (2002) Anatomy and Physiology for Dummies. John Wiley
& Sons Inc, Columbia.
Thibodeau, G. & Patton, K.T. (2002) Anatomy and Physiology, 5th edn.
C.V. Mosby, New York.
Tortora, G.J. & Grabowski, S.R. (2002) Principles of Anatomy and
Physiology, 10th edn. John Wiley & Sons Inc, Columbia.
Tucker, L. (2002) An Introductory Guide to Anatomy and Physiology,
revised edn. Holistic Therapy Books, Cambridge.
Watson, R. (2000) Anatomy and Physiology for Nurses, 11th edn. Baillère
Tindall, Royal College of Nursing, Edinburgh.

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