Digestive System

Human Anatomy & Physiology

University of NU Surabaya
Dr. Bambang Edi Suwito
Digestive System
Digestive (GI) Tract
 Actions of Digestive (GI) Tract
• Ingestion • Secretion
– Occurs when material enters – Release of water acids,
via the mouth buffers, enzymes & salts by
epithelium of GI tract and
• Mechanical Processing
glandular organs
– Crushing / Shearing – makes
material easier to move • Absorption
through the tract – Movement of organic
substrates, electrolytes,
• Digestion
vitamins & water across
– Chemical breakdown of food digestive epithelium
into small organic compounds
for absorption • Excretion
– Removal of waste products
from body fluids
Histological Structure of the Digestive (GI)
Tract
Peritoneum : serous membrane
• Visceral peritoneum: covers the external surfaces of most
digestive organs
• Parietal Peritoneum: lines the body wall
• Peritoneal Space: potential space containing fluid that
separates the visceral & parietal peritoneum

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Figure 23.5a
 Peritoneum
• Mesentery: double layer of peritoneum fused together that
extends to the organs from the posterior body wall.
– Provides support for the organs
– Provides support for vessels & nerves supplying the organs

Figure 23.5a
 Peritoneum
• Retroperitoneal organs
– Organs that adhere to the posterior abdominal wall & lose their
peritoneum by resorption
– Parts of the large & small intestine & most of the pancreas; (also
kidneys)

Figure 23.5b
 Functions of Oral Cavity
• Sensory analysis
– Of material before swallowing
• Mechanical processing
– Through actions of teeth,
tongue, and palatal surfaces
• Lubrication
– Mixing with mucus and salivary
gland secretions
• Limited digestion
– Of carbohydrates and lipids
 Functional Anatomy: Mouth
• Mouth: lips, palate, &
tongue
• Mouth cavity = Buccal
cavity

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 Functional Anatomy: Mouth

– Filiform papillae: rough surface

– Fungiform papillae: house taste buds
– Circumvallate papillae: house taste buds,
– Foliate papillae: posterolateral; taste buds
 Functional Anatomy: Mouth
• Salivary Glands: intrinsic & extrinsic
– Intrinsic glands: scattered throughout the buccal
cavity mucosa
– Extrinsic glands: supply most of the saliva; outside
buccal cavity & supply secretions via ducts:
• Parotid
• Submandibular
• Sublingual
 Esophagus
• A hollow muscular tube
• About 25 cm (10 in.) long
and 2 cm (0.80 in.) wide
• Conveys solid food and
liquids to the stomach
• Begins posterior to cricoid
cartilage
• Is innervated by fibers from
the esophageal plexus
 Stomach Function
• Major Functions of the Stomach
– Storage of ingested food
– Mechanical breakdown of ingested food
– Disruption of chemical bonds in food material by acid
and enzymes
– Production of intrinsic factor, a glycoprotein required
for absorption of vitamin B12 in small intestine

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Gastric Anatomy
 Microscopic
Anatomy : Stomach

• Gastric glands secrete

gastric juices
Figure 23.15

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 Small Intestine
• 90% of absorption occurs in the small intestine
 Small Intestine
• The Duodenum
– The segment of small intestine closest to stomach
– 25 cm (10 in.) long
– “Mixing bowl” that receives chyme from stomach and
digestive secretions from pancreas and liver
– Functions of the duodenum
• To receive chyme from stomach
• To neutralize acids before they can damage the absorptive
surfaces of the small intestine
 Small Intestine
• The Jejunum
– Is the middle segment of small intestine
– 2.5 meters (8.2 ft) long
– Is the location of most
• Chemical digestion
• Nutrient absorption
– Has few plicae circulares
– Small villi
 Small Intestine
• The Ileum
– The final segment of small intestine
– 3.5 meters (11.48 ft) long
– Ends at the ileocecal valve, a sphincter that
controls flow of material from the ileum into
the large intestine
 Pancreas
• Lies posterior to stomach
– From duodenum toward
spleen
• Is bound to posterior wall of
abdominal cavity
• Is wrapped in thin,
connective tissue capsule
Functions of the Pancreas
1. Endocrine cells of the
pancreatic islets:
• Secrete insulin and
glucagon into bloodstream
2. Exocrine cells:
• Acinar cells and epithelial
cells of duct system
secrete pancreatic juice
 Pancreas
• Pancreatic Enzymes • Pancreatic Enzymes
– Pancreatic alpha-amylase – Nucleases
• Break down nucleic acids
• A carbohydrase
• Breaks down starches – Proteolytic enzymes
• Break certain proteins apart
• Similar to salivary amylase
• Proteases break large protein
– Pancreatic lipase complexes
• Breaks down complex lipids • Peptidases break small peptides
• Releases products (e.g., fatty into amino acids
acids) that are easily absorbed • 70% of all pancreatic enzyme
production
• Secreted as inactive proenzymes
• Activated after reaching small
intestine

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Liver
 Liver: Gross Anatomy

• Largest gland
• 4 Lobes
• Falciform ligament
– mesentery supports
liver from diaphragm
& anterior body wall
– separates R & L
lobes
• Round ligament
fibrous remnant of Fig 23.23
umbilical vein

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Microanatomy of the Liver

Figure 23.24c, d
 Liver
• Hepatocytes
– Are liver cells
– Adjust circulating levels of nutrients
• Through selective absorption and secretion
– In a liver lobule form a series of irregular plates
arranged like wheel spokes
– Many Kupffer cells (stellate reticuloendothelial cells)
are located in sinusoidal lining
– As blood flows through sinusoids
• Hepatocytes absorb solutes from plasma
• And secrete materials such as plasma proteins
 Gallbladder
• Functions of the Gallbladder
– Stores bile
– Releases bile into duodenum, but only under
stimulation of hormone cholecystokinin (CCK)
– CCK
• Hepatopancreatic sphincter remains closed
• Bile exiting liver in common hepatic duct cannot flow through
common bile duct into duodenum

• Bile enters cystic duct and is stored in gallbladder

 Gall Bladder
• Gall Bladder = a muscular pouch that stores bile & expels bile when needed
via the cystic duct & the bile duct.

Figure 23.20
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 Regulation of Bile
Release
• Cholecystokinin (CCK) & secretin
released by the small intestine in
response to increased fats in chyme
• CCK:
– Stimulates both Gall bladder & pancreatic
secretion
– Relaxes hepatopancreatic sphincter
• Secretin: stimulates bile secretion

Figure 23.25
Coordination of Secretion & Absorption
 Large Intestine
• Is horseshoe shaped
• Extends from end of ileum to anus
• Lies inferior to stomach and liver
• Frames the small intestine
• Also called large bowel
• Is about 1.5 meters (4.9 ft) long and 7.5 cm
(3 in.) wide
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Parts of Colon

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 Large Intestine Functions
– Reabsorption of
water
– Compaction of
intestinal contents
into feces
– Absorption of
important vitamins
produced by
bacteria
– Storage of fecal
material prior to
defecation
 Parts of Large Intestine
• The Rectum
– Forms last 15 cm (6 in.) of
digestive tract
– Is an expandable organ for
temporary storage of feces
– Movement of fecal material
into rectum triggers urge to
defecate
• The anal canal is the last
portion of the rectum
– Contains small longitudinal folds
called anal columns
• Anus
– Also called anal orifice
– Is exit of the anal canal
– Has keratinized epidermis like
skin
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Embryology and Anatomy of
the Gastrointestinal Tract

Anatomical departement
University of NU Surabaya
Dr. Bambang Edi Suwito
 Normal Embryology
• Endoderm
– Epithelial lining and glands
• Mesoderm
– Lamina propria, muscularis mucosa,
submucosa, muscularis externa and serosa
• Ectoderm
– Enteric nervous system and posterior luminal
digestive structures

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 Gastrulation:
Epiblast cells
migrate through the
primitive streak.

Definitive (embryonic)
endoderm cells displace
the hypoblast.

Mesoderm spreads
between endoderm
and ectoderm.

Langman’s fig 5.3 39

 Early mesodermal patterning:

(buccopharyngeal membrane)

Specific regions of the epiblast migrate

through the streak at different levels
and assume different positions within
the embryo:

Cranial to caudal:
Notochord (n)
Paraxial mesoderm (pm)
Intermediate mesoderm (im)
*Lateral plate mesoderm (lpm)
Extraembryonic mesoderm (eem)

Langman’s fig 5-07

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 Endoderm

Carlson fig 6-20

The developing endoderm (yellow) is initially open to the

yolk sac (the cardiac region is initially most anterior)…

Cranio-caudal folding at both ends of the embryo and

lateral folding at the sides of the embryo
bring the endoderm inside and form the gut tube.
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 cloacal membrane

Carlson fig 6-20

Folding creates the anterior and posterior intestinal portals

(foregut and hindgut, respectively)

The cardiac region is brought to the ventral side of the

developing gut tube.

Juxtaposition of ectoderm and endoderm at:

Oropharyngeal (buccopharyngeal) membrane - future mouth
Cloacal membrane - future anus

Note: there actually isn’t much mesoderm in these membranes, which is important for42
their breakdown later in development to form the oral and anal orifices.
 Carlson fig 6-20

Gut-associated organs begin to form as buds from the

endoderm: (e.g., thyroid, lung, liver, pancreas)

Midgut opening to the yolk sac progressively narrows

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 With lateral folding,
mesoderm is recruited to
gut wall
Carlson fig 6-20

Langman’s fig 6-18

• Lateral folding of the embryo completes the gut tube

• Mesodermal layer of the gut tube is called splanchnic (visceral) mesoderm -
derived from lateral plate mesoderm
• Somatic mesoderm lines body cavity 44
 Gut tube proper Derivatives of gut tube

Foregut: pharynx thyroid

esophagus parathyroid glands
stomach tympanic cavity
proximal duodenum trachea, bronchi, lungs
liver, gallbladder
pancreas
Midgut: proximal duodenum to
right half of
transverse
colon
Hindgut: left half of urinary bladder
transverse
colon to anus

(These three regions are defined by their blood supply) 45

 4th week 5th week

Langman’s fig 14-14 Langman’s fig 14-4

Celiac artery supplies the foregut

Superior mesenteric artery supplies the midgut
Inferior mesenteric artery supplies the hindgut
The figure on the right also shows the mesenteries; note that the liver and stomach have 46
dorsal and ventral mesenteries whereas the rest of the gut has only a dorsal mesentery.
 Regional Organogenesis: Esophagus
• Region of foregut just caudal to
lung bud develops into esophagus
–errors in forming the
esophagotracheal septa and/or re-
canalization lead to
tracheoesophageal fistulas and/or
esophageal atresia, respectively.
• Endodermal lining is stratified
columnar and proliferates such that
the lumen is obliterated; patency of
the lumen established by re-
Langman’s fig 14-06
canalization –errors in this process
lead to esophageal stenosis
– NOTE: this process of recanalization
occurs throughout the gut tube, so
occlusion can occur anywhere along the
GI tract (e.g. duodenal stenosis)
• Tube initially short and must grow
in length to “keep up” with descent
of heart and lungs –failure of
growth in length leads to congenital
hiatal hernia in which the cranial
portion of the stomach is pulled into
7th week the hiatus.
Larsen’s fig 14-22
5th week 9th week
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 Regional Organogenesis: Stomach
4th week 5th week
6th week

Greater omentum

3rd month
3rd month

3rd month
Langman’s figs 14-08, 11, 12

• Stomach appears first as a fusiform dilation of the foregut endoderm which undergoes a 90° rotation such that the left
side moves ventrally and the right side moves dorsally (the vagus nerves follow this rotation which is how the left
vagus becomes anterior and the right vagus becomes posterior).
• Differential growth establishes the greater and lesser curvatures; cranio-caudal rotation tips the pylorus superiorly
• Dorsal AND ventral mesenteries of the stomach are retained to become the greater and lesser omenta, respectively
• Caudal end of the stomach separated from the duodenum by formation of the pyloric sphincter (dependent on factors
such as SOX-9, NKX-2.5, and BMP-4 signaling) –errors in this process lead to pyloric stenosis.
Pyloric Stenosis
• Rather common malformation:
present in 0.5% - 0.1% of infants

• Characterized by very forceful (aka

“projectile”), non-bilious vomiting
~1hr. after feeding (when pyloric
emptying would occur).
– NOTE: the presence of bile would indicate
POST-duodenal blockage of some sort.

• Hypertrophied sphincter can often be

palpated as a spherical nodule;
peristalsis of the sphincter seen/felt
under the skin.

• Stenosis is due to overproliferation /

hypertrophy of pyloric sphincter…
NOT an error in re-canalization.

• More common in males than females,

so most likely has a genetic basis
which is as yet undetermined.
 A closer look at the mesenteries
5 weeks Last trimester

Langman’s fig 14-30

Langman’s fig 14-26

• The stomach and liver are suspended in a mesentery that is attached to the dorsal AND
ventral body walls
– Dorsal mesentery of stomach becomes the greater omentum
– Ventral mesentery of stomach/dorsal mesentery of the liver becomes the lesser omentum
– Ventral mesentery of the liver becomes the falciform ligament
• The rest of the GI tract is suspended in a dorsal mesentery (mesodoudenum,
mesocolon, etc.)
Regional Organogenesis: Liver & Pancreas

Langman’s fig 14-19

• Liver and pancreas arise in the 4th week from foregut

endoderm in response to signals from nearby mesoderm
• Pancreas actually has ventral and dorsal components,
each specified in a different manner
 Rotation of the
duodenum brings
the ventral and
dorsal pancreas
together

Larsen’s fig 14-09

Aberrations in this process may

result in an annular pancreas, which
can constrict the duodenum.

Also, since the dorsal and ventral

pancreas arise by different
mechanisms, it’s possible that one or
the other may be absent in the adult.

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Larsen’s fig 14-10
Rotation of the duodenum also causes it and the pancreas
to become SECONDARILY retroperitoneal

5th week 3rd month

Langman’s fig 14-11

Secondarily retroperitoneal = a structure that was originally in the body coelom

but then got pushed into the body wall during development
Intraperitoneal vs. retroperitoneal vs.
secondarily retroperitoneal

Larsen’s fig 14-16

Development of the midgut and colon
Herniation and rotation:
– Growth of the GI tract exceeds volume of
abdominal cavity so the tube herniates through
umbilicus

– While herniated, gut undergoes a primary

rotation (fig B) of 90° “counterclockwise” (when
looking at the embryo); this corresponds with the
rotation of the stomach, and positions the
appendix on the left. The primary rotation also
brings the right vagus n. to the FRONT (hence
the change in its name to ANTERIOR vagus n.

– With the growth of the embryo, the abdominal

cavity expands thus drawing the gut tube back
within the abdominal cavity and causing an
additional, secondary rotation (fig C) of 180°
CCW (positioning the appendix on the RIGHT)

– Once in the abdominal cavity, the colon

continues to grow in length, pushing the
appendix to its final position in the lower right
quadrant.

– Note the attachment of the vitelline duct to the

gut at the region of the ileum. The duct normally
regresses during development, but not always….
 Defects associated with gut herniation
and rotation: vitelline duct abnormalities

Langman’s fig 14-32

Vitelline duct abnormalities of some sort occur in ~2% of all

live births. Note that these aberrant structures are almost
always found along the ileal portion of the GI tract.
Defects associated with gut herniation
and rotation: oomphalochele

Langman’s fig 14-31

Defects associated with gut herniation
and rotation: abnormal rotation

Langman’s fig 14-33

Absent or incomplete Reversed secondary rotation

secondary rotation
(90 CCW primary rotation occurs as usual
but followed by abnormal 180 CW rotation.
Net rotation is 90° CW; viscera are in their
normal location, but note that the duodenum
is anterior to the transverse colon)
Defects associated with gut herniation
and rotation: volvulus

Carlson fig 15-13

Fixation of a portion of the gut tube to the body wall; subsequent rotation causes
twisting of the tube, possibly resulting in stenosis and/or ischemia.
 Development of the hindgut
Langman’s fig 14-36
imperforate anus anal atresia

anoperineal fistula rectovaginal fistula

• Derivatives of the hindgut include everything

caudal to the distal 1/3 of the transverse colon.

• Distalmost portion (sigmoid colon and rectum)

divides cloaca into the anorectal canal and
urogenitial canals –errors in this process can
lead to imperforate anus (“A” on right), atresia rectourethral fistula rectovesical fistula
(B), and/or fistulas (C – F)

• As with the rest of the GI tract, enteric neurons

in the hindgut arise from vagal neural crest (plus
some sacral crest). Distalmost portions of the
hindgut are farthest away and therefore more
sensitive to perturbations in migration (e.g.
mutations in RET), resulting in congenital
megacolon (Hirschspring’s Disease). Carlson fig 15-18
 Hirschprung Disease
(congenital megacolon)

• Occurs in ~1:5000 births

• Caused by failure of vagal
neural crest cells to migrate
into a portion of the colon
• Denervated region tonically
constricted (role of myenteric
plexus is largely INHIBITORY)
• Upstream regions become
distended (hence
“megacolon”)
• Surgically repaired by
removing affected region