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Digestive System Disorders Stomach Small Intestine Large Intestine Chapter 33: Structure and Function of the Digestive System Rectum

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Digestive System Disorders Stomach Small Intestine Large Intestine Chapter 33: Structure and Function of the Digestive System Rectum Bio217 Fall 2012 Unit IX Gastrointestinal Tract (GI Tract, Alimentary canal) Bio217: Pathophysiology Class Notes Professor Linda Falkow Mouth Esophagus Unit IX: Digestive System Disorders Stomach Small intestine Large intestine Chapter 33: Structure and Function of the Digestive System Rectum Chapter 34: Alterations of Digestive Function Anus Gastrointestinal Tract Gastrointestinal Tract • Histology • Ingestion of food – Mucosa • Propulsion of food and wastes from mouth – Submucosa to anus (peristalsis) – Muscularis • Secretion of mucus, water, and enzymes – Serosa • Mechanical digestion of food particles or adventitia • Chemical digestion of food particles • Absorption of digested food • Elimination of waste products by defecation Stomach Gastric Secretion • Stomach secretes large volumes of gastric juices – Mucus (protective barrier) – Acid (HCl - activate enz., bactericide) – Enzymes (pepsin – proteolytic) – Hormones (gastrin – stim. gastric act.) – Intrinsic factor (absorption of Vit. B12) 1 Bio217 Fall 2012 Unit IX Gastric Pits and Gastric Glands Small Intestine • 5 to 6 meters long • Three segments – Duodenum – Jejunum – Ileum • Ileocecal valve • Peritoneum – Peritoneal cavity Small Intestine Small Intestine • Muscle layers – Outer—longitudinal – Inner—circular • Myenteric plexus • Mucosal folds (plica) • Villi • Microvilli – = Brush border • Lamina propria • Lacteal Intestinal Digestion and Absorption Intestinal Digestion and Absorption • Hydrochloric acid • Pepsin • Pancreatic enzymes • Intestinal enzymes • Bile salts 2 Bio217 Fall 2012 Unit IX Large Intestine Large Intestine • Ileocecal valve • Cecum • O’Beirne sphincter (sigmoid into rectum) • Appendix • Internal anal sphincter • Colon • External anal sphincter – Ascending – Transverse • Taenia coli – Descending • Haustra – Sigmoid • Rectum • Anus Gastrointestinal Absorption Accessory Organs of Digestion Accessory Organs of Digestion Liver • Liver – Lobes • Separated and attached to the anterior abdominal wall by the falciform ligament • Right lobe –Caudate and quadrate lobes • Left lobe – Glisson capsule 3 Bio217 Fall 2012 Unit IX Hepatic Portal Circulation Liver Lobules Vascular and Hematologic Vascular and Hematologic Liver Functions Liver Functions • Blood storage • Metabolizes proteins • Bacterial and foreign particle removal • Metabolizes carbohydrates • Synthesizes clotting factors • Metabolic detoxification • Produces bile to absorb fat-soluble vitamins • Storage of minerals and vitamins • Metabolizes fats Gallbladder Exocrine Pancreas • Gallbladder is a saclike organ that lies on • Exocrine pancreas is composed of acini and inferior surface of the liver networks of ducts that secrete enzymes and alkaline fluids to assist in digestion • Function of gallbladder is to store & • Pancreatic duct (Wirsung duct) concentrate bile between meals • Ampulla of Vater • Gallbladder holds about 90 mL of bile • Bile = emulsifies fats 4 Bio217 Fall 2012 Unit IX Exocrine Pancreas Exocrine Pancreas • Secretions – Potassium, sodium, bicarbonate, magnesium, calcium, and chloride • Enzymes – Trypsinogen, chymotrypsinogen, and procarboxypeptidase – Trypsin inhibitor – Pancreatic alpha-amylase – Pancreatic lipase Concept Check: 1. The muscularis layer of the digestive tract is: 4. What is not an example of mechanical digestion? A. skeletal muscle throughout A. Chewing B. the layer that contains blood vessels for the wall B. Churning and mixing of food in stomach C. composed of keratinized epithelium C. Peristalsis and mastication D. composed of circular and longitudinal fibers D. Conversion of proteins a.a. 2. Name the correct sequence of the GI tract layers from the 5. Which part of the S.I. is most distal from pylorus? lumen going out: A. Jejunum B. pyloric sphincter 3. Which layer of the S.I. includes microvilli? C. Duodenum A. submucosa C. muscularis D. Cardiac sphincter B. mucosa D. serosa Alterations of Digestive Function Clinical Manifestations of Gastrointestinal Dysfunction • Anorexia Chapter 34 – Lack of a desire to eat despite physiologic stimuli that would normally produce hunger • Vomiting (emesis) – Forceful emptying of the stomach and intestinal contents through the mouth • Nausea – Subjective experience associated with a number of conditions – Common symptoms of vomiting are hypersalivation and tachycardia 5 Bio217 Fall 2012 Unit IX Clinical Manifestations of Clinical Manifestations of Gastrointestinal Dysfunction Gastrointestinal Dysfunction • Constipation • Diarrhea – Constipation is defined as infrequent or difficult – Increased frequency of bowel movements defecation – Increased volume, fluidity, weight of the feces – Pathophysiology – Major mechanisms of diarrhea • Neurogenic disorders, low-residue diet, • Osmotic diarrhea (lactase deficiency) sedentary lifestyle, excessive use of antacids • Secretory diarrhea (excess mucosal secretions due (Ca carbonate), use of opiates (codeine) to bacteria) –Following antibiotic therapy • Motility diarrhea (increased motility due to intestinal surgery) Disorders of Motility Achalasia • Dysphagia – Dysphagia is difficulty swallowing – Types • Mechanical obstructions (tumors, diverticular Increase in LES muscle tone; herniations) loss of peristalsis in esophagus • Functional obstructions (neural or muscular) – Achalasia • Denervation of smooth muscle in the esophagus and lower esophageal sphincter relaxation Disorders of Motility Disorders of Motility • Hiatal hernia • Gastroesophageal reflux disease(GERD) – Defect in esophageal hiatus permits part of stomach to – Heartburn enter thoracic cavity – Caused by: – Reflux of chyme (high acid) from stomach to • Ascites esophagus • Pregnancy – If inflammation of esophagus esophagitis • Obesity – Less LES pressure means more reflux • Constrictive clothes • Bending, straining, coughing – Occurs with: • Reflux, peptic ulcer, g.b. disorders (inflammation & stones), pancreatitis, diverticulosis 6 Bio217 Fall 2012 Unit IX Hiatal Hernia Gastritis - inflammatory disorder of the gastric mucosa A. Sliding hiatial hernia- Stomach moves into • Acute gastritis – erosion of superficial thoracic cavity epithelium (due to drugs or chemicals) • Chronic gastritis – thinning degeneration of B. Paraesophageal hiatal hernia – stomach wall (elderly) Greater curvature herniates through 2nd opening Peptic Ulcer Disease Peptic Ulcer Disease • A break or ulceration in the protective • Duodenal ulcers mucosal lining of lower esophagus, – Most common of the peptic ulcers stomach, or duodenum – Developmental factors • Acute and chronic ulcers • *Helicobacter pylori infection • Superficial – Toxins and enzymes that promote inflammation – Erosions and ulceration • Deep • Hypersecretion of stomach acid and pepsin • *Use of NSAIDs (aspirin, ibuprofen, naproxen) – True ulcers • High gastrin levels • Acid production by cigarette smoking • Stress and ulcer disease – inconclusive major causes of duodenal ulcers Lesions caused by PUD Duodenal Ulcer Gastric Ulcer • Gastric ulcers tend to develop in antral A. Deep ulcer – into muscle region of stomach, adjacent to acid- layer secreting mucosa of body B. Sequence of ulcer • Pathophysiology formation (normal – Primary defect is an increased mucosal mucosa duodenal ulcer) permeability to hydrogen ions – Gastric secretions normal or less than normal C. Bilateral (kissing) ulcers due to NSAIDs 7 Bio217 Fall 2012 Unit IX Inflammatory Bowel Diseases (IBD) Ulcerative Colitis • Chronic, relapsing inflammatory bowel disorders of unknown origin • Chronic inflammatory disease that causes (due to genetics, immune system dysfunction, microbes) ulceration of the colonic mucosa – Sigmoid colon and rectum • Ulcerative colitis – Affects sigmoid colon and rectum (most often) • Suggested causes • Crohn disease – Infectious, immunologic (anticolon antibodies), – Affects small bowel – regional enteritis dietary, genetic (supported by family studies and – Affects colon - Crohn’s disease of colon (or granulomatous colitis) identical twin studies) Ulcerative Colitis Crohn Disease • Symptoms • Granulomatous colitis, ileocolitis, or regional – Diarrhea (10 to 20/day), bloody stools, cramping enteritis • Treatment – Broad-spectrum antibiotics and steroids • Idiopathic inflammatory disorder; affects any part – Immunosuppressive agents of digestive tract, from mouth to anus – Surgery • An increased colon cancer risk demonstrated • Difficult to differentiate from ulcerative colitis – Similar risk factors and theories of causation as ulcerative colitis Diverticular Disease of the Colon Appendicitis • Diverticula • Inflammation of the vermiform appendix – Herniations of mucosa through muscle – (affects 7-12% of pop.) layers of colon wall, especially sigmoid colon • Possible causes – Obstruction, ischemia, increased intraluminal • Diverticulosis pressure decr. blood flowhypoxia, infection, – Asymptomatic diverticular disease ulceration, etc. • Epigastric and RLQ pain • Diverticulitis – Inflammatory stage of diverticulosis • Most serious complication is peritonitis 8 Bio217 Fall 2012 Unit IX Ascites Ascites Liver Disorders • Jaundice (icterus) Hemolytic jaundice – Greenish, yellow pigmentation of skin due to increased • Excessive hemolysis of red blood cells or plasma bilirubin levels (hyperbilirubinemia) absorption of a hematoma • Extrahepatic Obstructive jaundice • Increased amount of unconjugated bilirubiin – Due to gallstone or tumor blockage of common bile duct (not water soluble) – Bilirubin conjugated by hepatocytes (liver) cannot enter duodenum appears in urine (water soluble) • Intrahepatic
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