14 May 2009

The Digestive System



The Digestive System
Very detailed lecture Presentation by:Patricia Zuk, Santa Monica College

The Digestive System
* Mouth---bite, chew, swallow
* Pharynx and esophagus----transport
* Stomach----mechanical disruption; absorption of water & alcohol
* Small intestine--chemical & mechanical digestion & absorption
* Large intestine----absorb electrolytes & vitamins (B and K)
* Rectum and anus---defecation

Layers of the GI Tract
1. Mucosal layer
2. Submucosal layer
3. Muscularis layer
4. Serosa layer

Mucosa
* Epithelium
* Lamina propria
* Muscularis mucosae---thin layer of smooth muscle

Submucosa
* Loose connective tissue
* Meissner’s plexus

Muscularis
* Skeletal muscle = voluntary control
* Smooth muscle = involuntary control
* Auerbach’s plexus (myenteric)

Serosa
* An example of a serous membrane
* Covers all organs and walls of cavities not open to the outside of the body
* Secretes a serous fluid
* Consists of connective tissue covered with simple squamous epithelium

Peritoneum
* Peritoneum
* Peritoneal cavity
* Mesentery – small intestines
* Mesocolon – large intestine
* Lesser omentum
* Greater omentum
* Peritonitis = inflammation

Greater Omentum, Mesentery & Mesocolon
Lesser Omentum
The path of food:
oral cavity/teeth/salivary glands
oropharynx/epiglottis
esophagus
stomach
small intestine: duodenum
small intestine: ileum
small intestine: jejunum
large intestine: ascending colon
large intestine: transverse colon
large intestine: descending colon
sigmoid colon
rectum
anus

Mouth
* Oral cavity proper---the roof = hard, soft palate and uvula
* Lined with an oral mucosa (stratified squamous epithelium & lamina propria)
* Landmarks: lingual frenulum, labial frenulum, uvula

Pharyngeal Arches
* Two arches skeletal muscles that elevate the soft palate when we swallow
* Palatoglossal muscle
* Palatopharyngeal muscle

Structure and Function of the Tongue
* Muscular structure covered with an oral mucosa
* Muscle of tongue is attached to hyoid, mandible, hard palate and styloid process
* Two groups of muscles
* 1. Intrinsic muscless
* 2. Extrinsic muscles

Salivary Glands
* Parotid below your ear and over the masseter
* Submandibular is under lower edge of mandible
* Sublingual is deep to the tongue in floor of mouth
* All have ducts that empty into the oral cavity (exocrine glands)
* Wet food for easier swallowing
* Dissolves food for tasting
* Bicarbonate ions buffer acidic foods
* Helps build stronger enamel
* Chemical digestion begins with enzyme salivary

amylase & lingual lipase
* Also contains lysozyme ---helps destroy bacteria
* Protects mouth from infection with its rinsing action---1 to 1 and 1/2qts/day
* Cells in acini (clusters)
* Serous glands - cells secrete a watery fluid - parotid
* Mucous glands - cells (pale staining) secrete a slimy, mucus secretion
* Mixed glands secrete both mucus and serous fluids – submandibular & sublingual

Salivation
* Increase salivation
* Stop salivation

Primary and Secondary Dentition

Teeth:

-grinding, tearing and shearing of food
-two main divisions: crown and root
-crown: above gumline/gingiva
-root: entry of nerves and blood vessels via the apical foramen
-neck – where crown and root meet
-gingiva forms a seal at this area
-innermost layer - pulp (nerves/blood vessels)
-nerves and BVs enter the root and travel
through root canals to enter the pulp cavity

-outer covering of calcified connective tissue – dentin
-outermost layer - enamel
-dentin and enamel – made of calcium phosphate (similar to bone)

Pharynx
* Funnel-shaped tube extending from internal nares to the esophagus (posteriorly) and larynx (anteriorly)
* Skeletal muscle lined by mucous membrane
* Deglutition or swallowing is facilitated by saliva and mucus

Esophagus
* Collapsed muscular tube
* In front of vertebrae
* Posterior to trachea
* Posterior to the heart
* Pierces the diaphragm at hiatus
* Mucosa = stratified squamous
* Submucosa = large mucous glands
* Muscularis = upper 1/3 is skeletal, middle is mixed, lower 1/3 is smooth

Physiology of the Esophagus - Swallowing
* Voluntary phase---tongue pushes food to back of oral cavity
* Involuntary phase----pharyngeal stage
* Peristalsis pushes food down
* Travel time is 4-8 seconds for solids and 1 sec for liquids
* Lower sphincter relaxes as food approaches

Anatomy of Stomach
* Size when empty
* Muscularis – three layers of smooth muscle
* Parts of stomach
* Empties as small squirts of chyme leave the stomach through the pyloric valve

Histology of the Stomach - Mucosa
* simple columnar epithelium with embedded surface mucus cells
* lamina propria layer under the epithelium (areolar connective tissue) + muscularis mucosae (smooth muscle)
* along the mucosa – will find columns of secretory cells = gastric glands that open into the stomach lumen through gastric pits
* Hydrochloric acid (parietal cells) converts pepsinogen (from chief cells) to the enzyme pepsin = protein digestion
* Intrinsic factor (parietal cells)
* Gastrin hormone (G cell)

Anatomy of the Small Intestine
Small Intestine

* Structures that increase surface area

Small intestine - Mucosa
* Absorptive cells
* epithelial cells at the bottom of the villus form a gland = Intestinal gland
* Goblet cells – mucus production
* Enteroendocrine cells
* Paneth cells
* Submucosal layer has duodenal glands


Anatomy of Large Intestine
* 5 feet long by 2½ inches in diameter
* Ascending & descending colon are retroperitoneal
* Cecum & appendix
* Rectum = last 8 inches of GI tract anterior to the sacrum & coccyx
* Anal canal = last 1 inch of GI tract

Histology of Large Intestine
* Muscular layer
* Serosa = visceral peritoneum
* Appendix

Histology of Large Intestine
* Mucosa
* Submucosal & mucosa contain lymphatic nodules

Defecation
* Gastrocolic reflex moves feces into rectum
* Stretch receptors signal sacral spinal cord
* Parasympathetic nerves contract muscles of rectum & relax internal anal sphincter
* External sphincter is voluntarily controlled

Anatomy of the Pancreas
* 5" long by 1" thick
* Head close to curve in C-shaped duodenum
* pancreatic duct joins common bile duct from liver
* Opens 4" below pyloric sphincter

Histology of the Pancreas
* Acini- dark clusters
* Islets of Langerhans

Composition and Functions of Pancreatic Juice
* 1 + 1/2 Quarts/day at pH of 7.1 to 8.2
* Contains water, enzymes & sodium bicarbonate
* Digestive enzymes
o pancreatic amylase, pancreatic lipase, proteases
# trypsinogen---activated by enterokinase (a brush border enzyme)
# chymotrypsinogen----activated by trypsin
# procarboxypeptidase---activated by trypsin
# proelastase---activated by trypsin
# trypsin inhibitor---combines with any trypsin produced inside pancreas
o ribonuclease----to digest nucleic acids
o deoxyribonuclease

Anatomy of the Liver and Gallbladder

* Liver
* Gallbladder

Blood Supply to the Liver
* Hepatic portal vein
* Hepatic artery from branch off the aorta (Common hepatic artery from the celiac trunk)

Histology of the Liver
* Hepatocytes arranged in lobules
* Sinusoids in between hepatocytes are blood-filled spaces
* Kupffer cells phagocytize microbes & foreign matter

Gallbladder
* Simple columnar epithelium
* No submucosa
* Three layers of smooth muscle
* Serosa or visceral peritoneum

Bile Production
* One quart of bile/day is secreted by the liver
* Components

Flow of Bile
* Bile capillaries
* Hepatic ducts connect to form common hepatic duct
* Cystic duct from gallbladder & common hepatic duct join to form common bile duct
* Common bile duct & pancreatic duct empty into duodenum

Liver Functions--Carbohydrate Metabolism
* Turn proteins into glucose
* Turn triglycerides into glucose
* Turn excess glucose into glycogen & store in the liver
* Turn glycogen back into glucose as needed

Liver Functions --Lipid Metabolism
* Synthesize cholesterol
* Synthesize lipoproteins----HDL and LDL (used to transport fatty acids in bloodstream)
* Stores some fat
* Breaks down some fatty acids

Liver Functions--Protein Metabolism
* Deamination = removes NH2 (amine group) from amino acids
* Converts resulting toxic ammonia (NH3) into urea for excretion by the kidney
* Synthesizes plasma proteins utilized in the clotting mechanism and immune system
* Convert one amino acid into another

Other Liver Functions
* Detoxifies the blood by removing or altering drugs & hormones (thyroid & estrogen)
* Releases bile salts help digestion by emulsification
* Stores fat soluble vitamins-----A, B12, D, E, K
* Stores iron and copper
* Phagocytizes worn out blood cells & bacteria
* Activates vitamin D (the skin can also do this with 1 hr of sunlight a week)

Types of Digestion
* Mechanical – mouth, stomach, LI
* Chemical – mouth, stomach, SI

Chemical Digestion in GI tract
Digestion of Carbohydrates
* Mouth---salivary amylase
* Esophagus & stomach---nothing happens
* Duodenum----pancreatic amylase
* Brush border enzymes (maltase, sucrase & lactase) act on disaccharides

Digestion of Proteins
* Stomach
* Pancreas
* Intestines

Digestion of Lipids
* Mouth----lingual lipase
* Small intestine

Digestion of Nucleic Acids
* Pancreatic juice contains 2 nucleases
* Nucleotides produced are further digested by brush border enzymes (nucleosidease and phosphatase)

Digestion in the Mouth
* Mechanical digestion (mastication or chewing)
* Chemical digestion

Stomach--Mechanical Digestion
* Gentle mixing waves
* More vigorous waves
* Intense waves near the pylorus

Stomach--Chemical Digestion
* Protein digestion begins
* Fat digestion continues
* HCl kills microbes in food
* Mucous cells protect stomach walls from being digested with 1-3mm thick layer of mucous

Absorption of Nutrients by the Stomach
* Water especially if it is cold
* Electrolytes
* Some drugs (especially aspirin) & alcohol
* Fat content in the stomach slows the passage of alcohol to the intestine where absorption is more rapid
* Gastric mucosal cells contain alcohol dehydrogenase that converts some alcohol to acetaldehyde-----more of this enzyme found in males than females
* Females have less total body fluid that same size male so end up with higher blood alcohol levels with same intake of alcohol

Mechanical Digestion in the Small Intestine
* 1. Weak peristalsis in comparison to the stomach---chyme remains for 3 to 5 hours
* 2. Segmentation---local mixing of chyme with digestive juices in the SI

Small Intestine-Chemical Digestion
Digestive Hormones
* Gastrin
* Gastric inhibitory peptide--GIP
* Secretin
* Cholecystokinin--CCK

Mechanical Digestion in Large Intestine
* Smooth muscle = mechanical digestion
* Peristaltic waves (3 to 12 contractions/minute)

Chemical Digestion in Large Intestine
* No enzymes are secreted only mucous – the goblet cells in the intestinal glands
* chyme is prepared by the action of bacteria
* Bacteria ferment
* Bacteria produce vitamin K and B in colon

Absorption & Feces Formation in the Large Intestine
* food has now been in the GI tract for 3 to 10 hours
* solid or semisolid due to water reaborption = feces
* feces – water, salts, sloughed-off epithelial cells, bacteria, products of bacterial decomposition, unabsorbed and undigested materials
* 90% of all water absorption takes place in the SI – 10% in the LI
* but the LI is very important in maintaining water balance
* also absorbs some electrolytes---Na+ and Cl- and vitamins
* dietary fiber = indigestible plant carbohydrates (cellulose, lignin and pectin)
* soluble fiber – dissolves in water (beans, barley, broccoli, prunes, apples and citrus)
* insoluble fiber – woody or structural parts of the plant (skins of fruits and vegetables, coatings around bran and corn)

Where will the absorbed nutrients go?
Absorption of Water
* 9 liters of fluid dumped into GI tract each day
* Small intestine reabsorbs 8 liters
* Large intestine reabsorbs 90% of that last liter
* Absorption is by osmosis through cell walls into vascular capillaries inside villi


The Digestive System.ppt

Read more...

Digestive System



Digestive System
Presentation lecture from:deltacollege.edu

Components
* Gastrointestinal (GI) tract
o Oral cavity
o Pharynx
o Esophagus
o Stomach
o Small intestine
o Large intestine
* Accessory digestive organs
o Teeth
o Tongue
o Salivary glands
o Liver
o Gallbladder
o Pancreas

Digestive system functions
* Digestion
o Breakdown of food
* Propulsion – movement along the GI tract
* Secretion – acid, bile, digestive enzymes, mucus
* Absorption of nutrients
* Elimination

Oral cavity
* Lined by stratified squamous epithelium
* Gingivae – gums
* Salivary glands

Teeth
* Crown
* Neck
* Root(s)
* Anchored in alveoli in maxilla and mandible

Peritoneum
* Serous membrane lining the abdominopelvic cavity
* Intraperitonealt
* Retroperitoneal

Peritoneal folds
* Falciform ligament
* Lesser omentum
* Mesentery
* Greater omentum
* Mesocolon

General microscopic plan of the GI tract
* Mucosa
* Submucosa
* Muscularis
* Adventitia or serosa

Esophagus
Stomach
Stomach - microscopy
* Mucosa
* Submucosa
* Muscularis
* Serosa (visceral peritoneum)

Small intestine
Small intestine microscopy
* Increased surface area
* Mucosa
* Submucosa
* Muscularis
* Serosa (mesentery)

Large intestine
* Cecum
* Ascending colon
* Transverse colon
* Descending colon
* Sigmoid colon
* Rectum
* Anus

Liver
* Location: upper right abdomen, below diaphragm
* Intraperitoneal (covered by visceral peritoneum)
* Falciform ligament – fold of peritoneum anchored to anterior abdominal wall
* Gall bladder on inferior surface
* Lesser omentum between liver and stomach

Liver – microscopy
* Liver lobules – structural and function units
* Central vein
* Portal triads – branches of bile duct, hepatic portal vein, hepatic artery
* Cords (sheets) of hepatocytes
* Hepatic sinusoids
* Kupffer cells (macrophages)

Exocrine pancreas
* Located posterior to greater curvature of stomach
* Retroperitoneal
* Pancreatic acini – groups of secretory cells – secrete digestive enzymes
* Pancreatic duct – empties into duodenum

Exocrine pancreas
Digestive system

* Components
* Functions
* Oral cavity
* Peritoneum
* Microscopic plan
* Esophagus
* Stomach
* Small intestine
* Large intestine
* Liver
* Pancreas

Digestive system.ppt

Read more...

Radiology Cases of the Month 2008-2009



Radiology Cases of the Month 2008-2009

Presented by Loyola Radiology Residents -Two cases will generally be posted at the beginning of the month as an unknown with researchable answers or responses.Answers will be posted the following month after posting date with discussion totake place in a designated conference time.

Click on the link below to open the power point presentation of the case.

April 2009 Case 1 - - Namit Mahajan, M.D. posted April 6, 2009 - Faculty Mentor: Dr. Sheikh

April 2009 Case 2 - - Sabir Taj, M.D. posted April 6, 2009 - Faculty Mentor: Dr. Sheikh

March 2009 Case 1 - - Damon Shearer, D.O. posted March 4, 2009 - Faculty Mentor: Dr. Lomasney

March 2009 Case 2 - - Sadaf Chaudhry, M.D. posted March 4, 2009 - Faculty Mentor: Dr. Lomasney

February 2009 Case 1 - - Heather Wichman, M.D. posted February 6, 2009 - Faculty Mentor: Dr. Lin

February 2009 Case 2 - - Monette Castillo, M.D. posted February 6, 2009 - Faculty Mentor: Dr. Lin

January 2009 Case 1 - - Laura Ross, M.D. posted January 5, 2009 - Faculty Mentor: Dr. Lim-Dunham

January 2009 Case 2 - - Anita Oza, M.D. posted January 5, 2009 - Faculty Mentor: Dr. Lim-Dunham

November 2008 Case 1 - Breast - Justin Spackey, M.D. posted October 12, 2008 - Faculty Mentor: Dr. Kral

November 2008 Case 2 - Breast - Joseph Park, M.D. posted October 12, 2008 - Faculty Mentor: Dr. Kral

October 2008 Case 1 - Small Bowel - Nathan Fedors, M.D. posted October 10, 2008 - Faculty Mentor: Dr. Dudiak

October 2008 Case 2 - - Nicholas Kennedy, M.D. posted October 10, 2008 - Faculty Mentor: Dr. Dudiak

September 2008 Case 1 - Breast - Kristen Wrigley, M.D. posted September 5, 2008 - Faculty Mentor: Dr. Cooper

September 2008 Case 2 - MSK - Enzo Cento, M.D. posted September 5, 2008 - Faculty Mentor: Dr. Cooper

August 2008 Case 1 - GU - Doug Brylka, M.D. posted August 11, 2008 - Faculty Mentor: Dr. Demos

August 2008 Case 2 - GU- Rekha Mody, M.D. posted August 11, 2008 - Faculty Mentor: Dr. Demos

May 2008 - - Joseph Park, M.D. posted May 26, 2008 (for eval dates 5/26-6/8/08) Faculty Mentor: Dr. Posniak

May 2008 - GI - Heather Wichman, M.D. posted May 12, 2008 (for eval dates 5/12-5/25/08) Faculty Mentor: Dr. Posniak

April 2008 - Thoracic Imaging - Anita Oza, M.D. posted April 28, 2008 (for eval dates 4/28-5/11/08) Faculty Mentor: Dr. Ward

April 2008 - Pediatric - Pia Dionisio, M.D. posted April 14, 2008 (for eval dates 4/14-4/27/08) Faculty Mentor: Dr. Ward

March 2008 - Ultrasound - Gary Turkel, D.O. posted March 17, 2008 (for eval dates 3/17-3/30/08) Faculty Mentor: Dr. Vade

March 2008 - Pediatric - Nicholas Kennedy, M.D. posted March 3, 2008 {for eval dates 3/3-3/16/08} Faculty Mentor: Dr. Vade

Feb 08 - Neuroradiology - Monette Castillo, M.D. posted February 18, 2008 (for eval dates 2/18-3/2/08) Faculty mentor: Dr. Woods

Feb 08 - Neuroradiology - Laura Ross, M.D. posted February 4, 2008 (for eval dates 2/4-2/17/08) Faculty Mentor: Dr. Woods ***Three cases are given - please diagnose each and give finding

Jan 08 - Nuclear Medicine - Kristen Wrigley, M.D. posted January 21, 2008 (for eval dates 1/21/08-2/3/08) Faculty Mentor: Dr. Wagner

Jan 08 - Nuclear Medicine - Douglas Brylka, M.D. posted January 7, 2008 (for eval dates 1/7-1/20/08) Faculty Mentor: Dr. Wagner

Read more...
All links posted here are collected from various websites. No video or powerpoint files are uploaded on this blog. If you are the original author and do not wish to display your content on this blog please Email me anandkumarreddy at gmail dot com I will remove it. The contents of this blog are meant for educational purpose and not for commercial use. If you use any content give due credit to the original author.

This site uses cookies from Google to deliver its services, to personalise ads and to analyse traffic. Information about your use of this site is shared with Google. By using this site, you agree to its use of cookies.

  © Blogger templates Newspaper III by Ourblogtemplates.com 2008

Back to TOP