CHAPTER 12 Digestive System Digestive System Overview Digestive

CHAPTER 12 Digestive System

Digestive System Overview • Digestive System – Known as gastrointestinal tract • Also known as digestive tract or alimentary canal – Approximately 30 feet long • Begins with mouth (oral cavity), ends with anus – Functions • Prepare foods for absorption into the bloodstream • Prepare foods for use by the body cells • Responsible for elimination of solid wastes from the body 2

Digestive System Structures • Oral cavity (Buccal cavity) – Lips – Cheeks – Hard palate • Rugae – Soft palate – Uvula – Tongue • Principle organ of the sense of taste • Also assists in process of chewing (mastication) and swallowing (deglutition) 3

Digestive System Structures • Salivary glands – Three pairs • Parotids • Submandibulars • Sublinguals – Secrete saliva • Mostly water, but contains mucus and digestive enzymes that aid in digestive process – Digestive enzymes contained in saliva • Amylase – aids in digestion of carbohydrates • Lipase – aids in digestion of fats 4

Digestive System Structures • Pharynx – Known as the throat – Serves as passageway for both respiratory and digestive systems – Oropharynx • Section leading away from oral cavity – Nasopharynx • Behind nasal cavity – Laryngopharynx • Lower portion – opens into esophagus and larynx 5

Digestive System Structures • Esophagus – Receives food from pharynx and propels it to stomach – Cardiac sphincter (lower esophageal sphincter) controls passage of food from esophagus into the stomach • Relaxes = food enters stomach • Contracts = stomach contents prevented from reentering the esophagus 6

Digestive System Structures • Stomach – Fundus • Upper rounded portion – Body • Central part 7

Digestive System Structures • Stomach – Pylorus • Lower tubular part (also called the gastric antrum) • Pyloric sphincter regulates passage of food from stomach into the duodenum – Folds in mucous membranes of stomach = Rugae 8

Digestive System Structures • Stomach – Gastric juices breakdown food in stomach – Muscular action of stomach causes churning of food • Mixes food with the secretions • Chyme = liquidlike mixture of partially digested food and digestive secretions 9

Digestive System Structures • Small intestine – Approximately 20 feet long – Also known as the small bowel – Divided into three parts • Duodenum • Jejunum • Ileum 10

Digestive System Structures • Large intestine – Cecum • Appendix hangs from lower portion of cecum – Ascending colon • Hepatic flexure – Transverse colon • Splenic flexure – – Descending colon Sigmoid colon Rectum Anus 11

Accessory Organs of Digestion • Liver – Located immediately under diaphragm, slightly to the right – Only digestive function • Production of bile for emulsification of fats in small intestine 12

Accessory Organs of Digestion • Liver – Additional functions of liver • Excretion of bile pigments into bile • Synthesis of vitamin K-dependent plasma proteins • Amino acid metabolism • Carbohydrate metabolism • Fat metabolism • Phagocytosis • Detoxification • Storage of vital nutrients 13

Accessory Organs of Digestion • Gallbladder – Pear-shaped sac, located under surface of liver – Main function: • To store and concentrate bile produced by the liver • Releases bile in response to presence of fatty content of food present in duodenum • Emulsifies fats 14

Accessory Organs of Digestion • Pancreas – Located in upper left quadrant of abdomen, behind stomach – Functions as exocrine gland to manufacture digestive juices • Trypsin – breaks down proteins • Pancreatic lipase – breaks down fats • Pancreatic amylase – breaks down carbohydrates • Sodium bicarbonate – neutralizes acidic stomach contents 15

Accessory Organs of Digestion • Pancreas – Functions as endocrine gland to manufacture insulin and glucagon • Insulin – hormone that makes it possible for glucose to pass from blood through cell membranes to be used for energy • Insulin also promotes conversion of excess glucose into glycogen • Glucagon – hormone that stimulates the liver to convert glycogen into glucose in time of need 16

Accessory Organs of Digestion • Teeth – Primary responsibility • Chewing (mastication) • Food is ground by teeth and softened by saliva – Primary teeth = deciduous teeth • Set of 20 teeth – appears around age 6 months – Secondary teeth = permanent teeth • Begin to appear around age 6 17

Accessory Organs of Digestion • Teeth – Incisors • Chisel shape with sharp edges for biting food – Canine or cuspid teeth • Useful for grasping and tearing food – Bicuspids (premolars) and molars • Flat surfaces, multiple projections for crushing and grinding food 18

Accessory Organs of Digestion • Teeth – Crown • Visible part of the tooth • Covered with enamel – hardest substance in body – Neck • Lies just beneath the gum line – Root • Embedded in bony socket of the jaw bone – Root canal = pulp cavity • Central core of the tooth 19

Accessory Organs of Digestion Layers of Teeth 20

Common Signs and Symptoms • Achlorhydria – Abnormal condition characterized by the absence of hydrochloric acid in the gastric juice • Anorexia – Lack or loss of appetite, resulting in the inability to eat 21

Common Signs and Symptoms • Aphagia – Condition characterized by the loss of the ability to swallow as a result of organic or psychologic causes • Ascites – Abnormal accumulation of fluid within the peritoneal cavity • Fluid contains large amounts of protein and electrolytes 22

Common Signs and Symptoms • Borborygmus – An audible abdominal sound produced by hyperactive intestinal peristalsis • Borborygmi are rumbling, gurgling, and tinkling noises heard when listening with a stethoscope 23

Common Signs and Symptoms • Constipation – Difficulty in passing stools, or an incomplete or infrequent passage of hard stools • Diarrhea – Frequent passage of loose, watery stools 24

Common Signs and Symptoms • Dyspepsia – Vague feeling of epigastric discomfort after eating – Involves an uncomfortable feeling of fullness, heartburn, bloating, and nausea • Dysphagia – Difficulty in swallowing, commonly associated with obstructive or motor disorders of the esophagus 25

Common Signs and Symptoms • Emaciation – Excessive leanness caused by disease or lack of nutrition • Emesis – Material expelled from the stomach during vomiting – Vomitus 26

Common Signs and Symptoms • Eructation – Act of bringing up air from the stomach with a characteristic sound through the mouth – Belching • Flatus; Flatulence – Air or gas in the intestine that is passed through the rectum 27

Common Signs and Symptoms • Gastroesophageal Reflux – Backflow of contents of stomach into esophagus – Often result of incompetence of the lower esophageal sphincter • Icterus – A yellowish discoloration of the skin, mucous membranes, and sclera of the eyes, caused by greater than normal amounts of bilirubin in the blood – Also called jaundice 28

Common Signs and Symptoms • Melena – An abnormal, black, tarry stool containing digested blood • Nausea – Unpleasant sensation often leading to the urge to vomit • Pruritus ani – A common chronic condition of itching of the skin around the anus 29

Common Signs and Symptoms • Steatorrhea – Greater than normal amounts of fat in the feces • Characterized by frothy, foul-smelling fecal matter that floats • Vomit – To expel the contents of the stomach through the esophagus and out of the mouth 30

PATHOLOGICAL CONDITIONS Digestive System

Achalasia • Pronounced – (ak-al-LAY-zee-ah) • Defined – Decreased mobility of the lower two-thirds of the esophagus along with constriction of the lower esophageal sphincter 32

Anal Fistula • Pronounced – (AY-nal FISS-too-lah) • Defined – Abnormal passageway in the skin surface near the anus usually connecting with the rectum • May occur as the result of a draining abscess 33

Aphthous Stomatitis • Pronounced – (AFF-thus stoh-mah-TYE-tis) • Defined – Small inflammatory noninfectious ulcerated lesions occurring in the lips, tongue, and inside the cheeks of the mouth – Also called canker sores 34

Appendicitis • Pronounced – (ap-pen-dih-SIGH-tis) • Defined – Inflammation of the vermiform appendix • Usually an acute condition that can lead to rupture (perforation) with resultant inflammation of the peritoneum (peritonitis) 35

Celiac Disease • Pronounced – (SEE-lee-ak disease) • Defined – Nutrient malabsorption due to damaged small bowel mucosa 36

Cirrhosis • Pronounced – (sih-ROH-sis) • Defined – Disease of the liver that is chronic and degenerative causing injury to the hepatocytes (functional cells of the liver) • Fat infiltrates lobules of the liver, causing tissue covering the lobes to become fibrous • Functions of liver eventually deteriorate 37

Colorectal Cancer • Pronounced – (koh-loh-REK-tal CAN-sir) • Defined – Presence of a malignant neoplasm in the large intestine 38

Constipation • Pronounced – (kon-stih-PAY-shun) • Defined – A state in which the individual’s pattern of bowel elimination is characterized by a decrease in the frequency of bowel movements and the passage of hard, dry stools • Individual experiences difficult defecation 39

Crohn’s Disease • Pronounced – (KROHNZ dih-ZEEZ) • Defined – Digestive tract inflammation of a chronic nature causing fever, cramping, diarrhea, weight loss, and anorexia 40

Dental Caries • Pronounced – (DEN-tal KAIR-eez) • Defined – Tooth decay caused by acid-forming microorganisms 41

Dysentery • Pronounced – (DISS-en-ter-ee) • Defined – A term used to describe painful intestinal inflammation typically caused by ingesting water or food containing bacteria, protozoa, parasites, or chemical irritants • Person has frequent stools that often contain blood 42

Diverticular Disease • Pronounced – (dye-ver-TIK-yoo-lar dih-ZEEZ) • Defined – Expression used to characterize both diverticulosis and diverticulitis • Diverticulosis = non-inflamed outpouchings or herniations of the muscular layer of the intestines, typically the sigmoid colon • Diverticulitis = inflammation of these outpouchings 43

Esophageal Varices • Pronounced – (eh-soff-ah-JEE-al VAIR-ih-seez) • Defined – Swollen, twisted (tortuous) veins located in the distal end of the esophagus 44

Gallstones (Cholelithiasis) • Pronounced – (koh-lee-lih-THIGH-ah-sis) • Defined – Pigmented or hardened cholesterol stones formed as a result of bile crystallization 45

Hemorrhoids • Pronounced – (HEM-oh-roydz) • Defined – Hemorrhoid is an unnaturally distended or swollen vein (varicosity) in distal rectum or anus 46

Hepatitis • Pronounced – (hep-ah-TYE-tis) • Defined – Acute or chronic inflammation of the liver due to a viral or bacterial infection, drugs, alcohol, toxins, or parasites 47

Hernia • Pronounced – (HER-nee-ah) • Defined – Irregular protrusion of tissue, organ, or a portion of an organ through an abnormal break in the surrounding cavity’s muscular wall 48

Herpetic Stomatitis • Pronounced – (her-PEH-tic stoh-mah-TYE-tis) • Defined – Inflammatory infectious lesions in or on the oral cavity occurring as a primary or a secondary viral infection caused by herpes simplex 49

Hirschsprung’s Disease (Congenital Megacolon) • Pronounced – (HIRSH-sprungz dih-ZEEZ) – (kon-JEN-ih-tal meg-ah-KOH-lon) • Defined – Absence at birth of the autonomic ganglia in a segment of the intestinal smooth muscle wall that normally stimulates peristalsis 50

Ileus • Pronounced – (ILL-ee-us) • Defined – Obstruction of the intestine • May occur due to twisting of the bowel, absence of peristalsis, or presence of adhesions or tumor 51

Intestinal Obstruction • Pronounced – (in-TESS-tin-al ob-STRUCK-shun) • Defined – Complete or partial alteration in the forward flow of the contents in the small or large intestines 52

Intussusception • Pronounced – (in-tuh-suh-SEP-shun) • Defined – Telescoping of a portion of proximal intestine into distal intestine usually in the ileocecal region causing an obstruction • Typically occurs in infants and young children 53

Irritable Bowel Syndrome Spastic Colon • Pronounced – (EAR-it-ah-b’l BOW-el SIN-drom) – (SPAS-tik COH-lon) • Defined – Increased motility of the small or large intestinal wall resulting in abdominal pain, flatulence, nausea, anorexia, and the trapping of gas throughout the intestines 54

Oral Leukoplakia • Pronounced – (OR-al loo-koh-PLAY-kee-ah) • Defined – Precancerous lesion occurring anywhere in the mouth 55

Pancreatitis • Pronounced – (pan-kree-ah-TYE-tis) • Defined – Acute or chronic destructive inflammatory condition of the pancreas • May be acute or chronic 56

Peptic Ulcers (Gastric, Duodenal, Perforated) • Pronounced – (PEP-tik ULL-sir) – (GAS-tric, doo-oh-DEE-nal, PER-foh-ray-ted) • Defined – Break in the continuity of the mucous membrane lining of the gastrointestinal tract as a result of hyperacidity or the bacterium, Helicobacter pylori 57

Peptic Ulcers • Peptic ulcer descriptions – Acute or chronic – Singular or clustered – Shallow or deep • Symptoms of an ulcer – Gnawing epigastric pain – Heartburn or indigestion – Nausea and vomiting – Bloated feeling after eating 58

Periodontal Disease • Pronounced – (pair-ee-oh-DON-tal dih-ZEEZ) • Defined – Group of inflammatory gum disorders – May lead to degeneration of teeth, gums, and sometimes surrounding bones 59

Polyps, Colorectal • Pronounced – (PALL-ips koh-loh-REK-tal) • Defined – Small growths projecting from the mucous membrane of the colon or rectum • May be sessile (attached by a base) or pedunculated (attached by a stalk) • May vary in size and may be benign or precancerous 60

Thrush • Pronounced – (THRUSH) • Defined – Fungal infection in the mouth and throat producing sore, creamy white, slightly raised curdlike patches on the tongue and other oral mucosal surfaces • Caused by Candida albicans 61

Ulcerative Colitis • Pronounced – (ULL-sir-ah-tiv koh-LYE-tis) • Defined – Chronic inflammatory condition resulting in a break in the continuity of the mucous membrane lining of the colon in the form of ulcers • Characterized by large watery diarrheal stools containing mucus, pus, or blood 62

Volvulus • Pronounced – (VOL-vyoo-lus) • Defined – Rotation of loops of bowel causing a twisting on itself that results in an intestinal obstruction 63

DIAGNOSTIC TECHNIQUES, TREATMENTS AND PROCEDURES Digestive System

Diagnostic Techniques, Treatments, and Procedures • Abdominal ultrasound – High-frequency sound waves to provide visualization of the internal organs of the abdomen (liver, gallbladder, bile ducts, pancreas, kidneys, bladder, and ureters) • Abdominocentesis (Paracentesis) – Insertion of a needle or trochar into abdominal cavity to remove excess fluid • Person is in a sitting position 65

Diagnostic Techniques, Treatments, and Procedures • Alanine Aminotransferase (ALT) – Hepatocellular enzyme released in elevated amounts due to liver dysfunction – Also known as serum glutamic pyruvic transaminase (SGPT) 66

Diagnostic Techniques, Treatments, and Procedures • Alkaline Phosphatase (ALP) – Enzyme found in highest concentrations in liver, biliary tract, and bone • Amylase – Enzyme secreted normally from pancreatic cells that travels to the duodenum by way of pancreatic duct – Aids in digestion 67

Diagnostic Techniques, Treatments, and Procedures • Appendectomy – Surgical removal of an inflamed appendix – May be removed via laparoscope if no rupture has occurred 68

Diagnostic Techniques, Treatments, and Procedures • Barium Enema (BE) – Infusion of a radiopaque contrast medium, barium sulfate, into the rectum and held in the lower intestinal tract while x-ray films are obtained of the lower GI tract 69

Diagnostic Techniques, Treatments, and Procedures • Barium Swallow (Upper GI Series) – Involves oral administration of a radiopaque contrast medium, barium sulfate, which flows into the esophagus as the person swallows 70

Diagnostic Techniques, Treatments, and Procedures • Cheiloplasty – Surgically correcting a defect of the lip • Cholecystectomy – Surgical removal of the gallbladder • Cholecystography (Oral) – Visualization of the gallbladder through x-ray following the oral ingestion of pills containing a radiopaque iodinated dye 71

Diagnostic Techniques, Treatments, and Procedures • Colonoscopy – Visualization of the lining of the large intestine using a fiberoptic colonoscope • Colostomy – Surgical creation of a new opening on the abdominal wall through which the feces will be expelled, by bringing the incised colon out to the abdominal surface • Abdominal-wall anus 72

Diagnostic Techniques, Treatments, and Procedures • CT of the abdomen – Painless, noninvasive x-ray procedure – Produces an image created by the computer representing a detailed cross section of the tissue structure within the abdomen – Computerized tomography (CT) of the abdomen 73

Diagnostic Techniques, Treatments, and Procedures • Endoscopic Retrograde Cholangiopancreatography – Examines the size of and filling of the pancreatic and biliary ducts through direct radiographic visualization with a fiberoptic endoscope 74

Diagnostic Techniques, Treatments, and Procedures • Esophagogastroduodenoscopy (EGD) – Process of direct visualization of the esophagus, stomach, and duodenum using a lighted, fiberoptic endoscope • Also known as an upper endoscopy 75

Diagnostic Techniques, Treatments, and Procedures • Extracorporeal Shock Wave Lithotripsy (ESWL) – Alternative treatment for gallstones by using ultrasound to align the computerized lithotripter and source of shock waves with the stones – To crush the gallstones and thus enable the contraction of the gallbladder to remove stone fragments 76

Diagnostic Techniques, Treatments, and Procedures • Fluoroscopy – Radiological technique used to examine the function of an organ or a body part using a fluoroscope • Gastric analysis – Study of the stomach contents to determine the acid content and to detect the presence of blood, bacteria, bile, and abnormal cells 77

Diagnostic Techniques, Treatments, and Procedures • Gastric Lavage – Irrigation, or washing out, of the stomach with sterile water or a saline solution 78

Diagnostic Techniques, Treatments, and Procedures • Herniorrhaphy – Surgical repair of a hernia by closing the defect using sutures, mesh, or wire • Liver biopsy – Piece of liver tissue obtained for examination by inserting a specially designed needle into the liver through the abdominal wall 79

Diagnostic Techniques, Treatments, and Procedures • Liver scan – Noninvasive scanning technique – Enables visualization of shape, size, and consistency of liver after IV injection of a radioactive compound • Magnetic Resonance Imaging (MRI) – Noninvasive scanning procedure that provides visualization of fluid, soft tissue, and bony structures without the use of radiation 80

Diagnostic Techniques, Treatments, and Procedures • Nasogastric intubation – Placement of a tube through the nose into the stomach – To relieve gastric distension by removing gastric secretions, gas, or food 81

Diagnostic Techniques, Treatments, and Procedures • Percutaneous Transhepatic Cholangiography (PTC) or (PTHC) – Examination of bile duct structure using a needle to pass directly into an intrahepatic bile duct to inject a contrast medium 82

Diagnostic Techniques, Treatments, and Procedures • Serum Bilirubin – Measurement of bilirubin level in serum • Serum bilirubin levels are a result of the breakdown of red blood cells • Serum Glutamic-oxaloacetic Transaminase (SGOT) – Enzyme that has very high concentrations in liver cells • Also known as aspartate aminotransferase (AT) 83

Diagnostic Techniques, Treatments, and Procedures • Small bowel follow-through – Oral administration of a radiopaque contrast medium, barium sulfate – Flows through the GI system – X-ray films are obtained at timed intervals to observe the progression of the barium through the small intestine 84

Diagnostic Techniques, Treatments, and Procedures • Stool analysis for occult blood – Analysis of a stool sample to determine presence of blood not visible to naked eye • Stool culture – Collection of a stool specimen placed on one or more culture mediums – Allowed to grow colonies of microorganisms to identify specific pathogen(s) 85

Diagnostic Techniques, Treatments, and Procedures • Stool Guaiac – Test on a stool specimen using guaiac as a reagent – Identifies presence of blood in stool • Urinary Bilirubin – Tests for conjugated or direct bilirubin in a urine specimen 86