NORTHWESTERN UNIVERSITY,INC

Laoag City, Ilocos Norte

MODULE 4: Responses to Metabolic- Gastrointestinal and

Liver Alteration

The digestive system is made up of the gastrointestinal tract—also called the GI tract or
digestive tract—and the liver, pancreas, and gallbladder. The GI tract is a series of hollow organs
joined in a long, twisting tube from the mouth to the anus. The hollow organs that make up the GI
tract are the mouth, esophagus, stomach, small intestine, large intestine, and anus. The liver, pancreas,
and gallbladder are the solid organs of the digestive system.

The small intestine has three parts. The first part is called the duodenum. The jejunum is in the
middle and the ileum is at the end. The large intestine includes the appendix, cecum, colon, and rectum.
The appendix is a finger-shaped pouch attached to the cecum. The cecum is the first part of the large
intestine. The colon is next. The rectum is the end of the large intestine.

NCM 118: Responses to Metabolic- Gastrointestinal and Liver Alteration

 NORTHWESTERN UNIVERSITY,INC
Laoag City, Ilocos Norte

FUNCTIONS OF THE DIGESTIVE SYSTEM

1. Ingestion- consumption of solid or liquid food usually through the mouth

2. Digestion- breakdown of large molecules into smaller molecules that can be absorbed.
Occurs through mechanical and chemical means.
3. Absorption – movement of molecules out of the digestive tract and into the blood or
circulatory system
4. Elimination – is the removal of undigested materials such as fiber from food plus other
waste products from the body as feces.

DIGESTIVE SYSTEM
− Consist of the digestive tract or gastrointestinal tract plus specific associated organs
− The specific portions of the digestive tract include:
a. Oral cavity (mouth)
b. Pharynx (throat)
c. Esophagus
d. Stomach
e. Small intestine
f. Large intestine
g. Anus
− the specific associated organs are the following:
a. Salivary glands
b. Liver
c. Pancreas

ORAL CAVITY, PHARYNX, AND ESOPHAGUS

− AKA mouth; the first part of the digestive tract

− It is bounded by the lips and cheeks and contains the teeth and tongue
− LIPS – are muscular structures, formed by the orbicularis oris muscle. Outer surfaces are
covered with/ skin
− CHEEKS – form the lateral walls of the oral cavity. Buccinator muscles are located within
the cheeks & flatten the cheeks against the teeth; it also helps form words during the speech
process

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 NORTHWESTERN UNIVERSITY,INC
Laoag City, Ilocos Norte

MASTICATION – begins the process of mechanical digestion which breaks down large food
particles into smaller ones. The lips and the cheeks move the food within the oral cavity and
hold the food in place while the teeth crush or tear it

TONGUE
- is a large, muscular organ that occupies most of the oral cavity
- FRENULUM- anterior part of the tongue
- Function of the tongue: moves food in the mouth and, in cooperation with the lips
and cheeks, holds the food in place during mastication.
- Major organ for speech.
TEETH
- 32 in normal adults located in the mandible and maxillae
- 4 quadrants – right upper; left upper; right lower; left lower.
- Each quadrant contains: 1 central incisor, 1 lateral incisor, 1 canine, first and second
pre-molars, and first, second, and third molars
- The third molars are called wisdom

PALATE
- separates the oral cavity from the nasal cavity and prevents food from passing into the
nasal cavity during chewing and swallowing
- 2 parts
a. Anterior part that contains bone – hard palate
b. Posterior part that contains skeletal muscles and connective tissues – soft palate
- Uvula is a posterior extension of the soft palate
- Tonsils – located in the lateral posterior walls of the oral cavity, in the nasopharynx,
and in the posterior surface of the tongue.

SALIVARY GLANDS - produce saliva

SALIVA
- is a mixture of serous (watery) and mucous fluids
- it helps keep the oral cavity moist and contains enxymes that begins the process of
digestion
- it is secreted at a rate of approximately 1 liter per day
- 3 major pairs of salivary galands
a. Parotid glands – largest salivary gland. Serous glands located just anterior to each
ear.
b. Submandibular glands – (below the mandible) produce more serous than mucous
secretions. Each gland can be felt as a soft lump along the inferior border of the
mandible

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 NORTHWESTERN UNIVERSITY,INC
Laoag City, Ilocos Norte

c. Sublingual glands – smallest salivary gland w/c produce primarily mucous

secretion. They lie immediately below the mucous membrane in the floor of the
oral cavity. Each sublingual glands has 10-12 small ducts opening onto the floor of
the oral cavity

- Enzymes
a. Salivary amylase – breaks down starch
b. Lysozyme – it prevents bacterial infections in the mouth by washing the oral cavity
c. Mucin – gives lubricating quality to the secretions of the salivary glands

PHARYNX
− AKA throat
− Connects the mouth with the esophagus
− 3 parts
a. Nasopharynx
b. Oropharynx
c. Laryngopharynx

ESOPHAGUS

− muscular tube that extends from the pharynx to

the stomach
− transport food from the pharynx to the stomach
− Esophageal sphincter of the esophagus are
located at the upper & lower ends of the
esophagus; they regulate the movement of
food into and out of the esophagus
− Cardiac sphincter – lower esophageal sphincter

SWALLOWING
− AKA deglutition
− 3 phases
a. Voluntary phase – a bolus or mass of
food, is formed in the mouth. The tongue pushes the bolus against the hard palate
–> this forces the bolus toward the posterior part of the mouth and into the
oropharynx

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 NORTHWESTERN UNIVERSITY,INC
Laoag City, Ilocos Norte

b. Pharyngeal phase – controlled by a reflex.

This is initiated when a bolus of food stimulates receptors in the oropharynx to
elevate the soft palate, closing off the nasopharynx.
The pharynx elevates to receive the bolus of food from the mouth
c. Esophageal phase – responsible for moving
food from the pharynx to the stomach

STOMACH
− Primarily houses food for mixing with hydrochloric
acid and other secretions
− Enlarged segment of the digestive tract in the left
superior part of the abdomen
Regions
a. Cardiac region – near the heart
b. Fundus – most superior part of the stomach
c. Body – largest part of the stomach; the body turns to the right forming a greater curvature
and a lesser curvature
d. Pyloric region – opening into the small intestines
− Secretions of the stomach
Chyme – semifluid mixture when food mixed with stomach
secretions
a. Mucus – lubricates & protects the epithelial cells of the stomach wall from the damaging
effect of the acidic chyme & pepsin
b. Hydrochloric acid – produces pH of about 2.0 in the stomach (low pH kills
microorganisms)
c. Pepsin – an active enzyme produced by the conversion of pepsinogen by HCl.
d. Intrinsic factor – binds with Vitamin B12 and makes it more readily absorbed in the small
intestines.

ANATOMY OF THE SMALL INTESTINE

− 6 meters long
− 3 parts
a. Duodenum – 25 cms long
b. Jejunum – 2.5 m long
c. Ileum – 3.5 m long

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Laoag City, Ilocos Norte

− major site of digestion and absorption of food which are accomplished due to the presence of a
large surface

Liver

− Processes nutrients and detoxifies harmful

substances from the blood
− It produces an important digestive fluid called
bile
– The liver produces and secretes about 600 to
1000ml of bile each day
Bile – is important for digestion because it
dilutes and neutralizes stomach acid. It also
dramatically increases the efficiency of fat
digestion and absorption. They are secreted by
the liver.

− Two major lobes –> right and left lobe. The 2 lobes are separated by a connective tissue
septum called the FALCIFORM LIGAMANET
− The liver receives blood from 2 sources
a. Hepatic artery – delivers oxygenated blood to the liver which supplies liver cells with
oxygen
b. Hepatic portal vein – carries nutrient-rich blood from the digestive tract to the liver. Blood
exists the liver through the hepatic veins. The hepatic veins empty into the inferior vena
cava

− Functions of the liver

1. Digestion – bile neutralizes stomach acid & emulsifies fats, w/c facilitates fat digestion
2. Excretion – bile contains excretory products such as cholesterol, fats and bile pigments
such as bilirubin that result from hemoglobin breakdown
3. Nutrient storage – liver cells remove sugar from the blood and store it in the form of
glycogen; also store fat, vitamins (A, B12, D, E & K), copper, and iron.
4. Nutrient conversion – liver cells convert some nutrients into others; for example, amino
acids can be converted to lipids or glucose; fats can be converted to phospholipids; Vitamin
D is converted to its active form.
5. Detoxification of harmful chemicals – liver cells remove ammonia from the circulation
and convert it to urea, w/c is eliminated in the urine; other substances are detoxified &
secreted in the bile or excreted in the urine.
6. Synthesis of new molecules – synthesized blood proteins such as albumin, fibrinogen,
globulins and clotting factors.

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Laoag City, Ilocos Norte

PANCREAS

− It is located retroperitoneal, posterior to the stomach in

the inferior part of the LUQ
− it has a head near the midline of the body and a tail that
extends to the left where it touches the spleen
− it is a complex organ of both endocrine and exocrine
tissues that performs several functions
a. endocrine part – consists of the pancreatic islet
or islets of Langerhans
- this produces insulin and glucagon which
enter the blood. These hormone are very
important in controlling blood levels of
nutrients.
b. exocrine part- is a compound acinar gland.

Acinar – produce digestive enzymes

*Cluster of acini are composed of small ducts, which join to form larger ducts, and the
larger ducts join to form the PANCREATIC DUCTS –> this joins with the common
bile duct and empties into the duodenum

− Function – the pancreatic enzymes are important in digesting all major classes of food. Without
pancreatic enzymes lipids, proteins and carbohydrates cannot be adequately digested.

ANATOMY OF THE LARGE INTESTINES

− consist of the cecum, colon, rectum and the anal canal

FUNCTIONS OF THE LARGE INTESTINES

− The major function of the large intestine is
to absorb water from the remaining
indigestible food matter and transmit the
useless waste material from the body
− DEFECATION RFLEX
- occurs when feces distend the rectal wall

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 NORTHWESTERN UNIVERSITY,INC
Laoag City, Ilocos Norte

COMPONENTS OF THE LARGE INTESTINES

1. CECUM
− is the proximal end of the large intestine where it joins with the small intestines at the
ileocecal junction
− it is located in the RLQ of the abdomen near the iliac fossa
− it is a sac that extends inferiorly about 6 cms past the ileocecal junction
− attached to the cecum is a tube about 9 cm long – APPENDIX
*secretions from the appendix cannot pass the obstruction, therefore they accumulate causing
enlargement and pain

COLON
− about 1.5 to 1.8 meters long and consisting of four parts
a. ascending colon – extends superiorly from the cecum to the right colic flexure, near
the liver, where it turns to the left
b. transverse colon – extends from the right colic flexure to the left colic flexure near the
spleen, where the colon turns inferiorly
c. descending colon – extends from the left colic flexure to the pelvis
d. sigmoid colon – forms an S-shaped tube that extends medially and then inferiorly into
the pelvic cavity and ends at the rectum

2. RECTUM
− is a straight, muscular tube that begins at the termination of the sigmoid colon and ends at
the anal canal

3. ANAL CANAL
− measures 2-3 cms
− it begins at the inferior wall and ends at the anus (external digestive tract opening)
− the smooth muscle layer of the anal canal is even thicker than that of the rectum and forms
the internal anal sphincter at its superior end
− the external anal sphincter at the inferior end of the anal canal is formed by skeletal

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