ANATOMY and PHYSIOLOGY of the DIGESTIVE SYSTEM

Digestive Organs
The digestive system is a group of organs (Buccal cavity (mouth), pharynx, oesophagus,
stomach, liver, gall bladder, jejunum, ileum and colon) that breakdown the chemical components
of food, with digestive juices, into tiny nutrients which can be absorbed to generate energy for
the body.

The Buccal Cavity

Food enters the mouth and is chewed by the teeth, turned over and mixed with saliva by
the tongue. The sensations of smell and taste from the food sets up reflexes which stimulate the
salivary glands.

The Salivary glands

These glands increase their output of secretions through three pairs of ducts into the oral
cavity, and begin the process of digestion.
Saliva lubricates the food enabling it to be swallowed and contains the enzyme ptyalin which
serves to begin to break down starch.

The Pharynx
Situated at the back of the nose and oral cavity receives the softened food mass or bolus
by the tongue pushing it against the palate which initiates the swallowing action. At the same
time a small flap called the epiglottis moves over the trachea to prevent any food particles
getting into the windpipe.
From the pharynx onwards the alimentary canal is a simple tube starting with the salivary
glands.

The Esophagus
 The esophagus travels through the neck and thorax, behind the trachea and in front of the
aorta. The food is moved by rhythmical muscular contractions known as peristalsis (wave-like
motions) caused by contractions in longitudinal and circular bands of muscle. Antiperistalsis,
where the contractions travel upwards, is the reflex action of vomiting and is usually aided by the
contraction of the abdominal muscles and diaphragm.

The Stomach
The stomach lies below the diaphragm and to the left of the liver. It is the widest part of
the alimentary canal and acts as a reservoir for the food where it may remain for between 2 and 6
hours. Here the food is churned over and mixed with various hormones, enzymes including
pepsinogen which begins the digestion of protein, hydrochloric acid, and other chemicals; all of
which are also secreted further down the digestive tract.
The stomach has an average capacity of 1 liter, varies in shape, and is capable of
considerable distension. When expanding this sends stimuli to the hypothalamus which is the
part of the brain and nervous system controlling hunger and the desire to eat.
The wall of the stomach is impermeable to most substances, although does absorb some water,
electrolytes, certain drugs, and alcohol. At regular intervals a circular muscle at the lower end of
the stomach, the pylorus opens allowing small amounts of food, now known as chyme to enter
the small intestine.

Small Intestine
The small intestine measures about 7m in an average adult and consists of the duodenum,
jejunum, and ileum. Both the bile and pancreatic ducts open into the duodenum together. The
small intestine, because of its structure, provides a vast lining through which further absorption
takes place. There is a large lymph and blood supply to this area, ready to transport nutrients to
the rest of the body. Digestion in the small intestine relies on its own secretions plus those from
the pancreas, liver, and gall bladder.

The Pancreas
The Pancreas is connected to the duodenum via two ducts and has two main functions:
1. To produce enzymes to aid the process of digestion
2. To release insulin directly into the blood stream for the purpose of controlling blood
sugar levels
Enzymes suspended in the very alkaline pancreatic juices include amylase for breaking down
starch into sugar, and lipase which, when activated by bile salts, helps to break down fat. The
hormone insulin is produced by specialised cells, the islets of Langerhans, and plays an
important role in controlling the level of sugar in the blood and how much is allowed to pass to
the cells.

The Liver
The liver, which acts as a large reservoir and filter for blood, occupies the upper right portion of
abdomen and has several important functions:
1. Secretion of bile to the gall bladder
2. Carbohydrate, protein and fat metabolism
3. The storage of glycogen ready for conversion into glucose when energy is required.
4. Storage of vitamins
5. Phagocytosis - ingestion of worn out red and white blood cells, and some bacteria

The Gall Bladder

The gall bladder stores and concentrates bile which emulsifies fats making them easier to
break down by the pancreatic juices.
The Large Intestine
The large intestine averages about 1.5m long and comprises the caecum, appendix, colon,
and rectum. After food is passed into the caecum a reflex action in response to the pressure
causes the contraction of the ileo-colic valve preventing any food returning to the ileum. Here
most of the water is absorbed, much of which was not ingested, but secreted by digestive glands
further up the digestive tract. The colon is divided into the ascending, transverse and descending
colons, before reaching the anal canal where the indigestible foods are expelled from the body.

Appendix
The appendix is a small, finger-like appendage about 10 cm (4in) long that is attached to
the cecum just below the ileocecal valve. The appendix fills with food and empties regularly into
the cecum. Because it empties inefficiently and its lumen is small, the appendix is small, the
appendix is prone to obstruction and is particularly vulnerable to infection.

Introduction

Background

Acute gastroenteritis is a common cause of morbidity and mortality worldwide.

Conservative estimates put diarrhea in the top 5 causes of deaths worldwide, with most occurring
in young children in nonindustrialized countries. In industrialized countries, diarrheal diseases
are a significant cause for morbidity across all age groups. Etiologies include bacteria, viruses,
parasites, toxins, and drugs. Viruses are responsible for a significant percentage of cases
affecting patients of all ages. Viral gastroenteritis ranges from a self-limited watery diarrheal
illness (usually <1 wk) associated with symptoms of nausea, vomiting, anorexia, malaise, or
fever, to severe dehydration resulting in hospitalization or even death.

The clinician encounters acute viral gastroenteritis in 3 settings. The first is sporadic
gastroenteritis in infants, which most frequently is caused by rotavirus. The second is epidemic
gastroenteritis, which occurs either in semi closed communities (eg, families, institutions, ships,
vacation spots) or as a result of classic food-borne or water-borne pathogens. Most of these
infections are caused by caliciviruses. The third is sporadic acute gastroenteritis of adults, which
most likely is caused by caliciviruses, rotaviruses, astroviruses, or adenoviruses.

For excellent patient education resources, visit Medicine's Esophagus, Stomach, and Intestine
Center. Also, see medicine’s patient education article Gastroenteritis.

The current knowledge on the mechanisms leading to diarrheal disease by rotavirus is as follows:

 Rotavirus infections induce maldigestion of carbohydrates, and their accumulation in the

intestinal lumen, as well as a malabsorption of nutrients and a concomitant inhibition of
water reabsorption, can lead to a malabsorption component of diarrhea.
 Rotavirus secretes an enterotoxin, NSP4, which leads to a Ca 2+ -dependent Cl- secretory
mechanism. Mobilization of intracellular calcium associated with NSP4 expressed
endogenously or added exogenously is known to induce transient chloride secretion.

Age

 Acute viral gastroenteritis occurs throughout life. Severe cases are seen in the very young
and in the elderly. Etiology also varies with age.
 In infants, most cases are due to rotavirus.  
 In adults, the most common cause is norovirus.

Symptoms and signs

Gastroenteritis often involves stomach pain or spasms, diarrhea and/or vomiting, with
noninflammatory infection of the upper small bowel, or inflammatory infections of the colon.

The condition is usually of acute onset, normally lasting 1–6 days, and is self-limiting.

 Nausea and vomiting

 Diarrhea
 Loss of appetite
 Fever
 Headaches
 Abnormal flatulence
 Abdominal pain
 Abdominal cramps
 Bloody stools (dysentery - suggesting infection by amoeba, Campylobacter, Salmonella,
Shigella or some pathogenic strains of Escherichia coli])
 Fainting and Weakness
 Heartburn

The main contributing factors include poor feeding in infants. Diarrhea is common, and may
be followed by vomiting. Viral diarrhea usually causes frequent watery stools, whereas blood
stained diarrhea may be indicative of bacterial colitis. In some cases, even when the stomach is
empty, bile can be vomited up.

A child with gastroenteritis may be lethargic, suffer lack of sleep, run a low fever, have signs
of dehydration (which include dry mucous membranes), tachycardia, reduced skin turgor, skin
color discoloration, sunken fontanelles, sunken eyeballs, darkened eye circles, glassy eyes, poor
perfusion and ultimately shock. Gastroenteritis is diagnosed based on symptoms, a complete
medical history and a physical examination. An accurate medical history may provide valuable
information on the existence or inexistence of similar symptoms in other members of the
patient's family or friends. The duration, frequency, and description of the patient's bowel
movements and if they experience vomiting are also relevant and these question are usually
asked by a physician during the examination. ]

No specific diagnostic tests are required in most patients with simple gastroenteritis. If
symptoms including fever, bloody stool and diarrhea persist for two weeks or more, examination
of stool for Clostridium difficile may be advisable along with cultures for bacteria including
Salmonella, Shigella, Campylobacter and enterotoxic Escherichia coli. Microscopy for parasites,
ova and cysts may also be helpful.

A complete medical history may be helpful in diagnosing gastroenteritis. A complete and

accurate medical history of the patient includes information on travel history, exposure to
poisons or other irritants, diet change, food preparation habits or storage and medications.
Patients who travel may be exposed to E. Coli infections or parasite infections contacted from
beverages or food. Swimming in contaminated water or drinking from suspicious fresh water
such as mountain streams or wells may indicate infection from Giardia - an organism found in
water that causes diarrhea.

Food poisoning must be considered in cases when the patient was exposed to undercooked or
improperly stored food. Depending on the type of bacteria that is causing the condition, the
reactions appear in 2 to 72 hours. Detecting the specific infectious agent is required in order to
establish a proper diagnosis and an effective treatment plan.

The doctor may want to find whether the patient has been using broad-spectrum or multiple
antibiotics in their recent past. If so, they could be the cause of an irritation of the gastrointestinal
tract.

During the physical examination, the doctor will look for other possible causes of the
infection. Conditions such as appendicitis, gallbladder disease, pancreatitis or diverticulitis may
cause similar symptoms but a physical examination will reveal a specific tenderness in the
abdomen which is not present in gastroenteritis.

Diagnosing gastroenteritis is mainly an exclusion procedure. Therefore in rare cases when

the symptoms are not enough to diagnose gastroenteritis, several tests may be performed in order
to rule out other gastrointestinal disorders. These include rectal examinations, complete blood
count, electrolytes and kidney function tests. However, when the symptoms are conclusive, no
tests apart from the stool tests are required to correctly diagnose gastroenteritis especially if the
patient has traveled to at-risk areas.