III.

ANATOMY AND PHYSIOLOGY

Figure 1

The Upper Gastrointestinal Tract

The upper gastrointestinal tract (or GI) includes

the esophagus, the stomach and the upper
small intestine (the duodenum).

Esophagus

The esophagus is a narrow muscular tube

about 20-30 centimeters long which starts
at pharynx at the back of the mouth, passes
through the thoracic diaphragm, and ends at
the cardiac orifice of the stomach. The wall of the esophagus is made up of two layers
of smooth muscles, which form a continuous layer from the esophagus to the open and contract
slowly, over long periods of time. The inner layer of muscles is arranged circularly in a series of
descending rings, while the outer layer is arranged longitudinally. At the top of the esophagus, is
a flap of tissue called the epiglottis that closes during swallowing to prevent food from entering
the trachea (windpipe). The chewed food is pushed down the esophagus to the stomach
through peristaltic contraction of these muscles. It takes only about seven seconds for food to
pass through the esophagus and now digestion takes place.

Stomach

The stomach is a small, 'J'-shaped pouch with walls made of thick, elastic muscles, which stores
and helps break down food. Food which has been reduced to very small particles is more likely
to be fully digested in the small intestine, and stomach churning has the effect of assisting the
physical disassembly begun in the mouth. Ruminants, who are able to digest fibrous material
(primarily cellulose), use fore-stomachs and repeated chewing to further the disassembly.
Rabbits and some other animals pass some material through their entire digestive systems
twice. Most birds ingest small stones to assist in mechanical processing in gizzards.

Food enters the stomach through the cardiac orifice where it is further broken apart and
thoroughly mixed with gastric acid, pepsin and other digestive enzymes to break down proteins.
The enzymes in the stomach also have an optimum, meaning that they work at a specific pH
and temperature better than any others. The acid itself does not break down food molecules,
rather it provides an optimum pH for the reaction of the enzyme pepsin and kills many
microorganisms that are ingested with the food. It can also denature proteins. This is the
process of reducing polypeptide bonds and disrupting salt bridges which in turn causes a loss of
secondary, tertiary or quaternary protein structure. Theparietal cells of the stomach also secrete
a glycoprotein called intrinsic factor which enables the absorption of vitamin B-12. Other small
molecules such as alcohol are absorbed in the stomach, passing through the membrane of the
stomach and entering the circulatory systemdirectly. Food in the stomach is in semi-liquid form,
which upon completion is known as chyme.

After consumption of food, digestive "tonic" and peristaltic contractions begin which help to
break down the food and move it through.When the chyme reaches the opening to the
duodenum known as the pylorus, contractions "squirt" the food back into the stomach through a
process called retropulsion, which exerts additional force and further grinds down food into
smaller particles. Gastric emptying is the release of food from the stomach into the duodenum;
the process is tightly controlled liquids are emptied much more quickly than solids.Gastric
emptying has attracted medical interest as rapid gastric emptying is related to obesity
and delayed gastric emptying syndrome is associated with diabetes mellitus, aging, and
gastroesophageal reflux.

The transverse section of the alimentary canal reveals four (or five, see description under
mucosa) distinct and well developed layers within the stomach:

 Serous membrane, a thin layer of mesothelial cells that is the outermost wall of the
stomach.

 Muscular coat, a well-developed layer of muscles used to mix ingested food, composed
of three sets running in three different alignments. The outermost layer runs parallel to
the vertical axis of the stomach (from top to bottom), the middle is concentric to the axis
(horizontally circling the stomach cavity) and the innermost oblique layer, which is
responsible for mixing and breaking down ingested food, runs diagonal to the
longitudinal axis. The inner layer is unique to the stomach, all other parts of the digestive
tract have only the first two layers.

 Submucosa, composed of connective tissue that links the inner muscular layer to the
mucosa and contains the nerves, blood and lymph vessels.
  Mucosa is the extensively folded innermost layer. It can be divided into
the epithelium, lamina propria, and the muscularis mucosae, though some consider the
outermost muscularis mucosae to be a distinct layer, as it develops from the mesoderm
rather than the endoderm (thus making a total of five layers). The epithelium and lamina
are filled with connective tissue and covered in gastric glands that may be simple or
branched tubular, and secrete mucus, hydrochloric acid, pepsinogen and rennin. The
mucus lubricates the food and also prevents hydrochloric acid from acting on the walls of
the stomach.

Duodenum

The duodenum is largely responsible for the breakdown of food in the small intestine, using
enzymes. Brunner's glands, which secrete mucus, are found in the duodenum. The duodenum
wall is composed of a very thin layer of cells that form the muscularis mucosae. The duodenum
is almost entirely retroperitoneal.

The duodenum also regulates the rate of emptying of the stomach via hormonal
pathways. Secretin and cholecystokinin are released from cells in the duodenal epithelium in
response to acidic and fatty stimuli present there when the pylorus opens and releases gastric
chyme into the duodenum for further konadigestion. These cause the liver and gall bladder to
release bile, and the pancreas to release bicarbonate and digestive enzymes such
as trypsin, lipase and amylase into the duodenum as they are needed.

The Resiratory System

The respiratory system is an intricate arrangement of spaces and passageways that conduct air
from outside the body into the lungs and finally into the blood as well as expelling waste gasses.
This system is responsible for the mechanical process called breathing, with the average adult
breathing about 12 to 20 times per minute.
When engaged in strenuous activities, the rate and depth of breathing increases in order to
handle the increased concentrations of carbon dioxide in the blood. Breathing is typically an
involuntary process, but can be consciously stimulated or inhibited as in holding your breath.

Nostrils/Nasal Cavities
During inhalation, air enters the nostrils and passes into the nasal cavities where foreign bodies
are removed, the air is heated and moisturized before it is brought further into the body. It is this
part of the body that houses our sense of smell.

Sinuses
The sinuses are small cavities that are lined with mucous membrane within the bones of the
skull.

Pharynx
The pharynx, or throat carries foods and liquids into the digestive tract and also carries air into
the respiratory tract.

Larynx
The larynx or voice box is located between the pharynx and trachea. It is the location of the
Adam's apple, which in reality is the thyroid gland and houses the vocal cords.

Trachea
The trachea or windpipe is a tube that extends from the lower edge of the larynx to the upper
part of the chest and conducts air between the larynx and the lungs.
 Lungs
The lungs are the organ in which the exchange of gasses takes
place. The lungs are made up of extremely thin and delicate
tissues. At the lungs, the bronchi subdivides, becoming
progressively smaller as they branch through the lung tissue, until
they reach the tiny air sacks of the lungs called the alveoli. It is at
the alveoli that gasses enter and leave the blood stream.

Bronchi
The trachea divides into two parts called the bronchi, which enter the lungs.

Bronchioles
The bronchi subdivide creating a network of smaller branches, with the smallest one being the
bronchioles. There are more than one million bronchioles in each lung.

Avleoli
The alveoli are tiny air sacks that are enveloped in a network of capillaries. It is here that the air
we breathe is diffused into the blood, and waste gasses are returned for elimination.

Hematologic System

The structures of the hematologic or hematopoietic system include the blood, blood vessels,
and blood-forming organs (bone marrow, spleen, liver, lymph nodes, and thymus gland). The
major function of blood is to carry necessary materials (oxygen, nutrients) to cells and to remove
carbon dioxide and metabolic waste products. The hematologic system also plays an important
role in hormone transport, the inflammatory and immune responses, temperature regulation,
fluid-electrolyte balance, and acid-base balance.

Bone Marrow

1. Contained inside all bones, occupies interior of spongy bones and center of long bones;
collectively one of the largest organs of the body (4%-5% of total body weight)

2. Primary function is hematopoiesis (the formation of blood cells)

3. Two kinds of bone marrow, red and yellow

 1. Red (functioning) marrow

1. Carries out hematopoiesis; production site of erythroid, myeloid, and

thrombocytic components of blood; one source of lymphocytes and
macrophages

2. Found in ribs, vertebral column, other flat bones

2. Yellow marrow: red marrow that has changed to fat; found in long bones; does
not contribute to hematopoiesis

4. All blood cells start as stem cells in the bone marrow; these mature into the different,
specific types of cells, collectively referred to as formed elements of blood or blood
components: erythrocytes, leukocytes, and thrombocytes.

Blood

1. Composed of plasma (55%) and cellular components (45%)

 2. Hematocrit

1. Reflects portion of blood composed of red blood cells

2. Centrifugation of blood results in separation into top layer of plasma, middle layer
of leukocytes and platelets, and bottom layer of erythrocytes.

3. Majority of formed elements is erythrocytes; volume of leukocytes and platelets is

negligible.

3. Distribution

1. 1300 ml in pulmonary circulation

1. 400 ml arterial

2. 60 ml capillary

3. 840 ml venous

2. 3000 ml in systemic circulation

1. 550 ml arterial

2. 300 ml capillary

3. 2150 ml venous

Plasma

1. Liquid part of blood; yellow in color because of pigments

2. Consists of serum (liquid portion of plasma) and fibrinogen

3. Contains plasma proteins such as albumin, serum globulins, fibrinogen, prothrombin,

plasminogen

1. Albumin: largest of plasma proteins, involved in regulation of intravascular

plasma volume and maintenance of osmotic pressure
 2. Serum globulins: alpha, beta, gamma

1. Alpha: role in transport of steroids, lipids, bilirubin

2. Beta: role in transport of iron and copper

3. Gamma: role in immune response, function of antibodies

3. Fibrinogen, prothrombin, plasminogen (see Coagulation)

Cellular Components
Cellular components or formed elements of blood are erythrocytes (red blood cells [RBCs]),
which are responsible for oxygen transport; leukocytes (white blood cells [WBCs]), which play a
major role in defense against microorganisms; and thrombocytes (platelets), which function in
hemostasis.

1. Erythrocytes

1. Bioconcave disc shape, no nucleus, chiefly sacs of hemoglobin

2. Cell membrane is highly diffusible to O2 and CO2

3. RBCs are responsible for oxygen transport via hemoglobin (Hgb)

1. Two portions: iron carried on heme portion; second portion is protein

2. Normal blood contains 12-18 g Hgb/100 ml blood; higher (14-18 g) in men

than in women (12-14 g)

4. Production

1. Start in bone marrow as stem cells, released as reticulocytes (immature

cells), mature into erythrocytes

2. Erythropoietin stimulates differentiation; produced by kidneys and

stimulated by hypoxia

3. Iron, vitamin B12, folic acid, pyridoxine (vitamin B6), and other factors
required for erythropoiesis
 1. Hemolysis (destruction)

1. Average life span 120 days

2. Immature RBCs destroyed in either bone marrow or other

reticuloendothelial organs (blood, connective tissue, spleen, liver, lungs,
and lymph nodes)

3. Mature cells removed chiefly by liver and spleen

4. Bilirubin: byproduct of Hgb released when RBCs destroyed, excreted in

bile

5. Iron: freed from Hgb during bilirubin formation; transported to bone

marrow via transferrin and reclaimed for new Hgb production

6. Premature destruction: may be caused by RBC membrane abnormalities,

Hgb abnormalities, extrinsic physical factors (such as the enzyme defects
found in G6PD)

7. Normal age RBCs may be destroyed by gross damage as in trauma or

extravascular hemolysis (in spleen, liver, bone marrow)

1. Leukocytes: granulocytes and mononuclear cells: involved in protection from bacteria

and other foreign substances

1. Granulocytes: eosinophils, basophils, and neutrophils

1. Eosinophils: involved in phagocytosis and allergic reactions

2. Basophils: involved in prevention of clotting in microcirculation and

allergic reactions

3. Eosinophils and basophils are reservoirs of histamine, serotonin, and

heparin

4. Neutrophils: involved in short-term phagocytosis

1. mature neutrophils: polymorphonuclear leukocytes

 2. immature neutrophils: band cells (bacterial infection usually
produces increased numbers of band cells)

1. Mononuclear cells: monocytes and lymphocytes: large nucleated cells

1. Monocytes: involved in long-term phagocytosis; play a role in immune

response

1. largest leukocyte

2. produced by bone marrow: give rise to histiocytes (Kupffer cells of

liver), macrophages, and other components of reticuloendothelial
system

1. Lymphocytes: immune cells; produce substances against foreign cells;

produced primarily in lymph tissue (B cells) and thymus (T cells) (see also
Immune Response)

1. Thrombocytes (platelets)

1. Fragments of megakaryocytes formed in bone marrow

2. Production regulated by thrombopoietin

3. Essential factor in coagulation via adhesion, aggregation, and plug formation

4. Release substances involved in coagulation

Spleen

1. Largest lymphatic organ: functions as blood

filtration system and reservoir

2. Vascular, bean shaped; lies beneath the

diaphragm, behind and to the left of the
stomach; composed of a fibrous tissue
capsule surrounding a network of fiber
 3. Contains two types of pulp

1. Red pulp: located between the fibrous strands, composed of RBCs, WBCs, and
macrophages

2. White pulp: scattered throughout the red pulp, produces lymphocytes and
sequesters lymphocytes, macrophages, and antigens

4. 1%-2% of red cell mass or 200 ml blood/minute stored in spleen; blood comes via the
splenic artery to the pulp for cleansing, then passes into splenic venules that are lined
with phagocytic cells, and finally to the splenic vein to the liver.

5. Important hematopoietic site in fetus; postnatally produces lymphocytes and monocytes

6. Important in phagocytosis; removes misshapen erythrocytes, unwanted parts of

erythrocytes

7. Also involved in antibody production by plasma cells and iron metabolism (iron released
from Hgb portion of destroyed erythrocytes returned to bone marrow)

8. In the adult, functions of the spleen can be taken over by the reticuloendothelial system.

Liver

1. Involved in bile production (via erythrocyte destruction and bilirubin production) and
erythropoiesis (during fetal life and when bone marrow production is insufficient).

2. Kupffer cells of liver have reticuloendothelial function as histiocytes; phagocytic activity

and iron storage.

3. Liver also involved in synthesis of clotting factors, synthesis of antithrombins.