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Human digestive system

The human digestive system consists of the gastrointestinal tract plus the accessory organs of digestion. Digestion involves the breakdown of food into smaller and smaller components, until they can be absorbed and assimilated into the body. The process of digestion has three stages: the cephalic phase, the gastric phase, and the intestinal phase.

Components
There are several organs involved in the digestion of food. The organs that are outside of the gastrointestinal tract (GI tract) but associated with digestion, are known as the accessory digestive organs and include the mouth, and tongue, and glandular organs – the salivary glands, the liver, gall bladder and pancreas. Other components considered are the teeth and epiglottis. A number of sphincters in the GI tract are also involved in digestion, including those of the esophagus (esophageal sphincters) and stomach (pyloric sphincter). The largest structure of the digestive system is the GI tract. This starts at the mouth and ends at the anus, covering a distance of about . A major digestive organ is the stomach. Within its mucosa are millions of embedded gastric glands. Their secretions as gastric juice are vital to the functioning of the organ. Most of the digestion of food takes place in the small intestine which is the longest part of the GI tract but has a smaller diameter than the large intestine. There are many specialised cells of the GI tract. These include the taste receptors, various cells of the gastric glands, centroacinar cells of the pancreas, enterocytes lining the intestinal epithelium, and microfold cells also known as mucosal cells, mainly found in gut-associated lymphoid tissue of the small intestine. Some parts of the digestive system are also part of the excretory system, including the large intestine. Mouth The mouth is the first part of the upper gastrointestinal tract and is equipped with several structures that begin the first processes of digestion. The vestibule is the area between the teeth, lips and cheeks, and the rest is the oral cavity proper. It covers the cheeks, inner surfaces of the lips, and floor of the mouth, and the mucin produced is highly protective against tooth decay. The roof of the mouth is termed the palate and it separates the oral cavity from the nasal cavity. The palate is hard at the front of the mouth since the overlying mucosa is covering a plate of bone; it is softer and more pliable at the back being made of muscle and connective tissue, and it can move to swallow food and liquids. The soft palate ends at the uvula. The surface of the hard palate allows for the pressure needed in eating food, to leave the nasal passage clear. The opening between the lips is termed the oral fissure, and the opening into the throat is called the fauces. At either side of the soft palate are the palatoglossus muscles which also reach into regions of the tongue. These muscles raise the back of the tongue and also close both sides of the fauces to enable food to be swallowed. Mucus helps in the mastication of food in its ability to soften and collect the food in the formation of the bolus. Salivary glands There are three pairs of main salivary glands and between 800 and 1,000 minor salivary glands, all of which mainly serve the digestive process, and also play an important role in the maintenance of dental health and general mouth lubrication, without which speech would be impossible. The main glands are all exocrine glands, secreting via ducts. All of these glands terminate in the mouth. The largest of these are the parotid glands—their secretion is mainly serous. The next pair are underneath the jaw, the submandibular glands, these produce both serous fluid and mucus. The serous fluid is produced by serous glands in these salivary glands which also produce lingual lipase. They produce about 70% of the oral cavity saliva. The third pair are the sublingual glands located underneath the tongue and their secretion is mainly mucous with a small percentage of saliva. Within the oral mucosa, and also on the tongue, palates, and floor of the mouth, are the minor salivary glands; their secretions are mainly mucous and they are innervated by the facial nerve (CN7). The glands also secrete amylase a first stage in the breakdown of food acting on the carbohydrate in the food to transform the starch content into maltose. There are other serous glands on the surface of the tongue that encircle taste buds on the back part of the tongue and these also produce lingual lipase. Lipase is a digestive enzyme that catalyses the hydrolysis of lipids (fats). These glands are termed Von Ebner's glands which have also been shown to have another function in the secretion of histatins which offer an early defense (outside of the immune system) against microbes in food, when it makes contact with these glands on the tongue tissue. Sensory information can stimulate the secretion of saliva providing the necessary fluid for the tongue to work with and also to ease swallowing of the food. Saliva Saliva moistens and softens food, and along with the chewing action of the teeth, transforms the food into a smooth bolus. The bolus is further helped by the lubrication provided by the saliva in its passage from the mouth into the esophagus. Also of importance is the presence in saliva of the digestive enzymes amylase and lipase. Amylase starts to work on the starch in carbohydrates, breaking it down into the simple sugars of maltose and dextrose that can be further broken down in the small intestine. Saliva in the mouth can account for 30% of this initial starch digestion. Lipase starts to work on breaking down fats. Lipase is further produced in the pancreas where it is released to continue this digestion of fats. The presence of salivary lipase is of prime importance in young babies whose pancreatic lipase has yet to be developed. As well as its role in supplying digestive enzymes, saliva has a cleansing action for the teeth and mouth. It also has an immunological role in supplying antibodies to the system, such as immunoglobulin A. This is seen to be key in preventing infections of the salivary glands, importantly that of parotitis. Saliva also contains a glycoprotein called haptocorrin which is a binding protein to vitamin B12. It binds with the vitamin in order to carry it safely through the acidic content of the stomach. When it reaches the duodenum, pancreatic enzymes break down the glycoprotein and free the vitamin which then binds with intrinsic factor. Tongue Food enters the mouth where the first stage in the digestive process takes place, with the action of the tongue and the secretion of saliva. The tongue is a fleshy and muscular sensory organ, and the first sensory information is received via the taste buds in the papillae on its surface. If the taste is agreeable, the tongue will go into action, manipulating the food in the mouth which stimulates the secretion of saliva from the salivary glands. The liquid quality of the saliva will help in the softening of the food and its enzyme content will start to break down the food whilst it is still in the mouth. The first part of the food to be broken down is the starch of carbohydrates (by the enzyme amylase in the saliva). The tongue is attached to the floor of the mouth by a ligamentous band called the frenum Teeth Teeth are complex structures made of materials specific to them. They are made of a bone-like material called dentin, which is covered by the hardest tissue in the body—enamel. The digestive enzymes in saliva also help in keeping the teeth clean by breaking down any lodged food particles. Its laryngeal surface faces into the larynx. The epiglottis functions to guard the entrance of the glottis, the opening between the vocal folds. It is normally pointed upward during breathing with its underside functioning as part of the pharynx, but during swallowing, the epiglottis folds down to a more horizontal position, with its upper side functioning as part of the pharynx. In this manner it prevents food from going into the trachea and instead directs it to the esophagus, which is behind. During swallowing, the backward motion of the tongue forces the epiglottis over the glottis' opening to prevent any food that is being swallowed from entering the larynx which leads to the lungs; the larynx is also pulled upwards to assist this process. Stimulation of the larynx by ingested matter produces a strong cough reflex in order to protect the lungs. Pharynx The pharynx is a part of the conducting zone of the respiratory system and also a part of the digestive system. It is the part of the throat immediately behind the nasal cavity at the back of the mouth and above the esophagus and larynx. The pharynx is made up of three parts. The lower two parts—the oropharynx and the laryngopharynx are involved in the digestive system. The laryngopharynx connects to the esophagus and it serves as a passageway for both air and food. Air enters the larynx anteriorly but anything swallowed has priority and the passage of air is temporarily blocked. The pharynx is innervated by the pharyngeal plexus of the vagus nerve. This expansion is enabled by a series of gastric folds in the inner walls of the stomach. The stomach of a newborn baby will only be able to expand to retain about 30 ml. Spleen The spleen is the largest lymphoid organ in the body but has other functions. It breaks down both red and white blood cells that are spent. This is why it is sometimes known as the 'graveyard of red blood cells'. Bile Bile produced by the liver is made up of water (97%), bile salts, mucus and pigments, 1% fats and inorganic salts. Bilirubin is its major pigment. Bile acts partly as a surfactant which lowers the surface tension between either two liquids or a solid and a liquid and helps to emulsify the fats in the chyme. Food fat is dispersed by the action of bile into smaller units called micelles. The breaking down into micelles creates a much larger surface area for the pancreatic enzyme, lipase to work on. Lipase digests the triglycerides which are broken down into two fatty acids and a monoglyceride. These are then absorbed by villi on the intestinal wall. If fats are not absorbed in this way in the small intestine problems can arise later in the large intestine which is not equipped to absorb fats. Bile also helps in the absorption of vitamin K from the diet. Bile is collected and delivered through the common hepatic duct. This duct joins with the cystic duct to connect in a common bile duct with the gallbladder. Bile is stored in the gallbladder for release when food is discharged into the duodenum and also after a few hours. It is a small organ where the bile produced by the liver is stored, before being released into the small intestine. Bile flows from the liver through the bile ducts and into the gall bladder for storage. The bile is released in response to cholecystokinin (CCK), a peptide hormone released from the duodenum. The production of CCK (by endocrine cells of the duodenum) is stimulated by the presence of fat in the duodenum. It is divided into three sections, a fundus, body and neck. The neck tapers and connects to the biliary tract via the cystic duct, which then joins the common hepatic duct to form the common bile duct. At this junction is a mucosal fold called ''Hartmann's pouch, where gallstones commonly get stuck. The muscular layer of the body is of smooth muscle tissue that helps the gallbladder contract, so that it can discharge its bile into the bile duct. The gallbladder needs to store bile in a natural, semi-liquid form at all times. Hydrogen ions secreted from the inner lining of the gallbladder keep the bile acidic enough to prevent hardening. To dilute the bile, water and electrolytes from the digestion system are added. Also, salts attach themselves to cholesterol molecules in the bile to keep them from crystallising. If there is too much cholesterol or bilirubin in the bile, or if the gallbladder does not empty properly the systems can fail. This is how gallstones form when a small piece of calcium gets coated with either cholesterol or bilirubin and the bile crystallises and forms a gallstone. The main purpose of the gallbladder is to store and release bile, or gall''. Bile is released into the small intestine in order to help in the digestion of fats by breaking down larger molecules into smaller ones. After the fat is absorbed, the bile is also absorbed and transported back to the liver for reuse. Pancreas The pancreas is a major organ functioning as an accessory digestive gland in the digestive system. It is both an endocrine gland and an exocrine gland. The endocrine part secretes insulin when the blood sugar becomes high; insulin moves glucose from the blood into the muscles and other tissues for use as energy. The endocrine part releases glucagon when the blood sugar is low; glucagon allows stored sugar to be broken down into glucose by the liver in order to re-balance the sugar levels. The pancreas produces and releases important digestive enzymes in the pancreatic juice that it delivers to the duodenum. The intestine is also called the bowel or the gut. The lower GI tract starts at the pyloric sphincter of the stomach and finishes at the anus. The small intestine is subdivided into the duodenum, the jejunum and the ileum. The cecum marks the division between the small and large intestine. The large intestine includes the rectum and anal canal. After four or five hours the stomach has emptied. In the small intestine, the pH becomes crucial; it needs to be finely balanced in order to activate digestive enzymes. The chyme is very acidic, with a low pH, having been released from the stomach and needs to be made much more alkaline. This is achieved in the duodenum by the addition of bile from the gall bladder combined with the bicarbonate secretions from the pancreatic duct and also from secretions of bicarbonate-rich mucus from duodenal glands known as Brunner's glands. The chyme arrives in the intestines having been released from the stomach through the opening of the pyloric sphincter. The resulting alkaline fluid mix neutralises the gastric acid which would damage the lining of the intestine. The mucus component lubricates the walls of the intestine. When the digested food particles are reduced enough in size and composition, they can be absorbed by the intestinal wall and carried to the bloodstream. The first receptacle for this chyme is the duodenal bulb. From here it passes into the first of the three sections of the small intestine, the duodenum (the next section is the jejunum and the third is the ileum). The duodenum is the first and shortest section of the small intestine. It is a hollow, jointed C-shaped tube connecting the stomach to the jejunum. It starts at the duodenal bulb and ends at the suspensory muscle of duodenum. The attachment of the suspensory muscle to the diaphragm is thought to help the passage of food by making a wider angle at its attachment. Most food digestion takes place in the small intestine. Segmentation contractions act to mix and move the chyme more slowly in the small intestine allowing more time for absorption (and these continue in the large intestine). In the duodenum, pancreatic lipase is secreted together with a co-enzyme, colipase to further digest the fat content of the chyme. From this breakdown, smaller particles of emulsified fats called chylomicrons are produced. There are also digestive cells called enterocytes lining the intestines (the majority being in the small intestine). They are unusual cells in that they have villi on their surface which in turn have innumerable microvilli on their surface. All these villi make for a greater surface area, not only for the absorption of chyme but also for its further digestion by large numbers of digestive enzymes present on the microvilli. The chylomicrons are small enough to pass through the enterocyte villi and into their lymph capillaries called lacteals. A milky fluid called chyle, consisting mainly of the emulsified fats of the chylomicrons, results from the absorbed mix with the lymph in the lacteals. Chyle is then transported through the lymphatic system to the rest of the body. The suspensory muscle marks the end of the duodenum and the division between the upper gastrointestinal tract and the lower GI tract. The digestive tract continues as the jejunum which continues as the ileum. The jejunum, the midsection of the small intestine contains circular folds, flaps of doubled mucosal membrane which partially encircle and sometimes completely encircle the lumen of the intestine. These folds together with villi serve to increase the surface area of the jejunum enabling an increased absorption of digested sugars, amino acids and fatty acids into the bloodstream. The circular folds also slow the passage of food giving more time for nutrients to be absorbed. The last part of the small intestine is the ileum. This also contains villi and vitamin B12; bile acids and any residue nutrients are absorbed here. When the chyme is exhausted of its nutrients the remaining waste material changes into the semi-solids called feces, which pass to the large intestine, where bacteria in the gut flora further break down residual proteins and starches. Transit time through the small intestine is an average of 4 hours. Half of the food residues of a meal have emptied from the small intestine by an average of 5.4 hours after ingestion. Emptying of the small intestine is complete after an average of 8.6 hours. The cecum receives chyme from the last part of the small intestine, the ileum, and connects to the ascending colon of the large intestine. At this junction there is a sphincter or valve, the ileocecal valve which slows the passage of chyme from the ileum, allowing further digestion. It is also the site of the appendix attachment. The taeniae coli can be seen and are responsible for the bulges (haustra) present in the colon. Most parts of the GI tract are covered with serous membranes and have a mesentery. Other more muscular parts are lined with adventitia. ==Blood supply==
Blood supply
The digestive system is supplied by the celiac artery. The celiac artery is the first major branch from the abdominal aorta, and is the only major artery that nourishes the digestive organs. There are three main divisions – the left gastric artery, the common hepatic artery and the splenic artery. The celiac artery supplies the liver, stomach, spleen and the upper 1/3 of the duodenum (to the sphincter of Oddi) and the pancreas with oxygenated blood. Most of the blood is returned to the liver via the portal venous system for further processing and detoxification before returning to the systemic circulation via the hepatic veins. The next branch from the abdominal aorta is the superior mesenteric artery, which supplies the regions of the digestive tract derived from the midgut, which includes the distal 2/3 of the duodenum, jejunum, ileum, cecum, appendix, ascending colon, and the proximal 2/3 of the transverse colon. The final branch which is important for the digestive system is the inferior mesenteric artery, which supplies the regions of the digestive tract derived from the hindgut, which includes the distal 1/3 of the transverse colon, descending colon, sigmoid colon, rectum, and the anus above the pectinate line. Blood flow to the digestive tract reaches its maximum 20–40 minutes after a meal and lasts for 1.5–2 hours. ==Nerve supply==
Nerve supply
The enteric nervous system consists of some one hundred million neurons that are embedded in the peritoneum, the lining of the gastrointestinal tract extending from the esophagus to the anus. These neurons are collected into two plexuses – the myenteric (or Auerbach's) plexus that lies between the longitudinal and the smooth muscle layers, and the submucosal (or Meissner's) plexus that lies between the circular smooth muscle layer and the mucosa. Parasympathetic innervation to the ascending colon is supplied by the vagus nerve. Sympathetic innervation is supplied by the splanchnic nerves that join the celiac ganglia. Most of the digestive tract is innervated by the two large celiac ganglia, with the upper part of each ganglion joined by the greater splanchnic nerve and the lower parts joined by the lesser splanchnic nerve. It is from these ganglia that many of the gastric plexuses arise. ==Development==
Development
Early in embryonic development, the embryo has three germ layers and abuts a yolk sac. During the second week of development, the embryo grows and begins to surround and envelop portions of this sac. The enveloped portions form the basis for the adult gastrointestinal tract. Sections of this foregut begin to differentiate into the organs of the gastrointestinal tract, such as the esophagus, stomach, and intestines. ==Clinical significance==
Clinical significance
Each part of the digestive system is subject to a wide range of disorders many of which can be congenital. Mouth diseases can also be caused by pathogenic bacteria, viruses, fungi and as a side effect of some medications. Mouth diseases include tongue diseases and salivary gland diseases. A common gum disease in the mouth is gingivitis which is caused by bacteria in plaque. The most common viral infection of the mouth is gingivostomatitis caused by herpes simplex. A common fungal infection is candidiasis commonly known as thrush which affects the mucous membranes of the mouth. There are a number of esophageal diseases such as the development of Schatzki rings that can restrict the passageway, causing difficulties in swallowing. They can also completely block the esophagus. Stomach diseases are often chronic conditions and include gastroparesis, gastritis, and peptic ulcers. A number of problems including malnutrition and anemia can arise from malabsorption, the abnormal absorption of nutrients in the GI tract. Malabsorption can have many causes ranging from infection, to enzyme deficiencies such as exocrine pancreatic insufficiency. It can also arise as a result of other gastrointestinal diseases such as coeliac disease. Coeliac disease is an autoimmune disorder of the small intestine. This can cause vitamin deficiencies due to the improper absorption of nutrients in the small intestine. The small intestine can also be obstructed by a volvulus, a loop of intestine that becomes twisted enclosing its attached mesentery. This can cause mesenteric ischemia if severe enough. A common disorder of the bowel is diverticulitis. Diverticula are small pouches that can form inside the bowel wall, which can become inflamed to give diverticulitis. This disease can have complications if an inflamed diverticulum bursts and infection sets in. Any infection can spread further to the lining of the abdomen (peritoneum) and cause potentially fatal peritonitis. Crohn's disease is a common chronic inflammatory bowel disease (IBD), which can affect any part of the GI tract, but it mostly starts in the terminal ileum. Ulcerative colitis, an ulcerative form of colitis, is the other major inflammatory bowel disease which is restricted to the colon and rectum. Both of these IBDs can give an increased risk of the development of colorectal cancer. Ulcerative colitis is the most common of the IBDs Irritable bowel syndrome (IBS) is the most common of the functional gastrointestinal disorders. These are idiopathic disorders that the Rome process has helped to define. Giardiasis is a disease of the small intestine caused by a protist parasite Giardia lamblia. This does not spread but remains confined to the lumen of the small intestine. It can often be asymptomatic, but as often can be indicated by a variety of symptoms. Giardiasis is the most common pathogenic parasitic infection in humans. There are diagnostic tools mostly involving the ingestion of barium sulphate to investigate disorders of the GI tract. These are known as upper gastrointestinal series that enable imaging of the pharynx, larynx, oesophagus, stomach and small intestine and lower gastrointestinal series for imaging of the colon. Cancer The estimated new cases of digestive system cancer in the Unitied States in 2023 was 348,840 and the estimated number of deaths from digestive system cancers was 172,010. The major specific causes of digestive system cancer related death in 2023 were cancers of the colon and rectum (52,550), pancreas (50,550), liver and intrahepatic bile duct (29,380), esophagus (16,120) and stomach (11,130). In pregnancy Gestation can predispose for certain digestive disorders. Gestational diabetes can develop in the mother as a result of pregnancy and while this often presents with few symptoms it can lead to pre-eclampsia. == History ==
History
. Illustrating the ill effects of drinking alcohol on the digestive system. In the early 11th century, the Islamic medical philosopher Avicenna wrote extensively on many subjects including medicine. Forty of these treatises on medicine survive, and in the most famous one titled the Canon of Medicine he discusses "rising gas". Avicenna believed that digestive system dysfunction was responsible for the overproduction of gas in the gastrointestinal tract. He suggested lifestyle changes and a compound of herbal drugs for its treatment. In 1497, Alessandro Benedetti viewed the stomach as an unclean organ separated off by the diaphragm. This view of the stomach and intestines as being base organs was generally held until the mid-17th century. In the Renaissance of the 16th century, Leonardo da Vinci produced some early drawings of the stomach and intestines. He thought that the digestive system aided the respiratory system. In 1895, Ivan Pavlov described its secretion as being stimulated by a neurologic reflex with the vagus nerve having a crucial role. Black in the 19th century suggested an association of histamine with this secretion. In 1916, Popielski described histamine as a gastric secretagogue of hydrochloric acid. William Beaumont was an army surgeon who in 1825, was able to observe digestion as it took place in the stomach. This was made possible by experiments on a man with a stomach wound that did not fully heal leaving an opening into the stomach. The churning motion of the stomach was described among other findings. Art historians have often noted that banqueters on iconographic records of ancient Mediterranean societies almost always appear to be lying down on their left sides. One possible explanation could lie in the anatomy of the stomach and in the digestive mechanism. When lying on the left, the food has room to expand because the curvature of the stomach is enhanced in that position. == See also ==
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