Human gastrointestinal tract

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Human gastrointestinal tract (Digestive System)
Stomach colon rectum diagram.svg
Stomach colon rectum diagram
LatinTractus digestorius (mouth to anus),
canalis alimentarius (esophagus to large Intestine),
canalis gastrointestinales (stomach to large Intestine)
SystemDigestive system
 
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Human gastrointestinal tract (Digestive System)
Stomach colon rectum diagram.svg
Stomach colon rectum diagram
LatinTractus digestorius (mouth to anus),
canalis alimentarius (esophagus to large Intestine),
canalis gastrointestinales (stomach to large Intestine)
SystemDigestive system

The human gastrointestinal tract is the stomach and intestine,[1] sometimes including all the structures from the mouth to the anus.[2] (The "digestive system" is a broader term that includes other structures, including the accessory organs of digestion).[3]

In an adult male human, the gastrointestinal (GI) tract is 5 metres (20 ft) long in a live subject, or up to 9 metres (30 ft) without the effect of muscle tone, and consists of the upper and lower GI tracts. The tract may also be divided into foregut, midgut, and hindgut, reflecting the embryological origin of each segment of the tract.

The GI tract always releases hormones to help regulate the digestive process. These hormones, including gastrin, secretin, cholecystokinin, and ghrelin, are mediated through either intracrine or autocrine mechanisms, indicating that the cells releasing these hormones are conserved structures throughout evolution.[4]

Structure[edit]

Upper gastrointestinal tract[edit]

Salivary glandsParotid glandSubmandibular glandSublingual glandpharynxTongueEsophagusPancreasStomachPancreatic ductIleumAnusRectumVermiform appendixCecumDescending colonAscending colonTransverse colonColon (anatomy)Bile ductDuodenumGallbladderLiveroral cavity
Upper and Lower human gastrointestinal tract

The upper gastrointestinal tract consists of the esophagus, stomach, and duodenum.[5] The exact demarcation between "upper" and "lower" can vary. Upon dissection, the duodenum may appear to be a unified organ, but it is often divided into two parts based upon function, arterial supply, or embryology.

Lower gastrointestinal tract[edit]

The lower gastrointestinal tract includes most of the small intestine and all of the large intestine.[6] According to some sources, it also includes the anus.[citation needed]

The Ligament of Treitz is sometimes used to divide the upper and lower GI tracts.[7]

Development[edit]

The gut is an endoderm-derived structure. At approximately the sixteenth day of human development, the embryo begins to fold ventrally (with the embryo's ventral surface becoming concave) in two directions: the sides of the embryo fold in on each other and the head and tail fold toward one another. The result is that a piece of the yolk sac, an endoderm-lined structure in contact with the ventral aspect of the embryo, begins to be pinched off to become the primitive gut. The yolk sac remains connected to the gut tube via the vitelline duct. Usually this structure regresses during development; in cases where it does not, it is known as Meckel's diverticulum.

During fetal life, the primitive gut can be divided into three segments: foregut, midgut, and hindgut. Although these terms are often used in reference to segments of the primitive gut, they are also used regularly to describe components of the definitive gut as well.

Each segment of the gut gives rise to specific gut and gut-related structures in later development. Components derived from the gut proper, including the stomach and colon, develop as swellings or dilatations of the primitive gut. In contrast, gut-related derivatives — that is, those structures that derive from the primitive gut but are not part of the gut proper, in general develop as out-pouchings of the primitive gut. The blood vessels supplying these structures remain constant throughout development.[8]

PartPart in adultGives rise toArterial supply
ForegutEsophagus to first 2 sections of the duodenumEsophagus, Stomach, Duodenum (1st and 2nd parts), Liver, Gallbladder, Pancreas, Superior portion of pancreas
(Note that though the Spleen is supplied by the celiac trunk, it is derived from dorsal mesentery and therefore not a foregut derivative)
celiac trunk
Midgutlower duodenum, to the first two-thirds of the transverse colonlower duodenum, jejunum, ileum, cecum, appendix, ascending colon, and first two-third of the transverse colonbranches of the superior mesenteric artery
Hindgutlast third of the transverse colon, to the upper part of the anal canallast third of the transverse colon, descending colon, rectum, and upper part of the anal canalbranches of the inferior mesenteric artery

Histology[edit]

General structure of the gut wall

The gastrointestinal tract has a form of general histology with some differences that reflect the specialization in functional anatomy.[9] The GI tract can be divided into four concentric layers in the following order:

Mucosa[edit]

The mucosa is the innermost layer of the gastrointestinal tract. that is surrounding the lumen, or open space within the tube. This layer comes in direct contact with digested food (chyme). The mucosa is made up of:

The mucosae are highly specialized in each organ of the gastrointestinal tract to deal with the different conditions. The most variation is seen in the epithelium.

Submucosa[edit]

The submucosa consists of a dense irregular layer of connective tissue with large blood vessels, lymphatics, and nerves branching into the mucosa and muscularis externa. It contains Meissner's plexus, an enteric nervous plexus, situated on the inner surface of the muscularis externa.

Muscularis externa[edit]

The muscularis externa consists of an inner circular layer and a longitudinal outer muscular layer. The circular muscle layer prevents food from traveling backward and the longitudinal layer shortens the tract. The layers are not truly longitudinal or circular, rather the layers of muscle are helical with different pitches. The inner circular is helical with a steep pitch and the outer longitudinal is helical with a much shallower pitch.

The coordinated contractions of these layers is called peristalsis and propels the food through the tract. Food in the GI tract is called a bolus (ball of food) from the mouth down to the stomach. After the stomach, the food is partially digested and semi-liquid, and is referred to as chyme. In the large intestine the remaining semi-solid substance is referred to as faeces.

Between the two muscle layers are the myenteric or Auerbach's plexus. This controls peristalsis. Activity is initiated by the pacemaker cells (interstitial cells of Cajal). The gut has intrinsic peristaltic activity (basal electrical rhythm) due to its self-contained enteric nervous system. The rate can of course be modulated by the rest of the autonomic nervous system.

Adventitia/serosa[edit]

The outermost layer of the GI tract consists of several layers of connective tissue.

Intraperitoneal parts of the GI tract are covered with serosa. These include most of the stomach, first part of the duodenum, all of the small intestine, caecum and appendix, transverse colon, sigmoid colon and rectum. In these sections of the gut there is clear boundary between the gut and the surrounding tissue. These parts of the tract have a mesentery.

Retroperitoneal parts are covered with adventitia. They blend into the surrounding tissue and are fixed in position. For example, the retroperitoneal section of the duodenum usually passes through the transpyloric plane. These include the esophagus, pylorus of the stomach, distal duodenum, ascending colon, descending colon and anal canal. In addition, the oral cavity has adventitia.

Physiology[edit]

The time taken for food or other ingested objects to transit through the gastrointestinal tract varies depending on many factors, but roughly, it takes less than an hour after a meal for 50% of stomach contents to empty into the intestines and total emptying of the stomach takes around 2 hours. Subsequently, 50% emptying of the small intestine takes 1 to 2 hours. Finally, transit through the colon takes 12 to 50 hours with wide variation between individuals.[10][11]

Immune function[edit]

The gastrointestinal tract is also a prominent part of the immune system.[12] The surface area of the digestive tract is estimated to be the surface area of a football field. With such a large exposure, the immune system must work hard to prevent pathogens from entering into blood and lymph.[13][WP:V]

The low pH (ranging from 1 to 4) of the stomach is fatal for many microorganisms that enter it. Similarly, mucus (containing IgA antibodies) neutralizes many of these microorganisms. Other factors in the GI tract help with immune function as well, including enzymes in saliva and bile. Enzymes such as Cyp3A4, along with the antiporter activities, also are instrumental in the intestine's role of detoxification of antigens and xenobiotics, such as drugs, involved in first pass metabolism.

Health-enhancing intestinal bacteria serve to prevent the overgrowth of potentially harmful bacteria in the gut. These two types of bacteria compete for space and "food," as there are limited resources within the intestinal tract. A ratio of 80-85% beneficial to 15-20% potentially harmful bacteria generally is considered normal within the intestines. Microorganisms also are kept at bay by an extensive immune system comprising the gut-associated lymphoid tissue (GALT).

Clinical relevance[edit]

There are a number of diseases and conditions affecting the gastrointestinal system, including:

See also[edit]

This article uses anatomical terminology, for an overview see anatomical terminology.

References[edit]

  1. ^ "gastrointestinal tract" at Dorland's Medical Dictionary
  2. ^ Gastrointestinal tract at the US National Library of Medicine Medical Subject Headings (MeSH)
  3. ^ "digestive system" at Dorland's Medical Dictionary
  4. ^ Nelson RJ. 2005. Introduction to Behavioral Endocrinology. Sinauer Associates: Massachusetts. p 57.
  5. ^ Upper Gastrointestinal Tract at the US National Library of Medicine Medical Subject Headings (MeSH)
  6. ^ Lower Gastrointestinal Tract at the US National Library of Medicine Medical Subject Headings (MeSH)
  7. ^ David A. Warrell (2005). Oxford textbook of medicine: Sections 18-33. Oxford University Press. pp. 511–. ISBN 978-0-19-856978-7. Retrieved 1 July 2010. 
  8. ^ Bruce M. Carlson (2004). Human Embryology and Developmental Biology (3rd ed.). Saint Louis: Mosby. ISBN 0-323-03649-X. 
  9. ^ Abraham L. Kierszenbaum (2002). Histology and cell biology: an introduction to pathology. St. Louis: Mosby. ISBN 0-323-01639-1. 
  10. ^ Kim SK. Small intestine transit time in the normal small bowel study. American Journal of Roentgenology 1968; 104(3):522-524.
  11. ^ [1] Uday C Ghoshal, Vikas Sengar, and Deepakshi Srivastava. Colonic Transit Study Technique and Interpretation: Can These Be Uniform Globally in Different Populations With Non-uniform Colon Transit Time? J Neurogastroenterol Motil. 2012 April; 18(2): 227–228.
  12. ^ Richard Coico, Geoffrey Sunshine, Eli Benjamini (2003). Immunology: a short course. New York: Wiley-Liss. ISBN 0-471-22689-0. 
  13. ^ Animal Physiology textbook

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