introduction of GIT System
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Introduction of gastrointestinal system
for BDS 2nd yearDr Laxman Khanal
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Introduction
1. Composed of GI tract and accessory organs2. Breaks down ingested food for use by the
body3. Digestion occurs by mechanical and chemical
mechanisms4. Excretes waste products or feces through
process of defecation
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1. Ingestion2. Secretion3. Mixing and
propulsion• Motility
4. Digestion• Mechanical• chemical
5. Absorption6. Defecation
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Topographic Divisions
• four-quadrant topographical pattern
• horizontal– transumbilical plane – between intervertebral
disc LIII and LIV
• vertical median plane
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Nine quadrant pattern
Horizontal planes• Subcostal plane or
transplyloric plane• intertubercular planeVertical planes• two Midclavicular
plane
• Epigastric region• R/L hypochondrium
region• Umbilical region• R/L lumbar region• Pelvic region• R/L inguinal region
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Wall of abdominal cavityAnteriolateral
abdominal wall• Three flat muscle– external oblique– Internal oblique– Transversus abdominus
• Two vertical muscle– Rectus abdominus– Pyramidalis
• Fascia transversalis• Parietal peritoneum
Posterior abdominal wall
• diaphragm• Rib 11/12• Lumbar vertebra• Sacrum• Ilium• Psoas major/minor• Qaudratus lumborum• iliacus
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Components
Gastrointestinal tube• Oropharynx• Laryngopharynx• Esophagus• Stomach• Small intestine • Large intestine
Accessory organs• Teeth• Tongue• Salivary glands• Liver• Gallbladder• Pancreas
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Layers of GIT
Same in all areas of GI tract• From deep to superficial:• Mucosa• Submucosa• Muscular layer• Serosa layer
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Layers of GIT
• Mucosa– Epithelium
• Type varies – Lamina propria – areolar connective tissue
• MALT – mucus-associated lymphatic tissue– Muscularis mucosae – smooth muscle
• Submucosa– Areolar connective tissue– Blood and lymphatic vessels– Neurons – submucosal plexus
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Layers of GIT
• Muscular layer– Skeletal and smooth muscle– Outer longitudinal and inner circular– Neurons – myenteric plexus
• Serosa– Areolar and simple squamous epithelium– Visceral peritoneum
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Peritoneum
• Developed from the splitting of the lateral plate mesoderm.
• Mesothelium• Parietal peritoneum• Visceral peritoneum• Peritoneal cavity• Retroperitoneal
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Peritoneal folds
• Greater omentum– Adipose tissue
• Falciform ligament– Liver to anterior abdominal wall
• Lesser omentum• Mesentery– Small intestine to posterior abdominal wall
• Mesocolon
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Accessory organs
• Fauces• Hard and soft palate• Uvula• Palatoglossal arch• palatopharyngeal arch
MOUTH
• Cheeks• Lips / labia• Labial frenulum• Orbicularis oris• Vestibule• Oral cavity proper
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Accessory organs
TONGUE
• Skeletal muscle • mucous membrane• form floor of oral cavity• Extrinsic muscles• Intrinsic muscles• Lingual frenulum
• Papillae– Fungiform– Filiform– Circumvallate– Foliate
• Lingual glands– Lingual lipase
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Accessory organs SALIVARY GLAND Release saliva to oral
cavity3 pairs of salivary glands• Parotid• Submandibular• SublingualSalivation controlled by
autonomic nervous system
PH- 6.8 to 7Composition
• 99.5 % water• 0.5% other solutes– Ions– Mucus– Immunoglobulin A– Enzymes
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Vessels , Nerves and Ductscomponents Parotid Submandibular sublingual
Artery ECA Facial (submental branch)
Facial and lingual
Vein EJV Facial and lingual Facial and lingual
Nerve (parasympathetic)
IX( otic ganglion) VII(submandibular ganglion)
VII(submandibular ganglion)
Nerve(sympathetic)
Sup cervical ganglion
Sup cervical ganglion
Sup cervical ganglion
Duct Stenson’s duct Wharton’s duct Bartholin’s ducts
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Accessory organs
TEETH• Carry out mechanical
digestion by mastication
• External regions1. Crown2. Root3. Neck
• Internal components1. Enamel2. Dentin3. Cementum4. Pulp cavity• Root canals• Apical foramen
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PANCREAS
• Produces secretions to aid digestion • Head• Body• Tail• Pancreatic duct /duct of Wirsung– Hepatopancreatic ampulla– Sphincter of the heatopancreatic ampulla (sphincter of
(Oddi)• Regulates passage of pancreatic juice and bile
• Accessory duct (duct of Santorini)
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Pancreas
99% is exocrine that secrets pancreatic juice
1% is endocrine ( islets of Langerhans)
• Insulin• Glucagon• somatostanin
Pancreatic Juice• 1200-1500 mL/day• pH 7.1-8.2• Sodium bicarbonate• Enzymes– Pancreatic amylase– Trypsin• Entereokinase
– Chymotrypsin– Carboxypeptidase– Elastase– Pancreatic lipase– Ribonuclease and
deoxyribonuclease
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Liver and Gallbladder
• Liver is the largest gland of the body• Bile is secreted by liver and carried to the gall
bladder for temporary storage.• Right and left lobe separated by falciform
ligament.• Coronary ligaments• Round ligament (ligamentum teres)– Remnant of umbilical vein
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Blood supply to the liver
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Liver functions• Metabolism of:– Carbohydrates– Lipids– Proteins
• Process drugs and hormones• Excrete bilirubin• Synthesize bile salts• Storage– Glycogen– Vtamins– Minerals
• Phagocytosis• Activate Vitamin D
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• End of which causes formation of endodermal lined gut tube.
• Open in both ends.• GI tube is formed during
the folding of embryo.
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Esophagus
• Narrowest part of GIT after Vermiform appendix.
• Extend from the pharynx( lower border of cricoid cartilage @ C6) to stomach ( @ T11).
• Consists of 3 parts. Cervical, thoracic (longest) and abdominal ( shortest ).
• Total length – 25cm• Pierce the diaphragm at the level of T10 and
open into the cardiac end of stomach at T11.
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Stomach
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Small intestine
• Adapted for digestion and absorption• About 6m in length• Duodenum• Jejunum• Ileum
• Ileocecal sphincter– Connection to large intestine
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Vessels of GIT
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Some clinical correlation
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GI bleeding:• Hematemesis ,Melena – Upper GI bleeding• Hematochezia- lower GI bleeding• Mallory-Weiss tear- Upper GI hemorrhage
may result from a tear at the gastro-esophageal junction. These tears are most common in alcoholic patients, following an episode of vomiting or retching
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• Peptic Ulcer Disease Peptic ulcer disease (PUD) causes over 50% of
GI bleeding, with the most common site being the duodenum. The use of NSAIDs is the most important risk factor for the development of bleeding from PUD, although the risk can be increased Further by the use of anticoagulants, by H. pylori, and by Increased acid in such conditions as Zollinger-Ellison syndrome.