Principles of Anatomy

and Physiology
Thirteenth Edition
Gerard J. Tortora Bryan H. Derrickson

Chapter 24
The Digestive System

Copyright 2012 by John Wiley & Sons, Inc.

Parotidgland
(salivarygland)
Submandibulargland
(salivarygland)

Mouth(oralcavity)
containsteethandtongue
Sublingualgland
(salivarygland)
Pharynx

Esophagus
Liver
Duodenum
Gallbladder
Jejunum
Ascendingcolon
Ileum
Cecum
Appendix

Stomach
Pancreas
Transversecolon
Descendingcolon
Sigmoidcolon
Rectum
Analcanal
Anus

(a)Rightlateralviewofheadandneckandanteriorviewoftrunk

SUPERIOR
Diaphragm

Falciform
ligament

Stomach

Liver

Transversecolon

Gallbladder
Ascendingcolon

Descendingcolon

Cecum

Jejunum

Ileum

(b)Anteriorview

Ductofglandoutside
tract(suchas
pancreas)

Submucosalplexus
(plexusofMeissner)
Glandin
mucosa

Mucosaassociated
lymphatictissue
(MALT)
Lumen

Mesentery

Vein
Glandsin
submucosa

Artery

MUCOSA:
Epithelium
Laminapropria
Muscularis
mucosae

Nerve
Myentericplexus
(plexusofAuerbach)

SUBMUCOSA
MUSCULARIS:
Circularmuscle
Longitudinalmuscle

SEROSA:
Areolarconnectivetissue
Epithelium

ENTERICNERVOUSSYSTEM

ToANSand
CNSneurons

Myentericplexus

Interneuron

Submucosalplexus

Motorneuron

Motorneuron

Longitudinaland
circularsmoothmuscle
layersofthemuscularis

Sensoryneuron

Mucosalepithelium

Diaphragm
Liver

LESSEROMENTUM

Pancreas
Stomach

MESOCOLON

Duodenum

MESENTERY

Transversecolon

GREATEROMENTUM

Jejunum
Ileum

PARIETALPERITONEUM

Sigmoidcolon
Uterus

VISCERALPERITONEUM

Urinarybladder

PERITONEALCAVITY

Rectum
Pubicsymphysis
POSTERIOR

ANTERIOR

(a)Midsagittalsectionshowingtheperitonealfolds

Midsagittal
plane

FALCIFORMLIGAMENT
Liver
Stomach
Transversecolon
GREATEROMENTUM
Urinarybladder
(b)Anteriorview

Gallbladder(reflected
upward)

LESSEROMENTUM

Liver
(reflectedupward)

Stomach
Duodenum

Transverse
colon

Descendingcolon

Ascending
colon

Sigmoidcolon

(c)Lesseromentum,anteriorview
(liverandgallbladderlifted)

GREATEROMENTUM
(reflectedupward)
Transversecolon
Jejunum(pulledlaterally)
MESENTERY
Descendingcolon
Ileum(pulledlaterally)
Sigmoidcolon
Urinarybladder

(d)Anteriorview(greateromentumlifted
andsmallintestinereflectedtorightside)

SUPERIOR
Lungs
Heart
Diaphragm
Rightlobeofliver
FALCIFORMLIGAMENT
Leftlobeofliver
Stomach
GREATEROMENTUM

(e)Anteriorview

Superiorlip(liftedupward)
Superiorlabialfrenulum
Gingivae(gums)
Palatoglossalarch

Hardpalate

Fauces

Softpalate

Palatopharyngealarch

Uvula
Cheek

Palatinetonsil
(betweenthearches)

Molars

Tongue(liftedupward)
Lingualfrenulum
Openingofductof
submandibulargland

Premolars
Cuspid(canine)
Incisors
Oralvestibule

Gingivae(gums)
Inferiorlabialfrenulum
Inferiorlip(pulleddown)
Anteriorview

Parotidduct
Zygomaticarch
PAROTIDGLAND

Openingofparotidduct
(nearsecondmaxillarymolar)
Secondmaxillarymolartooth

Tongue(raisedinmouth)
Lingualfrenulum

Sublingualducts
Lessersublingualduct

Submandibularduct

SUBMANDIBULARGLAND
SUBLINGUALGLAND

Mylohyoidmuscle

(a)Locationofsalivaryglands

Mucousacini

Serousacini

LM 240x

(b)Portionofsubmandibulargland

Sagittal
plane

Enamel
Dentin

CROWN

Gingival sulcus
Gingiva (gum)
Pulp in pulp
cavity

NECK

Cementum
Root canal
Alveolar bone

ROOT

Periodontal
ligament
Apical foramen
Nerve
Sagittal section of a mandibular (lower) molar

Blood supply

Central incisor(812 mo.)

Lateral incisor(1224 mo.)
Cuspid or canine (1624 mo.)

D E FG
H
C
B
I
A
J

First molar (1216 mo.)

Second molar (2432 mo.)

Upper Teeth

Lower Teeth

Second molar (2432 mo.)

T
K
S
L
R
M
Q P ON

First molar (1216 mo.)

Cuspid or canine (1624 mo.)
Lateral incisor(1215 mo.)

Central incisor(68 mo.)

(a) Deciduous (primary) dentition; teeth are designated by letters

(with times of eruption)

Central incisor (78 yr.)

Lateral incisor(89 yr.)
7 8
6

5
4

Cuspid or canine (1112 yr.)

9 1011
12
13

First premolar or bicuspid (910 yr.)

Second premolar or bicuspid
(1012 yr.)

14

First molar (67 yr.)

15

Upper Teeth 16

Lower Teeth

32
31

Second molar (1213 yr.)

Third molar or wisdom tooth
(1721 yr.)
Third molar or wisdom tooth
(1721 yr.)

17
18

30

Second molar (1113 yr.)

29
28
2726

19

First molar (67 yr.)

20
21

Second premolar or bicuspid

(1112 yr.)

22
252423

(b) Permanent (secondary)

dentition; teeth are designated by
numbers (with times of eruption)

First premolar or bicuspid (910 yr.)

Cuspid or canine (910 yr.)
Lateral incisor(78 yr.)
Central incisor(78 yr.)

Lumenofesophagus
Mucosa:
Nonkeratinized
stratifiedsquamous
epithelium
Laminapropria
Muscularismucosae
Transverseplane

Submucosa
Muscularis
(circularlayer)
Muscularis
(longitudinallayer)

Adventitia
LM

20x

Walloftheesophagus

Nasopharynx
Hardpalate
Softpalate
Uvula
Oropharynx

Bolus
Tongue

Epiglottis
Laryngopharynx
Larynx
Esophagus

(a)Positionofstructuresbeforeswallowing

(b)Duringpharyngealstage
ofswallowing

Esophagus
Relaxedmuscularis
Circularmuscles
contract

Longitudinalmuscles
contract
Relaxedmuscularis

Loweresophageal
sphincter

Bolus

Stomach

(c)Anteriorviewoffrontalsectionsofperistalsisinesophagus

Esophagus
Loweresophageal
sphincter

FUNDUS
Serosa
CARDIA

Muscularis:
Longitudinallayer

BODY

Circularlayer

Lessercurvature
PYLORUS

Obliquelayer

Greatercurvature
Duodenum
Pyloric
sphincter

Rugaeofmucosa

PYLORICANTRUM
PYLORICCANAL

(a)Anteriorviewofregionsofstomach

Esophagus
Duodenum
PYLORUS
Pyloricsphincter
PYLORICCANAL
Lesser
curvature
PYLORICANTRUM

FUNDUS
CARDIA
BODY
Rugaeofmucosa

Greatercurvature

(b)Anteriorviewofinternalanatomy

Lumenofstomach
Gastricpits
Surfacemucous
cell
Laminapropria

Lymphaticnodule

Mucousneckcell
Parietalcell
Chiefcell
Gastricgland
Gcell

Muscularismucosae

MUCOSA

SUBMUCOSA

Lymphaticvessel
MUSCULARIS

Venule
Arteriole
Obliquelayerofmuscle
Circularlayerofmuscle

SEROSA

Myentericplexus
Longitudinallayer
ofmuscle

(a)Threedimensionalviewoflayersofstomach

Gastricpit
Surfacemucouscells
Gastric
pit
Lamina
SEM

40x

propria

Stomachmucosa

Gastric
glands

Muscularis
mucosae

Surfacemucouscell
(secretesmucus)
Mucousneckcell
(secretesmucus)
Parietalcell(secretes
hydrochloricacid
andintrinsicfactor)
Chiefcell(secretes
pepsinogenand
gastriclipase)
Gcell(secretesthe
hormonegastrin)

Submucosa
(b)Sectionalviewofstomachmucosashowinggastricglandsandcelltypes

Gastricpit
Laminapropria
Surfacemucouscell

Lumenof
gastricgland

Mucousneckcell

Parietalcell

Gcells

Chiefcells

Lumenofgastric
gland
LM

(c)Fundicmucosa

180x

Chymein
stomachlumen

ATP

Bloodcapillaryin
laminapropria

ADP
H+
K+
CA

Cl

H2O+CO2

H2CO3

H++HCO3

HCO3

HCO3

Alkaline
tide

Cl
Apical
membrane

Parietalcell
Basolateral
membrane
Interstitial
fluid

Key:
Protonpump
(H+/K+ATPase)

CA

Carbonicanhydrase
Diffusion

K+(potassiumion)
channel
Cl(chlorideion)
channel

HCO3
HCO3/Clantiporter
Cl

Lumenofstomach

Interstitialfluid
Parietalcell
Acetylcholine
(ACh)
AChreceptor

HCl
secretion

Gastrin
Gastrinreceptor
Histamine

Apical
membrane

Histamine
receptor
Basolateral
membrane

Falciformligament
Diaphragm
Rightlobeofliver
Righthepatic
duct

Coronaryligament
Leftlobeofliver
Lefthepaticduct
Commonhepaticduct

Gallbladder:
Neck
Body

Roundligament

Cysticduct

Fundus

Commonbileduct
Pancreas

Tail
Body

Duodenum

Pancreaticduct(ductof
Wirsung)

Accessoryduct
(ductofSantorini)

Head

Hepatopancreaticampulla
(ampullaofVater)

Uncinateprocess

Jejunum

(a)Anteriorview

Commonbileduct
Hepatopancreaticampulla
(ampullaofVater)

Pancreaticduct
(ductofWirsung)

Mucosaof
duodenum

Major
duodenal
papilla
Sphincterofthehepatopancreatic
ampulla(sphincterofOddi)
(b)Detailsofhepatopancreaticampulla

Righthepatic
duct

Lefthepatic
duct

Commonhepatic
ductfromliver
Cysticductfrom
gallbladder

Commonbileduct

Key:
Liver
Gallbladder
Pancreas

Pancreaticduct
frompancreas
Sphincter
Duodenum

(c)Ductscarryingbilefromliverandgallbladderand
pancreaticjuicefrompancreastoduodenum

Falciform
ligament
Liver

Diaphragm

Hepatic
bileduct

Spleen

Cysticbile
duct

Tailofpancreas

Gallbladder

Pancreaticduct
(ductofWirsung)

Commonbile
duct

Bodyof
pancreas

Major
duodenalpapilla

Headof
pancreas

Duodenum
(d)Anteriorview

SUPERIOR
Duodenum
Tailofpancreas

Commonbile
duct

Bodyof
pancreas

Major
duodenalpapilla

Pancreaticduct
(ductofWirsung)

Headofpancreas
Uncinateprocess

MEDIAL

LATERAL
(e)Anteriorview

Liver
Inferiorvenacava
Hepaticartery
Hepaticportalvein
Connective
tissue
Portaltriad:
Bileduct

Hepatocyte
Hepatic
laminae

Branchof
hepaticartery
Branchof
hepaticportalvein
Centralvein

Hepaticsinusoids

(a)Overviewofhistologicalcomponentsofliver

Central
vein

Tohepatic
vein

Hepatic
sinusoids

Bilecanaliculi

Portaltriad:
Bileduct
Branchofhepatic
portalvein
Branchofhepatic
artery
Hepaticlaminae
Hepatocyte
Stellate
reticuloendothelial
(Kupffer)cell
Connectivetissue

Hepaticsinusoid
(b)Detailsofhistologicalcomponentsofliver

Hepatocyte
Centralvein

Sinusoid
LM 100x

LM 50x
Portaltriad:
Branchofhepaticartery
Bileduct
Branchofhepaticportalvein
LM 150x

(c)Photomicrographs

Centralvein
Portal
triad

Hepaticlobule

Portallobule

Hepaticacinus

(d)Comparisonofthreeunitsofliverstructureandfunction

Portaltriad

Central
vein

Central
vein

Zone3
Zone2
Zone1

(e)Detailsofhepaticacinus

Oxygenatedbloodfrom
hepaticartery

Nutrientrich,
deoxygenatedbloodfrom
hepaticportalvein

Liversinusoids

Centralvein

Hepaticvein

Inferiorvenacava

Rightatriumofheart

Stomach

DUODENUM

Large
intestine

JEJUNUM

ILEUM

(a)Anteriorviewofexternalanatomy

Circularfolds
(plicaecirculares)

(b)Internalanatomyofjejunum

Circularfolds
(plicaecirculares)

Circularfolds

Villi
Submucosa
(a)Relationshipof
villitocircularfolds

Circularlayerof
muscle
Longitudinal
layerofmuscle
Serosa

Lumenofsmallintestine
Blood
capillary

Lacteal

Villi

Openingof
intestinalgland

Absorptivecell
Gobletcell
Lacteal
Laminapropria

MUCOSA

Enteroendocrinecell
Panethcell
Lymphaticnodule
Muscularismucosae
Arteriole
Venule
Lymphaticvessel

SUBMUCOSA
MUSCULARIS

Circularlayerofmuscle
Myentericplexus
Longitudinallayer
ofmuscle

(b)Threedimensionalviewoflayersofthesmallintestineshowingvilli

SEROSA

Microvilli
Absorptivecell
(absorbsnutrients)

Blood
capillary
Lacteal
Mucosa

Gobletcell
(secretesmucus)

Lamina
propria
Intestinal
gland

Enteroendocrinecell
(secretesthehormones
secretin,
cholecystokinin,orGIP)

Muscularis
mucosae
Arteriol
Submucosa

Muscularis

Venule
Lymphatic
vessel

Panethcell(secretes
lysozymeandiscapable
ofphagocytosis)
(c)Enlargedvillusshowinglacteal,
capillaries,intestinalglands,andcelltype

Villi
Lumenofduodenum

Mucosa

Intestinalglands
Muscularismucosae

Submucosa

Duodenalgland
Muscularis

LM 45x

(a)Wallofduodenum

Villi

Lumenofduodenum
Brushborder
Simplecolumnar
epithelium
Gobletcell
Absorptivecell
Duodenum
Laminapropria
Intestinalglands

LM 160x

(b)Severalvillifromduodenum

Lumenofileum
Villus

Solitarylymphatic
nodule
Submucosa

Muscularis
LM 14x

(c)Lymphaticnodulesinileum

Microvilli

Brushborder

Simplecolumnar
epithelialcell
TEM 46,800x

(d)Severalmicrovillifromduodenum

Glucoseand
galactose

Fructose

Secondaryactive
transportwithNa+

Facilitated
diffusion

Facilitated
diffusion

Aminoacids

Activetransportor
secondaryactive
transportwithNa+

Dipeptides
Tripeptides
Smallshortchain
fattyacids

Toblood
capillaryofa
villus

Aminoacids
Diffusion

Secondaryactive
transportwithH+
Simplediffusion

Largeshortchain
andlongchain
fattyacids
Micelle

Monosaccharides

Diffusion
Triglyceride

Simple
diffusion

Tolacteal
ofavillus

Monoglycerides

Lumenofsmall
intestine

Chylomicron
Microvilli(brush
border)onapical
surface

Basolateralsurface

Epithelialcells
ofvillus

(a)Mechanismsformovementofnutrientsthroughabsorptiveepithelialcellsofvilli

Leftsubclavian
vein

Villus(greatlyenlarged)
Chylomicron

Heart

Liver

Thoracicduct

Hepatic
portal
vein

Small
short
chain
fatty
acid

Blood
capillary

Aminoacid

Lacteal

Monosaccharide

Arteriole

Venule
Blood

Lymphaticvessel

Lymph

(b)Movementofabsorbednutrientsintobloodandlymph

INGESTEDANDSECRETED

ABSORBED

Saliva(1liter)
Ingestionofliquids
(2.3liters)
Gastricjuice
(2liters)

Bile(1liter)
Pancreaticjuice
(2liters)
Intestinaljuice
(1liter)

Smallintestine
(8.3liters)

Totalingested
andsecreted
=9.3liters

Largeintestine
(0.9liters)
Totalabsorbed
=9.2liters

Excretedinfeces
(0.1liter)
FluidbalanceinGItract

TRANSVERSECOLON
Leftcolic(splenic)
flexure

Rightcolic
(hepatic)flexure

Teniaecoli
ASCENDING
COLON
Teniae
coli

DESCENDINGCOLON

Ileum

Omental
appendices

Mesoappendix

Haustra

Ileocecal
sphincter
(valve)

CECUM

RECTUM
VERMIFORMAPPENDIX

SIGMOID
COLON

ANALCANAL
ANUS

(a)Anteriorviewoflargeintestineshowingmajorregions

Rectum

Analcanal

Internalanalsphincter
(involuntary)
Externalanalsphincter
(voluntary)

Anus

Analcolumn

(b)Frontalsectionofanalcanal

Lumenoflargeintestine
Openings
ofintestinalglands
Absorptivecell

Gobletcell

MUCOSA

Intestinalgland
Laminapropria
Lymphaticnodule
Muscularismucosae
Lymphaticvessel
Arteriole
Venule
Circularlayerofmuscle

SUBMUCOSA
MUSCULARIS

SEROSA

Myentericplexus
Longitudinallayerof
muscle

(a)Threedimensionalviewoflayersoflargeintestine

Openingsof
intestinalglands
Laminapropria
Microvilli
Intestinalgland

Absorptivecell
(absorbswater)

Gobletcell(secretesmucus)
Muscularis
mucosae

Lymphatic
nodule

Submucosa
(b)Sectionalviewofintestinalglandsandcelltypes

Lumenoflarge
intestine
Mucosa

Lamina
propria
Intestinalgland

Submucosa

Lymphatic
nodule
Muscularis
mucosae
Muscularis

Serosa

LM 315x

(c)Portionofwalloflargeintestine

Openingofintestinalgland
Lumenoflargeintestine
Absorptivecell
Gobletcell

Laminapropria
Intestinal
gland

LM 300x

(d)Detailsofmucosaoflargeintestine

Foodentering
stomachdisrupts
homeostasisby
Increasing
pHofgastricjuice
Distention(stretching)
ofstomachwalls

Receptors
Chemoreceptors
andstretch
receptorsin
stomach
detectpH
increaseand
distention
Input
Controlcenter

Nerve
impulses

Submucosalplexus

Output

Returntohomeostasis
whenresponsebringspH
ofgastricjuiceand
distentionofstomach
wallsbacktonormal
(preeatingstatus)

Nerveimpulses
(parasympathetic)

Effectors
Parietalcells
secreteHCIand
smoothmusclein
stomachwall
contractsmore
vigorously

Increaseinacidityof
stomachchyme;mixing
ofstomachcontents;
emptyingofstomach

HCI