THE DIGESTIVE SYSTEM The primary function of the digestive system is to transfer nutrients, water and electrolytes from

the food we eat into the body. These functions are achieved by four basic of digestive processes which are motility, secretion, ingestion and absorption.

Structure of the digestive system The digestive system includes the following organs: mouth, pharynx, esophagus, stomach, small intestine (consisting of the duodenum, jejunum and ileum), large intestine (the cecum, appendix, colon and rectum) and anus.

The wall of the digestive tract is composed of four main layers. From the innermost layer outward they are the mucosa, the submucosa, the muscularis externa and the serosa. The mucosa lines the luminal surface of the digestive tract and is divided into three layers: 1. Mucous membrane, an inner epithelial layer that acts as protective surface. It contains exocrine gland cells that secrete digestive juices, endocrine gland cells to secrete

blood-borne gastrointestinal (GI) hormones and specialized epithelial cells to absorb nutrients. 2. Lamina propria, a layer of connective tissue that contains small blood and lymphatic vessels, immune cells and nerve fibers. 3. Muscularis mucosa, a thin layer of muscle cells with an internal circular and external longitudinal layer. It is important boundary in determining metastasis of GI tract cancer. Muscularis mucosa is outermost mucosal layer that lies adjacent to the submucosa.

The submucosa is a thick layer of loose connective tissue that contain larger blood and lymphatic vessels and a nerve plexus of the intrinsic or enteric nervous system, termed the submucosal nerve (Meissner's) plexus. This nerve plexus is particularly important for control of secretion in the GI tract. The muscularis externa is composed of an inner circular and an outer longitudinal layer of smooth muscle and is responsible for motility of the digestive tract. Between these muscle layers lies the myenteric nerve (Auerbach's) plexus, a division of the enteric nervous system that regulates motility. The outer connective tissue covering of the digestive tract is the serosa, where larger nerves and blood vessels travel in a bed of connective and adipose tissue.

Gastrointestinal diseases (GI diseases) GI diseases most often present with one or more of four common classes of symptoms and signs: 1. Abdominal or chest pain 2. Altered ingestion of food which resulting from nausea, vomiting, dysphagia, odynophagia, or anorexia 3. Altered bowel movements such as diarrhea or constipation 4. GI bleeding which manifests as either hematemesis or bloody stools (including melena, frank blood and occult blood) or both

GI bleeding may develop from any gut organ. Most commonly, upper GI bleeding presents with melena or hematemesis, whereas lower GI bleeding produces passage of bright red or maroon stools. However, briskly bleeding upper sites can elicit voluminous red rectal bleeding, while slowly bleeding ascending colon sites may produce melena. Chronic slow GI bleeding may present with iron deficiency anemia. The most common upper GI causes of

bleeding are ulcer disease, gastroduodenitis, and esophagitis. Other causes include portal hypertensive causes, malignancy, tears across the gastroesophageal junction, and vascular lesions. The most prevalent lower GI sources of bleeding include hemorrhoids, anal fissures, diverticula, ischemic colitis, and arteriovenous malformations. Other causes include neoplasm, inflammatory bowel disease, infectious colitis, drug-induced colitis, and other vascular lesions. Administration of drugs such as anticoagulant, NSAID and antidepressant can also be the cause of GI tract bleeding.