00:02
Now let's talk about the
gastrointestinal system,
which is very complex
and very far ranging.
00:09
And it consists of both the tract,
which is the long tubular structure
that's running proximately,
from the mouth distally to the anus,
as well as many GI associated
organs that help aid in digestion.
00:25
When we start proximately,
we're going to start with the mouth,
and then a space that's actually
somewhat of a shared air and food
spot called the pharynx.
It's an unusual area.
00:38
But then after the pharynx,
it becomes again
a dedicated Food Tube
called the esophagus.
00:45
And then it's going
to reach the stomach,
below the diaphragm
when we're finally into the abdomen.
00:52
Then it's going to form the first
part of the small intestine,
which is short called the duodenum.
00:58
And that's going to be the end of
what we will call the upper GI tract
before going on to the rest
of the small intestine,
and then the large intestine,
which is going to be
in the lower GI tract.
01:12
Again, there's also a lot of
accessory organs of digestion,
starting right away in the mouth
with things like the salivary
glands and the tongue.
01:21
And then down in the abdomen,
we have larger structures
such as the liver,
and the associated gallbladder
and biliary system.
01:31
As well as the pancreas,
which does digestion as
well as endocrine functions.
01:37
That's a really long
way to move food
all the way from the
mouth to the anus.
01:42
And generally what's happening
is the contraction of smooth muscle
in a very coordinated
fashion called peristalsis.
01:52
And in a nutshell, what's happening
is there are two layers of muscle
throughout most of the GI tract.
01:59
And there's an inner
circular portion
and an outer longitudinal portion.
02:05
And it's the inner circular portion
that's going to contract
just behind that food mass to make
sure it only moves in one direction.
02:14
And that outer longitudinal layer
is going to contract ahead
of the food mass
to help direct it further
and further distally
through the GI tract,
until essentially it's
expelled out through the anus.
02:28
So let's start by the
act of swallowing.
02:31
Swallowing is a very
complicated function,
because this space
is actually a shared
breathing and digestive space.
02:41
Here we have a bolus of food
sitting on top of the tongue.
02:46
posterior to the tongue,
we have two important
flaps of tissue,
or superiorly,
we have the soft palate,
and inferiorly we have this
flap called the epiglottis.
02:58
And as food is swallowed,
the soft palate is going to prevent
any sort of passage of that
bolus up into the nasal cavity.
03:08
Whereas, the epiglottis
is going to flap down
over the entrance to the airways
and therefore protect it,
forcing the food bolus posteriorly
and into the esophagus.
03:22
So let's look at the esophagus.
03:24
The esophagus is a
very long muscular tube
that's going to connect
that initial act of swallowing
all the way down to the
stomach in the abdomen.
03:35
So if we were to zoom in
to that proximal area,
we see there's a lot going on.
03:40
In the respiratory system
we covered the larynx
which leads into the trachea.
03:45
And sitting posterior to
the larynx is the pharynx.
03:50
And right where the larynx
transitions into the trachea is
where we're going
to find the pharynx
transitions into the esophagus.
03:58
And it's going to run
posterior to the trachea
throughout the
length of the trachea
and then eventually
down into the abdomen.
04:08
And this is where
we're going to find
the first of two sphincters
of the esophagus.
04:13
This one between the
pharynx and esophagus
is going to be the
upper esophageal sphincter.
04:21
After the esophagus has
passed through the diaphragm
to reach the abdominal cavity,
we're finally going
to see the stomach
which is where the
esophagus is heading.
04:33
And between the
esophagus and stomach
is where we're going to find
the lower esophageal sphincter
and this is a very
important sphincter
because the stomach is
going to be full of acid.
04:45
And that's really what the
upper GI portion is doing is
really breaking down food
either mechanically with teeth
or via acids in the stomach.
04:55
But the esophagus isn't
equipped to handle acids.
04:58
It's really for transporting
a food bolus down to the stomach.
05:01
So this lower esophageal
sphincter is very important
in stayin closed
when it's supposed to
so that way stomach acid doesn't
get up into the esophagus
and cause something
called reflux or GERD,
Gastroesophageal reflux disease.
05:21
Here we see the stomach itself,
after it's received its
contents from the esophagus.
05:28
Now, externally with the naked eye,
it's hard to tell some
of these locations.
05:34
But these different regions of
the stomach we're gonna talk about
have different microanatomies
and different functions
that are important to know.
05:43
So generally speaking,
the initial portion of the stomach,
even though it's very tiny,
and there's not a lot of
well defined borders for it
is the cardia.
05:53
And this small area,
microscopically,
is going to have a lot
of neutralizing glands
to help prevent any acid from
seeping up into the esophagus.
06:05
Then the majority of the stomach is
going to be composed of the body.
06:10
And then as you can
see, superiorly,
there's this little
bump called the fundus.
06:16
And this little bump is
usually something you can see
at the very bottom part of
a chest X-ray, for example.
06:23
It's usually where any gas in the
stomach is going to accumulate.
06:28
So it looks like what's
called a little gastric bubble
up in the fundus.
06:31
But even though we call
this little portion
that sort of rises up above
the rest of the fundus,
it's important to know that
microscopically, and functionally,
there really is no difference
between the body and fundus.
06:44
They're really the ones doing
the majority of the acid
and digestion breakdown
in the stomach.
06:51
But once you get to
this angle a little bit
distally called
the angular incisure,
things start to change.
06:58
Again, you can't see
this with the naked eye.
07:00
But this is about where you're
going to see the pylorus
and pylorus means gatekeeper.
07:07
And it's going to be broken
up into two portions,
a wide antrum and a narrow canal.
07:15
And the pylorus is going to
have different types of glands
than the body and fundus.
07:20
In fact, is going to be very similar
in a lot of ways to the cardia.
07:23
And that it's going to produce
a lot of neutralizing substances
to help neutralize the
acids of the stomach
before going into the duodenum,
which is the first part
of the small intestine.
07:35
And again, not something
that's really meant to handle
the very strong acids
that the body and fundus
of the stomach have.
07:42
If we were to look
inside the stomach,
we again see the esophagus,
which is fairly smooth walled
compared to the rest of the stomach.
07:53
It has a very brief portion
called the cardia.
07:56
And then most of the body
and fundus, for example,
is going to be thrown into
these folds called rugae.
08:05
Except around this very short area,
to the midline of the stomach,
that's something called
the lesser curvature,
as opposed to the outer curvature,
which is much longer that's
called the greater curvature.
08:21
And this lesser curvature has more
longitudinally oriented folds.
08:25
And as you can see,
it's actually the shortest
route between the esophagus
and the small intestine
to go along this area.
08:33
And sometimes it's called
Magenstrasse or stomach street,
because it's actually the
fastest route for food and fluids
to pass from a esophagus
to the small intestines.
08:46
And down in the pyloric area,
again, pylorus means gatekeeper.
08:50
And not only does it have
these neutralizing substances
that it's secreting into the lumen,
but it also has a very
thick prominent sphincter
called the pyloric sphincter.
09:02
And that's what's going
to protect the duodenum
from the acids coming
from the stomach.
09:10
And again, the duodenum
is going to be a very short
portion of the small intestine.
09:15
And then right after the duodenum,
we're actually going to
have the junction between
our upper and our lower GI tracts.