The Human Respiratory System

The Pathway
Air enters the nostrils
passes through the nasopharynx,
the oral pharynx
through the glottis
into the trachea
into the right and left bronchi, which
branches and rebranches into
bronchioles, each of which
terminates in a cluster of
alveoli
Only in the alveoli does actual gas exchange
takes place. There are some 300 million alveoli
in two adult lungs. These provide a surface area
of some 160 m
2
(almost equal to the singles area
of a tennis court and 80 times the area of our
skin!).
Breathing
In mammals, the diaphragm divides the body cavity into the
abdominal cavity, which contains the viscera (e.g., stomach and intestines) and the
thoracic cavity, which contains the heart and lungs.
The inner surface of the thoracic cavity and the outer surface of the lungs are lined with pleural membranes which adhere to each other. If air is introduced between
them, the adhesion is broken and the natural elasticity of the lung causes it to collapse. This can occur from trauma. And it is sometimes induced deliberately to allow
the lung to rest. In either case, reinflation occurs as the air is gradually absorbed by the tissues.
Because of this adhesion, any action that increases the volume of the thoracic cavity causes the lungs to expand, drawing air into them.
During inspiration (inhaling),
o The external intercostal muscles contract, lifting the ribs up and out.
o The diaphragm contracts, drawing it down .
During expiration (exhaling), these processes are reversed and the natural elasticity of the lungs returns them to their normal volume. At rest, we breath 15
18 times a minute exchanging about 500 ml of air.
In more vigorous expiration,
o The internal intercostal muscles draw the ribs down and inward
o The wall of the abdomen contracts pushing the stomach and liver upward.
Under these conditions, an average adult male can flush his lungs with about 4 liters of air at each breath. This is called the vital capacity. Even with
maximum expiration, about 1200 ml of residual air remain.
The table shows what happens to the composition of air when it reaches the alveoli. Some of the oxygen dissolves in the film of moisture covering the epithelium of the
alveoli. From here it diffuses into the blood in a nearby capillary. It enters a red blood cell and combines with the hemoglobin therein.
At the same time, some of the carbon dioxide in the blood diffuses into the alveoli from which it can be exhaled.
Link to discussion of gas transport in the blood.
Composition of atmospheric air and expired air in a typical subject.
Note that only a fraction of the oxygen inhaled is taken up by the lungs.
Component Atmospheric Air (%) Expired Air (%)
N2 (plus inert gases) 78.62 74.9
O2 20.85 15.3
CO2 0.03 3.6
H2O 0.5 6.2
100.0% 100.0%

The ease with which oxygen and carbon dioxide can pass between air and blood is clear from this electron micrograph of two alveoli (Air) and an adjacent capillary
from the lung of a laboratory mouse. Note the thinness of the epithelial cells (EP) that line the alveoli and capillary (except where the nucleus is located). At the closest
point, the surface of the red blood cell is only 0.7 m away from the air in the alveolus. (Reproduced with permission from Keith R. Porter and Mary A. Bonneville, An
Introduction to the Fine Structure of Cells and Tissues, 4th. ed., Lea & Febiger, 1973.)

Central Control of Breathing
The rate of cellular respiration (and hence oxygen consumption and carbon dioxide production) varies with level of activity. Vigorous exercise can increase by 2025
times the demand of the tissues for oxygen. This is met by increasing the rate and depth of breathing.
It is a rising concentration of carbon dioxide not a declining concentration of oxygen that plays the major role in regulating the ventilation of the lungs. Certain
cells in the medulla oblongata are very sensitive to a drop in pH. As the CO2 content of the blood rises above normal levels, the pH drops
[CO2 + H2O HCO3

+ H
+
],
and the medulla oblongata responds by increasing the number and rate of nerve impulses that control the action of the intercostal muscles and diaphragm. This produces
an increase in the rate of lung ventilation, which quickly brings the CO2 concentration of the alveolar air, and then of the blood, back to normal levels.
Link to a description of experiments that demonstrate this.
However, the carotid body in the carotid arteries does have receptors that respond to a drop in oxygen. Their activation is important in situations (e.g., at high altitude
in the unpressurized cabin of an aircraft) where oxygen supply is inadequate but there has been no increase in the production of CO2. People who live at high altitudes,
e.g., in the Andes, have enlarged carotid bodies.
Local Control of Breathing
The smooth muscle in the walls of the bronchioles is very sensitive to the concentration of carbon dioxide. A rising level of CO2 causes the bronchioles to dilate. This
lowers the resistance in the airways and thus increases the flow of air in and out.
Diseases of the Lungs
Pneumonia
Pneumonia is an infection of the alveoli. It can be caused by many kinds of both bacteria (e.g., Streptococcus pneumoniae) and viruses. Tissue fluids accumulate in the
alveoli reducing the surface area exposed to air. If enough alveoli are affected, the patient may need supplemental oxygen.
Asthma
In asthma, periodic constriction of the bronchi and bronchioles makes it more difficult to breathe in and, especially, out. Attacks of asthma can be
triggered by airborne irritants such as chemical fumes and cigarette smoke
airborne particles to which the patient is allergic.
Emphysema
In this disorder, the delicate walls of the alveoli break down, reducing the gas-exchange area of the lungs. The condition develops slowly and is seldom a direct cause of
death. However, the gradual loss of gas-exchange area forces the heart to pump ever-larger volumes of blood to the lungs in order to satisfy the body's needs. The added
strain can lead to heart failure.
The immediate cause of emphysema seems to be the release of proteolytic enzymes as part of the inflammatory process that follows irritation of the lungs. Most people
avoid this kind of damage during infections, etc. by producing an enzyme inhibitor (a serpin) called alpha-1 antitrypsin. Those rare people who inherit two defective
genes for alpha-1 antitrypsin are particularly susceptible to developing emphysema.
Chronic Bronchitis
Any irritant reaching the bronchi and bronchioles will stimulate an increased secretion of mucus. In chronic bronchitis the air passages become clogged with mucus, and
this leads to a persistent cough. Chronic bronchitis is usually associated with cigarette smoking.
Chronic Obstructive Pulmonary Disease (COPD)
Irritation of the lungs can lead to asthma, emphysema, and chronic bronchitis. And, in fact, many people develop two or three of these together. This constellation is
known as chronic obstructive pulmonary disease(COPD).
Among the causes of COPD are
cigarette smoke (often)
cystic fibrosis (rare)
Cystic fibrosis is a genetic disorder caused by inheriting two defective genes for the cystic fibrosis transmembrane conductance regulator (CFTR), a transmembrane
protein needed for the transport of Cl

and HCO3

ions through the plasma membrane of epithelial cells. Defective transport by the CFTR enhances the reabsorption of
Na
+
from the ECF; water follows by osmosis reducing the layer of liquid bathing the epithelia. In addition, diminished secretion of HCO3

lowers the pH of this liquid

making it more hospitable to colonization by inhaled bacteria. The resulting inflammation leads to the accumulation of mucus which plugs the airways and hampers the
ability of ciliated cells to move it up out of the lungs. All of this damages the airways interfering with breathing and causing a persistent cough. Cystic fibrosis is the
most common inherited disease in the U.S. white population.
lung Cancer
Lung cancer is the most common cancer and the most common cause of cancer deaths in U.S. males. Although more women develop breast cancer than lung cancer,
since 1987 U.S. women have been dying in larger numbers from lung cancer than from breast cancer.
Lung cancer, like all cancer, is an uncontrolled proliferation of cells. There are several forms of lung cancer, but the most common (and most rapidly increasing) types
are those involving the epithelial cells lining the bronchi and bronchioles.
Ordinarily, the lining of these airways consists of two layers of cells. Chronic exposure to irritants
causes the number of layers to increase. This is especially apt to happen at forks where the bronchioles branch.
The ciliated and mucus-secreting cells disappear and are replaced by a disorganized mass of cells with abnormal nuclei.
If the process continues, the growing mass penetrates the underlying basement membrane.
At this point, malignant cells can break away and be carried in lymph and blood to other parts of the body where they may lodge and continue to proliferate.
It is this metastasis of the primary tumor that eventually kills the patient.
The respiratory system (or ventilatory system) is a biological system consisting of specific organs and structures used for the process of respiration in
an organism. The respiratory system is involved in the intake and exchange of oxygen and carbon dioxidebetween an organism and the environment.
In air-breathing vertebrates like human beings, respiration takes place in the respiratory organs called lungs. The passage of air into the lungs to supply
the body with oxygen is known as inhalation, and the passage of air out of the lungs to expel carbon dioxide is known as exhalation; this process is
collectively called breathing or ventilation. In humans and other mammals, the anatomical features of the respiratory system
include trachea, bronchi, bronchioles, lungs, and diaphragm. Molecules of oxygen and carbon dioxide are passively exchanged, by diffusion, between
the gaseous external environment and the blood. This exchange process occurs in the alveoli air sacs in the lungs.
[1]

In fish and many invertebrates, respiration takes place through the gills. Other animals, such as insects, have respiratory systems with very simple
anatomical features, and in amphibians even the skin plays a vital role in gas exchange. Plants also have respiratory systems but the directionality of
gas exchange can be opposite to that in animals. The respiratory system in plants also includes anatomical features such as holes on the undersides
of leaves known as stomata.
[2]

Physiology in mammals
Ventilation
In respiratory physiology, ventilation (or ventilation rate) is the rate at which gas enters or leaves the lung. It is categorized under the following
definitions:
Measurement Equation Description
Minute ventilation tidal volume * respiratory rate[1][2] the total volume of gas entering the lungs per minute.
Alveolar ventilation
(tidal volume dead space) *
respiratory rate [1]
the volume of gas per unit time that reaches the alveoli, the respiratory portions of the lungs
where gas exchange occurs.
Dead space
ventilation
dead space * respiratory rate[3]
the volume of gas per unit time that does not reach these respiratory portions, but instead
remains in the airways (trachea, bronchi, etc.).
Control
Ventilation occurs under the control of the autonomic nervous system from parts of the brain stem, the medulla oblongata and the pons. This area of the
brain forms the respiration regulatory center, a series of interconnected brain cells within the lower and middle brain stem which coordinate respiratory
movements. The sections are thepneumotaxic center, the apneustic center, and the dorsal and ventral respiratory groups. This section is especially
sensitive during infancy, and the neurons can be destroyed if the infant is dropped and/or shaken violently. The result can be death due to "shaken baby
syndrome".
[10]

The breathing rate increases with the concentration of carbon dioxide in the blood, which is detected by peripheral chemoreceptors in
the aorta and carotid artery and central chemoreceptors in the medulla. Exercise also increases respiratory rate, due to the action of proprioceptors, the
increase in body temperature, the release of epinephrine, and motor impulses originating from the brain.
[11]
In addition, it can increase due to increased
inflation in the lungs, which is detected by stretch receptors.
Inhalation
Inhalation is initiated by the diaphragm and supported by the external intercostal muscles. Normal resting respirations are 10 to 18 breaths per minute,
with a time period of 2 seconds. During vigorous inhalation (at rates exceeding 35 breaths per minute), or in approaching respiratory failure, accessory
muscles of respiration are recruited for support. These consist of sternocleidomastoid, platysma, and the scalene muscles of the neck. Pectoral
muscles and latissimus dorsi are also accessory muscles.
Under normal conditions, the diaphragm is the primary driver of inhalation. When the diaphragm contracts, the ribcage expands and the contents of the
abdomen are moved downward. This results in a larger thoracic volume and negative pressure (with respect to atmospheric pressure) inside the thorax.
As the pressure in the chest falls, air moves into the conducting zone. Here, the air is filtered, warmed, and humidified as it flows to the lungs.
During forced inhalation, as when taking a deep breath, the external intercostal muscles and accessory muscles aid in further expanding the thoracic
cavity. During inhalation the diaphragm contracts.
Exhalation
Exhalation is generally a passive process; however, active or forced exhalation is achieved by the abdominal and the internal intercostal muscles. During
this process air is forced or exhaled out.
The lungs have a natural elasticity: as they recoil from the stretch of inhalation, air flows back out until the pressures in the chest and the atmosphere
reach equilibrium.
[12]

During forced exhalation, as when blowing out a candle, expiratory muscles including the abdominal muscles and internal intercostal muscles, generate
abdominal and thoracic pressure, which forces air out of the lungs.
Gas exchange
The major function of the respiratory system is gas exchange between the external environment and an organism's circulatory system. In humans and
other mammals, this exchange facilitates oxygenation of the blood with a concomitant removal of carbon dioxide and other gaseous metabolic
wastes from the circulation.
[13]
As gas exchange occurs, the acid-base balance of the body is maintained as part of homeostasis. If proper ventilation is
not maintained, two opposing conditions could occur: respiratory acidosis, a life-threatening condition, and respiratory alkalosis.
Upon inhalation, gas exchange occurs at the alveoli, the tiny sacs which are the basic functional component of the lungs. The alveolar walls are
extremely thin (approx. 0.2 micrometres). These walls are composed of a single layer of epithelial cells (type I and type II epithelial cells) close to
the pulmonary capillaries which are composed of a single layer of endothelial cells. The close proximity of these two cell types allows permeability to
gases and, hence, gas exchange. This whole mechanism of gas exchange is carried by the simple phenomenon of pressure difference. When the air
pressure is high inside the lungs, the air from lungs flow out. When the air pressure is low inside, then air flows into the lungs.
Immune functions
Airway epithelial cells can secrete a variety of molecules that aid in the defense of lungs. Secretory immunoglobulins (IgA), collectins (including
Surfactant A and D), defensins and other peptides and proteases, reactive oxygen species, and reactive nitrogen species are all generated by airway
epithelial cells. These secretions can act directly as antimicrobials to help keep the airway free of infection. Airway epithelial cells also secrete a variety
of chemokines and cytokines that recruit the traditional immune cells and others to site of infections.
Most of the respiratory system is lined with mucous membranes that contain mucosal-associated lymphoid tissue, which produces white blood cells such
as lymphocytes.
Metabolic and endocrine functions of the lungs
In addition to their functions in gas exchange, the lungs have a number of metabolic functions. They manufacture surfactant for local use, as noted
above. They also contain a fibrinolytic system that lyses clots in the pulmonary vessels. They release a variety of substances that enter the systemic
arterial blood and they remove other substances from the systemic venous blood that reach them via the pulmonary artery. Prostaglandins are removed
from the circulation, but they are also synthesized in the lungs and released into the blood when lung tissue is stretched. The lungs also activate one
hormone; the physiologically inactive decapeptide angiotensin I is converted to the pressor, aldosterone-stimulating octapeptide angiotensin II in the
pulmonary circulation. The reaction occurs in other tissues as well, but it is particularly prominent in the lungs. Large amounts of the angiotensin-
converting enzyme responsible for this activation are located on the surface of the endothelial cells of the pulmonary capillaries. The converting enzyme
also inactivates bradykinin. Circulation time through the pulmonary capillaries is less than one second, yet 70% of the angiotensin I reaching the lungs is
converted to angiotensin II in a single trip through the capillaries. Four other peptidases have been identified on the surface of the pulmonary endothelial
cells.
Vocalization
The movement of gas through the larynx, pharynx and mouth allows humans to speak, or phonate. Vocalization, or singing, in birds occurs via
the syrinx, an organ located at the base of the trachea. The vibration of air flowing across the larynx (vocal cords), in humans, and the syrinx, in birds,
results in sound. Because of this, gas movement is extremely vital for communication purposes.
Temperature control
Panting in dogs, cats and some other animals provides a means of controlling body temperature. This physiological response is used as a cooling
mechanism.
Coughing and sneezing
Irritation of nerves within the nasal passages or airways, can induce a cough reflex and sneezing. These responses cause air to be expelled forcefully
from the trachea or nose, respectively. In this manner, irritants caught in the mucus which lines the respiratory tract are expelled or moved to
the mouth where they can be swallowed. During coughing, contraction of the smooth muscle narrows the trachea by pulling the ends of the cartilage
plates together and by pushing soft tissue out into the lumen. This increases the expired airflow rate to dislodge and remove any irritant particle or
mucus.
Development
Humans and mammals
The respiratory system lies dormant in the human fetus during pregnancy. At birth, the respiratory system becomes fully functional upon exposure to air,
although some lung development and growth continues throughout childhood.
[14]
Pre-term birth can lead to infants with under-developed lungs. These
lungs show incomplete development of thealveolar type II cells, cells that produce surfactant. The lungs of pre-term infants may not function well
because the lack of surfactant leads to increased surface tension within the alveoli. Thus, many alveoli collapse such that no gas exchange can occur
within some or most regions of an infant's lungs, a condition termed respiratory distress syndrome. Basic scientific experiments, carried out using cells
from chicken lungs, support the potential for using steroids as a means of furthering development of type II alveolar cells.
[15]
In fact, once a pre-mature
birth is threatened, every effort is made to delay the birth, and a series of steroid shots is frequently administered to the mother during this delay in an
effort to promote lung growth.
[16]

Disease
Disorders of the respiratory system can be classified into four general areas:
Obstructive conditions (e.g., emphysema, bronchitis, asthma)
Restrictive conditions (e.g., fibrosis, sarcoidosis, alveolar damage, pleural effusion)
Vascular diseases (e.g., pulmonary edema, pulmonary embolism, pulmonary hypertension)
Infectious, environmental and other "diseases" (e.g., pneumonia, tuberculosis, asbestosis, particulate pollutants):
Coughing is of major importance, as it is the body's main method to remove dust, mucus, saliva, and other debris from the lungs. Inability to cough can
lead to infection. Deep breathing exercises may help keep finer structures of the lungs clear from particulate matter, etc.
The respiratory tract is constantly exposed to microbes due to the extensive surface area, which is why the respiratory system includes many
mechanisms to defend itself and prevent pathogens from entering the body.
Disorders of the respiratory system are usually treated internally by a pulmonologist and Respiratory Therapist.
Plants
Plants use carbon dioxide gas in the process of photosynthesis, and exhale oxygen gas as waste. The chemical equation of photosynthesis is 6
CO2 (carbon dioxide) and 6 H2O (water) and that makes 6 O2 (oxygen) and C6H12O6 (glucose). What is not expressed in the chemical equation is the
capture of energy from sunlight which occurs. Photosynthesis uses electrons on the carbon atoms as the repository for that energy. Respiration is the
opposite of photosynthesis. It reclaims the energy to power chemical reactions in cells. In so doing the carbon atoms and their electrons are combined
with oxygen forming a gas which is easily removed from both the cells and the organism. Plants use both processes, photosynthesis to capture the
energy and respiration to use it.
Plant respiration is limited by the process of diffusion. Plants take in carbon dioxide through holes on the undersides of their leaves known as stoma or
pores. However, most plants require little air.
[citation needed]
Most plants have relatively few living cells outside of their surface because air (which is required
for metabolic content) can penetrate only skin deep. However, most plants are not involved in highly aerobic activities, and thus have no need of these
living cells.
Human digestive system
In the human digestive system, the process of digestion has many stages, the first of which starts in the mouth (oral cavity). Digestion involves the
breakdown of food into smaller and smaller components which can be absorbed and assimilated into the body. The secretion of saliva helps to produce
a bolus which can be swallowed in the oesophagus to pass down into the stomach. Saliva also contains a catalytic enzyme called amylase which starts
to act on food in the mouth. Digestion is helped by the mastication of food by the teeth and also by the muscular contractions of peristalsis. Gastric
juice in the stomach is essential for the continuation of digestion as is the production of mucus in the stomach. Peristalsis is the rhythmic contraction
of muscles that starts along the wall of the stomach. This initially results in the production of chyme which when fully broken down in the small
intestine is absorbed into theblood. Most of the digestion of food takes place in the small intestine. Water and some minerals are reabsorbed back into
the blood, in the colon of the large intestine. The waste products of digestion are defecated from the anus via the rectum.
Digestive system
There are several organs and other components involved in the digestion of food and the largest structure of the digestive system is the gastrointestinal
tract (GI). This starts at the mouth and ends at the anus, covering a distance of about nine metres.
[1]
The largest component of the GI tract is the colon.
Other components include the mouth, teeth and epiglottis, and the accessory digestive glands, the (liver, gall bladder and pancreas),
Mouth[edit]
The oral cavity that is the mouth, is the first part of the alimentary canal and is equipped with several structures that begin the first processes of
digestion. These include salivary glands, teeth and the tongue. Most of the oral cavity is lined with oral mucosa a mucous membrane that produces a
lubricating mucus, of which only a small amount is needed. Mucous membranes vary in structure in the different regions of the body but they all produce
a lubricating mucus, which is either secreted by surface cells or more usually by underlying glands. The mucous membrane in the mouth continues as
the thin mucosa which lines the bases of the teeth. The main component of mucus is a glycoprotein called mucin and the type secreted varies according
to the region involved. Mucin is viscous, clear, and clinging. Underlying the mucous membrane in the mouth is a thin layer of smooth muscle tissue and
the loose connection to the membrane gives it its great elasticity.
[2]
It covers the cheeks, inner surfaces of the lips, and floor of the mouth.
[3]
The roof of
the mouth is termed the palate and it separates the oral cavity from the nasal cavity. The palate is hard at the front of the mouth since the overlying
mucosa is covering a plate of bone; it is softer and more pliable at the back being made of muscle and connective tissue, and it can move to swallow
food and liquids. The soft palate ends at the uvula. The surface of the hard palate allows for the pressure needed in eating food, to leave the nasal
passage clear.
[4]
The lips are the mouth's front boundary and the fauces (the passageway between the tonsils, also called the throat), mark its posterior
boundary. At either side of the soft palate are the palatoglossus muscles which also reach into regions of the tongue. These muscles raise the back of
the tongue and also close both sides of the fauces to enable food to be swallowed. Mucus helps in the mastication of food in its ability to soften and
collect the food in the formation of the bolus.
Salivary glands[edit] Oral cavity
There are three pairs of main salivary glands and between 800 and 1,000 minor salivary glands, all of which mainly serve the digestive process, and
also play an important role in the maintenance of dental health and general mouth lubrication, without which speech would be impossible. The main
glands are all exocrine glands, secreting via ducts. All of these glands terminate in the mouth. The largest of these are the parotid glands their
secretion is mainly serous. The next pair are underneath the jaw, the submandibular glands, these produce bothserous fluid and mucus.They produce
about 70% of the oral cavity saliva. The third pair are the sublingual glands located underneath the tongue their secretion is mainly mucous with a small
percentage of saliva. Within the submucosa of the mucous membranes lining the mouth and also on the tongue and palates and mouth floor, are the
minor salivary glands; their secretions are mainly mucous and are innervated by the facial nerve, the seventh cranial nerve. The glands also
secrete amylase a first stage in the breakdown of food acting on the carbohydrate in the food to transform the starch content into maltose. There are
other glands on the surface of the tongue that encircle taste buds on the back part of the tongue and these produce a serous fluid which
contains lipase (lingual lipase). Lipase is a digestive enzyme that catalyses the hydrolysis of lipids (fats). These glands are termed Von Ebner's
glands which have also been shown to have another function in the secretion of histatins which offer an early defense (outside of the immune system)
against microbes in food, when it makes contact with these glands on the tongue tissue.
[5]
Sensory information can stimulate the secretion of saliva
providing the necessary fluid for the tongue to work with and also to ease swallowing of the food.
Saliva[edit]
Main article: Saliva
Saliva functions initially in the digestive system to moisten and soften food into the formation of a bolus. The bolus is further helped by the lubrication
provided by the saliva in its passage from the mouth into the oesophagus. Also of importance is the presence in saliva of the digestive
enzymes amylase and lipase. Amylase starts to work on the starch incarbohydrates, breaking it down into the
simple sugars of maltose and dextrose that can be further broken down in the small intestine. Saliva in the mouth can account for 30% of this initial
starch digestion. Another digestive enzyme present in the saliva is lipase which starts to work on breaking down fats. Lipase is further produced in
the pancreas where it is released to continue this digestion of fats. The presence of salivary lipase is of prime importance in young babies whose
pancreatic lipase has yet to be developed.
[6]

As well as its role in supplying digestive enzymes, saliva has a cleansing action for the teeth and mouth, and has an immunological role in supplying
antibodies to the system, such as immunoglobulin A. This is seen to be key in preventing infections of the salivary glands, importantly that of parotitis.


Tongue[edit]
Food enters the mouth where the first stage in the digestive process takes place, with the action of the tongue and the secretion of saliva. The tongue is
a fleshy and muscular sensory organ, and the very first sensory information is received via the taste buds on its surface. If the taste is agreeable the
tongue will go into action, manipulating the food in the mouth which stimulates the secretion of saliva from the salivary glands. The liquid quality of the
saliva will help in the softening of the food and its enzyme content will start to break down the food whilst it is still in the mouth. The first part of the food
to be broken down is the starch of carbohydrates. The tongue is attached to the floor of the mouth by a ligamentous band called the frenum
[7]
and this
gives it great mobility for the manipulation of food (and speech); the range of manipulation is optimally controlled by the action of several muscles and
limited in its external range by the stretch of the frenum. The tongue's two sets of muscles, are four intrinsic muscles that originate in the tongue and are
involved with its shaping, and four extrinsic muscles originating in bone that are involved with its movement.
Taste[edit]
Main article: Gustatory system
Taste is a form of chemoreception that takes place in the specialised receptors of taste cells, contained in structures called taste buds in the mouth.
Taste buds are mainly on the upper surface (dorsum) of the tongue. Taste perception is vital to help prevent harmful or rotten foods from being
consumed. This is a function of the gustatory system where the taste buds are at the forefront. There are taste buds elsewhere in the mouth not just on
the surface of the tongue. The taste buds are innervated by a branch of the facial nerve the chorda tympani, and the glossopharyngeal nerve. Taste
messages are sent via these cranial nerves to the brain. The brain can distinguish between the chemical qualities of the food. The five basic tastes are
referred to as those of saltiness, sourness, bitterness and sweetness, and the most recent addition of a certain savouriness termed umami. The
detection of saltiness and sourness enables the control of salt and acid balance. The detection of bitterness warns of poisons many of a plant's
defences are of poisonous compounds that are bitter. Sweetness guides to those foods that will supply energy; the initial breakdown of the energy-giving
carbohydrates by salivary amylase creates the taste of sweetness since simple sugars are the first result. The taste of umami is thought to signal
protein-rich food. Sour tastes are acidic which is often found in bad food. The brain has to decide very quickly whether to eat the food or not. It was the
findings in 1991, describing the first olfactoryreceptors that helped to prompt the research into taste. The olfactory receptors are located on cell surfaces
in the nose which bind to chemicals enabling the detection of smells. It is assumed that signals from taste receptors work together with the signals from
those in the nose, to form an idea of complex food flavours.
[8]

Teeth[edit]
Main article: Human teeth
Teeth are complex structures made of materials specific to them. They are made of a bonelike material dentin, which is covered by the hardest tissue
in the bodyenamel.
[9]
Teeth have different shapes to deal with different aspects of mastication employed in tearing and chewing pieces of food into
smaller and smaller pieces. Incisors are used for cutting or biting off pieces of food; canines, are used for tearing, premolars and molars for chewing and
grinding. Mastication of the food with the help of saliva and mucus results in the formation of a soft bolus which can then be swallowed to make its way
down the upper gastrointestinal tract to the stomach. Dental health is maintained by the salivary secretion of gingival crevical fluid.
[10]
The digestive
enzymes in saliva also help in keeping the teeth clean by breaking down any lodged food particles.
Epiglottis[edit]
Main article: Epiglottis
The epiglottis is a flap that is made of elastic cartilage and attached to the entrance of the larynx. It is covered with a mucous membrane and there are
taste buds on its lingual surface which faces into the mouth.
[11]
Its laryngeal surface faces into the larynx. The epiglottis functions to guard the entrance
of the glottis, the opening between the vocal folds. It is normally pointed upward during breathing with its underside functioning as part of the pharynx,
but during swallowing, the epiglottis folds down to a more horizontal position, with its upper side functioning as part of the pharynx. In this manner it
prevents food from going into the trachea and instead directs it to the esophagus, which is posterior. During swallowing, the backward motion of the
tongue forces the epiglottis over the glottis' opening to prevent any food that is being swallowed from entering the larynx which leads to the lungs; the
larynx is also pulled upwards to assist this process. Stimulation of the larynx by ingested matter produces a strong cough reflex in order to protect the
lungs.
Pharynx[edit]
Main article: Pharynx
The pharynx is a part of the digestive system and also a part of the conducting zone of the respiratory system. It is the part of the throat immediately
behind the nasal cavity at the back of the mouth and superior to the esophagus and larynx.The pharynx is made up of three parts. The lower two parts
the oropharynx and the laryngopharynx are involved in the digestive system. The laryngopharynx connects to the oesophagus and it serves as a
passageway for both air and food. Air enters the larynx anteriorly but anything swallowed has priority and the passage of air is temporarily blocked. The
pharynx is innervated by the pharyngeal plexus of vagus nerve. Muscles in the pharynx push the food into the oesophagus.The pharynx joins the
oesophagus at the oesophageal inlet which is located behind the cricoid cartilage.
Oesophagus[edit]
Main article: Oesophagus
The oesophagus commonly known as the gullet, is an organ which consists of a muscular tube through which food passes from the pharynx to the
stomach. The oesophagus is continuous with the laryngeal part of the pharynx. It passes through the posterior mediastinum in the thorax and enters
the stomach through a hole in the diaphragm at the level of the tenth thoracic vertebra (T10). Its length averages 25 cm, varying with height . It is divided
into cervical, thoracic and abdominal parts. The pharynx joins the oesophagus at the oesophageal inlet which is behind the cricoid cartilage. At rest the
oesophagus is closed at both ends, by the upper and lower oesophageal sphincters. The opening of the upper sphincter is triggered by the swallowing
reflex so that food is allowed through. The sphincter also serves to prevent back flow from the oesophagus into the pharynx. The oesophagus has a
mucous membrane and the epithelium which has a protective function is continuously replaced due to the volume of food that passes inside the
oesophagus. During swallowing, food passes from the mouth through the pharynx into the oesophagus. The epiglottis folds down to a more horizontal
position so as to prevent food from going into the trachea, instead directing it to the oesophagus. Once in the oesophagus, the bolus travels down to the
stomach via rhythmic contraction and relaxation of muscles known as peristalsis .The lower oesophageal sphincter is a muscular sphincter surrounding
the lower part of the oesophagus. The junction between the oesophagus and the stomach (the gastroesophageal junction) is controlled by the lower
oesophageal sphincter, which remains constricted at all times other than during swallowing and vomiting to prevent the contents of the stomach from
entering the oesophagus. As the oesophagus does not have the same protection from acid as the stomach, any failure of this sphincter can lead to
heartburn. The oesophagus has a mucous membrane of epithelium which has a protective function as well as providing a smooth surface for the
passage of food. Due to the high volume of food that is passed over time, this membrane is continuously renewed.
Diaphragm[edit]


The diaphragm is an important part of the body's digestive system. The diaphragm separates the thoracic cavity from the abdominal cavity where most
of the digestive organs are located. The suspensory muscle attaches the ascending duodenum to the diaphragm. This muscle is thought to be of help in
the digestive system in that its attachment offers a wider angle to the duodenojejunal flexure for the easier passage of digesting material. The diaphragm
also attaches to the bare area of the liver, which it anchors. The oesophagus enters the abdomen through a hole in the diaphragm at the level of T10.
Stomach[edit]
Main article: Stomach


Areas of the stomach
Gastric acid (informally gastric juice), produced in the stomach plays a vital role in the digestive process. Gastric juice mainly contains hydrochloric
acid and sodium chloride. The gastric acid activates the digestive enzymes. Pepsinogen is a zymogen produced by the gastric chief cells and gastric
acid activates this to the enzyme pepsin which begins the digestion of proteins. As these two chemicals would damage the stomach wall, mucus is
secreted by the stomach, to provide a slimy protective layer against the damaging effects of the chemicals. At the same time that protein is being
digested, mechanical churning occurs through the action of peristalsis, waves of muscular contractions that move along the stomach wall. This allows
the mass of food to further mix with thedigestive enzymes. Gastric lipase secreted by the chief cells in the fundic mucosa of the stomach, is an acidic
lipase, in contrast with the alkaline pancreatic lipase. This breaks down fats to some degree though is not as efficient as the pancreatic lipase.
The pylorus, the lowest section of the stomach which attaches to the duodenum via the pyloric canal, contains countless glands which secrete digestive
enzymes including gastrin. After an hour or two, a thick semi-liquid called chyme is produced. When the pyloric sphincter, or valve opens, chyme enters
the duodenum where it mixes further with digestive enzymes from the pancreas, and then passes through the small intestine, where digestion continues.
When the chyme is fully digested, it is absorbed into the blood. 95% of absorption of nutrients occurs in the small intestine. Water and minerals are
reabsorbed back into the blood in the colon of the large intestine, where the environment is slightly acidic. Some vitamins, such as biotin and vitamin
K produced by bacteria in the colon are also absorbed.
The stomach is a distensible organ and can normally expand to hold about one litre of food.
[12]
The stomach of a newborn baby will only be able to
expand to retain about 30 ml.
Spleen[edit]
Main article: Spleen
The spleen breaks down both red and white blood cells that are spent, and blood platelets that is why it is known as the 'graveyard of red blood cells' . A
product of this digestionis the pigment bilirubin which is sent to the liver and secreted in the bile. Another product is iron which is used in the formation of
new blood cells in the bone marrow.
[2]
Western medicine treats the spleen solely as belonging to the lymphatic system, though it is acknowledged that
the full range of its important functions is not yet understood.
[13]
In contrast to this view, traditional Chinese medicine sees the spleen to be of central
importance in the digestive system. The role of the spleen is seen to affect the health and vitality of the body in its turning of digested material from the
stomach into usable nutrients and energy. Symptoms that include poor appetite, indigestion, bloating and jaundice, are seen to be indications of an
imbalance in the spleen. The spleen is further seen to play a part in the metabolism of water, in ridding the body of excess fluid.
[14]
In the west, the
spleen is seen to be paired with the stomach but in Chinese medicine, reference is made to the spleen system, which involves the pancreas. Fluids in
the body are seen in traditional Chinese medicine to be under the control of the spleen. Fluids include digestive enzymes, saliva, mucus, fluid in the
joints, tears, sweat and urine. They are categorised as thin and thick and together they are seen as nourishing all tissues and organs.
In acupuncture two widely used acupuncture points - the stomach, (close to the knee) and the spleen, (halfway down from the knee) have long been
seen to be connected and involved in digestive issues.
Liver[edit]
Main article: Human liver
The liver is the largest organ (after the skin) and is an accessory digestive gland which plays a role in the body's metabolism. The liver has many
functions some of which are important to digestion. The liver can detoxify various metabolites; synthesise proteins and producebiochemicals needed for
digestion. It regulates the storage of glycogenwhich it can form from glucose (glycogenesis). The liver can also synthesise glucose from certain amino
acids. Its digestive functions are largely involved with the breaking down of carbohydrates. It also maintains protein metabolism in its synthesis and
degradation. In lipidmetabolism it synthesises cholesterol. Fats are also produced in the process of lipogenesis. The liver synthesises the bulk of
lipoproteins.The liver is located in the upper right quadrant of the abdomen and below the diaphragm to which it is attached at one part, This is to the
right of the stomach and it overlies thegall bladder. The liver produces bile, an important alkaline compound which aids digestion.
Bile[edit]
Bile produced by the liver is made up of water (85%), bile salts, mucus and pigments, 1% fats and inorganic salts. Bilirubin is its major pigment. Bile acts
partly as a surfactantwhich lowers the surface tension between either two liquids or a solid and a liquid and helps to emulsify the fats in the chyme. Food
fat is dispersed by the action of bile into smaller units called micelles. The breaking down into micelles creates a much larger surface area for the
pancreatic enzyme, lipase to work on. Lipase digests the tryglycerideswhich are broken down into two fatty acids and a monoglyceride. These are then
absorbed by villi on the intestinal wall. If fats are not absorbed in this way in the small intestine problems can arise later in the large intestine which is not
equipped to absorb fats. Bile also helps in the absorption of vitamin K from the diet. Bile is collected and delivered through the common hepatic duct.
This duct joins with the cystic duct to connect in a common bile duct with the gallbladder. Bile is stored in the gallbladder for release when food is
discharged into the duodenum and also after a few hours.
[15]

Gallbladder[edit]
The gallbladder is a hollow part of the biliary system that sits just beneath the liver. It is a small organ where the bile produced by the liver is stored,
before it is released into the small intestine. The bile flows from the liver through the bile ducts and into the gall bladder for storage. The bile is released
in response to cholecystokinin (CKK) a hormone released from the small intestine.It is divided into three sections: fundus, body and neck. The neck
tapers and connects to the biliary tree via the cystic duct, which then joins thecommon hepatic duct to become the common bile duct. At the neck of the
gallbladder is a mucosal fold called Hartmann's pouch, where gallstones commonly get stuck. The angle of the gallbladder is located between the costal
margin and the lateral margin of the rectus abdominis muscle. The fundus is at the same level as the transpyloric plane; the body is attached to the
liver.The muscularis, is a layer of smooth muscular tissue that helps the gallbladder contract, so that it discharges its bile into the bile duct. The
gallbladder needs to store bile in a natural, semi-liquid form at all times. Hydrogen ions secreted from the inner lining of the gallbladder keep the bile
acidic enough to prevent hardening. To dilute the bile, water and electrolytes from the digestion system are added. Also, salts attach themselves to
cholesterol molecules in the bile to keep them from crystallising. If there is too much cholesterol or bilirubin in the bile, or the gallbladder doesn't empty
properly the systems can fail. This is how gallstones form when a small piece of calcium gets coated with either cholesterol or bilirubin and the bile
crystallises and forms a gallstone. The main purpose of the gallbladder is to store and release bile, or gall. The liver produces the bile and then it flows
through the bile ducts into the gallbladder. When the bile is released, it is released into the small intestine and its purpose is to break down large fat
molecules into smaller ones. After the fat is absorbed, the bile is also absorbed and transported back to the liver for reuse.
Pancreas[edit]
Main article: Pancreas Action of digestive hormones
Pancreas, duodenum and bile duct
The pancreas is a major organ functioning as an accessory digestive gland in the digestive system. It is both an endocrine gland and an exocrine gland.
The endocrine part secretes insulin when theblood sugar becomes high; insulin moves glucose from the blood into the muscles and other tissues for use
as energy. The exocrine part releases glucagon when the blood sugar is low; glucagon allows stored sugar to be broken down into glucose by the liver
in order to rebalance the sugar levels. Digestive enzymes are also produced. The pancreas lies below and at the back of the stomach. It connects to
the duodenum via the pancreatic duct where it can act on the chymethat is released from the stomach into the duodenum. There is a nearby connection
of the common bile duct to the duodenum. Aqueous pancreatic secretions from duct cells contain bicarbonate ions which are alkaline and help to
neutralise the acidic chyme that is churned out by the stomach. The pancreas is also the main source of enzymes for the digestion of fats (lipids) and
proteins. (The enzymes that digest polysaccharides, by contrast, are primarily produced by the walls of the intestines.) The cells are filled with secretory
granules containing the precursor digestive enzymes. The major proteases, the pancreatic enzymes which work on proteins,
are trypsinogen and chymotrypsinogen. Elastase is also produced. Smaller amounts of lipase and amylase are secreted. The pancreas also
secretes phospholipase A2,lysophospholipase, and cholesterol esterase. The precursor proenzymes ( also called zymogens), are inactive variants of the
enzymes; which avoids the onset of pancreatitiscaused by autodegradation. Once released in the intestine, the enzyme enteropeptidase present in the
intestinal mucosa activates trypsinogen by cleaving it to form trypsin; further cleavage results in chymotripsin.
Lower gastrointestinal tract[edit]
Main article: Human gastrointestinal tract
Lower GI tract 3) Small intestine; 5) Caecum; 6) Large intestine
Small intestine[edit]

Duodenum
Food eaten, starts to arrive in the small intestine after one hour, and after two hours the stomach has emptied. Until this time the food is termed a bolus.
It then becomes the partially digested semi-liquid termed chyme. In the small intestine, the pH becomes crucial; it needs to be finely balanced in order to
activate digestive enzymes. The chyme is very acidic, with a low pH, having been released from the stomach and needs to be made much more
alkaline. This is achieved in the duodenum by the addition of bile from the gall bladder combined with the bicarbonate secretions from the pancreatic
duct and also from secretions of mucus-rich bicarbonate from duodenal glands known as Brunner's glands. The chyme arrives in the intestines having
been released from the stomach through the opening of the pylorus sphincter. The resulting alkaline fluid mix, neutralises the gastric acid which would
damage the lining of the intestine. The mucus component lubricates the walls of the intestine. When the digested food particles are reduced enough in
size and composition, they can be absorbed by the intestinal wall and carried to the bloodstream. The first receptacle for this chyme is the duodenal
bulb. From here it passes into the first of the three sections of the small intestine, the duodenum. (The next section is the jejunum and the third is
the ileum). The duodenum is the first and shortest section of the small intestine. It is a hollow, jointed C-shaped tube connecting the stomach to the
jejunum. It starts at the duodenal bulb and ends at thesuspensory muscle of duodenum. The attachment of the suspensory muscle to the diaphragm is
thought to help the passage of food by making a wider angle at its attachment.
Most food digestion takes place in the small intestine. In the duodenum, pancreatic lipase is secreted together with a co-enzyme, colipase to further
digest the fat content of the chyme. From this breakdown, smaller particles of emulsified fats called chylomicrons are produced. There are also digestive
cells called enterocytes lining the intestines (the majority being in the small intestine). They are unusual cells in that they have villi on their surface which
in turn have innumerable microvilli on their surface. All these villi make for a greater surface area, not only for the absorption of chyme but also for its
further digestion by large numbers of digestive enzymes present on the microvilli.
The cholymicrons are small enough to pass through the enterocyte villi and into their lymph capillaries called lacteals. A milky fluid
called chyle consisting mainly of the emulsified fats of the cholymicrons results from the absorbed mix with the lymph in the lacteals. Chyle is then
transported through the lymphatic system to the rest of the body.
The suspensory muscle marks the end of the duodenum and the division between the upper gastrointestinal tract and the lower GI tract. The digestive
tract continues as the jejunum which continues as the ileum. The jejunum, the midsection of the small intestine contains circular folds, flaps of doubled
mucosal membrane which partially encircle and sometimes completely encircle the lumen of the intestine. These folds together with villi serve to
increase the surface area of the jejunum enabling an increased absorption of digested sugars, amino acids and fatty acids into the bloodstream. The
circular folds also slow the passage of food giving more time for nutrients to be absorbed.
The last part of the small intestine is the ileum. This also contains villi and vitamin B12; bile acids and any residue nutrients are absorbed here. When the
chyme is exhausted of its nutrients the remaining waste material changes into the semi solids called faeces, which pass to the large intestine, where
bacteria in the gut flora further break down residual proteins and starches.
Caecum
Caecum and beginning of ascending colon
The caecum is a pouch marking the division between the small intestine and the large intestine.
[16]
The caecum receives chyme from the last part of the
small intestine, the ileum, and connects to the ascending colon of the large intestine. At this junction there is a sphincter or valve, the ileocecal
valve which slows the passage of chyme from the ileum. It is also the site of the appendix attachment.
Large intestine[edit]
In the large intestine, the passage of the digesting food in the colon is a lot slower, taking anything from 12 to 50 hours until it is removed by defecation.
The colon mainly serves as a site for the fermentation of digestible matter by the gut flora.The time taken varies considerably between individuals. The
remaining semi-solid waste is termed faeces and is removed by the coordinated contractions of the intestinal walls, termed peristalsis which propels
the excreta forward to reach the rectum and exit via defecation from the anus. The wall has an outer layer of longitudinal muscles, the taeniae coli, and
an inner layer of circular muscles. The circular muscle keeps the material moving forward and also prevents any back flow of waste. Also of help in the
action of peristalsis is the basal electrical rhythmthat determines the frequency of contractions.
[17]
The taeniae coli can be seen and are responsible for
the bulges (haustra) present in the colon. Most parts of the GI tract are covered with serous membranes and have a mesentery. Other more muscular
parts are lined with adventitia.
Dietary life rules
The enteric nervous system consisting of some one hundred million neurons
[18]
is embedded in the peritoneum, the lining of thegastrointestinal
tract extending from the oesophagus to the anus.
[19]
The neurons are collected into plexuses.
Parasympathetic innervation to the ascending colon is supplied by the vagus nerve. Sympathetic innervation is supplied by thesplanchnic nerves which
join the celiac ganglia. Most of the digestive tract is innervated by the two large celiac ganglia, with the upper part of each ganglion joined by the greater
splanchnic nerve and the lower parts joined by the lesser splanchnic nerve. It is from these ganglia that many of the gastric plexuses arise.