yoga book / exercise physiology / digestion
Contents
Mund
Task: Sense of taste, crushing and testing food, pre-digestion
Teeth
(tooth: odon, dens) from the centre outwards:
Incisivi 1st-2nd tooth: incisors, 1 root
canine 3. Tooth: canine or eye tooth, 1 root
preemolar each 4th-5th tooth: jaw teeth, 2 roots
molar each 6. -8th tooth: molar teeth, 3 roots each
Task: grasping, crushing, grinding food; sound formation (especially involved in the sound S)
A distinction is made between the milk teeth (dentes decidui) and the remaining (dentes permanentes): The deciduous teeth take until the 2nd-4th year of life to fully develop. A child’s dentition has 20 milk teeth; their roots recede when the teeth fall out, children are missing the 6th, 7th, 8th (wisdom tooth). Rule: Those who get their first teeth late also get their second teeth late.
NHK: The wisdom tooth is more important in the energy system, do not pull all 4 at once. The change of teeth takes place between the ages of 5 and 8. The adult dentition has 32 teeth
The upper and lower jaw are each divided into 2 quadrants:
1st quadrant: upper jaw right
2nd quadrant: upper jaw left
3rd quadrant: lower jaw left
4th quadrant: lower jaw right
NHK: There is a close correlation between teeth and body organs: an organ may be damaged, but the cause lies in the tooth. On the one hand, impacted teeth can negatively influence the body’s energy flow if they are connected to a meridian. On the other hand, chronic inflammation or permanent toxic stress can overstimulate the immune system, leading to its exhaustion (immunodeficiency) or overreaction (allergy).
Salivary glands
The salivary glands are exocrine glands that produce Saliva saliva, which contains:
– lysozyme defence enzyme in the mouth
– ptyalin (form of alpha-amylase)
Per day, humans produce 0.5-2 litres of saliva (released from large and small glands together). Salivation is regulated via the nervous system (sympathetic nervous system inhibits/ parasympathetic nervous system promotes saliva production). Saliva secretion is triggered by
– conditioned reflex
– psychological factors (e.g. positive expectation)
– unconditioned reflex: mechanical stimulation of the oral mucosa,
– through excitation of the taste and odour sensations
Tasks:
1. Cleaning of the oral cavity (some saliva components have an antibacterial effect)
2. Defence mechanism; through the lysozyme; here we have many lysosomes in the cells; most pathogens are therefore intercepted directly in the mouth
3. Splitting of carbohydrates by ptyalin (a form of alpha-amylase)
4. Moistening the food to make it more fluid
5. Brings flavourings into aqueous solution, because this is the only way the taste receptors can register them
Salivary glands:
– Glandulae salivariae minores: viele winzige Speicheldrüsen der Mundschleimhaut: Lippen-, Wangen-, Gaumen, Zungen- und Schlunddrüsen
– Glandulae salivariae majores: 3 große paarig angelegte Speicheldrüsen, jeweils auf beiden Körperseiten vorhanden und liegen außerhalb des Mundraums, geben Ihre Sekrete über Ausführungsgänge in die Mundhöhle ab:
1. Parotid gland oder parotis, Parotid gland, sitzt seitlich unter der Haut auf dem Kaumuskel und erstreckt sich über den Ober- und Unterkiefer; der Ausführungsgang liegt am Oberkiefer bei den Praemolaren, gibt Ptyalin ab, wodurch Kohlenhydrate verdaut werden, rein seröse Drüse, entlehrt ihr Sekret durch Kaubewegungen, größte Speicheldrüse, pathologisch können sich im Gang Steine bilden. Inflammation der Ohrspeicheldrüse bei Mumps (Parotitis epidemica)
2. Glandula submandibularis Unterkieferspeicheldrüse, liegt unterhalb des Mundbodens an der Innenseite des Unterkiefers; der Ausführungsgang mündet auf der Erhebung rechts/links des Frenulums (Zungenbändchen: dieses befestigt die Unterseite der Zunge am Boden der Mundhöhle); seromuköse Drüse, überwiegend serös3. Sublingual gland Unterzungendrüse , liegt auf der Mundbodenmuskulatur, ihr Sekret wird aus vielen Ausführungsgängen in die Mundhöhle abgegeben, ein größerer Ausführungsgang mündet gemeinsam mit dem der Glandula parotis am Frenulum; gemischt, überwiegend muköse (=dickflüssiges Sekret) Drüse
Es gibt noch weitere Speicheldrüsen:
Zungenspitzendrüse (Glandula lingualis anterior, Blandin-Nuhn-Drüse) , Lippendrüsen (Glandulae labiales) , Wangendrüsen (Glandulae buccales), Zungendrüsen (Glandulae linguales) , Mahlzahndrüsen (Glandulae molares) , Gaumendrüsen (Glandulae palatinae) , Geschmacksdrüsen (Glandulae gustatoriae), Spüldrüsen der Geschmacksknospen (Synonym Ebner-Drüsen)
Pathology: Parotitis epidemica = mumps = goat’s stomach
Waldeyer’s pharyngeal ring = lymphatic pharyngeal ring
This is the body’s first defence system. It is located at the transition from the oral cavity and nasal cavity to the pharynx and the deeper airways and serves as an immune defence at the beginning of the airway and alimentary canal. It is not a ring in the classical sense but a collection of tissue islands, the various tonsils. They try to ward off germs such as viruses, bacteria and fungi:
– pharyngeal tonsil: pharyngeal tonsil (unpaired)
– palatine tonsil: palatine tonsil (paired)
– lingual tonsil: Lymphoid cell groups (lingual tonsil, lingual glands)
– Tonsillae tubariae: lymphoid follicles, lymphoid tissue, lateral cords. Pathology: Inflammation (lateral cord angina)
The tongue, or glossa, consists of striated muscles (nine in total) and is covered with mucous membrane. It lies at the bottom of the oral cavity and almost fills it when the jaws are closed. It is involved in chewing, swallowing and sucking, has taste and touch senses, and is involved in sound formation.
The tongue absorbs:
– toxins, e.g. nicotine, cyanide, alcohol
NHK: Always clean the tongue with a toothbrush to remove waste products and toxins; rinsing with sunflower oil is also possible
Tasks:
1. Assists with chewing and sucking movements
2. Forms a swallowable bite and initiates swallowing movements, moving food toward the throat
3. Serves to perceive taste, touch, and temperature
4. Plays a key role in sound formation when speaking
5. Supports the immune system with lymphatic cells
Flavor papillae: To perceive what we eat, we have taste buds on the back and sides of the tongue. These contain flavor buds (taste buds) with chemoreceptors that are stimulated by liquid food or food dissolved in saliva. Each of the less than 100 papillae contains around 100 taste buds, each of which contains around 100 sensory cells. The papillae also detect spoiled food, preventing us from eating it. The taste stimuli are transmitted to the brain via nerve impulses, and the brain immediately sends feedback to the mouth as to whether or not to swallow. About 75% of our sense of taste is located on the tongue, mainly in the rear third, with the rest located in the soft palate, nasopharynx, larynx, and upper esophagus. In addition to taste buds, the tongue also contains mechanical papillae for perceiving the physical properties of food.
Swallowing reflex: The swallowing reflex occurs when the tongue presses the bolus (bite) against the palatum molle (soft palate), and the airway is involuntarily secured by raising the soft palate against the rear pharyngeal wall (throat wall).
The tensor and levator veli palatini muscles, which press the soft palate against the soft palate, originate at the Eustachian tube, which is why swallowing also leads to pressure relief between the middle ear and the outside world. This separates the upper airways from the digestive tract. The tongue and larynx are raised and the epiglottis approaches the entrance to the larynx. At the same time, the glottis closes and breathing stops. This also separates the lower respiratory tract from the digestive tract. Coordination takes place in the swallowing center (in the moblongata above the foramen magnum) of the brain. The nose is closed and the muscles at the base of the mouth contract, causing the epiglottis to close. The epiglottis closes over the trachea (windpipe), causing the throat muscles to contract so that the bolus can enter the esophagus. In older people, the muscles that lift the epiglottis slacken, as does the skin, leading to more frequent swallowing. Humans swallow between 1,000 and 3,000 times a day. In addition to the obvious task of transporting a bolus to the stomach, swallowing also cleanses the esophagus of any stomach acid that may have entered it. The swallowed bolus can be up to 20 g (watery food pulp) or 40 ml in size. For comparison: a soup spoon holds 10 ml. Passage through the esophagus can take 8 to 20 seconds.
Ösophagus
Oesophagus: approx. 22 – 25 cm long muscular tube, stretchable up to 3.5 cm in diameter, 1.5 cm at the thinnest point. It begins at the level of the larynx, lies in the posterior mediastinum (space between the lungs) between the WS and trachea and transports food to the stomach with peristaltic movement.
It has three parts:
– Pars cervicalis (beginning to entry into the torso) approx. 8 cm,
– Pars thoracica (up to the passage through the diaphragm) approx. 16 cm
– Pars abdominalis (up to the stomach) 1-3 cm
If it is still attached to the trachea at the upper end, it splits off laterally into the main bronchi at the level of Th4 in the bifurcatio tracheae (tracheal bifurcation).
It has an upper and lower oesophageal sphincter (sphincter muscle) and 3 physiological constrictions (which are predisposed to carcinomas, more common in men, mainly due to alcohol consumption and spicy food):
1. Cartilaginous narrowing or esophageal orifice (constrictio pharyngooesophagealis, constrictio cricoidea or angustia cricoidea) near the larynx, the narrowest part, closed with sphincter at rest
2. Aortic constriction (Angustia aortica or Constrictio partis thoracica): left main bronchus and aorta constrict
3. Diaphragmatic constriction (constrictio diaphragmatica or constrictio phrenica), here the oesophagus is elastically connected to the diaphragm by a ligament, is also closed at rest, but not with a sphincter but by several mechanisms: 1) the HIS angle between the oesophagus and stomach, 2) the spiral muscular tube around the lower oesophagus, 3) the higher pressure in the abdomen pushes the oesophageal opening closed
In the final phase of the swallowing act, the oesophagus contracts at the level of the bolus, below which the musculature relaxes in each case, creating the transporting peristalsis. Various hormones and substances can affect the lower closure of the oesophagus: Cholecystokinin, somatostatin, glucagon and prostaglandin E1 relax the closure; also coffee, nicotine and fats
Pathology: achalasia, oesophageal varices, oesophageal diverticula, oesophagitis, oesophageal CA, Mallory-Weiss syndrome, reflux (GERD: gastroesophageal reflux disease)
Horner’s triad, is only present on one side:
– Miosis: pupillary constriction caused by paralysis of the m. dillatator pupillae
– Ptosis: paralysis of the mullerian muscle, resulting in a drooping eyelid (Karl-Dall effect)
– Enophthalmos: Apparent drooping of the eyelid back into the orbit as the cervical sympathetic nerve, which moves the eyelid, is constricted by tumour growth
Following CA have Horner’s triad:
oesophageal CA, Pancoast CA (lung apexes), laryngeal CA, thyroid CA. In addition, Hodgkin’s disease (potato-sack-like caking of the lymph nodes)
Magen
The stomach (gaster, ventriculus) is a muscular hollow organ and consists of the following parts:
Cardia stomach mouth,
fundus stomach base, is usually filled with air swallowed during food intake
corpus stomach body,
antrum, the vestibule of the pylorus and the final sphincter
pylorus, the pylorus, this sphincter can open up to approx.
The stomach lies in the left upper abdomen in the epigastric region, with the hepar on the right, the splenum on the left, the pancreas behind it, the diaphragm (diaphragm) behind it, the transverse colon just below it, the kidney on the left and the duodenum on the right. Liquids pass through the stomach in between 10 and 20 minutes (water on an empty stomach). Particles can leave the stomach if they are smaller than 2 mm in diameter, large or indigestible particles can leave the stomach during digestive rest (interdigestive motor activity).
The stomach holds up to 1.5 litres. Its wall tension adapts to the volume (accommodation).
The gastric tract is located in the small curvature, the short, inner curve of the stomach, also defined as the shortest connection between the cardia and pylorus, the large curvature is the longest connection. The position of the stomach changes with the filling and position of the person; only the position of the cardia, which is strongly fused with connective tissue, is relatively constant. In women, the stomach is usually somewhat deeper and steeper than in men.
Task of the stomach: digestive function:
– mix the chyme: Stretching of the upper corpus triggers peristaltic waves.
– Stopping carbohydrate digestion due to the acidic environment (pH with empty stomach 0.8 – 1.4, with chyme temporarily up to 6.5)
– Enabling absorption of B12 by the intrinsic factor
– Beginning of protein digestion = breakdown of proteins by pepsin to polypeptides
Further functions of HCl:
1. Activation of pepsinogen to pepsin
2. Bactericidal effect (unfortunately does not work with all bacteria, e.g. TB, helicobacter pylori. According to research from 2006, 128 other extremophilic bacteria are known that can live in the stomach)
3. denaturation of proteins to polypeptide chains
4. conversion of Fe3 to Fe2, only this can be absorbed
5. inactivation of ptyalin
The muscularis of the gaster consists of 3 layers: Transverse, annular and longitudinal musculature.
The blood supply to the stomach is via the arteria gastrica, the disposal is via the V. gastrica and then V. portae. The muscles of the stomach are always working; the rumbling of the stomach is the working of the muscles in the empty stomach, a consequence of the migrating motor complex (MMC), a cyclic, motor activity pattern of the small intestine and stomach in which air is compressed and sounds are produced.
Regulation of gastric activity by:
1. N. vagus: increases peristalsis and emptying; chemosensors of the small intestine are analysed
2. Gastrin: increases gastric motility, increases HCl production, increases pepsinogen production
Mucus is constantly produced in large quantities.
The phases of gastric juice secretion:
1. Nervous phase:
controlled by the vagus nerve, odours and flavours trigger a reflex secretion of HCl, gastrin and pepsinogen before and during food intake (this is why constant chewing of gum is detrimental)
2. gastric phase:
is triggered when food arrives in the stomach: HCl, pepsinogen and gastrin production is stimulated
3. intestinal phase:
begins when chyme enters the duodenum: the hormone
– secretin is released (the antagonist to gastrin), effect: Reduces motility, inhibits HCl production, inhibits pepsinogen release, ensures that bicarbonate (the acid buffer) is released from the pancreas and that bile is released into the duodenum. In addition
– GIP „Gastric Inhibitory Polypeptide“ is released, formerly also called enterogastrone, effect: reduces motility and ensures rapid insulin release.
– Cholecystotomin is released, also known as „pancreozymin“, effect: reduces motility, stimulates duodenal peristalsis, causes contraction of the gallbladder and ensures that pancreatic enzymes are released.
Gastric transit time is generally between 2-3 h for vegetables and 7 h for tinned tuna, and around 4-5 h for meat. The gastric transit time is the time a food needs to pass through the stomach. It is normally 1-6 hours, sometimes longer:
| up to 1 | Drinks |
| up to 2 | Milk, rice, white bread, potatoes (cooked) |
| bis 3 | Scrambled eggs, cream, mixed bread, some vegetables, fish (cooked) |
| bis 4 | Poultry (cooked), wholemeal bread, lots of vegetables, roast potatoes |
| bis 5 | Meat dishes, pulses, fatty fish |
| bis 7 | very fatty foods, such as goose, fatty roast pork, oil sardines, eel |
The retention time essentially depends on the
1) Consistency / structure of the food: the gastric passage is shorter with liquids than with very solid, less chopped food,
2) Osmolarity: monosaccharides in particular, especially glucose, increase the M. by stimulating the osmoreceptors of the duodenum,
3) Nutrient composition: especially fat and carbohydrates increase the M. by acting on osmo- and chemoreceptors, and
4) Energy density: a high energy density increases the gastric retention time. However, if the energy density of the food is high, more energy passes into the small intestine per unit of time than if the energy density is low.
For isotonic liquids, the M. is particularly short (0.5-1 h).
Fine structure of the mucosa:
fundus and corpus glands:
– accessory cells produce mucin (a mucus, as a protective shield from HCl and pepsin)
– parietal cells produce HCl and intrinsic factor (needed to absorb B12)
– principal cells produce pepsinogen, which is converted to pepsin by HCl
antrum–pyloric glands:
– the G-cells in front of the pylorus produce the hormone gastrin
Pathology: Acute gastritis, chronic gastritis, erosive gastritis, gastric CA, ulcus ventriculi, gastropathia nervosa, hiatal hernia, dumping syndrome, pyloric stenosis
Pancreas
Pancreas Pancreas, the most important digestive gland, approx. 15-20 cm long, 1.2 cm thick, wedge-shaped, weighing approx. 80 g (40-120 g), crosses the WS at the L1/L2 level, 3 sections:
caput pancreatis head of the pancreas: lies in the duodenal C, the excretory duct ductus panreaticus opens there, approximately together with the bile duct ductus choledochus
corpus pancreatis body of the pancreas
cauda pancreatis tail of the pancreas, adjoins the spleen
The pancreas produces a serous secretion. Part of the tissue is similar to that of the parotid gland (alpha-amylase and ptyalin are similar), which is why the pancreas can also be affected in mumps.
Tasks
Exocrine production
Production of digestive enzymes or (for protein-digesting enzymes, their precursors are activated in the duodenum):
– Carbohydrate-digesting enzymes: alpha-amylase
– Fat-digesting enzymes: lipase, phospholipase, cholinesterase
– Protein-digesting enzymes: procarboxypeptidase, is activated in the duodenum from enterokinase to carboxypeptidase, proelastase is activated in the duodenum from enterokinase to elastase, trypsinogen is activated in the duodenum from enterokinase to trypsin, chymotrypsinogen is activated in the duodenum from trypsin to chymotrypsin. In the case of the protein-digesting enzymes, only precursors are produced in the pancreas and only activated in the small intestine because the pancreas would otherwise digest itself, which is what happens with a gallstone located in the papilla vateri, as the bile backs up to the pancreas and activates its precursors. The enzymes mentioned are always released at the same time.
– Nucleases (enzymes that digest nuclear material): deoxyribonuclease, ribonuclease
– Bicarbonate: the strongly alkaline bicarbonate serves as an acid buffer for the duodenum.
Endocrine production
Production of hormones in the islets of Langehans:
– insulin in the B cells, creates glucose in the cells and thereby lowers the blood sugar level, increases glycogen formation (the storage form of glucose, stores are mainly liver and muscles) and protein synthesis in the liver, most important anabolic hormone. Insulin deficiency leads to diabetes mellitus, also known as „honey-sweet urine flood“. The B cells make up approx. 80% of the islet apparatus. Furthermore, insulin is the only hormone that builds up body fat and ensures that it remains in the depots. Forms of substitution in case of deficiency: Parenterally as genetically engineered human insulin, old insulin and insulin analogue Lispro (short action), delayed-release insulin (depot insulin)
– Amylin supplements the function of insulin and inhibits the effect of glucagon
– Glucagon in the A cells, is an antagonist to insulin, therefore increases blood sugar levels, promotes glycogen breakdown, stimulates the release of fatty acids from fatty tissue (e.g. during endurance sports). e.g. during endurance sports). The A cells make up approx. 20% of the islet apparatus.
– Somatostatin in the D cells, inhibits the enzyme release of the pancreas
– pancreatic polypeptide inhibits the enzyme and hydrogen carbonate production of the pancreas, as well as the motility of the intestine and the bile flow.
– Ghrelin (Growth Hormone Release Inducing)
Diabetes mellitus means a chronically elevated blood sugar level
Type 1: occurs up to the age of 40. therefore also called juvenile diabetes and is insulin-dependent, endocrine pancreatic insufficiency, can be recognised by the excretion of ketones in the urine. Has hyperglycaemia and hypoinsulinaemia. Type a: immune-mediated, type b: idiopathic
Type 2: occurs from the age of 40 years. Distinctions:
Type 2 a: affluent diabetes: not insulin-dependent, caused by down-regulation of the cells (breakdown of insulin receptors), has hyperglycaemia and hyperinsulinaemia, can be treated by adjusting lifestyle habits, several moderate and less primitive forms of diabetes. several moderate and less primitive meals plus exercise therapy, no ketones in the blood or urine
Type 2 b: Exhaustive diabetes: relative endocrine pancreatic insufficiency, insulin-dependent, hyperglycaemia and hypoinsulinaemia, ketones in the blood and urine, exercise and diet therapy alone are not enough!
Nowadays the trend is to speak of insulin resistance (type 2a) and –deficiency (type 2b) in different compositions and to differentiate between different types, especially
type 1: insulin-dependent with absolute insulin deficiency due to destruction of Langerhans cells, peak onset 11-13 years of age, genetic plus autoimmune. Lj, genetic plus autoimmunological
Type 2: not insulin-dependent, from 40 Lj, insulin resistance plus relative insulin deficiency, mostly life-related
and some spiecific forms
Consequences of diabetes mellitus are micro- and macroangiopathies, poorly healing wounds, weakened immune defence, risk of stroke and heart attack,…
Hypoglycaemia and gluconeogenesis
At rest, humans consume approx. 200 mg of glucose per day, of which the brain alone needs ¾, the rest goes mainly to the erythrocytes, which can only utilise glucose as they have no mitochondria that could utilise anything else. The brain also mainly utilises glucose. The body stores around 400 – 500 ml of glucose, 2/3 in the muscles and 1/3 in the liver. Even after a relatively short period of starvation, gluconeogenesis begins in the liver and renal cortex, and less so in the brain, skeletal and heart muscles, in which glucose is built from protein
Hypoglycaemia is actually a problem for diabetics or people with a diabetogenic metabolic condition caused by the disease. However, depending on the usual sugar level, symptoms of hypoglycaemia can also occur in healthy people even above the usually set limit of 70 mg/dl (below 50 mg/dl is called hypoglycaemia) concentration in the blood, as the brain, which is used to a higher level, releases messenger substances that trigger a hyperadrenergic state (adrenaline promotes gluconeogenesis) with trembling, sweating, ravenous hunger, tachycardia, rise in blood pressure, paleness, soft knees. If no appropriate food is consumed, further symptoms are added in the next phase:
visual, thinking and speech disorders, moodiness, irritability, lack of concentration, movement disorders or a furry feeling around the lips.
This can be caused by a metabolic switch to larger quantities of low-quality short-chain carbohydrates, such as those found in luxury foods like sweets and soft drinks. Triggers are often longer, more intense physical activity or sport, too long phases without food intake, inadequate insulin doses, alcohol consumption without food intake and, of course, medication and its side effects. However, levels below 45 mg/dl need to be clarified, as they are usually symptoms of liver or kidney disease.
In less dramatic cases, immediate carbohydrate intake helps, preferably sugar, sugar-containing products or glucose in liquid or solid form. In more severe cases, the diabetic himself or the emergency doctor must inject the insulin antagonist glucagon (promotes glycogenolysis and gluconeogenesis) and administer glucose intravenously. In very severe cases, the patient is no longer able to help himself, at some point he goes into hypoglycaemic shock and then falls into a coma.
Liver and gallbladder
Chole bile. The bile is produced in the liver, stored in the cholecyst gallbladder also known as the vesica fellea (approx. 8-11 cm long and 3-4 cm in diameter, approx. 30-60 ml capacity, ends with a sphincter) and released into the duodenum through the cholangio bile duct (as part of an enterohepatic circulation)
The main task of bile is to emulsify fats, but it also contains a degradation product of erythrocytes: bilirubin
Hepar Liver, the heaviest and largest abdominal organ at 1.5 kg, largest gland,
Tasks:
– Production of vital proteins (e.g. coagulation factors),
– Utilisation of food components that have been absorbed from the intestine via the portal vein (e.g. storage of glycogen and vitamins),
– Production of bile
– Breakdown and excretion of metabolic products, medications and vitamins. e.g. storage of glycogen and vitamins),
– production of bile
– breakdown and excretion of metabolic products, drugs and toxins
The liver consists of 4 lobes with a total of approx. 100. 000 lobules together:
Lobus dexter the largest lobe,
Lobus sinister the second largest lobe,
Lobus caudatus the lobe lying in the centre inferior posterior
Lobus quadratus the lobe lying in the centre inferior anterior, lies directly next to the gallbladder
The ligamentum falciforme lies between the lobus sinister and the other lobules. Through the hilus or porta hepatici enter the hepatic portal: A. hepatica, V. portae (portal vein) and it exits: ductus hepaticus communis (which later becomes the ductus choledochus). This makes the liver the only organ in which not all blood vessels leading to and from the liver pass through the hilum, namely the v. hepatica. 25% of the liver’s blood comes from the a. hepatici and 75% from the portal vein; together they enter the liver. Physiologically, the membrane surfaces of the hepatocytes facing the bile duct are larger than the membrane surfaces facing the blood. This is why indirect bilirubin can enter from the blood side, but not direct bilirubin (if present), and direct bilurubin can leak out on the bile side. In hepatitis, the membrane surfaces are both enlarged, so that direct bilirubin can re-enter from the bile side and pass through the hepatocyte into the blood. In the centre of the lobules are the v. centralis central veins, which collect the blood and conduct it via the 3 venae hepaticae to the v.cava inferior. Embedded in the clefts between the hepatocytes are the Kupffer’s stellate cells, which belong to the MMS (monocyte-macrophage system) and thus to the defence system. They contain many lysosomes (which contain a lot of lysozyme) and can also break down erythrocytes. Cell debris, foreign substances and bacteria are phagocytised (eliminated) by them.
Fine anatomy of the liver: the liver lobules have a honeycomb arrangement; the hepatocytes are arranged in the liver lobules in a star shape. The space between the individual rays of the star is called the sinosoid or blood bank, where the blood from the portal vein and the a. hepatica mixes. At the corners between the honeycombs are the Glisson’s triangles, where there is an offshoot of the a. hepatica, portal vein and common hepatic duct. The offshoot of the bile duct branches inside the lobules to form a network of ducti biliferus bile capillaries. The trio of a.interlobularis , v.interlobularis and ductus biliferus is called trias hepatis.
During inspiration, the liver lowers due to the pressure of the diaphragm and the chest rises, making the lower edge of the liver palpable; during expiration, the chest moves back in front of the lower edge of the liver and the liver moves upwards again.
The liver is the largest metabolic and detoxification organ and is involved in carbohydrate, protein and fat metabolism. It detoxifies e.g. alcohol, but also environmental toxins and medication (NHK: the liver and kidneys should therefore be supported when detoxifying from whatever). The degradation products of the toxins are transported via the blood to the kidneys, collected in the bladder and excreted in liquid form. The liver produces bile to emulsify the fats, approx. 600 ml per day; this is stored in the gall bladder. Some of the bile released into the small intestine is later reabsorbed by the non-specific absorption mechanisms of the intestinal mucosa (enterohepatic circulation of bile)
Pathology: Hepatitis A-E, liver cirrhosis, fatty liver/liver cell fatty degeneration, liver CA
Milz
Splenium Spleen also known as lien , lymphatic organ, the size of a fist, coffee bean-shaped, weighing approx. 150-200 g. Without the spleen, humans are in principle viable, as the liver can take over its function with Kupffer’s stellate cells.
Task: Destruction of leucocytes and erythrocytes, the latter after 120 days or in the case of recognisable weakness (reduced deformability) or enlargement.
Diagnosis: the spleen is normally not palpable, only if enlarged.
Pathology: 2-stage splenic rupture: the blood leaking from the spleen damaged by external influences (e.g. accident) initially only flows into the capsule surrounding the spleen, which is why the splenic rupture is difficult to recognise, and only continues into the abdominal cavity after a few hours, which means that hypovolaemic shock is imminent.
Därme
The organs of the digestive tract consist of four layers, these are from the outside to the inside:
1. serosa, called adventitia in the oesophagus
2. (tunica) muscularis pink muscle layer
3. submucosa connective tissue separating layer
4. mucosa mucous membrane
There are further sub-layers; the muscularis is also divided into three parts.
The mouth, pharynx and the first section of the oesophagus have more striated muscles, which here, as is usually the case, are subject to voluntary control (voluntary). Smooth muscles are mostly involuntary and are used for peristalsis in the digestive area.
Small intestine
Intestinum tenue Dünndarm
Main task: Finish digesting chyme until only small molecules remain, then absorb and reabsorb 7-10 litres of digestive juices daily. The small intestine consists of
– duodenum duodenum approx. 12 own finger widths long)
– jejunum jejunum , approx. 2/5th of the length of the small intestine, with many villi, decreasing towards the end and transitioning to the
– Ileum Crooked intestine approx. 3/5th of the length of the small intestine, hardly any to no villi
Structure of the mucosa: Kerkring folds: high, ring-shaped folds of the mucosa, particularly high and dense in the jejunum, decrease towards the illeum, at the end of which there are no more. They increase the surface area by approx. 35%. Together, the kerkring folds + villi + crypts + microvilli have a surface area of approx. 200 square metres. The microvilli are each approx. 0.1 micrometres long and increase the surface area of the approx. 4 million villi by a factor of 600. The villi are ring-shaped protrusions of the mucosa on the nuclear ring folds and make up an area of approx. 4 square metres. In the centre of each villus there is always a chyle lymphatic vessel, which serves to absorb long-chain fatty acids. The main components of the villi are the enterocytes (border cells) with their microvilli. Mucus-producing goblet cells are located between the enterocytes. The number of villi is higher in the duodenum than in the other parts of the small intestine. During the digestive process, the villi are in constant motion, controlled by the submucosal plexus. The villi move back and forth, absorbing food molecules via the venous blood system (villus pump) and transporting them to the portal vein. The blood here is therefore very rich in nutrients. The portal vein (shown in purple in many illustrations) is an isolated piece of venous blood circulation that connects all unpaired abdominal organs and serves to transport nutrients. The tubular crypts descend between the villi, especially the jejunum and illeum. Lieberkühn’s glands, which produce enzyme-containing intestinal juice, open into these.
The duodenum has the shape of a „C“ and is responsible for the resorption of carbohydrates that have already been predigested in the mouth and stomach. For this purpose, the enzymes alpha-amylase and lipase produced in the pancreas, the head of which includes the duodenum, flow in via the pancreatic duct and from the gallbladder via the choledochal duct. In most people, the two ducts flow into a short common duct, the papilla vateri, which is present in 90% of people. At its end is the sphincter oddi, which releases the digestive juice in portions. The alpha-amylase breaks down the carbohydrates into monosaccharides, which are completely absorbed by the duodenum (this should not always work, depending on the quantity and type) and fed to the liver via the portal vein.
The jejunum is responsible for the resorption of proteins broken down into amino acids with the help of pepsin, which are also channelled to the liver via the portal vein.
Finally, most short- and medium-chain fats are absorbed in the ileum and are also channelled to the liver via the portal vein, together with the unused bile. The ileum has an abundant number of lymphatic follicles called Peyer’s plaques. These contain a high number of lymphocytes. They are the centres for the development of antibodies, enabling invading pathogens to be rendered harmless. Peyer’s patches belong to the MMS monocyte-macrophage system (old name: „reticuloendotheal system“). Between the mucosa and submucosa lies a nerve plexus called the submucosal plexus or Meissner’s plexus. The muscularis consists of 2 layers, between which lies the plexus myentericus or Auerbach plexus (not to be confused with the plexus further cranially, which was also discovered by Auerbach). The mesentery or mesentery of the small intestine is the suspension of the small intestine on the posterior abdominal wall; it also supplies the small intestine with blood and lymph vessels as well as nerve fibres.
Carbohydrate digestion
The enzyme glucosidase is formed in the crypts of the small intestinal mucosa, which together with alpha-amylase converts carbohydrates into monosaccharides.
Protein digestion
The small intestinal mucosa also produces enterokinase for protein digestion. The enzyme (precursors) proelastase, trypsinogen and procarboxypeptidase formed in the pancreas are activated by enterokinase to form elastase, trypsin and carboxypeptidase. Trypsin converts chymotrypsinogen into chymotrypsin. All these enzymes convert proteins into amino acids, which are then absorbed via the small intestinal mucosa and transported via the portal vein to the liver and further into the large circulation.
Fat digestion
The fats are 90-95% triglycerides (neutral fats: glycerol with three fatty acids attached) and are emulsified by bile acid to form micelles, which are then broken down into fatty acid compounds by lipase, phospholipase and cholinesterase. Short and medium-chain fats are bound to LDL (low density lipoprotein), VLDL (very low density lipoprotein) and HDL (high density lipoprotein) and transported to the liver via the portal vein. The *DL is formed in the liver. Long-chain lipids are packaged in a chylomicron protein envelope (similar to vesicles) and are transported via the central lymphatic vessel to the thoracic duct, from where they are transported to the Virchow gland and on to the left venous angle (heart). They are bound to LDL, VLDL and HDL. The bloodstream then releases the fats to the liver with a delay.
The enzymes deoxyribonucleases and ribonucleases produced in the pancreas, known as nucleases, break down cell nuclei and their material. If a lot of cell material is produced, which is the case when animals are eaten, a lot of uric acid is produced, which can lead to gout. The uric acid crystals that accumulate are sharp and therefore cause pain. The risk of gout increases significantly with the addition of alcohol, including alcohol that is formed in the body by fermentation by E. coli bacteria from sugar as fusel alcohol (methanol, n-propanol and isobutanol, butanols, amyl alcohols and hexanol). This fusel alcohol is also absorbed by the intestine and can lead to liver cirrhosis. Liver values are significantly elevated in the presence of fusel alcohol formation. The cause may be the sheer amount of sugar consumed (the sugar should actually be digested and absorbed in the duodenum) or a dysbiosis. Gout can also develop in leukaemia and often manifests itself in Hallux. Gouty tofis are white pea-shaped but smaller formations that contain uric acid crystals.
large intestine
intestinum crassum or colon large intestine consists of several parts, the caecum rectum below the Bauhin’s valve (ileocoecal valve at the junction of the small intestine, protects the small intestine from the large intestine flora), the colon ascendens ascending part , the colon transversum transverse part, the colon descendens descending part, the sigmoideum S-shaped part and finally the rectum rectum, rectum as the last part before the anus equipped with shpinkter. The length of the colon is approx. 1.5 – 1.8 metres, the thickness approx. 6 cm. The colon is covered „outside“ and „inside“ with taenia, a narrow, three-layered musculature, the contraction of which creates the cavernous sinuses. The mucosa of the large intestine has no villi (no enzyme production), but particularly deep crypts with many goblet cells that secrete mucus for better transport of the faeces (the chyme from the colon is called faeces or stool). The large intestine is connected to the blood, lymph and nervous system via the mesocolon. About 2/3 of the feaces consists of bacteria, mainly E. coli, followed by various lactobacilli. E. coli bacteria can presumably produce vitamin K, from which the coagulation factors 7,9,10 are produced. The bacteria of the large intestine also attack the plant fibre cellulose, whereby further bound water is available for resorption. 1g of faeces contains approx. 10,000,000,000 bacteria.
Task: Resorption of water, absorption of electrolytes such as K, Na, Mg; thickening of faeces
Pathology: ulcerative colitis, Crohn’s disease, colon-rectal-CA, diverticulitis, polyposis intestinalis, irritable colon
NHK: Dysbiosis can have many consequences, e.g. tendency to chronic sinusitis or enteric mycoses, as well as weakened immune defence.
Blinddarm
caecum, or cecum, can be considered the first part of the large intestine. The chyme flows from the small intestine via the Bauhin’s valve or ileocecal valve into the caecum, which lies below the ascending colon. The valve prevents reflux between the large intestine and small intestine so that the colonic flora does not invade the small intestine (overgrowth syndrome).
Pathology: Appendicitis