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Anatomic and Clinical Pathologist
digestive system consists of the digestive tractoral cavity,
esophagus, stomach, small and large intestines, rectum, and
anusand its associated glandssalivary glands, liver, gall
bladder and pancreas
1. to obtain from ingested food the molecules necessary for the
maintenance, growth, and energy needs of the body
macromolecules are broken down into small moleculesmore
easily absorbed through the lining of the digestive tract
2. protective barrier
first step in digestion occurs in the mouthfood is moistened by
saliva and ground by the teeth into smaller pieces
continues in the stomach and small intestinefood's basic
components (eg, amino acids, monosaccharides, free fatty acids)
are absorbed
water absorption occurs in the large intestine, causing
undigested material to become semisolid

General Structure of the Digestive Tract
entire GIT has certain common structural characteristics:
hollow tube with a lumen of variable diameter
wall made up of four main layers: the mucosa, submucosa,
muscularis, and serosa

mucosa comprises an epithelial lining(aka mucous
membrane) underlying lamina propria of loose
connective tissue rich in blood vessels, lymphatics,
lymphocytes, glands; and a thin layer of smooth muscle,
muscularis mucosae, separating mucosa from submucosa

submucosacontains denser connective tissue with many
blood and lymph vessels, autonomic submucosal plexus,
may also contain glands and lymphoid tissue

muscularis propriacomposed of smooth muscle cells that are
spirally oriented and divided into two sublayers:
1. internal sublayer (closer to the lumen)---orientation is circular
2. external sublayerorientation is longitudinal
connective tissue between the muscle sublayers are blood and
lymph vessels, and autonomic myenteric plexus
autonomic myenteric plexus and autonomic submucosal plexus
comprise the local enteric nervous system, functioning
independently of the CNS
Serosathin layer of loose connective tissue, rich in blood
vessels, lymphatics, and adipose tissue, with a simple squamous
covering epithelium (mesothelium)
in the abdominal cavityserosa is continuous with the mesenteries
(thin membranes covered by mesothelium on both sides), which
support the intestines, and with the peritoneum, a serous
membrane that lines the cavity
in places where the digestive tract is bound to other structures (eg,
esophagus)serosa is replaced by a thick adventitia, consisting of
connective tissue containing vessels and nerves, lacking
main functions of the digestive tract's epithelial lining are to:
provide a selectively permeable barrier between the contents of the
tract and the tissues of the body
facilitate the transport and digestion of food
promote the absorption of the products of this digestion
produce hormones that affect the activity of the digestive system
produce mucus for lubrication and protection

abundant lymphoid nodules in the lamina propria and the
submucosal layerprotect the organism from bacterial invasion
secretory IgAsecreted into the intestinal lumen protects against
viral and bacterial invasion

muscularis mucosaeallows local movements of the mucosa
independent of other movements of the digestive tract,
increasing contact of the lining with food
contractions generated and coordinated by autonomic nerve
plexuses (parasympathetic ganglia), propel and mix the food in the
digestive tract

Hirschsprung disease (congenital megacolon) or Chagas disease
(Trypanosoma cruzi infection)plexuses in the digestive tract
are severely injured and most of their neurons are destroyed
results in disturbances of digestive tract motility, with frequent
dilatations in some areas

abundant innervation from the autonomic nervous system that
the digestive tract receives provides an anatomic explanation of
the widely observed action of emotional stress on this tract
Oral Cavity
lined with stratified squamous epithelium, keratinized or

keratin layer protects the oral mucosa from damage during
masticatory functiongingiva (gum) and hard palate
lamina propriahas many papillae and rests directly on bony tissue

nonkeratinized epitheliumsoft palate, lips, cheeks, and the
floor of the mouth
lamina propriapapillae similar to those in the dermis of the skin
and is continuous with a submucosa containing diffuse small
salivary glands
soft palatehas a core of skeletal muscle and lymphoid nodules

mass of striated muscle bundles that cross one another in 3
planes covered by a mucous membrane

ventral surfacemucous membrane is smooth

dorsal surfaceirregular, covered anteriorly by small eminences
called papillae

posterior third of dorsal surface is separated from the anterior
two thirds by a V-shaped groove terminal sulcus

behind this boundaryroot of the tongue, whose surface
shows the many bulges of the lingual tonsils and smaller
collections of lymphoid nodules
4 types of papillae on the anterior portion of the tongue:
1. filiform papillaevery numerous, have an elongated conical shape,
heavily keratinized, lacks taste buds, provide a rough surface that
facilitates food movement during chewing
2. fungiform papillaeless numerous, lightly keratinized, mushroom-
shaped with connective tissue cores and scattered taste buds,
irregularly interspersed among the filiform papillae
3. foliate papillaepoorly developed in adults, consist of parallel ridges
and furrows on the sides of the tongue, with taste buds
4. vallate (circumvallate) papillaeleast numerous, largest lingual
papillae, have over half the taste buds, with diameters of 1 - 3 mm, 7 -
12 papillae normally form a V-shaped line

ducts from several serous salivary (von Ebner) glands empty into the
deep groove that surrounds each vallate papillaprovides a continuous
flow of fluid over the taste buds which washes food particles so that the
taste buds can receive and process new gustatory stimuli

taste buds are also present in other parts of the oral cavity (eg, soft

taste budsovoid structures, each containing 5075 cells, within
the stratified epithelium of the tongue and the oral mucosa
half the cells are elongated gustatory (taste) cells, slender
supportive cells, immature cells, and basal stem cells that give rise
to the other two types
base of each bud rests on the basal lamina, entered by afferent
sensory axons that form synapses on the gustatory cells
apical ends of the gustatory cells microvilli project through an
opening called the taste poremolecules (tastants) dissolved in
saliva contact the microvilli through the pore and interact with cell
surface taste receptors
receptor binding produces depolarization of the gustatory cells,
stimulating the sensory nerve fibers which send information to the
brain for processing

detect at least five broad categories of tastants: metal ions
(salty); hydrogen ions from acids (sour); sugars and related
organic compounds (sweet); alkaloids and certain toxins (bitter);
and certain amino acids such as glutamate (umami, savory)

transitional space between the oral cavity and the
respiratory and digestive systems

forms an area of communication between the nasal region
and the larynx

lined by stratified nonkeratinized squamous epithelium in
the region continuous with the esophagus and by ciliated
pseudostratified columnar epithelium containing goblet
cells in the regions close to the nasal cavity

contains tonsils and the mucosa also has many small
mucous salivary glands in its lamina propria
in the adult human32 permanent teeth, arranged in two bilaterally
symmetric arches in the maxillary and mandibular bones
each quadrant has eight teeth: two incisors, one canine, two premolars, and
three permanent molars
twenty of the permanent teeth are preceded by deciduous (baby) teeth which
are shed; permanent molars have no deciduous precursors
each tooth has a crown exposed above the gingiva, a constricted neck at the
gum, and one or more roots below the gingiva that hold the teeth in bony
sockets called alveoli
crown is covered by the extremely hard enamel, and the roots by a bone-like
tissue cementumtwo coverings meet at the neck of the tooth
bulk of a tooth is composed of calcified materialdentin, which surrounds a
soft connective tissue-filled spacepulp cavity
pulp cavity narrows in the roots as the root canalswhich extend to the tip of
each root, where an opening (apical foramen) permits the entrance and exit of
blood vessels, lymphatics, and nerves of the pulp cavity
periodontal ligamentsfibrous connective tissue bundles of collagen fibers
inserted into both the cementum and alveolar bone, fixing the tooth firmly in
its bony socket (alveolus)

calcified tissue consisting of 70% calcium hydroxyapatite

organic matrix (predentin) contains type I collagen fibers
and GAGs secreted by odontoblaststall polarized cells
that line the pulp cavity

teeth are sensitive to stimuli such as cold, heat, and acidic
pH, all of which can be perceived as pain
pulp is highly innervated
unlike bone, dentin does not turn over or get remodeled
persisting as a mineralized tissue long after loss of the
it is therefore possible to maintain teeth whose pulp and
odontoblasts have been destroyed by infection (canal

in adult teethdestruction of the enamel by erosion from
use or dental caries (tooth decay) usually triggers a reaction
in odontoblasts that causes them to resume the synthesis
of dentin components

hardest component of the human body98% hydroxyapatite and the rest
organic material including two unique proteins, amelogenin and enamelin, but
no collagen
other ions, such as fluoride, can be incorporated or adsorbed by the
hydroxyapatite crystals
enamel containing fluorapatite is more resistant to acidic dissolution caused by
microorganisms, hence the addition of fluoride to toothpaste and water supplie

consists of interlocking rods or columns, enamel rods (prisms)precise
arrangement of rods in groups is very important for enamel's strength and
mechanical properties
in developing teeth enamel matrix is secreted by a layer of cellsameloblasts,
each of which produces one enamel prism
long, polarized cell with numerous mitochondria, well-developed RER and
Golgi apparatus, and an apical extension, the ameloblast process, containing
numerous secretory granules with proteins for the enamel matrix
after finishing the synthesis of enamel, ameloblasts form a protective
epithelium that covers the crown until the eruption of the tooth, a function
important in preventing several enamel defects
consists of connective tissue resembling mesenchyme

main components: layer of odontoblasts, many fibroblasts,
thin collagen fibrils, and ground substance

highly innervated and vascularized tissue
blood vessels and myelinated nerve fibers enter the apical
foramen and divide into numerous branches
pulp fibers are sensitive to pain
comprises the structures responsible for maintaining the teeth in
the maxillary and mandibular bones
consists of the cementum, periodontal ligament, alveolar bone, and

cementumcovers the dentin of the root and is similar in
composition to bone, although osteons and blood vessels are
thicker in the apical region around the root, where there are
cementocytescells resembling osteocytes, in lacunae
unlike osteocytes, cementocytes do not communicate via canaliculi
and their nourishment comes from external tissues
like bone, cementum is labile and reacts to the stresses to which it is
subjected by resorbing old tissue or producing new tissue
continuous production of cementum in the apex compensates for
the physiologic wear of the teeth and maintains close contact
between the roots of the teeth and their sockets

in comparison with bonecementum has lower metabolic
activity because it is not irrigated by blood vessels
this feature allows the movement of teeth within alveolar bone by
orthodontic appliances without significant root resorption

periodontal ligamentconnective tissue with collagen fiber
bundles connecting the cementum and the alveolar bone of the
tooth socket
permits limited movement of the tooth within the socket and the
fibers are organized to support the pressures exerted during
avoids transmission of pressure directly to the bone which would
cause localized bone resorption
unlike typical ligamentsit is highly cellular and has a rich supply
of blood vessels and nerves, giving it protective, sensory, and
nutritive functions
high rate of collagen renewal in the periodontal ligament allows
processes affecting protein or collagen synthesiseg, protein or
vitamin C deficiency (scurvy), to cause atrophy of this ligament,
teeth become loose in their sockets; in extreme cases they fall out

gingivamucous membrane firmly bound to the periosteum of
the maxillary and mandibular bones
composed of stratified squamous epithelium and lamina propria
with numerous connective tissue papillae
junctional epitheliumbound to the tooth enamel by means of a
cuticle resembling a thick basal lamina
epithelial cells are attached to this cuticle by numerous
between the enamel and the epithelium is the gingival sulcus, a
groove up to 3 mm deep surrounding the neck
depth of the gingival sulcusimportant indicator of potential
periodontal disease
muscular tube whose function is to transport food from the mouth to
the stomach

lined by nonkeratinized stratified squamous epithelium

has the same major layers as the rest of the digestive tract

submucosagroups of small mucus-secreting glandsesophageal
glands, secretions of which facilitate the transport of foodstuffs and
protect the mucosa

proximal thirdmuscularis is exclusively skeletal muscle

middle thirdcombination of skeletal and smooth muscle fibers

distal thirdmuscularis contains only smooth muscle

distal portion of the esophagus, in the peritoneal cavity covered by
serosa; rest is enclosed by a layer of loose connective tissue
adventitia, which blends into the surrounding tissue

like the small intestinemixed exocrine-endocrine organ

dilated segment of the GIT whose main functions are to continue the
digestion of carbohydrates initiated in the mouth, add an acidic fluid
to the ingested food, transform it into a viscous mass (chyme), and
promote the initial digestion of proteins with the enzyme pepsin

produces gastric lipase that digests triglycerides

four regions on gross: cardia, fundus, body, and pylorus

three histologically distinct regionsfundus and body are identical in
microscopic structure

mucosa and submucosa of the empty stomachlongitudinally directed
folds, rugaeflatten when the stomach is filled with food

wall in all regions of the stomach is made up of all four major layers
consists of a simple columnar epithelium that invaginates into the
lamina propria, forming gastric pits
emptying into the gastric pitsbranched, tubular glands characteristic
of the stomach region (cardiac, gastric, and pyloric)
stem cells for the entire epithelial lining are located in the upper
regions of these glands

separating the mucosa from the submucosamuscularis mucosae

surface epithelial cells form an important line of defense due to their
production of a protective mucus layer that is firmly adherent to the
epithelial surface, their tight intercellular junctions, and ion
transporters to maintain intracellular pH and bicarbonate production

another line of defense is the underlying circulatory bedwhich
provides bicarbonate ions, nutrients, and oxygen to the mucosal cells,
while removing toxic metabolic products
rich vasculature also favors the rapid healing of superficial wounds to
the mucosa

stress and other psychosomatic factors; ingested substances such
as aspirin, NSAIDs or ethanol; the hyperosmolality of meals; and
some microorganisms (eg, Helicobacter pylori)can disrupt this
epithelial layer and lead to ulceration
processes that enable the gastric mucosa to rapidly repair
superficial damage play a very important role in the defense
mechanismadequate blood flow that supports gastric physiologic

any imbalance between aggression and protection may lead to
pathologic alterations.
aspirin and ethanol irritate the mucosa partly by reducing mucosal
blood flow
anti-inflammatory druginhibit the production of prostaglandins
E, which are very important substances for the alkalinization of the
mucus layer and important for protection
Regional Differences in the Stomach Mucosa
cardianarrow circular region, only 1.53 cm in width, at the transition
between the esophagus and the stomach
pylorusfunnel-shaped region opening into the small intestine
mucosa of these two stomach regions contains branched tubular glands, with
coiled secretory portions called cardial glands and pyloric glands
pits leading to these glands are longer in the pylorus
glands secrete abundant mucus and lysozyme (enzyme that attacks bacterial
fundus and bodymucosa's lamina propria is filled with branched tubular
gastric glands, three to seven of which open into the bottom of each gastric pit
gastric glandhas an isthmus, neck, and base
isthmusnear the gastric pit, contains differentiating mucous cells that
migrate and replace surface mucous cells, few undifferentiated stem cells, and a
few parietal (oxyntic) cells
neckconsists of stem cells, mucous cells (different from the isthmus
mucous cells), and parietal cells
basecontains parietal cells and chief (zymogenic) cells
various enteroendocrine cells are dispersed in the neck and the base of the
cells of the gastric glands provide key stomach functions:
1. mucous neck cellspresent in clusters or as single cells between
parietal cells in the necks of gastric glands
irregular in shape, with nucleus at the base of the cell and secretory
granules near the apical surface, mucus secretion is less alkaline

2. parietal cellspresent mainly in the upper half of gastric glands,
fewer in the base
large rounded or pyramidal cells, with one central spherical nucleus
and intensely eosinophilic cytoplasm due to the high density of
striking feature: deep, circular invagination of the apical plasma
membrane, forming an intracellular canaliculus
secrete both HCl and IF (required for uptake of vitamin B12 in the small
carbonic anhydrase produces H2CO3 which dissociates in the
cytoplasm into H+ and HCO3+
releases K+ and Cl and Cl ions combine with H+ to form HCl
secretory activity stimulated both through cholinergic nerve endings
(parasympathetic stimulation) and by histamine and gastrin, both
secreted by local enteroendocrine cells

atrophic gastritisboth parietal and chief cells are much
less numerous, and the gastric juice has little or no acid or
pepsin activity
complex of vitamin B12 with IF is absorbed by pinocytosis into
the cells in the ileumthis explains why a lack of IF can lead to
vitamin B12 deficiency
condition results in a disorder known as pernicious anemia,
usually caused by atrophic gastritis
in some cases, pernicious anemia seems to be an autoimmune
diseaseantibodies against parietal cell are often detected in
the blood of patients with the disease

3. chief (zymogenic) cellspredominate in the lower region of the
tubular glands with protein-synthesizing and -exporting properties
cytoplasmic granulescontain the inactive enzyme pepsinogen,
converted into highly active proteolytic enzyme pepsin after being
released into the acid environment of the stomach
also produce the enzyme lipase and the hormone leptin
4. enteroendocrine cellssecrete a variety of hormones
in the fundus enterochromaffin cells (EC cells) secrete serotonin
in the pylorus and lower body of the stomach other enteroendocrine
cells, including G cellsproduce gastrin which stimulates the
secretion of acid by parietal cells and has a trophic effect on gastric
5. stem cellsfew in number, found in the neck region of the glands
low columnar cells with basal nuclei and divide asymmetrically
some of the daughter cells move upward to replace the pit s and
surface mucous cells, which have a turnover time of 47 days
other daughter cells migrate more deeply into the glands and
differentiate into mucous neck cells and parietal, chief, and
enteroendocrine cells, these cells are replaced much more slowly
Cell Type and Location Hormone Produced Major Action
X/A-likestomach Ghrelin Increase sense of hunger
Gpylorus Gastrin Stimulation of gastric acid secretion
Ssmall intestine Secretin Pancreatic and biliary bicarbonate and
water secretion
Ksmall intestine Gastric inhibitory polypeptide Inhibition of gastric acid secretion
Lsmall intestine Glucagon-like peptide 1 (GLP-1) Decrease sense of hunger
Ismall intestine Cholecystokinin (CCK) Pancreatic enzyme secretion, gallbladder
Dpylorus, duodenum Somatostatin Local inhibition of other endocrine cells
Mosmall intestine Motilin Increased gut motility
ECdigestive tract Serotonin, substance P Increased gut motility
digestive tract

Vasoactive intestinal polypeptide
Ion and water gut motility secretion,
carcinoids tumorsarise from the EC cells,
responsible for the clinical symptoms caused by
overproduction of serotonin
serotonin increases gut motility, high levels of this
hormone/neurotransmitter have been related to
mucosal vasoconstriction and damage
Other Layers of the Stomach
submucosacomposed of connective tissue containing
blood and lymph vessels
infiltrated by lymphoid cells, macrophages, and mast cells

muscularis propriacomposed of smooth muscle fibers
oriented in three main directions
external layer is longitudinal, the middle layer is circular, and
the internal layer is oblique
rhythmic contractions serve to mix ingested food and chyme
with the secretions from the gastric mucosa
at the pylorusmiddle layer is greatly thickened to form the
pyloric sphincter

stomach is covered by a thin serosa
Small Intestine
site of terminal food digestion, nutrient absorption, and
endocrine secretion

approximately 5 m

consists of three segments: duodenum, jejunum, and ileum
Mucous Membrane
shows a series of permanent circular or semilunar foldsplicae circulares,
best developed in the jejunum, increase the intestinal surface 3-fold
villi0.5- to 1.5-mm-long, project into the lumen, increase the intestinal
surface 10-fold
in the duodenumleaf-shaped, gradually assume fingerlike shapes moving
toward the ileum
covered by a simple columnar epithelium and goblet cells
between the villi are small openings of short tubular glandsintestinal crypts
or crypts of Lieberkhn, contain absorptive cells (enterocytes), goblet cells,
Paneth cells, enteroendocrine cells, and stem cells
enterocytestall columnar cells, with an oval nucleus
apex has microvillistriated (or brush) border, increase the intestinal surface
disaccharidases and peptidases secreted by these cells, bound to the microvilli,
hydrolyze the disaccharides and dipeptides into monosaccharides and amino
plicae, villi, and microvilliresponsible for a 600-fold increase in the intestinal
surface, resulting in a total absorptive area of 200 m2!greatly increase the
area of contact between the intestinal surface and the nutrients
fats digestion results from the action of pancreatic lipase and bileabsorption
takes place in the duodenum and upper jejunum
deficiencies of disaccharidasescharacterized by digestive
disturbances, some are genetic in origin

absorption of nutrientsgreatly hindered by atrophy of the
intestinal mucosa caused by infections or nutritional
deficiencies, producing the malabsorption syndrome

goblet cellsproduce mucins that are hydrated and form mucus,
protect and lubricate the lining of the intestine

paneth cellsexocrine cells with large, eosinophilic secretory
granules in their apical cytoplasm, release lysozyme,
phospholipase A2, and defensinsbind and breakdown
bacterial walls, important role in innate immunity and in
regulating the microenvironment of the intestinal crypts

enteroendocrine cellssecreting various peptides and
represents part of the diffuse neuroendocrine system , release
their secretory granules by exocytosis and the hormones exert
paracrine (local) or endocrine (blood-borne) effects
hormone secretincaused the pancreas to secrete its alkaline
digestive fluid

M (microfold) cellsspecialized epithelial cells in the ileum
overlying Peyer patches, characterized by the presence of basal
membrane invaginations or pockets containing many
intraepithelial lymphocytes and antigen-presenting cells
selectively endocytose antigens and transport them to the
underlying macrophages and lymphocytes, which then migrate to
lymph nodes where immune responses to foreign antigens are
serve as sampling stations where material in the lumen of the gut is
transferred to immune cells of the MALT in the lamina propria
basement membrane under the M cells is porous, facilitating transit
of cells between the lamina propria and the pockets of M cells
Lamina Propria through Serosa
lamina propriacomposed of loose connective tissue with blood and
lymph vessels, nerve fibers, and smooth muscle cells
smooth muscle fibers inside the villiresponsible for their rhythmic
movements, which are important for efficient absorption
muscularis mucosaeproduces local movements of the villi and plicae
proximal part of the duodenumhas large clusters of branched
tubular mucous glandsduodenal/submucosal (or Brunner)
glands, with small excretory ducts opening among the intestinal crypts
product of the glands is alkaline (pH 8.19.3)neutralizes chyme
entering the duodenum from the pylorus, protecting the mucous
membrane and bringing the intestinal contents to the optimum pH for
pancreatic enzyme action
in the ileum both the lamina propria and submucosacontain the
lymphoid nodule aggregates known as Peyer patches, an important
component of the MALT
muscularis propriacomposed of an internal circular layer and an
external longitudinal layer, and is covered by a thin serosa with
Vessels & Nerves
nourish the intestine and remove absorbed products of
digestion, penetrate the muscularis propria and form a large
submucosal plexus

from the submucosa, branches extend through the muscularis
mucosae and lamina propria and into the villi
each villus receives, one or more branches that form a capillary
network just below its epithelium
at the tips of the villi, one or more venules arise from these
capillaries and run in the opposite direction, reaching the veins of
the submucosal plexus and surround lymphoid nodules

lymph vessels of the intestinebegin as closed tubes in the cores
of villi

lactealsimportant for lipid absorption; chylomicrons of
lipoprotein are preferentially taken up by lacteals rather than
blood capillaries
another important intestinal functionrhythmic movement of the villi
result of the contraction of smooth muscle fibers running vertically
from the muscularis mucosae to the tip of the villi
contractions occur at the rate of several strokes per minute and have a
pumping action on the villi that propel the lymph to the mesenteric

innervationformed by intrinsic and extrinsic components
comprising the enteric nervous system

intrinsic componentcomprises many small and diffuse groups of
neurons that form the myenteric (Auerbach) plexus, between the
ICOL layers of the muscularis propria, and the smaller submucosal
(Meissner) plexus in the submucosa
intrinsic innervationresponsible for the intestinal contractions that
occur even in the absence of the extrinsic innervation that modulates
the activity

enteric nervous systemcontains sensory neurons that receive
information regarding the intestinal content (chemoreceptors) and the
degree of intestinal wall expansion (mechanoreceptors)
Large Intestine (Bowel)
consists of a mucosal membrane with no folds except in its distal (rectal)
portion and no villi
mucosapenetrated throughout its area by tubular intestinal glands lined by
goblet and absorptive cells, with a small number of enteroendocrine cells
absorptive cells or colonocytescolumnar and have short, irregular microvilli
main functions: absorption of water, formation of fecal mass from
undigestible material, and production of mucus that lubricates the intestinal
lamina propriarich in lymphoid cells and in lymphoid nodules that
frequently extend into the submucosa
richness in MALT is related to the large bacterial population of the large
muscularis propriacomprises longitudinal and circular strands, with fibers of
the outer layer gathered in three longitudinal bands called taeniae coli
intraperitoneal portions of the colon are covered by serosacharacterized by
small, pendulous protuberances of adipose tissue.
near the beginning of the large intestineappendixan evagination of the
has no function in digestion, a significant component of the MALT, with
abundant lymphoid follicles in its wall

appendixcan easily become a site of inflammation
severe appendicitis is a medical emergency since a burst
appendix will produce infection of the peritoneal cavity

anal regionmucous membrane forms a series of
longitudinal folds, the anal columns

about two cm above the anal opening, at the recto-anal
junction, the lining of the mucosa is replaced by stratified
squamous epithelium
in this regionlamina propria contains a plexus of large
veins, when excessively dilated and varicose, can produce
approximately 9095% of malignant tumors of the
digestive systemderived from gastric or intestinal
epithelial cells, usually in the large intestine

malignant tumors of the colon are derived almost
exclusively from its glandular epithelium

thank you. good am.