Histology of the Esophagus & Stomach Flashcards
4 Layers of GI Tract: Lumen –> Superficial
(1) Mucosa
(2) Submucosa
(3) Muscularis Externa
(4) Serosa/Adventitia
Serosa: Intraperitoneal or Retroperiotneal?
Intraperitoneal
Adventitia: Intraperitoneal or Retroperiotneal?
Retroperitoneal
3 Components of the Mucosal Layer:
(1) Lining Epithelium (varies segment to segment)
(2) Underlying Lamina Propria
(3) Muscularis Mucosae
Mucosal Layer: Lamina Propria
- Vascularized, loose connective tissue
- Contains lymphatic nodules and WBCs
Mucosal Layer: Muscularis Mucosae
- Thin layer of smooth muscle that controls mobility and infoldings of mucosa
Submucosal Layer
- Consists of a dense irregular connective tissue with neurovasculature and lymphatics
- Nerve plexus associated with this layer
- Glands may also be present (esophagus and duodenum)
Muscularis Externa
- Two layers of smooth muscle
- Neurovasculature plexuses located between layers
Muscularis Externa: Circular Layer
- Inner layer
- Function is to constrict the lumen
Muscularis Externa: Longitudinal Layer
- Outer layer
- Function is to shorten the tube
Serosa/Adventitia
- GI tract is suspended by a mesentery/peritoneal fold
- Organs may have adventitia and/or serosa
The Adventitial is covered by ___ and forms ____ layer
- Mesothelium
- Serosa
Areas without mesothelium covering have an:
Adventitia
What are the 4 Basic Mucosal Types?
- Protective
- Secretory
- Absorptive
- Absorptive + Protective
Mucosa Types: Protective
- Nonkeratinized stratified squamous epithelium
- Located in oral cavity, pharynx and anal canal
Mucosa Types: Absorptive
- Simple columnar epithelium
- Mucosa arranged as villi with crypts; glands may or may not be present
- Located in SI
Mucosa Types: Secretory
- Simple columnar epithelium
- Mucosa is packed with glands
- Located in Stomach
Mucosa Types: Absorptive + Protective
- Simple columnar epithelium
- Mucosa arranged into closely packed glands with extensive goblet cells
- Located in LI
Two Plexuses of Sensory and Motor Neurons (Intrinsic/Enteric Innervation), linked by interneurons:
(1) Submucosal Plexus (of Meissner)
(2) Myenteric Plexus (of Auerbach)
Intrinsic/Enteric Innervation
Responsive to local stimuli and input from ANS
Intrinsic/Enteric Innervation Regulates and Controls:
(1) Peristaltic contractions of muscularis externa and movements of muscularis mucosae
(2) Secretory activities of mucosal and submucosal glands
Location of Myenteric Plexus:
Between the Circular Muscle and Longitudinal Muscle
Location of Submucosal Plexus:
Between the Submucosa and Circular Muscle
Preganglionic axons of the Parasympathetics ____ motility.
Increase
Postganglionic axons of the Sympathetics _____ motlity
Decrease
Esophagus
- Fibromuscular tube that conveys food from oropharynx to stomach
- Contains both Serosa and Adventitia
- Contains both mucosal and submucosal glands that produce a thin layer of mucus to lubricate the epithelium
Part of Esophagus that has Adventitia:
Thoracic Esophagus
Part of Esophagus that has Serosa:
Inferior to Diaphragm
Glands of the Esophagus: Cardiac Esophageal Glands
Reside in the Lamina Propria of the terminal esophagus
Glands of the Esophagus: Submucosal Glands
Consist of small lobules with mucous and serous cell types
Esophagus: Mucosal Layer
- Non-keratinized stratified squamous overlying a lamina propria
- Numerous folds distend with food passage
Esophagus: Submucosal Layer
- Network of collagen and elastic fibers
- Contains many small blood vessels
- Submucosal venous plexuses drain into both the systemic and portal venous system
Increased pressure in the Esophageal Submucosal Venous Plexuses can lead to:
Esophageal Varices (dilation of submucosal venous sinuses)
Esophagus: Muscularis Layer
Consists of inner circular layer and outer longitudinal layer; layers have segment-dependent variations
Muscularis Layer: Upper 1/3 Esophagus
Skeletal Muscle (Striated)
Muscularis Layer: Middle 2/3 Esophagus
Skeletal and Smooth Muscle
Muscularis Layer: Lower 1/3 Esophagus
Smooth Muscle
Lower Esophageal Spincter
Functional sphincter that prevents reflux of gastric contents
Gastroesophageal Reflux Disease (GERD)
Causes chronic inflammation, ulceration, and difficulty in swallowing (dysphagia) due to reflux of gastric contents
Barrett’s Esophagus
- Result of chronic GERD
- Nonkeratinized stratified squamous epithelium in the transition zone transform into columnar mucous secreting/glandular tissue
Gastroesophageal Junction
- Epithelial transition from esophagus to stomach
- Nonkeratinized stratified squamous –> simple columnar
Epithelium in the stomach is:
Glandular, with pits and glands
4 Regions of the Stomach:
(1) Carida
(2) Fundus
(3) Body
(4) Pyloris
Stomach: Cardia
2-3 cm near the esophageal opening
Stomach: Fundus
Projects to the left of the cardia
Stomach: Body
Extensive central region
Stomach: Pyloris
Ends at gastroduodenal orifice
Rugae
- Longitudinal fold of the gastric mucosa and submucosa
- Expand during filling of the stomach
- Covered by gastric pits (contain gastric glands)
Gastric Glands
- Located in Gastric Pits
- Produce a mucosal barrier to protect the mucosal surface
- Shorter and wider base
Stomach: Mucosa Layer
- Simple columnar epithelium
- Lamina propria contains cardiac, gastric, and pyloric glands
- Reticular and collagen fibers predominate
- Muscularis mucosae facilitates release of gastric gland secretions
Stomach: Submucosal Layer
- Dense irregular connective tissue with collagen and elastic fibers
- Contains arterioles, venous plexuses and lymphatics
- Meissner’s Plexus located here
Stomach: Muscularis Externa
- Consists of 3 layers of smooth muscle: oblique, circular and longitudinal
- Circular muscle layer thickens in pyloric region
Pyloric Sphincter
Thickening of circular muscle layer in the pyloris
Stomach: Serosa
Loose connective tissue and blood vessels
Fundic (Gastric) Glands
- Simple (one opening), branched, tubular glands present throughout the gastric mucosa
- Extend from bottom of gastric pits to muscularis mucosae (entire length of mucosa)
Gastric Glands: Gastric Pit
Invaginations of the mucosal surface
Gastric Glands: Isthmus/Neck
Narrow region between the gastric pit and gastric gland
3 Regions of Fundic Glands:
(1) Gastric Pit
(2) Isthmus/Neck
(3) Gastric Gland
2 Main Cell Types within the Gastric Pit of the Fundic Gland:
(1) Surface mucous cells
(2) Mucous neck cells
2 Main Cell Types within the Isthmus/Neck of the Fundic Gland:
(1) Mucous neck cells
(2) Parietal cells
2 Main Cell Types within the Gastric Gland of the Fundic Gland:
(1) Chief cells
(2) G cells
2 Types of Mucous Cells:
(1) Surface Mucous Cells
(2) Mucous Neck Cells
Surface Mucous Cells
Line the lumen of the stomach and gastric pits
Mucous Neck Cells
- Located in the neck, in singles and/or clusters
- Round nuclei and apical secretory granules
Function of Mucous Cells
- Form an insoluble gel (mucins + water) that attaches to surface of gastric mucosa
- Neutralizes the microenvironment to an alkaline pH (form bicarb ions)
____ Nerve stimulation and ____ increase the secretion of soluble mucous by Mucous Neck Cells.
- Vagal
- ACh
Chief (Zymogenic) Cells
- Located in body of stomach; found in clusters in inferior 1/3 of gastric glands
- Secrete Pepsinogen, but also produce Gastric Lipase (digests lipids)
Hallmarks of Chief Cells
- Abundant RER
- Abundant apical secretory (zymogen) granules
- Basal nuclei with basophilic cytoplasm
Pepsinogen
- Proenzyme stored in secretory granules in chief cells
- Releases and converted to pepsin by acidic environment of stomach
- Proteolytic enzyme that digests most proteins
- Exocytosis of pepsinogen is rapid and stimulated by feeding
Parietal Cells
- Located in body of stomach; found near neck and upper segment of gastric gland
- Produce HCl (gastric juice) and Intrinsic Factor (IF)
- Active cells have deep invaginations of the apical plasma membrane
Hallmarks of Parietal Cells
- Large, typically round or pyramid-shaped
- One (sometimes two) central round nuclei
- Cytoplasm is eosinophilic due to large amount of mitochondria
Intracellular Canaliculus
- Found in active parietal cells
- Deep invaginations of the apical plasma membrane – large SA produced by thousands of microvilli
Intrinsic Factor
- Secreted from Parietal Cells
- Glycoprotein
- Binds to Vitamin B12
Gastric Ulcers
- Painful erosive lesions of the mucosa that may extend to deeper layers
- Occur between the lower esophagus and portions of the small intestine
- Causes: bacterial infection with H. Pylori, NSAIDS, overproduction of HCl or Pepsin, lowered production or secretion of mucus or bicarb
Enteroendocrine Cells
- Scattered epithelial cells in the gastric mucosa
- Produce hormones that are important in digestion
- Release products that exert either paracrine or endocrine effects
Most Enteroendocrine Cells are ____ cells that process ___
- APUD (amine precursor uptake and decarboxylation)
- Amines
All Enteroendocrine Cells are considered part of the:
Diffuse Neuroendocrine System (DNES)
Hormones Produced by Enteroendocrine Cells in the Fundus of the Stomach:
- Ghrelin
- Somatostatin
- VIP
- Gastrin (small amount)
Hormones Produced by Enteroendocrine Cells in the Antrum of the Stomach:
- Somatostatin
- VIP
- Gastrin
Hormones Produced by Enteroendocrine Cells in the Duodenum:
- Somatostatin
- Motilin
- GIP
- VIP
- Secretin
- CCK
- Gastrin
Hormones Produced by Enteroendocrine Cells in the Jejunum:
- Somatostatin
- Motilin
- GIP
- VIP
- Secretin
- CCK
- Gastrin (small amount)
Hormones Produced by Enteroendocrine Cells in the Ileum:
- Somatostatin
- VIP
- Secretin (small amount)
- CCK (small amount)
Hormones Produced by Enteroendocrine Cells in the Colon:
- Somatostatin
- VIP
Enteroendocrine Cells: Closed Type
- Cellular apex is covered by neighboring epithelial cells
- Not exposed to GI lumen
Enteroendocrine Cells: Open Type
Apical end of cell contacts the lumen and has chemoreceptors that sample luminal contents
Effects of Hormones released from Enteroendocrine Cells:
- Regulation of peristalsis and motility
- Secretion of digestive enzymes, water and electrolytes
- Sense of being satiated after eating
Pyloric Glands
- Branched, coiled, tubular glands of the pylorus
- Largely release Gastrin from G Cells
- Occasional Parietal Cells are present
- Lymphoid nodules can be seen in the lamina propria (GALT)
Pyloric Glands are lined by ___-___ cells with large and pale ___ mucus
- Mucus-secreting
- Secretory
Pyloric Glands empty into ____ that occupy ___ of the mucosa
- Pits
- Half