Organs of the Upper Gastrointestinal Tract<\/h1>\r\n<\/div>\r\nBesides the esophagus, organs of the\u00a0[pb_glossary id=\"4574\"]upper gastrointestinal (GI) tract[\/pb_glossary]<\/strong>\u00a0include the mouth, pharynx, and stomach. These hollow organs are all connected to form a tube through which food passes during digestion. The only role in digestion played by the pharynx and esophagus is to move food through the GI tract. The mouth and stomach, in contrast, are organs where digestion \u2014 or the breakdown of food \u2014 also occurs. In both of these organs, food is broken into smaller pieces ([pb_glossary id=\"4550\"]mechanical digestion[\/pb_glossary]), as well as broken down chemically ([pb_glossary id=\"4551\"]chemical digestion[\/pb_glossary]). It should be noted that the first part of the small intestine (duodenum) is considered in some contexts to be part of the upper GI tract, but that practice is not followed here.\r\n\r\nMouth<\/h1>\r\n<\/div>\r\nThe\u00a0[pb_glossary id=\"4297\"]mouth[\/pb_glossary]<\/strong>\u00a0is the first organ of the GI tract. Most of the oral cavity is lined with [pb_glossary id=\"3538\"]mucous membrane[\/pb_glossary]. This tissue produces mucus, which helps moisten, soften, and lubricate food. Underlying the mucous membrane is a thin layer of [pb_glossary id=\"2982\"]smooth muscle[\/pb_glossary] to which the mucous membrane is only loosely connected. This gives the mucous membrane considerable ability to stretch as you eat food. The roof of the mouth, called the palate, separates the oral cavity from the nasal cavity. The front part is hard, consisting of mucous membrane covering a plate of bone. The back part of the palate is softer and more pliable, consisting of mucous membrane over muscle and connective tissue. The hard surface of the front of the palate allows for pressure needed in chewing and mixing food. The soft, pliable surface of the back of the palate can move to accommodate the passage of food while swallowing. Muscles at either side of the soft palate contract to create the swallowing action.\r\n\r\nSeveral specific structures in the mouth are specialized for digestion. These include salivary glands, tongue, and teeth.\r\nSalivary Glands<\/h2>\r\n[caption id=\"attachment_4611\" align=\"alignright\" width=\"357\"]![\"15.4.2\"](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Blausen_0780_SalivaryGlands-2.png\")
Figure 15.4.2 Salivary glands in the mouth include the three major pairs of glands shown here.<\/em>[\/caption]\r\n\r\nThe mouth contains three pairs of major\u00a0[pb_glossary id=\"4577\"]salivary glands[\/pb_glossary]<\/strong>, shown in Figure 15.4.2. These three pairs are all [pb_glossary id=\"6001\"]exocrine glands<\/span>[\/pb_glossary]<\/span>\u00a0that secrete <\/span>[pb_glossary id=\"4595\"]saliva[\/pb_glossary]<\/strong>\u00a0into the mouth through ducts.<\/span>\r\n\r\n \t- The largest of the three major pairs of salivary glands are the\u00a0[pb_glossary id=\"4612\"]parotid glands[\/pb_glossary]<\/strong>, which are located on either side of the mouth in front of the ears.<\/li>\r\n \t
- The next largest pair is the\u00a0[pb_glossary id=\"5457\"]submandibular glands[\/pb_glossary]<\/strong>, located beneath the lower jaw.<\/li>\r\n \t
- The third pair is the\u00a0[pb_glossary id=\"5527\"]sublingual glands[\/pb_glossary]<\/strong>, located underneath the tongue.<\/li>\r\n<\/ol>\r\nIn addition to these three pairs of major salivary glands, there are also hundreds of minor salivary glands in the oral mucosa lining the mouth and on the [pb_glossary id=\"4615\"]tongue[\/pb_glossary]. Along with the major glands, most of the minor glands secrete the digestive enzyme [pb_glossary id=\"4578\"]amylase[\/pb_glossary], which begins the chemical digestion of starch and glycogen (polysaccharides). However, the minor salivary glands on the tongue secrete the fat-digesting enzyme [pb_glossary id=\"4602\"]lipase[\/pb_glossary], which in the mouth is called lingual lipase (to distinguish it from pancreatic lipase secreted by the pancreas).\r\n\r\nSaliva secreted by the salivary glands mainly helps digestion, but it also plays other roles. It helps maintain dental health by cleaning the teeth, and it contains [pb_glossary id=\"5659\"]antibodies[\/pb_glossary] that help protect against infection. By keeping the mouth lubricated, saliva also allows the mouth movements needed for speech.\r\n
Tongue<\/h2>\r\nThe [pb_glossary id=\"4615\"]tongue[\/pb_glossary] is a fleshy, muscular organ that is attached to the floor of the mouth by a band of ligaments that gives it great mobility. This is necessary so the tongue can manipulate food for chewing and swallowing. Movements of the tongue are also necessary for speaking. The upper surface of the tongue is covered with tiny projections called [pb_glossary id=\"4616\"]papillae[\/pb_glossary], which contain taste buds. The latter are collections of [pb_glossary id=\"3128\"]chemoreceptor[\/pb_glossary] cells (shown in Figure 15.4.3). These sensory cells sense chemicals in food and send the information to the brain via cranial nerves, thus enabling the sense of taste.\r\n\r\n[caption id=\"attachment_4617\" align=\"aligncenter\" width=\"567\"]![\"15.4.3](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1402_The_Tongue-2.jpg\")
Figure 15.4.3 There are several types of papillae located in different areas on the tongue.<\/em>[\/caption]\r\n\r\nThere are five basic tastes detected by the chemoreceptor cells in taste buds: saltiness, sourness, bitterness, sweetness, and umami (often described as a meaty taste). Contrary to popular belief, taste buds for the five basic tastes are not located on different parts of the tongue. Why does taste matter? The taste of food helps to stimulate the secretion of saliva from the salivary glands. It also helps us to eat foods that are good for us, instead\u00a0of\u00a0rotten or toxic foods. The detection of saltiness, for example, enables the control of salt intake and salt balance in the body. The detection of sourness may help us avoid spoiled foods, which often taste sour due to fermentation by bacteria. The detection of bitterness warns of poisons, because many plants defend themselves with toxins that taste bitter. The detection of sweetness guides us to foods that supply quick energy. The detection of umami may signal protein-rich foods.\r\nTeeth<\/h2>\r\nThe\u00a0[pb_glossary id=\"5455\"]teeth[\/pb_glossary]<\/strong> are complex structures made of a bone-like material called dentin and covered with enamel, which is the hardest tissue in the body. Adults normally have a total of 32 teeth, with 16 in each jaw. The right and left sides of each jaw are mirror images in terms of the numbers and types of teeth they contain. Teeth have different shapes to suit them for different aspects of mastication (chewing). The different types of teeth are illustrated in Figure 15.4.4.\r\n\r\n[caption id=\"attachment_4623\" align=\"alignright\" width=\"453\"]![\"15.4.4](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1024px-3D_Medical_Animation_Still_Showing_Types_of_Teeth-2.jpg\")
Figure 15.4.4 In adults, both sides of each jaw normally have the same numbers of the four types of teeth shown here.<\/em>[\/caption]\r\n\r\n \t- [pb_glossary id=\"4619\"]Incisors[\/pb_glossary]<\/strong>\u00a0are the sharp, blade-like teeth at the front of the mouth. They are used for cutting or biting off pieces of food. In adults, there are normally four incisors in each jaw, or eight in total.<\/li>\r\n \t
- [pb_glossary id=\"4620\"]Canines[\/pb_glossary]<\/strong>\u00a0are the pointed teeth on either side of the incisors. They are used for tearing foods that are tough or stringy. Adults normally have two canines in each jaw, or four altogether.<\/li>\r\n \t
- [pb_glossary id=\"4621\"]Premolars[\/pb_glossary]<\/strong>\u00a0and\u00a0[pb_glossary id=\"4622\"]molars[\/pb_glossary]<\/strong>\u00a0are cuboid teeth with cusps and grooves that are located on the sides and toward the back of the jaws. Premolars are closer to the front of the mouth. Molars are larger and have more cusps than premolars, but both are used for crushing and grinding food. Adults normally have two premolars and three molars on each side of each jaw, for a total of eight premolars and twelve molars.<\/li>\r\n<\/ul>\r\n\r\n
Pharynx<\/h1>\r\n<\/div>\r\nThe tube-like [pb_glossary id=\"4296\"]pharynx[\/pb_glossary] (see Figure 15.4.5 below) plays a dual role as an organ of both respiration and digestion. As part of the [pb_glossary id=\"2912\"]respiratory system[\/pb_glossary], it conducts air between the [pb_glossary id=\"4295\"]nasal cavity[\/pb_glossary] and [pb_glossary id=\"4298\"]larynx[\/pb_glossary]. As part of the [pb_glossary id=\"5969\"]digestive system[\/pb_glossary], it allows swallowed food to pass from the oral cavity to the [pb_glossary id=\"4557\"]esophagus[\/pb_glossary]. Anything swallowed has priority over inhaled air when passing through the pharynx. During swallowing, the backward motion of the tongue causes a flap of elastic cartilage \u2014 called the [pb_glossary id=\"4302\"]epiglottis[\/pb_glossary] \u2014 to close over the opening to the larynx. This prevents food or drink from entering the larynx.\r\n\r\n[caption id=\"attachment_4625\" align=\"aligncenter\" width=\"424\"]![\"15.4.5\"](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Illu01_head_neck-2.jpg\")
Figure 15.4.5 The tongue moves backward during swallowing to cause the epiglottis to cover the opening to the larynx. As a result, food passes from the pharynx to the esophagus \u2014 and not into the larynx.<\/em>[\/caption]\r\n\r\nEsophagus<\/span>\r\n\r\nThe\u00a0[pb_glossary id=\"4557\"]esophagus[\/pb_glossary]<\/strong> (shown in Figure 15.4.6) is a muscular tube through which food is pushed from the pharynx to the stomach. The esophagus passes through an opening in the [pb_glossary id=\"4292\"]diaphragm[\/pb_glossary] (the large breathing muscle that separates the abdomen from the thorax) before reaching the [pb_glossary id=\"4558\"]stomach[\/pb_glossary]. In adults, the esophagus averages about 25 cm (about 9.8 inches) in length, depending on a person\u2019s height. The inner lining of the esophagus consists of mucous membrane, which provides a smooth, slippery surface for the passage of food. The cells of this membrane are constantly being replaced as they are worn away from the frequent passage of food over them.\r\n\r\n[caption id=\"attachment_4626\" align=\"aligncenter\" width=\"234\"]![\"15.4.6](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/ZenkerSchraeg-2.gif\")
Figure 15.4.6 The esophagus moves food by peristalsis from the pharynx to the stomach. Note, this x-ray of a swallow shows a fraction of the ingested liquid being trapped in an atypical diverticulum of the esophagus.<\/em>[\/caption]\r\n\r\nWhen food is not being swallowed, the esophagus is closed at both ends by upper and lower esophageal sphincters.\u00a0[pb_glossary id=\"4627\"]Sphincters[\/pb_glossary]<\/strong>\u00a0are rings of muscle that can contract to close off openings between structures. The upper esophageal sphincter is triggered to relax and open by the act of swallowing, allowing a bolus of food to enter the esophagus from the pharynx. Then, the esophageal sphincter closes again to prevent food from moving back into the pharynx from the esophagus.\r\n\r\nOnce in the esophagus, the food [pb_glossary id=\"4579\"]bolus[\/pb_glossary] travels down to the stomach, pushed along by the rhythmic contraction and relaxation of muscles ([pb_glossary id=\"2890\"]peristalsis[\/pb_glossary]). The lower esophageal sphincter is located at the junction between the esophagus and the stomach. This sphincter opens when the bolus reaches it, allowing the food to enter the stomach. The sphincter normally remains closed at other times to prevent the contents of the stomach from entering the esophagus. Failure of this sphincter to remain completely closed can lead to heartburn. If it happens chronically, it can lead to gastroesophageal reflux disease<\/a> (GERD), in which the mucous membrane of the esophagus may become damaged by the highly acidic contents of the stomach.\r\n\r\nSee the video below to see how the parts of the upper GI tract work together to carry out swallowing:\r\n\r\nhttps:\/\/youtu.be\/pNcV6yAfq-g\r\nSwallowing, uploaded by Alejandra Cork, 2012.<\/p>\r\nStomach<\/span>\r\n\r\nThe\u00a0[pb_glossary id=\"4558\"]stomach[\/pb_glossary]<\/strong> is a J-shaped organ (shown in Figure 15.4.7) that is joined to the esophagus at its upper end, and to the first part of the [pb_glossary id=\"4559\"]small intestine[\/pb_glossary] ([pb_glossary id=\"4576\"]duodenum[\/pb_glossary]) at its lower end. When the stomach is empty of food, it normally has a volume of about 75 millilitres, but it can expand to hold up to about a litre of food. Waves of muscle contractions (peristalsis) passing through the muscular walls of the stomach cause the food inside to be mixed and churned. The wall of the stomach has an extra layer of muscle tissue not found in other organs of the GI tract that helps it squeeze and mix the food. These movements of the stomach wall contribute greatly to mechanical digestion by breaking the food into much smaller pieces. The churning also helps mix the food with stomach secretions that aid in its chemical digestion.\r\n\r\n\r\n[caption id=\"attachment_4628\" align=\"aligncenter\" width=\"412\"]![\"15.4.7\"](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/stomach-layers-white-cc_20190410_1053046020-2.jpg\")
Figure 15.4.7 The stomach is connected at the top to the esophagus and at the bottom to the duodenum of the small intestine. The pylorus, or pyloric sphincter, controls emptying of the stomach into the small intestine. The outer surface of the stomach is covered with fibrous connective tissue. There are three layers of muscle in the stomach wall. Each layer runs in a different direction: circular, longitudinal and oblique.<\/em>[\/caption]\r\n\r\n<\/div>\r\nSecretions of the stomach include gastric acid, which consists mainly of hydrochloric acid (HCl). This makes the stomach contents highly acidic, which is necessary so that the enzyme [pb_glossary id=\"4581\"]pepsin[\/pb_glossary] \u2014 also secreted by the stomach \u2014 can begin the digestion of [pb_glossary id=\"5813\"]protein[\/pb_glossary]. [pb_glossary id=\"4571\"]Mucus[\/pb_glossary] is secreted by the lining of stomach to provide a slimy protective coating against the otherwise damaging effects of gastric acid. The fat-digesting enzyme [pb_glossary id=\"4602\"]lipase[\/pb_glossary] is secreted in small amounts in the stomach, but very little fat digestion occurs there.\r\n\r\nBy the time food has been in the stomach for about an hour, it has become the thick, semi-liquid [pb_glossary id=\"4582\"]chyme[\/pb_glossary]. When the [pb_glossary id=\"4559\"]small intestine[\/pb_glossary] is ready to receive chyme, a sphincter between the stomach and duodenum \u2014 called the pyloric sphincter \u2014 opens to allow the chyme to enter the small intestine for further digestion and absorption.\r\n\r\nFeature: Reliable Sources<\/h1>\r\n<\/div>\r\nThe ongoing epidemic of obesity in the wealthier nations of the world, including Canada, has led to the development of several different bariatric surgeries that modify the stomach to help obese patients reduce their food intake and lose weight. Go online to learn more about bariatric surgery. Find sources you judge to be reliable that answer the following questions:\r\n\r\n \t- Who qualifies for bariatric surgery?<\/li>\r\n \t
- Describe the bariatric surgeries commonly called stomach stapling, lap band, and gastric sleeve. How does each type of surgery modify the stomach? In terms of weight loss, how effective is each type?<\/li>\r\n \t
- What are the major potential risks of bariatric surgery?<\/li>\r\n \t
- Besides weight loss, what other benefits have been shown to result from bariatric surgery?<\/li>\r\n<\/ol>\r\n\r\n
\r\n15.4 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- Organs of the [pb_glossary id=\"4574\"]upper gastrointestinal (GI) tract[\/pb_glossary] include the mouth, pharynx, esophagus, and stomach.<\/li>\r\n \t
- The [pb_glossary id=\"4297\"]mouth[\/pb_glossary] is the first organ of the GI tract. It has several structures that are specialized for digestion, including [pb_glossary id=\"4577\"]salivary glands[\/pb_glossary], [pb_glossary id=\"4615\"]tongue[\/pb_glossary], and [pb_glossary id=\"5455\"]teeth[\/pb_glossary]. Both [pb_glossary id=\"4550\"]mechanical digestion[\/pb_glossary] and [pb_glossary id=\"4551\"]chemical digestion[\/pb_glossary] of carbohydrates and fats begin in the mouth.<\/li>\r\n \t
- The [pb_glossary id=\"4296\"]pharynx[\/pb_glossary] and [pb_glossary id=\"4557\"]esophagus[\/pb_glossary] move food from the mouth to the stomach, but are not involved in the process of digestion or absorption. Food moves through the esophagus by [pb_glossary id=\"2890\"]peristalsis[\/pb_glossary].<\/li>\r\n \t
- Mechanical and chemical digestion continue in the stomach. Acid and digestive enzymes secreted by the stomach start the chemical digestion of proteins. The stomach turns masticated food into a semi-fluid mixture called [pb_glossary id=\"4582\"]chyme[\/pb_glossary].<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n15.4 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [h5p id=\"622\"]<\/li>\r\n \t
- Identify structures in the mouth that are specialized for digestion.<\/li>\r\n \t
- Describe digestion in the mouth.<\/li>\r\n \t
- What general role do the pharynx and esophagus play in the digestion of food?<\/li>\r\n \t
- How does food travel through the esophagus?<\/li>\r\n \t
- Describe digestion in the stomach.<\/li>\r\n \t
- Describe the differences between how air and food normally move past the pharynx.<\/li>\r\n \t
- Name two structures in the mouth that contribute to mechanical digestion.<\/li>\r\n \t
- What structure normally keeps stomach contents from backing up into the esophagus?<\/li>\r\n \t
- Thirty minutes after you eat a meal, where is most of your food located? Explain your answer.<\/li>\r\n \t
- What are two roles of mucus in the upper GI tract?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n
\r\n15.4 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/zGoBFU1q4g0\r\nWhat causes cavities? - Mel Rosenberg, TED-Ed, 2016.<\/p>\r\nhttps:\/\/youtu.be\/gCrmFbgT37I\r\n
How does alcohol make you drunk? - Judy Grisel, TED-Ed, 2020.<\/p>\r\nhttps:\/\/youtu.be\/twJBEypJDfU\r\n
Gastric Bypass Surgery: One Patient\u2019s Journey - Mayo Clinic, 2014.<\/p>\r\nhttps:\/\/youtu.be\/u_1sVri3b2w\r\n
Here's What Happens In Your Body When You Swallow Gum | The Human Body, Tech Insider, 2018.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 15.4.1<\/strong>\r\n\r\nHandstand, Pender Island, B.C.<\/a> [photo] by Jasper Garratt<\/a> on Unsplash<\/a> is used under the Unsplash License<\/a> (https:\/\/unsplash.com\/license).\r\n\r\nFigure 15.4.2<\/strong>\r\n\r\nBlausen_0780_SalivaryGlands<\/a> by BruceBlaus<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 15.4.3<\/strong>\r\n\r\n1402_The_Tongue<\/a>\u00a0by OpenStax<\/a> on Wikimedia Commons is used under a CC BY 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/4.0) license.\r\n\r\nFigure 15.4.4<\/strong>\r\n\r\n1024px-3D_Medical_Animation_Still_Showing_Types_of_Teeth<\/a>\u00a0by http:\/\/www.scientificanimations.com<\/a> on Wikimedia Commons is used under a CC BY-SA 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/4.0) license.\r\n\r\nFigure 15.4.5<\/strong>\r\n\r\nIllu01_head_neck<\/a> by Arcadian<\/a> from NCI\/ SEER Training Modules<\/a> on Wikimedia Common is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/public_domain).\r\n\r\nFigure 15.4.6<\/strong>\r\n\r\nZenkerSchraeg<\/a> by Bernd Br\u00e4gelmann<\/a>\u00a0Braegel<\/a> on Wikimedia Commons is used under a\u00a0CC BY 3.0<\/a>\u00a0 (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\u00a0 (Courtesy of Dr. Martin Steinhoff. It is not known whether there is a possibly necessary approval from the patient.)\r\n\r\nFigure 15.4.7<\/strong>\r\n\r\nAnatomy stomach \u2013 white<\/a> by www.medicalgraphics.de from MedicalGraphics<\/a> is used under a\u00a0 CC BY-ND 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/) license.\r\nReferences<\/h2>\r\n
Alejandra Cork. (2012). Swallowing. YouTube. https:\/\/www.youtube.com\/watch?v=pNcV6yAfq-g&t=4s<\/p>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 27). Figure\u00a0<\/span><\/span>14.3<\/span><\/span>\u00a0<\/span>The tongue [digital image]. In Anatomy and Physiology<\/em> (Section 14.1). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/14-1-sensory-perception<\/span><\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nMayo Clinic. (2014, August 26). Gastric bypass surgery: One patient\u2019s journey - Mayo Clinic. https:\/\/www.youtube.com\/watch?v=twJBEypJDfU&feature=youtu.be<\/p>\r\n
Mayo Clinic Staff. (n.d.). Gastroesophageal reflux disease (GERD) [online article]. MayoClinic.org. https:\/\/www.mayoclinic.org\/diseases-conditions\/gerd\/symptoms-causes\/syc-20361940<\/p>\r\n
Tech Insider. (2018, March 20). Here's what happens in your body when you swallow gum | The human body. YouTube. https:\/\/www.youtube.com\/watch?v=u_1sVri3b2w&feature=youtu.be<\/p>\r\n
TED-Ed. (2020, April 9). How does alcohol make you drunk? - Judy Grisel. YouTube. https:\/\/www.youtube.com\/watch?v=gCrmFbgT37I&feature=youtu.be<\/p>\r\n
TED-Ed. (2016, October 17). What causes cavities? - Mel Rosenberg. YouTube. https:\/\/www.youtube.com\/watch?v=zGoBFU1q4g0&feature=youtu.be<\/p>\r\n ","rendered":"
<\/p>\n![\"15.4.1](\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/Handstand-by-jasper-garratt-v5gl4leh-Mk-unsplash-scaled-3.jpg\")
Figure 15.4.1 Let’s hope gravity doesn’t work too hard in this case.<\/em><\/figcaption><\/figure>\n <\/p>\n
Head Stand<\/span><\/p>\nDid you ever wonder what would happen if you tried to swallow food while standing on your head like this person in Figure 15.4.1? Many people think that food travels down the gullet from the mouth by the force of gravity. If that were the case, then food you swallowed would stay in your throat while you were standing on your head. In reality, your position doesn\u2019t have much to do with your ability to swallow. Food will travel from your mouth to your stomach whether you are standing upright or upside down. That\u2019s because the tube the food travels through \u2014 the esophagus<\/a> \u2014 moves the food along via muscular contractions known as peristalsis<\/a>. The esophagus is one of several organs that make up the upper gastrointestinal tract.<\/p>\n\nOrgans of the Upper Gastrointestinal Tract<\/h1>\n<\/div>\n
Besides the esophagus, organs of the\u00a0upper gastrointestinal (GI) tract<\/a><\/strong>\u00a0include the mouth, pharynx, and stomach. These hollow organs are all connected to form a tube through which food passes during digestion. The only role in digestion played by the pharynx and esophagus is to move food through the GI tract. The mouth and stomach, in contrast, are organs where digestion \u2014 or the breakdown of food \u2014 also occurs. In both of these organs, food is broken into smaller pieces (mechanical digestion<\/a>), as well as broken down chemically (chemical digestion<\/a>). It should be noted that the first part of the small intestine (duodenum) is considered in some contexts to be part of the upper GI tract, but that practice is not followed here.<\/p>\n\nMouth<\/h1>\n<\/div>\n
The\u00a0mouth<\/a><\/strong>\u00a0is the first organ of the GI tract. Most of the oral cavity is lined with mucous membrane<\/a>. This tissue produces mucus, which helps moisten, soften, and lubricate food. Underlying the mucous membrane is a thin layer of smooth muscle<\/a> to which the mucous membrane is only loosely connected. This gives the mucous membrane considerable ability to stretch as you eat food. The roof of the mouth, called the palate, separates the oral cavity from the nasal cavity. The front part is hard, consisting of mucous membrane covering a plate of bone. The back part of the palate is softer and more pliable, consisting of mucous membrane over muscle and connective tissue. The hard surface of the front of the palate allows for pressure needed in chewing and mixing food. The soft, pliable surface of the back of the palate can move to accommodate the passage of food while swallowing. Muscles at either side of the soft palate contract to create the swallowing action.<\/p>\nSeveral specific structures in the mouth are specialized for digestion. These include salivary glands, tongue, and teeth.<\/p>\n
Salivary Glands<\/h2>\nFigure 15.4.2 Salivary glands in the mouth include the three major pairs of glands shown here.<\/em><\/figcaption><\/figure>\nThe mouth contains three pairs of major\u00a0salivary glands<\/a><\/strong>, shown in Figure 15.4.2. These three pairs are all exocrine glands<\/span><\/a><\/span>\u00a0that secrete <\/span>saliva<\/a><\/strong>\u00a0into the mouth through ducts.<\/span><\/p>\n\n- The largest of the three major pairs of salivary glands are the\u00a0parotid glands<\/a><\/strong>, which are located on either side of the mouth in front of the ears.<\/li>\n
- The next largest pair is the\u00a0submandibular glands<\/a><\/strong>, located beneath the lower jaw.<\/li>\n
- The third pair is the\u00a0sublingual glands<\/a><\/strong>, located underneath the tongue.<\/li>\n<\/ol>\n
In addition to these three pairs of major salivary glands, there are also hundreds of minor salivary glands in the oral mucosa lining the mouth and on the tongue<\/a>. Along with the major glands, most of the minor glands secrete the digestive enzyme amylase<\/a>, which begins the chemical digestion of starch and glycogen (polysaccharides). However, the minor salivary glands on the tongue secrete the fat-digesting enzyme lipase<\/a>, which in the mouth is called lingual lipase (to distinguish it from pancreatic lipase secreted by the pancreas).<\/p>\nSaliva secreted by the salivary glands mainly helps digestion, but it also plays other roles. It helps maintain dental health by cleaning the teeth, and it contains antibodies<\/a> that help protect against infection. By keeping the mouth lubricated, saliva also allows the mouth movements needed for speech.<\/p>\nTongue<\/h2>\n
The tongue<\/a> is a fleshy, muscular organ that is attached to the floor of the mouth by a band of ligaments that gives it great mobility. This is necessary so the tongue can manipulate food for chewing and swallowing. Movements of the tongue are also necessary for speaking. The upper surface of the tongue is covered with tiny projections called papillae<\/a>, which contain taste buds. The latter are collections of chemoreceptor<\/a> cells (shown in Figure 15.4.3). These sensory cells sense chemicals in food and send the information to the brain via cranial nerves, thus enabling the sense of taste.<\/p>\nFigure 15.4.3 There are several types of papillae located in different areas on the tongue.<\/em><\/figcaption><\/figure>\nThere are five basic tastes detected by the chemoreceptor cells in taste buds: saltiness, sourness, bitterness, sweetness, and umami (often described as a meaty taste). Contrary to popular belief, taste buds for the five basic tastes are not located on different parts of the tongue. Why does taste matter? The taste of food helps to stimulate the secretion of saliva from the salivary glands. It also helps us to eat foods that are good for us, instead\u00a0of\u00a0rotten or toxic foods. The detection of saltiness, for example, enables the control of salt intake and salt balance in the body. The detection of sourness may help us avoid spoiled foods, which often taste sour due to fermentation by bacteria. The detection of bitterness warns of poisons, because many plants defend themselves with toxins that taste bitter. The detection of sweetness guides us to foods that supply quick energy. The detection of umami may signal protein-rich foods.<\/p>\n
Teeth<\/h2>\n
The\u00a0teeth<\/a><\/strong> are complex structures made of a bone-like material called dentin and covered with enamel, which is the hardest tissue in the body. Adults normally have a total of 32 teeth, with 16 in each jaw. The right and left sides of each jaw are mirror images in terms of the numbers and types of teeth they contain. Teeth have different shapes to suit them for different aspects of mastication (chewing). The different types of teeth are illustrated in Figure 15.4.4.<\/p>\nFigure 15.4.4 In adults, both sides of each jaw normally have the same numbers of the four types of teeth shown here.<\/em><\/figcaption><\/figure>\n\n- Incisors<\/a><\/strong>\u00a0are the sharp, blade-like teeth at the front of the mouth. They are used for cutting or biting off pieces of food. In adults, there are normally four incisors in each jaw, or eight in total.<\/li>\n
- Canines<\/a><\/strong>\u00a0are the pointed teeth on either side of the incisors. They are used for tearing foods that are tough or stringy. Adults normally have two canines in each jaw, or four altogether.<\/li>\n
- Premolars<\/a><\/strong>\u00a0and\u00a0molars<\/a><\/strong>\u00a0are cuboid teeth with cusps and grooves that are located on the sides and toward the back of the jaws. Premolars are closer to the front of the mouth. Molars are larger and have more cusps than premolars, but both are used for crushing and grinding food. Adults normally have two premolars and three molars on each side of each jaw, for a total of eight premolars and twelve molars.<\/li>\n<\/ul>\n\n
Pharynx<\/h1>\n<\/div>\n
The tube-like pharynx<\/a> (see Figure 15.4.5 below) plays a dual role as an organ of both respiration and digestion. As part of the respiratory system<\/a>, it conducts air between the nasal cavity<\/a> and larynx<\/a>. As part of the digestive system<\/a>, it allows swallowed food to pass from the oral cavity to the esophagus<\/a>. Anything swallowed has priority over inhaled air when passing through the pharynx. During swallowing, the backward motion of the tongue causes a flap of elastic cartilage \u2014 called the epiglottis<\/a> \u2014 to close over the opening to the larynx. This prevents food or drink from entering the larynx.<\/p>\nFigure 15.4.5 The tongue moves backward during swallowing to cause the epiglottis to cover the opening to the larynx. As a result, food passes from the pharynx to the esophagus \u2014 and not into the larynx.<\/em><\/figcaption><\/figure>\nEsophagus<\/span><\/p>\nThe\u00a0esophagus<\/a><\/strong> (shown in Figure 15.4.6) is a muscular tube through which food is pushed from the pharynx to the stomach. The esophagus passes through an opening in the diaphragm<\/a> (the large breathing muscle that separates the abdomen from the thorax) before reaching the stomach<\/a>. In adults, the esophagus averages about 25 cm (about 9.8 inches) in length, depending on a person\u2019s height. The inner lining of the esophagus consists of mucous membrane, which provides a smooth, slippery surface for the passage of food. The cells of this membrane are constantly being replaced as they are worn away from the frequent passage of food over them.<\/p>\nFigure 15.4.6 The esophagus moves food by peristalsis from the pharynx to the stomach. Note, this x-ray of a swallow shows a fraction of the ingested liquid being trapped in an atypical diverticulum of the esophagus.<\/em><\/figcaption><\/figure>\nWhen food is not being swallowed, the esophagus is closed at both ends by upper and lower esophageal sphincters.\u00a0Sphincters<\/a><\/strong>\u00a0are rings of muscle that can contract to close off openings between structures. The upper esophageal sphincter is triggered to relax and open by the act of swallowing, allowing a bolus of food to enter the esophagus from the pharynx. Then, the esophageal sphincter closes again to prevent food from moving back into the pharynx from the esophagus.<\/p>\nOnce in the esophagus, the food bolus<\/a> travels down to the stomach, pushed along by the rhythmic contraction and relaxation of muscles (peristalsis<\/a>). The lower esophageal sphincter is located at the junction between the esophagus and the stomach. This sphincter opens when the bolus reaches it, allowing the food to enter the stomach. The sphincter normally remains closed at other times to prevent the contents of the stomach from entering the esophagus. Failure of this sphincter to remain completely closed can lead to heartburn. If it happens chronically, it can lead to gastroesophageal reflux disease<\/a> (GERD), in which the mucous membrane of the esophagus may become damaged by the highly acidic contents of the stomach.<\/p>\nSee the video below to see how the parts of the upper GI tract work together to carry out swallowing:<\/p>\n
Mouth<\/h1>\r\n<\/div>\r\nThe\u00a0[pb_glossary id=\"4297\"]mouth[\/pb_glossary]<\/strong>\u00a0is the first organ of the GI tract. Most of the oral cavity is lined with [pb_glossary id=\"3538\"]mucous membrane[\/pb_glossary]. This tissue produces mucus, which helps moisten, soften, and lubricate food. Underlying the mucous membrane is a thin layer of [pb_glossary id=\"2982\"]smooth muscle[\/pb_glossary] to which the mucous membrane is only loosely connected. This gives the mucous membrane considerable ability to stretch as you eat food. The roof of the mouth, called the palate, separates the oral cavity from the nasal cavity. The front part is hard, consisting of mucous membrane covering a plate of bone. The back part of the palate is softer and more pliable, consisting of mucous membrane over muscle and connective tissue. The hard surface of the front of the palate allows for pressure needed in chewing and mixing food. The soft, pliable surface of the back of the palate can move to accommodate the passage of food while swallowing. Muscles at either side of the soft palate contract to create the swallowing action.\r\n\r\nSeveral specific structures in the mouth are specialized for digestion. These include salivary glands, tongue, and teeth.\r\nSalivary Glands<\/h2>\r\n[caption id=\"attachment_4611\" align=\"alignright\" width=\"357\"] Figure 15.4.2 Salivary glands in the mouth include the three major pairs of glands shown here.<\/em>[\/caption]\r\n\r\nThe mouth contains three pairs of major\u00a0[pb_glossary id=\"4577\"]salivary glands[\/pb_glossary]<\/strong>, shown in Figure 15.4.2. These three pairs are all [pb_glossary id=\"6001\"]exocrine glands<\/span>[\/pb_glossary]<\/span>\u00a0that secrete <\/span>[pb_glossary id=\"4595\"]saliva[\/pb_glossary]<\/strong>\u00a0into the mouth through ducts.<\/span>\r\n\r\n \t- The largest of the three major pairs of salivary glands are the\u00a0[pb_glossary id=\"4612\"]parotid glands[\/pb_glossary]<\/strong>, which are located on either side of the mouth in front of the ears.<\/li>\r\n \t
- The next largest pair is the\u00a0[pb_glossary id=\"5457\"]submandibular glands[\/pb_glossary]<\/strong>, located beneath the lower jaw.<\/li>\r\n \t
- The third pair is the\u00a0[pb_glossary id=\"5527\"]sublingual glands[\/pb_glossary]<\/strong>, located underneath the tongue.<\/li>\r\n<\/ol>\r\nIn addition to these three pairs of major salivary glands, there are also hundreds of minor salivary glands in the oral mucosa lining the mouth and on the [pb_glossary id=\"4615\"]tongue[\/pb_glossary]. Along with the major glands, most of the minor glands secrete the digestive enzyme [pb_glossary id=\"4578\"]amylase[\/pb_glossary], which begins the chemical digestion of starch and glycogen (polysaccharides). However, the minor salivary glands on the tongue secrete the fat-digesting enzyme [pb_glossary id=\"4602\"]lipase[\/pb_glossary], which in the mouth is called lingual lipase (to distinguish it from pancreatic lipase secreted by the pancreas).\r\n\r\nSaliva secreted by the salivary glands mainly helps digestion, but it also plays other roles. It helps maintain dental health by cleaning the teeth, and it contains [pb_glossary id=\"5659\"]antibodies[\/pb_glossary] that help protect against infection. By keeping the mouth lubricated, saliva also allows the mouth movements needed for speech.\r\n
Tongue<\/h2>\r\nThe [pb_glossary id=\"4615\"]tongue[\/pb_glossary] is a fleshy, muscular organ that is attached to the floor of the mouth by a band of ligaments that gives it great mobility. This is necessary so the tongue can manipulate food for chewing and swallowing. Movements of the tongue are also necessary for speaking. The upper surface of the tongue is covered with tiny projections called [pb_glossary id=\"4616\"]papillae[\/pb_glossary], which contain taste buds. The latter are collections of [pb_glossary id=\"3128\"]chemoreceptor[\/pb_glossary] cells (shown in Figure 15.4.3). These sensory cells sense chemicals in food and send the information to the brain via cranial nerves, thus enabling the sense of taste.\r\n\r\n[caption id=\"attachment_4617\" align=\"aligncenter\" width=\"567\"] Figure 15.4.3 There are several types of papillae located in different areas on the tongue.<\/em>[\/caption]\r\n\r\nThere are five basic tastes detected by the chemoreceptor cells in taste buds: saltiness, sourness, bitterness, sweetness, and umami (often described as a meaty taste). Contrary to popular belief, taste buds for the five basic tastes are not located on different parts of the tongue. Why does taste matter? The taste of food helps to stimulate the secretion of saliva from the salivary glands. It also helps us to eat foods that are good for us, instead\u00a0of\u00a0rotten or toxic foods. The detection of saltiness, for example, enables the control of salt intake and salt balance in the body. The detection of sourness may help us avoid spoiled foods, which often taste sour due to fermentation by bacteria. The detection of bitterness warns of poisons, because many plants defend themselves with toxins that taste bitter. The detection of sweetness guides us to foods that supply quick energy. The detection of umami may signal protein-rich foods.\r\nTeeth<\/h2>\r\nThe\u00a0[pb_glossary id=\"5455\"]teeth[\/pb_glossary]<\/strong> are complex structures made of a bone-like material called dentin and covered with enamel, which is the hardest tissue in the body. Adults normally have a total of 32 teeth, with 16 in each jaw. The right and left sides of each jaw are mirror images in terms of the numbers and types of teeth they contain. Teeth have different shapes to suit them for different aspects of mastication (chewing). The different types of teeth are illustrated in Figure 15.4.4.\r\n\r\n[caption id=\"attachment_4623\" align=\"alignright\" width=\"453\"] Figure 15.4.4 In adults, both sides of each jaw normally have the same numbers of the four types of teeth shown here.<\/em>[\/caption]\r\n\r\n \t- [pb_glossary id=\"4619\"]Incisors[\/pb_glossary]<\/strong>\u00a0are the sharp, blade-like teeth at the front of the mouth. They are used for cutting or biting off pieces of food. In adults, there are normally four incisors in each jaw, or eight in total.<\/li>\r\n \t
- [pb_glossary id=\"4620\"]Canines[\/pb_glossary]<\/strong>\u00a0are the pointed teeth on either side of the incisors. They are used for tearing foods that are tough or stringy. Adults normally have two canines in each jaw, or four altogether.<\/li>\r\n \t
- [pb_glossary id=\"4621\"]Premolars[\/pb_glossary]<\/strong>\u00a0and\u00a0[pb_glossary id=\"4622\"]molars[\/pb_glossary]<\/strong>\u00a0are cuboid teeth with cusps and grooves that are located on the sides and toward the back of the jaws. Premolars are closer to the front of the mouth. Molars are larger and have more cusps than premolars, but both are used for crushing and grinding food. Adults normally have two premolars and three molars on each side of each jaw, for a total of eight premolars and twelve molars.<\/li>\r\n<\/ul>\r\n\r\n
Pharynx<\/h1>\r\n<\/div>\r\nThe tube-like [pb_glossary id=\"4296\"]pharynx[\/pb_glossary] (see Figure 15.4.5 below) plays a dual role as an organ of both respiration and digestion. As part of the [pb_glossary id=\"2912\"]respiratory system[\/pb_glossary], it conducts air between the [pb_glossary id=\"4295\"]nasal cavity[\/pb_glossary] and [pb_glossary id=\"4298\"]larynx[\/pb_glossary]. As part of the [pb_glossary id=\"5969\"]digestive system[\/pb_glossary], it allows swallowed food to pass from the oral cavity to the [pb_glossary id=\"4557\"]esophagus[\/pb_glossary]. Anything swallowed has priority over inhaled air when passing through the pharynx. During swallowing, the backward motion of the tongue causes a flap of elastic cartilage \u2014 called the [pb_glossary id=\"4302\"]epiglottis[\/pb_glossary] \u2014 to close over the opening to the larynx. This prevents food or drink from entering the larynx.\r\n\r\n[caption id=\"attachment_4625\" align=\"aligncenter\" width=\"424\"] Figure 15.4.5 The tongue moves backward during swallowing to cause the epiglottis to cover the opening to the larynx. As a result, food passes from the pharynx to the esophagus \u2014 and not into the larynx.<\/em>[\/caption]\r\n\r\nEsophagus<\/span>\r\n\r\nThe\u00a0[pb_glossary id=\"4557\"]esophagus[\/pb_glossary]<\/strong> (shown in Figure 15.4.6) is a muscular tube through which food is pushed from the pharynx to the stomach. The esophagus passes through an opening in the [pb_glossary id=\"4292\"]diaphragm[\/pb_glossary] (the large breathing muscle that separates the abdomen from the thorax) before reaching the [pb_glossary id=\"4558\"]stomach[\/pb_glossary]. In adults, the esophagus averages about 25 cm (about 9.8 inches) in length, depending on a person\u2019s height. The inner lining of the esophagus consists of mucous membrane, which provides a smooth, slippery surface for the passage of food. The cells of this membrane are constantly being replaced as they are worn away from the frequent passage of food over them.\r\n\r\n[caption id=\"attachment_4626\" align=\"aligncenter\" width=\"234\"] Figure 15.4.6 The esophagus moves food by peristalsis from the pharynx to the stomach. Note, this x-ray of a swallow shows a fraction of the ingested liquid being trapped in an atypical diverticulum of the esophagus.<\/em>[\/caption]\r\n\r\nWhen food is not being swallowed, the esophagus is closed at both ends by upper and lower esophageal sphincters.\u00a0[pb_glossary id=\"4627\"]Sphincters[\/pb_glossary]<\/strong>\u00a0are rings of muscle that can contract to close off openings between structures. The upper esophageal sphincter is triggered to relax and open by the act of swallowing, allowing a bolus of food to enter the esophagus from the pharynx. Then, the esophageal sphincter closes again to prevent food from moving back into the pharynx from the esophagus.\r\n\r\nOnce in the esophagus, the food [pb_glossary id=\"4579\"]bolus[\/pb_glossary] travels down to the stomach, pushed along by the rhythmic contraction and relaxation of muscles ([pb_glossary id=\"2890\"]peristalsis[\/pb_glossary]). The lower esophageal sphincter is located at the junction between the esophagus and the stomach. This sphincter opens when the bolus reaches it, allowing the food to enter the stomach. The sphincter normally remains closed at other times to prevent the contents of the stomach from entering the esophagus. Failure of this sphincter to remain completely closed can lead to heartburn. If it happens chronically, it can lead to gastroesophageal reflux disease<\/a> (GERD), in which the mucous membrane of the esophagus may become damaged by the highly acidic contents of the stomach.\r\n\r\nSee the video below to see how the parts of the upper GI tract work together to carry out swallowing:\r\n\r\nhttps:\/\/youtu.be\/pNcV6yAfq-g\r\nSwallowing, uploaded by Alejandra Cork, 2012.<\/p>\r\nStomach<\/span>\r\n\r\nThe\u00a0[pb_glossary id=\"4558\"]stomach[\/pb_glossary]<\/strong> is a J-shaped organ (shown in Figure 15.4.7) that is joined to the esophagus at its upper end, and to the first part of the [pb_glossary id=\"4559\"]small intestine[\/pb_glossary] ([pb_glossary id=\"4576\"]duodenum[\/pb_glossary]) at its lower end. When the stomach is empty of food, it normally has a volume of about 75 millilitres, but it can expand to hold up to about a litre of food. Waves of muscle contractions (peristalsis) passing through the muscular walls of the stomach cause the food inside to be mixed and churned. The wall of the stomach has an extra layer of muscle tissue not found in other organs of the GI tract that helps it squeeze and mix the food. These movements of the stomach wall contribute greatly to mechanical digestion by breaking the food into much smaller pieces. The churning also helps mix the food with stomach secretions that aid in its chemical digestion.\r\n\r\n\r\n[caption id=\"attachment_4628\" align=\"aligncenter\" width=\"412\"] Figure 15.4.7 The stomach is connected at the top to the esophagus and at the bottom to the duodenum of the small intestine. The pylorus, or pyloric sphincter, controls emptying of the stomach into the small intestine. The outer surface of the stomach is covered with fibrous connective tissue. There are three layers of muscle in the stomach wall. Each layer runs in a different direction: circular, longitudinal and oblique.<\/em>[\/caption]\r\n\r\n<\/div>\r\nSecretions of the stomach include gastric acid, which consists mainly of hydrochloric acid (HCl). This makes the stomach contents highly acidic, which is necessary so that the enzyme [pb_glossary id=\"4581\"]pepsin[\/pb_glossary] \u2014 also secreted by the stomach \u2014 can begin the digestion of [pb_glossary id=\"5813\"]protein[\/pb_glossary]. [pb_glossary id=\"4571\"]Mucus[\/pb_glossary] is secreted by the lining of stomach to provide a slimy protective coating against the otherwise damaging effects of gastric acid. The fat-digesting enzyme [pb_glossary id=\"4602\"]lipase[\/pb_glossary] is secreted in small amounts in the stomach, but very little fat digestion occurs there.\r\n\r\nBy the time food has been in the stomach for about an hour, it has become the thick, semi-liquid [pb_glossary id=\"4582\"]chyme[\/pb_glossary]. When the [pb_glossary id=\"4559\"]small intestine[\/pb_glossary] is ready to receive chyme, a sphincter between the stomach and duodenum \u2014 called the pyloric sphincter \u2014 opens to allow the chyme to enter the small intestine for further digestion and absorption.\r\n\r\nFeature: Reliable Sources<\/h1>\r\n<\/div>\r\nThe ongoing epidemic of obesity in the wealthier nations of the world, including Canada, has led to the development of several different bariatric surgeries that modify the stomach to help obese patients reduce their food intake and lose weight. Go online to learn more about bariatric surgery. Find sources you judge to be reliable that answer the following questions:\r\n\r\n \t- Who qualifies for bariatric surgery?<\/li>\r\n \t
- Describe the bariatric surgeries commonly called stomach stapling, lap band, and gastric sleeve. How does each type of surgery modify the stomach? In terms of weight loss, how effective is each type?<\/li>\r\n \t
- What are the major potential risks of bariatric surgery?<\/li>\r\n \t
- Besides weight loss, what other benefits have been shown to result from bariatric surgery?<\/li>\r\n<\/ol>\r\n\r\n
\r\n15.4 Summary<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- Organs of the [pb_glossary id=\"4574\"]upper gastrointestinal (GI) tract[\/pb_glossary] include the mouth, pharynx, esophagus, and stomach.<\/li>\r\n \t
- The [pb_glossary id=\"4297\"]mouth[\/pb_glossary] is the first organ of the GI tract. It has several structures that are specialized for digestion, including [pb_glossary id=\"4577\"]salivary glands[\/pb_glossary], [pb_glossary id=\"4615\"]tongue[\/pb_glossary], and [pb_glossary id=\"5455\"]teeth[\/pb_glossary]. Both [pb_glossary id=\"4550\"]mechanical digestion[\/pb_glossary] and [pb_glossary id=\"4551\"]chemical digestion[\/pb_glossary] of carbohydrates and fats begin in the mouth.<\/li>\r\n \t
- The [pb_glossary id=\"4296\"]pharynx[\/pb_glossary] and [pb_glossary id=\"4557\"]esophagus[\/pb_glossary] move food from the mouth to the stomach, but are not involved in the process of digestion or absorption. Food moves through the esophagus by [pb_glossary id=\"2890\"]peristalsis[\/pb_glossary].<\/li>\r\n \t
- Mechanical and chemical digestion continue in the stomach. Acid and digestive enzymes secreted by the stomach start the chemical digestion of proteins. The stomach turns masticated food into a semi-fluid mixture called [pb_glossary id=\"4582\"]chyme[\/pb_glossary].<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n15.4 Review Questions<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\n \t- [h5p id=\"622\"]<\/li>\r\n \t
- Identify structures in the mouth that are specialized for digestion.<\/li>\r\n \t
- Describe digestion in the mouth.<\/li>\r\n \t
- What general role do the pharynx and esophagus play in the digestion of food?<\/li>\r\n \t
- How does food travel through the esophagus?<\/li>\r\n \t
- Describe digestion in the stomach.<\/li>\r\n \t
- Describe the differences between how air and food normally move past the pharynx.<\/li>\r\n \t
- Name two structures in the mouth that contribute to mechanical digestion.<\/li>\r\n \t
- What structure normally keeps stomach contents from backing up into the esophagus?<\/li>\r\n \t
- Thirty minutes after you eat a meal, where is most of your food located? Explain your answer.<\/li>\r\n \t
- What are two roles of mucus in the upper GI tract?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n
\r\n15.4 Explore More<\/span><\/h1>\r\n<\/header>\r\n\r\n\r\nhttps:\/\/youtu.be\/zGoBFU1q4g0\r\nWhat causes cavities? - Mel Rosenberg, TED-Ed, 2016.<\/p>\r\nhttps:\/\/youtu.be\/gCrmFbgT37I\r\n
How does alcohol make you drunk? - Judy Grisel, TED-Ed, 2020.<\/p>\r\nhttps:\/\/youtu.be\/twJBEypJDfU\r\n
Gastric Bypass Surgery: One Patient\u2019s Journey - Mayo Clinic, 2014.<\/p>\r\nhttps:\/\/youtu.be\/u_1sVri3b2w\r\n
Here's What Happens In Your Body When You Swallow Gum | The Human Body, Tech Insider, 2018.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 15.4.1<\/strong>\r\n\r\nHandstand, Pender Island, B.C.<\/a> [photo] by Jasper Garratt<\/a> on Unsplash<\/a> is used under the Unsplash License<\/a> (https:\/\/unsplash.com\/license).\r\n\r\nFigure 15.4.2<\/strong>\r\n\r\nBlausen_0780_SalivaryGlands<\/a> by BruceBlaus<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 15.4.3<\/strong>\r\n\r\n1402_The_Tongue<\/a>\u00a0by OpenStax<\/a> on Wikimedia Commons is used under a CC BY 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/4.0) license.\r\n\r\nFigure 15.4.4<\/strong>\r\n\r\n1024px-3D_Medical_Animation_Still_Showing_Types_of_Teeth<\/a>\u00a0by http:\/\/www.scientificanimations.com<\/a> on Wikimedia Commons is used under a CC BY-SA 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/4.0) license.\r\n\r\nFigure 15.4.5<\/strong>\r\n\r\nIllu01_head_neck<\/a> by Arcadian<\/a> from NCI\/ SEER Training Modules<\/a> on Wikimedia Common is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/public_domain).\r\n\r\nFigure 15.4.6<\/strong>\r\n\r\nZenkerSchraeg<\/a> by Bernd Br\u00e4gelmann<\/a>\u00a0Braegel<\/a> on Wikimedia Commons is used under a\u00a0CC BY 3.0<\/a>\u00a0 (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\u00a0 (Courtesy of Dr. Martin Steinhoff. It is not known whether there is a possibly necessary approval from the patient.)\r\n\r\nFigure 15.4.7<\/strong>\r\n\r\nAnatomy stomach \u2013 white<\/a> by www.medicalgraphics.de from MedicalGraphics<\/a> is used under a\u00a0 CC BY-ND 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/) license.\r\nReferences<\/h2>\r\n
Alejandra Cork. (2012). Swallowing. YouTube. https:\/\/www.youtube.com\/watch?v=pNcV6yAfq-g&t=4s<\/p>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 27). Figure\u00a0<\/span><\/span>14.3<\/span><\/span>\u00a0<\/span>The tongue [digital image]. In Anatomy and Physiology<\/em> (Section 14.1). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/14-1-sensory-perception<\/span><\/span><\/p>\r\nBlausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\nMayo Clinic. (2014, August 26). Gastric bypass surgery: One patient\u2019s journey - Mayo Clinic. https:\/\/www.youtube.com\/watch?v=twJBEypJDfU&feature=youtu.be<\/p>\r\n
Mayo Clinic Staff. (n.d.). Gastroesophageal reflux disease (GERD) [online article]. MayoClinic.org. https:\/\/www.mayoclinic.org\/diseases-conditions\/gerd\/symptoms-causes\/syc-20361940<\/p>\r\n
Tech Insider. (2018, March 20). Here's what happens in your body when you swallow gum | The human body. YouTube. https:\/\/www.youtube.com\/watch?v=u_1sVri3b2w&feature=youtu.be<\/p>\r\n
TED-Ed. (2020, April 9). How does alcohol make you drunk? - Judy Grisel. YouTube. https:\/\/www.youtube.com\/watch?v=gCrmFbgT37I&feature=youtu.be<\/p>\r\n
TED-Ed. (2016, October 17). What causes cavities? - Mel Rosenberg. YouTube. https:\/\/www.youtube.com\/watch?v=zGoBFU1q4g0&feature=youtu.be<\/p>\r\n ","rendered":"
<\/p>\nFigure 15.4.1 Let’s hope gravity doesn’t work too hard in this case.<\/em><\/figcaption><\/figure>\n <\/p>\n
Head Stand<\/span><\/p>\nDid you ever wonder what would happen if you tried to swallow food while standing on your head like this person in Figure 15.4.1? Many people think that food travels down the gullet from the mouth by the force of gravity. If that were the case, then food you swallowed would stay in your throat while you were standing on your head. In reality, your position doesn\u2019t have much to do with your ability to swallow. Food will travel from your mouth to your stomach whether you are standing upright or upside down. That\u2019s because the tube the food travels through \u2014 the esophagus<\/a> \u2014 moves the food along via muscular contractions known as peristalsis<\/a>. The esophagus is one of several organs that make up the upper gastrointestinal tract.<\/p>\n\nOrgans of the Upper Gastrointestinal Tract<\/h1>\n<\/div>\n
Besides the esophagus, organs of the\u00a0upper gastrointestinal (GI) tract<\/a><\/strong>\u00a0include the mouth, pharynx, and stomach. These hollow organs are all connected to form a tube through which food passes during digestion. The only role in digestion played by the pharynx and esophagus is to move food through the GI tract. The mouth and stomach, in contrast, are organs where digestion \u2014 or the breakdown of food \u2014 also occurs. In both of these organs, food is broken into smaller pieces (mechanical digestion<\/a>), as well as broken down chemically (chemical digestion<\/a>). It should be noted that the first part of the small intestine (duodenum) is considered in some contexts to be part of the upper GI tract, but that practice is not followed here.<\/p>\n\nMouth<\/h1>\n<\/div>\n
The\u00a0mouth<\/a><\/strong>\u00a0is the first organ of the GI tract. Most of the oral cavity is lined with mucous membrane<\/a>. This tissue produces mucus, which helps moisten, soften, and lubricate food. Underlying the mucous membrane is a thin layer of smooth muscle<\/a> to which the mucous membrane is only loosely connected. This gives the mucous membrane considerable ability to stretch as you eat food. The roof of the mouth, called the palate, separates the oral cavity from the nasal cavity. The front part is hard, consisting of mucous membrane covering a plate of bone. The back part of the palate is softer and more pliable, consisting of mucous membrane over muscle and connective tissue. The hard surface of the front of the palate allows for pressure needed in chewing and mixing food. The soft, pliable surface of the back of the palate can move to accommodate the passage of food while swallowing. Muscles at either side of the soft palate contract to create the swallowing action.<\/p>\nSeveral specific structures in the mouth are specialized for digestion. These include salivary glands, tongue, and teeth.<\/p>\n
Salivary Glands<\/h2>\nFigure 15.4.2 Salivary glands in the mouth include the three major pairs of glands shown here.<\/em><\/figcaption><\/figure>\nThe mouth contains three pairs of major\u00a0salivary glands<\/a><\/strong>, shown in Figure 15.4.2. These three pairs are all exocrine glands<\/span><\/a><\/span>\u00a0that secrete <\/span>saliva<\/a><\/strong>\u00a0into the mouth through ducts.<\/span><\/p>\n\n- The largest of the three major pairs of salivary glands are the\u00a0parotid glands<\/a><\/strong>, which are located on either side of the mouth in front of the ears.<\/li>\n
- The next largest pair is the\u00a0submandibular glands<\/a><\/strong>, located beneath the lower jaw.<\/li>\n
- The third pair is the\u00a0sublingual glands<\/a><\/strong>, located underneath the tongue.<\/li>\n<\/ol>\n
In addition to these three pairs of major salivary glands, there are also hundreds of minor salivary glands in the oral mucosa lining the mouth and on the tongue<\/a>. Along with the major glands, most of the minor glands secrete the digestive enzyme amylase<\/a>, which begins the chemical digestion of starch and glycogen (polysaccharides). However, the minor salivary glands on the tongue secrete the fat-digesting enzyme lipase<\/a>, which in the mouth is called lingual lipase (to distinguish it from pancreatic lipase secreted by the pancreas).<\/p>\nSaliva secreted by the salivary glands mainly helps digestion, but it also plays other roles. It helps maintain dental health by cleaning the teeth, and it contains antibodies<\/a> that help protect against infection. By keeping the mouth lubricated, saliva also allows the mouth movements needed for speech.<\/p>\nTongue<\/h2>\n
The tongue<\/a> is a fleshy, muscular organ that is attached to the floor of the mouth by a band of ligaments that gives it great mobility. This is necessary so the tongue can manipulate food for chewing and swallowing. Movements of the tongue are also necessary for speaking. The upper surface of the tongue is covered with tiny projections called papillae<\/a>, which contain taste buds. The latter are collections of chemoreceptor<\/a> cells (shown in Figure 15.4.3). These sensory cells sense chemicals in food and send the information to the brain via cranial nerves, thus enabling the sense of taste.<\/p>\nFigure 15.4.3 There are several types of papillae located in different areas on the tongue.<\/em><\/figcaption><\/figure>\nThere are five basic tastes detected by the chemoreceptor cells in taste buds: saltiness, sourness, bitterness, sweetness, and umami (often described as a meaty taste). Contrary to popular belief, taste buds for the five basic tastes are not located on different parts of the tongue. Why does taste matter? The taste of food helps to stimulate the secretion of saliva from the salivary glands. It also helps us to eat foods that are good for us, instead\u00a0of\u00a0rotten or toxic foods. The detection of saltiness, for example, enables the control of salt intake and salt balance in the body. The detection of sourness may help us avoid spoiled foods, which often taste sour due to fermentation by bacteria. The detection of bitterness warns of poisons, because many plants defend themselves with toxins that taste bitter. The detection of sweetness guides us to foods that supply quick energy. The detection of umami may signal protein-rich foods.<\/p>\n
Teeth<\/h2>\n
The\u00a0teeth<\/a><\/strong> are complex structures made of a bone-like material called dentin and covered with enamel, which is the hardest tissue in the body. Adults normally have a total of 32 teeth, with 16 in each jaw. The right and left sides of each jaw are mirror images in terms of the numbers and types of teeth they contain. Teeth have different shapes to suit them for different aspects of mastication (chewing). The different types of teeth are illustrated in Figure 15.4.4.<\/p>\nFigure 15.4.4 In adults, both sides of each jaw normally have the same numbers of the four types of teeth shown here.<\/em><\/figcaption><\/figure>\n\n- Incisors<\/a><\/strong>\u00a0are the sharp, blade-like teeth at the front of the mouth. They are used for cutting or biting off pieces of food. In adults, there are normally four incisors in each jaw, or eight in total.<\/li>\n
- Canines<\/a><\/strong>\u00a0are the pointed teeth on either side of the incisors. They are used for tearing foods that are tough or stringy. Adults normally have two canines in each jaw, or four altogether.<\/li>\n
- Premolars<\/a><\/strong>\u00a0and\u00a0molars<\/a><\/strong>\u00a0are cuboid teeth with cusps and grooves that are located on the sides and toward the back of the jaws. Premolars are closer to the front of the mouth. Molars are larger and have more cusps than premolars, but both are used for crushing and grinding food. Adults normally have two premolars and three molars on each side of each jaw, for a total of eight premolars and twelve molars.<\/li>\n<\/ul>\n\n
Pharynx<\/h1>\n<\/div>\n
The tube-like pharynx<\/a> (see Figure 15.4.5 below) plays a dual role as an organ of both respiration and digestion. As part of the respiratory system<\/a>, it conducts air between the nasal cavity<\/a> and larynx<\/a>. As part of the digestive system<\/a>, it allows swallowed food to pass from the oral cavity to the esophagus<\/a>. Anything swallowed has priority over inhaled air when passing through the pharynx. During swallowing, the backward motion of the tongue causes a flap of elastic cartilage \u2014 called the epiglottis<\/a> \u2014 to close over the opening to the larynx. This prevents food or drink from entering the larynx.<\/p>\nFigure 15.4.5 The tongue moves backward during swallowing to cause the epiglottis to cover the opening to the larynx. As a result, food passes from the pharynx to the esophagus \u2014 and not into the larynx.<\/em><\/figcaption><\/figure>\nEsophagus<\/span><\/p>\nThe\u00a0esophagus<\/a><\/strong> (shown in Figure 15.4.6) is a muscular tube through which food is pushed from the pharynx to the stomach. The esophagus passes through an opening in the diaphragm<\/a> (the large breathing muscle that separates the abdomen from the thorax) before reaching the stomach<\/a>. In adults, the esophagus averages about 25 cm (about 9.8 inches) in length, depending on a person\u2019s height. The inner lining of the esophagus consists of mucous membrane, which provides a smooth, slippery surface for the passage of food. The cells of this membrane are constantly being replaced as they are worn away from the frequent passage of food over them.<\/p>\nFigure 15.4.6 The esophagus moves food by peristalsis from the pharynx to the stomach. Note, this x-ray of a swallow shows a fraction of the ingested liquid being trapped in an atypical diverticulum of the esophagus.<\/em><\/figcaption><\/figure>\nWhen food is not being swallowed, the esophagus is closed at both ends by upper and lower esophageal sphincters.\u00a0Sphincters<\/a><\/strong>\u00a0are rings of muscle that can contract to close off openings between structures. The upper esophageal sphincter is triggered to relax and open by the act of swallowing, allowing a bolus of food to enter the esophagus from the pharynx. Then, the esophageal sphincter closes again to prevent food from moving back into the pharynx from the esophagus.<\/p>\nOnce in the esophagus, the food bolus<\/a> travels down to the stomach, pushed along by the rhythmic contraction and relaxation of muscles (peristalsis<\/a>). The lower esophageal sphincter is located at the junction between the esophagus and the stomach. This sphincter opens when the bolus reaches it, allowing the food to enter the stomach. The sphincter normally remains closed at other times to prevent the contents of the stomach from entering the esophagus. Failure of this sphincter to remain completely closed can lead to heartburn. If it happens chronically, it can lead to gastroesophageal reflux disease<\/a> (GERD), in which the mucous membrane of the esophagus may become damaged by the highly acidic contents of the stomach.<\/p>\nSee the video below to see how the parts of the upper GI tract work together to carry out swallowing:<\/p>\n
Figure 15.4.2 Salivary glands in the mouth include the three major pairs of glands shown here.<\/em>[\/caption]\r\n\r\nThe mouth contains three pairs of major\u00a0[pb_glossary id=\"4577\"]salivary glands[\/pb_glossary]<\/strong>, shown in Figure 15.4.2. These three pairs are all [pb_glossary id=\"6001\"]exocrine glands<\/span>[\/pb_glossary]<\/span>\u00a0that secrete <\/span>[pb_glossary id=\"4595\"]saliva[\/pb_glossary]<\/strong>\u00a0into the mouth through ducts.<\/span>\r\n- \r\n \t
- The largest of the three major pairs of salivary glands are the\u00a0[pb_glossary id=\"4612\"]parotid glands[\/pb_glossary]<\/strong>, which are located on either side of the mouth in front of the ears.<\/li>\r\n \t
- The next largest pair is the\u00a0[pb_glossary id=\"5457\"]submandibular glands[\/pb_glossary]<\/strong>, located beneath the lower jaw.<\/li>\r\n \t
- The third pair is the\u00a0[pb_glossary id=\"5527\"]sublingual glands[\/pb_glossary]<\/strong>, located underneath the tongue.<\/li>\r\n<\/ol>\r\nIn addition to these three pairs of major salivary glands, there are also hundreds of minor salivary glands in the oral mucosa lining the mouth and on the [pb_glossary id=\"4615\"]tongue[\/pb_glossary]. Along with the major glands, most of the minor glands secrete the digestive enzyme [pb_glossary id=\"4578\"]amylase[\/pb_glossary], which begins the chemical digestion of starch and glycogen (polysaccharides). However, the minor salivary glands on the tongue secrete the fat-digesting enzyme [pb_glossary id=\"4602\"]lipase[\/pb_glossary], which in the mouth is called lingual lipase (to distinguish it from pancreatic lipase secreted by the pancreas).\r\n\r\nSaliva secreted by the salivary glands mainly helps digestion, but it also plays other roles. It helps maintain dental health by cleaning the teeth, and it contains [pb_glossary id=\"5659\"]antibodies[\/pb_glossary] that help protect against infection. By keeping the mouth lubricated, saliva also allows the mouth movements needed for speech.\r\n
Tongue<\/h2>\r\nThe [pb_glossary id=\"4615\"]tongue[\/pb_glossary] is a fleshy, muscular organ that is attached to the floor of the mouth by a band of ligaments that gives it great mobility. This is necessary so the tongue can manipulate food for chewing and swallowing. Movements of the tongue are also necessary for speaking. The upper surface of the tongue is covered with tiny projections called [pb_glossary id=\"4616\"]papillae[\/pb_glossary], which contain taste buds. The latter are collections of [pb_glossary id=\"3128\"]chemoreceptor[\/pb_glossary] cells (shown in Figure 15.4.3). These sensory cells sense chemicals in food and send the information to the brain via cranial nerves, thus enabling the sense of taste.\r\n\r\n[caption id=\"attachment_4617\" align=\"aligncenter\" width=\"567\"]
Figure 15.4.3 There are several types of papillae located in different areas on the tongue.<\/em>[\/caption]\r\n\r\nThere are five basic tastes detected by the chemoreceptor cells in taste buds: saltiness, sourness, bitterness, sweetness, and umami (often described as a meaty taste). Contrary to popular belief, taste buds for the five basic tastes are not located on different parts of the tongue. Why does taste matter? The taste of food helps to stimulate the secretion of saliva from the salivary glands. It also helps us to eat foods that are good for us, instead\u00a0of\u00a0rotten or toxic foods. The detection of saltiness, for example, enables the control of salt intake and salt balance in the body. The detection of sourness may help us avoid spoiled foods, which often taste sour due to fermentation by bacteria. The detection of bitterness warns of poisons, because many plants defend themselves with toxins that taste bitter. The detection of sweetness guides us to foods that supply quick energy. The detection of umami may signal protein-rich foods.\r\nTeeth<\/h2>\r\nThe\u00a0[pb_glossary id=\"5455\"]teeth[\/pb_glossary]<\/strong> are complex structures made of a bone-like material called dentin and covered with enamel, which is the hardest tissue in the body. Adults normally have a total of 32 teeth, with 16 in each jaw. The right and left sides of each jaw are mirror images in terms of the numbers and types of teeth they contain. Teeth have different shapes to suit them for different aspects of mastication (chewing). The different types of teeth are illustrated in Figure 15.4.4.\r\n\r\n[caption id=\"attachment_4623\" align=\"alignright\" width=\"453\"]
Figure 15.4.4 In adults, both sides of each jaw normally have the same numbers of the four types of teeth shown here.<\/em>[\/caption]\r\n- \r\n \t
- [pb_glossary id=\"4619\"]Incisors[\/pb_glossary]<\/strong>\u00a0are the sharp, blade-like teeth at the front of the mouth. They are used for cutting or biting off pieces of food. In adults, there are normally four incisors in each jaw, or eight in total.<\/li>\r\n \t
- [pb_glossary id=\"4620\"]Canines[\/pb_glossary]<\/strong>\u00a0are the pointed teeth on either side of the incisors. They are used for tearing foods that are tough or stringy. Adults normally have two canines in each jaw, or four altogether.<\/li>\r\n \t
- [pb_glossary id=\"4621\"]Premolars[\/pb_glossary]<\/strong>\u00a0and\u00a0[pb_glossary id=\"4622\"]molars[\/pb_glossary]<\/strong>\u00a0are cuboid teeth with cusps and grooves that are located on the sides and toward the back of the jaws. Premolars are closer to the front of the mouth. Molars are larger and have more cusps than premolars, but both are used for crushing and grinding food. Adults normally have two premolars and three molars on each side of each jaw, for a total of eight premolars and twelve molars.<\/li>\r\n<\/ul>\r\n
\r\nPharynx<\/h1>\r\n<\/div>\r\nThe tube-like [pb_glossary id=\"4296\"]pharynx[\/pb_glossary] (see Figure 15.4.5 below) plays a dual role as an organ of both respiration and digestion. As part of the [pb_glossary id=\"2912\"]respiratory system[\/pb_glossary], it conducts air between the [pb_glossary id=\"4295\"]nasal cavity[\/pb_glossary] and [pb_glossary id=\"4298\"]larynx[\/pb_glossary]. As part of the [pb_glossary id=\"5969\"]digestive system[\/pb_glossary], it allows swallowed food to pass from the oral cavity to the [pb_glossary id=\"4557\"]esophagus[\/pb_glossary]. Anything swallowed has priority over inhaled air when passing through the pharynx. During swallowing, the backward motion of the tongue causes a flap of elastic cartilage \u2014 called the [pb_glossary id=\"4302\"]epiglottis[\/pb_glossary] \u2014 to close over the opening to the larynx. This prevents food or drink from entering the larynx.\r\n\r\n[caption id=\"attachment_4625\" align=\"aligncenter\" width=\"424\"]
Figure 15.4.5 The tongue moves backward during swallowing to cause the epiglottis to cover the opening to the larynx. As a result, food passes from the pharynx to the esophagus \u2014 and not into the larynx.<\/em>[\/caption]\r\n\r\nEsophagus<\/span>\r\n\r\nThe\u00a0[pb_glossary id=\"4557\"]esophagus[\/pb_glossary]<\/strong> (shown in Figure 15.4.6) is a muscular tube through which food is pushed from the pharynx to the stomach. The esophagus passes through an opening in the [pb_glossary id=\"4292\"]diaphragm[\/pb_glossary] (the large breathing muscle that separates the abdomen from the thorax) before reaching the [pb_glossary id=\"4558\"]stomach[\/pb_glossary]. In adults, the esophagus averages about 25 cm (about 9.8 inches) in length, depending on a person\u2019s height. The inner lining of the esophagus consists of mucous membrane, which provides a smooth, slippery surface for the passage of food. The cells of this membrane are constantly being replaced as they are worn away from the frequent passage of food over them.\r\n\r\n[caption id=\"attachment_4626\" align=\"aligncenter\" width=\"234\"] Figure 15.4.6 The esophagus moves food by peristalsis from the pharynx to the stomach. Note, this x-ray of a swallow shows a fraction of the ingested liquid being trapped in an atypical diverticulum of the esophagus.<\/em>[\/caption]\r\n\r\nWhen food is not being swallowed, the esophagus is closed at both ends by upper and lower esophageal sphincters.\u00a0[pb_glossary id=\"4627\"]Sphincters[\/pb_glossary]<\/strong>\u00a0are rings of muscle that can contract to close off openings between structures. The upper esophageal sphincter is triggered to relax and open by the act of swallowing, allowing a bolus of food to enter the esophagus from the pharynx. Then, the esophageal sphincter closes again to prevent food from moving back into the pharynx from the esophagus.\r\n\r\nOnce in the esophagus, the food [pb_glossary id=\"4579\"]bolus[\/pb_glossary] travels down to the stomach, pushed along by the rhythmic contraction and relaxation of muscles ([pb_glossary id=\"2890\"]peristalsis[\/pb_glossary]). The lower esophageal sphincter is located at the junction between the esophagus and the stomach. This sphincter opens when the bolus reaches it, allowing the food to enter the stomach. The sphincter normally remains closed at other times to prevent the contents of the stomach from entering the esophagus. Failure of this sphincter to remain completely closed can lead to heartburn. If it happens chronically, it can lead to gastroesophageal reflux disease<\/a> (GERD), in which the mucous membrane of the esophagus may become damaged by the highly acidic contents of the stomach.\r\n\r\nSee the video below to see how the parts of the upper GI tract work together to carry out swallowing:\r\n\r\nhttps:\/\/youtu.be\/pNcV6yAfq-g\r\nSwallowing, uploaded by Alejandra Cork, 2012.<\/p>\r\nStomach<\/span>\r\n\r\nThe\u00a0[pb_glossary id=\"4558\"]stomach[\/pb_glossary]<\/strong> is a J-shaped organ (shown in Figure 15.4.7) that is joined to the esophagus at its upper end, and to the first part of the [pb_glossary id=\"4559\"]small intestine[\/pb_glossary] ([pb_glossary id=\"4576\"]duodenum[\/pb_glossary]) at its lower end. When the stomach is empty of food, it normally has a volume of about 75 millilitres, but it can expand to hold up to about a litre of food. Waves of muscle contractions (peristalsis) passing through the muscular walls of the stomach cause the food inside to be mixed and churned. The wall of the stomach has an extra layer of muscle tissue not found in other organs of the GI tract that helps it squeeze and mix the food. These movements of the stomach wall contribute greatly to mechanical digestion by breaking the food into much smaller pieces. The churning also helps mix the food with stomach secretions that aid in its chemical digestion.\r\n
\r\n\r\n[caption id=\"attachment_4628\" align=\"aligncenter\" width=\"412\"] Figure 15.4.7 The stomach is connected at the top to the esophagus and at the bottom to the duodenum of the small intestine. The pylorus, or pyloric sphincter, controls emptying of the stomach into the small intestine. The outer surface of the stomach is covered with fibrous connective tissue. There are three layers of muscle in the stomach wall. Each layer runs in a different direction: circular, longitudinal and oblique.<\/em>[\/caption]\r\n\r\n<\/div>\r\nSecretions of the stomach include gastric acid, which consists mainly of hydrochloric acid (HCl). This makes the stomach contents highly acidic, which is necessary so that the enzyme [pb_glossary id=\"4581\"]pepsin[\/pb_glossary] \u2014 also secreted by the stomach \u2014 can begin the digestion of [pb_glossary id=\"5813\"]protein[\/pb_glossary]. [pb_glossary id=\"4571\"]Mucus[\/pb_glossary] is secreted by the lining of stomach to provide a slimy protective coating against the otherwise damaging effects of gastric acid. The fat-digesting enzyme [pb_glossary id=\"4602\"]lipase[\/pb_glossary] is secreted in small amounts in the stomach, but very little fat digestion occurs there.\r\n\r\nBy the time food has been in the stomach for about an hour, it has become the thick, semi-liquid [pb_glossary id=\"4582\"]chyme[\/pb_glossary]. When the [pb_glossary id=\"4559\"]small intestine[\/pb_glossary] is ready to receive chyme, a sphincter between the stomach and duodenum \u2014 called the pyloric sphincter \u2014 opens to allow the chyme to enter the small intestine for further digestion and absorption.\r\n\r\nFeature: Reliable Sources<\/h1>\r\n<\/div>\r\nThe ongoing epidemic of obesity in the wealthier nations of the world, including Canada, has led to the development of several different bariatric surgeries that modify the stomach to help obese patients reduce their food intake and lose weight. Go online to learn more about bariatric surgery. Find sources you judge to be reliable that answer the following questions:\r\n
- \r\n \t
- Who qualifies for bariatric surgery?<\/li>\r\n \t
- Describe the bariatric surgeries commonly called stomach stapling, lap band, and gastric sleeve. How does each type of surgery modify the stomach? In terms of weight loss, how effective is each type?<\/li>\r\n \t
- What are the major potential risks of bariatric surgery?<\/li>\r\n \t
- Besides weight loss, what other benefits have been shown to result from bariatric surgery?<\/li>\r\n<\/ol>\r\n\r\n
\r\n 15.4 Summary<\/span><\/h1>\r\n<\/header>\r\n
\r\n- \r\n \t
- Organs of the [pb_glossary id=\"4574\"]upper gastrointestinal (GI) tract[\/pb_glossary] include the mouth, pharynx, esophagus, and stomach.<\/li>\r\n \t
- The [pb_glossary id=\"4297\"]mouth[\/pb_glossary] is the first organ of the GI tract. It has several structures that are specialized for digestion, including [pb_glossary id=\"4577\"]salivary glands[\/pb_glossary], [pb_glossary id=\"4615\"]tongue[\/pb_glossary], and [pb_glossary id=\"5455\"]teeth[\/pb_glossary]. Both [pb_glossary id=\"4550\"]mechanical digestion[\/pb_glossary] and [pb_glossary id=\"4551\"]chemical digestion[\/pb_glossary] of carbohydrates and fats begin in the mouth.<\/li>\r\n \t
- The [pb_glossary id=\"4296\"]pharynx[\/pb_glossary] and [pb_glossary id=\"4557\"]esophagus[\/pb_glossary] move food from the mouth to the stomach, but are not involved in the process of digestion or absorption. Food moves through the esophagus by [pb_glossary id=\"2890\"]peristalsis[\/pb_glossary].<\/li>\r\n \t
- Mechanical and chemical digestion continue in the stomach. Acid and digestive enzymes secreted by the stomach start the chemical digestion of proteins. The stomach turns masticated food into a semi-fluid mixture called [pb_glossary id=\"4582\"]chyme[\/pb_glossary].<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
\r\n 15.4 Review Questions<\/span><\/h1>\r\n<\/header>\r\n
\r\n- \r\n \t
- [h5p id=\"622\"]<\/li>\r\n \t
- Identify structures in the mouth that are specialized for digestion.<\/li>\r\n \t
- Describe digestion in the mouth.<\/li>\r\n \t
- What general role do the pharynx and esophagus play in the digestion of food?<\/li>\r\n \t
- How does food travel through the esophagus?<\/li>\r\n \t
- Describe digestion in the stomach.<\/li>\r\n \t
- Describe the differences between how air and food normally move past the pharynx.<\/li>\r\n \t
- Name two structures in the mouth that contribute to mechanical digestion.<\/li>\r\n \t
- What structure normally keeps stomach contents from backing up into the esophagus?<\/li>\r\n \t
- Thirty minutes after you eat a meal, where is most of your food located? Explain your answer.<\/li>\r\n \t
- What are two roles of mucus in the upper GI tract?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n
\r\n 15.4 Explore More<\/span><\/h1>\r\n<\/header>\r\n
\r\n\r\nhttps:\/\/youtu.be\/zGoBFU1q4g0\r\nWhat causes cavities? - Mel Rosenberg, TED-Ed, 2016.<\/p>\r\nhttps:\/\/youtu.be\/gCrmFbgT37I\r\n
How does alcohol make you drunk? - Judy Grisel, TED-Ed, 2020.<\/p>\r\nhttps:\/\/youtu.be\/twJBEypJDfU\r\n
Gastric Bypass Surgery: One Patient\u2019s Journey - Mayo Clinic, 2014.<\/p>\r\nhttps:\/\/youtu.be\/u_1sVri3b2w\r\n
Here's What Happens In Your Body When You Swallow Gum | The Human Body, Tech Insider, 2018.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n
Attributions<\/h2>\r\nFigure 15.4.1<\/strong>\r\n\r\nHandstand, Pender Island, B.C.<\/a> [photo] by Jasper Garratt<\/a> on Unsplash<\/a> is used under the Unsplash License<\/a> (https:\/\/unsplash.com\/license).\r\n\r\nFigure 15.4.2<\/strong>\r\n\r\nBlausen_0780_SalivaryGlands<\/a> by BruceBlaus<\/a> on Wikimedia Commons is used under a CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\nFigure 15.4.3<\/strong>\r\n\r\n1402_The_Tongue<\/a>\u00a0by OpenStax<\/a> on Wikimedia Commons is used under a CC BY 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/4.0) license.\r\n\r\nFigure 15.4.4<\/strong>\r\n\r\n1024px-3D_Medical_Animation_Still_Showing_Types_of_Teeth<\/a>\u00a0by http:\/\/www.scientificanimations.com<\/a> on Wikimedia Commons is used under a CC BY-SA 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/4.0) license.\r\n\r\nFigure 15.4.5<\/strong>\r\n\r\nIllu01_head_neck<\/a> by Arcadian<\/a> from NCI\/ SEER Training Modules<\/a> on Wikimedia Common is in the public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/public_domain).\r\n\r\nFigure 15.4.6<\/strong>\r\n\r\nZenkerSchraeg<\/a> by Bernd Br\u00e4gelmann<\/a>\u00a0Braegel<\/a> on Wikimedia Commons is used under a\u00a0CC BY 3.0<\/a>\u00a0 (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\u00a0 (Courtesy of Dr. Martin Steinhoff. It is not known whether there is a possibly necessary approval from the patient.)\r\n\r\nFigure 15.4.7<\/strong>\r\n\r\nAnatomy stomach \u2013 white<\/a> by www.medicalgraphics.de from MedicalGraphics<\/a> is used under a\u00a0 CC BY-ND 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/) license.\r\n
References<\/h2>\r\n
Alejandra Cork. (2012). Swallowing. YouTube. https:\/\/www.youtube.com\/watch?v=pNcV6yAfq-g&t=4s<\/p>\r\n
Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 27). Figure\u00a0<\/span><\/span>14.3<\/span><\/span>\u00a0<\/span>The tongue [digital image]. In Anatomy and Physiology<\/em> (Section 14.1). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/14-1-sensory-perception<\/span><\/span><\/p>\r\n
Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\r\n
Mayo Clinic. (2014, August 26). Gastric bypass surgery: One patient\u2019s journey - Mayo Clinic. https:\/\/www.youtube.com\/watch?v=twJBEypJDfU&feature=youtu.be<\/p>\r\n
Mayo Clinic Staff. (n.d.). Gastroesophageal reflux disease (GERD) [online article]. MayoClinic.org. https:\/\/www.mayoclinic.org\/diseases-conditions\/gerd\/symptoms-causes\/syc-20361940<\/p>\r\n
Tech Insider. (2018, March 20). Here's what happens in your body when you swallow gum | The human body. YouTube. https:\/\/www.youtube.com\/watch?v=u_1sVri3b2w&feature=youtu.be<\/p>\r\n
TED-Ed. (2020, April 9). How does alcohol make you drunk? - Judy Grisel. YouTube. https:\/\/www.youtube.com\/watch?v=gCrmFbgT37I&feature=youtu.be<\/p>\r\n
TED-Ed. (2016, October 17). What causes cavities? - Mel Rosenberg. YouTube. https:\/\/www.youtube.com\/watch?v=zGoBFU1q4g0&feature=youtu.be<\/p>\r\n ","rendered":"
<\/p>\n
Figure 15.4.1 Let’s hope gravity doesn’t work too hard in this case.<\/em><\/figcaption><\/figure>\n <\/p>\n
Head Stand<\/span><\/p>\n
Did you ever wonder what would happen if you tried to swallow food while standing on your head like this person in Figure 15.4.1? Many people think that food travels down the gullet from the mouth by the force of gravity. If that were the case, then food you swallowed would stay in your throat while you were standing on your head. In reality, your position doesn\u2019t have much to do with your ability to swallow. Food will travel from your mouth to your stomach whether you are standing upright or upside down. That\u2019s because the tube the food travels through \u2014 the esophagus<\/a> \u2014 moves the food along via muscular contractions known as peristalsis<\/a>. The esophagus is one of several organs that make up the upper gastrointestinal tract.<\/p>\n
\nOrgans of the Upper Gastrointestinal Tract<\/h1>\n<\/div>\n
Besides the esophagus, organs of the\u00a0upper gastrointestinal (GI) tract<\/a><\/strong>\u00a0include the mouth, pharynx, and stomach. These hollow organs are all connected to form a tube through which food passes during digestion. The only role in digestion played by the pharynx and esophagus is to move food through the GI tract. The mouth and stomach, in contrast, are organs where digestion \u2014 or the breakdown of food \u2014 also occurs. In both of these organs, food is broken into smaller pieces (mechanical digestion<\/a>), as well as broken down chemically (chemical digestion<\/a>). It should be noted that the first part of the small intestine (duodenum) is considered in some contexts to be part of the upper GI tract, but that practice is not followed here.<\/p>\n
\nMouth<\/h1>\n<\/div>\n
The\u00a0mouth<\/a><\/strong>\u00a0is the first organ of the GI tract. Most of the oral cavity is lined with mucous membrane<\/a>. This tissue produces mucus, which helps moisten, soften, and lubricate food. Underlying the mucous membrane is a thin layer of smooth muscle<\/a> to which the mucous membrane is only loosely connected. This gives the mucous membrane considerable ability to stretch as you eat food. The roof of the mouth, called the palate, separates the oral cavity from the nasal cavity. The front part is hard, consisting of mucous membrane covering a plate of bone. The back part of the palate is softer and more pliable, consisting of mucous membrane over muscle and connective tissue. The hard surface of the front of the palate allows for pressure needed in chewing and mixing food. The soft, pliable surface of the back of the palate can move to accommodate the passage of food while swallowing. Muscles at either side of the soft palate contract to create the swallowing action.<\/p>\n
Several specific structures in the mouth are specialized for digestion. These include salivary glands, tongue, and teeth.<\/p>\n
Salivary Glands<\/h2>\n
Figure 15.4.2 Salivary glands in the mouth include the three major pairs of glands shown here.<\/em><\/figcaption><\/figure>\n The mouth contains three pairs of major\u00a0salivary glands<\/a><\/strong>, shown in Figure 15.4.2. These three pairs are all exocrine glands<\/span><\/a><\/span>\u00a0that secrete <\/span>saliva<\/a><\/strong>\u00a0into the mouth through ducts.<\/span><\/p>\n
- \n
- The largest of the three major pairs of salivary glands are the\u00a0parotid glands<\/a><\/strong>, which are located on either side of the mouth in front of the ears.<\/li>\n
- The next largest pair is the\u00a0submandibular glands<\/a><\/strong>, located beneath the lower jaw.<\/li>\n
- The third pair is the\u00a0sublingual glands<\/a><\/strong>, located underneath the tongue.<\/li>\n<\/ol>\n
In addition to these three pairs of major salivary glands, there are also hundreds of minor salivary glands in the oral mucosa lining the mouth and on the tongue<\/a>. Along with the major glands, most of the minor glands secrete the digestive enzyme amylase<\/a>, which begins the chemical digestion of starch and glycogen (polysaccharides). However, the minor salivary glands on the tongue secrete the fat-digesting enzyme lipase<\/a>, which in the mouth is called lingual lipase (to distinguish it from pancreatic lipase secreted by the pancreas).<\/p>\n
Saliva secreted by the salivary glands mainly helps digestion, but it also plays other roles. It helps maintain dental health by cleaning the teeth, and it contains antibodies<\/a> that help protect against infection. By keeping the mouth lubricated, saliva also allows the mouth movements needed for speech.<\/p>\n
Tongue<\/h2>\n
The tongue<\/a> is a fleshy, muscular organ that is attached to the floor of the mouth by a band of ligaments that gives it great mobility. This is necessary so the tongue can manipulate food for chewing and swallowing. Movements of the tongue are also necessary for speaking. The upper surface of the tongue is covered with tiny projections called papillae<\/a>, which contain taste buds. The latter are collections of chemoreceptor<\/a> cells (shown in Figure 15.4.3). These sensory cells sense chemicals in food and send the information to the brain via cranial nerves, thus enabling the sense of taste.<\/p>\n
Figure 15.4.3 There are several types of papillae located in different areas on the tongue.<\/em><\/figcaption><\/figure>\n There are five basic tastes detected by the chemoreceptor cells in taste buds: saltiness, sourness, bitterness, sweetness, and umami (often described as a meaty taste). Contrary to popular belief, taste buds for the five basic tastes are not located on different parts of the tongue. Why does taste matter? The taste of food helps to stimulate the secretion of saliva from the salivary glands. It also helps us to eat foods that are good for us, instead\u00a0of\u00a0rotten or toxic foods. The detection of saltiness, for example, enables the control of salt intake and salt balance in the body. The detection of sourness may help us avoid spoiled foods, which often taste sour due to fermentation by bacteria. The detection of bitterness warns of poisons, because many plants defend themselves with toxins that taste bitter. The detection of sweetness guides us to foods that supply quick energy. The detection of umami may signal protein-rich foods.<\/p>\n
Teeth<\/h2>\n
The\u00a0teeth<\/a><\/strong> are complex structures made of a bone-like material called dentin and covered with enamel, which is the hardest tissue in the body. Adults normally have a total of 32 teeth, with 16 in each jaw. The right and left sides of each jaw are mirror images in terms of the numbers and types of teeth they contain. Teeth have different shapes to suit them for different aspects of mastication (chewing). The different types of teeth are illustrated in Figure 15.4.4.<\/p>\n
Figure 15.4.4 In adults, both sides of each jaw normally have the same numbers of the four types of teeth shown here.<\/em><\/figcaption><\/figure>\n - \n
- Incisors<\/a><\/strong>\u00a0are the sharp, blade-like teeth at the front of the mouth. They are used for cutting or biting off pieces of food. In adults, there are normally four incisors in each jaw, or eight in total.<\/li>\n
- Canines<\/a><\/strong>\u00a0are the pointed teeth on either side of the incisors. They are used for tearing foods that are tough or stringy. Adults normally have two canines in each jaw, or four altogether.<\/li>\n
- Premolars<\/a><\/strong>\u00a0and\u00a0molars<\/a><\/strong>\u00a0are cuboid teeth with cusps and grooves that are located on the sides and toward the back of the jaws. Premolars are closer to the front of the mouth. Molars are larger and have more cusps than premolars, but both are used for crushing and grinding food. Adults normally have two premolars and three molars on each side of each jaw, for a total of eight premolars and twelve molars.<\/li>\n<\/ul>\n
\nPharynx<\/h1>\n<\/div>\n
The tube-like pharynx<\/a> (see Figure 15.4.5 below) plays a dual role as an organ of both respiration and digestion. As part of the respiratory system<\/a>, it conducts air between the nasal cavity<\/a> and larynx<\/a>. As part of the digestive system<\/a>, it allows swallowed food to pass from the oral cavity to the esophagus<\/a>. Anything swallowed has priority over inhaled air when passing through the pharynx. During swallowing, the backward motion of the tongue causes a flap of elastic cartilage \u2014 called the epiglottis<\/a> \u2014 to close over the opening to the larynx. This prevents food or drink from entering the larynx.<\/p>\n
Figure 15.4.5 The tongue moves backward during swallowing to cause the epiglottis to cover the opening to the larynx. As a result, food passes from the pharynx to the esophagus \u2014 and not into the larynx.<\/em><\/figcaption><\/figure>\n Esophagus<\/span><\/p>\n
The\u00a0esophagus<\/a><\/strong> (shown in Figure 15.4.6) is a muscular tube through which food is pushed from the pharynx to the stomach. The esophagus passes through an opening in the diaphragm<\/a> (the large breathing muscle that separates the abdomen from the thorax) before reaching the stomach<\/a>. In adults, the esophagus averages about 25 cm (about 9.8 inches) in length, depending on a person\u2019s height. The inner lining of the esophagus consists of mucous membrane, which provides a smooth, slippery surface for the passage of food. The cells of this membrane are constantly being replaced as they are worn away from the frequent passage of food over them.<\/p>\n
Figure 15.4.6 The esophagus moves food by peristalsis from the pharynx to the stomach. Note, this x-ray of a swallow shows a fraction of the ingested liquid being trapped in an atypical diverticulum of the esophagus.<\/em><\/figcaption><\/figure>\n When food is not being swallowed, the esophagus is closed at both ends by upper and lower esophageal sphincters.\u00a0Sphincters<\/a><\/strong>\u00a0are rings of muscle that can contract to close off openings between structures. The upper esophageal sphincter is triggered to relax and open by the act of swallowing, allowing a bolus of food to enter the esophagus from the pharynx. Then, the esophageal sphincter closes again to prevent food from moving back into the pharynx from the esophagus.<\/p>\n
Once in the esophagus, the food bolus<\/a> travels down to the stomach, pushed along by the rhythmic contraction and relaxation of muscles (peristalsis<\/a>). The lower esophageal sphincter is located at the junction between the esophagus and the stomach. This sphincter opens when the bolus reaches it, allowing the food to enter the stomach. The sphincter normally remains closed at other times to prevent the contents of the stomach from entering the esophagus. Failure of this sphincter to remain completely closed can lead to heartburn. If it happens chronically, it can lead to gastroesophageal reflux disease<\/a> (GERD), in which the mucous membrane of the esophagus may become damaged by the highly acidic contents of the stomach.<\/p>\n
See the video below to see how the parts of the upper GI tract work together to carry out swallowing:<\/p>\n
- Canines<\/a><\/strong>\u00a0are the pointed teeth on either side of the incisors. They are used for tearing foods that are tough or stringy. Adults normally have two canines in each jaw, or four altogether.<\/li>\n
- The next largest pair is the\u00a0submandibular glands<\/a><\/strong>, located beneath the lower jaw.<\/li>\n
- The largest of the three major pairs of salivary glands are the\u00a0parotid glands<\/a><\/strong>, which are located on either side of the mouth in front of the ears.<\/li>\n
- [pb_glossary id=\"4620\"]Canines[\/pb_glossary]<\/strong>\u00a0are the pointed teeth on either side of the incisors. They are used for tearing foods that are tough or stringy. Adults normally have two canines in each jaw, or four altogether.<\/li>\r\n \t
- The next largest pair is the\u00a0[pb_glossary id=\"5457\"]submandibular glands[\/pb_glossary]<\/strong>, located beneath the lower jaw.<\/li>\r\n \t
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