Kupffer cells within the sinusoids are phagocytic antigen-presenting cells that clear bacteria from the portal circulation releasing cytokines into the systemic circulation. They synthesize essential proteins including albumin, coagulation factors, lipoproteins, and transport molecules, and they synthesize and secrete the bile salts necessary for digestion and absorption of fats. Hepatocytes remove toxic metabolic products and toxins absorbed by the gut eliminating them via the circulation or bile after processing. In the liver portal venous blood from the gut, pancreas, and spleen percolates from the portal triads through a radial array of sinusoids to the central vein, hepatic vein and inferior vena cava (IVC). It also contains the islets of Langerhans, which release insulin, glucagon, and somatostatin in response to blood glucose changes and other stimuli. The pancreas releases bicarbonate, amylase, lipase, and proteinases in response to specific foods and duodenal contents. The liver and pancreas parenchyma arises from condensation of mesenchyma around embryonic gut evaginations forming the biliary and pancreatic ducts. Physical signs include changes in overall nutrition, abnormal abdominal contour, altered bowel sounds, solid-organ enlargement, increased peritoneal fluid, localized mass, and tenderness. Symptoms include changes in appetite and interest in food, abdominal sensations including pain, and alterations in stool character and frequency. Disruption of this system results in symptoms and signs referred to the abdomen.
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It is susceptible to intraluminal obstruction at narrow points (gastroesophageal junction, pylorus, ileocecal valve), to obstruction by extraluminal compression, and to twisting or kinking where suspended on a mesentery (especially the small bowel, cecum, and sigmoid). The bowel is a muscular tube suspended by a mobile mesentery (stomach, small intestine, cecum, transverse and sigmoid colon) or anchored to the posterior abdominal wall (duodenum, ascending and descending colon) or pelvic floor (rectum). Normal motility and digestion depend upon coordinated muscular and secretory activity mediated by local and systemic neural and endocrine systems. The intra-abdominal portion extends from the gastroesophageal junction the diaphragmatic hiatus to the anus.
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The alimentary system starts at the mouth and ends at the anus.