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PowerPoint® Lecture Slides prepared by Janice Meeking, Mount Royal College CHAPTER 23 The Digestive System Copyright © 2010 Pearson Education, Inc. Digestive System** • Two groups of organs 1. Alimentary canal (gastrointestinal or GI tract) • Digests and absorbs food • Mouth, pharynx, esophagus, stomach, small intestine, and large intestine Copyright © 2010 Pearson Education, Inc. Digestive System** 2. Accessory digestive organs • Teeth, tongue, gallbladder • Digestive glands • Salivary glands • Liver • pancreas Copyright © 2010 Pearson Education, Inc. Mouth (oral cavity) Tongue Esophagus Liver Gallbladder Duodenum Jejunum Small intestine Ileum Anus Copyright © 2010 Pearson Education, Inc. Parotid gland Sublingual gland Salivary Submandibular glands gland Pharynx Stomach Pancreas (Spleen) Transverse colon Descending colon Ascending colon Large Cecum intestine Sigmoid colon Rectum Vermiform appendix Anal canal Figure 23.1 Digestive Processes** • Six essential activities 1. Ingestion 2. Propulsion 3. Mechanical digestion 4. Chemical digestion 5. Absorption 6. Defecation Copyright © 2010 Pearson Education, Inc. Ingestion Mechanical digestion • Chewing (mouth) • Churning (stomach) • Segmentation (small intestine) Chemical digestion Food Pharynx Esophagus Propulsion • Swallowing (oropharynx) • Peristalsis Stomach (esophagus, stomach, small intestine, large intestine) Absorption Lymph vessel Small intestine Large intestine Defecation Copyright © 2010 Pearson Education, Inc. Blood vessel Mainly H2O Feces Anus Figure 23.2 ** Peristalsis – the contraction and relaxation of muscles that move food along the alimentary canal. Copyright © 2010 Pearson Education, Inc. From mouth (a) Peristalsis: Adjacent segments of alimentary tract organs alternately contract and relax, which moves food along the tract distally. Copyright © 2010 Pearson Education, Inc. (b) Segmentation: Nonadjacent segments of alimentary tract organs alternately contract and relax, moving the food forward then backward. Food mixing and slow food propulsion occurs. Figure 23.3 GI tract regulatory mechanisms 1. Mechanoreceptors and chemoreceptors • Respond to stretch, changes in osmolarity and pH, and presence of substrate and end products of digestion • Initiate reflexes that • Activate or inhibit digestive glands • Stimulate smooth muscle to mix and move lumen contents Copyright © 2010 Pearson Education, Inc. GI tract regulatory mechanisms 2. Intrinsic and extrinsic controls • Enteric nerve plexuses (gut brain) initiate short reflexes in response to stimuli in the GI tract • Long reflexes in response to stimuli inside or outside the GI tract involve CNS centers and autonomic nerves • Hormones from cells in the stomach and small intestine stimulate target cells in the same or different organs Copyright © 2010 Pearson Education, Inc. External stimuli (sight, smell, taste, thought of food) Central nervous system and extrinsic autonomic nerves Long reflexes Afferent impulses Internal (GI tract) stimuli Efferent impulses Chemoreceptors, osmoreceptors, or mechanoreceptors Local (intrinsic) nerve plexus (“gut brain”) Effectors: Smooth muscle or glands Short reflexes Gastrointestinal wall (site of short reflexes) Lumen of the alimentary canal Copyright © 2010 Pearson Education, Inc. Response: Change in contractile or secretory activity Figure 23.4 Peritoneum and Peritoneal Cavity • Peritoneum: serous membrane of the abdominal cavity – has two parts • 1. Visceral peritoneum on external surface of most digestive organs • 2. Parietal peritoneum lines the body wall • Peritoneal cavity • Between the two peritoneums • Fluid lubricates mobile organs Copyright © 2010 Pearson Education, Inc. Abdominopelvic cavity Vertebra Dorsal mesentery Parietal peritoneum Ventral mesentery Visceral peritoneum Peritoneal cavity Alimentary canal organ Liver (a) Schematic cross sections of abdominal cavity illustrate the peritoneums and mesenteries. Copyright © 2010 Pearson Education, Inc. Figure 23.5a Peritoneum and Peritoneal Cavity • Mesentery is a double layer of peritoneum • Routes for blood vessels, lymphatics, and nerves • Holds organs in place and stores fat Copyright © 2010 Pearson Education, Inc. Blood Supply: Splanchnic Circulation • Arteries • Hepatic (_____), splenic (______), and left gastric (_____) • Inferior and superior mesenteric • Hepatic portal circulation • Drains nutrient-rich blood from digestive organs • Delivers it to the liver for processing Copyright © 2010 Pearson Education, Inc. Histology of the Alimentary Canal • Four basic layers (tunics) • Mucosa • Submucosa • Muscularis externa • Serosa Copyright © 2010 Pearson Education, Inc. Nerve Artery Vein Mesentery Copyright © 2010 Pearson Education, Inc. Intrinsic nerve plexuses • Myenteric nerve plexus • Submucosal nerve plexus Glands in submucosa Mucosa • Epithelium • Lamina propria • Muscularis mucosae Submucosa Muscularis externa • Longitudinal muscle • Circular muscle Serosa • Epithelium • Connective tissue Lumen Gland in mucosa Lymphatic Mucosa-associated Duct of gland outside vessel lymphoid tissue alimentary canal Figure 23.6 Mucosa • Lines the lumen • Functions • Secretes mucus, digestive enzymes and hormones • Absorbs end products of digestion • Protects against infectious disease • Three sublayers: epithelium, lamina propria, and muscularis mucosae Copyright © 2010 Pearson Education, Inc. Mucosa • Epithelium • Simple columnar epithelium and mucussecreting cells • Mucus • Protects digestive organs from enzymes • Eases food passage • May secrete enzymes and hormones (e.g., in stomach and small intestine) Copyright © 2010 Pearson Education, Inc. Mucosa • Lamina propria • Loose areolar connective tissue • Capillaries for nourishment and absorption • Lymphoid follicles (part of MALT) • Muscularis mucosae: smooth muscle that produces local movements of mucosa Copyright © 2010 Pearson Education, Inc. Submucosa and Muscularis Externa • Submucosa • Dense connective tissue • Blood and lymphatic vessels, lymphoid follicles, and submucosal nerve plexus Copyright © 2010 Pearson Education, Inc. Submucosa and Muscularis Externa • Muscularis externa • Responsible for segmentation and peristalsis • Inner circular and outer longitudinal layers • Myenteric nerve plexus • Sphincters in some regions Copyright © 2010 Pearson Education, Inc. Serosa • Visceral peritoneum • Replaced by the fibrous adventitia in the esophagus • Retroperitoneal organs have both an adventitia and serosa Copyright © 2010 Pearson Education, Inc. Nerve Artery Vein Mesentery Copyright © 2010 Pearson Education, Inc. Intrinsic nerve plexuses • Myenteric nerve plexus • Submucosal nerve plexus Glands in submucosa Mucosa • Epithelium • Lamina propria • Muscularis mucosae Submucosa Muscularis externa • Longitudinal muscle • Circular muscle Serosa • Epithelium • Connective tissue Lumen Gland in mucosa Lymphatic Mucosa-associated Duct of gland outside vessel lymphoid tissue alimentary canal Figure 23.6 Enteric Nervous System • Intrinsic nerve supply of the alimentary canal • Submucosal nerve plexus • Regulates glands and smooth muscle in the mucosa • Myenteric nerve plexus • Controls GI tract motility Copyright © 2010 Pearson Education, Inc. Enteric Nervous System • Linked to the CNS via afferent visceral fibers • Long ANS fibers synapse with enteric plexuses • Sympathetic impulses inhibit secretion and motility • Parasympathetic impulses stimulate Copyright © 2010 Pearson Education, Inc. Mouth • Oral (buccal) cavity • Bounded by lips, cheeks, palate, and tongue • Oral orifice is the anterior opening • Lined with stratified squamous epithelium Copyright © 2010 Pearson Education, Inc. Soft palate Palatoglossal arch Hard palate Uvula Oral cavity Palatine tonsil Tongue Oropharynx Lingual tonsil Epiglottis Hyoid bone Laryngopharynx Esophagus Trachea (a) Sagittal section of the oral cavity and pharynx Copyright © 2010 Pearson Education, Inc. Figure 23.7a Lips and Cheeks • Contain orbicularis oris and buccinator muscles • Vestibule: recess internal to lips and cheeks, external to teeth and gums • Oral cavity proper lies within the teeth and gums • Labial frenulum: median attachment of each lip to the gum Copyright © 2010 Pearson Education, Inc. Gingivae (gums) Palatine raphe Hard palate Soft palate Uvula Palatine tonsil Sublingual fold with openings of sublingual ducts Vestibule Lower lip Upper lip Superior labial frenulum Palatoglossal arch Palatopharyngeal arch Posterior wall of oropharynx Tongue Lingual frenulum Opening of submandibular duct Gingivae (gums) Inferior labial frenulum (b) Anterior view Copyright © 2010 Pearson Education, Inc. Figure 23.7b Palate • Hard palate: palatine bones and palatine processes of the maxillae • Slightly corrugated to help create friction against the tongue • Soft palate: fold formed mostly of skeletal muscle • Closes off the nasopharynx during swallowing • Uvula projects downward from its free edge Copyright © 2010 Pearson Education, Inc. Tongue • Functions include • Repositioning and mixing food during chewing • Formation of the bolus • Initiation of swallowing, speech, and taste • Intrinsic muscles change the shape of the tongue • Extrinsic muscles alter the tongue’s position • Lingual frenulum: attachment to the floor of the mouth Copyright © 2010 Pearson Education, Inc. Tongue • Surface bears papillae 1. Filiform—whitish, give the tongue roughness and provide friction 2. Fungiform—reddish, scattered over the tongue 3. Circumvallate (vallate)—V-shaped row in back of tongue • These three house taste buds 4. Foliate—on the lateral aspects of the posterior tongue Copyright © 2010 Pearson Education, Inc. Tongue • Terminal sulcus marks the division between • Body: anterior 2/3 residing in the oral cavity • Root: posterior third residing in the oropharynx Copyright © 2010 Pearson Education, Inc. Epiglottis Palatopharyngeal arch Palatine tonsil Lingual tonsil Palatoglossal arch Terminal sulcus Foliate papillae Circumvallate papilla Midline groove of tongue Dorsum of tongue Fungiform papilla Filiform papilla Copyright © 2010 Pearson Education, Inc. Figure 23.8 Salivary Glands • Extrinsic salivary glands (parotid, submandibular, and sublingual) Copyright © 2010 Pearson Education, Inc. Salivary Glands • Intrinsic (buccal) salivary glands are scattered in the oral mucosa • Secretion (saliva) • Cleanses the mouth • Moistens and dissolves food chemicals • Aids in bolus formation • Contains enzymes that begin the breakdown of starch Copyright © 2010 Pearson Education, Inc. Salivary Glands • Parotid gland • Anterior to the ear external to the masseter muscle • Parotid duct opens into the vestibule next to second upper molar • Submandibular gland • Medial to the body of the mandible • Duct opens at the base of the lingual frenulum Copyright © 2010 Pearson Education, Inc. Salivary Glands • Sublingual gland • Anterior to the submandibular gland under the tongue • Opens via 10–12 ducts into the floor of the mouth Copyright © 2010 Pearson Education, Inc. Tongue Teeth Parotid gland Ducts of sublingual gland Frenulum of tongue Sublingual gland Mylohyoid muscle (cut) Anterior belly of digastric muscle (a) Submandibular gland Parotid duct Masseter muscle Body of mandible (cut) Posterior belly of digastric muscle Submandibular duct Mucous cells (b) Copyright © 2010 Pearson Education, Inc. Serous cells forming demilunes Figure 23.9 Composition of Saliva • Secreted by serous and mucous cells • 97–99.5% water, slightly acidic solution containing • Electrolytes—Na+, K+, Cl–, PO4 2–, HCO3– • Salivary amylase and lingual lipase • Mucin • Metabolic wastes—urea and uric acid • Lysozyme, IgA, defensins, and a cyanide compound protect against microorganisms PLAY Animation: Rotatable head Copyright © 2010 Pearson Education, Inc. Control of Salivation • Intrinsic glands continuously keep the mouth moist • Extrinsic salivary glands produce secretions when • Ingested food stimulates chemoreceptors and mechanoreceptors in the mouth • Salivatory nuclei in the brain stem send impulses along parasympathetic fibers in cranial nerves VII and IX • Strong sympathetic stimulation inhibits salivation and results in dry mouth (xerostomia) Copyright © 2010 Pearson Education, Inc. Teeth • Primary and permanent dentitions are formed by age 21 • 20 deciduous teeth erupt (6–24 months of age) • Roots are resorbed, teeth fall out (6–12 years of age) as permanent teeth develop • 32 permanent teeth • All except third molars erupt by the end of adolescence Copyright © 2010 Pearson Education, Inc. (b) Deciduous teeth Copyright © 2010 Pearson Education, Inc. Permanent teeth Figure 23.10b Classes of Teeth • Incisors • Chisel shaped for cutting • Canines • Fanglike teeth that tear or pierce • Premolars (bicuspids) and molars • Have broad crowns with rounded cusps for grinding or crushing Copyright © 2010 Pearson Education, Inc. Incisors Central (6–8 mo) Lateral (8–10 mo) Canine (eyetooth) (16–20 mo) Molars First molar (10–15 mo) Second molar (about 2 yr) (a) Copyright © 2010 Pearson Education, Inc. Deciduous (milk) teeth Incisors Central (7 yr) Lateral (8 yr) Canine (eyetooth) (11 yr) Premolars (bicuspids) First premolar (11 yr) Second premolar (12–13 yr) Molars First molar (6–7 yr) Second molar (12–13 yr) Third molar (wisdom tooth) (17–25 yr) Permanent teeth Figure 23.10a Dental Formulas • A shorthand way of indicating the number and relative position of teeth • Ratio of upper to lower teeth for one-half of the mouth • Primary: 2I,1C, 2M • Permanent: 2I,1C, 2PM, 3M Copyright © 2010 Pearson Education, Inc. Tooth Structure • Crown: the exposed part above the gingiva (gum) • Covered by enamel—the hardest substance in the body (calcium salts and hydroxyapatite crystals) • Root: portion embedded in the jawbone • Connected to crown by neck Copyright © 2010 Pearson Education, Inc. Tooth Structure • Cementum: calcified connective tissue • Covers root and attaches it to the periodontal ligament • Periodontal ligament • Forms fibrous joint called a gomphosis • Gingival sulcus: groove where gingiva borders the tooth Copyright © 2010 Pearson Education, Inc. Falciform ligament Liver Gallbladder Spleen Stomach Ligamentum teres Greater omentum Small intestine Cecum (a) Copyright © 2010 Pearson Education, Inc. Figure 23.30a Tooth Structure • Dentin: bonelike material under enamel • Maintained by odontoblasts of pulp cavity • Pulp cavity: cavity surrounded by dentin • Pulp: connective tissue, blood vessels, and nerves • Root canal: extends from pulp cavity to the apical foramen of the root Copyright © 2010 Pearson Education, Inc. Crown Neck Enamel Dentin Dentinal tubules Pulp cavity (contains blood vessels and nerves) Gingiva (gum) Cementum Root Root canal Periodontal ligament Apical foramen Bone Copyright © 2010 Pearson Education, Inc. Figure 23.11 Tooth and Gum Disease • Dental caries (cavities): gradual demineralization of enamel and dentin • Dental plaque (sugar, bacteria, and debris) adheres to teeth • Acid from bacteria dissolves calcium salts • Proteolytic enzymes digest organic matter • Prevention: daily flossing and brushing Copyright © 2010 Pearson Education, Inc. Tooth and Gum Disease • Gingivitis • Plaque calcifies to form calculus (tartar) • Calculus disrupts the seal between the gingivae and the teeth • Anaerobic bacteria infect gums • Infection reversible if calculus removed Copyright © 2010 Pearson Education, Inc. Tooth and Gum Disease • Periodontitis • Immune cells attack intruders and body tissues • Destroy periodontal ligament • Activate osteoclasts • Consequences • Possible tooth loss, promotion of atherosclerosis and clot formation in coronary and cerebral arteries Copyright © 2010 Pearson Education, Inc. Copyright © 2010 Pearson Education, Inc. Large Intestine: Microscopic Anatomy • Mucosa of simple columnar epithelium except in the anal canal (stratified squamous) • Abundant deep crypts with goblet cells • Superficial venous plexuses of the anal canal form hemorrhoids if inflamed Copyright © 2010 Pearson Education, Inc. Bacterial Flora • Enter from the small intestine or anus • Colonize the colon • Ferment indigestible carbohydrates • Release irritating acids and gases • Synthesize B complex vitamins and vitamin K Copyright © 2010 Pearson Education, Inc. Functions of the Large Intestine** • Vitamins, water, and electrolytes are reclaimed • Major function is propulsion of feces toward the anus • Colon is not essential for life Copyright © 2010 Pearson Education, Inc. Copyright © 2010 Pearson Education, Inc. Chemical Digestion and Absorption of Carbohydrates • Digestive enzymes • Salivary amylase, pancreatic amylase, and brush border enzymes (dextrinase, glucoamylase, lactase, maltase, and sucrase) Copyright © 2010 Pearson Education, Inc. Chemical Digestion and Absorption of Carbohydrates • Absorption • Secondary active transport (cotransport) with Na+ • Facilitated diffusion of some monosaccharides • Enter the capillary beds in the villi • Transported to the liver via the hepatic portal vein Copyright © 2010 Pearson Education, Inc. Carbohydrate digestion Foodstuff Enzyme(s) and source Site of action Starch and disaccharides Oligosaccharides and disaccharides Lactose Maltose Sucrose Galactose Glucose Fructose Copyright © 2010 Pearson Education, Inc. Salivary amylase Pancreatic amylase Brush border enzymes in small intestine (dextrinase, glucoamylase, lactase, maltase, and sucrase) Mouth Small intestine Small intestine Path of absorption • Glucose and galactose are absorbed via cotransport with sodium ions. • Fructose passes via facilitated diffusion. • All monosaccharides leave the epithelial cells via facilitated diffusion, enter the capillary blood in the villi, and are transported to the liver via the hepatic portal vein. Figure 23.32 (1 of 4) Chemical Digestion and Absorption of Proteins • Enzymes: pepsin in the stomach • Pancreatic proteases • Trypsin, chymotrypsin, and carboxypeptidase • Brush border enzymes • Aminopeptidases, carboxypeptidases, and dipeptidases • Absorption of amino acids is coupled to active transport of Na+ Copyright © 2010 Pearson Education, Inc. Amino acids of protein fragments Brush border enzymes Apical membrane (microvilli) Lumen of intestine Pancreatic proteases 1 Proteins and protein fragments are digested to amino acids by pancreatic proteases (trypsin, chymotrypsin, and carboxypeptidase), and by brush border enzymes (carboxypeptidase, aminopeptidase, and dipeptidase) of mucosal cells. Na+ Na+ Absorptive epithelial cell 2 The amino acids are then absorbed by active transport into the absorptive cells, and move to their opposite side (transcytosis). Amino acid carrier 3 The amino acids leave the Active transport Passive transport Copyright © 2010 Pearson Education, Inc. Capillary villus epithelial cell by facilitated diffusion and enter the capillary via intercellular clefts. Figure 23.33 Protein digestion Foodstuff Protein Large polypeptides Small polypeptides, small peptides Amino acids (some dipeptides and tripeptides) Copyright © 2010 Pearson Education, Inc. Enzyme(s) and source Pepsin (stomach glands) in presence of HCl Pancreatic enzymes (trypsin, chymotrypsin, carboxypeptidase) Brush border enzymes (aminopeptidase, carboxypeptidase, and dipeptidase) Site of action Path of absorption • Amino acids are absorbed by cotransport with Stomach sodium ions. • Some dipeptides and tripeptides are absorbed via cotransport with H++ Small and hydrolyzed to amino intestine acids within the cells. • Amino acids leave the epithelial cells by Small facilitated diffusion, enter intestine the capillary blood in the villi, and are transported to the liver via the hepatic portal vein. Figure 23.32 (2 of 4) Chemical Digestion and Absorption of Lipids • Pre-treatment—emulsification by bile salts • Enzymes—pancreatic lipase • Absorption of glycerol and short chain fatty acids • Absorbed into the capillary blood in villi • Transported via the hepatic portal vein Copyright © 2010 Pearson Education, Inc. Chemical Digestion and Absorption of Lipids • Absorption of monoglycerides and fatty acids • Cluster with bile salts and lecithin to form micelles • Released by micelles to diffuse into epithelial cells • Combine with proteins to form chylomicrons • Enter lacteals and are transported to systemic circulation Copyright © 2010 Pearson Education, Inc. Fat globule 1 Large fat globules are emulsified (physically broken up into smaller fat droplets) by bile salts in the duodenum. Bile salts Fat droplets coated with bile salts 2 Digestion of fat by the pancreatic enzyme lipase yields free fatty acids and monoglycerides. These then associate with bile salts to form micelles which “ferry” them to the intestinal mucosa. Micelles made up of fatty acids, monoglycerides, and bile salts 3 Fatty acids and monoglycerides leave micelles and diffuse into epithelial cells. There they are recombined and packaged with other lipoid substances and proteins to form chylomicrons. 4 Chylomicrons are extruded from the Epithelial cells of small intestine Copyright © 2010 Pearson Education, Inc. Lacteal epithelial cells by exocytosis. The chylomicrons enter lacteals. They are carried away from the intestine by lymph. Figure 23.34 Fat digestion Foodstuff Enzyme(s) and source Unemulsified fats Emulsification by the detergent action of bile salts ducted in from the liver Pancreatic lipases Monoglycerides Glycerol and fatty acids and fatty acids Copyright © 2010 Pearson Education, Inc. Site of action Path of absorption • Fatty acids and monoglycerides enter the intestinal cells via diffusion. Small intestine • Fatty acids and monoglycerides are recombined to form triglycerides and then combined with other lipids and proteins within the cells, and the resulting chylomicrons are Small extruded by exocytosis. intestine • The chylomicrons enter the lacteals of the villi and are transported to the systemic circulation via the lymph in the thoracic duct. • Some short-chain fatty acids are absorbed, move into the capillary blood in the villi by diffusion, and are transported to the liver via the hepatic portal vein. Figure 23.32 (3 of 4) Chemical Digestion and Absorption of Nucleic Acids • Enzymes • Pancreatic ribonuclease and deoxyribonuclease • Absorption • Active transport • Transported to liver via hepatic portal vein Copyright © 2010 Pearson Education, Inc. Nucleic acid digestion Foodstuff Enzyme(s) and source Nucleic acids Pentose sugars, N-containing bases, phosphate ions Copyright © 2010 Pearson Education, Inc. Pancreatic ribonuclease and deoxyribonuclease Brush border enzymes (nucleosidases and phosphatases) Site of action Path of absorption • Units enter intestinal cells by active transport via Small intestine membrane carriers. • Units are absorbed into capillary blood in the villi Small and transported to the intestine liver via the hepatic portal vein. Figure 23.32 (4 of 4) Vitamin Absorption • In small intestine • Fat-soluble vitamins (A, D, E, and K) are carried by micelles and then diffuse into absorptive cells • Water-soluble vitamins (vitamin C and B vitamins) are absorbed by diffusion or by passive or active transporters. • Vitamin B12 binds with intrinsic factor, and is absorbed by endocytosis Copyright © 2010 Pearson Education, Inc. Vitamin Absorption • In large intestine • Vitamin K and B vitamins from bacterial metabolism are absorbed Copyright © 2010 Pearson Education, Inc. Electrolyte Absorption • Mostly along the length of small intestine • Iron and calcium are absorbed in duodenum • Na+ is coupled with absorption of glucose and amino acids • Ionic iron is stored in mucosal cells with ferritin • K+ diffuses in response to osmotic gradients • Ca2+ absorption is regulated by vitamin D and parathyroid hormone (PTH) Copyright © 2010 Pearson Education, Inc. Malabsorption of Nutrients • Causes • Anything that interferes with delivery of bile or pancreatic juice • Damaged intestinal mucosa (e.g., bacterial infection) Copyright © 2010 Pearson Education, Inc. Malabsorption of Nutrients • Gluten-sensitive enteropathy (celiac disease) • Gluten damages the intestinal villi and brush border • Treated by eliminating gluten from the diet (all grains but rice and corn) Copyright © 2010 Pearson Education, Inc. Developmental Aspects • During old age • GI tract activity declines, absorption is less efficient, and peristalsis is slowed • Diverticulosis, fecal incontinence, and cancer of the GI tract Copyright © 2010 Pearson Education, Inc. Cancer • Stomach and colon cancers rarely have early signs or symptoms • Metastasized colon cancers frequently cause secondary liver cancer • Prevention • Regular dental and medical examination Copyright © 2010 Pearson Education, Inc. Homeostatic Imbalance • Gastritis: inflammation caused by anything that breaches the mucosal barrier • Peptic or gastric ulcers: erosion of the stomach wall • Most are caused by Helicobacter pylori bacteria Copyright © 2010 Pearson Education, Inc. Bacteria Mucosa layer of stomach (a) A gastric ulcer lesion Copyright © 2010 Pearson Education, Inc. (b) H. pylori bacteria Figure 23.16