Enhanced  computed tomography  showing severe  atherosclerosis  of the arteries. The  aorta  shows broad calcifications, and the  celiac artery  shows moderate  stenosis , although the lumen of the  superior mesenteric artery  was relatively patent. In addition,  stenosis  of the  inferior mesenteric artery  was very severe.


A  computed tomography angiogram  showing  stenosis  of the  superior mesenteric artery  (arrow).


Painful perianal abscess


MRI image of U-shaped fluid collection around the anus, showing perianal abscess formation.


The perineum of a 27-year-old man shows scar (on the right) after surgical treatment of paraproctitis.


Stylized diagram showing action of the puborectalis sling, and the formation of the anorectal angle. A-puborectalis, B-rectum, C-level of anorectal ring and anorectal angle, D-anal canal, E- anal verge , F-representation of internal and external anal sphincters, G-coccyx & sacrum, H-pubic symphysis, I-Ischium, J-pubic bone.


Abscess locations.


Finger ring with a bezoar stone, from 17th century


Bowel infarction. Note the grey discoloration.


A small bowel obstruction as seen on CT


Average inner diameters and ranges of different sections of the large intestine. [ 15 ]


Upright abdominal X-ray demonstrating a small bowel obstruction. Note multiple air fluid levels.


Upright abdominal X-ray of a person with a large bowel obstruction showing multiple air fluid levels and dilated loops of bowel


Campylobacter bacteria are the number-one cause of food-related   gastrointestinal illness  in the United States. This scanning electron microscope image shows the characteristic spiral, or corkscrew, shape of  C. jejuni  cells and related structures.


Other medicinal claims for Coca-Cola


Typical cholera diarrhea that looks like "rice water"


Scanning electron microscope  image of  Vibrio cholerae


Vibrio cholerae , the bacterium that causes cholera


The role of  biofilm  in the intestinal colonization of  Vibrio cholerae


Preventive inoculation against cholera in 1966


Euvichol-plus oral vaccine for cholera


Women at a village pond in  Matlab, Bangladesh  washing utensils and vegetables. The woman on the right is putting a sari filter onto a water-collecting pot (or  kalash ) to filter water for drinking.


Cholera patient being treated by  oral rehydration therapy  in 1992


Disposal of dead bodies during the cholera epidemic in  Palermo  in 1835


Map of the  2008–2009 cholera outbreak  in  sub-Saharan Africa  showing the statistics as of 12 February 2009


Robert Koch  (third from the right) on a cholera research expedition in  Egypt  in 1884, one year after he identified  V. cholerae


How to avoid the cholera  leaflet;  Aberystwyth ; August 1849


Prof.  Sambhu Nath De , who discovered the  cholera toxin  and successfully demonstrated the transmission of cholera pathogen by  bacterial enteric toxin


US President  James K. Polk  was a famous victim of cholera


Kolkata  suffers from frequent cholera outbreaks


DQ α 5 -β 2  -binding cleft with a deamidated gliadin peptide (yellow), modified from  PDB :  1S9V  [ 65 ]


HLA region of chromosome 6


Illustration of deamidated α-2 gliadin's 33mer, amino acids 56–88, showing the overlapping of three varieties of T-cell epitope [ 77 ]


The active form of  tissue transglutaminase  (green) bound to a  gluten  peptide mimic (blue).  PDB :  3q3z


Immunofluorescence  staining pattern of endomysial antibodies on a monkey oesophagus tissue sample


Endoscopic  still of  duodenum  of a person with coeliac disease showing scalloping of folds and "cracked-mud" appearance to mucosa


Schematic of the Marsh classification of upper  jejunal  pathology in coeliac disease [ image reference needed ]


Micrograph  showing  cryptitis  in a case of  Crohn's disease .  H&E stain .


Spiral CT showing ascites and concentric thickening of colon and ileum in EG


Abdominal CT scan, Epiploic Appendagitis (circle)


Gross pathology of a peritoneal loose body, caused torsion and autoamputation of an epiploic appendage, which eventually becomes embedded in a fibrous capsule.


Stylized diagram showing the action of the puborectalis sling, the looping of the  puborectalis muscle  around the bowel. This pulls the bowel forwards and forms the anorectal angle, the angle between the anal canal and the rectum. A-puborectalis, B-rectum, C-level of the anorectal ring and anorectal angle, D-anal canal, E- anal verge , F-representation of internal and external anal sphincters, G- coccyx  &  sacrum , H- pubic symphysis , I- Ischium , J- pubic bone .


Structure of anal canal


Incontinence products


H&E stain of fundic gland polyp showing shortening of the gastric pits with cystic dilatation


Causes of gastrointestinal bleeding


The Blakemore esophageal balloon used for stopping esophageal bleeds if other measures have failed


Reddish stool in toilet bowl water due to  dragon fruit  consumption


A: Plain abdominal radiograph showing a PARTZ at rectosigmoid, arrow. B: Plain abdominal radiograph showing a PARTZ at midsigmoid, arrow. C: Plain abdominal radiograph showing a PARTZ at descending colon, arrow. D: Contrast enema showing a CETZ at rectosigmoid, arrow. E: Contrast enema showing a CETZ at midsigmoid, arrow. F: Contrast enema showing a CETZ at descending colon, arrow.


Associated loci pane. Pink genes are in IBD associated loci, blue are not.


Cryptosporidium muris


Praziquantel


Micrograph  showing intestinal spirochetosis.  H&E stain .


Colonic blood supply. Pink - supply from  superior mesenteric artery  (SMA) and its branches: middle colic, right colic, ileocolic arteries. Blue - supply from  inferior mesenteric artery  (IMA) and its branches: left colic, sigmoid, superior rectal artery. 7 is for so-called Cannon-Böhm point (the border between the areas of SMA and IMA supplies), which lies at the splenic flexure


Diverticular disease – a cause of LGIBs


Basic algorithm for the management of lower GI bleed.


Small intestine : major site of absorption


Biopsy of  small bowel  showing  coeliac disease  manifested by blunting of  villi , crypt  hyperplasia , and  lymphocyte  infiltration of crypts.


Micrograph  of  melanosis coli , with the characteristic  mucosal   lipofuscin -laden  macrophages  (brown).


Life cycle of the various organisms that cause microsporidiosis.


Radiograph  of a baby with necrotizing enterocolitis


This image shows constipation in a young child as seen on X-ray.


A perianal hematoma, identified by the typical blue tinge under the skin (to the left in the above image)


Micrograph  of  Peutz–Jeghers  type  colonic polyp .  H&E stain .


Drawing from 1896 publication of twins thought to have Peutz–Jeghers Syndrome


Most people with Peutz–Jeghers syndrome will have developed some form of neoplastic disease by age 60.


Barium enema radiograph showing multiple polyps (mostly pedunculated) and at least one large mass at the hepatic flexure coated with contrast in a patient with Peutz–Jeghers syndrome


A normal throat


Exudative  pharyngitis in a person with  infectious mononucleosis


A case of strep throat


Throat swab


Upper and lower human gastrointestinal tract


Proteoglycan


US states with Restroom Access Acts.


Deficiency of vitamin B 12  can occur in bacterial overgrowth [ citation needed ]


E. coli , shown in this electron micrograph, is commonly isolated in patients with bacterial overgrowth


Aspiration of bacteria from the  jejunum  is the gold standard for diagnosis.  A bacterial load of greater than 10 5  bacteria per millilitre is diagnostic for bacterial overgrowth


Biopsies of the small bowel in bacterial overgrowth can mimic  celiac disease , with partial  villous  atrophy.


Superior mesenteric artery compressing the duodenum, featuring the superior mesenteric artery syndrome


Upper gastrointestinal series  showing duodenojejuonostomy (white arrow).


SMA syndrome was first described in 1861 by  Carl Freiherr von Rokitansky .


Gastric ulcer in  antrum  of  stomach  with overlying clot.  Pathology was consistent with  gastric lymphoma .


Endoscopic  image of small  gastric ulcer  with visible vessel


The above ulcer seen after endoscopic clipping


High magnification  micrograph  showing the characteristic foamy  macrophages  in the  lamina propria ,  H&E stain


The back of an East Asian man showing alcohol flush reaction.


Genotype frequency distribution of ALDH2 (rs671).


Deaths due to digestive diseases per million persons in 2012     36-131    132-205    206-232    233-274    275-313    314-352    353-390    391-460    461-546    547-1109


Abdominal X-rays  may be used to visualise the  large intestine .


An  external hemorrhoid


Gross pathology  of hemorrhoids, showing engorged blood vessels


A  thrombosed  external hemorrhoid


An 11th-century English miniature. On the right is an operation to remove hemorrhoids.


Pathophysiology of Heyde's Syndrome a.  von Willebrand Factor (vWF) passes through a normal aortic valve and remains in its coiled form. b.  vWF passes through a stenotic aortic valve and uncoils. c.  Coiled vWF is unaffected by the catabolic enzyme ADAMTS13. d.  Uncoiled vWF is cleaved in two by ADAMTS13. e.  In damaged arterioles vWF uncoils and becomes active. It binds collagen, platelets bind to vWF, and a clot forms. f.  Inactive vWF cannot bind to the collagen, no clot forms.


Image of a piece of food obstructing the  esophagus , a complication in lymphocytic esophagitis


Endoscopic image of lymphocytic esophagitis, demonstrating narrow lumen esophagus (left), linear furrows (right) and esophageal rings (right)


Relative position of the heart and stomach in the human body


Human stomach with  fundus  part visible and Vagus nerve


Gastric nerve connections to the  spinal cord  and  brain   medulla oblongata , which regulate the movements of the stomach


Drawings of Bozzini's "Lichtleiter", an early  endoscope


McClendon's  pH-probe


Diagram of a colonoscopy procedure


Sigmoidoscopy


Endoscopy


ERCP


Gastroesophageal reflux


Anal plug.


An assortment of A-tam anal tampons produced by Med SSE-System.


Schematics and crystal structures of HAstV-1 CP core and spike.


Schematic representation of the genomic organization of the two novel Passerine Astroviruses.


Phylogenetic tree of astroviruses and the species infected by them


Balsalazide synthesis: Biorex Laboratories,  GB 2080796    (1986).


Rectal barostat balloon, partially inflated


Chromoendoscopy using  Lugol's iodine  in the  esophagus . The image on the left uses regular white light  endoscopy . The image on the right stains with Lugol's iodine, and identifies a  squamous cell carcinoma , which does not pick up the stain.


Chemical structure of timoprazole, the backbone-structure of PPIs


The proton pump inhibitor omeprazole


The proton pump inhibitor lansoprazole


The proton pump inhibitor pantoprazole


The proton pump inhibitor rabeprazole


The proton pump inhibitor esomeprazole


The proton pump inhibitor dexlansoprazole


The proton pump inhibitor tenatoprazole


General structure of proton pump inhibitors.  Asterisk  indicates  stereocenter . Dots indicate  lone pair


SCH28080 — the prototypical P-CAB


A single-use rotatable endoclip in packaging


Gastric ulcer  with a red spot seen in  gastroscopy  of a patient with  upper gastrointestinal hemorrhage


Successful closure of the gastric ulcer with an endoclip


An ulcer seen after  polypectomy  (left) with a visible vessel suggesting recent bleeding is successfully closed with two endoclips (right)


Endoscopy tower and procedural area of an  endoscopy unit


An endoscopy procedure room


An endoscopy recovery area


Rectal bulb syringe to administer smaller enemas.


Soapsuds enemas, one in an enema bucket with a nozzle typical for a cleansing enema, and another in an enema bag with a nozzle typical for a contrast enema


A prepared, disposable enema.


A barium enema in a disposable bag manufactured for that purpose


Pressure enema from an animal bladder (African wooden sculpture, 19th century)


The Enema  by  Abraham Bosse , ca. 1632–33


Portable enema self-administration apparatus by  Giovanni Alessandro Brambilla  (18th century; Medical History Museum, University of Zurich)


A normal clyster syringe  (front)  and the nozzle for a syringe designed for self-administration  (rear) . The latter avoided the need for a second party to attend an embarrassing procedure.


19th century satirical cartoon of a monkey rejecting an old style clyster for a new design, filled with marshmallow and opium


This nozzle (shown here in harness) can be inflated to a diameter wider than a rectum to force holding in an enema that could not otherwise be retained. Used either for pleasure or as part of  BDSM  activities.


A filled 5 litre enema bag connected to a bored  dildo , ready to inject into a recipient on the ground beneath.


Fluoroscopic image of  common bile duct


Schematic diagram of hepato-biliary system


Dr. B Blumberg, awarded Nobel prize 1976 for discovery of hepatitis B virus


Hand bill from the  New York City Board of Health , 1832. The outdated public health advice demonstrates the lack of understanding of the disease and its actual causative factors.


First cholera pandemic


Disposal of dead bodies during the cholera epidemic in  Palermo  in 1835


Register of Patients Gosport Naval Hospital August 1832 cholera cases


A pump memorializing  John Snow  for his study of contaminated water as a likely source of cholera during the  1854 Broad Street Cholera outbreak


Patients suffering from cholera in 1854


1892 cholera outbreak in  Hamburg , hospital ward


Bodies of  Rwandan refugees  who died during the cholera epidemic, October 1994


By 12 February 2009, the number of cases of infection by cholera in sub-Saharan Africa had reached 128,548 and the number of fatalities, 4,053.


Human feces photographed in a  toilet , shortly after  defecation .


Fresh feces collected from a child for a drying experiment


Feces after drying in an experiment to determine moisture content


Prescription parenteral nutrition formulation.


Isolated intestine transplant diagram.


Kellogg in 1881, aged about 29


Battle Creek Medical Surgical Sanitarium  before 1902


Breathing exercises at Battle Creek Sanitarium (c. 1900)


Early Kellogg's Corn Flakes advertisement


Radiant heat bath by John H. Kellogg at the USPTO museum, patent no. 558,394; patented April 14, 1896


Mechanical Camel designed by John Harvey Kellogg.


Kellogg's grave (second from left) at Oak Hill Cemetery


Schematic of the metabolism of acetaminophen ( paracetamol ) by the hepatocyte.


Amanita phalloides , the death cap mushroom, is a cause of acute liver failure


Glycerin suppositories used as laxatives.


Senna plant


A Murphy drip apparatus [ 1 ]


John Murphy, inventor of the Murphy drip


A person with  cholera  drinking oral rehydration solution (ORS)


Commercially available oral rehydration salts:  left , from  Nepal ;  right , from  Peru .


Commercially available ORS in water.


UNICEF-WHO Oral Rehydration Salt (ORS) packet


Intestinal epithelium (H&E stain)


Crane  and his sketch of the sodium-glucose  symporter


Refugee camp near  Goma


Urostoma and wafer/baseplate


A typical ostomy pouch, in this case a closed-end or "disposable". Note the  flange  ring, which uses a " Tupperware " type of seal


One-piece (open-end) bags


Reaction catalysed by pancreatic elastase 1. This image represents the  hydrolysis  of the succinyl-Ala-Ala-Ala-p-nitroanalide. The addition of one water molecule provokes the  hydrolysis  of the molecule and the release of p-nitroaniline.


The gastrointestinal tract is composed of numerous cell types that are important for immune activation and barrier surface defenses. The gastrointestinal epithelium is composed of enterocytes, goblet cells, Paneth cells, enteroendocrine cells, tuft cells, and stem cells. In contrast, the lamina propria is composed of immune cells such as dendric cells, T cells, and macrophages.


The Phrygian cap results from folding of the  gallbladder fundus .


Ulcerative and destructive skin lesion on a dog caused by Pythium insidiosum


Pythium  hyphae


A mature  sporangium  of a  Mucor  sp. fungus


The activation of PPIs


A set of antique rectal dilators exhibited at  Glore Psychiatric Museum .


Two (2)  pilonidal cysts  in the  intergluteal cleft  showing mucopurulent discharge.


A simplified diagram of the location of rotavirus structural proteins [ 34 ]


Electron micrograph of gold nanoparticles attached to rotavirus. The small dark circular objects are gold nanoparticles coated with a  monoclonal antibody  specific for rotavirus protein VP6.


A simplified drawing of the rotavirus replication cycle. [ 61 ]  The stages are: Attachment of the virus to the host cells, which is mediated by VP4 and VP7 Penetration of the cell by the virus and uncoating of the viral capsid Plus strand ssRNA synthesis (this acts as the mRNA) synthesis, which is mediated by VP1, VP3 and VP2 Formation of the viroplasm, viral RNA packaging and minus strand RNA synthesis and formation of the double-layered virus particles Virus particle maturation and release of progeny virions


Rotaviruses in the  faeces  of an infected child


Electron micrograph of a rotavirus infected enterocyte (top) compared to an uninfected cell (bottom). The bar = approx. 500   nm.


One of Flewett's original electron micrographs showing a single rotavirus particle. When examined by negative stained electron microscopy, rotaviruses often resemble wheels.


Rotarix vaccine for oral administration


Schematic of self-expandable metallic stent used to treat vascular abnormalities


Fluoroscopic  image of self-expandable  metallic stent in the esophagus . The black solid structure is the  endoscope  used to place the stent.


Fluoroscopic image of two metal biliary stents in the  common bile duct .  The large black tube across the image is the duodenoscope.


Diagram of a Minnesota tube (a similar device to the Sengstaken – Blakemore tube, but with four lumens)


Colostomy


Patient with a  colostomy  complicated by a large parastomal hernia, which is when tissue protrudes adjacent to the stoma tract.


CT scan  of same patient, showing intestines within the hernia.  Parastomal hernia is the most common late complication of stomata through the  abdominal wall , occurring in 10 to 25% of the patients. [ 1 ]


Endoscopic image of  esophageal varices  being ligated with rubber bands.  The varix being ligated has a longitudinal red mark on it, termed the wale mark


Two Alka-Seltzer Plus tablets next to an Alka-Seltzer Plus packet


The crystal structure of bismuth subgallate. [ 5 ]


Simplified molecular structure of bismuth subsalicylate.


A generic version of Pepto-Bismol, back view


1957  Life  magazine ad for the product


The crystal structure of bismuth subsalicylate. [ 27 ]


Bromo-Seltzer newspaper ad (1908)


Emerson Drug Company's  Bromo-Seltzer Tower  headquarters in Baltimore


A horse-drawn Bromo-Seltzer wagon


Dalby's Carminative, leftmost bottle


The antacid,  Maalox


Alison Howe Price, M.D.


Reabsorption of metabolites and toxic substances in the intestine (Chart)


PMSPH eliminates reverse absorption of metabolites and toxic substances in the intestine


Figure N1. A vicious circle of damage to the intestinal mucosa and endotoxin aggression (Scheme)


Figure 2. Reverse development of damage to the intestinal mucosa, restoration of intestinal barrier function


Antique  Stothert's  Seidlitz Tin


A map showing the origin of the name "Seidlitz powder"


Glycerin  suppositories ( laxative )


Four 500 mg  paracetamol  suppositories


Androderm testosterone skin patch


A vial of Depo-Testosterone (testosterone cypionate in oil) for intramuscular injection


Abdominal examination and potential findings


Examination of the abdomen of a child.


Colonscopy image of the cecum showing a  bow and arrow sign . The appendiceal orifice, depicted, curves like a  bow  to show the location of the  ileocecal valve  on the most distal cecal fold.


Endoscopic capsule end-on, showing six LEDs and camera lens.


Image of the intestines acquired by capsule endoscopy


Image of the colon acquired by capsule endoscopy


Inner diameters of colon sections


A container of PEG ( polyethylene glycol or macrogol ) with electrolyte used to clean out the  intestines  before certain  bowel  exam procedures such as a colonoscopy.


Schematic overview of colonoscopy procedure


Endoscopic image of polyp in small bowel detected on double-balloon enteroscopy


3D graph of a human gastroenterogramm: electrical signals from GI smooth muscle (in μV) on the vertical y-axis; from left to right on the x-axis: large intestine, stomach, ileum, jejunum, duodenum. The time (in minutes) is drawn on the z-axis.


Operation part of the endoscope


Insertion tip of an endoscope


An  anoscope , a  proctoscope , and a  rectoscope  with approximate lengths


Endoscopy surgery


Esophageal Bougie Dilator


96 Hour Bravo pH monitoring  A sample of Bravo pH tracing recorded over 48 hours


Gastroscopy or duodenoscopy is performed for a number of indications, one of the most common being in unexplained anemia, where it is used to diagnose  gastric  or  duodenal ulcers , among other things.


A LabCorp fecal occult blood immunoassay testing kit.


A positive traditional guaiac fecal occult blood test


Endoscopy  image of a  duodenal ulcer  in the posterior part of the  duodenal bulb  without stigmata of recent hemorrhage.  This would be a  Forrest III  lesion


Endoscopic capsule


Given Imaging headquarters in  Yokneam


A barium enema in a disposable bag manufactured for that purpose


Right lateral Sims position. (The more usual left lateral Sims position, suitable for a right-handed practitioner, has the patient lying on their left side.)


Posterior view of Sims' position


Anterior view of Sims' position


Both square test areas in the upper area of the card show the intense blue color of a positive result. The lower two smaller circular areas on the orange stripe are analytical control reactions, positive on the left and negative on the right, that help assure that the card and developer bottle have been maintained in proper conditions and have not been damaged before the test is performed.


Proposed oxidations of compounds in guaiac oil as explanation for the formation of the blue bis-methylenequinone as part of the guaiac test.


Barium meal examination showing the stomach and duodenum in double contrast technique with CO2 as negative contrast medium


Barium follow-through showing the small bowel


Enteroclysis in double contrast technique showing stenosis of the small intestine


Zenker's diverticulum  as seen in a barium swallow examination


Barium in the lungs resulting from aspiration during a barium swallow


Adult digestive system


3D medical illustration explaining the oral digestive system


The main salivary glands


Cross section of  circumvallate papilla  showing arrangement of nerves and taste buds


Esophagus shown in yellow passing behind the trachea and the heart


Areas of the stomach


Liver and gall bladder


Gallbladder shown in green below the liver


Pancreas, duodenum and bile duct


Action of digestive hormones


Illustration of small intestine


Layers of the small intestine


Cecum and beginning of ascending colon


Lower GI tract - 3) Small intestine; 5) Cecum; 6)  Large intestine


Arteries and veins around the pancreas and spleen


Dietary life rules, Japan,  Edo period  Illustrating the ill effects of drinking alcohol on the digestive system.


Historical depiction of the digestive system, 17th century Persia


The ruminant digestive system


Vein skeleton of a  Hydrangea  leaf showing anastomoses of veins


A network of blood vessels


Anastomosing gills of Marasmius cf. cladophyllus


Ileocecal junction (Ascending colon appear in white color)


Bile (yellow material) in a  liver   biopsy  stained with  hematoxylin-eosin  in a condition called  cholestasis  (setting of bile stasi)


Action of bile salts in digestion


Recycling of the bile


1.  Bile ducts :         2.  Intrahepatic bile ducts          3.  Left and right hepatic ducts          4.  Common hepatic duct           5.  Cystic duct           6.  Common bile duct          7.  Ampulla of Vater          8.  Major duodenal papilla  9.  Gallbladder     10–11.  Right  and  left  lobes of  liver     12.  Spleen    13.  Esophagus     14.  Stomach    15.  Pancreas :         16.  Accessory pancreatic duct           17.  Pancreatic duct    18.  Small intestine :         19.  Duodenum          20.  Jejunum    21–22. Right and left  kidneys     The front border of the liver has been lifted up (brown arrow). [ 1 ]


Stylised diagram of choledochojejunostomy indicating anastomoses


This bolus from an  albatross  has several ingested flotsam items, including  monofilament  from  fishing nets  and a discarded  toothbrush .  Tern Island ,  French Frigate Shoals


Human Brunner's gland


Inner diameters of different sections of the large intestine, with cecum (at bottom left) measuring on average 8.7 cm (range 8.0-10.5 cm). [ 4 ]


Gastric cecum of dissected  cockroach .  Scale bar, 2 mm.


A  stump-tailed macaque  using mastication to process tough plant matter


A piece of chewing gum after being trodden on.


Masticator on the  Zaca Fire


Cloaca of a  red-tailed hawk


Cloaca of a female bird


Cloaca of a male bird


A  roseate spoonbill  excreting urine in flight


Diagrams to illustrate the changes in the cloaca in mammals during development.  A , early embryonic stage, showing the cloaca receiving the urinary bladder, the rectum, and the Wolffian duct, as in non- therian  vertebrates.  B , later stage, showing the beginning of the fold which divides the cloaca into a ventral  urogenital sinus  which receives the  urinary bladder , Wolffian ducts, and  ureters , and into a dorsal part which receives the  rectum .  C , further progress of the fold, dividing the cloaca into urogenital sinus and rectum; the ureter has separated from the Wolffian duct and is shifting anteriorly.  D , completion of the fold, showing complete separation of the cloaca into ventral urogenital sinus and dorsal rectum. [ 13 ]


Cloacal opening in an  Australian brushtail possum


1.  Bile ducts :         2.  Intrahepatic bile ducts          3.  Left and right hepatic ducts          4.  Common hepatic duct           5.  Cystic duct           6.  Common bile duct          7.  Ampulla of Vater          8.  Major duodenal papilla  9.  Gallbladder     10–11.  Right  and  left  lobes of  liver     12.  Spleen    13.  Esophagus     14.  Stomach    15.  Pancreas :         16.  Accessory pancreatic duct           17.  Pancreatic duct    18.  Small intestine :         19.  Duodenum          20.  Jejunum    21–22. Right and left  kidneys     The front border of the liver has been lifted up (brown arrow). [ 3 ]


Human anatomy  of the  anorecturm  ( anus  and  rectum )


A person defacating outside. Etching, paper. Jacques Callot. Rijksmuseum,  Amsterdam. 1621


The  caganer  is a defecating figurine in Spanish  nativity scenes .


Schematic drawing of bacterial conjugation.  1-  Donor cell produces  pilus .  2-  Pilus attaches to recipient cell, bringing the two cells together.  3-  The mobile plasmid is nicked and a single strand of DNA is transferred to the recipient cell.  4-  Both cells recircularize their plasmids, synthesize second strands, and reproduce pili; both cells are now viable donors.


Venus Flytrap ( Dionaea muscipula ) leaf


Trophozoites  of  Entamoeba histolytica  with ingested erythrocytes


Rough illustration of a ruminant digestive system


A flesh fly "blowing a bubble", possibly to concentrate its food by evaporating water


Upper and lower human gastrointestinal tract


Action of the major digestive hormones


Drawing of the digestive tract of  Anostoma depressum  viewed as if through the  apex  of the shell


3D reconstruction  of the digestive system of  Pseudunela cornuta :  mo - mouth  r -  radula  ph - pharynx  sgl and sgr -  salivary glands  oe - oesophagus  i - intestine  a - anus  dg -  digestive gland .


Drawing of the digestive system of  Paryphanta busbyi .  1-2 - buccal mass,  1 - mouth,  2 - pharynx,  3 - retractor muscles of the pharynx,  4 - salivary glands,  5 - salivary ducts,  6 - oesophagus,  7 - stomach.


Drawing of the digestive system of carnivorous  Schizoglossa novoseelandica , showing the large  pharynx .  1-2 - buccal mass,  1 - mouth,  2 - pharynx,  3 - retractor muscles of the pharynx,  4 - salivary glands,  5 - salivary ducts,  6 - oesophagus and stomach,  7 - intestine,  8 - hepatic ducts.


The feeding track of  Triboniophorus graeffei  made by grazing with the  radula .


Dorsal view of an anesthetized individual of  Plakobranchus ocellatus  with spread  parapodia . Stomach and branched  digestive glands  are visible. The tissue region in the red square was dissected and used for DNA extraction in the study by Maeda T. et al. (2012). [ 6 ]


Garden snail,  Cornu aspersum , defecating.


Diagram illustrating renal flow along the nephron


Histamine


Enterohepatic circulation of drugs.


Location of the epiglottis


A high rising epiglottis (with forward-facing  anterior  surface being visible)


The esophagus is constricted in three places. [ inconsistent ]


A mass seen during an  endoscopy  and an  ultrasound  of the mass conducted during the endoscopy session.


Anatomy of a snake. file info   esophagus trachea tracheal lungs rudimentary left lung right lung heart liver stomach air sac gallbladder pancreas spleen intestine testicles kidneys


1.  Bile ducts :         2.  Intrahepatic bile ducts          3.  Left and right hepatic ducts          4.  Common hepatic duct           5.  Cystic duct           6.  Common bile duct          7.  Ampulla of Vater          8.  Major duodenal papilla  9.  Gallbladder     10–11.  Right  and  left  lobes of  liver     12.  Spleen    13.  Esophagus     14.  Stomach    15.  Pancreas :         16.  Accessory pancreatic duct           17.  Pancreatic duct    18.  Small intestine :         19.  Duodenum          20.  Jejunum    21–22. Right and left  kidneys     The front border of the liver has been lifted up (brown arrow). [ 38 ]


Mammals excrete urine through the  urinary system .


Chemical structure of  uric acid .


White cast of uric acid defecated along with the dark feces by a  lizard . Insects, birds and some other reptiles also use a similar mechanism.


From a series of woodcuts (1545) usually referred to as the  Papstspotbilder  or  Papstspottbilder  in German or  Depictions of the Papacy  in English, [ 8 ]  by  Lucas Cranach , commissioned by  Martin Luther . [ 9 ]  Title: Kissing the Pope's Feet. [ 10 ]  German peasants respond to a papal bull of  Pope Paul III . Caption reads: "Don't frighten us Pope, with your ban, and don't be such a furious man. Otherwise we shall turn around and show you our rears." [ 11 ] [ 12 ]


John Bull  emits an explosive bout of flatulence at a poster of  George III  as an outraged  William Pitt the Younger  admonishes him.  Newton 's etching was probably a comment on Pitt's threat (realized the following month) to suspend  habeas corpus .


Faucitis in a 12-year-old cat that presented with  inappetence , tenderness of the mouth, and inability to groom itself.  Gingivitis , erosive lingual  ulcers  and faucitis were evident clinically


He-gassen  (detail), an art scroll depicting a battle of flatulence, from Japan during the  Edo period


A Japanese  ukiyo-e  print employing  fart humor


The flatulence of  cows  is only a small portion (around one-twentieth) of cows' methane release. Cows also  burp  methane, due to the physiology of their digestive systems. [ 60 ]


Gal4 domains and regulation


Micrograph  of a normal gallbladder wall.  H&E stain .


Abdominal ultrasonography  showing gallbladder and common bile duct


1.  Bile ducts :         2.  Intrahepatic bile ducts          3.  Left and right hepatic ducts          4.  Common hepatic duct           5.  Cystic duct           6.  Common bile duct          7.  Ampulla of Vater          8.  Major duodenal papilla  9.  Gallbladder     10–11.  Right  and  left  lobes of  liver     12.  Spleen    13.  Esophagus     14.  Stomach    15.  Pancreas :         16.  Accessory pancreatic duct           17.  Pancreatic duct    18.  Small intestine :         19.  Duodenum          20.  Jejunum    21–22. Right and left  kidneys     The front border of the liver has been lifted up (brown arrow). [ 14 ]


3D still showing gallstones


Abdominal ultrasonography  showing  biliary sludge  and  gallstones


Illustration of stomach  wall showing gastric mucosa and the gastric glands


Histology of  mucosa  showing gastric glands. H&E stain


Diagram depicting the major determinants of gastric acid secretion


Gastric chief cell


Parietal cell


G cell  is visible near bottom left, and gastrin is labeled as the two black arrows leading from it. Note: this diagram does not illustrate gastrin's stimulatory effect on ECL cells.


Illustration of  digestive system


General structure of the gut wall


The general structure of the intestinal wall


Image of the mucosa of the  stomach , showing an epithelium (at top, and also facing the elongated cavities) made up of  column-shaped cells .


Muscular layers of the  stomach  wall.


Plesiosaur  gastroliths from  Tropic Shale


Gastroliths from Jurassic strata near Starr Springs, Utah


A  diplodocid  ingesting gastroliths entangled in vegetation it is consuming


Psittacosaurus  fossil with gastroliths in its stomach region, American Museum of Natural History


Escherichia coli , one of the many species of  bacteria  present in the human gut


Composition and distribution of gut microbiota in human body


Candida albicans , a dimorphic fungus that grows as a yeast in the gut


Illustration showing the developmental colonization of gut microbiota


Microfold cells  transfer antigens (Ag) from the lumen of the gut to  gut-associated lymphoid tissue  (GALT) via  transcytosis  and present them to different innate and adaptive immune cells.


Gut–brain axis overview [ 1 ]


Gut-brain communication


Bifidobacterium adolescentis


Lactobacillus  sp 01


Dorsal view of an anesthetized individual of  Plakobranchus ocellatus  with spread  parapodia .  Stomach  and branched parapodial  digestive glands  are visible. The tissue region in the red square was dissected and used for DNA extraction in the study by Maeda T. et al. (2012). [ 5 ]


Anatomy of the human anus. Frontal section.


Image of the anus affected by  hemorrhoids . The  pectinate line , which separates the internal from the external anus, can be seen.


The  anogenital distance  is a measurement of the distance from the anus to the genitals. In women, this distance tends to be much smaller than in men.


Anatomy of the mouth.


Floor of the mouth with  lingual frenum  and  sublingual fold


A closed human mouth.


Structure of the hydrogen potassium ATPase. The α subunit is shown in pink; the β subunit is shown in blue.


Mechanism of the H + /K +  ATPase demonstrating how E1-E2 conformational change corresponds to ion release. See Shin et al. [ 2 ]


Foreign body in esophagus


An isolated Interstitial cell of Cajal from the  myenteric plexus  of the mouse small intestine grown in a primary cell culture.


Colonic crypts ( intestinal glands ) within four tissue sections. In panel A, the bar shows 100  μm  and allows an estimate of the frequency of crypts in the colonic epithelium. Panel B includes three crypts in cross-section, each with one segment deficient for CCOI expression and at least one crypt, on the right side, undergoing fission into two crypts. Panel C shows, on the left side, a crypt fissioning into two crypts. Panel D shows typical small clusters of two and three CCOI deficient crypts (the bar shows 50 μm). The images were made from original photomicrographs, but panels A, B and D were also included in an article [ 7 ]


Physical, biochemical, and immune elements of the intestinal mucosal barrier.


Scheme of selective permeability routes of epithelial cells (red arrows). The transcellular (through the cells) and paracellular (between the cells) routes control the passage of substances between the intestinal lumen and blood.


primary biliary cirrhosis. Bile duct intraepithelial lymphocytes


Percentage of adults that can digest lactose in the indigenous population of Eurasia, Africa and Oceania.


Percentage of adults with a known lactase persistence genotype in the indigenous population of the Old World


Shirota, a  Lactobacillus casei  strain.


An estimate of the percentage of adults that can digest lactose in the indigenous population of the Old World [ 75 ]


Illustration of the large intestine.


Inner diameters of colon sections


3D file generated from  computed tomography  of large intestine


Colonic crypts ( intestinal glands ) within four tissue sections.  The cells have been  stained  to show a brown-orange color if the cells produce the  mitochondrial  protein  cytochrome c oxidase subunit I  (CCOI), and the  nuclei  of the cells (located at the outer edges of the cells lining the walls of the crypts) are stained blue-gray with  haematoxylin . Panels A, B were cut across the long axes of the crypts and panels C, D were cut parallel to the long axes of the crypts. In panel A the bar shows 100 μm and allows an estimate of the frequency of crypts in the colonic epithelium. Panel B includes three crypts in cross-section, each with one segment deficient for CCOI expression and at least one crypt, on the right side, undergoing fission into two crypts. Panel C shows, on the left side, a crypt fissioning into two crypts. Panel D shows typical small clusters of two and three CCOI deficient crypts (the bar shows 50 μm). The images were made from original photomicrographs, but panels A, B and D were also included in an article [ 31 ]  and illustrations were published with Creative Commons Attribution-Noncommercial License allowing re-use.


Histological section.


Colonoscopy image,  splenic flexure , normal  mucosa . The  spleen  can be seen through it


Cupid's bow feature of a human lip


Surface anatomy of the human lips


Illustration of lips from  Gray's Anatomy  showing the  inferior  and  superior labial arteries , the glands of the lips, and the nerves of the right side seen from the posterior surface after removal of the mucous membrane


Breastfeeding


Lips of a young woman wearing red  lipstick


Lips of a young  man


A child with  cleft lip


Pierced lips


This  Asian arowana  has large, protruding  barbels


1.  Bile ducts :         2.  Intrahepatic bile ducts          3.  Left and right hepatic ducts          4.  Common hepatic duct           5.  Cystic duct           6.  Common bile duct          7.  Ampulla of Vater          8.  Major duodenal papilla  9.  Gallbladder     10–11.  Right  and  left  lobes of  liver     12.  Spleen    13.  Esophagus     14.  Stomach    15.  Pancreas :         16.  Accessory pancreatic duct           17.  Pancreatic duct    18.  Small intestine :         19.  Duodenum          20.  Jejunum    21–22. Right and left  kidneys     The front border of the liver has been lifted up (brown arrow). [ 1 ]


Superior mesenteric artery and its branches in humans


Inferior mesenteric artery and its branches in humans


Two of the stages in the development of the digestive tube and its mesentery


Mesentery in red. Dorsal mesentery is the lower part of the circuit. The upper part is ventral mesentery.


Abdominal part of digestive tube and its attachment to the primitive or common mesentery. Human embryo of six weeks.


Schematic figure of the bursa omentalis, etc. Human embryo of eight weeks.


Development of the mouth and anus in protostomes and deuterostomes


Butterfly  tongue


Orange-eyed tree frog  calling


Domestic cat  meowing


Tasmanian devil  in defensive stance


Structure of the nitrosamino group


Metabolic activation of the nitrosamine  NDMA  converts it to the alkylating agent  diazomethane [ 6 ]


Structural formula  of nitroso group


Structure of 2-nitrosotoluene dimer [ 3 ]


Linear and bent metal nitrosyls


The ruminant digestive system


The 'leaflets' of the omasum


A time-space diagram of a peristaltic wave after a water swallow. High-pressure values are red, zero pressure is blue-green. The ridge in the upper part of the picture is the high pressure of the upper esophageal sphincter which only opens for a short time to let water pass.


A simplified image showing peristalsis


A simplified image showing Earthworm movement via peristalsis


Upper respiratory system, with the nasopharynx, oropharynx and laryngopharynx labeled at left


Details of  torus tubarius


Pharyngitis is the painful swelling of the throat. The oropharynx shown here is very inflamed and red.


An illustration of the pharyngeal jaws of a moray eel


The three phases of gastric secretion


A bottle of  Yakult , a probiotic drink containing  Lactobacillus paracasei


Élie Metchnikoff  first suggested the possibility of colonizing the gut with beneficial bacteria in the early 20th century.


Fructans


Lactobacillus acidophilus


Putrefaction in human hands after several days of one of the  Oba Chandler  victims underwater in Florida, United States


Timeline of postmortem changes (stages of death), with putrefaction labeled near middle.


Putrefaction, the eighth alchemical key of Basil Valentine, 1678, Chemical Heritage Foundation


Diagram from  cancer.gov : * 1.  Body of stomach * 2.  Fundus * 3. Anterior wall * 4.  Greater curvature * 5.  Lesser curvature * 6.  Cardia * 9.  Pyloric sphincter * 10.  Pyloric antrum * 11. Pyloric canal * 12.  Angular incisure * 13.  Gastric canal * 14.  Rugal folds


Microscopic cross-section of the pylorus


The inside of a normal human rectum in a 70-year-old, seen during  colonoscopy


Retroflexed view of the human rectum seen at colonoscopy showing anal verge


A  digital rectal exam  is conducted to investigate or diagnose conditions including of the  prostate .


Reticulum beef  tripe


Rumen of a sheep from left. 1 Atrium ruminis, 2 Saccus dorsalis, 3 Saccus ventralis, 4 Recessus ruminis, 5 Saccus cecus caudodorsalis, 6 Saccus cecus caudoventralis, 7 Sulcus cranialis, 8 Sulcus longitudinalis sinister, 9 Sulcus coronarius dorsalis, 10 Sulcus coronarius ventralis, 11 Sulcus caudalis, 12 Sulcus accessorius sinister, 13 Insula ruminis, 14 Sulcus ruminoreticularis, 15 Reticulum, 16 Abomasum, 17 Oesophagus, 18 Spleen.


Bacteria dominate rumen microbiome; composition can change substantially with diet. [ 8 ]


Ruminant stomach structure


Yeast colonies on an agar plate.


Saccharomyces cerevisiae  mating type  a  with a cellular bulging called a  shmoo  in response to  α -factor


S. cerevisiae ,  differential interference contrast  image


Saccharomyces cerevisiae Numbered ticks are 11 micrometers apart.


Statue of  Saccharomyces cerevisiae  ( Hustopeče ,  Czech Republic )


Simethicone tablets


Labeled diagram of the small intestine and its surrounding structures


Micrograph  of the small intestine  mucosa  showing the  intestinal villi  and  crypts of Lieberkühn .


This cross section diagram shows the 4 layers of the small intestine wall.


Absorption of glucose in the small intestine


Diagram showing parts of the stomach


Schematic image of the blood supply to the human stomach:  left  and  right gastric artery ,  left  and  right gastroepiploic artery  and  short gastric arteries [ 15 ]


The gastrointestinal wall of the human stomach


Layers of the gastrointestinal wall of which the stomach is a dilated part


Diagram showing gastric pits (13) gastric glands (12) lamina propria (10) epithelium (11)


Histology of normal fundic mucosa. Fundic glands are simple, branched tubular glands that extend from the bottom of the gastric pits to the muscularis mucosae; the more distinctive cells are parietal cells. H&E stain.


Histology of normal antral mucosa. Antral mucosa is formed by branched coiled tubular glands lined by secretory cells similar in appearance to the surface mucous cells. H&E stain.


Emptying of stomach chyme into the duodenum through the pyloric sphincter


An  endoscopy  of a normal stomach of a healthy 65-year-old woman


Endoscopic image of a fundic gland  polyp


Comparison of stomach glandular regions from several mammalian species. Frequency of glands may vary more smoothly between regions than is diagrammed here.  Asterisk (ruminant) represents the omasum, which is absent in  Tylopoda  (Tylopoda also have some cardiac glands opening onto ventral  reticulum  and  rumen [ 58 ] )  Many other variations exist among the mammals. [ 59 ] [ 60 ]


The underside of a human tongue, showing its rich blood supply.


Foramen cecum and terminal sulcus labelled above


Features of the tongue surface


Lateral view of the tongue, with extrinsic muscles highlighted


Coronal section of tongue, showing intrinsic muscles


Blood supply of the tongue


Section through the human tongue; stained  H&E


Floor of pharynx at about 26 days showing lateral swellings at first pharyngeal arch (mandibular arch).


Giraffe's tongue


Extended proboscis of a long tongued  Macroglossum   moth


A possible function of the human appendix is a "safe house" for beneficial bacteria in the recovery from  diarrhea


An appendiceal carcinoid tumor


Wikipedia


United European Gastroenterology Headquarters


Gross pathology of a  tubulovillous adenoma  resected by  minimally invasive colorectal surgery .


Intersphincteric fistula in the lower anal canal. Ultrasound image where the fistula is labeled with a letter F.


Japan: A man with an anal fistula. From the Yamai no Soshi, late 12th century.


Germ cells tumors constitute a vast majority of the incidences of  testicular tumors . [ 3 ]


Two female pinworms next to a ruler: The markings are 1 mm apart.


Life cycle of  E. vermicularis  showing the stages inside and outside of the human body


Two female pinworms next to a ruler. The markings are one millimetre apart.


Pinworm life cycle.


High magnification  micrograph  of a pinworm in  cross section  in the  appendix .  H&E stain .


A proctoscope (middle) with an  anoscope  and a rectoscope


Two proctoscopes


A . Internal rectal intussusception.  B . External (complete) rectal prolapse


A. Normal anatomy: (r) rectum, (a) anal canal   B. Recto-rectal intussusception   C. Recto-anal intussusception


A severe example of complete (external) rectal prolapse. Note circumferential arrangement of mucosal folds.


Micrograph  showing a rectal wall with changes seen in rectal prolapse. There is a marked increase of fibrous tissue in the submucosa and fibrous tissue +/- smooth muscle  hyperplasia  in the  lamina propria .  H&E stain


A nurse assisting a patient. 1941


Chest X-ray  showing a  Canadian dollar coin  in the esophagus of a young child


Fluoroscopic image of  common bile duct   stone  seen at the time of ERCP. The stone is impacted in the distal common bile duct. A nasobiliary tube has been inserted.


Fluoroscopic image showing dilatation of the pancreatic duct during ERCP investigation. Endoscope is visible.


Diagram of an endoscopic retrograde cholangiopancreatography (ERCP)


Classification for hepatic insufficiency


Combined MARS and PrismaFlex monitors


Albumin dialysis circuit


Cytopathology  of peritoneal fluid from paracentesis ( Pap stain ), showing typical features of  adenocarcinoma


Large volume abdominal  ascites


Small fluid collection in  Morison's pouch


Ascitic fluid, 7 litres, drained during paracentesis


A young woman using an automated peritoneal dialysis machine.


Continuous Ambulatory Peritoneal Dialysis (CAPD)


Rapid Urease test that enables testing three biopsy specimens of the same patient simultaneously.


Sleeve gastrectomy surgery


APC of bleeding oesophageal ulcer


Pyloric stricture dilated with endoscopic balloon


Polyp is identified, snare is passed over stalk and polyp is then removed


Expandable metal stent


Diagram of stages of ulcer development


Diagram showing parts of the stomach


Micrograph of  H. pylori  colonizing the  stomach lining


Diagram of  H. pylori  and associated  virulence factors


Diagram showing how  H. pylori  reaches the epithelium of the stomach


H. pylori   urease  enzyme diagram


H. pylori  colonized on the surface of regenerative epithelium ( Warthin-Starry silver stain )


Electron micrograph of  H. pylori


Gastric ulcer


Piece of intestine, blocked by worms, surgically removed from a three-year-old boy in South Africa [ 16 ]


Ascaris  life cycle: Adult worms (1) live in the lumen of the small intestine. A female may produce approximately 200,000 eggs per day, which are passed with feces (2). Unfertilized eggs may be ingested but are not infective. Fertile eggs embryonate and become infective after 18 days to several weeks (3), depending on the environmental conditions (optimum: moist, warm, shaded soil). After infective eggs are swallowed (4), the larvae hatch (5), invade the intestinal mucosa, and are carried via the portal, then systemic circulation and/or lymphatics to the lungs. The larvae mature further in the lungs (6) (10 to 14 days), penetrate the alveolar walls, ascend the bronchial tree to the throat, and are swallowed (7). Upon reaching the small intestine, they develop into adult worms (8). Between 2 and 3 months are required from ingestion of the infective eggs to oviposition by the adult female. Adult worms can live 1 to 2 years.


Ascariasis deaths per million persons in 2012     0-1    1-2    2-3


Disability-adjusted life year  for ascariasis per 100,000 inhabitants in 2004      no data      less than 10      10-20      20-30      30-40      40-50      50-60      60-80      80-100      100-120      120-140      140-150      more than 150


Percentage of  Blastocystis  infections detected by direct microscopy in various studies


Percentage of stool samples from US states found to contain various protozoa in 1987 and 2000 [ 90 ]


Number of stool samples from Canadian lab found to contain various protozoa in 2005 [ 91 ]


An infant with botulism. Despite not being asleep or sedated, he cannot open his eyes or move; he also has a weak cry.


A photomicrograph of  Clostridium botulinum  bacteria.


Sign on the  Noordhollandsch Kanaal  in 1976, warning bathers of the presence of  C. botulinum  in the water.


Capillaria philippinensis  egg


Capillaria philippinensis  life cycle


How  C. difficile  spreads


Individual, drumstick-shaped  C. difficile  bacilli seen through  scanning electron microscopy


C. difficile  colonies on a blood  agar plate


Micrograph  of a colonic pseudomembrane in  C. difficile  colitis, a type of pseudomembranous colitis,  H&E stain


Endoscopic  image of pseudomembranous colitis, with yellow pseudomembranes seen on the wall of the  sigmoid colon


Pseudomembranous colitis on computed tomography


Longitudinally opened freshly resected colon segment showing a cancer and four polyps. Plus a schematic diagram indicating a likely field defect (a region of tissue that precedes and predisposes to the development of cancer) in this colon segment. The diagram indicates sub-clones and sub-sub-clones that were precursors to the tumors.


Colon cancer with extensive metastases to the liver


Relative incidence of various histopathological types of colorectal cancer. The vast majority of colorectal cancers are  adenocarcinomas . [ 84 ]


Micrograph of colorectal adenocarcinoma, showing "dirty necrosis".


A diagram of a local resection of early stage colon cancer


A diagram of local surgery for rectal cancer


Margins of a colonic resection.


Colon and rectum cancer deaths per million persons in 2012     3–17    18–21    22–27    28–36    37–54    55–77    78–162    163–244    245–329    330–533


Bristol stool scale


Significant constipation in the plain X-ray of an 8-year-old


19th century satirical cartoon of a monkey rejecting an old style clyster for a new design, filled with marshmallow and opium


Diagram of the  human gastrointestinal tract


Poverty often leads to unhygienic living conditions, as in this community in the Indian Himalayas. Such conditions promote contraction of diarrheal diseases, as a result of poor  sanitation  and  hygiene .


Deaths due to diarrhoeal diseases per million persons in 2012     0–2    3–10    11–18    19–30    31–46    47–80    81–221    222–450    451–606    607–1799


Disability-adjusted life year  for diarrhea per 100,000 inhabitants in 2004 [ 61 ]      no data      < 500      500–1000      1000–1500      1500–2000      2000–2500      2500–3000      3000–3500      3500–4000      4000–4500      4500–5000      5000–6000      > 6000


A person consuming oral rehydration solution


Diverticulosis in the  sigmoid colon  of a  70-year-old


Drawing showing a sigmoid colon with many diverticula


CT scan showing extensive diverticulosis of the sigmoid colon


Diverticular disease


Whole slide of a transverse section of the left colon with diverticulosis


Cross-section of diseased intestines. Colored lithograph  c.  1843


A  Red Army  soldier dies of dysentery after eating unwashed vegetables. This is a common way of contracting dysentery. From a health advisory pamphlet given to soldiers.


Allied  prisoners of war  with dysentery in a Japanese camp in  Thailand  in 1943


A peptic ulcer may accompany gastritis.  Endoscopic image .


Early acute superficial gastritis: Marked neutrophilic infiltrates appear in the mucous neck region and lamina with a pit microabscess. This case was caused by  Helicobacter pylori .


Updated Sydney System for visual classification of gastritis on histopathology.


Bristol stool chart


Salmonella enterica  serovar Typhimurium (ATCC 14028) as seen with a microscope at 1000 fold magnification and following Gram staining


Percentage of rotavirus tests with positive results, by surveillance week, United States, July 2000 – June 2009


Disability-adjusted life year  for diarrhea per 100,000 inhabitants in 2004              no data       ≤500       500–1000       1000–1500       1500–2000       2000–2500       2500–3000           3000–3500       3500–4000       4000–4500       4500–5000       5000–6000       ≥6000


Lifecycle of  Giardia lamblia


Giardia  trophozoites stained with Giemsa; 100x magnification


Multiple views of a  G. lamblia  cyst imaged by confocal microscopy: Bar = 10 micrometers (A) Cyst imaged by transmission (differential interference contrast) (B) Cyst wall selectively imaged through use of fluorescent-labelled antibody (C) Cyst imaged through use of carboxy fluorescein diacetate, a viability stain (D) Composite image of (B) and (C) (E) Composite image of (A), (B), and (C)


A  Giardia  trophozoite, drawn by Vilém Lambl and published in 1859


Drawings of a  Giardia  trophozoite and cyst by Charles E. Simon in 1921


Ascaris  life cycle: Adult worms in the lumen of the small intestine (1). The female produces eggs (approximately 200,000 per day) that are excreted with the feces (2). Unfertilized eggs are harmless, but fertilized ones are infective after 18 days to several weeks (3). Infective eggs are ingested (4), enter the gut (5), develop into larvae in the intestine, and penetrate the blood vessel to enter lungs, where they develop further (6), after 10 to 14 days, penetrate the alveolar walls, ascend the bronchial tree to the throat, and are re-swallowed (7). Upon reaching the small intestine, they develop into adult worms (8). It takes 2 to 3 months for one complete cycle. Adult worms can live 1 to 2 years.


Collage of various helminth eggs, from left to right:  Trichosomoides  egg,  Ascaris lumbricoides  with larva hatching, sample of adult roundworms,  Hymenolepis nana ,  Schistosoma mansoni  and  Toxocara canis  with larva hatching


Example clinical photo: Guinea worm infection ( dracunculiasis ), worm coming out of the foot of an infected person.


Ascaris infection: Antimesenteric splitting of the outer layers of the bowel wall due to a large amount of ascaris (South Africa)


Micrograph of cut section of human  appendix  showing a pin worm.


Identification and quantification of helminth eggs at UNAM university in Mexico City, Mexico


Example of  ascariasis  (ascaris infection) - Difficult surgical procedure in South Africa on a gangrenous piece of bowel that had to be cut out; live ascaris worms are emerging.


Piece of intestine, blocked by worms, surgically removed from a 3-year-old boy in South Africa. [ 57 ]


Ancylostoma braziliense  mouthparts


Hookworm  life cycle


Civilian Public Service  workers built and installed 2,065  outhouses  for hookworm eradication in  Mississippi  and  Florida  from 1943 to 1947.


Hookworm egg


Ethiopian children treated for schistosoma and hookworms


Disability-adjusted life year  for  hookworm disease  per 100,000 inhabitants in 2002      no data       <10      10–15      15–20      20–25      25–30      30–35      35–40      40–45      45–50      50–55      55–60      more than 60


A doctor examines a boy for signs of hookworm in  Coffee County, Alabama , 1939.


A 16-year-old girl with a 2-month history of diarrhea, anorexia, bipedal edema and borborygmi found to have Capillaria infection in the Philippines


Prevalence of protozoal infections in industrialized countries (United States and Canada) in the 21st century [ 49 ] [ 50 ]


Percentage of population with IBS reported in various studies in different countries (see sources in the table)


Eggs  of different species of parasitic worm


Hookworms  attached to the intestinal  mucosa


Two  pinworms


Image showing life cycle inside and outside of the human body of one fairly typical and well described helminth:  Ascaris  lumbricoides


Processed helminth eggs samples from a dry toilet in Kenya


Analysing for helminth eggs in samples of feces from a dry toilet in Kenya


A  colonoscopy  showing  radiation proctitis .


Keratoderma blennorrhagicum due to reactive arthritis


Strongyloides  life cycle


Trichinella spiralis   larvae  in muscle tissue


Animal tissue infected with the parasite that causes the disease trichinosis: Most parasites are shown in cross-section, but some randomly appear in long section.


Lifecycle of  Trichinella spiralis


Pork sausages eaten raw by consumers caused an outbreak of trichinellosis in 2015 in France.


Life cycle of  Trichuris trichiura  inside and outside the human body


Cross-section of whipworm on microscopy


Eggs of  Trichuris trichura . Image C shows  HE stain .


A 1939 conceptual illustration showing various ways that typhoid bacteria can contaminate a  water well  (center)


Pathogenesis of typhoid fever


Widal test card


Doctor administering a typhoid  vaccination  at a school in  San Augustine County, Texas , 1943


Vivotif – oral typhoid vaccine of live-attenuated  S. enterica  Typhi strain Ty21a


Typhoid fever incidence; most common in Asia, Africa, Central and South America    Strongly endemic areas    Moderately endemic areas


Map of Typhoid Fever Outbreaks 1989–2018 [ 78 ]


Mary Mallon  ("Typhoid Mary") in a hospital bed (foreground): She was forcibly quarantined as a carrier of typhoid fever in 1907 for three years and then again from 1915 until she died in 1938.


New Typhoid carrier cases reported in L.A. County between 2006 and 2016 [ 1 ]


Almroth Edward Wright  developed the first effective typhoid vaccine.


Classification of colitis, often used in defining the extent of involvement of ulcerative colitis, with proctitis (blue), proctosigmoiditis (yellow), left sided colitis (orange) and pancolitis (red). All classes extend distally to the end of the rectum.


Gross pathology of normal colon (left) and severe ulcerative colitis (right), forming pseudopolyps (smaller than the cobblestoning typically seen in Crohn's disease), over a continuous area (rather than skip lesions of Crohn's disease), and with a relatively gradual transition from normal colon (while Crohn's is typically more abrupt).


Aphthous ulcers  involving the  tongue ,  lips ,  palate , and  pharynx .


Pyoderma gangrenosum  with large ulcerations affecting the back.


Endoscopic  image of ulcerative colitis affecting the left side of the colon. The image shows confluent superficial ulceration and loss of mucosal architecture. Crohn's disease may be similar in appearance, a fact that can make diagnosing UC a challenge.


H&E stain of a colonic biopsy showing a crypt abscess, a classic finding in ulcerative colitis


Colonic  pseudopolyps  of a person with intractable UC,  colectomy  specimen


Biopsy sample ( H&E stain ) that demonstrates marked  lymphocytic  infiltration (blue/purple) of the  intestinal mucosa  and architectural distortion of the crypts.


Crypt abscess. H&E stain.