1 PART SPLANCHOLOGY SHANDONG UNIVERSITY Liu Zhiyu 2 Chapter 1 General description Splanchnology includes alimentary system respiratory system urinary system genital system 3 .General structure of viscera The organs of viscera may be divided into two types according to their general structures: hollow organs parenchymatous organs 4 .General structure of viscera 1. Hollow organs The wall of these organs consists of three or four layers of different tissues. (1)mucosa (2)submucosa (3)muscular layer (4)adventitia 5 .General structure of viscera (1) This kind of organs are commonly enclose by thin fibrous capsule and divided into manyunits known as lobules (2) Hilum or porta a somewhat depression or slit on the surface of organ, where the blood vessle, nerve and lymphatic enter or leave the organ. 2. Parenchymatous organs Porta hepatis 6 The reference line of thorax 1.Anterior median line 2.Lateral sternal line Midclavicular line Parasternal line Anterior axillary line 3.Midaxillary line Posterior axillary line Scapular line 4.Posterior median line The reference line of thorax and abdominal region 7 transtubercular line subcostal line midinguinal line 1.Nine-area method Reference line: transtubercular line subcostal line midinguinal line Nine regions Epigastric region Umbilical region Hypogastric region Right and left hypochondriac region lateral region(lumbar region) inguinal region(iliac region) Abdonminal regions 8 2. Quadrants The quadrants is made by the planes, a transverse and a vertical,which pass through the umbilicus and intersec at right angle,so the abdomen is divided into four quadrants: Upper right quadrant(RUQ) Upper left quadrant(LUQ) Lower right quadrant(RLQ) Lower left quadrant(LLQ) RUQ LUQ LLQ RLQ Abdonminal regions 9 Chapter 2. alimentary system 10 Mouth Pharynx Esophagus Stomach Small intestine Large intestine Digestive glands Superior digestive tube Inferior digestive tube Major salivary glands Liver Pancreas Function : ingestion, digestion, absorption, egesting Digestive tube Duodenum Jejunum Ileum Cecum Vermiform appendix Colon rectum Anal canal Composition 11 oral cavity cheek palate Hard palate Soft palate Uvula palatine Velum Palatoglossal arch Palatopharyngeal arch oral lips oral fissure oral vestibule oral cavity proper alimentary canal 12 Uvula Palatoglossal arch Root of tongue Free border of soft palatine Isthmus of fauces 13 1 shape of teeth CrownProjecting above the gum and to be seen ; Root In the jaw. NeckBetween the crown and root and covered by gum; apical foramen root canal pulp chamber root canal dental Cavity pulp cavity contains dental pulp teeth 14 2 the structure of the teeth 3 periodontal tissues Dentine Enamel Cement Gingiva alveolar bone periodontal menbrane alveolar bone Gingiva Dentine Enamel Cement dental pulp teeth 15 1 kinds of teeth deciduous teeth 20 permanent teeth 28-32 16 Upper jaw Lower jaw Ten teeth in each mandibular and maxillary arch Central incisor lateral incisor canine first molar and second molar in each quadrant lateral incisor canine first molar second molar Central incisor Deciduous teeth 20 in number 17 Sixteen in each mandibular and maxillary arch Two incisors Central incisor lateral incisor one canine, two premolars first and secon premolarmolar three molars first second and third molar Upper jaw Lower jaw Permanent teeth (adult) 32 in number 18 1 shape of tongue 2 Lingual mucous membrane 1 papillae of tongue filiform papillae fungiform papillae foliate papillae vallate papillae 2 lingual tonsil Terminal sulcus filiform papillae fungiform papillae foliate papillae vallate papillae lingual tonsil superrior dorsum of tongue Inferior Body Root Apex ( ) tongue 19 Frenulum of tongue Sublingual gland sublingual caruncle sublingual fold 20 intrinsic muscles extrinsic muscles Longitudinal Transverse m. Vertical m. genioglossus Actions: ( protrude the tongue ) Origin: mental spine of mandible; Insertion: 3 Muscles of tongue 21 Minor salivary glands Major salivary glands 1 parotid gland Deep part Superficial part parotid duct passes forwards across masseter m. and then turns inwards passing through the buccinator m. to open upon a small papilla on the cheek mucous membrane opposite the crown of the second upper molar tooth masseter buccinator parotid duct parotid gland submandibular glandsublingual gland Salivary glands 22 3 sublingual gland major sublingual duct--- sublingual caruncle minor sublingual duct sublingual fold Lies in the submandibular triangle its duct opens into the sublingual caruncle 2 submandibular gland 23 nasopharynx pharyngeal tonsil. pharyngeal opening of auditory tube 1cm tubal torus pharyngeal recess nasopharynx oropharynx laryngopharynx pharanx 24 isthmus of fauces Anterior wall median glossoepiglotic fold epiglottic vallecula Lateral wall palatine tonsiltonsillar fossa ( ) oropharynx 25 pharyngeal tonsile tubal tonsile palatine tonsile lingual tonsile Functuion defend and protection tonsillar ring of pharynx 26 piriform recess ( ) laryngopharynx 27 position and division narrows of the esophagus: position distance from middle inscior first beginning 15cm second front of left branchi 25cm third esophageal hiatus 40cm three parts: Cervical parts 5cm; Thoracic parts: cm; Abdominal parts:only 1-2cm. three narrows : Esophagus 28 position cardia pylorus mostly lies in the left hypochondriac region and lesser part lie in the epigastric region shape and division shape Cardia Pylorus Two opening Stomach 29 Two wall Anterior wall Posterior wall 4 parts : cardiac part fundus of stomach body of stomach Pyloric canal pyloric part Pyloric canal Pyloric antrum fundus of stomach body of stomach cardiac part Lesser curvature of stomach Greater curvature of stomach Two curvature Lesser curvature of stomach Greater curvature of stomach 30 Cardia pylorus Lesser curvature Greater curvature fundus body Pyloric part Pyloric antrum Pyloric canal 31 consists of four layers Mucous membrane Submucous ( loose areolar tissue connecting the mucous and muscular layer) Muscular layer contains superficial longitudinal frbres middle circular fibres Sphincter of pylorus Pyloric valve Inner oblique fibres Serous (visceral peritoneum) Structure of stomach wall 32 duodenum 1 superior part sup erior duodenal flexure duodenal bulb About 5-7m long, Divided into Duodenum Jejunum Ilium small intestine 33 3 horizontal part 4 ascending part suspensory lig.of duodenum Treitz duodenojejunal flexure inferior duodenal flexure Major duodenal papilla longitudinal fold of duodenum 2 descending part 34 Jejunum and ilium T he jejunum and ileum lies free in the abdomen. They are attached to the posterior abdominal wall by the mesentery Their total length is approximately 5~7 metres The upper 2/5 of it is called jejunum and lower 3/5 is called ileum.the terminal part of the ileum open to the large intestine 35 CharacteristicJejunumIleum PositionUpper 2/5Lower 3/5 DiameterGreaterLess WallThickerThin Circular foldsLarger, numerous and large villi Fewer smaller and less abundant villi VascularityGreaterLess ColourDeeper redPaler Lymphatic follicles SolitaryAggregated Jejunum and ileum 36 Approximately 1.5m long, Five parts: Cecum Vermiform appendix Colon Rectum Canal large intestine 37 colic bands haustra of colon epiploic appendices colic bands haustra of colon epiploic appendices Features 38 first part of large intestine, Lies in right iliac fossa The ilium enters the cecum obliquely, and partially invaginates into it, forming the ileocecal valve consists of two folds. ileocec al valve Cecum 39 is a narrow blind tube, usually 6 ~ 8cm long. It opens into the caecum position: very variable in position, frequently lies in the retrocaecal recess or extend into the lesser pelvis vermiform appendix 40 The surface projection (McBurneys point) of the base of appendix is the junction of the lateral and middle thirds of the line joining the right anterior superior iliac spine to the umbilicus The base of the appendix lies at the point of convergence of three colic bands (used as a guide to find the appendix during operation) Appendix 41 Cecum rectum 1 asccending colon 2 transverse colon 3 descending colon 4 sigmoid colon right colic flexure left colic flexure colon 42 Sacral flexure of rectum Perineal flexure of rectum 1 position: 2 Two flexure 3 ampulla 4. three transverse folds of rectum ( ) rectum 43 1 position: anus 4cm 2 struture anal columns anal valves anal sinus Dentate line anal pecten anal canal 44 3 sphincters of anus Sphincter ani internus Sphincter ani externus Anorectal ring anal canal 45 The liver is divided into a large right lobe and a small left lobe by the falciform ligament which is attached to the superior surface of the liver to the anterior abdominal wall. right lobe left lobe liver The liver is the largest digestive gland, lies mainly in the right hypochondrium and epigastric region of the abdominal cavity below the right half of the diaphragm, lesser part of it lies in the left hypochondrium region.. 46 superior surface is smooth and curved, and fits into the diagphragm. at the posterior part of the surface,A large part of which is not covered by the peritonium is called the bare area. superior surface (diaphragmatic surface) 47 inferior surface visceral surface There are 3 fissures arranged like H: left longitudinal fissure right longitudinal fissure transverse sulcus porta hepatis 48 right longitudinal fissure ant: Fissure for ligamentum teres post: Fissure for ligamentum venosum Ant: fossa for gall-bladde Post: sulcue for inferior vena cava left longitudinal fissure 49 right and left branches of the hepatic artery right and left hepatic ducts hepatic portal vein lymphatics Nerves supplying the liver. contains The structures passing through the porta hepatis is inclosed by connective tissues form the Hepatic padicle porta hepatis 50 Anterior ( inferior) margin is sharp, posterior marge Right margin Lfet margin The fundus of the Gallbladder Protude below the Inferior margin of the Liver at the notch for Gallbladde. The liver has 4 borders: 51 left lobe. Left to the left longitudinal fissure right lobe. right to right longitudinal fissure caudate lobe. Behint the porta hepatis quadrate lobe. anterior to the porta hepatis In the inferior surface, the liver may be divided into 4 lobes: 52 Upper border: on the right midclavicular line it extends to the level of 5th rib Lower border: Normally, the right lobe extends just beneath the costal margin, it doesnt down beyond the costal margin; on the anterior median line its lower border crosses a point about 3~5cm below the xiphoid process. In children, the liver may extends cm below the costal arch. Surface projection of the liver 53 The gallbladder and biliary ducts It consists of the fundus, body, neck, and the duct of gallbladder 4 parts. the fundus is the expanded anterior end of the organ and protruds below the inferior margin of the liver, it lies behind the point where the lateral margin of the right rectus abdominis meets the costal arch. 1 The gallbladder 54 body of gallbladder neck of gallbladder the cystic duct is about 2cm in length, it joins the common hepatic duct to form the common bile duct. 55 Common bile duct The common bile duct descends first in the hepatoduodenal ligament, and then posterior to the superior part of the duodenum and the head of the pancreas. It enters the the descending part of the duodenum at its middle and open into its lumen via the greater duodenal papilla. The pancreatic duct joins it during its passage through the duodenal wall to form the ampulla, which is called hepatopancreatic ampulla (of Vater). 56 sphincter of hepatopancreatic ampulla The sphincter of hepatopancreatic ampulla (Odis) is layer circular muscle surrounding the ampulla of hepatopancreatic ampulla, it controls the flow of bile and pancreatic secretions into the duodenum. Obstruction of the biliary system results in the clinic condition of jaundice (yellow skin). 57 Pancreas Division : It may be divided into head, neck, body and tail 4 parts. head lies in the concavity of the duodenum, anterior to the inferior vana cava. its inferomedial extension is clled uncinate process. Position: lies behind the peritoneum on the upper part of the posterior abdominal wall, roughly at the level of the L1~L2 vertebra. 58 pancreas Pancreatic ducts it begins in the tail, runs through the body,neck and the head, usually it joins the common bile duct as it pierces the duodenal wall. body lies anterior to the abdominal aorta and the left kidney, behind the stomach. tail may reach the hilus of the spleen. Accessory pancreatic duct 59 The function of the pancreas The pancreas has both exocrine and endocrine function. The exocrine part secretes a number of the different enzymes that break down proteins, carbohydrates,and fats. The endocrine part consists of minute islands(islets) of cells which secretes insulin directly into the blood stream for the control of blood sugar level. 60 Bile is secreted by the liver cells Common hepatic duct when taking food, the gallbladder contracts, the sphincter of hepatopancreatic ampulla relax Common bile duct Major duodenal papilla Biliary ductuli Right and left hepatic ducts Gallbladder (store, concentrate) Cystic duct The place of bile secreted and path of bile discharged 61 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 Cardia pylorus Lesser curvature Greater curvature fundus body Pyloric part Pyloric antrum Pyloric canal 83