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Zoltan Juhasz, M.D.

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I. Stomach (ventriculus, gaster)

J- shaped, intraperitoneal organ (lig. hepatogastricum, lig. gastrophrencicum, lig. phrencolienale, bursa omentalis)found mainly in epigastriumfunction: food storing-mixing, digestionparts: cardia, fundus (in left dome of diaphragm), incisura cardiaca, corpus (body), pylorus (outflow tract; antrum pyloricum canalispyloricus), anterior and posterior walls; greater and lesser curvature, incisura angularisblood supply:

anastomosis along greater and lesser curvaturelesser curvature: right gastric a.( from proper hepatic a.) --- left gastric a. (from celiac trunk)greater curvature: right gastroepiploic a. (from gastroduodenal a.) --- leftgastroepiploic a. (from splenic a.)fundus: short gastric aa. (from splenic a. ; in gastrolienal lig.)veins: right and left gastric v. portal vein; short gastric veins, leftgastroepiploic vein splenic vein; right gastroepiploic v. superiormesenteric v.

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lymph drainage:upper two-third: gastric lymph nodes

upper third of fundus and body: pancreatico-lienal lymph nodeslower third of body and greater curvature: pyloric lymph nodes, pancreatico-duodenal lymph nodes

nerve supply:parasympathetic: vagus nerve (esophageal hiatus; the right branchsupplies the posterior wall, the left branch the anterior wall of thestomach)

sympathetic: greater splanchnic nerve (T6-T9)

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1. esophagus2. gastric fundus

with air bubble3. body of stomach3a. lesser curvature3b. greater curvature4. incisura angularis5. pars pylorica6. ampulla duodeni7. descendent part of duodenum8. jejunum9. left dome of diaphragm10. left colic flexure (filled with air)

AP enema X-ray

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II. Small intestine (intestinum tenue)

extends from pylorus to ileocecal junctionparts:

duodenumjejunumileum

main function:absorbtion of nutrientsplicae circulares(circular folds)

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1. Duodenum

the first and shortest segment of small intestinesurround in C-shape the head of pancreasmost of duodenum is attached to the posterior abdominal wall by theperitoneum, partly retroperitonealparts:

superior horizontal part (intraperitoneal, hepatoduodenal lig.; omental/epiploicforamen of Winslow; at the level of L1)descendent part (7-10 cm; major duodenal papilla of Vater- m.sphincter Oddi ; minor duodenal papilla; L1-L3)inferior horizontal part (6-8 cm; L3)ascendent part (5 cm; L3 L2; ligament of Treitz= m. suspensorius duodeni)duoudeno-jejunal flexure (L2)

blood supply:gastroduodenal a. (from common hepatic a.) superior pancreatico-duodenal a.; inferiorpancreatico- duodenal a. (from superior mesenteric a.) anastomosis between themvenous drainage: superior mesenteric v. and splenic vein

lymph drainage: pancreatico-duodenal,- pyloric, - mesenteric supp., -celiac lymph nodes

nerve suppply: celiac plexus, superior mesenteric plexus (psy.: vagus n., sy.: greater and lessersplanchnic nerves)

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2. Jejunum and ileum

altogether 6-7 m in lengthmain part of ileum lies in the right lower quadrant of abdomen, the last part is in the pelvisintraperitoneal (mesenterium- root of mesenterium;at the level of L2, vessels, nerves,lymphatics, fat)blood supply : branches of superior mesenteric artery: ileal et jejunal aa.; superior mesenteric v. (with the splenic vein it forms the portal vein)lymph drainage: mesenteric and ileocolic lymph nodesnerve supply: vagus n., greater and lesser splanchnic nerves

presynaptic sympathic fibers synape in celiac and inferior mesenteric ganglionpresynaptic parasympathic fibers synapse in myenteric and submucous plexusvisceral afferent sensory fibers- PAIN (distension of intestine wall -- colic:abdominal pain withspasm)

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10Double contrast barium enema X-ray

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III. Large intestine1. Cecum; vermiform appendix

a cecum is the first part of large intestine, continuous with theascendant colon; ileum ileocecal foramen (valve of Bauhin)in the right lower quadrant of abdominal cavity, in iliac fossacecum is covered with peritoneumvermiform appendix is a 6-10 cm long blind process, containinglymphoid tissue; peritoneal coverage: mesoappendixinflammation of vermiform appendix: appendicitis (McBurney s point: punctum maximum of pain: the outer and medial third border of a linebetween superior anterior iliac spine and umbillicus)blood supply: ileocolic a. ( branch of superior mesenteric a.) and itsbranch: appendicular arterylymph drainage: nodi lymphatici ileocolic and superior mesentericnerve supply: superior mesenteric plexus (sy. and psy. fibers)

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Mc Burney s point

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2. Ascendent colon

extends from cecum to right lobe of liver when it turnsleft: left colic flexureonly the anterior and lateral part is covered byperitoneumblood supply: right colic a., ileocolic a., middle colic a. (arcade anastomosis)- marginal a.; right colic v., ileocolic v. superior mesenteric veinlymph drainage: paracolic-, epicolic-, ileocolic-, superior mesenteric lymph nodesinnervation: superior mesenteric plexus

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3.Transverse colon

45 cm in length, right colic flexure left colic flexurephrenicocolic lig., phrenicolienal lig., gastrocolic lig.

intraperitoneal (transverse mesocolon)blood supply: middle colic a. , right and left colic arteries(anastomosis); superior mesenteric veinlymph drainage: superior mesenteric lymph nodesinnervation: superior mesenteric plexus (sympathetic, parasympathetic and visceral afferent fibers)

4. Descendent colon

secondarily retroperitoneal (peritoneal coverage anteriorly andlaterally)left colic flexure left iliac fossa, continuous with sigmoid colon

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4. Sigmoid colon

40 cm in length, S-shapedextends from iliac fossa to S3 segment, where it joins rectum15 cm before anus taenias disappear, this is the rectosigmoidealjunctionintraperitoneal- mesosigmoidblood supply: left colic a. and sigmoid a. (from inferior mesenterica.); inferior mesenteric veinlymph drainage: intermedial colic and superior mesenteric lymphnodesnerve supply:

sympathetic: aortic plexus, superior mesenteric plexusparasympathetic: pelvic splanchnical nerves- inferior hypogastric plexusa visceral afferent fibers run together with the autonomic fibers

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slightly S-shapedsacral flexure, perineal flexureanal canal, rectal ampullaupper third intraperitoneal, middle thirdretroperitoneal, lower third infraperitonealrectovesical/rectouterine pouch (cavity ofDouglas)in males the prostate and seminal vesicles, infemales the vagina can be palpated throughthe rectum (rectal digital examination)

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blood supply: superior rectal a. (from inferior mesenteric a.), middle rectal a. (from internal iliac a.), inferior rectal a. (frominternal pudendal a.)- anastomosisvenous drainage: portosystemic anastomosis;v. superiorrectal v. portal vein; middle and inferior rectal v. inferiorvena cavaclinical importance: absorption of medicines from rectum is more effective as it avoids the liver; rich submucosal venousplexuses- dilatation and protrusion: haemorrhoidal nodeslymph drainage: pararectal and sacral lymph nodeslymph nodes around aorta and IVCnerve supply: inferior hypogatric plexus/pelvic nn., anus: m. sphincter ani internus (smooth muscle) andexternus (striated muscle), m. levator ani (striated)