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ANATOMY OF GASTROINTESTINAL

SYSTEM

ANATOMY DEPARTMENT

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GASTROINTESTINAL SYSTEM

• Alimentary canal (gastrointestinal tract): digestive tube.– The mouth,

pharynx, esophagus, stomach, small & large intestine.

• Accessory digestive organs– Teeth, tongue.– Digestive glands:

salivary glands, liver, gallbladder, pancreas.

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ABDOMINAL WALL

• Boundaries:– Superior: xyphoid

process & costal margin

– Posterior: vertebral column

– Inferior: upper parts of the pelvic bones.

Layers of the abdominal wall

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ABDOMINAL WALLmuscles and sheaths

• Muscles of anterior abdominal wall:Flat muscles:– External oblique – Internal oblique– Transverse

abdominalVertical muscles:– Rectus abdominis– Pyramidalis

• Sheath and aponeurosis.

• Linea alba: attachment of deep layer of superficial fascia and the three aponeurosis

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Inguinal ligament• Inguinal canal • Structures passing

through the canal (male & female)

• Superficial inguinal ring (annulus inguinalis medial/ superficial)

• Deep inguinal ring (annulus inguinalis lateral /profundus)

• Conjoint tendon• Inguinal hernias:

direct & inderect

ABDOMINAL WALLINGUINAL REGION

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ORGANIZATION OF THE RECTUS SHEATH

• Rectus sheath formed by a layering of the aponeuroses of external and internal oblique, and transverse abdominal muscle.

• The pattern of upper three quarter of the sheath of rectus abdominis muscle:– The anterior wall: aponeurosis of external oblique, half of the aponeurosis of internal

oblique.– The posterior wall: half of the aponeurosis of internal oblique and the aponeurosis of

transverse abdominal muscles.• The pattern of lower one-quarter:

– The anterior wall: contains all of the aponeuroses.– The posterior wall: contains no aponeuroses. From this point inferiorly, rectus abdominis

muscle is in contact with transversalis fascia. And foms a line: linea arcuata (arcuate line).

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PERITONEUM• A membrane that lines the walls

of the abdominal cavity and covers much of the viscera. Divided into:

• Parietal peritoneum : lines the inner surface of abdominal & pelvic walls, & the lower surface of diaphragm.

• Visceral peritoneum: lines the outer surface of the organs.

• Peritoneal folds: suspend the organs; in the peritoneal cavity intraperitoneal

• Organs outside the peritoneal cavity, with only one surface or part covered by peritoneum retroperitoneal

• Peritoneal folds: – omenta :the folds suspending

the stomach– Mesenteries: the folds

suspending the small and large intestines

– Ligament

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PERITONEUM

• Peritoneal cavity: potential space enclosed within the peritoneum.

• The peritoneal cavity is divided into:– The greater sac– The omental bursa

• Connected by omental foramen (epiploic foramen of Winslow)

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ABDOMINAL REGIONS AND QUADRANTS

Divisions of the anterior abdominal wall for mapping the digestive organs into abdominal cavity

(a)The nine surface regions of the anterior abdominal wall(b)The abdominal viscera as they relate to the nine surface

(a)

(b)

Subcostal plane

Transtubercular plane

Midclavicular plane

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(c) Simpler scheme of four quadrants centered at the navel

ABDOMINAL REGIONS AND QUADRANTS

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GASTROINTESTINAL TRACT

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THE MOUTH• Boundaries:

– Anterior: lips– Lateral: cheeks– Superior: palate– Inferior: tongue– Posterior: fauces of the

oropharynx ( isthmus faucium)

• Divided into:– The vestibule

(vestibulum oris)– Oral cavity proper

(cavitas oris proria): lies internal to the teeth

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ORAL CAVITYORAL CAVITY PROPERRoof:• Anterior: hard palate (palatum

durum)• Posterior: soft palate (palatum

molle)

Floor:• Mostly anterior 2/3 of tongue, • gum (mandible side)

Base of mouth• frenulum of tongue: a single

median fold that continuous with the mucosa covering the floor of oral cavity.

• Right/left to frenulum of tongue opening of submandibular glands

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ORAL CAVITY

ORAL VESTIBULE• Area between the teeth (internal border)

with cheeks & lips(external border).• Lateral wall buccinator muscle &

mucous • Opposite to the upper M2 opening of

the parotid duct

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PHARYNX

• Divide into 3 parts:– Nasopharynx:

posterior to choane

– Oropharynx: posterior to oral cavity

– Laryngopharynx: posterior to larynx

• Open to esophagus at the level C VI vertebrae.

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PHARYNX

• Lies behind oral cavity proper.• Extends from hard palate up to upper margin of

the epiglottis• Palatoglossal arch fold of mucous membran

which covered palatoglossal muscles.• Area between the palatoglossal arch fauces of

the oropharynx (isthmus faucium) • Palatopharyngeal arch fold of mucous

membran on the lateral wall of oropharynx; covers the palatopharyngeal muscle

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SWALLOWING MECHANISM IA

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ESOPHAGUS

• Muscular tube, + 25 cm

• Begins as a continuation of the pharynx, at the level of the vertebra CVI.

• Descends on the anterior surface of the vertebral column, at the thorax

• Enter the abdomen through the esophageal hiatus and joins the stomach at the cardiac orifice

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ESOPHAGUS

• Based on the location, esophagus divided into:– Cervical part– Thoracic part– Abdominal part

• Four location of esophageal constriction: – Trachea & laryngeal nerve, 15 cm from the

incisive teeth– Aorta arch, 22 cm from the incisive teeth– Left bronchus, 27 cm from the incisive teeth– Diaphragm esophagus hiatus, 37 cm

from the incisive teeth

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ESOPHAGUS

RELATION TO OTHER ORGANS (syntopi)

Cervical part:boundaries:• Anterior : trachea,

reccurent laryngeal nerve• Posterior : vertebral

column, longus colli muscle, prevertebral fascia

• Lateral left : common carotid artery

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ESOPHAGUSThoracic part

Anterior :trachea, right pulmonal artery, left bronchus, pericardium

Posterior : vertebral column, longus colli muscle, thoracic duct, azygos vein, hemiazygos vein, aorta

Left lateral : aortic arch, left subclavia artery, thoracic duct, n. left recurrent laryngeal nerve

Right lateral : azygos vein, left vagus nerve (in front), right vagus nerve (behind)

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ESOPHAGUS

Abdominal part• Enter the abdominal

cavity at the level of the vertebra TX

• Curved to the left & enters the cardia of the stomach

• Covered by peritoneum on the front & left

• Boundaries:– Posterior : left crus,

phrenic artery, right vagus nerve.vagus dextra

– Anterior : left vagus nerve.

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ESOPHAGUS

CLINICAL APPLICATION• esophageal Varices• cardia achalasia • Hernias

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STOMACH

Location:• Lies obliquely in the upper and left

part of abdomen.• Epigastric, umbilical & left

hypochondriac regions.• Mostly covered by the left costal

margin and the ribs.

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THE STOMACH J - shaped

Regions :• Cardia : opening of

oesophagus into the stomach)

• Fundus (dome shape): area above the cardiac opening (orificium cardiaca)

• Body of stomach (corpus)• Pylorus:

– Pyloric antrum (cave): wide area of pylorus

– Pyloric canal : distal end of the stomach

– Pyloric sphincter

Graeter curvatur

e

Lesser curvature

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STOMACH• Greater curvature/ curvatura

major: convex; forms left border; point of attachment of greater omentum (omentum majus) and gastrosplenic lig.

• Lesser curvature/curvatura minor: concave; forms right border; point of attachment of lesser omentum (omentum minus)

• Cardial notch (incisura cardiaca): superior angle between fundus and esophagus

• Angular incisure (incisura angularis):a bend on the lesser curvature

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STOMACH PROJECTION

• Cardia– 3 cm left to the trunk,

at the level of the vertebra TX, posterior to the cartilage costal 7

• Fundus– The dome at the groove

of intercostal V

• Pylorus– At the level of vertebra

LI; 2,5 cm right to the trunk

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STOMACHRelation to other organs

(syntopy)• Fundus : within the

curved of diaphragm• Body : pancreas &

descending part of diaphragm

• Greater curvature : lies in front of the left suprarenal gland & upper part of the left kidney

• Lesser curvature : pancreas & tuber omentale of the liver

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• Posterior surface: splenic artery & vein

• Anterior surface: abdominal wall

• Right surface: left & quadrate lobes of the liver.

• Left surface of the fundus: spleen

• Caudal part of the greater curvature: transverse colon

STOMACHIA

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SMALL INTESTINE• Extends from the pyloric

orifice of the stomach to the ileocecal fold.– Duodenum – Jejunum– Ileum

• The mesentery of small intestine is a broat, fan shaped fold of peritoneum.– Suspends the jejunum &

ileum from the posterior abdominal wall by the root of mesentery.

– Contents: jejunal & ileal branches of superior mesenteric vessels, autonomic nerve plexuses, lymphatics, lymph nodes, connective tissue fat.

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DUODENUM• C-shaped• Rounding the head of the

pancreas• Retroperitoneal, except for

its beginning• Location: epigastric &

umbilical region• Connected to the liver by

hepatodudenal lig.Flexures:• Superior duodenal flexure• Inferior duodenal flexure• Duodenojejunal flexure:

surounded by a fold of peritoneum containing muscle fibers ligament of Treitz

Internal part of duodenum: • Major duodenal papilla:

common entrance for the bile and pancreatic ducts

• Minor duodenal papilla: entrance for the accessory pancreatic duct

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DUODENUMAbout 10 inches long. Parts of duodenum:1. Superior: just to the right of the body of the

vertebra LI – Anterior: the neck of the gallbladder, quadrate lobe of liver– Posterior: the bile duct, gastroduodenal artery, portal vein &

inferior vena cava– Superior: eplipoic foramen– Inferior: head & neck of pancreas

2. Descending: just right to the midline, at the level of the vertebra LII– Anterior: crossed by the transverse colon, right lobe of liver,

small intestines– Posterior: right kidney, right renal vessels, right edge of

inferior vena cava– Medial: the head of the pancreas & bile duct– Lateral: right colic flexure

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DUODENUM

• Horizontal/inferior: crossing from right to the left of the body of the vertebra LIII

– Anterior: crossed by superior mesenteric vessels– Posterior: crossing inferior vena cava, right ureter,

abdominal aorta

– Superior: head of pancreas & uncinate process

• Ascending: upward along the left side of abdominal aorta to the level of the vertebra LII and terminates at the duodenojejunal flexure.

– Anterior: transverse colon & mesocolon, lesser sac, stomach– Posterior: inferior mesenteric vein, left renal vessels– Superior: body of pancreas

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JEJUNUM & ILEUM

• Jejunum (proximal 2/5 of jejunum-ileum; mostly in left upper quadrant)

• Ileum (distal 3/5 of jejunum-ileum; mostly in right lower quadrant)

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CHARACTERISTIC OF JEJUNUM & ILEUM

Mesentery of jejunum Mesentery of ileum

Or “windows”

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CHARACTERISTIC OF JEJUNUM & ILEUM

Characteristics Jejunum Ileum

Location Upper left quadrant Lower right quadrant

Diameter 2 – 4 cm 2 – 3 cm

Lumen Wider Narrower

Walls Thicker and more vascular Thinner and less vascular

Circular mucosal folds (plicae circulares)

Larger and more closely set Smaller and sparse

Mesentery

Windows present No windows

Fat less abundant Fat more abundant

Arterial arcade, 1 or 2 Arterial arcades, 3-6

Vasa recta, longer & fewerVasa recta shorter &

more numerous

Lymphoid nodules (Peyer’s Patches)

absent present

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LARGE INTESTINE

• Extends from the distal end of the ileum to the anus.

• Approximately 1.5 m long.• Parts of large intestine:

– Cecum– Colon– Rectum– Anus

• Characteristic: appendices epiploicae, taenia coli, sacculation (haustra), semilunar fold

Appendix epiploicae

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CECUM & APPENDIX

• A large blind sac• Location: right iliac fossa,

inferior to the ileocecal opening.

• Continuous with the ascending colon at the entrance of ileum (ileocecal opening)

• Ileocecal valves: fold of ileocecal opening

• The appendix: narrow, hollow tube.

• Connected to cecum at the posteromedial wall of caecum; 2 cm inferior of ileocecal valve

• Suspended by mesoappendix.

Semilunar fold

Haustra

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CECUM & APPENDIX• The Base of appendix:

attached to the posteromedial wall of caecum; 2 cm inferior of ileocecal valve.

• Surface marking of appendix: a point about 2 cm below the junction of transtubercular & right lateral plane.

• McBurney point: surface projection of the base of appendix.– The junction of lateral 1/3

and middle 2/3 of a line from anterior superior iliac spine (SIAS) to the umbilicus.

– Site of maximum tenderness of in acute appendicitis

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CECUM & APPENDIX

APPENDICITIS•Rovsing’s sign•Psoas Sign (Cope): •Obturator sign (Cope):

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APPENDIX

Position of the appendix:a. Pelvicb. Retrocecalc. Preilieald. Postileal (retroileal)

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COLON

(1)

(2)

(3)

(4)Colon extends superiorly from the cecum.

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COLON

Colon consist of:• Ascending colon• Transverse colon• Descending colon• Sigmoid colon• At the junction between:

– ascending & transverse colon : right colic flexure (hepatic flexure); just inferior to the right lobe

– Transverse & descending colon: left colic flexure (splenic flexure); just inferior to the spleen

• Ascending & descending colon are retroperitoneal• Transverse & sigmoid colon are intraperitoneal

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COLON

Sigmoid colon• Begins above the

pelvic inlet & extends to the vertebra SIII

• The S-shaped• Mesentery:

– Transverse mesocolon: suspends the transverse colon from the upper part of posterior abdominal wall

– Sigmoid mesocolon: suspends the sigmoid colon from the pelvic wall.

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RECTUM

• Begins at the level of vertebra SIII, at the rectosigmoid junction.

• Location: posterior part of lesser pelvis, in front of the 3 pieces of lower sacrum & coccyx

• Retroperitoneal position

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RECTUMRectum shows 2 types of curvatures:• Anteroposterior curves:

a) Sacral flexureb) Perineal flexure

• Mucosal folds:– Longitudinal folds: lies in the lower part of an empty

rectum, and are obliterated by distension– Transverse (horizontal) folds/valve (plicae transversalis

recti): permanent. • Superior rectal valve: lies near the upper end of rectum,

projects from the right or left wall.• Middle rectal valve: lies at the upper end of the rectal

ampulla. Projects from the anterior and right walls.• Inferior rectal valve: lies 2.5 cm below the middle fold.

Projects from the left wall.

a)

b)

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RECTUMPeritoneal relations• Upper 1/3 of rectum is

covered by peritoneum• Middle 1/3 of rectum, is

covered only in anterior part.

• The lower 1/3 of rectum is devoid of peritoneum, and dilated to form the ampulla (ampulla recti). It lies posterior to Douglas pouch (rectouterine pouch) in females; and rectovesical pouch in male.

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RECTUM

CLINICAL APPLICATIONPalpasi/ rectal touche• Male: posterior surface of prostat,

seminal vesicle, & vasa diferentia• Female: perineal body & occasionally

ovarium• Male & female: anorectal ring, sacral &

coccyg bones, ischiorectal fossa, sciatic spine

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ANAL CANAL• Terminal part of large intestine• Lies between the 2 ischiorectal fossaeThe interior of the anal canal can be

divided into 3 parts:• Upper part (mucous):

– Limited below by pectinate line– Anal columns (of Morgani) :

containing the terminal radicles of superior rectal vessels

– Anal sinuses: small pocket above the anal valves

– Pectinate line: the circular line of attachment of the anal valves; separated the internal & external piles (haemorrhoids)

• Middle part (transitionalzone /pecten)– Lies between the pectinate line &

the white line of Hilton

• Lower part (cutaneus)– External anal sphincter: voluntary

control– Internal anal sphincter: involuntary

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ANAL CANAL

• Anorectal ring: muscular ring that forms by fusion of puborectal muscle.

CLINICAL APPLICATION• Haemorrhoids external & internal• Anal fissure• Fistula ani

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ACCESSORIES DIGESTIVE ORGANS

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TEETH

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TEETH

• Vessels of the teeth• Innervation of the teeth

– Upper: anterior, middle, posrweioe superior alveolar nerves

– Lower: inferior alveolar nerve

• Innervation of gingivae

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TONGUE

• Forms part of the floor of the oral cavity.

• The anterior part is triangular in shape apex of tongue (apex linguae)

• Separated into 2/3 anterior & 1/3 posterior of tongue by a V-shaped terminal sulcus of tongue.

• The terminal sulcus forms the inferior of the oropharyngeal isthmus, between oral and pharyngeal cavity.

• Papillae: filliform, fungiform, vallate, foliate.

• Vessels: lingual artery & vein

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TONGUEMUSCLE OF THE TONGUE

• Extrinsic muscle, originate outside of the tongue and insert to the tongue: genioglossus, hyoglossus, styloglossus & palatoglossus muscles

• Intrinsic muscle, originate and insert within the tongue: superior & inferior longitudinal, transverse & vertical muscles.– Function: alter the shape

of the tongue: lengthening & shortening; curling & uncurling its apex and edges; flattening & rounding its surface.

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TONGUEINNERVATION

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SALIVARY GLANDS

• Opens into oral cavity

• Divide into: intrinsic & extrinsic salivary glands

• Intrinsic salivary glands: glands of tongue, palate, lips, dan pipi

• Extrinsic glands: parotid, submandibular, and sublingual glands

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PAROTID GLAND

• The parotid duct across the external surface of masseter, & penetrates buccinator muscle.

• It open into oral cavity adjacent to the crown of upper molar 2

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SUBMANDIBULAR & SUBLINGUAL GLANDS

SUBMANDIBULAR GLANDS• Divided into 2 arms: the larger (superficial) and the smaller arm (deep) by

mylohyoid muscle.• Submandibular ducts drains into oral cavity, lateral to the base of frenulum of

the tongueSUBLINGUAL GLANDS• Location: on sublingual fossa, lateral to submandibular ducts• Superior margin of the glands raises an elongate fold of mukosa sublingual

folds.• Sublingual ducts opens on to sublingual folds,

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ACCESSORIES DIGESTIVE GLANDS

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LIVER

• Location: right hypochondrium & epigastric region or right upper quadrant

• Surfaces: – Diaphragmatic surface:

anterior, superior & posterior direction

– Visceral surface: inferior direction. Covered by visceral peritoneum except in the fossa for gallbladder & at the porta hepatis.

• The porta hepatis consist of: hepatic artery proper, portal vein, hepatic duct

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LIVER• Lobes: divided into left & right lobes by the gallbladder & inferior vena cava. Includes caudate lobe on the upper part and quadrate lobe on the lower part of liver.

• Ligaments:– Falcicorm lig.: attach the

liver to the anterior abdominal wall

– Round ligament of liver: degeneration of umbilical vein

– Triangular lig.( left & right): attach the liver to the diaphragm

– Coronary lig.( anterior & posterior): attach the liver to the diaphragm

– Hepatogastric lig: connect the liver-stomach

– Hepatoduodenal lig: connect the liver-duodenum

• Bare area of liver: an area between the liver & diaphragm which is devoid of peritoneum.

• Relation to other organs.

(The right colic flexure & colic transverse)

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LIVER• Ligaments:

– Falcicorm lig.: attach the liver to the anterior abdominal wall

– Round ligament of liver: degeneration of umbilical vein

– Triangular lig.( left & right): attach the liver to the diaphragm

– Coronary lig.( anterior & posterior): attach the liver to the diaphragm

– Hepatogastric lig: connect the liver-stomach

– Hepatoduodenal lig: connect the liver-duodenum

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GALLBLADDERParts of gallbladder:• Fundus: may project

from the inferior border of liver

• Body of gallbladder.• Neck of gallbladder.• Duct: cystic duct• Hepatic duct &

cystic duct open to common bile duct (ductus coledochus) and drains to descending part of duodenum.

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GALLBLADDER

• Projection to anterior abdominal:– The fundus of

gallbladder can be located at the angle between the right border of rectus abdominis muscle and the lower costal margin of the vertebrae C10.

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PANCREAS• Extends across the posterior

abdominal wall from the duodenum (on the right) to the spleen (on the left)

• Location: posterior to the stomach, retroperitoneal.

• It consist: – The head :within the C-shaped

of duodenum– The uncinate process:

projection of the lower part of the head, posterior to the superior mesenteric artery & vein

– The neck: anterior to the superior mesenteric artery & vein.

– The body: anterior to abdominal aorta

– The tail ends as it passes between layers of the splenorenal lig.

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PANCREAS

• Pancreatic ducts:– Major pancreatic duct : begins in the tail of the pancreas. The main

pancreatic duct join the bile duct and forms the papilla of Vater, which enters the descending part of the duodenum at the major duodenal papilla of Vater.

– Minor pancreatic duct: drains into the duodenum, above the major duodenal papilla at the minor duodenal papilla

Head

Body

Tail

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BLOOD SUPPLIES

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ARTERIAL SUPPLY OF THE GASTROINTESTINAL VISCERA & ASSOCIATED ORGANS

The gastrointestinal viscera and associated organs are supplied by the anterior branches of the abdominal aorta.

• Celiac artery (celiac trunk): branches from the abdominal aorta below the aortic opening (at the upper border of vertebra LI) and supplies foregut derivatives. – abdominal part of esophagus, stomach, upper 1 ½ parts of duodenum

up to duodenal papilla of Vater, liver, common bile duct, pancreas, spleen

• Superior mesenteric artery: branches from the abdominal aorta at the lower border of vertebra LI and supply midgut derivatives.– Lower 2 ½ part of duodenum below the duodenal papilla of Vater,

jejunum, ileum, cecum, appendix , ascending colon, right of 2/3 transverse colon

• Inferior mesenteric artery: branches from the abdominal aorta at approximately vertebral level LIII and suplies hindgut derivatives.– Left of 1/3 transverse colon ,descending colon, sigmoid colon, rectum,

upper part of the anal canal above the pectinate line.

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ANTERIOR BRANCHES OF THE ABDOMINAL AORTA

Celiac trunk

Superior mesenteric artery

Inferior mesenteric artery

AORTA ABDOMINALIS

Abdominal aorta

Superior mesenteric artery

Celiac trunk

Inferior mesenteric artery

FOREGUT

MIDGUT

HINDGUT

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CELIAC ARTERY (CELIAC TRUNK): BRANCHES

Left gastric artery: • Run downwards along the lesser curvature.• Branches: esophageal & gastric branches

Splenic artery:• Run along the superior border of the pancreas• Branches:

– Short gastric artery: supply the fundus of the stomach– Left gastro-omental (gastroepiploic) artery: run along the greater

curvature of the stomach.– Pancreatic branches– Splenic branches

Common hepatic artery:– Right gastric artery: run along the lesser curvature– Hepatic artery proper. Near the porta hepatis it divides into:

• right & left hepatic artery– Gastroduodenal artery. Downward to duodenum. Branches:

• Supraduodenal artery• Right gastro-omental (gastroepiploic) artery: run along the greater

curvature of the stomach• Superior pancreaticoduodenal artery: supplies the head of the pancreas and

the duodenum.

74CELIAC TRUNK AND ITS BRANCHES

Celiac trunk

Splenic artery

Left gastric artery

Common hepatic artery

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SPLENIC ARTERY AND ITS BRANCHES

Splenic artery

Gastro-omenta (Gastroepiploic) artery

Short gastric artery

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COMMON HEPATIC ARTERY & ITS BRANCHES

Right heparic artery

Common hepatic artery

Proper hepatic artery

Gastroduodenal artery

Right hepatic artery

Left hepatic artery

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SUPERIOR MESENTERIC ARTERY

• Crossed anteriorly by the splenic vein & the neck of pancreas.

• Posterior to the artery: left renal vein, uncinate process of the pancreas & inferior (horizontal) part of the duodenum

• Branches:– Inferior pancreaticoduodenal artery: the head of the

pancreas & the duodenum

– Intestines arteries jejunal & ileai arteries– Ileocolic artery colic, cecal & appendicular branch– Right colic artery : the ascending colon & the right flexure colon

– Middle colic artery: right 2/3 of the transverse colon

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SUPERIOR MESENTERIC ARTERY & ITS BRANCHES

SUPERIOR MESENTERIC ARTERY

JEJUNUM

INFERIOR PANCREATICODUODENAL ARTERY

MIDDLE COLIC ARTERY

RIGHT COLIC ARTERY

ILEOCOLIC ARTERY

JEJUNAL ARTERIES

ILEAL ARTERIES

APPENDICULAR ARTERIES

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INFERIOR MESENTERIC ARTERY

Branches:• Left colic artery: supplies the left 1/3 of the transverse

colon & the descending colon– Anastomose: middle colic & sigmoid arteries

• Sigmoid arteries: supplies the lowest part of the descending colon & the sigmoid colon– Anastomose: left colic artery & superior rectal artery

• Superior rectal artery: supplies the rectum & canal anal above the pectinate line– Divide into 2 terminal branch at the level vertebra SIII:

right & left brances.– Anastomose: middle rectal artery (branch of internal illiac

artery) & inferior rectal artery (branch of internal pudendal artery)

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INFERIOR MESENTERIC ARTERY & ITS BRANCHES

RIGHT COLIC ARTERY

INFERIOR MESENTERIC ARTERY

SUPERIOR RECTAL ARTERY

SIGMOID ARTERIES

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VENOUS DRAINAGEOF THE GASTROINTESTINAL VISCERA &

ASSOCIATED ORGANS

• Venous drainage from the spleen, pancreas, gallbladder, and the abdominal part of the gastrointestinal tract (except for the inferior part of the rectum)

PORTAL VEINPORTAL VEIN

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PORTAL VEIN

• Venous blood from stomach, duodenum, jejunum, ileum colon, rectum, pancreas, gallbladder & spleen enters the liver through hepatic portal vein sinusoids of liver hepatic veins drains into inferior vena cava enters the right atrium of the heart.

• Formed by the union of the splenic vein & superior mesenteric vein, at the level of the vertebra LII.

• Course: passed posterior to the superior part of the duodenum & enters the hepatic portal vein with the bile duct & proper hepatic artery.

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PORTAL VEIN

PORTAL VEIN

SPLENIC VEIN

SUPERIOR MESENTERIC VEIN

INFERIOR MESENTERIC VEIN

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VENOUS DRAINAGE OF THE ABDOMINAL PORTION OF THE GASTROINTESTINAL TRACT

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PORTOCAVAL SYSTEM• Anastomosis (communication) between portal vein (portal

system) with the vena cava (caval system).• Forms collateral circulation in portal obstruction.• Important sites:

– Abdominal part of the esophagus:• esophageal tributaries of the left gastric vein (portal) with

esophageal tributaries of the azygos & hemiazygos veins (systemic)

– Umbilicus • paraumbilical veins (portal) & epigastric veins (systemic)

– Bare area of liver • hepatic venules (portal) with the intercostal veins & phrenic

vein (systemic)– Posterior abdominal wall

• Veins of retroperitoneal organs (portal) with the retroperitoneal veins of the abdominal wall & the renal capsule (systemic)

– Anal canal• superior rectal vein (portal) with the middle rectal & inferior

rectal veins (systemic)

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PORTOCAVAL SYSTEM

ROUND LIG. (LIG. TERES HEPATIS) &.PARAUMBICAL VEINS

V. PORTA

INFERIOR VENA CAVA

SUPERIOR RECTAL VEIN

INFERIOR RECTAL VIEN

Superficial veins on abdominal wall

Tributaries to azygos vein

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PORTOCAVAL SYSTEM

Portal vein obstruction portal hypertension

• Caput medusae at the umbilicus• Esophageal varices at the

gastroesophageal junction

• Haemorrhoids at the anorectal junction

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LYMPHATICS

• Lymphatic vessels & nodes of the gastrointestinal tract & associated organs pre aortic lymph nodes

• Almost all the lymphatic vessels of the gastrointestinal viscera & associated organs drained to thoracic duct

• Run with arteries of the gastrointestinal viscera• Pre aortic lymph nodes contains :

– Celiac nodes (nn.ll.coeliacus) : • Receive lymph from the foregut origin: gastric (nn.ll. gastrica),

hepatic (nn.ll. Hepatica) & pancreaticosplenic (nn.ll. Pancreaticolienalis) nodes

• Also receive lymph from superior & inferior mesenteric nodes

– Superior mesenteric nodes (nn.ll. Mesenterica superior):• Receive lymph from the midgut origin: Mesenteric nodes, ileocolic

nodes • Also receive lymph from inferior mesenteric nodes.• Drains to celiac nodes

– Inferior mesenteric nodes (nn.ll. mesenterica superior):• Receive lymph from descending & sigmoid colon, superior part of the

rectum, superior part of the canal anal.• Drains to superior mesenteric nodes

89

LYMPHATICS

• Gastric nodes lies along lesser curvature. Receive lymph from the esophagus, lesser curvature, posterior-anterior-inferior aspect of the stomach.

• Hepatic nodes lies with hepatic artery. Receive lymph from the stomach, duodenum, liver, gallbladder & pancreas.

• Pancreaticosplenic nodes lies along splenic artery. Receive lymph from stomach, spleen & pancreas.

• Mesenteric nodes lies along superior mesenteric artery. Receive lymph from the jejunum & ileum (except from the terminal ileum)

• Ileocolic nodes lies along ileocolic artery. Receive lymph from the terminal ileum, appendix, cecum, ascending colon.

• Transverse mesocolic nodes between transverse mesocolon. Receive lymph from the transverse, descending & sigmoid colon.

90

CELIAC & SUPERIOR MESENTERY NODES

NN.LL.COELIACUS

NN.LL.GASTRICUSNN.LL.PANCREATICOLIENALIS

SUPERIOR MESENTERIC NODES

91

CELIAC NODES

HEPATIC NODES

CELIAC NODES

CYSTIC NODES

92

SUPERIOR & INFERIOR MESENTERIC NODES

93

INNERVATION

Parasymphatetic :

• Increase peristaltic movement

• Increase secretion of the digestive glands

Symphatetic :• Inhibitory to peristalsis• Increase contraction of the sphincter muscle

94

PARASIMPATISPusat : craniosacralDorsal nuclei N.X

esophagus, stomach, liver, pancreas, duodenum, jejunum, ileum, ascending colon , proximal 2/3 of transverse colon

Sacral 2-4 1/3 proximal transverse colon, rectum, anus

INNERVATION

95

INNERVATION

SYMPHATETICCenter : thoracolumbalPrevertebral ganglion :• Celiac ganglion • Superior mesenteric

ganglion• Inferior mesenteric

ganglionUrinary bladder

Genital organs

Stomach

Duodenum

Pancreas

Spleen

Liver

Jejunum, ileum, ascending colon,

proximal 2/3 of the transverse colon

Distal 1/3 of the transverse colon, sigmoid colon, rectum, anus

96Contracts bladder

Increases digestive

function of stomach

Constricts bronchi

Increases digestive

function of intestine

Slows heart

Increases salivation

Inhibits tear glands

Constricts pupil

PARASYMPHATETIC SYMPHATETIC

Stimulates tear glands

Dilates pupil

Accelerates heart

Inhibits salivation, increases sweating

Dilates bronchi

Decreases digestive functions of stomach

Secretes adrenalin

Decreases digestive function of intestine

Inhibits bladder contraction

97

INNERVATION

CANAL ANAL• Above pectinate line:

– symphatetic plexus hypogastrikus L1,2– parasymphatetic

• Below pectinate line : – somatic (inferior rectal nerve)