Digestive systemDigestive systemGlands and peritoneum

Glands of the digestive tubeGlands of the digestive tube

• glandulae salivariae = salivary glands

• pancreas

• hepar = liver

• vesica fellea + ductus choledochus = gallbladder + bile duct

Glandulae orisGlandulae orisglandulae salivariae majores

–gl. parotidea (parotid gland)–gl. sublingualis (sublingual gland)–gl. submandibularis

(submandibular gland)glandulae salivariae minores

buccales, molares, labiales, palatinae, linguales anterior (Blandini = Nuhni), posterior (gustatoriae Ebneri, radicis linguae Weberi)

Glandulae salivariae majoresGlandulae salivariae majores

• capsula (collagen fibres) septa

• secretory part– serous, mucous and myoepithelial (basket)

cells

• system of ducts – intralobular

• intercalated striated

– excretory interlobular interlobar principal oral

cavity

Glandulae salivariae - cellsGlandulae salivariae - cells• serous cells

• acinus (pyramid shape)

• produce proteins• basophillic, ER, GA• microvilli apically,

secretory granules

• mucous cells• cuboidal, columnar• form tubules • produce mucus light

granula (which can fuse)• viscose secretion

more distally than serous cells

Glandulae salivariae - cellsGlandulae salivariae - cells• cells of intercalated

duct• simple flat / low cuboidal

epithelium• lactoferin, lysozyme

ductus intercalati converge in ductus striati

• cells of striated duct• radial arrangement• striation = fold of BM +

mitochondria • cells transporting ions• form hypotonic saliva

Glandulae salivariae

into intelobular ducts

Glandula parotideaGlandula parotidea• ductus parotideus Stenoni above upper M2

• pars profunda, superficialis – in between plexus intraparotideus n. VII

• glandula parotidea accessoria• regio parotideomasseterica

innervation:

parasympathetic: n. IX n. tympanicus n. petrosus minor (Jacobson‘s anastomosis) ganglion oticum Arnoldi n. auriculotemporalis

sympathetic: truncus sympaticus ggl. cervicale sup. plexus a. meningeae mediae

Glandula parotidea - Glandula parotidea - structurestructure

• pure serous, compound acinar gland

• ramified acines, long ducts• plasmocytes in lamina propria - IgA

complexes with secretory component (synthetized in serous, intercalated and striated parts)

• PAS+ granule (polysacharids, amylase)

• 25% of saliva volume

Glandula submandibularisGlandula submandibularis

• ductus submandibularis Whartoni caruncula sublingualis

• trigonum submandibulare

innervation: parasympathetic: n. VII. chorda tympani n. lingualis ganglion submandibulare

sympathetic: truncus sympathicus ggl. cervicale sup. plexus a. facialis

Glandula submandibularis - Glandula submandibularis - structurestructure

• seromucous, compound tubulo-acinar gland

• serous acines adjacent to mucous tubules are transformed in serous demilunes (semiluna serosa – semiluna Giannuzzi-Heidenhain)

• serous elements prevail (basophilic cytoplasm)

• PAS+ granule • 70% of saliva volume

Glandula sublingualisGlandula sublingualis

• ductus sublingualis major Bartholini caruncula sublingualis

• ductus sublinguales minores plicae sublinguales

innervation: identical with glandula submandibularis

Glandula sublingualis - Glandula sublingualis - structurestructure

• seromucous, compound tubulo-acinar gland

• mucous cells prevail

• no intercalated ducts

• short striated ducts

• 5% of saliva volume

PancreasPancreas• description: caput (processus uncinatus,

incisura), collum, corpus (margines, facies), cauda

• structure: ductus pancreaticus Wirsungi (sphincter d.p.), d.p. accessorius Santorini

• insulae pancreaticae Langerhansi (1%)

• fixation: lig. pancreaticosplenicum, - colicum, vasa mesenterica sup.

• syntopy: duodenal window L2, secondary retroperitoneal organ

Slinivka (břišní) = pancreas, micter

• Popis: caput (processus uncinatus, incisura), collum, corpus (margines, facies), cauda

• Stavba: ductus pancreaticus Wirsungi (sphincter d.p.), d.p. accessorius Santorini

• Insulae pancreaticae Langerhansi (1%)

• Fixace: lig. pancreaticosplenicum, - colicum, vasa mesenterica sup.

• Syntopie: duodenální okénko L2, sekundárně retroperitoneálně

PancreasPancreas – – arterial supplyarterial supplycaput:• truncus coeliacus a. hepatica

communis a. gastroduodenalis a. pancreaticoduodenalis sup. post. + sup. ant. + aa. retroduodenales

• a. mesenterica sup. a. pancreaticoduodenalis inf. ramus ant. + r. post.

corpus et cauda:• truncus coeliacus a. splenica rr.

pancreatici

Pancreas Pancreas – – other supplyother supplyveins:• vv. pancreaticoduodenales v. mesenterica sup.

v. portae• vv. pancreaticae v. splenica v. portae

lymph drainage:• n.l. pancreaticoduodenales, mesenterici sup. n.l.

lumbales

nerves: • parasympathetic – n. X • sympathetic – truncus sympaticus nn. splanchnici

major + minor ggl. coeliacum + mesentericum sup.

PancreasPancreas – – mixed glandmixed gland• pars exocrinna – serous, compound tubulo-acinar

gland– serous cells (pancreatocytus exocrinus)

• form acines, ER, GA, granula zymogeni apically

– no striated intralobular ducts– ductus intercalatus d. intralobularis d. interlobularis

d. excretorius d. pancreaticus (+ d.p. accessorius)– secretion: water, ions, (chymo-)trypsinogen,

carboxypeptidase, (deoxy-)ribonuclase, lipase, amylase, elastase

• secretin much fluid, HCO 3

-, neutralization of chymus

• cholecystokinin much enzymes (realease of granules)

• pars endocrinna – insulae pancreaticae = islets of Langerhans

PancreasPancreas – – pars exocrinnapars exocrinna

acines surrounded with BM

1 – exocrinne cells of pancreas (pancreatocytus exocrinus)– zymogen granula

2 – centroacinar cells (cellula centroacinosa)

3 – intercalated duct (ductus intercalatus)

Hepar = Liver

regiohypochondriaca

dextra

Liver - Liver - descriptiondescription

• facies diaphragmatica (area nuda, impressio cardiaca), visceralis (impression of organs - 6)

• margo inferior• 4 lobes (descriptive)• 8 segments (according to blod vessels branching)• ligaments: lig. teres hepatis, venosum,

coronarium /falciforme, triangulare dx. et sin., hepatorenale/, appendix fibrosa hepatis, lig. venae cavae

• fixation: suspended on v. cava inf., grows together with diaphragm, supported by other organs, lig. teres hepatis

Liver - Liver - SegmentsSegments• segment has in tis center: artery, veins (branch

from v. portae, bile duct• vv. hepaticae are between segments !• plane along v. hepatica media divides liver into

lobus dx, et sin.– projects on surface as Rex-Cantlie‘s line (center of

fossa vesicae feleae → v. cava inf.)• v. hepatica dx. divides right lobe into anterior

(V+VI) and posterior segments (VII+VIII)• v. hepatica sin. dělí divides left lobe into lateral

(II+III) and medial segments (IV)• clock-wise

Liver classification (Claude Couinaud 1957)Liver classification (Claude Couinaud 1957) SegmentumSegmentum

Pars hepatis sinistra

Divisio lateralis sinistra

Segmentum posterius laterale sinistrum II

Segmentum anterius laterale sinistrum III

Divisio medialis sinistra

Segmentum mediale sinistrum IV

Pars posterior hepatis; Lobus caudatus

Segmentum posterius; Lobus caudatus Spigeli

I

Pars hepatis dextra

Divisio medialis dextra

Segmentum anterius mediale dextrum V

Segmentum posterius mediale dextrum VIII

Divisio lateralis dextra

Segmentum anterius laterale dextrum VI

Segmentum posterius laterale dextrum VII

Segmenta Segmenta hepatishepatis

• borders by vv. hepaticae

• lobus caudatus = segmentum I

Bismuth‘s clasification

(USA)

• 4 sectors

• 8 segments

• Segmentum IV– IVa– IVb

Liver blood supply

• porta hepatis:v. portae, a. hepatica propria, ductus hepaticus

dx. et sin., lymph vessels and nerves• fissurae (3) + fossa vesicae felleae• arteries: truncus coeliacus a. hepatica

communis a. hepatica propria (+ a. hepatica accessoria) r. dx.+ sin. aa. interlobulares

• veins: v. portae vv. interlobulares capillaries vv. centrales v. hepaticae v. cava inf.

Liver - Liver - facies visceralisfacies visceralis• Porta hepatis• Fissura lig. venosi, fissura lig. teretis• Sulcus venae cavae• Fossa vesicae biliaris

Porta hepatisPorta hepatis

v. porta dorsal

a. hepatica propria

r. dx. et sin. ventromedial

ductus hepaticus dx. et sin

ventrolateral

lymph vessels nerve plexus

Liver Liver blood supply – blood supply – 2 circulations2 circulations

• arteries: truncus coeliacus a. hepatica communis a. hepatica propria (+ a. hepatica accessoria) r. dx.+ sin. aa. interlobulares

• veins: v. portae vv. interlobulares capillaries vv. centrales v. hepaticae (dx., media, sin.) v. cava inf.

Liver - lymph and nerves

lymph: 3 directions• n.l. coeliaci• n.l. mediastinales ant.• n.l. mediastinales post.

nerves:• parasympathetic – n. X• sympathetic – truncus sympathicus plexus

coeliacus plexus hepaticus• viscerosensory – n. phrenicus (peritoneum under

liver as far as gallbladder !!!)

Liver - Liver - structurestructure

• tunica fibrosa Glissoni

• hepatocytes– lamina hepatocytica = trabecules of hepatocytes– spatium perisinusoiodeum = Disse‘s space– sinusoides in between (= irregulary extended capillaries

with fenestrated endothelium)

• von Kupffer´s cells = macrocytophagus stellatus• Ito´s cells = cellulae perisinusoidalis (fat storing cell)

– production of collagen for trabecules, storage of vitamin A,

– canaliculus bilifer (bile canaliculus) – wall is formed directly by plasmalemma of hepatocytes

HepatocyteHepatocyte• polyhedric• oeosinophilic• large spheroid

nucleus– can be

polyploid• GER + SER mitochondria

• bile canaliculus• tight junction• microvilli• Disse‘s space• endothelium

Classical hepatic lobuleClassical hepatic lobuleLobulus hepaticus classicus = polygonalisLobulus hepaticus classicus = polygonalis

• Weppler 1665• 3 zones

– central III– intermediate II– peripheral I

• structural unit of liver parenchyma

• hexagonal shape• v. centralis• hepatocytes in radiate

trabecules• spatium portale• blood flows from the periphery

to the centre

• portal triad (trias hepatica)– venula ( v. portae), PV– arteriola ( a. hepatica), A– interlobular bile duct (

ductus hepaticus), B• simple cuboidal epithelium

perivascular fibrous capsulespace of Malllymph capillaries

• portal lobule (lobulus portalis)– centre = portal triad

PPortortal al area/canal/zone area/canal/zone ((spatium portalespatium portale))

Liver acinus of Rappaport

Acinus hepaticus

• rhomboid• functional unit • according to blood

supply (preterminal branch of hepatic arteriole)

• 3 zones– selective damage of

hepatocytes

Spatium portale (PA):branch of a. hepatica

bile ductule

branch of portal vein

Classical hepatic lobule

Liver acinus

Portal lobule

Central vein (CV)

Liver - Liver - functionfunction• synthesis of proteins

– continuous release into blood– albumin, fibrinogen, protrombin, transferrin,

lipoproteins...

• secretion of bile– water, ions, bile acids, phospholipids, cholesterol,

bilirubin

• metabolic– accumulation of metabolits: TAG, glycogen, vit. A– gluconeogenesis, glycogenolysis, deamination of

AA– detoxication: oxidation, methylation, conjugation

• hemopoiesis– during development

Bile ductsBile ductsDuctus biliferiDuctus biliferi

• intrahepatic:

canaliculus bilifer canalis

bilifer of Hering

ductus bilifer interlobularis • extrahepatic:

ductus hepaticus dx. et sin. d.h. communis connection with d. cysticus d. choledochus (m. sphincter d. ch.) ampulla hepatopancreatica (m. sphincter a. h. Oddi) papilla duodeni major Vateri duodenum

Ductus choledochus

• pars supraduodenalis

• pars retroduodenalis

• pars pancreatica

• pars intramuralis

• ampulla hepatopancreatica (77 %)

Vesica fellea/biliaris = GallbladderVesica fellea/biliaris = Gallbladder

• description: fundus, corpus, infundibulum, collum, ductus cysticus (plica spiralis Heisteri)

• arteries: truncus coeliacus a. hepatica communis a. hepatica propria, r. dx. a. cystica

• veins correspond to arteries

v. portae• lymph: n.l. hepatici• trigonum cystohepaticum Caloti• intraperitoneal organ

Gallbladder - Gallbladder - structurestructure• tunica mucosa

– simple columnar epithelium– frequent folds– missing lamina musuclaris mucosae– collum – mucosal glands– pouches of mucosa into muscle layer (Aschoff-Rokitansky‘s sinuses)

• no tunica mucosa• tunica muscularis

– plexiform; cholecystokinin + ANS contraction

• tunica serosa– thick tela subserosa– tunica adventitia: largely sessile to liver in fossa vesicae biliaris

• function: – accumulation and concentration of bile (reabsorption of water to 10%)– 30-50 ml

Bile ducts - Bile ducts - structurestructure

• simple columnar epithelium– cholangiocytes– scattered goblet cells

• glandulae ductus choledochi – mucinous• wall made of connective tissue predominatly• missing continuous muscle layer

• thin wall can be easily compressed → jaundice