Anatomy #6 (Digestive) Flashcards
Understanding of Digestive system through time
William Bomant - Practiced medicine in northern michagen as the only healthcare persn in the area
He was called to a store where Alex Markete was shot –> there was not enough tissue to covery the hole s Bomant sutured the edges of the hole –> guy lived and the hole healed over
- Hole would be covered when he was not moile but was open when he moved up = could look inside of hole
After surery - St. Marine had a flap develope that was not always closed
What did the hole in Alex markete open into
Hole opened into his stomach
When Bomant sutured he wall of his abdomen and teh wall of his stomach he made a window into the womach
Bomant tried to entice St. Markete to be able to look into his stomach
St. Markete would go away on a bender and when he would come back Bomant would look at the hole in hist stomach –> For the first time they were able to see something in the stocmah changes when we eat food
Bomant experimnte on St. Markete Stomach
Bomant would tie food on a thread and put it into his stomach and pulled it out –> see what changed
Thoughts before Bomant
Before Bomant - peoople thought that there was osmething inherint in food (food would have something that allows it to decompose)
NOW we know that it is the envirnment/things in the body that break down food
Thoughts before Bomant (Experiments)
Before = they did expeirments to see how food is degraed by putting food in a jaw with cloth
They saw the decomposition of food is different if in a uncovered or covered jar = see it is not something in the food itself it is envirnmental factor that chnages food
After Bomant = reserach moved foward
St. Martin + Wife
St.Martin ended up outliving Bomant
At the time - Bomant’s reearch was very big
After Bomant died - Olso contacted his wife to see if they could expeirment on his body but the wife said no
Ciculation in GI (overall)
Blood goes from the Left ventricle –> Aorta –> Thoracis Aorta –> Diaphram –> Absominal Aorta –> (Major vessle that feed sthe gut) –> Blood goes through the gut –> Blood will go through the portal vein –> Liver –> Inferior Vena cava -> Heart
- Gives Oxygen to Digetsive + will pick u nutrients being broken down by GI –> transports it to the liver –> Liver detoxifies and absorbs the nurteinets –> blood goes to the heart
- Digestive has own blood supply + hets oxygen from ciculatory
Image - Focusing on Blue circle
Digestive system (Overall)
Consists of the Alemantary Canal + Accesroy organs
Alamantary canal
Tubular space that opens up to the outside world at the mouth and the anus
- Has things to provent infection because open to the outside
Tube goes through the whole body (40 Ft long - of surface area)
- Designed so eveyrthing that we eat has the time and the surface area to be broken down to absorb nutrients
Accesory organs in GI
- Pancreus
- Liver
- Gallblader
- Salivary Gland
ALL support the function of digestive/Alemantray canal
- They put things into the Alamntary Canal
1st part of digestion
First part of digestion = Machanical (Chewing/Mastication) + Hydrolisys
- Need to swallow food (Ex. need to be able to have the trahea give way for bolus food)
- Mastication - Chewing allows food to be maulable + increases Surface area (increases in surface area allows cheamals to surround the food better which allows the chemicals to break the food down)
- Hydrolysis - Salivia in mouth (Fluidity + conetnts of saliva = break food down)
Area of storage in Digestive
Gallblader – not producing things
- Bile is made in the liver and goes to the gallbladder for storage
Oral cavity
Mouth is bound by the hard pallet and Soft pallet
- Soft pallet = Uvula (thing dangling in back of mouth) ; soft pallet important in swallowing as a sentinal
- Mucosa of oral cavity and orropharynxs = non-ciliated + Digetsive is not ciliated
- Roof of mouth = Hard pallet ; Posterior = soft pallet
Inferior = have the tonigue (takes up most of space in mouth) + gutter of the mouth)
- Tongue = voice + chewing + swallowing
Space between the tongue + the cheeck + the teeth = vetsibule - food goes into vestible as chew
laterally = have cheecks
Anterior = have lips
Boundery of the mouth
Boundery of the mouth = affects chewing
Chewing - teeth move up and down because the Jaw bone moves + tongue moves the food to keep food positioned in the right place + mouth muscles contract
Muculature of the lateral side of face
- Temeraris mucsle
- Maseter muscle
- Buxinator
- Obicular Oras - controls lips
Temperalis muscle
Goes to the temperal line –> goes to the tendounous formun (tendenos mprtion that goes to the fronal condice of jaw)
When chew + talk = can see the Tmeralis Fire (espcially in bald people)
Maseter mucle
Bone + Master = make up the Jaw line that you can see
- People can have stout maseters = creates a good jaw line
- Goes to underside of zygomatic arch
Buxinator
Important in the movement of food around mouth + compression of the oral cavity
There is a foam pad on the Buzanator - More pronounced in infants
- Helps babies feed - Babies need suction to build = volume of the oral cavity needs to be low to increase pressure = Buxinator foam pad keeps the mouth cavity small to increase pressure
Flexibility of the mouth
Flexibility of the mouth is usually low
Story - Disey Galespy (Jazz person) –> Cheecks were very extended out –> developed circle breathing
- Bretah out of respirtory like normal and take air in and as breath in they can continue to let chect vcavity relax as they bretah in
- He oulwd take air in –> make resiviror of air in mouth –> muscle would relax and push air ut and could miantain note as he also breathed in through nose
- He closed false vocal cords to do this - to make resvior indepent = could play while breathing in
Fill mouth with air and let recoil tendon of ucle of mouth = move air out ; breath in through nose = can play note for a long time
Shows importnace of mouth in breathing
Teeth (Overall)
32 Adult teeth (16 per jaw)
3rd molars = can cause an issue –> very far back in jaw
Molar = for grinding (humans don’t use as much = don’t need 3rd molars = can take them out)
Canine = For ripping
Ensziers (at the front) = for ensizing
Wisdom teeth
Teeth can come in so the towards the other molars –> causes crwoding in the lower midsizers because the wisdom teth can push in
40% of people habe wisdom teeth extracted by 20-30
Oral surgury for wisdom teeth = more advancd
- Before it was more complicated - many peope got dry sockets + infection + bleeding
Surface of the tongue
Surface of the tongue = rough Have different Types of papilae (raised areas of the tongue)
Papillae Function - House nerve endings for taste (sensory organs = taste buds)
Concical Papilae
Filaform papillae at the front
- Supplied sensation by the facial nerve
Have Fungiforum paillar in middle
- Supplied sensation by the facial nerve
Vallet papilarr = in back
- Supplied sensation by the glossophyrngeal
Areas of the tongue
Taste different things in different areas of the tongue
Taste + Smell
Story - Rini sense of smell has decreased over time = it is harder for him to taste
- Doesn’t taste well - instead he tastes the sensation of flavors (sensation of salty or sweet but not tasting flavor)
Smell is tied to the sense of taste
- Decrease sense of smell = can’t distiguish flavors well
- Taste = Olfactory + Sensory perception
Salivary Glands
- Parotoid Gland
- Submandbular Gland/Duct
- Sublingular Gland
Paratoid Gland
- Parotoid Gland = biggest salivary glands
- Opens abive ipper second molar
- When olfactory or eating causes salivation = saliva dumos from the paratoid gand to oral cavity
Clincal - People can get stones in tha Patroid Gland = gland gets blocked (painful)
- Can get the stone removed
- Gland can also get infection
- Dentists = do sweep of the mouth + makes sure nothing is weird in mouth
Submandbular Gland/Duct
Under the Ramus of the jaw
Can palpate it
Sublingular Gland
On the floor of the mouth under tongue
1st line of digestion
Chewing + Saliva
Saliva = has Tyline = starch degrader
- IF take a salitine and just put in mouth it would dissolve ebcause teh Tyline breaks down strach
Salivary Gland (Picture #2)
Paratoid duct - across from second molar on outside of vestibule at the top is fenetration that open paratoid duct
- Where the Paratoid duct dumps saliva in
See Fimbriated Fold = Fold under the tongue - sheet of tissue under tongue
Sublingual ducts - ducts were tongue meets the floor of the mouth
- Sublugual glands have a row of fenetrations - opening of ducts for sublinual gland
Submandibular ducts (come out in renulum - Typically closed when saliva is released
- People shoot Saliva out –> point tongue and move frenum to open mandibular and to eject saliva out
Swallowing Steps
- Buccinator compresses cheecks = oral cavity gets smaller
- Tongue + hyoid bone + thyroid cartildge raise and food is pushed backwards from the mouth into the pharynx
- Larynx goes up
- Several muscles act at once to narrowing the opeing between the mouth and the pharync ; soft pallet elvates which closes off the nasopahrync and prevents the backflow of food or liquid into the nasal cavity
- Mucles contract in a way to close off nasal cavity (don’t want food going to nasal cavity)
- People can chose = get food in Eustaton tibe = get food in cilitaed mucus in tube
- Tonguge and Hyoid bone elvates which causes the epiglotis and the laryngeal inlet to elevate –> food passes over the anterior surface of the epiglotus into the largypharynx
- Epiglotis flaps back and allows food to go to the esophogus + make sure food is not going to the trachea
- Food is propelled int and down the esopgafus by constrictor muscles + gravity helps move food to esophogus
Midsaigital section + chewing
Tongue - puts food to back of
See epiglotus
See opening to Eustacian
Talking + Swallow
If talk and swallow = messes up system because talking requires different movements
Breathing and swallowing at the same time = body doesn’t know what to do = get fluid in airway
- Fluid into airway = have strong refelx –. cough so you get air out forfully with vasalvels manuver = removing fluid away from airway
- People can inhale food (example - lobster roll competition -> guy chocked –> governer of maschusets did hymlic)
Hylmlic Manuver
Hylic is not good fro self selaing things (Ex. penut butter)
If get too much peanut butter in the airway –> try to cough it out = blows open a hole in the peanut butter = hole opens whe breath out and closes when breath in
Rini + Hylmic
Rini met Dr. Hymlic (made the Hmlic manuver)
Hymlic = makes thoracic cavity small fast = increases pressure = frce air out
- To do - put hand below Xyphoid processes –> pull up (push up on diaphram to raise diaphram)
Swallowing Video
Swallow barium under floroscapy
- Often done in kids because they have issues swallowing
See soft pallet goes back + see epiglots flaps down + see muscle makes tongue and hyloid bone go up
Lining of Abdomen
Entire Abdomen is lined by Mesothelium –> mesothelium makes up the periteneum
- Lining of Abdommenal (peritenieam) = emerges from wall t come foward to cover liver LI + SI
Image -
Red = Parietal peritenium (mesothelium lining cavity) on the wall –> Parietal refelx on self –> becomes mesocolon
- Have double layer of peretinum = two layers of mesothelium invests the organs of the digestive tracts
- Reflection of petrinal covering = mesocolon
Organs behind the Peritenium
Some organs live behind the Pareital Peritenium
Back of Abdomenal Cavty is covered with peritenium but do have some organs behind the perutnium
- Ex. Kidneys + duadneum of SI + Ascending and Dcesnding Colon are retroperetiual = live behind the peretinium of the posterior wall
Peritenual cavity
Wall of the Abdomen + Things in space = Peretineal cavity
Lining of cavity = Peritenium
What is found in the lining of the abdomen
Mesocolon cotains the vessels (arteries + veins + lymphatic vessels)
- Vessels will go out to the suprior mesonteric –> ___ –> Mesenary –> goes to the intestines
Layers of the lining of the peretinium
parietal peretinmum –> Mesontary (double leaf) –> Visceral pertenium
Visceral = on all of the organs (like piamoter)
Red = Pareital peritnium (lines abdomonal cavity) –> Pareital emerge from back wall and joins and becomes sheet of peritenium that goes out and surroind the SI - NOW becomes visceral peritenium
- Folds that come out from posterior wall to ecomass intestines = mesontary
- Mesonteric flods (mesontary) makes intestines/Gut mobile - insteines need to be able to move for digestion
Peritenium cavity
Closed to outside world in males (everything in abdomen is covered by oeretinium)
NOT closed to outside world in females - females have space between overay and follopian tube (communication betwen pertenium cavity and outside world)
- Opening can be a plave for ifection to enter periteniual cavity
- Toxic Shock (often caused by tampon) - infection introduced through falopian tube (often diagnosed when too late to treat) and goes to peretibeal cavity = get peritiniutus (infection of peretinial cavity)
Is the samll intestine in abdomenal cavity
Yes/No - because it is intraperitineal
Connected to the back wall of the mediastinum + covered by peretinium
What is adhered to the back wall of the abdonmen
Adhered to the back wall of the body = Kidney + Acsending/Descending colon + Aorta + verna cana = ALL retroperitineal
Spaces of the Peritenium
Way the peritenial refelcts in body = creates the two spaces
- Greater sac - Most of the abdomen
- Lesser sac - Behind the stomach
Epicale foramane = communication between the lesser sac and greater sac
- Peitnitus = infection in area –> if infection gets to the lower sac = hard to treat because hard to get to the area
Blue = lesser sac ; Red = Greater Sac
Pritinitus/Sepsis
Infection in peritenial = can get bad fast because it is a warm moist space
- Spreads fast because big space = in contact with many things
- Infection can go to the lesser and greater sacs
Hard to get AB because have sequestered space –> somtimes pump AB to the peritenal cavity
- Might change how patient is positioned on table tp move the medication through peritneal cavity
Septic shock
If have GI surgery on bowl = need to be very carful to make sure eveyrthing is sutured shut because whenopen bowl you can have fecal material inside = need to make sure it is completlet closed
IF you put it back into he abdomen and there is an opening = you can get peritinutus/Sepsis
- Ruptured bowl can occur from trauma
- Ex - Rini illistrated for court case where women had things leaking
Can happen with Apendex –> Bursts = puts bowl matareila to parietal cavity = get peritinitus
Muppet story
Jim Hemson (muppet guy) - died of peritnitus (Steptocohcal infection)
Omentum
Fold of tissue (Visceral pertinueam that becomes free) - looks like apron of thin tissue with fat that covers intestines
- Provides some lubrictaion (because fat filled) = allows movment
- Omentum will migrate to where injury happens = sequesters area = protection
Shows retroperiteaal things
Asceding colon + Sigmoid colon + Kidney + Diuadneum + Pancreus = retropertineal
- image = cut the mesontary - see peritnum energing from back wall and coming togtehr to surround in the SI (SI removed in image)
- Sheets coming from the back wall = mesontray
- Transverse colon = NOT retroperetenal
Image = can also see ascending + Transverse + Decending colon
Image = removed retropreitenual organs (exceot kidneys)
Blue = pariteal peritenium on the back wall
- When reove retropertitenal organs = have bare spots
3 Parts of Small intestine
1. Duadenum
2. Jejunum
3. Ilum
DUadenum = retroperitenial then becomes intraperitaneal
- In the C of the duadenum = have the pancreus
Alimetray canal
- 3 parts of Small intestine
Mouth –> Pharynx –> Asophogus –> Sphinkter –> Stomach –> sfincter –> Duadenus (1st part of the small intestine) –> Jejunum –> Ilium (last third of SI) –> Colon (Large Intestine) –> Secum (Twisting of the Large intestine) –> Aceding colon –> transverse colon –> Decsening colon –> sigmoid colon –> Rectum
Splenic felxture
Heplanic felxture
Stomach
Location - Beneath Diaphram
- Has Hydrpcholic acid + mechanicall breaks down food
In stomach = have folds (Called Rugi) – Increase the surface area
- Stomach is making hydrochloric acid = breaks down proteins
- Rugi = have secretory cells
See tube coming from Esophous – goes to the esophogeal hiatus (near inferior vena cava)
See cardiac Oraphic (Sphincter) - Prevnets food from refluxing out of the stomach (Weak)
- Found where asophus goess into the stomach
See Pylerus (end of stcomach going to duadenum) + Pyleris Actrium
See Duadenoum of SI
Fundus of stomach = large part
Have greaer curvature = inferior boarder of stomach + less curvature
Pylerus
Goes to the small Intestine
- Strong sphicter
Closes until the food is ready to go to the Duadenum
Takes Acidic envirnment and selectivle dumps food to the duadneum
- It is very prescise - din’t get acidic material)
Papillae
Openings for pancretic duct –> put panreotic juice to Duadenum
- Digestive enzymes from pancreus goes to the Small Intestine
Cardiac Sphincter strength
Cardiac sphicter is not as strong as the pyleric sphicter
Cardiac can be weaker becayse the angle in which Esophgus comes into stomach - weak sphicter is helped by angle (created mechanical closure) bevase when the stoach is distended/full = makes an more accute angle = blocks esophogus
- Want Esopgus blocked because have stomach acid - don’t wnat that acid going into the esophogus
Stomach + fighting infections
Acidic envirnment = when swallow bacteria and vrisues - acidic envirnment prevents getting infection + virus
Blood Supply of stomach
Stomach = well profused - have lots of colateral circulation (creates circle)
After the aorta –> blood goes to the celiac trunk (comes off the aorta)
- Gives rise to the splenic artery (Screw shape)
- Gives rise to left gastic aretry –> Anastomoses with another artery (gastroductual artery?) –> feeds lesser cuvature
- Haptic artery = goes to the gallbaldeer + branch anastomoses and goes ot greater curvature of stomach
Celiac trunk = bramches to lefy gastric artery –> goes to the lesser cruvature of the stomach –> Anastomosas
Branches off Duadenum –> goes around the greater curvature of stomach –> Anastomas with Splenic artery
- Splenic artery is screw shape (spleen is well profused)
Cystic artery + Cystic artery proper go to the gall bladder
GERD
Problem with cardiac sphicter = get acid in the distal esophogus = get heart burn + can erode esophogus (can cause esophogeal cancer)
OR
Can get herna of the fungus of the stomach into the thoracic cavity (pulls through the hiatus)
- Do surgery to correct - Pull the fungus down through the hiatus –> pull fungus on self –> prevewnts the stomach from being pulled through the hiatus –> Suture the hiatus shut to mkae tighter
- Nisen fundification = takes fundus of stomach –> pul to abdomen –> Wrap fundus around the esophogus and suture (makes knot at top of stomach = won’t pull through diaphram)
Baeratirc surgery
Overall - reduce area of the stomach
Example - put band around the stomach –> inflate the band –> Make stomach smaller + can adjust size
Gastric Bypass –> Pouch off part of Fondus of stomach = make small stomach –> but jejunum up to puch( revert small intestine t stomach) (food gos to puch and puts on way) ; deudunum is left intact and side to end sutured into new routing so panreotic enzymes can get in
Gastric sleeve - Take greater curvatire of stomach and sutire t make stomach smaller = make new stomach and make same route of digestion but change size of stomach
NOTE - need to be carful who is chose for the surgery because perosn could to take in the same caloreis and keep wieght
- Surgery s trying to make person eat less (people eat less but each more often)
- Surgerie s= very succesful (help people with metabolic issues)
Image = removed stomach + remove periteneum
See Duadenum – small part is intraperitneal
See Celiac track – branches to feed duadenum
See superior medienteric artry and vein –> branch off abdoman aorta
- Feed whole digestive tract
Superior medienteric artry and vein
Come out behind pancreus in front of deududeum and goes down to the intestines
Pancreotic cancer
Hard to treat because diagnosis is often late because it is deeply buried (esocially when the tumor does not affect the pancreotic enzyms going to the duadunum)
- Treatment can be effective if they catch it early enough
- Worse if in the tail of pancreus
- If in head of pancreus = can get digetsive issues because blocks off digestive enzymes + put pressure on vessles going to liver so get juandice
Wipple procdeur
Rerouts the Bowl
Wipple = remove the head of the pancreus –> retract the small intestine to serve as the pancreatic duct –. connect Stomach to Small intestine
- Bypass the duadenum
- Still get enzymes dumped into the small intestine
Video:
Take jeunum after reoving head of pancreus and duadenum –> bring up jejunum and suture jejum to remainder of the pancreus –> open pancrues into dudeum
- Need to connect stomch to jejunum –> jejunum becomes the duct to the pancreus and dumps in and food goes down
Wall of the pancreus
Thin walled - looked like a vein but it is the tissue of the pancreus
Pancerus
See pilerus + deudeum + Jejunum
Greater omentum
Budlging from stomach = Greater omentum –> double sheet of peritenum
- Don’t know exact purpose but think it reduces frication
If have injury = omentum will migrate and sequester area = proetxts body
Image - Top is the liver ; green is the gall bladder ; below gall blader is epiloic foramoan ; center is the less opentum (less sac)
Gall Blader + Ducts
Gallballder = adhered to the inferior surface of the liver (stores bile –> puts bile into liver)
Common hepatic duct = joins with the systic duct –> when comes together you get the common bild duct
Cystsic duct + common bild duct + pancretoic duct = come togetrh and dump into the duadenum
Gall bladder removal
When do a gallblader removal you need to be very carful because the bild has infleunce on emulcification of fats = need to be carful how much you eat
Liver
Right quandrant = fundas of gall bladder (tucked behind overhand)
See left and right lobe
See Infrior vena cava
Anteriorly = quatrate lobe - smaller lobe
Have caudate lobe - smaller lobe
Blood supply to liver
Blood supply to liver is from hepatic arty - fans to lobes of livrer (gives liver 30% of O2) ; rest of O2 is from portal system where blood is coming from digestive (has nuterints) –> goes o be filtered and absobed in liver + gives rest of O2 to the liver
hapetaic goes up and feed stomach + also fans out to lobes of liver
Blood supply to Large Intestine
Blood goes to the superior mesonteric vein –> protal –> liver –> Inferior vena cava
- Portal drains blood with nuertinets to the liver
Artery and vein follow the same pattern
See Small intestine + jejunum + Liver + Duadenum
Archades
When pull intestine out - disect area of mesontary –> seklotnize vessles - see veins and are=teries that come out (called archades - come out in arches and sent supply to bowl)
mesonraty have branches coming down and fan out to create arcahdes to feed the colon and Small intestine
- See mesontary –> ___ to Small intestine –> Suprior mesonteric –> portal
Anaotomy of Colon
Have Secum (pouch)
Have Acending
Have hepatic flexture (by liver)
Have transverse
Have spleic flecture (by spleen)
Haved decsdncing colon
Have signmoid colon
Have rectum
Secum
Secum = begining of the Acdencing colon
ileum comes in and has iliosecal valve (weak valve ; relies on orehintation)
- As secum beocmes filled withmaterial it creates a more oblique angle and blocks it off so there is no material retrograding into ilium
See apendix
Iluium
Goes to the Large intestine at teh secume
- Angle is important
If there is nothing insecim then the iliosecal valve is open
- Can dump things to secom when open
If the secum is full = angle closed = can’t get things retrograding
Blod suppluy to colon
Sueprior mesontraic spreading out through mesontray to feed colon
Blood supply to the rectum
Entire digestive tract = supplied by sperior mesonteric artery EXCET the last 1/3 of the rectum
Inferior emsonteric = need to cut supirorily –> blood is put in digestive = metabolized or goes to system - effficnet at metabolizing bt supriopr can’t put in rectus = venous drains and arteris is back = bypass prtal = sraught to systemic
Video:
Superior mesntretic feds the gut and goes through liver BUT final 1/3 of rectum is no fed by that oath it is fed by the inferior mesonteric (comes off aorta)
- inferior mesonteric feeds diatls 1/3 of the rectum
- reason you can use depositories (would be drained by liver out but this way it goes to systemic )
Hemroids
Vericisity of veins in anus/rectal area
Pressure of the veins increase because blockage/restcition further up
- get enlargment of veins vecause blook can flow back up
- Liver is often blocked
Radiograoh
Shows there is a lot of variation
- Long transverse colon + long apendix + long sigmoid colon
