Digestive system Flashcards
Organs of digestive system,
systema digestorium
Cavitas oris Pharynx Oesophagus Gaster s. ventriculus Intestinum tenue Intestinum crassum Glandulae salivales Hepar Pancreas Splen s. lien
Cavitas oris parts
Consists of two parts: Vestibulum oris and Cavitas oris propria
Vestibulum oris
other part of cavities oris
Slip-like space between:
- The lips – labia
- The cheeks – bucca
- Processus alveolaris mandibulas et maxillae
- -> Covered by the gum – gingiva
- -> the teeth – dentes
Communicates with the surface of the body by the oral opening – rima oris
Communicates with cavitas oris propria, when the jaws are closed through narrow clefts between
opposing teeth and by an aperture on both sides behind the molars.
Please explain gingiva
- Composed of dense fibrous tissue
- closely connected to the periosteum of processus alveolaris mandibula et maxillae and
- surrounding the necks of the teeth
There are no glands in the mucous membrane of the gum
Lips
The lips are covered externally by skin and internally by mucosa
The vermilion boarder, is the transitional zone from skin to the mucosa
The mucosa contains glandulae labiales
The inner surface of each lip is connected in the midline to the corresponding gum by frenulum labii superioris and frenulum labii inferioris
Bucca
Forms the sides of the face and continues into the lips
The base is formed by m. buccinator
–> covered by fascia buccopharyngea
Corpus adiposum buccae lies on m. buccinator
Externally covered by skin and internally covered by mucous membrane
At the level of the 2nd upper molar tooth in the mucous membrane is papilla ductus parotidei
Oral opening & the lips
Boarded by:
o Labium superius et labium inferius
The lips are connected at angulus oris
o by commisura labiorum
Labium superior reaches the external nose and laterally sulcus nasolabialis
o in the middle of the upper lip a groove is present – philtrum
Labium inferior extend into the lower direction to the chin and the sulcus mentolabialis
The lips are formed by m. Orbicularis oris
Cavitas oris propria
Limited laterally and anteriorly by processus alveolaris maxillae et mandibule and by the teeth
posteriorly it communicates with the pharynx by isthmus faucium
Superiorly Roofed with the hard (palatum drum) and soft palate (palatum drum)
Inferiorly The floor is composed of three muscles:
o m. mylohyoideus
o venter anterior m. digastrici
o m. geniohyoideus
–> Glandula submandibularis is situated beneath the muscles
–> On the upper surface of the muscles lies glandula sublingualis, covered by the mucous membrane
Medially to Plica sublingualis is caruncula sublingualis
Glandulae salivarie
Glandulae salivariae minores are scattered in the mucous membrane of the oral cavity and tongue o glandulae labiales o glandulae buccales o glandulae palatinae o glandulae linguales
Glandulae salivariae majores:
o glandula parotidea (also accessoria)
o glandula sublingualis
o glandula submandibularis
Glandula parotidea
- Largest salivary gland
- Pars superficialis – lies in front of the external ear on m. masseter
- Pars profunda – is situated in the retromandibular fossa
- Fascia parotidea surrounds the parotid gland
- Ductus parotidus starts at the gland’s anterior boarder, crosses m. masseter and runs through m.Buccinator and opens into the vestibulum oris on papilla parotidea
Glandula submandibularis
- Lies in trigonum submandibulare
- Surrounded by lamina superficialis fasciae cervicales / fasciae colli superficiales
- Opens on caruncula sublingualis
Glandula sublingualis
- The mucous membrane covers the gland and forms plica sublingualis
- The gland has several ducts, but the main duct – ductus
sublingualis major opens on caruncula sublingualis together
with ductus submandibulare - Ductus sublinguales minores open by small openings
directly on plica sublingualis
Dentes
Two sets of teeth:
o Dentes decidui 20 – 6-8 months (primary milk teeth)
o Dentes permanentes 32 – 6-12 years
o Dens serotinus 17-24 years (wisdom tooth)
- Dens inscivus – for biting
- Dens caninus – tearing and gripping
- Dens premolaris – chewing movement
- Dens molaris – chewing
Corona dentis = crown Radix dentis = root Cervix dentis = neck Cavitas dentis Cavitas coronae Cavitas radices dentis Foramen apicis dentis for Bv and nerves Pulpa dentis is soft part
Palatum
Forms the roof of the oral cavity
Consists of two parts:
o Hard palate – palatum durum, is anteriorly
o Soft palate – palatum molle, lies behind the hard palate
Separates the oral and nasal cavities and is formed by bone palate and is covered by the periosteum
and mucous membrane
Mucous membrane contains numerous glandulae
palatinae (=Glandulae salivariae minores)
About the soft palate
–> is a movable fold and consists of the fold
of the mucous membrane enclosing muscular tissue, a
palatine aponeurosis, blood vessels, nerves, lymphoid
tissue and mucous glands
–> Palatine aponeurosis is formed by C.T. and serves as the soft skeleton of the soft palate
–> From it 5 pairs of muscles of soft palate and fauces start
–> The posterior boarder of the soft palate is free and hangs like a curtain between cavitas oris and pharynx
o There is a small conical process – uvula palatina.
–> When the soft palate elevates (swallowing) –> separates cavitas nasi and the nasopharynx from the
posterior part of cavitas oris and oropharynx
uvula palatina
- Folds on each side of the uvula form two arches:
1. Arcus palatoglossus (extends to the lateral border of the tongue)
2. Arcus palatopharyngeus ( extends to the wall of the pharynx) - -> Sinus tonsillaris s. fossa tonsillaris between the arches (tonsilla palatina locates here)
The palate arches boarder isthmus faucium
o Isthmus faucium is the orifice in the posterior wall of the oral cavity
o Connects the latter with the pharynx
o Isthmus faucium is limited by:
- Superiorly: uvula
- Laterally: arcus palatoglossus et arcus palatopharyngeus
- inferiorly: radix linguae et tonsilla lingualis
There are 5 pairs of muscles of the soft palate and fauces: M. uvulae o. palatum drum i. uvula f. elevates and shortens uvula
M. levator veli palatini
o. basis cranii
i. aponeurosis
f. elevates and shortens uvula
M. tensor veli palatini o. lamina medialis processus pterygoidei i. aponeurosis f. stretches palatum molle and widens the auditory tube
M. palatoglossus
o. aponeurosis
i. root of the tongue
f. narrows isthmus faucium and shortens arcus palatoglossus
M. palatopharyngeus
o. aponeurosis
i. lateral wall of pharynx
f. narrows isthmus faucium and shortens arcus palatopharyngeus
Lingua s. Glossa
Takes part in chewing, sucking, contains sense organs for taste and touch and is involved in speech production
- two parts:
1. Corpus linguae - central part - -> anterior part of the body is the apex linguae
2. Radix linguae – posterior part, connected to os hyoideum - On corpus linguae is the upper part – dorsum linguae and the lower part – facies inferior linguae
- Margo linguae is between the dorsum and the lower surface
- Sulcus medianus linguae is in the middle of the dorsum
- Sulcus terminalis linguae is between the dorsum and the root
- Foramen caecum linguae is in the middle of sulcus terminalis linguae
- Tonsilla lingualis is on the root
The mucous membrane of the tongue contains numerous glands – glandulae linguales
The mucous membrane forms three folds from the root of the tongue toward the epiglottis:
o Plica glossoepiglottica mediana
o Plica glossoepiglottica lateralis dextra et sinistra
2 depressions between them - vallecula epiglottica
The mucosa forms a fold in the midline of the lower surface of the tongue – frenulum linguae
o connects the tongue with the gum of mandibula
Numerous papilla linguales on the dorsum of the tongue
o Papillae filiformes – across the dorsum of the tongue, a rough surface
o Papillae fungiforme – around the margin and the tip of the tongue, contain taste buds
o Papillae vallate – 7-11, arranged frontally of sulcus terminalis, contains taste buds
o Papillae foliate – transverse folds of the mucosa at the margin and the tip of the tongue,
Mucosal formations of lingua s. Glossa
- The mucous membrane of the tongue contains numerous glands – glandulae linguales
- The mucous membrane forms three folds from the root of the tongue toward the epiglottis:
1. Plica glossoepiglottica mediana
2. & 3. Plica glossoepiglottica lateralis dextra et sinistra- -> 2 depressions between them - vallecula epiglottica
- The mucosa forms a fold in the midline of the lower surface of the tongue – frenulum linguae
- -> connects the tongue with the gum of mandibula
Numerous papilla linguales on the dorsum of the tongue
o Papillae filiformes – across the dorsum of the tongue, a rough surface
o Papillae fungiforme – around the margin and the tip of the tongue, contain taste buds
o Papillae vallate – 7-11, arranged frontally of sulcus terminalis, contains taste buds
o Papillae foliate – transverse folds of the mucosa at the margin and the tip of the tongue,
Muscles of lingua s. Glossa
Extrinsic muscles: M. Genioglossus o. Spina mentalis mandibula i. Root of the tongue f. Pulls the tongue forward and downward
M. Styloglossus
o. Processus styloideus
i. Root of the tongue
f. Pulls the tongue backward and downward
M. Hyoglossus
o. Os hyoideum
I. Root of the tongue
f. Pulls the tongue backward and downward
Intrinsic muscles run perpendicular to each other and their main function is to change the shape of the tongue: M. Longitudinalis superior et inferior from apex linguae shortens the tongue
M. Verticalis linguae
connects radix linguae with the lower surface of the tongue
flattens toung
M. Transversus linguae
from median fibrous septum
passes laterally to the sides of the tongue
narrows the tongue
Pharynx
Placed behind the nasal and oral cavities and the larynx
The airway and food passage crosses the pharynx
Cavitas pharyngis is divided into 3 parts:
- Pars nasalis pharynges s. nasopharynx
- Pars oralis pharynges s. oropharynx
- Pars laryngea pharynges s. laryngopharynx
Wall structure:
Tunica mucosa
o glandulae pharyngeales in mucous membrane
o Pars nasalis pharynges s. nasopahrynx: respiratory epithelium
o Pars oralis et laryngea: stratified squamous epithelium
Fascia pharyngobasilaris –> soft skeleton of the pharynx between mucous and muscular layer.
–> Transforms into tela submucosa toward the oesophagus.
Tunica muscularis
Tunica adventitia
Nasopharynx – s. Pars nasalis pharynges
- Lies behind cavitas nasi from basis cranii externa palatum molle (soft palate)
- Skeletotopically: C1 to C2
- attached to basis cranii externa and forms fornix pharynges
- Anteriorly nasopharynx comminucates via choana with cavitas nasi
- Between the superior and posterior walls of pharynx is tonsilla pharyngealis
- In the lateral wall of pharynx is ostium pharyngeum tubae auditivae
- -> This opening leads via tubae auditivae to the cavitas tympani
- equalizing the air pressure on both sides of membrana tympanica
- Torus tubarius – a protube of cartilage from tubae auditivae
- Recessus pharyngeus – small recess behind the opening of tubae auditivae
- Below the pharyngeal opening is tonsilla tubaria
Oropharynx – s. Pars oralis pharyngis
From palatum molle –> epiglottis
Skeletotopically: C3 to C4
Anteriorly it communicates with cavitas
oris through isthmus faucium
Laryngopharynx – s. Pars laryngea pharyngis
Lies behind larynx from epiglottis oesophagus Skeletotopically: C5 to C6 Two openings: the aditus laryngis and oesophagus
Tonsils of the pharynx
Tonsillae tubariae (one on each side)
Tonsilla pharyngealis (single at the top of the pharynx)
Tonsilla palatina (paired)
Tonsilla lingualis (single)
Anulus lymphoideus pharyngis (Waldeyer’s throat ring)
Muscles of pharynx
(constrictors, elevatio pharynx): M. Constrictor pharyngis superior o. Processus pterygoideus rhaphe pterygomandibularis linea mylohyoidea margo linguae
M. Constrictor pharyngis medius
o. Os hyoideum
M. Constrictor pharyngis inferior
o. Cartilago thyroidea
cartilago cricoidea
i. Raphe pharynges
f. Narrows the pharyngeal space and elevatio pharynx
(levatores, elevatio pharynx):
M. Stylopharyngeus
o. Processus styloideus
M. Palatopharyngeus
o. Palatine aponeurosis
i. Lateral wall of pharynx
f. Elevatio pharynx
Topography of pharynx
Holotopically: Cervical region
Skeletotopically: Basis cranii externa –> C6
Syntopically:
Anteriorly: cavitas nasi
cavitas oris
cavitas larynges
Laterally: BV, nerves
Posteriorly: mm. profundi colli
fascia prevertebralis of fascia cervicales
columna vertebralis
- Posteriorly there is spatium retropharyngeum and it extends laterally to spatium parapharyngeum
- Both spaces continue into mediastinum superius
Oesophagus
- Canal about 23-25cm
- Extending from pharynx to gaster
3 parts:
1. Pars cervicalis
-> extend to the level of apertura thoracis superior
2. Pars thoracica
-> apertura thoracis superior to hiatus esophageus
diaphragm
3. Pars abdominalis
-> below hiatus esophageus diaphragm to the ostium
cardiacum
3 narrow spaces:
1. Constricto pharyngooesophagealis
-> Oesophagus entrance, behind cartilago cricoidea
2. Constricto broncoaortica
-> Trachea and r. Aorta, aorta thoracica (Th4-Th5)
3. Constricto phrenica s. Diaphragmatica
-> Passage through diaphragma, beginning of pars
abdominalis
Tunica mucosa
o forms longitudinal folds
Tela submucosa
o contains glandulae oesophageae
Tunica muscularis
o longitudinal and circular layers
Tunica adventitia or tunica serosa
- > Tunica adventitia covers cervical and thoracic part
- > the abdominal part is covered by tunica serosa (peritoneum)
Topography of the oesophagus
Holotopically:
- cervical region
- mediastinum superior and posterior
- cavitas abdominalis
Skeletotopically: C6 - Th11
Syntopically:
Posteriorly: columna vertebralis (aorta crosses at Th8-9)
Anteriorly:
- trachea
- bronchus principalis sinister
- pericardium
- hepar
Laterally:
- BV, nerves
- lobuli glandula thyroidea
- pleura parietalis pars mediastinalis,
- hepar
pleura parietalis pars mediastinalis
the continuation of the costal and diaphragmatic pleura of each side that passes from the vertebral column and sternum covering the sides of the mediastinum.
Intestinum tenue
- Convoluted tube extending from pylorus to ostium ileale
- Digestion and absorption takes place is intestinum tenue
- Lenght: 5-6m
3 portions:
o Duodenum
o Jejunum
o Ileum
Duodenum
C-shaped and winds around caput pancreas
Has 4 parts: o Pars superior o Pars descendens o Pars inferior s. Pars horizontalis o Pars ascendens
Pars superior
o starts at ostium pyloricum –> crosses columna vertebralis from left to right at the level of L1 –> continues with flexura duodeni superior into the next part
o In the beginning it has a dilated duodenal cap – bulbus s. Ampulla
Pars descendens
o descends along the right side of columna vertebralis to the level of L3 –> forms flexura duodeni inferior –> continues to the next part
Pars inferioris s. Pars horizontalis
o crosses columna vertebralis from the right to left at the level of L3 –> passes the on to the last part
Pars ascendens
o runs upward obliquely to L2 –> forms flexura duodenojejunalis –> continues then into jejunum
Jejunum et Ileum
- Involved in the fold of peritoneum – mesenterium intestinale
- Mesenterium is a peritoneal fold which attach jejunum and ileum to the posterior abdominal wall by radix mesenterii
- jejunum and ileum are mobile intraperitoneal coils attached to the posterior abdominal wall by radix
mesenterii (radix mesenterii from flexura duodenojejunalis to ileocaecal junction) - No strict boarder
o Jejunum is wider, more vascular and deeper in color than ileum
o Ileum is much narrower and thinner
o Jejunum is 2/5 and Ileum is 3/5 of their total common length
Wall structure of intestine ten
Tunica mucosa
o forms plicae circulares with villi intestinales
–> In duodenum there is only one fold – plica longutudinales duodeni (in the descending
part of duodenum)
–> the fold ends at papilla duodeni major, which is formed by the enlargement ampulla hepatopancreatica for the common opening of bile and pancreatic ducts
o glandulae duodenales s. glandulae intestinales
Tela submucosa (loose connective tissue) o noduli lymphoidei solitarii are scattered in all parts of small intestine o in the end part of ileum are also noduli lymphoidei aggregati
Tunica muscularis (two layers) o External longitudinal o inner circular In the descending part of duodenum they from a sphincter, surrounding the hepatopancreatic ampulla.
Tunica serosa (peritoneum) covers jejunum and ileum completely, making them intraperitoneal organs. o The duodenum is a retroperitoneal organ.
topography of intestine tenue
Holotopically
- Duodenum regio epigastrica (upper part) and in regio umbilicalis (lower part)
- Jejunum regio umbilicalis and regio lateralis sinistra
- Ileum regio lateralis dextra, regio inguinalis dextra, regio pubica and pelvis minor
Skeletopically
- Pars superior duodeni – 1st lumbar vertebra
- Pars descendens duodeni – from the 1st to the 3rd lumbar vertebra
- Pars horizontalis duodeni – 3rd lumbar vertebra
- Pars ascendens duodeni – from the 3rd to the 2nd lumbar vertebra
Syntopically - Duodenum: Posteriorly: * abdominal aorta * vena cava inferior * the descending part faces ren dexter and glandula suprarenalis dexter
Medially: caput pancreas
Anteriorly:
* colon transversus
* Hepar
- Jejunum and ileum:
Posteriorly: organs of the retroperitoneal space
On the right: colon ascendes
Anteriorly: covered by omentum majus
Inferiorly: descend into pelvis minor
Intestinum Crassum
Average length 100-150 cm
- Important for vital absorbtion and reabsorbtion of water and plasma electrolytes
- Residence for endemic bacterial flora
- -> Produce also K and B12-vitamins
- Final process of chyme into faeces for defecation
- Caecum et Appendix Vermiformis
Colon: o Colon Ascendens o Colon Transversum o Colon Descendens o Colon Sigmoideum o Rectum o Canalis Analis
Wall of intestine crassum
tunica mucosa
- Glandulae intestinales s. cryptae intestinales secrete lubricating mucus
- Lymphatic drainage is well developed in intestinum crassum. In tunica mucosa – noduli lymphoidei
solitari, in appendix vermiformis – noduli lymphoidei aggregati appendicis vermiformis
- Plicae semilunares coli
- well developed in colon, poorly in caecum, not present in
appendix vermiformis and rectum.
tela submucosa
- Lamina propria, mucosae et tela submucosa are very well vascularized with capillaries, venous drainage
is eventually to vena mesenterica superior and finally to venae portae hepatis.
tunica muscularis s. muscularis externa
- Three longitudinal muscle layers in muscularis externa of caecum et colon –> form taeniae coli.
= longitudinal muscle layers, which are reduced to 3 bands.
Taenia libera is free
Taenia omentalis attachment of omentum majus
Taenia mesocolia attachment of mesocolon trnaversum
- Taeniae coli are shorter than intestinum crassum – creating haustra coli
tunica serosa (intraperitoneal) / tunica adventitia (retroperitoneal) - has fatty protrusions – appendices epiploicae s. appendices omentales
Main differences between small and large intestine:
larger diameter
Taenia
Haustra and plicae semilunares
Appendices apiploicae
Caecum at Appendix Vermiformis
Caecum is 6-8 cm in lenght, 7-7,5 cm in diameter
(the widest part of intestinum crassum)
Locates in regio inguinalis dextra
Caecum communicates with Ileum via ostium
ileale
o one-way valve formed by tunica mucosa
foldings
communicates with appendix vermiformis via ostium appendicis vermiformis
Colon
Colon Ascendens
- 12-20 cm in lenght, smaller in diameter than Caecum
- Locates in regio lateralis dextra
- Goes up untill reaches inferior surface of Hepar formates bending to the left flexura coli
dextra s. flexura coli hepatica and continues as colon transversum
Colon Transversum
- 30-80 cm in length
- The most motile portion of intestinum crassum
- starts from regio hypochondriaca dextra passes transversally with downward convexity in
regio umbilicalis reaching regio hypochondriaca sinistra
- In regio hypochondriaca sinistra makes turn down at flexura coli sinistra s. flexura coli splenica.
- Colon transversum is within peritoneum
–> Fixed to posterior abdominal wall by mesocolon transversum
–> Lig. Gastrocolicum and omentum majus attach to tenia omentalis coli transversi
Colon Descendens
- 10-15 cm in length
- starts at flexura coli sinistra s. flexura coli splenica with direction downwards
- Locates in regio lateralis sinistra
- At the level of crista iliaca sinistra becomes colon sigmoideum
Colon Sigmoideum
- Average 40 cm in length
- Continuation of colon descendens at crista iliaca sinistra
- Locates in regio inguinalis sinistra
- Formates an angled loop and is located in fossa iliaca sinistra
- At the level of art. sacroiliaca dextra continues as rectum
Rectum
- 13-20 cm in length
- Locates in regio hypogastrica and pelvis minor
- shape called flexura sacralis (correspond the shape of os sacrum)
- In the lower portion of rectum the diameter expands creating ampulla recti (final storage of faeces)
–> When ampulla recti is filled with faeces the need for deficatio is induced due to pressure on m.
sphincter ani internus
Canalis analis
Continuation from ampulla recti
2-3 cm in length
Canalis analis penetrates perineum and has flexura perinealis
Anus is the terminal portion of canalis analis
- Plicae transversae recti
- Columnae anales
- Sinus anales
- Plexus venosus rectalis (in mucosa et
submucosa) - M. sphincter ani internus
- M. sphincter ani externus
- M. levator ani
Intestinum Crassum et Peritoneum
Caecum
- Intraperitoneal organ – covered by
peritoneum
- No mesenterium
Appendix vermiformis
- Intraperitoneal organ
- Has mesenterium – mesoappendix
connecting ileum to appendix
Colon ascendens et descendens
o Mesoperitoneal organ – covered by peritoneum anteriorly, laterally and medially
o Posteriorly covered by tunica adventitia
Colon transversum
o Intraperitoneal organ
o Mesocolon transversum
Colon sigmoideum
o Intraperitoneal organ
o Mesocolon sigmoideum
Rectum o Upper 1/3 intraperitoneal o Middle 1/3 mesoperitoneal --> anteriorly and laterally by peritoneum, posteriorly by tunica adventitia o Lower 1/3 retroperitoneal --> covered by tunica adventitia
Topography of large intestine
Holotopia
- Cavitas abdominis caecum , appendix vermiformis et colon
- Pelvis minor rectum et canalis analis
Skeletotopia
- Caecum fossa iliaca dextra, vertebra Lumbalis V
- Colon ascendens vertebra L V cartilagines costarum IX-X, vertebra L II
- Colon transversum skeletotopia is impossible to describe due to large positional variations
(Sobotta)
- Colon descendens cartilagines costarum IX – X, vertebra Lumbalis II –> crista iliaca sinistra
- Colon sigmoideum crista iliaca sinistra –> art. sacroiliaca dextra
- Rectum art. sacroiliaca dextra –> os coccygis
Syntopia
- Caecum et colon ascendens
Medially: intestinum tenue
- Flexura coli dextra
Superiorly: - hepar
- fundus vesicae biliaris
Posteriorly ren dexter
-Colon transversum Superiorly: * gaster *pars superior duodeni * pancreas
Inferiorly: intestinum tenue
- Flexura coli sinistra Superiorly: * splen s. lien * cauda pancreatic Posteriorly: ren sinister
- Colon descendens et sigmoideum
Medially: intestinum tenue
Rectum
Posteriorly:
* os sacrum
* os coccygis
Laterally: plexus venosus rectalis
Anteriorly in males:
- vesica urinaria
- Prostate
- ductus deferens
- glandula vesiculosa
Anteriorly in females
- uterus
- vagina
Peritoneum
- serous covering of cavitas abdominalis
2 parts:
- Peritoneum parietale
- Peritoneum viscerale
- -> between these parts is cavitas peritonealis with serous fluid to lubricate organs
- Between cavitas peritonealis and posterior abdominal wall is spatium retroperitoneale
- Peritoneum parietale continues into peritoneum viscerale and forms: o Mesocolon o Mesenterii o Ligamenta o Omenta o Folds
- Mesocolon and mesenterii are peritoneal folds that attach organs to the posterior abdominal wall
–> allow movement
–> contain BV, nerves and lymph vessels
o Mesenterii connects jejunum and ileum to the posterior abdominal wall by radix mesenterii
o Radix mesenterii passes obliquely downward from flexura duodenojejunale at 2nd LV to
ileocaecal junction
o Mesocolon transversum fix colon transversum
o Mesocolon sigmoideum fix colon sigmoideum
o Mesoappendix is for appendix vermiformis
Peritoneal cavity in pelvis minor
Female: Excavatio rectouterine
Excavatio vesicouterina
Male: Excavatio rectovesicalis
Retroperitoneal organs
Covers only anterior side
- duodenum
- pancreas
- ren
- glandula suprarenalis
- empty vesica urinaria
- ureter
Mesoperitoneal organs
Covers all but posterior side
- hepar
- vesical biliaris
- colon ascendes
- colon descendes
- rectum (middle 1/3)
- full vesica urinaria
- uterus
Intraperitoneal organs
Covers all sides
- oesophagus (pars abdominalis)
- gaster
- jejunum
- ileum
- caecum
- appendix
- colon transversum
- colon sigmoideum
- rectum (upper 1/3)
- splen s. lien
- tuba uterine
Lien s. Splen
- Organ for the destruction of erythrocytes
- -> Red pulp filtrates RBC’s
- Produces leucocytes
- -> White pulp synthesizes antibodies
- Durin fetal life and shortly after it creates erythrocytes
Facies diaphragmatica – convex, smooth, directed upward to diaphragma
Facies visceralis – with hilum splenicum (entrance and exit of vessels and nerves)
Margo superior – projected forward
Margo inferior – more rounded, projected posteriorly
Tunica fibrosa surrounds the spleen (capsule)
Tunica serosa (peritoneum) covers from all sides –> intraperitoneal
- -> forms 2 LIGAMENTS (= double fold of peritoneum)
1. Lig. Gastrosplenicum – from hilum splenicum to curvaura major (gaster)
2. Lig. Phrenicosplenicum – from facies diaphragmatica to diaphragm
Topography of spleen
Holotopically: Regio hypochondriaca sinistra
Skeletotopically:
- Superior border at costae IX
- Hilum splenicum at costae X
- Inferior border at costae XI
Syntopically: * facies diaphragmatica: Diaphragma * Facies visceralis: Gaster Ren sinister Glandula suprarenalis Colon Cauda pancreatis
Pancreas
- Produces the pancreatic juice –> drains into the duodenum
Exocrine portion (pancreas is primarly an exocrine gland)
- Acinar cells: Enzymatic components (trypsinogen, chymotrypsinogen, elastase, pancreatic lipase….) (regulated by cholecystokinin)
- Centroacinar cells: bicarbonate (regulated by secretin)
Endocrine portion (only 2% of total mass)
- The cells of Langerhans (beta cells) produce insulin –> the blood stream for sugar metabolism
- Alpha cells produce glucagon –> raises the concentration of glucoce in blood stream –> causes the liver (hepar) to convert stored glycogen into glucose
- Lies transversely across the posterior wall of the abdominal cavity
- Peritoneum covers the anterior side = retroperitoneal organ
- Caput pancreatis – head of pancreas, curve of duodenum
- Corpus pancreatis – crosses the vertebral column
- Cauda pancreatis – reaches the visceral surface of the spleen
The body (corpus pancreatis) and the tail (cauda pancreatis) are TRIANGULAR on cross section –> 3 surfaces
- Anterosuperior
- Anteroinferior
- Posterior
3 borders
- Superior
- Anterior
- Inferior
Ductus pancreaticus – through the pancreas
- joins the bile duct to form ampulla hepatopancreatica
- opens at papilla duodeni major
- Frequently there is ductus pancreaticus accessories
- -> Excretes pancreatic juice from caput pancreatic
- -> opens into the duodenum by papilla duodeni minor
topography of pancreas
Holotopically:
Regio epigastrica
Regio hypochondrica sinistra
Skeletotopically:
Caput pancreas at L2
Corpus pancreas crosses columna vertebralis at the level of L1
Cauda pancreatis at 10th costae
Syntopically:
- Caput pancreas surrounded by Duodenum and crossed by mesocolon transversum anteriorly
Posteriorly: Vena cava inferior Vena portae hepatis Corpus and cauda pancreatis face: Anteriorly * Gaster * Mesocolon transversum
Posteriorly
- Aorta abdominalis
- Ren sinister
Inferiorly
- Coils of jejunum
- Flexura coli sinistra
Cauda pancreatis reaches lien s. splen
Vesica Biliaris
storage of bile
- in fossa vesica biliaris, on the visceral side of the right lobe
It is composed of;
o fundus vesicae biliaris
o corpus vesicae biliaris
o collum vesicae biliaris
The mucus membrane lines the gallbladder and forms the mucosal folds
o Mucous glands are scattered in the mucosa
Tunica muscularis: one circular layer which forms musculus sphincter ampullae at the region of ampulla hepatopancreatica
Tunica Serosa (peritoneum) covers the gall bladder from the lower surface
Tunica adventitia covers the upper surface
There is no submucosa!
Bile pathway
- Bile is excreted via ductus hepaticus sinister et dexter
- They join at the porta hepatis to form Ductus hepaticus communis
- Ductus hepaticus communis joins with Ductus cycticus form ductus choledochus
- Ductus choledochus runs along lig. hepatoduodenale together with portae arteria hepatica
- crosses the superior part of the duodenum and caput pancreas
- pierces the posterior wall of the pars descendens duodenum –> form plica longitudinalis duodeni
- with ductus pancreaticus to form ampulla hepatopancreatica –> opens into papilla duodeni major
Topography of hepar
Holotopically:
regio hypchondriaca dextra
regio epigastrica
regio hypochondriaca sinister
Syntopically: impressio cardiaca impressio Oesophageale impressio gastrica impressio duodenalis impressio colica impressio renalis impressio suprarenalis
Skeletopically: upper border on the right side:
- -> intersection of linea medioclavicularis dextra and the 4th intercostal space
- -> turns downwards towards the left, near the 5th intercostal space
The lower border:
intersection of linea axillaris media and 10th rib
curves along arcus costales
junction between cartilagines costarum 9th and 8th
border crosses regio epigastrica
reaches the left side where the cartilage of the 7th and 8th rib join
ends in 6th intercostal space
Posteriorly:
between 9th and 11th thoracic vertebrae
Hepar
Main function; exocrine gland responsible for the production of bile
Secondary functions;
o Thermoregulation
o metabolism of carbohydrates, proteins and fats
o production of erythrocytes during the fetal period
- Margo Inferior - Thin, sharp border projecting downwards
- Area Nuda - bare, not covered by peritoneum
- Facies diaghragmatica
o Superior convex surface projected towards diaphragm
–> Lig. falciforme - divides the liver into lobus hepatis dexter et sinister
–> lig. cononarium - borders Area Nuda and forms the two attaching ligaments on either end –> lig. triangulare dexter et sinister
Facies Visceralis
- Inferior surface, directed towards the abdominal organs
- liver can be divided into 4 lobes
- The right lobe is bordered by the right sagittal groove
- The left lobe is bordered by the left sagittal groove
- The transverse groove lies between the two sagittal grooves
- -> separates lobus quadratus and lobus caudatus
- -> lobus quadratus lies anteriorly while lobus caudatus lies posteriorly
Tunica fibrosa & serosa of the liver
Tunica fibrosa and Tunica Serosa (peritoneum) cover the liver
- -> The peritoneum covers the liver from 3 sides, but does not cover area nuda
- -> It also forms the attaching ligaments of the liver, which can be divided into 2 groups:
- Ligaments extending to the diaphragm;
- Lig. Falciforme: b. diaphragm and upper surface of the liver
- Lig. Coronarium: from area nuda to diaphragm, with two attaching ends
- Lig. Triangulare Dexter et Sinister - Ligaments extending from porta hepatis towards the organs;
- Lig. Hepatogastricum: to curvatura minor gaster
- Lig. Hepatoduodenale: to the superior portion of duodenum
- Lig. Hepatorenale: to ren dexter
Nutrition entrance to liver and the formations within the sagittal grooves
Porta hepatis is located within the transverse groove and contains; o Ductus hepaticus communis o Vena portae heptis o Arteria hepatica propria o nerves and lymphatic vessels
Formations within the sagittal grooves;
- Fossa vesicae biliaris: depression for the gall bladder
- Sulcus venae cavae: groove for the vena cavae
- Fissura ligamentum teres: Lig. teres hepatis lies within
- Fissura ligamentum venosi: Lig. venosum
