Gastrointestinal System PDF

Gastrointestinal System general considerations oral cavity pharynx esophagus...

Gastrointestinal System general considerations oral cavity pharynx esophagus stomach 1.list the digestive system organs in oder. 2.names the masticatory muscles and explain their functions-innervations. 3.define salivary glands. 4.explain digestive system related terms. A. Veli 5.explain vascular and neural supplyment ofIsmailoglu, PhD the digestive system. 6.lists accessory digestive system organs. 7.explain the 9 abdominal region. 8.list the abdominal muscles. 9.difine the differences between ileum & jejunum.  Definitions  Alimentation/Ingestion: intake of food  Digestion: breakup of food into smaller pieces  Absorption/resorption: transfer into blood/lymph  Defecation: sending the undigested content out of the system  Peristaltism rhythmic movement of the smooth muscles within the digestive tract to push the content distally "alimentary canal" starts with oral cavity and ends at anal canal. first organ=mouth last organ=anal  2 basic parts Digestive canal Accessory organs  Digestive canal: From mouth to anus A canal of 8-10 m parts: ▪ Mouth (cavitas oris) ▪ Pharynx ▪ Oesophagus ▪ Stomach (gaster) ▪ Small intestine (intestinum tenue) ▪ Large intestine (intestinum crassum) ▪ Anus Accessory organs: 1. Teeth 2. Salivatory Connected to the glands digestive canal with 3. Liver particular ducts 4. Pancreas osephagus = thoracic region ectum & anus = pelvic regionÞvery other organ in between them = abdominal region duodenum part of small intestine is located below the liver. cecum (entrance of large intestine) & vermiform appendix are located in the lower right quadrant of abdominal region. thoracic region the end of anal canal is called "anus". abdominal region the major part of liver is located on right side of the body. osephagus opens the stomach behind pelvic region the liver. gallbladder is located on the visceral surface of liver (upper right quadrant of the abdominal region). stomach is located on the left upper quadrant of abdominal region.  the cavity in the alimentary canal organs is called "lumen". wall of lumen is called "mucosa". Basic structure mucosa is an epithelium tissue that covers the wall of lumen. alimentary canal organs have 2 different layers of muscle "muscularis" Organs with lumen & " longitudinal" layer. the most outer layer of abdominal Common wall organs is "seros" layer which is made by "peritoneum". Layers of wall (from inner to outer) peritoneum is a membrane of seros. ◦ Tunica mucosa ◦ Tunica submucosa ◦ Tunica muscularis ◦ Tunica serosa muscularis longitudinal layer lumen liver and stomach is mostly coverd by ribs on the right and left side of the body except on the middle, so if we punch the lower part of sternum liver and stomac maybe traumatised. Abdominal cavity Separated by the diaphragm from the upper thoracic cavity No structure below, separating from the pelvic cavity No bony skeleton Closed by the abdominal muscles on the front, by muscles and partly ribs on the sides and at the back. diaphragm separates thoracic cavity from abdominal cavity. diaphragm is the main inspirator (inhale) muscle that once its contracted it goes down and thoracic cavity volume increases but abdominal volume is diminished. taking the full inspiration and holding the abdominal pressure for a while is called "valsalva maneuver". this maneuver is mostly used in coughing, sneezing or defecation.  Anterior abdominal wall divided into 9 regions by two vertical and two horizontal lines vertical lines: Mid-clavicular horizontal lines : Interspinal Anterior abdominal wall Superficial fascia Rich in fatty tissue Inguinal ligament: Thickened part of the aponeurosis between ant. sup. iliac spine and pubis Aponeurosis: flat tendons of abdominal muscles inguinal ligament separates the abdominal cavity from thighs external oblique abdominal m. all these 3 muscles meet at the lateral border of internal oblique abdominal m aponeurosis and aponeurosis covers them all. transverse abdominal m. rectus abdominis m. Functions: - support - protection - trunk flexion, lat. flexion, rotation - increase intra abdominal pressure during coughing, defecat,on, giving birth etc. main job of transverse abdominis (the strongest muscle). kegel & pilates exercises targets transverse abdominis and deep back muscles. Inguinal canal Canal between the deep inguinal ring and superficial inguinal ring 4cm long. spermatic cord Site for inguinal hernia. inguinal canal is larger in males since threw the canal developed testis(balls) in abdominal cavity passes down to scrotum (ball sack). so the testis originally develops in abdominal cavity and then goes to scrotum. in males the inguinal canal contains spermatic cord but in females contains round ligament of uterus. Inguinal Hernia in males Inguinal hernia occur because of a weakening of the muscles in the lower abdomen. in females because the inguinal canal is smaller the chance of hernia is low. surgical removal is recommended. Peritoneum sagittal section liver pancreas Fascia that lines the inner wall of abdominal cavity and the stomach organs. Its part that covers the transverse colon abdominal wall is: (large intestine) PARIETAL small intestine urinary bladder Its part that covers the organs is: VISCERAL rectum (large intestine) parietal layer covers the abdominal walls, visceral layer is called serous layer of the organs. organs inside the peritoneum are movable. pancreas is NOT inside the peritoneum hence is not movable. rectum & urinary bladder is also not mobile.  Mouth (cavitas oris) Oral cavity proper Vestibulum oris proper=main vestibul=entrance Vestibulum oris externally: lips & cheeks internally: teeth & gingiva ORAL CAVITY Vestibulum oris Space between the lips and teeth. oral cavity proper: larger part internal to vestibulum vestibul and proper cavity connected by a small space back of 3rd molar tooth (retro molar space). if a patient is in comba state, a feeding tube can be inserted from nose or mouth from the space in back of 3rd molar tooth to prevent the patient from accidental chewing. TEETH Dentes desidiu (primary) Dentes permenantes (secondary) 8 (adult) / 5 (child) teeth in each jaw quadrant  TEETH incisors…cutting canine…tearing premolars…grinding molars…grinding TEETH Corona dentis (crown) Cervix dentis (neck) Radix dentis (root) Alveol Gingiva Periodontium (alveolar periosteum) Dentine Cement (substantia ossea) Enamel (mine) Canal for root of teeth ARTERIES OF TEETH Branches of maxillary a. post. sup. alveolar a. middle alveolar a. (infraorbital a.) ant. alveolar a. (infraorbital a.) inf. alveolar a. VEINS OF TEETH Upper jaw: sup. alveolar veins facial v. (front) pterygoid venous pl. (back) Lower jaw: inf. alveolar veins facial v. pterygoid venous pl. INNERVATION OF TEETH Upper jaw: maxillary n. greater palatine n. ant. alveolar n. middle alveolar n. post. sup. alveolar n. Lower jaw: mandibular n. inf. alveolaris n. mental n. tongue 1. Formed by striated muscle 2. Functions: Relaying the food to pharynx Regulation of voice Articulating words Taste 3. Three parts: 1. body 2. root 3. apex  Papillae of tongue ◦ Papillae fungiformes  Taste receptors ◦ Papillae filiformes  No taste mechanic function Papillae circumvallatae ◦ Papillae foliatae  Taste receptors Papillae foliatae ◦ Papillae circumvallatae  Taste receptors Papillae filiformes papillae circumvallatae is more sensitive to bitter taste. Papillae papillae foliatae is more sensitive to sour fungiformes tase.  tongue  Extrinsic muscles Genioglossus m. Hyoglossus m. Styloglossus m. Palatoglossus m. (pharyngeal pl.)  Intrinsic muscles Sup. longitudinal m. Inf. longitudinal m. Vertical m. Transverse m. Hypoglossal n.:12th cranial INNERVATION OF TONGUE GENERAL SENSATION 2/3 ant: lingual n. 1/3 post: glossopharyngeal n. TASTE SENSATION 2/3 ant: chorda tympani 1/3 post: glossopharyngeal n. ** taste and general sensation of the most posterior part of tongue is received by the internal ramus of sup. laryngeal n. VESSELS OF TONGUE ext. carotid a. lingual a. deep lingual a. sublingual a. Palate palate separates nasal cavity from the oral cavity. Forms the roof Two parts: 1. Hard palate (palatum durum) 2. Soft palate (palatum molle) uvula HARD PALATE (PALATUM DURUM) (inferior view) incisive foramen palatine proc. (maxillary bone) horizontal lamina (palatine bone) major & minor palatine foramina HARD PALATE (PALATUM DURUM) Palatine raphe Incisive foramen Incisive papilla Transverse palatine folds (Rugae palatinae) HARD PALATE (PALATUM DURUM) (vessels & nerves) nasopalatine n. greater & lesser palatine a.- v. greater & lesser palatine nn. SOFT PALATE (PALATUM MOLLE) between the oral cavity and pharynx "palatine tonsils" are located on each side of "isthmus faucium" isthmus faucium Uvula Palatine aponeurosis Palatoglossal arch Palatopharyngeal arch Tonsillary fossa (sinus) SOFT PALATE (PALATUM MOLLE) tensor veli palatini m. levator veli palatini m. uvulae m. palatoglossus m. palatopharyngeus m. tonsillary vessels & nerves pterygomandibular raphe palatine aponeurosis (tendon of tensor veli palatini m.) Salivary glands (Glandulae salivariae) Glands around the oral cavity 1. Minor glands (Gll. Salivariae minores) 2. Major glands (Gll. Salivariae majores) 1. Parotis Gland 2. Submandibular Gland 3. Sublingual Gland Mumps is an illness caused by a virus. It usually affects the glands on each side of the face. These glands, called parotis glands which is more dangerous in males because this virus can also effect the testis. Parotis Sternocleidomastoid m. Internal Jugular Vein Sublingual Submandibular  SALIVARY GLANDS (major) Parotid gl.: salivatory glands have special cannals to deliver the parotid duct (Stensen) salaiva into the oral cavity. salaiva contains enzymes and it shouldnt be mixed external carotid a. with blood. auriculotemporal (ps)  SALIVARY GLANDS (major) Submandibular gl.: Sublingual gl: submandibular duct (Wharton) sublingual ducts (8-20) SALIVARY GLANDS (major) SALIVARY GLANDS (minor) labial gll.. buccal gll. palatine gll molar gll. lingual gll.  Pharynx Joint organ for digestive & respiratory systems Connects oral cavity with oesophagus and nose with larynx Three parts: 1. nasopharynx 2. oropharynx 3. laryngopharynx Pharynx coana (entrance of nasal cavity Nasopharynx Oropharynx Laryngopharynx isthmus faucium(entrance of oral cavity) larynx(opens during swallowing by epiglottis) esophagus Pharynx (posterior and lateral walls) Outer layer: constrictor pharyngeal muscles sup. constrictor pharyngis m. med. constrictor pharyngis m. inf. constrictor pharyngis m. Inner layer: palatopharyngeus m. salpingopharyngeus m. stylopharyngeus m. ** All muscles with one exception** are innervated by the plexus pharyngeus **(glossopharyngeal n.)  Esophagus connects the pharynx with stomach 25-30 cm long Three parts: 1. cervical 2. thoracic 3. abdominal  trachea & heart is located anteriorly of the oesophagus. aorta is located on the left side of the Esophagus oesphagus. transesophageal echo (TEE) is an imaging test that uses sound waves to produce high-quality, moving pictures of  Relations: the heart. ◦ front: trachea, heart ◦ back: vertebral column aorta trachea oesophagus oesophagus & aorta pierce diaphragm to reach abdominal cavity. Muscular layer of esophagus Outer longitudinal Inner circular  Constricted parts of esophagus: 1. Site where it connects with the pharynx (its beginning) 2. Where it crosses the left main bronchus (also crossing the arch of aorta) 3. Where it passes through the diaphragma Esophagus esophagogastric junction Physiologic sphincter Prevents reflux  Arteries of esophagus cervical part: inf. thyroideal a. thoracal part : bronchial aa. + esophageal a. abdominal part : left gastric a. + left phrenic a. Veins of esophagus Submucos plexus peri-esophageal plexus oesophageal veins deep to the mucosa, veins of esophagus can somtimes enlarge and if they do when food passes, it can cause bleeding which will lead to DEATH (liver diseases).  Veins of esophagus 1. cervical part inf. thyroideal vein sup. v. cava* 2. thoracal part azygos v. hemiazygos v. (partly) post.intercostal vv. (partly) sup. v. cava* 3. abdominal part left gastric v. portal vein**  stomach (gaster) Inferior to diaphragm, at the upper part of abdominal cavity Largest part of all digestive system “J” shaped when empty capacity: 30– 1500 ml  Stomach (Gaster) pylorus parts duodenum  Cardiac part (connection with oesophagus)  Fundus  Body  Pyloric part Antrum Pyloric canal pylorus is the junction between the stomach and duodenum. parts of stomach  parts of stomach endoscopy OR gastroscopy Cardia Fundus Body Pyloric part antrum pylorus Lesser curvature Greater curvature Cardiac orifice: (at Th12 level), 40cm away from incisor teeth Gastroeosophageal junction mostly with gas  MİDE’NİN KAS YAPISI Pyloric orifice Pylorik sphincter arteries of stomach: left gastric a. right gastric a. short gastric a. left gastroepiploic a. right gastroepiploic a. Veins of stomach: left gastric vein right gastric vein short gastric veins left gastroepiploic vein right gastroepiploic vein portal vein  innervation of stomach Parasymphathetic: left vagus n. oesophageal pl. ant. vagal trunk right vagus n. oesophageal pl. post. vagal trunk gastroscopy  Gastroscopic views cardiac orifice greater curvature lesser curvature pylorus Gastroscopic views Benign gastric ulcus  Gastroscopic views ulcer is the damage of mucosa Benign duodenal ulcus Gastroscopic views ulserative adeno CA Gastroscopic views polypoid adeno CA Gastrointestinal System small intestine large intestine rectum anal canal Small intestine Duodenum Jejunum Ileum between pylorus and ileocaecal valve 5m after duodenum, proximal 2/5 jejunum, distal 3/5 ileum intraperitoneal (except mesenteric border) circular plica 2/3 tour, rarely a total tour begins 2.5cm after pylorus, observed till ½ proximal part of jejunum. never observed at distal ileum.  Duodenum at L1-L3 level 20-25 cm, shortest and largest part of small intestine proximal 2.5cm intraperitoneal, rest retroperitoneal Duodenum 1.= superior part 2.= descending part 3.= horizontal part 4.= ascending part neighbouring structures of Duodenum front view  Duodenum 1.= superior part 5 cm, shortest part first 3 cm smooth inner surface (duodenal bulb)  Duodenum 2.= descending part 10 cm between upper and lower duodenal flexures  Duodenum pancreatic duct bile duct 2.= descending part common bile duct major pancreatic duct hepatopancretic ampulla (Vateri) major duodenal papilla minor duodenal papilla accessory pancreatic duct common bile duct delivers the bile into the second part of duodenum, moreover pancreatic duct transmits pancreatic juice to second part of duodenum aswell. in the mucosa line of the duodenum, the opening of those 2 ducts are visible and called "major duodenal papilla". in surgeon cases the accessory pancreatic major duodenal papilla duct may present which opens to the "minor duodenal papilla".  Duodenum 2.= descending part hepatopancretic ampulla (Vateri) minor duodenal papilla major duodenal papilla Duodenum 2.= descending part common bile duct major pancreatic duct common bile duct sphincter pancreatic duct sphincter sphincter of hepatopancretic ampulla major duodenal papilla Duodenum 3.= horizontal part 10 cm  Duodenum 4.= ascending part flexura duodenojejunalis 2.5 cm treitz ligament is used to differentiate upper gastrointestinal bleedings from Treitz lig.** lower gastrointestinal bleedings. (suspensorium lig. of duodenum)  arteries of Duodenum a. pancreaticoduodenalis sup. (a. gastroduodenalis) a. pancreaticoduodenalis inf. (a. mesenterica sup.) a. supraduodenalis a. gastroduodenalis Önden görünüm Arkadan görünüm  veins of Duodenum sup. mesenteric v. portal v. Jejunum + Ileum  root of mesentery 15 cm begins at L2 level, between duodenojejunal flexure - right sacroiliac joint  JEJUNUM ILEUM lumen diameter 2.5cm 2cm wall thickness thick thin arterial source rich less than jejunum color red pale red circular plica prominent and multiple less, absent distally folliculi aggregati absent proximally, rare distally prominent and multiple mesentary length short longer artery single arcade a few arcades long vasa recta short vasa recta folliculi solitari Peyer’s patches (folliculi aggregati) ileocaecal junction Terminal ileum= distal 30 cm of ileum arteries of small intestine sup. mesenteric a. jejunal a. (5-10 br.) ileal a. (more than jejunal br.) ileocolic a. veins of small intestine sup. mesenteria v. porta v. Portal system sup. mesenteric v. + splenic v.  "portal vein" is formed by the union of "splenic vein" & "superior mesenteric vein". Portal system the portal vein enters to the liver to reach inferior vena cava and the liver acts as port and the circulation is "portal circulation". tnx to this system, nutrition rich blood or toxic rich blood will be balanced (around 80% or 90%) by the liver before reach up to the systemic circulation.  Lymphatics of small intestine (lacteal) mucosal muscular mesenteric lacteal mesenteric lymph nodes sup. mesenteric lymph nodes innervation of small intestine Sympathetic: T5-9 (greater and lesser splanchnic n.) coeliac plexus sup. mesenteric plexus Parasympathetic: vagus n. Caecum Ascending colon Transverse colon Descending colon Sigmoid colon Rectum 1.5 m length 7.5 cm width at caecum and gets thinner distally  * * Typical external features teniae coli (strips) haustra coli (lumps) appendices epiploicae right colic flexure* (hepatic flexure) left colic flexure* (splenic flexure)  Colic teniae (thickenings of longitudinal muscle layer) tenia libera Appendices epiploicae tenia omentalis (adipose structures tenia mesocolica protruding from the serosal surface of the colon) waste feces poop shit gaita ileocaecal junction  ileocaecal junction frenulum ileocaecal sphincter opening of appendix vermiformis  Ascending colon: 15 cm Retroperitoneal  Transverse colon: 50 cm Intraperitoneal Colon descendens: 25 cm Retroperitoneal  Colon sigmoideum: in lesser pelvis close to left pelvic wall variable length (~45cm) Intraperitoneal arteries of large intestine sup. mesenteric a. ilecolic a. right colic a. middle colic a. inf. mesenteric a. left colic a. sigmoid a. sup. rectal a.  veins of large intestine ileocolic v. sup. rectal v. right colic v. sigmoid v. middle colic v. left colic v.. sup. mesenteric v.. inf. mesenteric.v. veins of large intestine lymphatics of large intestine  innervation of large intestine caecum, ascending colon, 2/3 prox. of transverse colon: symphathetic T5-T12 parasymphathetic vagus n. coeliac pl.+ sup. mesenteric pl. 1/3 distal of transverse colon, descending colon, sigmoid colon: symphathetic lumbar – upper sacral spinal segments parasymphathetic pelvic splancnic nerves (nn. erigentes) inf. mesenteric pl. sup. hypogastric pl. inf. hypogastric pl. (pelvic) normal colon CA  Rectum & anal canal Rectum part distal to sigmoid colon Anal canal part distal to rectum ends at anus 5cm in females rectum anteriorly intimate with vagina & uterus. in males rectum anteriorly intimate with seminal vesicle & prostate. therefore doctor can examine the prostate threw anus to check for enlargement (cancer).  Kohlrausch plica 15cm 4-5cm External anal sphincter  * * transverse rectal plicae rectal valves * * rectal ampulla sphincter ani int. m. sphincter ani ext. m. perineal flexura (junction between rectum and anal canal)  anal columns (sup. rectal a. v.) anal valves anal sinuses dentate line (pectinate) Pecten (transitional anocutaneus line (Hilton line) zone)  m. sphincter int. m. sphincter ext. anal column (deep part) m. sphincter ext anal valve (superficial part) m. sphincter ext (subcutaneous part) anal sinus m. corrugator cutis  arteries of rectum inf. mesenterica a. sup. mesenterica a. common iliac a. int. iliac a. middle rectal a. inf. rectal a.  veins of rectum inf. v. cava sup. rectal v. (to portal v.) left common iliac v. ext. iliac v. rectal perimuscular int. iliac v. plexus (ext) middle rectal v. inf. rectal plexus inf. rectal v. innervation rectum: inf. mesenteric pl. Anal sphincter: inf. rectal n.  hemorrhoid just like at the end of esophagus when veins get enlarged and caused bleeding, at the end of the anal canal this bleeding can also happen during defecation but its not fatal. Anal fissure -Anal fistula