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G IT

g a s t r o in t e
s t in a l
s y s t e m II.
S t o m a c h , l iv e r ,
pa n c r e a s , b il e d u c t s ,
in t e s t in e s , r e c t u m
s t o m a c h -
g a s t e r
Esophagical
fold (plica)

Cardie
cardia

Pyloric fold
(plica)
Liver (hepar lat.)
the largest gland of the body with variety
of functions
Function:
Production and secretion of bile (40 ml per hour)
Involvement to metabolic processes related to
carbohydrates, fat and synthesis of proteins from
amino-acids
Filtration of the blood (removing bacteria and other foreign
particles)
Storehouse of absorbed compounds (e.g. derivative of
carbohydrate – glycogen)
Heparin synthesis (anticoagulant compound)
Detoxication
Pigment production
Liver
External structure
Four lobes: left, right, caudate, quadrate
Surfaces: upper (superior), visceral
(posteroinferior), ventral (anterior), “bare“ area
Hilum (porta hepatis)
Attaching ligamentous structures: coronary,
triangular, falciform ligaments, teres ligament,
ligamentum venosum

It is covered by fibrous capsule and partially by the


peritoneum
Liver
grooves and fossas on the visceral surface
 Porta hepatis (hilum of the liver):

there are left and right hepatic ducts, the right and
left branches of the hepatic artery, the portal vein, a
few lyph nodes, autonomic nerves
Gallbladder fossa
Groove of the inferior vena cava
Groove for the ligamentum venosum
Groove for the round hepatic ligament
Liver
Internal structure
 liver tissue is made up the liver lobules:

They consist of the trabecular system of the liver


cells forming the lobule mass. In the central part of
the each lobule is the central vein (tributary of the
hepatic veins).
In the spaces between the lobules are the portal
canals (branches of the hepatic artery, portal vein, a
tributary of a bile duct)
Liver
Important relations:

Anteriorly: diaphragm, right and left costal margins,


right and left pleura and lower margins of both lungs,
xiphoid process, anterior abdominal wall in the
subcostal angle
Liver
Important relations:

Posteriorly and inferiorly: diaphragm, right kidney,


hepatic flexure of the colon, duodenum, gallbladder,
inferior vena cava, esophagus, fundus of the stomach,
lesser sac
Liver
Development
Develops as a sprout of alimentary canal tissue ,
growing ventrally and laterally through the primitive
ventral mesentery (ventral mesogastrium). The liver
sprout is enveloped into fascia (capsule) and it is
covered by peritoneum on both the sides
After making contact with the diaphragm the
peritoneal cover is changed with fascial fusion
between diapgragm fascia and liver capsule
Liver
Hepatic suspensory system
(liver fixation):

Teres hepatic ligament


Ligament of the vena cava inferior
Fusion between the diaphragmatic fascia and
hepatic capsule in the bare “area“
All the other ligaments and structures they have
only supporting role
Extrahepatic bile
system
(common hepatic duct, cystic duct, gall
structure, topography, x-ray examinations
bladder, bile duct - choledochus lat.)
Gallbladder
(cysticus latin)
Concentrates bile
Stores bile
Selectively absorbs bile salts
Excretes cholesterol
Secretes mucus
Bile duct
(choledochus, latin)
Supraduodenal (hepatoduodenal) part,
retroduoenal part, pancreatic part, ampullar part –
common with main pancreatic duct)

Opens into a small papilla in the duodenal wall


(descending duodenum), called the papilla of
Vater (major duodenal papilla)
Papilla contains sphincter (sphincter of Oddi)
Bile ducts
Development
Gallbladder
anomalies
Bile ducts
anomalies in form and position
Liver (hepar lat.)
Blood supply:
Hepatic artery
Hepatic veins
Lymph vessels are open to the nodes in the
porta hepatis, celiac nodes and to the
posterior lymph nodes
Nerve supply of the
liver
a b d o m e n
s m a l l & l a r g e
in t e s t in e s &
m e s e n t e r ie s &
m e s e n t e r ic
v e s s e l s &
po r t a l
Small Intestine
Duodenum
Duodenum, Duodenum; the anterior wall has been removed to show the
mucous layer; ventral view. The superior part leaves the stomach to
the right and dorsosuperiorly and turns ventroinferiorly at the
duodenojejunal flexure.
* clinically: Bulbus duodeni
** clinically: TREITZ's muscle
*** clinically: Papilla of VATER
Superior part of the duodenum, Pars superior duodeni;
the layers of the wall have been removed in steps to
show the duodenal glands. The glands on the right
side are near the pylorus.
* clinically: BRUNNER's glands
Jejunum, Jejunum;
the wall at the
mesenteric
insertion has been
partially sectioned
to show the
mucous layer.
Ileum, Ileum; the
wall at the
mesenteric
insertion has been
partially sectioned
to show the
mucous layer.
Terminal ileum, Pars terminalis ilei; the wall at the mesenteric
insertion has been sectioned. PEYER's patches are also
found in the duodenum and the jejunum, they are not
characteristic of the ileum.
* clinically:PEYER's patches
MECKEL's diverticulum (Diverticulum intestinale ilei). This
remnant of the Ductus omphalo-entericus occurs in 1-3% of
all individuals. In 90% it is 1 to 10 cm long and is found
between 30 and 70 cm oral to the ileocaecal valve.
Colon, Colon;
projection onto the
anterior abdominal
wall; ventral view.
The position of the
transverse colon and
the sigmoid varies
considerably
Transverse colon, Colon transversum; the greater
omentum has been retracted superiorly in order to
show the free taenia; the mucous folds in the
exposed part of the intestine can be clearly seen;
ventroinferior view.
Caecum, Caecum; vermiform appendix,
Appendix vermiformis; terminal part of the
small intestine, Pars terminalis ilei; dorsal
view.
Ascending colon, Colon
ascendens; caecum,
Caecum; vermiform
appendix, Appendix
vermiformis; the
intestine has been
exposed by a frontal
section to show the
ileocaecal valve; the
hooks keep the orifice
open; ventral view.
* clinically: BAUHIN's
valve
Colon, Colon; the layers of the wall have been
removed in steps; low magnification.
Colon, Colon; rectum,
Rectum; ap-
radiograph, the
lumen has been
filled with a fluid
contrast medium
and at the same time
with gas (double
contrast method).

Ascending colon, Colon ascendens; view through an


endoscope which has been introduced through the
rectum, the sigmoid flexure, the descending colon
and the transverse colon (coloscopy).
Transverse colon, Colon transversum; frequent variations.
 a normal topography; b twisted; c U-form; d V-form.
 The position of the transverse colon also depends how full it
is and on the position of the body; ventral view.
Pe l v ic
c o l o n ,
r e c t u m &
An a l c a n a l
Mesocolon
= mesentery
of sigmoid
colon in its root
there is
intersigmoid
recess

Left ureter and left


common iliac artery lie
in its bottom
Sigmoid
colon
Rectum
Anal canal
Upper one third
of the rectal
bulb is covered
by peritoneum
(periproctium)
lower two thirds
are covered by
fascia
(paraproctium)

Proctos = rectum
Small perineal and anococcygeal
bodies – relation to rectum
Large perineal and anococcygeal
bodies – relation to rectum
Anorectal angle – normally 90°
If it is altered to over 100°,
incontinence ensues

Fecal continence – is
depenent on complex
mechanism involving
both the internal and
external sphincters and
the anorectal angle,
maintained by the
puborectalis muscle
Relaxed
Pubococcygeal muscle

relaxed

contracted
Pubococcygeal muscle
Anal canal

Structures laterally located


Anal triangle
content
Anal canal
Upper part
Anal columns
Anal valves

Lower part
(Proctodeal
part)
Pectinate line
Anal canal – vascular and nerve supply
Arteries – superior rectal artery (from the inferior mesenteric a.)
– inferior rectal artery (from the internal pudendal a.)
Veins – superior rectal vein (to the inferior mesewnteric vein)
– inferior rectal vein (to the internal pudendal vein)
Lymph drainage –
to the pararectal and inferior mesenteric nodes
to the superficial inguinal lymph nodes
Nerves – from the hypogastric plexuses (stretch)
– from the inferior rectal nerves (pudendal)
(pain, touch, pressure)
Rectal examination
anteriorly- terminal phalanx: rectovesical
pouch, urinary bladder, seminal vesicles, vasa
deferentia
middle phalanx: rectoprostatic fascia,
prostate
proximal phalanx: perineal body, urogenital
diaphragm, bulb of the penis

anteriorly - terminal phalanx: rectouterine


pouch, cervix, vagina
middle phalanx: urogenital diaphragm,
vagina
proximal phalanx: perineal body, lower part
of the vagina

posteriorly: sacrum, coccyx, anococcygeal


body
laterally: ischiorectal fossae, ischial spines
Hemorrhoids They are dilatations
and varicosities of
External Internal the superior rectal
They are common cause veins which may
of bleeding on protrude through
defecation into the rectum
Anal canal
Rectal (per
rectum)
examination
(palpation)
occurs in four
directions.

It is different in
male and female
Rectal (per rectum) examination of the pelvic
organs and eventual contents in the male
Anteriorly:
Opposite the terminal phalanx:
the contents in the rectovesical pouch, posterior
the surface of the bladder, the seminal vesicles, the
vasa deferentia
Opposite the middle phalanx:
the rectoprostatic fascia, the prostate
Opposite the proximal phalanx:
the perineal body, the urogenital diaphragm, the
bulb of the penis
Rectal (per rectum) examination of the
pelvic organs and eventual contents in the
female
Anteriorly:
Opposite the terminal phalanx:
the contents in the rectouterine pouch, the vagina,
the cervix
Opposite the middle phalanx:
the urogenital diaphragm, the vagina
Opposite the proximal phalanx:
the perineal body, the lower part of the vagina
Rectal (per rectum) examination of the
pelvic organs and eventual contents in
the peritoneal cavity in the male and
female

Laterally and posteriorly:


Opposite the terminal phalanx:
the ischiorectal fossae and the ischial spines
the sacrum, the coccyx, the anococcygeal body
END
Ab d o m in a l
c a v it ie s ,
m e s e n t e r ie
s a n d it s
d e r iv a t iv e
Properties and function

 Absorbtion of the water and water soluble


compounds – peritoneal dialysis
 Production of the peritoneal fluid (for
lubrication of the organ surfaces; fluid has a
immunostimulating cells
 Forms suspensory system of the adominal
peritoneal organs
 Sensation
Properties and function

 Absorbtion of the water and water soluble


compounds – peritoneal dialysis
 Production of the peritoneal fluid (for
lubrication of the organ surfaces; fluid has a
immunostimulating cells
 Forms suspensory system of the adominal
peritoneal organs
 Sensation
Supramesocolic space

Inframesocolic space