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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
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:
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
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
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
Inframesocolic space