Download 3.消化系统

内脏学
SPLANCHOLOGY
Chapter 1
General description
总 论
Splanchnology includes
alimentary system 消化系统
respiratory system 呼吸系统
urinary system 泌尿系统
genital system 生殖系统
Ⅰ.General structure of viscera
The organs of viscera may be divided
into two types according to their general
structures:
hollow organs(中空性器官) ;
parenchymatous organs(实质性器官)
Ⅰ.General structure of viscera
1. Hollow organs中空性器官
The wall of these organs consists of
three or four layers of different
tissues.
(1)mucosa 黏膜;
(2)submucosa 黏膜下层;
(3)muscular layer 肌层;
(4)adventitia 外膜
5
Ⅰ.General structure of viscera
2. Parenchymatous organs实质性器官
(1) This kind of organs are commonly
enclose by thin fibrous capsule纤维囊
and divided into manyunits known as
lobules小叶;
(2) Hilum or porta 门:
a somewhat depression or slit on the
surface of organ, where the blood
vessle, nerve and lymphatic enter or
leave the organ.
Porta hepatis肝门
7
Ⅱ The reference line of thorax
and abdominal region
一、 The reference line of thorax 胸部的标志线
1. Anterior median line 前正中线
2. Lateral sternal line 胸骨线
3. Midclavicular line 锁骨中线
4. Parasternal line 胸骨旁线
5. Anterior axillary line 腋前线
6. Midaxillary line 腋中线
7. Posterior axillary line 腋后线
8. Scapular line 肩胛线
9. Posterior median line 后正中线
9
二、Abdonminal regions 腹部分区
1. Nine-area method 九分法
Reference line:
transtubercular line 结节间线 subcostal line 肋
下线 midinguinal line 腹股沟中线
Nine regions
Epigastric region 腹上区 Umbilical region 脐区
Hypogastric region 腹下区
Right and left hypochondriac region
lateral region(lumbar region)
左右季肋区
外侧区(腰区)
inguinal region(iliac region) 腹股沟区(髂区)
subcostal line
midinguinal line
transtubercular line
11
二、Abdonminal regions 腹部分区
2. Quadrants 四分法
The quadrants is made by
the planes, a transverse and a
vertical,which pass through
the umbilicus and intersec at
right angle,so the abdomen is
divided into four quadrants:
Upper right quadrant(RUQ)右上腹
RUQ
LUQ
Upper left quadrant(LUQ)左上腹
Lower right quadrant(RLQ)右下腹
Lower left quadrant(LLQ)左下腹
LLQ
消 化 系 统
Alimentary System
14
Composition
Digestive tube 消化管
Mouth 口腔
Superior digestive tube
Pharynx 咽
上消化道
Esophagus 食管
Duodenum 十二指肠
Stomach 胃
Small intestine 小肠 Jejunum 空肠
Inferior digestive
Ileum 回肠
Large intestine 大肠
tube下消化道
Cecum 盲肠， Vermiform appendix 阑尾、
Colon 结肠，rectum直肠、Anal canal 肛管
Digestive glands 消化腺
• Major salivary glands 大唾液腺
• Liver 肝
• Pancreas 胰
Function: ingestion, digestion, absorption, egesting
第一节 alimentary canal 消化管
一、 oral cavity 口腔
借上下牙弓分为:
硬腭
oral vestibule 口腔前庭
oral cavity proper 固有口腔
腭垂
（一）oral lips 口唇:
oral fissure 口裂
腭舌弓
（二）cheek 颊
Hard palate 硬腭
（三）palate
腭
软腭
腭咽弓
palatine Velum 腭帆
Soft
Uvula 腭垂
palate
Palatoglossal arch
软腭
腭舌弓
Palatopharyngeal arch
腭咽弓
Isthmus of fauces 咽峡
Uvula 腭垂
Free border of soft
palatine
Palatoglossal arch 腭舌弓
Root of tongue 舌
根
腭
垂
（四）teeth 牙
pulp chamber
1、shape of teeth
Crown 牙冠:Projecting above the
gum and to be seen ;
Neck 牙颈:Between the crown
and root and covered
by gum;
Root 牙根:In the jaw.
root
canal
每个牙根有apical foramen
根尖孔
apical
root canal牙根管
forame
n
pulp chamber牙冠腔。
牙根管与牙冠腔合称牙腔dental
cavity或 髓腔pulp cavity，contains dental pulp
牙髓
牙
龈
（四）teeth 牙
Enamel
2、the structure of the teeth：
Dentine
Dentine 牙质、
Enamel 釉质、
dental
pulp
Cement 牙骨质、
dental pulp 牙髓
Gingiva
Cement
3、periodontal tissues
牙周组织: 包括
periodontal menbrane 牙周膜、
alveolar bone 牙槽骨、
Gingiva 牙龈
periodontal menbrane
alveolar bone
4、牙的种类和排列
（1）kinds of teeth
deciduous teeth 乳牙：20
permanent teeth 恒牙： 28-32
Deciduous teeth 乳牙: 20 in number
Ten
teeth in each mandibular and maxillary arch
incisor 中切牙, lateral incisor 侧切牙, canine 尖
牙, first molar 第一磨牙 and second molar 第二磨牙 in
each quadrant
Central
Upper jaw
Ⅰ
Ⅱ
Lower jaw
Central
incisor
lateral
incisor
Ⅲ
canine
Ⅳ
Ⅴ
first
molar
second
molar
Permanent teeth (adult) 恒牙: 32 in number
•
•
•
•
•
Sixteen in each mandibular and maxillary arch
Two incisors（ Central incisor 中切牙, lateral incisor 侧切牙）
one canine,
two premolars （first and secon premolarmolar）
three molars（ first ，second and third molar）
Upper jaw
1 2 3 4 5 6 7 8
Lower jaw
1 2 3 4 5 6 7 8
5
表示左上颌第
二前磨牙
Ⅲ
表示右下颌第三
颗乳牙-乳尖牙
(五) tongue 舌
Terminal
sulcus
1、shape of tongue Body 舌体
superrior
（dorsum of
tongue 舌背）
lingual
Apex 舌尖 tonsil
Root 舌根
Inferior 下面
2、 Lingual mucous membrane
（1） papillae of tongue 舌乳头
filiform papillae 丝状乳头
fungiform papillae 菌状乳头
foliate papillae 叶状乳头
vallate papillae 轮廓乳头
（2） lingual tonsil 舌扁桃体
舌盲孔
foliate
papillae
filiform
papillae
fungiform
papillae
舌根背部粘膜内，由淋巴组织组成的突起。
vallate
papillae
2）舌下面
Frenulum of
tongue舌系带
sublingual fold
Sublingual
gland舌下腺
舌下襞
sublingual caruncl
下颌下腺管及舌
下腺大管开口
舌下阜
舌垂直肌
3、 Muscles of tongue
舌肌
舌横肌
Longitudinal m.纵肌
intrinsic
muscles Transverse m.横肌
舌固有肌 Vertical m.垂直肌
extrinsic muscles 舌外肌
genioglossus
颏舌肌
Origin: mental spine of
mandible;
Insertion: 舌的中线两侧。
上纵肌
舌垂直肌
下纵肌
颏舌肌
（六） Salivary glands 口腔腺
Minor
salivary glands 小唾液腺
包括： parotid gland、 submandibular gland和
sublingual gland
大唾液腺
parotid
1、 parotid gland 腮腺
duct
Deep part 深部
buccinator
Superficial part 浅部:
Major
salivary glands
parotid duct 腮腺管
passes forwards across
masseter m. and then turns
inwards passing through the
buccinator m.颊肌 to open
upon a small papilla on the
cheek mucous membrane
opposite the crown of the
second upper molar tooth
开口于与上颌第二磨牙牙冠相
对的颊粘膜上
腮腺
masseter
2、 submandibular gland 下颌下腺
Lies in the submandibular triangle 颌下三角内，its duct opens
into the sublingual caruncle 舌下阜
3、 sublingual gland
舌下腺
major sublingual duct--sublingual caruncle舌下阜
minor sublingual duct—
sublingual fold 舌下襞
舌
下
襞
下颌下腺
二、 pharanx 咽
咽腔分别以软腭与会厌上缘为界，
分为:
nasopharynx 鼻咽、
oropharynx 口咽
laryngopharynx 喉咽
咽鼓管咽口
咽鼓管圆枕
（一） nasopharynx
咽扁桃体pharyngeal tonsil.
咽鼓管咽口pharyngeal opening
of auditory tube，距下鼻甲后端约
1cm，通中耳鼓室。
咽鼓管圆枕tubal torus、
咽隐窝pharyngeal recess
咽隐窝
(二) oropharynx 口咽
Lateral wall：
舌会厌正中襞
palatine tonsil腭扁桃体
tonsillar fossa扁桃体窝
Anterior wall ： 舌根后部
median glossoepiglotic fold
舌会厌正中襞
epiglottic vallecula 会厌谷
会厌
谷
tonsillar ring of pharynx
pharyngeal tonsile 咽扁桃体、
tubal tonsile 咽鼓管扁桃体、
palatine tonsile 腭扁桃体
lingual tonsile 舌扁桃体，
Functuion：
defend and protection
咽淋巴环
(三) laryngopharynx 喉咽
位于会厌上缘至第六颈椎体
下缘平面之间，经喉口与喉
腔相通。
piriform recess 梨状隐窝 :
喉的两侧和甲状软骨内
面之间的粘膜下陷形成。
三、 Esophagus 食管
（一）position and division
three parts:
Cervical parts：5cm;
Thoracic parts: 18-20 cm;
Abdominal parts:only 1-2cm.
（二）narrows of the esophagus:
three narrows:
position
distance
from
middle
inscior
first
beginning
15cm
second
front of left branchi
25cm
third
esophageal hiatus
40cm
四、 Stomach 胃
（一）position
（二）shape and division
shape：胃有上下两口、
前后两壁和大小两弯。
cardia
Two opening ：
Cardia 贲门
Pylorus 幽门
pylorus
Two curvature
Lesser curvature of stomach 胃小弯
Greater curvature of stomach 胃大弯
fundus of
stomach
Two wall
Anterior wall
cardiac part
Posterior wall
Lesser curvature
of stomach
4 parts:
cardiac part 贲门;
body of
stomach
fundus of stomach 胃底,
body of stomach 胃体;
pyloric part
幽门部
Pyloric canal 幽门管
Pyloric antrum 幽门窦
Greater curvature
of stomach
贲门切迹
Pyloric part
fundus
Pyloric antrum
幽门部
Pyloric canal
Cardia
Lesser
curvature
body
Greater
curvature
pylorus
Structure of stomach wall
－consists of four layers
• Mucous membrane 黏膜
• Submucous 黏膜下层( loose areolar
tissue connecting the mucous and
muscular layer)
• Muscular layer 肌层: contains
superficial longitudinal frbres
– middle circular fibres
Sphincter of pylorus
幽门括约肌
Pyloric valve 幽门瓣
– Inner oblique fibres
• Serous (visceral peritoneum) 浆膜层
五、small intestine 小肠
About
5-7m long,
Divided
into

Duodenum 十二指肠

Jejunum 空肠

Ilium 回肠

（一）duodenum 十二指肠

1、superior part
十二指肠上曲 superior duodenal
flexure


十二指肠球部 duodenal bulb
2、descending part 降部
inferior duodenal flexure 十二指肠下曲
longitudinal fold of duodenum 十二指肠纵襞
Major duodenal papilla 十二指肠大乳头
3、horizontal part 水平部
4、ascending part 升部
duodenojejunal flexure
十二指肠空肠曲
suspensory lig.of duodenum
十二指肠悬韧带
Jejunum 空肠 and ilium 回肠
The jejunum and
ileum lies free in the
abdomen. They are
attached to the posterior
abdominal wall by the
mesentery 系肠膜.
Their total length is
approximately 5~7 metres，
The upper 2/5 of it is called
jejunum空肠 and lower 3/5 is
called ileum回肠.the terminal
part of the ileum open to the
large intestine。
Jejunum and ileum
Characteristic
Jejunum
Ileum
Position
Upper 2/5
Lower 3/5
Diameter
Greater
Less
Wall
Thicker
Thin
Circular folds
Larger, numerous
and large villi
Fewer，smaller
and less
abundant villi
Vascularity
Colour
Greater
Deeper red
Less
Paler
Lymphatic
follicles
Solitary
Aggregated
六、 large intestine 大肠
• Approximately 1.5m
long,
• Five parts:
– Cecum 盲肠
– Vermiform
appendix 阑尾
– Colon 结肠
– Rectum 直肠
– Canal 肛管
Features：
colic bands 结肠带
由肠壁的纵行肌增厚而成，有3条，汇集
于阑尾根部。
haustra of colon 结肠袋
两袋之间为横沟，结肠内面，相当
于横沟处，环形肌增厚，形成结肠
半月襞。
epiploic appendices 肠脂垂
haustra of
colon
结肠半月襞
epiploic
appendices
colic
bands
（一）Cecum盲肠
first part of large intestine, Lies in right iliac fossa
The
ilium enters the cecum obliquely, and partially
invaginates into it, forming the ileocecal valve回盲瓣－
consists of two folds.
ileocec
al valve
（二）vermiform appendix 阑尾
is a narrow blind tube, usually 6 ~
8cm long. It opens into the caecum
盲肠。
position: very variable in position,
frequently lies in the retrocaecal
recess盲肠后窝 or extend into the
lesser pelvis小骨盆.
阑尾孔
阑尾
Appendix 阑尾
The surface projection
(McBurney’s point) of the base
of appendix 阑尾体表投影 ：
is the junction of the lateral
and middle thirds of the line
joining the right anterior
superior iliac spine to the
umbilicus 脐.
（三）colon 结肠
1、asccending colon升结肠
2、transverse colon 横结肠
3、descending colon 降结肠
4、sigmoid colon 乙状结肠
right colic flexure结肠右曲
left colic flexure结肠左曲
(四) rectum 直肠
1、position:
2、 Two flexure
3、ampulla 直肠壶腹
Sacral flexure of
rectum 骶曲
4. three transverse folds of rectum
Perineal flexure of
rectum 会阴曲
骶曲
直肠壶腹
会阴曲
肛管
直肠壶腹
直肠横襞
（五）anal canal 肛管
1、position:
2、struture：
anal columns 肛柱
anal valves 肛瓣
肛柱
anal sinus 肛窦
肛窦
Dentate line 齿状线
肛瓣
anal pecten 肛梳
（痔环）
肛梳
白线
（五）anal canal 肛管
3、sphincters of anus
肛门括约肌
Anorectal ring 肛直肠环：由
肛门外括约肌浅深部、直肠纵
肌下份、肛内括约肌以及肛提
肌等组成。
Sphincter ani
internus肛门内括约肌
Sphincter ani externus
肛门外括约肌
liver 肝
The liver is the largest digestive gland, lies mainly in the
right hypochondrium and epigastric region of the abdominal cavity
below the right half of the diaphragm, lesser part of it lies in the left
hypochondrium region .
The liver is divided into a large right lobe右叶 and a small left
lobe 左叶 by the falciform ligament 镰状韧带 which is attached to
the superior surface of the liver to the anterior abdominal wall.
left lobe
right lobe
镰状韧带
superior surface (diaphragmatic surface)上面或膈面
superior surface is smooth and curved, and fits into the
diagphragm. at the posterior part of the surface ,A large
part of which is not covered by the peritonium is called
the bare area 肝裸区.
inferior surface（visceral surface）下面或 脏面
• There are 3 fissures arranged like “H”:
left longitudinal fissure 左纵沟
right longitudinal fissure 右纵沟
transverse sulcus—porta hepatis 肝门
left longitudinal fissure
ant: Fissure for ligamentum teres 肝圆韧带裂
左纵沟
post: Fissure for ligamentum venosum 静脉韧带裂
right longitudinal fissure
右纵沟
Ant: fossa for gall-bladde 胆囊窝
Post: sulcue for inferior vena cava 腔静脉沟
porta hepatis 肝门
contains
right and left branches
of the hepatic artery
肝固有动脉左右支
right and left hepatic
ducts 肝左右管
hepatic portal vein
肝门静脉左右支
lymphatics 淋巴管
Nerves 神经
The structures passing through the porta hepatis is inclosed
by connective tissues form the Hepatic padicle 肝蒂
The liver has 4 borders:
Anterior (inferior) margin
前缘: is sharp,
posterior marge 后缘:
Right margin 右缘
Lfet margin 左缘
The fundus of the Gallbladder
胆囊底 Protude below the Inferior
margin of the Liver at the notch
for Gallbladde 胆囊切迹.
In the inferior surface, the liver may be
divided into 4 lobes:
left lobe 左叶、 right lobe 右叶、 caudate
lobe 尾状叶 、quadrate lobe 方叶
尾状叶.
左叶
右叶
方叶
Surface projection of the liver
• Upper border: on the right
midclavicular line it extends to
the level of 5th rib
• Lower border:
• Normally, the right lobe
extends just beneath the
costal margin, it doesn’t down
beyond the costal margin;
•
on the anterior median line
its lower border crosses a
point about 3~5cm below the
xiphoid process. In children,
the liver may extends 1.5- 2cm
below the costal arch.
The gallbladder and biliary ducts
1、The gallbladder 胆囊
It consists of the
fundus底, body体,
neck 颈, and the duct
of gallbladder胆囊管 4
parts.
body of gallbladder ：胆囊体
neck of gallbladder ：胆囊颈
the cystic duct胆
囊管 is about 2cm
in length, it joins
the common
hepatic duct to
form the common
bile duct.
Common bile duct 胆总管
The common bile duct descends
first in the hepatoduodenal ligament,
of the duodenum and the head and
then posterior to the superior part of
the pancreas. It enters the the
descending part of the duodenum at
its middle and open into its lumen
via the greater duodenal papilla 十
二肠大乳头. The pancreatic duct胰管
joins it during its passage through
the duodenal wall to form the
ampulla, which is called
hepatopancreatic ampulla (of Vater)
肝胰壶腹.
sphincter of hepatopancreatic ampulla 肝胰壶腹括约肌
The sphincter of
hepatopancreatic ampulla
肝胰壶腹括约肌 is layer
circular muscle surrounding
the ampulla of
hepatopancreatic ampulla, it
controls the flow of bile and
pancreatic secretions into
the duodenum.
Pancreas 胰
Position:
Division: It may be
divided into head, neck,
body and tail 4 parts.
head 胰头 lies in the
concavity of the
duodenum, anterior to
the inferior vana cava.
its inferomedial
extension is clled
uncinate process钩突.
body 胰体 lies anterior to
the abdominal aorta and the
left kidney, behind the
stomach.
tail 胰尾 may reach the
hilus of the spleen.
Pancreatic ducts 胰管
it begins in the tail, runs
through the body ,neck and the
head, usually it joins the
common bile duct as it pierces
the duodenal wall.
Accessory pancreatic duct 副胰管
十二肠小乳头
pancreas 胰
The function of the pancreas
The pancreas has both exocrine外分泌 and
endocrine内分泌 function.
The exocrine part secretes a number of
the different enzymes that break down proteins,
carbohydrates,and fats.
The endocrine part consists of minute
islands(islets) 胰岛of cells which secretes
insulin胰岛素 directly into the blood stream for
the control of blood sugar level.
The place of bile secreted and path of bile discharged
Bile is secreted by
the liver cells
Common
hepatic duct
Biliary ductuli
Cystic duct
Common bile duct
Major duodenal papilla
Right and left
hepatic ducts
Gallbladder (store,
concentrate)
when taking food, the
gallbladder contracts, the
sphincter of hepatopancreatic
ampulla relax
贲门切迹
Pyloric part
fundus
Pyloric antrum
幽门部
Pyloric canal
Cardia
Lesser
curvature
body
Greater
curvature
pylorus