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Anatomy
AnatomyoftheupperGItract–3.2.16
Summarisethemajorstructuresoftheoralcavity,teeth,tongueandsalivaryglands
Theoralcavityisanteriorlyborderedbytheoralorifice,whichissurroundedbythelips.
Thelipshavenosebaceousglands,sweatglandsorhair,andaremadeofthefollowing
features:cupidsbow,vermillionborder,oralcommissures,andphiltrum.Thelateralwallsof
themouthareformedbythechecksandthesuperiorwallsareformedbythehardpalate
andsoftpalate.Theposteriorborderoftheoralcavityisformedbythefauces
(palatoglossalandpalatopharyngealarch)andtheoropharynx.Theoralcavityconsistsof
tworegions:thevestibule(betweenthelips/cheeksandteeth/gingivae)andtheoralcavity
proper(enclosedbytheteeth).
Theteetharedifferentbetweenchildrenandadults.Childrenhavedeciduousteeth,also
knownasprimarydentition.Thereare20deciduousteeth(4xcentralincisor,4xlateral
incisor,4xcuspidorcanine,4xfirstmolar,4xsecondmolar).Theseeruptfrom6months
(centralincisor)to32months(secondmolar).Adultshavepermanentteeth,alsoknownas
secondarydentition.Thereare32permanentteeth(4xcentralincisor,4xlateralincisor,4x
canine,4x1stpremolar,4x2ndpremolar,4x1stmolar,4x2ndmolar,4x3rdmolar).These
typicallyappearfromtheageof6years(1stmolar,centralincisor)to21years(3rdmolari.e.
wisdomteeth).
Thesurfaceanatomyoftheteethisin3parts:crown,neckandroot.Thecrownismadeof
densurroundedbyalayerofenamel.Theneck(surroundedbygingiva)androot(withinthe
alveolarbone)oftheteethismadeofanpulpcavitywhichisfullofpulp,alveolarvessels
andnerves.Thepulpissurroundedbyalayerofdentin,whichisthensurroundedbyalayer
ofcementum.Thecementumisattachedtothealveolarbonebyperiodontalligaments,
formingthegomphosis/dental-alveolarjoint,whichisapegandsocketjoint.Therootcanal
istheextensionofthepulpfromthenecktotheapicalforamen,wherethebloodvessels
andnervespasstoenterthepulpcavity.
Thetonguehasitsrootattachedposteriorlytothemandibleandhyoid.Itsanterior2/3
formsthefloorofthemouthandextendsanteriorlyastheapexwhichisposteriortothe
incisors.Theanterior2/3(oralpart)consistsoffiliform,fungiformandcircumvallate
papillae.Thefungiformandcircumvallatepapillaecontaintastebuds.Thecircumvallate
papillaeformavshapeattheborderoftheanterior2/3andposterior1/3ofthetongue,
whichisknownasthesulcusterminalis.Theposterior1/3(pharyngealpart)ofthetongue
consistsoflingualtonsils.
Thetongueismadeofintrinsicandextrinsicmuscles.Theintrinsicmusclesare
longitudinal/transverse/verticallyorientedandareconfinedtothetongueitself(nobony
attachments).Theyallowthetonguetoalteritsshape,givingprecisionmovement.The
extrinsicmusclesgivethetonguegrossmovements.
Name
Origin
Insertion
Function
Genioglossus
Mandible
Tongue,hyoidbone Protraction
Hyoglossus
Hyoidbone
Tongue
Depression
Styloglossus
Styloidprocessof
Tongue
Retraction
temporalbone
Palatoglossus
Softpalate
Sideoftongue
Elevation
Summarisethedivision,connectionandmusclesofthepharynx
ThepharynxspansfromthebaseoftheskulltoC6andisdividedintothreeparts:
nasopharynx(fromtorustubariusinnasalcavitytothesalpingopharymgealfold),
oropharynx(fromsalpingopharyngealfoldtoepiglottis)andthelaryngopharynx(from
epiglottistocricoidcartilage).Thepharynxismadeoftwogroupsofstriatedmuscles:the
constrictorsandlongitudinals.Thereare3constrictormuscles–superior,middleand
inferior–andthesearetheexternallayerwhichhasthefunctionofsequentially
contracting,thuspushingthefoodbolusdowntotheoesophagusintheactionof
swallowing.
Name
Origin
Attachment
Action
Superiorconstrictor Mandible,
Pharyngealtubercle, Swallowing
(CNX–pharyngeal
pterygomandibular Pharyngealraphe
plexus)
ligament,pterygoid
hamulus
Middleconstrictor
Hyoidbone,
Pharyngealraphe
Swallowing
(CNX–pharyngeal
stylohyoidligament
plexus)
Inferiorconstrictor Thyroidcartilage,
Pharyngealraphe
Swallowing
(CNX,pharyngeal
cricoidcartilage
plexus,
recurrent/external
laryngealnerve)
Thereare3longitudinalmuscles–palatopharyngeus,salpinopharyngeus,and
stylopharyngeus–andthesearetheinternallayer,whichelevatethepharynxintheaction
ofswallowingandyawning.
Name
Origin
Attachment
Action
Palatopharyngeus
Hardpalate
Musclesofpharynx Elevatepharynx
(CNX)
Thyroidcartilage
Closesnasopharynx
Salpinopharyngeus Cartilageofauditory Musclesofpharynx Elevatepharynx
(CNX)
tube
Opensauditorytube
Stylopharyngeus
Styloidprocess
Musclesofpharynx Elevatepharynxand
(CNIX)
Thyroidcartilage
larynx
Differentiatethedifferentpartsoftheoesophagus,includingthemuscles,bloodsupply,
lymphaticdrainageandnervesupply
Theoesophagusisa25cmlongtubethatiscontinuouswiththepharynxandstomachandit
hasthreeconstrictions.Thecervicalconstrictionisatitsjunctionwiththepharynx,15cm
fromtheteethandistheupperesophagealsphincter(C6).Thebronchoaorticconstrictionis
25cmfromtheteethandisatthecrossingoftheaorticarchandleftmainbronchus.The
diaphragmaticconstrictionis41cmfromtheteethandistheloweroesophagealsphincter.
Theoesophagusismadeof3parts:cervical,thoracicandabdominal.Thecervicalportionis
fromC6tothejugularnotchandrunsposteriorlytothetracheaandmedialtothecarotid
sheath.Thethoracicportionisfromthejugularnotchtotheoesophagealhiatus,andruns
posteriorlytotheheart(LA)andaortaandanteriorlytothevertebralcolumn.The
abdominalportionisinferiortothediaphragm.
Themusculature,bloodsupplyanddrainageoftheoesophagusisdividedintothirds.
Third
Muscles
Arterialsupply
Venous
Lymphatic
drainage
drainage
Upper
Striated
Subclavianartery-> Inferiorthyroid Deepcervical
thyrocervicaltrunk- veins->
nodes
>inferiorthyroid
brachiocephalic
arteries
veins->SVC
Middle
Striatedand Thoracicaorta->
Oesophageal
Superiorand
smooth
oesophageal
veins->azygos posterior
arteries
vein->SVC
mediastinal
nodes
Lower
Smooth
Abdominalaorta-> Leftgastricvein Leftgastric
coeliactrunk->left ->portalvein
nodes
gastricartery
Coeliacnodes
Thenervesupplyoftheoesophagusisdividedintohalves
Half
Nervesupply
Typeofinnervation
Upper
Recurrentlaryngealnerve
Somaticmotor
(fromCNX)
Lower
CNX
Parasympathetic
Sympatheticganglia
Sympathetic
Enteric
Describethestomachandthemajorparts,bloodsupply,lymphaticdrainageandnerve
supply
Thestomachhasfourmajorparts,thesebeingthecardia(justaftertheoesophagus),the
fundus(theanteriorprotrudingportion),thebody(makesupmostofthemass),andthe
pyloricregion(theantrumandcanalwhichheadintotheduodenum).Ithastwoborders:
lessercurvature(moresuperior)andgreatercurvature(moreinferior),whichbothhave
omentaattachedtothem.Theomentaarepartoftheperitoneum.Thestomachis
innervatedbybranchesoftheceliactrunk.
Theceliactrunkbranchesintotheleftgastricartery,splenicartery(leftgastroepiploic,short
gastric),andcommonhepaticartery(rightgastric,gastroduodenal->rightgastroepiploic).
Artery
Course
Supplies
Leftgastric
Coeliactrunk->leftgastric Superiorpartoflesser
curvature,cardia
Rightgastric
Leftgastro-epiploic
Rightgastro-epiploic
Shortgastric
Gastroduodenal
Coeliactrunk->common
hepaticartery->right
gastric
Coeliactrunk->splenic
artery->leftgastro-epiploic
artery
Coeliactrunk->common
hepaticartery->gastroduodenalartery->right
gastro-epiploicartery
Coeliactrunk->splenic
artery->shortgastric
Inferiorpartoflesser
curvature,cardia
Greateromentum
(superiorly)
Greatercurvature
Greateromentum
(inferiorly)
Greatercurvature
Upperportionofgreater
curvature
Fundus
Pylorus
Coeliactrunk->common
hepaticartery->
gastroduodenalartery
Theveinsofthestomachareasfollows:leftgastro-epiploicvein,shortgastricvein,left
gastricvein,IMV->splenicvein->portalvein;rightgastricvein->portalvein;rightgastroepiploicvein->pancreaticoduodenalvein->SMV->portalvein.
Thestomachisinnervatedbytheanteriorandposteriorvagaltrunks(parasympathetic),
thoracicsplanchnicnerves,celiacganglionandplexus,sympathetictrunkandganglia
(lumbarportion),lumbarsplanchnicnerves,andthesuperiormesentericganglionand
plexus.
Thelymphaticdrainageofthestomachistothesplenicnodes,gastro-epiploicnodes,gastric
nodes,andpyloricnodes.
Describethedifferentpartsoftheduodenumandpancreas,andtheirbloodsupplyand
lymphaticdrainage
Theduodenumandpancreasarebothretroperitonealorgans,whichmeansthattheyare
situatedposteriortotheperitoneuminthespacebetweentheparietalperitoneumandthe
erectorspinaemusclesandvertebralcolumn.TheduodenumisaCshapedtubewhichhas4
parts.Thesuperiorpart(bulbofduodenum),descendingpart(hasthegreaterandlesser
duodenalpapilla),horizontalpart,andtheascendingpart(duojejunalflexure,suspensory
ligmantofduodenum,alsoknownastheligamentofTreitz).Theinsideofthetubeislined
byplicaecirculares,whicharecircularfoldsinthemucosa.Thepancreasissituatedadjacent
tothecurvatureoftheduodenumandhas4parts:uncinatedprocess(nexttoascending
partofduodenum),head(nexttothehorizontalpartoftheduodenum),neck(nexttothe
descendingpartoftheduodenum),bodyandtail.
Theduodenumandpancreasaresuppliedbybranchesofthecoeliactrunkandthesuperior
mesentericartery.
Artery
Source
Supplies
Superioranterior
Coeliactrunk->common
Headofpancreas(drains
pancreatico-duodenal
hepaticartery->
intoSMV)
artery
gastroduodenalartery->
Upperhalfofduodenum
superioranterior
pancreatico-duodenal
artery
Superiorposterior
pancreatico-duodenal
artery
Inferior
pancreaticoduodenal
Coeliactrunk->common
hepaticartery->
gastroduodenalartery->
superiorposterior
pancreaticoduodenalartery
Superiormesentericartery>inferior
pancreaticoduodenalartery
Coeliactrunk->splenic
artery->pancreaticartery
Headofpancreas(drains
intoSMV)
Upperhalfofduodenum
Headofpancreas(drains
intoSMV)
Lowerhalfofduodenum
Pancreatic
Neck,bodyandtailof
pancreas(thendrainsinto
splenicvein)
Lymphaticdrainageisthroughthepancreatico-duodenalnodes.
Surfaceanatomyoftheabdomen–9/2/16
Understandtheboundariesoftheabdominalcavity
Superiorly,theabdomenisboardedbythediaphragm.Posteriorly,itisborderedbythe
lumbarvertebrae,quadratuslumborum,andtransverseabdominis.Anterolaterally,itis
borderedbythemusclesoftheabdominalwall:transversusabdominis,internaland
externalabdominalobliques.Inferiorly,itisborderedbythepelvicbrim:leftandrightcoxal
bones.
Beabletolocatesurfacelandmarksoftheabdomen
Thefollowingisthelistofsurfacelandmarksontheabdomen:
Alsousefulis:lineasemilunaris,iliaccrest,iliactubercle,pubicsymphysis,superficial
inguinalring
Knowtheplanesthatcreatethefourquadrantsandnineregions
Thefourquadrantsoftheabdomenaremadebythemedianplaneandthetransumbilical
plane.Therearetwolongitudinalandtwotransverseplanesthatcreatethenineregionsof
theabdomen.Thetwolongitudinalplanesaretheleftandrightmidclavicularplanes.The
twotransverseplanesarethesubcostalandtranstubercularplanes
Listthestructuresatthetranspyloricplane.Whatvertebrallevelisthis?
Thetranspyloricplaneishalfwaybetweenthejugularnotch(T2/T3)andthetopofthepubic
symphysis.ThiscorrespondstovertebrallevelL1.Thestructuresitcontainscanbe
rememberedusingthemnemonicGrandparentsLikePaediatricDoctorsPreventingKids
Sickness.SickNewbornsOftenRank#One.
Gallbladderfundus
Liver
Pylorusofstomach
Duodenalbulbandduodenojejunalflexure
Pancreasneck
Kidneyshila
Spleen
Spinalcord–end
Ninthcostalcartilage
Originalofsuperiormesentericartery
Rootoftransversemesocolon
Originofportalvein
Knowthefourquadrantsoftheabdomenandtheircontents
Rightupperquadrant
Leftupperquadrant
• Liver
• Tipofmedialliverlobe
• Duodenum
• Spleen
• Pancreas
• Stomach
• Pylorusofstomach
• Leftkidney
• Rightkidney
• Pancreas
• Hepaticflexure
• Splenicflexure
• Partsofascendingandtransverse
• Partsoftransverseanddescending
colons
colons
Rightlowerquadrant
Leftlowerquadrant
• Appendix
• Sigmoidcolon
• Caecum
• Descendingcolon
• Ascendingcolon
• Bladder
• Bladder
• Leftovary
• Rightovary
• Uterus
• Uterus(ifenlarged)
• Leftspermaticcord
• Rightspermaticcord
• Leftureter
• Rightureter
Knowthenineregionsoftheabdomenandtheircontents
Righthypochondriacregion Epigastricregion
• Liver
• Stomach
• Gallbladder
• Liver
• Rightkidney
• Pancreas
• Smallintestine
• Duodenum
• Spleen
• Adrenalglands
Lefthypochondriacregion
• Spleen
• Colon
• Leftkidney
• Pancreas
Rightlumbarregion
• Gallbladder
• Liver
• Ascendingcolon
Umbilicalregion
• Umbilicus
• Jejunum
• Ileum
• Duodenum
Leftlumbarregion
• Descendingcolon
• Leftkidney
Rightiliacregion
• Appendix
• Caecum
Hypogastricregion
Leftiliacregion
• Urinarybladder
• Descendingcolon
• Sigmoidcolon
• Sigmoidcolon
• Femalereproductive
organs
Knowtheclinicalrelevanceofimportantsurfacemarkings
Organ
Surfacemarkings
Diaphragm-dome
Right4thintercostalspace
Left5thintercostalspace
Periphery
Costalmarginto12thribs
Anterior
Xiphoidprocess
Liver–upperborder
Underdiaphragm
Liver–rightedge
4thintercostalatmid-clavicularline
Liver–leftedge
Epigastrium
Gallbladder-fundus
Transpyloricplane(L1)atsemilunaris
Pancreas-neck
Transpyloricplane(L1)atthemidline
Pancreas-head
L1-3,totherightofthemidline
Pancreas–bodyandtail
Landupwardtohilumofspleen
Spleen
5cmtotheleft,9-11thribsposteriorly
(behindmid-axillaryline)
Kidney-hila
Transpyloricplane(L1),4fingerbreadths
fromthemidline
Kidney–upperhalf
Sitsunder11-12thribs