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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