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The Alimentary SystemⅡ 张 正 洪 副教授 Yunyang Medical College Composition Digestive tube 消化管 • oral Mouth cavity Major salivary glands • Pharynx • Esophagus Duodenum • Stomach Liver • Small intestine Jejunum Ileum Duodenum • Large intestine Digestive glands 消化腺 • Major salivary glands唾液腺 • Liver 肝 Ileum • Pancreas 胰 Pharynx Esophagus Stomach Pancreas Large intes Jejunum The Stomach 胃 The stomach is a mascular capsule ,and it is the most dilated portion of the alimentary canal,and is situated between the end of the esophagus and the beginning of the small intestine. The Stomach 胃 Shape Two surfaces: anterior and posterior Two curvatures两个弯曲 Lesser curvature 胃小弯 : angular incisure 角切迹 Greater curvature 胃大弯 Two openings Cardia 贲门 Pylorus 幽门 Fundus of stomach 胃底 Parts of stomach Cardiac part 贲门部 Cardiac part 贲门部 Fundus of stomach 胃底 Body of stomach 胃体 Body of stomach 胃体 Pyloric part 幽门部 Pyloric antrum 幽门 Pyloric canal 幽门管 Pyloric antrum 幽门窦 窦 Pyloric canal 幽门管 Pyloric part 幽门部 Position -Main parts is situated in the left hypochondriac region, small in the epigastric region; the cardia is situated in the left of T11, the pylorus lies in the right of L1 The Small Intestine小肠 It extends from the pylorus to the ileocecal orifice,and it is About 57m long. Duodenum Be divided into Duodenum 十二指肠 Jejunum 空肠 Ileum回肠 Ileum Jejunum Duodenum十二指肠 It is the shortest,widest and most fixed part of the small intestine,and is about 20-25cm long. Position and shape It lies on the posterior abdominal wall (L1L3) ,and likes a C-shape which enclose the head of the pancreas Four parts Superior part Duodenal bulb 十二指肠球 Descending part Longitudinal fold of duodenum Major duodenal papilla 十二指肠大乳头 Horizontal part Ascending part duodenojejunal flexure 十二指 肠空肠曲 Suspensory muscle of duodenum十 二指肠悬肌 (ligament of Treitz) Jejunum and ileum 空肠和回肠 The upper 2/5 of this part of small intestine is called jejunum and the lower 3/5,ileum. The features of the jejunum and ileum Meckel憩室 Large Intestine大肠 It is about 1.5m long, and it extends from ileum to anus. Five parts: Caecum 盲肠 Vermiform appendix 阑 尾 Colon 结肠 Rectum 直肠 Anal canal 肛管 Three Features on apparence Colic bands 结肠带 Haustra of colon 结肠袋 Epiploic appendices 肠脂垂 Caecum 盲肠 It is a Blind pouch and the first part of large intestine. Lies in right iliac fossa The ileum enters the cecum obliquely, and partially invaginates into it, forming the ileocecal valve-consists of two folds, probably delays flow of ileal contents into large intestine A opening of appendix Vermiform appendix 阑尾 Blind worm-like tube It springs from the posteromedial wall of the cecum. It is about 5-7cm long. The base of the appendix lies at the point of convergence of three colic bands (used as a guide to find the appendix during operation) Position: It lies usually in the right iliac fossa Surface projection of the base is at the so-called McBurney’s point which is at junction of lateral and middle thirds of line joining right anterior superior iliac spine and umbilicus variable in position Colon 结肠 three characteristics on surface Four parts Ascending colon right colic flexure Transverse colon left colic flexure Descending colon Sigmoid colon(Sa3) Rectum 直肠(10-14cm ) Curvatures Sagittal plane Sacral flexure Perineal flexure Coronal plane Lower part of rectum dilated to form ampulla of rectum 直肠壶腹 Three transverse folds of rectum 直肠横襞 (7cm) Anal canal 肛管(3-4cm) Anal columns 肛柱 Anal valves 肛瓣 Anal sinuses 肛窦 Dentate line齿状线 Anal pecten 肛梳 White line 白线(Hilton’s line) Anus 肛门 Anal sphincters 肛门括约肌 Sphincter ani internus肛门内括约肌 Sphincter ani externus 肛门外括约肌 A question for discussion Mouth How does the remainder of food pass the degestive canal ? Pharynx Esophagus Stomach Liver Pancre Duodenum Large in Ileum Jejunum The Liver 肝 The liver is the largest gland in the body and is essential to life. Shape Two surfaces Diaphragmatic surface 膈面 falciform ligament And coronary lig.镰状韧 带和冠状韧带,bare area Visceral surface脏面 -has a H-shaped groove Left limb of H Anteriorly: fissure for ligamentum teres hepatis肝 圆韧带裂 Posteriorly: fissure for ligamentum venosum 静脉 韧带裂 Right limb of H Anteriorly: fossa for gallbladder 胆囊窝 Posteriorly: sulcus for vena cava 下腔静脉沟 Cross-bar of H is the porta hepatic 肝门: traversed by right and left hepatic ducts, left and right branches of proper hepatic artery and hepatic portal vein, nerves and lymphatic vessels. hepatic pedicle 肝蒂 Four lobes: left, right, quadrate and caudate lobes Position: Most of liver lies in the right hypochondriac region and epigastric region, less part extends into the left hypochondriac region Border and adjacency Extrahepatic Biliary ducts system It consists of: Gall bladder 胆囊 Left and right hepatic ducts 肝左、 右管 Common hepatic duct肝总管 Common bile duct 胆总管 Gallbladder 胆囊 Position : Four parts: Fundus of gallbladder 胆囊底 Surface projection: at the junction of right midclavicular line and right costal arch Body of gallbladder 胆囊体 Neck of gallbladder 胆囊颈 Cystic duct 胆囊管 Triangle of Calot Boundaries: the common hepatic duct on the left, the cystic duct on the right, the visceral surface of liver, superiorly Content: cystic artery Biliary duct system and Drainage of the bile Right and left hepatic ducts unite outside of liver to form the common hepatic duct Cystic duct joins common hepatic duct to form common bile duct Common bile duct and pancreatic duct usually unite to form the hepatopancreatic ampulla The Pancreas 胰 Shape and Position Lies behind the peritoneum on the posterior abdominal wall, roughly at the level of of L1~L2 three parts Head Uncinate process Body Tail-runs in base of lienorenal ligament to reach hilum of spleen Pancreatic duct Main Pancreatic duct Begins at tail and throughout gland. Joins common bile duct before entering descending part of duodenum at major duodenal papilla(Vater ampulla) Accessory pancreatic duct Opens 2cm above main duct at lesser duodenal papilla SUMMARY