Download Stomach

PART Ⅱ
SPLANCHOLOGY
SHANDONG UNIVERSITY
Liu Zhiyu
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Chapter 1
General description
Splanchnology includes
alimentary system
respiratory system
urinary system
genital system
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Ⅰ.General structure of viscera
The organs of viscera may be divided
into two types according to their general
structures:
hollow organs parenchymatous organs
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Ⅰ.General structure of viscera
1. Hollow organs
The wall of these organs
consists of three or four
layers of different tissues.
(1)mucosa (2)submucosa
(3)muscular layer
(4)adventitia
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Ⅰ.General structure of viscera
2. Parenchymatous organs
(1) This kind of organs are
commonly enclose by thin
fibrous capsule and
divided into manyunits
known as lobules
Porta hepatis
(2) Hilum or porta
a somewhat depression or slit
on the surface of organ,
where the blood vessle, nerve
and lymphatic enter or leave
the organ.
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Ⅱ The reference line of thorax
and abdominal region
一、 The reference line
of thorax
1.
Anterior median line
2.
Lateral sternal line
Midclavicular line Parasternal
line Anterior axillary line
3.
Midaxillary line Posterior
axillary line Scapular line
4.
Posterior median line
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二、Abdonminal regions
1. Nine-area method Reference line:
transtubercular line subcostal line
midinguinal line
Nine regions
Epigastric region Umbilical
region
Hypogastric region
subcostal line
Right and left hypochondriac
region
lateral region(lumbar region)
inguinal region(iliac region)
transtubercular line
midinguinal
line
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二、Abdonminal regions
2. Quadrants
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) Upper
left quadrant(LUQ) Lower right
quadrant(RLQ)
Lower left quadrant(LLQ)
RUQ
LUQ
RLQ
LLQ
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Chapter 2.
alimentary
system
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Composition
Digestive tube
Mouth Pharynx
Esophagus
Stomach
Small intestine
Superior digestive tube
Duodenum
Jejunum
Inferior digestive tube
Ileum
Large intestine
Cecum 、 Vermiform appendix
Colon 、rectum 、Anal canal
Digestive glands
• Major salivary glands
• Liver
• Pancreas
Function:
ingestion, digestion, absorption, egesting
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alimentary canal
一、 oral cavity
oral vestibule
oral cavity proper
（一）oral lips
oral fissure
（二）cheek
Hard palate
（三）palate
palatine Velum
Soft
Uvula
palate
Palatoglossal arch
Palatopharyngeal arch
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Isthmus of fauces
Uvula
Free border of soft palatine
Palatoglossal arch
Root of tongue
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pulp chamber
（四）teeth
1、shape of teeth
Crown
Projecting above the
gum and to be seen ;
Between the crown
and root and covered
by gum;
In the jaw.
root
Neck
Root
canal
apical foramen
root canal
apical
foramen
pulp chamber
dental
Cavity pulp cavity，contains dental pulp 。
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（四）teeth
2、the structure of the teeth：
Dentine
Enamel
Cement
Enamel
Gingiva
Dentine
dental
pulp
dental pulp
Cement
3、periodontal tissues
periodontal menbrane
alveolar bone
Gingiva
periodontal menbrane
alveolar bone
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（1）kinds of teeth
deciduous teeth 20
permanent teeth
28-32
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Deciduous teeth 20 in number
Ten
teeth in each mandibular and maxillary arch
Central
incisor lateral incisor canine first molar and
second molar in each quadrant
Upper jaw
Ⅰ
Ⅱ
Lower jaw
Central
incisor
lateral
incisor
Ⅲ
canine
Ⅳ
Ⅴ
first
molar
second
molar
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Permanent teeth (adult) 32 in number
•
•
•
•
•
Sixteen in each mandibular and maxillary arch
Two incisors（ Central incisor lateral incisor ）
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
Ⅲ
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(五) tongue
Terminal
sulcus
1、shape of tongue
superrior（dorsum
of tongue
Inferior
Body
Apex
lingual
tonsil
Root
2、 Lingual mucous membrane
（1） papillae of tongue
filiform papillae
fungiform papillae
foliate papillae
vallate papillae
vallate
papillae
foliate
papillae
filiform
papillae
fungiform
papillae
（2） lingual tonsil
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Frenulum of
tongue
sublingual fold
Sublingual
gland
sublingual caruncl
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3、 Muscles of tongue
Longitudinal
intrinsic
muscles
Transverse m.
Vertical m.
extrinsic muscles
genioglossus
Origin: mental spine of
mandible;
Insertion:
Actions: ，(protrude
the tongue)；
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（六） Salivary glands
Minor
salivary glands
Major
salivary glands
parotid gland、 submandibular
glandsublingual gland
parotid
duct
1、 parotid gland
buccinator
Deep part
Superficial part
parotid duct passes
forwards across masseter m.
and then turns inwards
passing through the
buccinator m. to open upon
a small papilla on the cheek
mucous membrane opposite
the crown of the second
upper molar tooth
腮腺
masseter
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2、 submandibular gland
Lies in the submandibular triangle ，its duct opens into the
sublingual caruncle
3、 sublingual gland
major sublingual duct--sublingual caruncle
minor sublingual duct—
sublingual fold
下颌下腺
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二、 pharanx
nasopharynx
oropharynx
laryngopharynx
（一） nasopharynx
pharyngeal tonsil.
pharyngeal opening of auditory
tube，1cm，
tubal torus、
pharyngeal recess
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(二) oropharynx
isthmus of fauces
Lateral wall：
palatine
tonsiltonsillar
fossa
Anterior wall ：
median glossoepiglotic fold
epiglottic vallecula
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tonsillar ring of pharynx
pharyngeal tonsile
tubal tonsile
palatine tonsile lingual
tonsile
Functuion：
defend and protection
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(三) laryngopharynx
piriform recess
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三、 Esophagus
（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
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四、 Stomach
（一）position
mostly lies in the left hypochondriac region and lesser part lie in the
epigastric region

（二）shape and division
cardia
shape：
Two opening ：
Cardia
Pylorus
pylorus
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Two curvature
Lesser curvature of stomach
Greater curvature of stomach
fundus of
stomach
Two wall
Anterior wall
cardiac part
Posterior wall
4 parts:
Pyloric canal
cardiac part
Lesser curvature
of stomach
body of
stomach
fundus of stomach
body of stomach
pyloric part
幽门部
Pyloric canal
Pyloric antrum
Greater curvature
of stomach
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fundus
Pyloric part
Pyloric antrum
Pyloric canal
Cardia
Lesser
curvature
body
Greater
curvature
pylorus
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Structure of stomach wall
－consists of four layers
• Mucous membrane Submucous
( loose areolar tissue connecting
the mucous and muscular layer)
• Muscular layer contains
– superficial longitudinal frbres
– middle circular fibres
Sphincter of pylorus
Pyloric valve
– Inner oblique fibres
• Serous (visceral peritoneum)
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五、small intestine
About
5-7m long,
Divided
into

Duodenum

Jejunum

Ilium
（一）duodenum
1、superior part
superior duodenal
flexure
duodenal bulb
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2、descending part
inferior duodenal flexure
longitudinal fold of duodenum
Major duodenal papilla
3、horizontal part
4、ascending part
duodenojejunal flexure
suspensory lig.of duodenum
Treitz
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Jejunum and ilium
The jejunum and
ileum lies free in the
abdomen. They are
attached to the posterior
abdominal wall by the
mesentery
Their total length is
approximately 5~7 metres，
The upper 2/5 of it is called
jejunum and lower 3/5 is
called ileum.the terminal
part of the ileum open to the
large intestine。
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Jejunum and ileum
Characteristic
Jejunum
Ileum
Position
Upper 2/5
Lower 3/5
Diameter
Greater
Less
Wall
Thicker
Thin
Circular folds
Larger, numerous and Fewer，smaller
large villi
and less
abundant villi
Vascularity
Greater
Less
Colour
Deeper red
Paler
Lymphatic
follicles
Solitary
Aggregated
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六、 large intestine
• Approximately 1.5m long,
• Five parts:
– Cecum
– Vermiform appendix
– Colon
– Rectum
– Canal
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Features：
colic bands
haustra of colon
epiploic appendices
haustra
of colon
colic
bands
epiploic
appendices
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（一）Cecum
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 consists of
two folds.
ileocec
al valve
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（二）vermiform appendix
is a narrow blind tube, usually 6 ~
8cm long. It opens into the caecum
position: very variable in position,
frequently lies in the retrocaecal
recess or extend into the lesser
pelvis
阑尾孔
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Appendix
The surface projection
(McBurney’s point) of the
base of appendix ：
is the junction of the
lateral and middle thirds
of the line joining the right
anterior superior iliac
spine to the umbilicus 。
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)
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Cecum rectum
（三）colon
1、asccending colon
2、transverse colon
right colic flexure
left colic flexure
3、descending colon
4、sigmoid colon
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(四) rectum
1、position:
2、 Two flexure
Sacral flexure of
rectum
Perineal flexure of
rectum
3、ampulla
4. three transverse folds of rectum
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（五）anal canal
1、position:
anus，4cm。
2、struture：
anal columns
anal valves
anal sinus
Dentate line
anal pecten
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（五）anal canal
3、sphincters of anus
Anorectal ring ：
Sphincter ani internus
Sphincter ani externus
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liver
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 and a small left lobe by
the falciform ligament which is attached to the superior surface of the
liver to the anterior abdominal wall.
left lobe
right lobe
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superior surface (diaphragmatic surface)
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.
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inferior surface（visceral surface）
• There are 3 fissures arranged like “H”:
left longitudinal fissure
right longitudinal fissure
transverse sulcus—porta hepatis
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left longitudinal fissure
ant: Fissure for ligamentum teres
post: Fissure for ligamentum venosum
right longitudinal fissure
Ant: fossa for gall-bladde Post: sulcue for
inferior vena cava
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porta hepatis
contains
right and left branches
of the hepatic artery
right and left hepatic
ducts
hepatic portal vein
lymphatics
Nerves supplying the
liver.
The structures passing through the porta hepatis is inclosed
by connective tissues form the Hepatic padicle
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The liver has 4 borders:
Anterior (inferior) margin
is sharp,
posterior marge
Right margin
Lfet margin
The fundus of the Gallbladder
Protude below the Inferior
margin of the Liver at the notch for
Gallbladde.
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In the inferior surface, the liver may be divided into 4 lobes:
left lobe . Left to the left longitudinal fissure
right lobe . right to right longitudinal fissure
caudate lobe . Behint the porta hepatis
quadrate lobe . anterior to the porta hepatis
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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.
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1、The gallbladder
The gallbladder and
biliary ducts
It consists of the fundus,
body, neck , and the duct
of gallbladder 4 parts.
the fundus is the
expanded anterior end of
the organ and protruds
below the inferior margin of
the liver, it lies behind the
point where the lateral
margin of the right rectus
abdominis meets the
costal arch.
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body of gallbladder ：
neck of gallbladder ：
the cystic duct is
about 2cm in length, it
joins the common
hepatic duct to form the
common bile duct.
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Common bile duct
The common bile duct
descends first in the
hepatoduodenal ligament , and
then posterior to the superior part
of the duodenum and the head 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.
The pancreatic duct joins it
during its passage through the
duodenal wall to form the ampulla,
which is called hepatopancreatic
ampulla (of Vater).
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sphincter of hepatopancreatic ampulla
The sphincter of
hepatopancreatic ampulla
(Odis) is layer circular muscle
surrounding the ampulla of
hepatopancreatic ampulla, it
controls the flow of bile and
pancreatic secretions into the
duodenum.
Obstruction of the biliary
system results in the clinic
condition of jaundice (yellow
skin).
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Position: lies behind the
Pancreas
peritoneum on the upper
part of the posterior
abdominal wall, roughly at the
level of the L1~L2 vertebra.
Division: It may be divided
into head, neck, body and
tail 4 parts.
head lies in the
concavity of the duodenum,
anterior to the inferior vana
cava. its inferomedial
extension is clled uncinate
process.
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body
lies anterior to the
abdominal aorta and the left
kidney, behind the stomach.
pancreas
tail may reach the hilus
of the spleen.
Pancreatic ducts
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
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The function of the pancreas
The pancreas has both exocrine and
endocrine 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) of cells which secretes insulin
directly into the blood stream for the control of
blood sugar level.
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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
Right and left
hepatic ducts
Gallbladder (store,
concentrate)
when taking food, the
gallbladder contracts, the
sphincter of hepatopancreatic
ampulla relax
Major duodenal papilla
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fundus
Pyloric part
Pyloric antrum
Pyloric canal
Cardia
Lesser
curvature
body
Greater
curvature
pylorus
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