Digestive system

Question 1

Organs of digestive system,

systema digestorium

Answer 1

 Cavitas oris
 Pharynx
 Oesophagus
 Gaster s. ventriculus
 Intestinum tenue
 Intestinum crassum
 Glandulae salivales
 Hepar
 Pancreas
 Splen s. lien

Question 2

Cavitas oris parts

Answer 2

Consists of two parts: Vestibulum oris and Cavitas oris propria

Question 3

Vestibulum oris

Answer 3

other part of cavities oris

Slip-like space between:

• The lips – labia
• The cheeks – bucca
• Processus alveolaris mandibulas et maxillae
  
  • -> Covered by the gum – gingiva
  • -> the teeth – dentes

Communicates with the surface of the body by the oral opening – rima oris

Communicates with cavitas oris propria, when the jaws are closed through narrow clefts between
opposing teeth and by an aperture on both sides behind the molars.

Question 4

Please explain gingiva

Answer 4

• Composed of dense fibrous tissue
• closely connected to the periosteum of processus alveolaris mandibula et maxillae and
• surrounding the necks of the teeth

There are no glands in the mucous membrane of the gum

Question 5

Lips

Answer 5

 The lips are covered externally by skin and internally by mucosa

 The vermilion boarder, is the transitional zone from skin to the mucosa

 The mucosa contains glandulae labiales

 The inner surface of each lip is connected in the midline to the corresponding gum by frenulum labii superioris and frenulum labii inferioris

Question 6

Bucca

Answer 6

 Forms the sides of the face and continues into the lips

 The base is formed by m. buccinator
–> covered by fascia buccopharyngea
 Corpus adiposum buccae lies on m. buccinator

 Externally covered by skin and internally covered by mucous membrane

 At the level of the 2nd upper molar tooth in the mucous membrane is papilla ductus parotidei

Question 7

Oral opening & the lips

Answer 7

Boarded by:
o Labium superius et labium inferius

The lips are connected at angulus oris
o by commisura labiorum

Labium superior reaches the external nose and laterally sulcus nasolabialis
o in the middle of the upper lip a groove is present – philtrum

Labium inferior extend into the lower direction to the chin and the sulcus mentolabialis

 The lips are formed by m. Orbicularis oris

Question 8

Cavitas oris propria

Answer 8

Limited laterally and anteriorly by processus alveolaris maxillae et mandibule and by the teeth

posteriorly it communicates with the pharynx by isthmus faucium

Superiorly Roofed with the hard (palatum drum) and soft palate (palatum drum)

Inferiorly The floor is composed of three muscles:
o m. mylohyoideus
o venter anterior m. digastrici
o m. geniohyoideus
–> Glandula submandibularis is situated beneath the muscles
–> On the upper surface of the muscles lies glandula sublingualis, covered by the mucous membrane
 Medially to Plica sublingualis is caruncula sublingualis

Question 9

Glandulae salivarie

Answer 9

Glandulae salivariae minores are scattered in the mucous membrane of the oral cavity and tongue
o glandulae labiales
o glandulae buccales
o glandulae palatinae
o glandulae linguales

Glandulae salivariae majores:
o glandula parotidea (also accessoria)
o glandula sublingualis
o glandula submandibularis

Question 10

Glandula parotidea

Answer 10

• Largest salivary gland
• Pars superficialis – lies in front of the external ear on m. masseter
• Pars profunda – is situated in the retromandibular fossa
• Fascia parotidea surrounds the parotid gland
• Ductus parotidus starts at the gland’s anterior boarder, crosses m. masseter and runs through m.Buccinator and opens into the vestibulum oris on papilla parotidea

Question 11

Glandula submandibularis

Answer 11

• Lies in trigonum submandibulare
• Surrounded by lamina superficialis fasciae cervicales / fasciae colli superficiales
• Opens on caruncula sublingualis

Question 12

Glandula sublingualis

Answer 12

• The mucous membrane covers the gland and forms plica sublingualis
• The gland has several ducts, but the main duct – ductus
  sublingualis major opens on caruncula sublingualis together
  with ductus submandibulare
• Ductus sublinguales minores open by small openings
  directly on plica sublingualis

Question 13

Dentes

Answer 13

Two sets of teeth:
o Dentes decidui  20 – 6-8 months (primary milk teeth)
o Dentes permanentes  32 – 6-12 years
o Dens serotinus  17-24 years (wisdom tooth)

• Dens inscivus – for biting
• Dens caninus – tearing and gripping
• Dens premolaris – chewing movement
• Dens molaris – chewing

 Corona dentis = crown
 Radix dentis = root
 Cervix dentis = neck
 Cavitas dentis
 Cavitas coronae
 Cavitas radices dentis
 Foramen apicis dentis for Bv and nerves
 Pulpa dentis is soft part

Question 14

Palatum

Answer 14

Forms the roof of the oral cavity

Consists of two parts:
o Hard palate – palatum durum, is anteriorly
o Soft palate – palatum molle, lies behind the hard palate

Separates the oral and nasal cavities and is formed by bone palate and is covered by the periosteum
and mucous membrane

Mucous membrane contains numerous glandulae
palatinae (=Glandulae salivariae minores)

Question 15

About the soft palate

Answer 15

–> is a movable fold and consists of the fold
of the mucous membrane enclosing muscular tissue, a
palatine aponeurosis, blood vessels, nerves, lymphoid
tissue and mucous glands

–> Palatine aponeurosis is formed by C.T. and serves as the soft skeleton of the soft palate

–> From it 5 pairs of muscles of soft palate and fauces start

–> The posterior boarder of the soft palate is free and hangs like a curtain between cavitas oris and pharynx
o There is a small conical process – uvula palatina.

–> When the soft palate elevates (swallowing) –> separates cavitas nasi and the nasopharynx from the
posterior part of cavitas oris and oropharynx

Question 16

uvula palatina

Answer 16

• Folds on each side of the uvula form two arches:
  1. Arcus palatoglossus (extends to the lateral border of the tongue)
  2. Arcus palatopharyngeus ( extends to the wall of the pharynx)
• -> Sinus tonsillaris s. fossa tonsillaris between the arches (tonsilla palatina locates here)

The palate arches boarder isthmus faucium
o Isthmus faucium is the orifice in the posterior wall of the oral cavity
o Connects the latter with the pharynx
o Isthmus faucium is limited by:
- Superiorly: uvula
- Laterally: arcus palatoglossus et arcus palatopharyngeus
- inferiorly: radix linguae et tonsilla lingualis

There are 5 pairs of muscles of the soft palate and fauces:
M. uvulae
 o. palatum drum
 i. uvula
 f. elevates and shortens uvula

M. levator veli palatini
 o. basis cranii
 i. aponeurosis
 f. elevates and shortens uvula

M. tensor veli palatini
 o. lamina medialis processus
pterygoidei
 i. aponeurosis
 f. stretches palatum molle and widens the auditory tube

M. palatoglossus
 o. aponeurosis
 i. root of the tongue
 f. narrows isthmus faucium and shortens arcus palatoglossus

M. palatopharyngeus
 o. aponeurosis
 i. lateral wall of pharynx
 f. narrows isthmus faucium and shortens arcus palatopharyngeus

Question 17

Lingua s. Glossa

Answer 17

Takes part in chewing, sucking, contains sense organs for taste and touch and is involved in speech production

• two parts:
  1. Corpus linguae - central part
• -> anterior part of the body is the apex linguae
  2. Radix linguae – posterior part, connected to os hyoideum
• On corpus linguae is the upper part – dorsum linguae and the lower part – facies inferior linguae
• Margo linguae is between the dorsum and the lower surface
• Sulcus medianus linguae is in the middle of the dorsum
• Sulcus terminalis linguae is between the dorsum and the root
• Foramen caecum linguae is in the middle of sulcus terminalis linguae
• Tonsilla lingualis is on the root

 The mucous membrane of the tongue contains numerous glands – glandulae linguales
 The mucous membrane forms three folds from the root of the tongue toward the epiglottis:
o Plica glossoepiglottica mediana
o Plica glossoepiglottica lateralis dextra et sinistra
 2 depressions between them - vallecula epiglottica

 The mucosa forms a fold in the midline of the lower surface of the tongue – frenulum linguae
o connects the tongue with the gum of mandibula
 Numerous papilla linguales on the dorsum of the tongue
o Papillae filiformes – across the dorsum of the tongue, a rough surface
o Papillae fungiforme – around the margin and the tip of the tongue, contain taste buds
o Papillae vallate – 7-11, arranged frontally of sulcus terminalis, contains taste buds
o Papillae foliate – transverse folds of the mucosa at the margin and the tip of the tongue,

Question 18

Mucosal formations of lingua s. Glossa

Answer 18

• The mucous membrane of the tongue contains numerous glands – glandulae linguales
• The mucous membrane forms three folds from the root of the tongue toward the epiglottis:
  1. Plica glossoepiglottica mediana
  2. & 3. Plica glossoepiglottica lateralis dextra et sinistra
  
  • -> 2 depressions between them - vallecula epiglottica
• The mucosa forms a fold in the midline of the lower surface of the tongue – frenulum linguae
• -> connects the tongue with the gum of mandibula

Numerous papilla linguales on the dorsum of the tongue
o Papillae filiformes – across the dorsum of the tongue, a rough surface
o Papillae fungiforme – around the margin and the tip of the tongue, contain taste buds
o Papillae vallate – 7-11, arranged frontally of sulcus terminalis, contains taste buds
o Papillae foliate – transverse folds of the mucosa at the margin and the tip of the tongue,

Question 19

Muscles of lingua s. Glossa

Answer 19

Extrinsic muscles:
M. Genioglossus
 o. Spina mentalis mandibula
 i. Root of the tongue
 f. Pulls the tongue forward and downward

M. Styloglossus
 o. Processus styloideus
 i. Root of the tongue
 f. Pulls the tongue backward and downward

M. Hyoglossus
 o. Os hyoideum
 I. Root of the tongue
 f. Pulls the tongue backward and downward

Intrinsic muscles run perpendicular to each other and their main function is to change the shape of the
tongue:
M. Longitudinalis superior et inferior
 from apex linguae
 shortens the tongue

M. Verticalis linguae
 connects radix linguae with the lower surface of the tongue
 flattens toung

M. Transversus linguae
 from median fibrous septum
 passes laterally to the sides of the tongue
 narrows the tongue

Question 20

Pharynx

Answer 20

Placed behind the nasal and oral cavities and the larynx

The airway and food passage crosses the pharynx

Cavitas pharyngis is divided into 3 parts:

1. Pars nasalis pharynges s. nasopharynx
2. Pars oralis pharynges s. oropharynx
3. Pars laryngea pharynges s. laryngopharynx

Wall structure:

Tunica mucosa
o glandulae pharyngeales in mucous membrane
o Pars nasalis pharynges s. nasopahrynx: respiratory epithelium
o Pars oralis et laryngea: stratified squamous epithelium

Fascia pharyngobasilaris –> soft skeleton of the pharynx between mucous and muscular layer.
–> Transforms into tela submucosa toward the oesophagus.

Tunica muscularis

Tunica adventitia

Question 21

Nasopharynx – s. Pars nasalis pharynges

Answer 21

• Lies behind cavitas nasi from basis cranii externa  palatum molle (soft palate)
• Skeletotopically: C1 to C2
• attached to basis cranii externa and forms fornix pharynges
• Anteriorly nasopharynx comminucates via choana with cavitas nasi
• Between the superior and posterior walls of pharynx is tonsilla pharyngealis
• In the lateral wall of pharynx is ostium pharyngeum tubae auditivae
• -> This opening leads via tubae auditivae to the cavitas tympani
• equalizing the air pressure on both sides of membrana tympanica
• Torus tubarius – a protube of cartilage from tubae auditivae
• Recessus pharyngeus – small recess behind the opening of tubae auditivae
• Below the pharyngeal opening is tonsilla tubaria

Question 22

Oropharynx – s. Pars oralis pharyngis

Answer 22

From palatum molle –> epiglottis

Skeletotopically: C3 to C4

Anteriorly it communicates with cavitas
oris through isthmus faucium

Question 23

Laryngopharynx – s. Pars laryngea pharyngis

Answer 23

Lies behind larynx
 from epiglottis  oesophagus
 Skeletotopically: C5 to C6
 Two openings: the aditus laryngis and
oesophagus

Question 24

Tonsils of the pharynx

Answer 24

Tonsillae tubariae (one on each side)

Tonsilla pharyngealis (single at the top of the pharynx)

Tonsilla palatina (paired)

Tonsilla lingualis (single)

Anulus lymphoideus pharyngis (Waldeyer’s throat ring)

Question 25

Muscles of pharynx

Answer 25

``` (constrictors, elevatio pharynx): M. Constrictor pharyngis superior o. Processus pterygoideus rhaphe pterygomandibularis linea mylohyoidea margo linguae ``` M. Constrictor pharyngis medius o. Os hyoideum M. Constrictor pharyngis inferior o. Cartilago thyroidea cartilago cricoidea i. Raphe pharynges f. Narrows the pharyngeal space and elevatio pharynx (levatores, elevatio pharynx): M. Stylopharyngeus o. Processus styloideus M. Palatopharyngeus o. Palatine aponeurosis i. Lateral wall of pharynx f. Elevatio pharynx

Question 26

Topography of pharynx

Answer 26

Holotopically: Cervical region Skeletotopically: Basis cranii externa --> C6 Syntopically: Anteriorly: cavitas nasi cavitas oris cavitas larynges Laterally: BV, nerves Posteriorly: mm. profundi colli fascia prevertebralis of fascia cervicales columna vertebralis - Posteriorly there is spatium retropharyngeum and it extends laterally to spatium parapharyngeum - Both spaces continue into mediastinum superius

Question 27

Oesophagus

Answer 27

- Canal about 23-25cm - Extending from pharynx to gaster 3 parts: 1. Pars cervicalis -> extend to the level of apertura thoracis superior 2. Pars thoracica -> apertura thoracis superior to hiatus esophageus diaphragm 3. Pars abdominalis -> below hiatus esophageus diaphragm to the ostium cardiacum 3 narrow spaces: 1. Constricto pharyngooesophagealis -> Oesophagus entrance, behind cartilago cricoidea 2. Constricto broncoaortica -> Trachea and r. Aorta, aorta thoracica (Th4-Th5) 3. Constricto phrenica s. Diaphragmatica -> Passage through diaphragma, beginning of pars abdominalis Tunica mucosa o forms longitudinal folds Tela submucosa o contains glandulae oesophageae Tunica muscularis o longitudinal and circular layers Tunica adventitia or tunica serosa - > Tunica adventitia covers cervical and thoracic part - > the abdominal part is covered by tunica serosa (peritoneum)

Question 28

Topography of the oesophagus

Answer 28

Holotopically: - cervical region - mediastinum superior and posterior - cavitas abdominalis Skeletotopically: C6 - Th11 Syntopically: Posteriorly: columna vertebralis (aorta crosses at Th8-9) Anteriorly: - trachea - bronchus principalis sinister - pericardium - hepar Laterally: - BV, nerves - lobuli glandula thyroidea - pleura parietalis pars mediastinalis, - hepar

Question 29

pleura parietalis pars mediastinalis

Answer 29

the continuation of the costal and diaphragmatic pleura of each side that passes from the vertebral column and sternum covering the sides of the mediastinum.

Question 30

Intestinum tenue

Answer 30

- Convoluted tube extending from pylorus to ostium ileale - Digestion and absorption takes place is intestinum tenue - Lenght: 5-6m 3 portions: o Duodenum o Jejunum o Ileum

Question 31

Duodenum

Answer 31

C-shaped and winds around caput pancreas ``` Has 4 parts: o Pars superior o Pars descendens o Pars inferior s. Pars horizontalis o Pars ascendens ``` Pars superior o starts at ostium pyloricum --> crosses columna vertebralis from left to right at the level of L1 --> continues with flexura duodeni superior into the next part o In the beginning it has a dilated duodenal cap – bulbus s. Ampulla Pars descendens o descends along the right side of columna vertebralis to the level of L3 --> forms flexura duodeni inferior --> continues to the next part Pars inferioris s. Pars horizontalis o crosses columna vertebralis from the right to left at the level of L3 --> passes the on to the last part Pars ascendens o runs upward obliquely to L2 --> forms flexura duodenojejunalis --> continues then into jejunum

Question 32

Jejunum et Ileum

Answer 32

- Involved in the fold of peritoneum – mesenterium intestinale - Mesenterium is a peritoneal fold which attach jejunum and ileum to the posterior abdominal wall by radix mesenterii - jejunum and ileum are mobile intraperitoneal coils attached to the posterior abdominal wall by radix mesenterii (radix mesenterii from flexura duodenojejunalis to ileocaecal junction) - No strict boarder o Jejunum is wider, more vascular and deeper in color than ileum o Ileum is much narrower and thinner o Jejunum is 2/5 and Ileum is 3/5 of their total common length

Question 33

Wall structure of intestine ten

Answer 33

Tunica mucosa o forms plicae circulares with villi intestinales --> In duodenum there is only one fold – plica longutudinales duodeni (in the descending part of duodenum) --> the fold ends at papilla duodeni major, which is formed by the enlargement ampulla hepatopancreatica for the common opening of bile and pancreatic ducts o glandulae duodenales s. glandulae intestinales ``` Tela submucosa (loose connective tissue) o noduli lymphoidei solitarii are scattered in all parts of small intestine o in the end part of ileum are also noduli lymphoidei aggregati ``` ``` Tunica muscularis (two layers) o External longitudinal o inner circular  In the descending part of duodenum they from a sphincter, surrounding the hepatopancreatic ampulla. ``` ``` Tunica serosa (peritoneum) covers jejunum and ileum completely, making them intraperitoneal organs. o The duodenum is a retroperitoneal organ. ```

Question 34

topography of intestine tenue

Answer 34

Holotopically - Duodenum regio epigastrica (upper part) and in regio umbilicalis (lower part) - Jejunum regio umbilicalis and regio lateralis sinistra - Ileum regio lateralis dextra, regio inguinalis dextra, regio pubica and pelvis minor Skeletopically - Pars superior duodeni – 1st lumbar vertebra - Pars descendens duodeni – from the 1st to the 3rd lumbar vertebra - Pars horizontalis duodeni – 3rd lumbar vertebra - Pars ascendens duodeni – from the 3rd to the 2nd lumbar vertebra ``` Syntopically - Duodenum: Posteriorly: * abdominal aorta * vena cava inferior * the descending part faces ren dexter and glandula suprarenalis dexter ``` Medially: caput pancreas Anteriorly: * colon transversus * Hepar - Jejunum and ileum: Posteriorly: organs of the retroperitoneal space On the right: colon ascendes Anteriorly: covered by omentum majus Inferiorly: descend into pelvis minor

Question 35

Intestinum Crassum

Answer 35

Average length 100-150 cm - Important for vital absorbtion and reabsorbtion of water and plasma electrolytes - Residence for endemic bacterial flora - -> Produce also K and B12-vitamins - Final process of chyme into faeces for defecation - Caecum et Appendix Vermiformis ``` Colon: o Colon Ascendens o Colon Transversum o Colon Descendens o Colon Sigmoideum o Rectum o Canalis Analis ```

Question 36

Wall of intestine crassum

Answer 36

tunica mucosa - Glandulae intestinales s. cryptae intestinales secrete lubricating mucus - Lymphatic drainage is well developed in intestinum crassum. In tunica mucosa – noduli lymphoidei solitari, in appendix vermiformis – noduli lymphoidei aggregati appendicis vermiformis - Plicae semilunares coli - well developed in colon, poorly in caecum, not present in appendix vermiformis and rectum. tela submucosa - Lamina propria, mucosae et tela submucosa are very well vascularized with capillaries, venous drainage is eventually to vena mesenterica superior and finally to venae portae hepatis. tunica muscularis s. muscularis externa - Three longitudinal muscle layers in muscularis externa of caecum et colon --> form taeniae coli. = longitudinal muscle layers, which are reduced to 3 bands.  Taenia libera is free  Taenia omentalis attachment of omentum majus  Taenia mesocolia attachment of mesocolon trnaversum - Taeniae coli are shorter than intestinum crassum – creating haustra coli ``` tunica serosa (intraperitoneal) / tunica adventitia (retroperitoneal) - has fatty protrusions – appendices epiploicae s. appendices omentales ```

Question 37

Main differences between small and large intestine:

Answer 37

 larger diameter  Taenia  Haustra and plicae semilunares  Appendices apiploicae

Question 38

Caecum at Appendix Vermiformis

Answer 38

 Caecum is 6-8 cm in lenght, 7-7,5 cm in diameter (the widest part of intestinum crassum)  Locates in regio inguinalis dextra  Caecum communicates with Ileum via ostium ileale o one-way valve formed by tunica mucosa foldings  communicates with appendix vermiformis via ostium appendicis vermiformis

Question 39

Colon

Answer 39

Colon Ascendens - 12-20 cm in lenght, smaller in diameter than Caecum - Locates in regio lateralis dextra - Goes up untill reaches inferior surface of Hepar  formates bending to the left flexura coli dextra s. flexura coli hepatica and continues as colon transversum Colon Transversum - 30-80 cm in length - The most motile portion of intestinum crassum - starts from regio hypochondriaca dextra  passes transversally with downward convexity in regio umbilicalis  reaching regio hypochondriaca sinistra - In regio hypochondriaca sinistra makes turn down at flexura coli sinistra s. flexura coli splenica. - Colon transversum is within peritoneum --> Fixed to posterior abdominal wall by mesocolon transversum --> Lig. Gastrocolicum and omentum majus attach to tenia omentalis coli transversi Colon Descendens - 10-15 cm in length - starts at flexura coli sinistra s. flexura coli splenica with direction downwards - Locates in regio lateralis sinistra - At the level of crista iliaca sinistra becomes colon sigmoideum Colon Sigmoideum - Average 40 cm in length - Continuation of colon descendens at crista iliaca sinistra - Locates in regio inguinalis sinistra - Formates an angled loop and is located in fossa iliaca sinistra - At the level of art. sacroiliaca dextra continues as rectum

Question 40

Rectum

Answer 40

- 13-20 cm in length - Locates in regio hypogastrica and pelvis minor - shape called flexura sacralis (correspond the shape of os sacrum) - In the lower portion of rectum the diameter expands creating ampulla recti (final storage of faeces) --> When ampulla recti is filled with faeces the need for deficatio is induced due to pressure on m. sphincter ani internus

Question 41

Canalis analis

Answer 41

Continuation from ampulla recti 2-3 cm in length Canalis analis penetrates perineum and has flexura perinealis Anus is the terminal portion of canalis analis - Plicae transversae recti - Columnae anales - Sinus anales - Plexus venosus rectalis (in mucosa et submucosa) - M. sphincter ani internus - M. sphincter ani externus - M. levator ani

Question 42

Intestinum Crassum et Peritoneum

Answer 42

Caecum - Intraperitoneal organ – covered by peritoneum - No mesenterium Appendix vermiformis - Intraperitoneal organ - Has mesenterium – mesoappendix connecting ileum to appendix Colon ascendens et descendens o Mesoperitoneal organ – covered by peritoneum anteriorly, laterally and medially o Posteriorly covered by tunica adventitia Colon transversum o Intraperitoneal organ o Mesocolon transversum Colon sigmoideum o Intraperitoneal organ o Mesocolon sigmoideum ``` Rectum o Upper 1/3 intraperitoneal o Middle 1/3 mesoperitoneal --> anteriorly and laterally by peritoneum, posteriorly by tunica adventitia o Lower 1/3 retroperitoneal --> covered by tunica adventitia ```

Question 43

Topography of large intestine

Answer 43

Holotopia - Cavitas abdominis caecum , appendix vermiformis et colon - Pelvis minor rectum et canalis analis Skeletotopia - Caecum fossa iliaca dextra, vertebra Lumbalis V - Colon ascendens vertebra L V  cartilagines costarum IX-X, vertebra L II - Colon transversum skeletotopia is impossible to describe due to large positional variations (Sobotta) - Colon descendens cartilagines costarum IX – X, vertebra Lumbalis II --> crista iliaca sinistra - Colon sigmoideum crista iliaca sinistra --> art. sacroiliaca dextra - Rectum art. sacroiliaca dextra --> os coccygis Syntopia - Caecum et colon ascendens Medially: intestinum tenue - Flexura coli dextra Superiorly: * hepar * fundus vesicae biliaris Posteriorly ren dexter ``` -Colon transversum Superiorly: * gaster *pars superior duodeni * pancreas ``` Inferiorly: intestinum tenue ``` - Flexura coli sinistra Superiorly: * splen s. lien * cauda pancreatic Posteriorly: ren sinister ``` - Colon descendens et sigmoideum Medially: intestinum tenue Rectum Posteriorly: * os sacrum * os coccygis Laterally: plexus venosus rectalis Anteriorly in males: * vesica urinaria * Prostate * ductus deferens * glandula vesiculosa Anteriorly in females * uterus * vagina

Question 44

Peritoneum

Answer 44

- serous covering of cavitas abdominalis 2 parts: 1. Peritoneum parietale 2. Peritoneum viscerale - -> between these parts is cavitas peritonealis with serous fluid to lubricate organs - Between cavitas peritonealis and posterior abdominal wall is spatium retroperitoneale ``` - Peritoneum parietale continues into peritoneum viscerale and forms: o Mesocolon o Mesenterii o Ligamenta o Omenta o Folds ``` - Mesocolon and mesenterii are peritoneal folds that attach organs to the posterior abdominal wall --> allow movement --> contain BV, nerves and lymph vessels o Mesenterii connects jejunum and ileum to the posterior abdominal wall by radix mesenterii o Radix mesenterii passes obliquely downward from flexura duodenojejunale at 2nd LV to ileocaecal junction o Mesocolon transversum fix colon transversum o Mesocolon sigmoideum fix colon sigmoideum o Mesoappendix is for appendix vermiformis

Question 45

Peritoneal cavity in pelvis minor

Answer 45

Female: Excavatio rectouterine Excavatio vesicouterina Male: Excavatio rectovesicalis

Question 46

Retroperitoneal organs

Answer 46

Covers only anterior side - duodenum - pancreas - ren - glandula suprarenalis - empty vesica urinaria - ureter

Question 47

Mesoperitoneal organs

Answer 47

Covers all but posterior side - hepar - vesical biliaris - colon ascendes - colon descendes - rectum (middle 1/3) - full vesica urinaria - uterus

Question 48

Intraperitoneal organs

Answer 48

Covers all sides - oesophagus (pars abdominalis) - gaster - jejunum - ileum - caecum - appendix - colon transversum - colon sigmoideum - rectum (upper 1/3) - splen s. lien - tuba uterine

Question 49

Lien s. Splen

Answer 49

- Organ for the destruction of erythrocytes - -> Red pulp filtrates RBC’s - Produces leucocytes - -> White pulp synthesizes antibodies - Durin fetal life and shortly after it creates erythrocytes Facies diaphragmatica – convex, smooth, directed upward to diaphragma Facies visceralis – with hilum splenicum (entrance and exit of vessels and nerves) Margo superior – projected forward Margo inferior – more rounded, projected posteriorly Tunica fibrosa surrounds the spleen (capsule) Tunica serosa (peritoneum) covers from all sides --> intraperitoneal - -> forms 2 LIGAMENTS (= double fold of peritoneum) 1. Lig. Gastrosplenicum – from hilum splenicum to curvaura major (gaster) 2. Lig. Phrenicosplenicum – from facies diaphragmatica to diaphragm

Question 50

Topography of spleen

Answer 50

Holotopically: Regio hypochondriaca sinistra Skeletotopically: * Superior border at costae IX * Hilum splenicum at costae X * Inferior border at costae XI ``` Syntopically: * facies diaphragmatica: Diaphragma * Facies visceralis: Gaster Ren sinister Glandula suprarenalis Colon Cauda pancreatis ```

Question 51

Pancreas

Answer 51

- Produces the pancreatic juice --> drains into the duodenum Exocrine portion (pancreas is primarly an exocrine gland) - Acinar cells: Enzymatic components (trypsinogen, chymotrypsinogen, elastase, pancreatic lipase....) (regulated by cholecystokinin) - Centroacinar cells: bicarbonate (regulated by secretin) Endocrine portion (only 2% of total mass) - The cells of Langerhans (beta cells) produce insulin --> the blood stream for sugar metabolism - Alpha cells produce glucagon --> raises the concentration of glucoce in blood stream --> causes the liver (hepar) to convert stored glycogen into glucose - Lies transversely across the posterior wall of the abdominal cavity - Peritoneum covers the anterior side = retroperitoneal organ - Caput pancreatis – head of pancreas, curve of duodenum - Corpus pancreatis – crosses the vertebral column - Cauda pancreatis – reaches the visceral surface of the spleen The body (corpus pancreatis) and the tail (cauda pancreatis) are TRIANGULAR on cross section --> 3 surfaces 1. Anterosuperior 2. Anteroinferior 3. Posterior 3 borders - Superior - Anterior - Inferior Ductus pancreaticus – through the pancreas - joins the bile duct to form ampulla hepatopancreatica - opens at papilla duodeni major - Frequently there is ductus pancreaticus accessories - -> Excretes pancreatic juice from caput pancreatic - -> opens into the duodenum by papilla duodeni minor

Question 52

topography of pancreas

Answer 52

Holotopically: Regio epigastrica Regio hypochondrica sinistra Skeletotopically: Caput pancreas at L2 Corpus pancreas crosses columna vertebralis at the level of L1 Cauda pancreatis at 10th costae Syntopically: - Caput pancreas surrounded by Duodenum and crossed by mesocolon transversum anteriorly ``` Posteriorly: Vena cava inferior Vena portae hepatis Corpus and cauda pancreatis face: Anteriorly * Gaster * Mesocolon transversum ``` Posteriorly * Aorta abdominalis * Ren sinister Inferiorly * Coils of jejunum * Flexura coli sinistra Cauda pancreatis reaches lien s. splen

Question 53

Vesica Biliaris

Answer 53

storage of bile - in fossa vesica biliaris, on the visceral side of the right lobe It is composed of; o fundus vesicae biliaris o corpus vesicae biliaris o collum vesicae biliaris The mucus membrane lines the gallbladder and forms the mucosal folds o Mucous glands are scattered in the mucosa Tunica muscularis: one circular layer which forms musculus sphincter ampullae at the region of ampulla hepatopancreatica Tunica Serosa (peritoneum) covers the gall bladder from the lower surface Tunica adventitia covers the upper surface There is no submucosa!

Question 54

Bile pathway

Answer 54

- Bile is excreted via ductus hepaticus sinister et dexter - They join at the porta hepatis to form Ductus hepaticus communis - Ductus hepaticus communis joins with Ductus cycticus  form ductus choledochus - Ductus choledochus runs along lig. hepatoduodenale together with portae arteria hepatica - crosses the superior part of the duodenum and caput pancreas - pierces the posterior wall of the pars descendens duodenum --> form plica longitudinalis duodeni - with ductus pancreaticus to form ampulla hepatopancreatica --> opens into papilla duodeni major

Question 55

Topography of hepar

Answer 55

Holotopically: regio hypchondriaca dextra regio epigastrica regio hypochondriaca sinister ``` Syntopically: impressio cardiaca impressio Oesophageale impressio gastrica impressio duodenalis impressio colica impressio renalis impressio suprarenalis ``` Skeletopically: upper border on the right side: - -> intersection of linea medioclavicularis dextra and the 4th intercostal space - -> turns downwards towards the left, near the 5th intercostal space The lower border:  intersection of linea axillaris media and 10th rib  curves along arcus costales  junction between cartilagines costarum 9th and 8th  border crosses regio epigastrica  reaches the left side where the cartilage of the 7th and 8th rib join  ends in 6th intercostal space Posteriorly: between 9th and 11th thoracic vertebrae

Question 56

Hepar

Answer 56

Main function; exocrine gland responsible for the production of bile Secondary functions; o Thermoregulation o metabolism of carbohydrates, proteins and fats o production of erythrocytes during the fetal period - Margo Inferior - Thin, sharp border projecting downwards - Area Nuda - bare, not covered by peritoneum - Facies diaghragmatica o Superior convex surface projected towards diaphragm --> Lig. falciforme * divides the liver into lobus hepatis dexter et sinister --> lig. cononarium * borders Area Nuda and forms the two attaching ligaments on either end --> lig. triangulare dexter et sinister Facies Visceralis * Inferior surface, directed towards the abdominal organs * liver can be divided into 4 lobes - The right lobe is bordered by the right sagittal groove - The left lobe is bordered by the left sagittal groove - The transverse groove lies between the two sagittal grooves - -> separates lobus quadratus and lobus caudatus - -> lobus quadratus lies anteriorly while lobus caudatus lies posteriorly

Question 57

Tunica fibrosa & serosa of the liver

Answer 57

Tunica fibrosa and Tunica Serosa (peritoneum) cover the liver - -> The peritoneum covers the liver from 3 sides, but does not cover area nuda - -> It also forms the attaching ligaments of the liver, which can be divided into 2 groups: 1. Ligaments extending to the diaphragm; - Lig. Falciforme: b. diaphragm and upper surface of the liver - Lig. Coronarium: from area nuda to diaphragm, with two attaching ends - Lig. Triangulare Dexter et Sinister 2. Ligaments extending from porta hepatis towards the organs; - Lig. Hepatogastricum: to curvatura minor gaster - Lig. Hepatoduodenale: to the superior portion of duodenum - Lig. Hepatorenale: to ren dexter

Question 58

Nutrition entrance to liver and the formations within the sagittal grooves

Answer 58

``` Porta hepatis is located within the transverse groove and contains; o Ductus hepaticus communis o Vena portae heptis o Arteria hepatica propria o nerves and lymphatic vessels ``` Formations within the sagittal grooves; * Fossa vesicae biliaris: depression for the gall bladder * Sulcus venae cavae: groove for the vena cavae * Fissura ligamentum teres: Lig. teres hepatis lies within * Fissura ligamentum venosi: Lig. venosum