ANATOMY OF GASTROINTESTINAL SYSTEM

By : Nurul Amalia Nrp: 1010.211.113

GASTROINTESTINAL SYSTEM
Alimentary canal (gastrointestinal tract): digestive tube.

Accessory digestive organs

The mouth, pharynx, esophagus, stomach, small & large intestine.

Teeth, tongue. Digestive glands: salivary glands, liver, gallbladder, pancreas.

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ABDOMINAL WALL
Boundaries: Superior: xyphoid process & costal margin Posterior: vertebral column Inferior: upper parts of the pelvic bones.

Layers of the abdominal wall

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ABDOMINAL WALL
muscles and sheaths
Muscles of anterior abdominal wall:
Flat muscles: External oblique Internal oblique Transverse abdominal Vertical muscles: Rectus abdominis Pyramidalis

Sheath and aponeurosis. Linea alba: attachment of deep layer of superficial fascia and the three aponeurosis
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ABDOMINAL WALL
INGUINAL REGION
Inguinal ligament Inguinal canal Structures passing through the canal (male & female) Superficial inguinal ring (annulus inguinalis medial/ superficial) Deep inguinal ring (annulus inguinalis lateral /profundus) Conjoint tendon Inguinal hernias: direct & inderect
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ORGANIZATION OF THE RECTUS SHEATH

Rectus sheath formed by a layering of the aponeuroses of external and internal oblique, and transverse abdominal muscle. The pattern of upper three quarter of the sheath of rectus abdominis muscle:
The anterior wall: aponeurosis of external oblique, half of the aponeurosis of internal oblique. The posterior wall: half of the aponeurosis of internal oblique and the aponeurosis of transverse abdominal muscles.

The pattern of lower one-quarter:

The anterior wall: contains all of the aponeuroses. The posterior wall: contains no aponeuroses. From this point inferiorly, rectus abdominis muscle is in contact with transversalis fascia. And foms a line: linea arcuata (arcuate line). 6

PERITONEUM
A membrane that lines the walls of the abdominal cavity and covers much of the viscera. Divided into: Parietal peritoneum : lines the inner surface of abdominal & pelvic walls, & the lower surface of diaphragm. Visceral peritoneum: lines the outer surface of the organs. Peritoneal folds: suspend the organs; in the peritoneal cavity intraperitoneal Organs outside the peritoneal cavity, with only one surface or part covered by peritoneum retroperitoneal Peritoneal folds: omenta :the folds suspending the stomach Mesenteries: the folds suspending the small and large intestines Ligament

PERITONEUM
Peritoneal cavity: potential space enclosed within the peritoneum. The peritoneal cavity is divided into: The greater sac The omental bursa Connected by omental foramen (epiploic foramen of Winslow)

ABDOMINAL REGIONS AND QUADRANTS

Midclavicular plane

Subcostal plane

Transtubercular plane

(a)

(b)

(a) The nine surface regions of the anterior abdominal wall (b) The abdominal viscera as they relate to the nine surface

Divisions of the anterior abdominal wall for mapping the digestive organs into abdominal cavity
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ABDOMINAL REGIONS AND QUADRANTS

(c) Simpler scheme of four quadrants centered at the navel

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GASTROINTESTINAL TRACT

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THE MOUTH
batas: Anterior: bibir Lateral: pipi Superior: langit-langit Inferior: lidah Posterior: tenggorok dari orofaring (isthmus faucium) Dibagi menjadi: Ruang depan (vestibulum oris) Rongga mulut (cavitas oris proria): terletak internal untuk gigi
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ORAL CAVITY
Rongga mulut: atap: Langit-langit keras (palatum durum): Anterior Langit-langit lunak (palatum molle): posterior lantai: Sebagian anterior 2/3 lidah, gusi (sisi mandibula) Dasar mulut frenulum lidah: lipatan median tunggal yang berkesinambungan dengan mukosa yang menutupi lantai rongga mulut. Kanan / kiri ke frenulum lidah pembukaan kelenjar submandibula

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ORAL CAVITY
ORAL VESTIBULE Area between the teeth (internal border) with cheeks & lips(external border). Lateral wall buccinator muscle & mucous Opposite to the upper M2 opening of the parotid duct

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PHARYNX
Divide into 3 parts: Nasopharynx: posterior to choane Oropharynx: posterior to oral cavity Laryngopharynx: posterior to larynx Open to esophagus at the level C VI vertebrae.

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PHARYNX
Lies behind oral cavity proper. Extends from hard palate up to upper margin of the epiglottis Palatoglossal arch fold of mucous membran which covered palatoglossal muscles. Area between the palatoglossal arch fauces of the oropharynx (isthmus faucium) Palatopharyngeal arch fold of mucous membran on the lateral wall of oropharynx; covers the palatopharyngeal muscle

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SWALLOWING MECHANISM

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ESOPHAGUS
Muscular tube, + 25 cm Begins as a continuation of the pharynx, at the level of the vertebra CVI. Descends on the anterior surface of the vertebral column, at the thorax Enter the abdomen through the esophageal hiatus and joins the stomach at the cardiac orifice
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ESOPHAGUS
Based on the location, esophagus divided into:
Cervical part Thoracic part Abdominal part

Four location of esophageal constriction:

Trachea & laryngeal nerve, 15 cm from the incisive teeth Aorta arch, 22 cm from the incisive teeth Left bronchus, 27 cm from the incisive teeth Diaphragm esophagus hiatus, 37 cm from the incisive teeth
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ESOPHAGUS
RELATION TO OTHER ORGANS (syntopi)

Cervical part: boundaries:

Anterior : trachea, reccurent laryngeal nerve Posterior : vertebral column, longus colli muscle, prevertebral fascia Lateral left : common carotid artery
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ESOPHAGUS
Thoracic part
Anterior : trachea, right pulmonal artery, left bronchus, pericardium Posterior : vertebral column, longus colli muscle, thoracic duct, azygos vein, hemiazygos vein, aorta Left lateral : aortic arch, left subclavia artery, thoracic duct, n. left recurrent laryngeal nerve Right lateral : azygos vein, left vagus nerve (in front), right vagus nerve (behind)
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ESOPHAGUS
Abdominal part
Enter the abdominal cavity at the level of the vertebra TX Curved to the left & enters the cardia of the stomach Covered by peritoneum on the front & left Boundaries:

Posterior : left crus, phrenic artery, right vagus nerve.vagus dextra Anterior : left vagus nerve.
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ESOPHAGUS
CLINICAL APPLICATION esophageal Varices cardia achalasia Hernias

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STOMACH
Location: Lies obliquely in the upper and left part of abdomen. Epigastric, umbilical & left hypochondriac regions. Mostly covered by the left costal margin and the ribs.
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STOMACH
Greater curvature/ curvatura major: convex; forms left border; point of attachment of greater omentum (omentum majus) and gastrosplenic lig. Lesser curvature/curvatura minor: concave; forms right border; point of attachment of lesser omentum (omentum minus) Cardial notch (incisura cardiaca): superior angle between fundus and esophagus Angular incisure (incisura angularis): a bend on the lesser curvature
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THE STOMACH

Lesser curvature

Graeter curvature

J - shaped Regions : Cardia : opening of oesophagus into the stomach) Fundus (dome shape): area above the cardiac opening (orificium cardiaca) Body of stomach (corpus) Pylorus: Pyloric antrum (cave): wide area of pylorus Pyloric canal : distal end of the stomach Pyloric sphincter
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STOMACH PROJECTION
Cardia
3 cm left to the trunk, at the level of the vertebra TX, posterior to the cartilage costal 7

Fundus
The dome at the groove of intercostal V

Pylorus
At the level of vertebra LI; 2,5 cm right to the trunk

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STOMACH
Relation to other organs (syntopy) Fundus : within the curved of diaphragm Body : pancreas & descending part of diaphragm Greater curvature : lies in front of the left suprarenal gland & upper part of the left kidney Lesser curvature : pancreas & tuber omentale of the liver
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STOMACH
Posterior surface: splenic artery & vein Anterior surface: abdominal wall Right surface: left & quadrate lobes of the liver. Left surface of the fundus: spleen Caudal part of the greater curvature: transverse colon
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SMALL INTESTINE
Extends from the pyloric orifice of the stomach to the ileocecal fold.
Duodenum Jejunum Ileum

The mesentery of small intestine is a broat, fan shaped fold of peritoneum.

Suspends the jejunum & ileum from the posterior abdominal wall by the root of mesentery. Contents: jejunal & ileal branches of superior mesenteric vessels, autonomic nerve plexuses, lymphatics, lymph nodes, connective tissue fat.
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DUODENUM
C-shaped Rounding the head of the pancreas Retroperitoneal, except for its beginning Location: epigastric & umbilical region Connected to the liver by hepatodudenal lig. Flexures: Superior duodenal flexure Inferior duodenal flexure Duodenojejunal flexure: surounded by a fold of peritoneum containing muscle fibers ligament of Treitz Internal part of duodenum: Major duodenal papilla: common entrance for the bile and pancreatic ducts Minor duodenal papilla: entrance for the accessory pancreatic duct
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DUODENUM
About 10 inches long. Parts of duodenum: 1. Superior: just to the right of the body of the vertebra LI

Anterior: the neck of the gallbladder, quadrate lobe of liver Posterior: the bile duct, gastroduodenal artery, portal vein & inferior vena cava Superior: eplipoic foramen Inferior: head & neck of pancreas

2. Descending: just right to the midline, at the level of the vertebra LII

Anterior: crossed by the transverse colon, right lobe of liver, small intestines Posterior: right kidney, right renal vessels, right edge of inferior vena cava Medial: the head of the pancreas & bile duct Lateral: right colic flexure
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DUODENUM

Horizontal/inferior: crossing from right to the left of the body of the vertebra LIII
Anterior: crossed by superior mesenteric vessels Posterior: crossing inferior vena cava, right ureter, abdominal aorta Superior: head of pancreas & uncinate process

Ascending: upward along the left side of abdominal aorta to the level of the vertebra LII and terminates at the duodenojejunal flexure.
Anterior: transverse colon & mesocolon, lesser sac, stomach Posterior: inferior mesenteric vein, left renal vessels Superior: body of pancreas
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JEJUNUM & ILEUM

Jejunum (proximal 2/5 of jejunum-ileum; mostly in left upper quadrant)
Ileum (distal 3/5 of jejunumileum; mostly in right lower quadrant)
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CHARACTERISTIC OF JEJUNUM & ILEUM

Or windows

Mesentery of jejunum

Mesentery of ileum

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CHARACTERISTIC OF JEJUNUM & ILEUM

Characteristics Location Diameter Jejunum Upper left quadrant 2 4 cm Ileum Lower right quadrant 2 3 cm

Lumen
Walls Circular mucosal folds (plicae circulares)

Wider
Thicker and more vascular Larger and more closely set Windows present Fat less abundant

Narrower
Thinner and less vascular Smaller and sparse No windows Fat more abundant Arterial arcades, 3-6 Vasa recta shorter & more numerous present

Mesentery

Arterial arcade, 1 or 2 Vasa recta, longer & fewer

Lymphoid nodules (Peyers Patches)

absent

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LARGE INTESTINE
Extends from the distal end of the ileum to the anus. Approximately 1.5 m long. Parts of large intestine:
Cecum Colon Rectum Anus

Appendix epiploicae

Characteristic: appendices epiploicae, taenia coli, sacculation (haustra), semilunar fold

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CECUM & APPENDIX

A large blind sac Location: right iliac fossa, inferior to the ileocecal opening. Continuous with the ascending colon at the entrance of ileum (ileocecal opening)
Ileocecal valves: fold of ileocecal opening

Haustra Semilunar fold

The appendix: narrow, hollow tube. Connected to cecum at the posteromedial wall of caecum; 2 cm inferior of ileocecal valve Suspended by mesoappendix.
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CECUM & APPENDIX

The Base of appendix: attached to the posteromedial wall of caecum; 2 cm inferior of ileocecal valve. Surface marking of appendix: a point about 2 cm below the junction of transtubercular & right lateral plane. McBurney point: surface projection of the base of appendix.
The junction of lateral 1/3 and middle 2/3 of a line from anterior superior iliac spine (SIAS) to the umbilicus. Site of maximum tenderness of in acute appendicitis

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CECUM & APPENDIX

APPENDICITIS Rovsings sign Psoas Sign (Cope): Obturator sign (Cope):

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APPENDIX

Position of the appendix: a. Pelvic b. Retrocecal c. Preilieal d. Postileal (retroileal)

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COLON
(2)

(1)

(3)

Colon extends superiorly from the cecum.

(4)

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COLON
Colon consist of: Ascending colon Transverse colon Descending colon Sigmoid colon At the junction between:
ascending & transverse colon : right colic flexure (hepatic flexure); just inferior to the right lobe Transverse & descending colon: left colic flexure (splenic flexure); just inferior to the spleen

Ascending & descending colon are retroperitoneal Transverse & sigmoid colon are intraperitoneal
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COLON
Sigmoid colon Begins above the pelvic inlet & extends to the vertebra SIII The S-shaped Mesentery:
Transverse mesocolon: suspends the transverse colon from the upper part of posterior abdominal wall Sigmoid mesocolon: suspends the sigmoid colon from the pelvic wall.

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RECTUM
Begins at the level of vertebra SIII, at the rectosigmoid junction. Location: posterior part of lesser pelvis, in front of the 3 pieces of lower sacrum & coccyx Retroperitoneal position
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RECTUM
Rectum shows 2 types of curvatures: Anteroposterior curves:
a) Sacral flexure b) Perineal flexure
b) a)

Mucosal folds:
Longitudinal folds: lies in the lower part of an empty rectum, and are obliterated by distension Transverse (horizontal) folds/valve (plicae transversalis recti): permanent.
Superior rectal valve: lies near the upper end of rectum, projects from the right or left wall. Middle rectal valve: lies at the upper end of the rectal ampulla. Projects from the anterior and right walls. Inferior rectal valve: lies 2.5 cm below the middle fold. Projects from the left wall.

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RECTUM
Peritoneal relations Upper 1/3 of rectum is covered by peritoneum Middle 1/3 of rectum, is covered only in anterior part. The lower 1/3 of rectum is devoid of peritoneum, and dilated to form the ampulla (ampulla recti). It lies posterior to Douglas pouch (rectouterine pouch) in females; and rectovesical pouch in male.

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RECTUM
CLINICAL APPLICATION Palpasi/ rectal touche Male: posterior surface of prostat, seminal vesicle, & vasa diferentia Female: perineal body & occasionally ovarium Male & female: anorectal ring, sacral & coccyg bones, ischiorectal fossa, sciatic spine

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 Terminal part of large intestine Lies between the 2 ischiorectal fossae The interior of the anal canal can be divided into 3 parts: Upper part (mucous): Limited below by pectinate line Anal columns (of Morgani) : containing the terminal radicles of superior rectal vessels Anal sinuses: small pocket above the anal valves Pectinate line: the circular line of attachment of the anal valves; separated the internal & external piles (haemorrhoids) Middle part (transitionalzone /pecten) Lies between the pectinate line & the white line of Hilton Lower part (cutaneus) External anal sphincter: voluntary control Internal anal sphincter: involuntary

ANAL CANAL

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ANAL CANAL
Anorectal ring: muscular ring that forms by fusion of puborectal muscle.

CLINICAL APPLICATION
Haemorrhoids external & internal Anal fissure Fistula ani
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ACCESSORIES DIGESTIVE ORGANS

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T E E T H
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TEETH
Vessels of the teeth Innervation of the teeth
Upper: anterior, middle, posrweioe superior alveolar nerves Lower: inferior alveolar nerve

Innervation of gingivae

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TONGUE
Forms part of the floor of the oral cavity. The anterior part is triangular in shape apex of tongue (apex linguae) Separated into 2/3 anterior & 1/3 posterior of tongue by a V-shaped terminal sulcus of tongue. The terminal sulcus forms the inferior of the oropharyngeal isthmus, between oral and pharyngeal cavity. Papillae: filliform, fungiform, vallate, foliate. Vessels: lingual artery & vein
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MUSCLE OF THE TONGUE

Extrinsic muscle, originate outside of the tongue and insert to the tongue: genioglossus, hyoglossus, styloglossus & palatoglossus muscles Intrinsic muscle, originate and insert within the tongue: superior & inferior longitudinal, transverse & vertical muscles. Function: alter the shape of the tongue: lengthening & shortening; curling & uncurling its apex and edges; flattening & rounding its surface.

TONGUE

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INNERVATION

TONGUE

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SALIVARY GLANDS
Opens into oral cavity Divide into: intrinsic & extrinsic salivary glands Intrinsic salivary glands: glands of tongue, palate, lips, dan pipi Extrinsic glands: parotid, submandibular, and sublingual glands

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PAROTID GLAND
The parotid duct across the external surface of masseter, & penetrates buccinator muscle.
It open into oral cavity adjacent to the crown of upper molar 2

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SUBMANDIBULAR & SUBLINGUAL GLANDS

SUBMANDIBULAR GLANDS Divided into 2 arms: the larger (superficial) and the smaller arm (deep) by mylohyoid muscle. Submandibular ducts drains into oral cavity, lateral to the base of frenulum of the tongue SUBLINGUAL GLANDS Location: on sublingual fossa, lateral to submandibular ducts Superior margin of the glands raises an elongate fold of mukosa sublingual folds. Sublingual ducts opens on to sublingual folds,
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ACCESSORIES DIGESTIVE GLANDS

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LIVER
Location: right hypochondrium & epigastric region or right upper quadrant Surfaces:

The porta hepatis consist of: hepatic artery proper, portal vein, hepatic duct

Diaphragmatic surface: anterior, superior & posterior direction Visceral surface: inferior direction. Covered by visceral peritoneum except in the fossa for gallbladder & at the porta hepatis.

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Lobes: divided into left & right lobes by the gallbladder & inferior vena cava. Includes caudate lobe on the upper part and quadrate lobe on the lower part of liver. Ligaments:

LIVER

Falcicorm lig.: attach the liver to the anterior abdominal wall Round ligament of liver: degeneration of umbilical vein Triangular lig.( left & right): attach the liver to the diaphragm Coronary lig.( anterior & posterior): attach the liver to the diaphragm Hepatogastric lig: connect the liver-stomach Hepatoduodenal lig: connect the liver-duodenum

Bare area of liver: an area between the liver & diaphragm which is devoid of peritoneum. Relation to other organs.

(The right colic flexure & colic transverse)

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LIVER
Ligaments:
Falcicorm lig.: attach the liver to the anterior abdominal wall Round ligament of liver: degeneration of umbilical vein Triangular lig.( left & right): attach the liver to the diaphragm Coronary lig.( anterior & posterior): attach the liver to the diaphragm Hepatogastric lig: connect the liverstomach Hepatoduodenal lig: connect the liverduodenum
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GALLBLADDER
Parts of gallbladder: Fundus: may project from the inferior border of liver Body of gallbladder. Neck of gallbladder. Duct: cystic duct Hepatic duct & cystic duct open to common bile duct (ductus coledochus) and drains to descending part of duodenum.
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GALLBLADDER
Projection to anterior abdominal:
The fundus of gallbladder can be located at the angle between the right border of rectus abdominis muscle and the lower costal margin of the vertebrae C10.
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PANCREAS
Extends across the posterior abdominal wall from the duodenum (on the right) to the spleen (on the left) Location: posterior to the stomach, retroperitoneal. It consist: The head :within the C-shaped of duodenum The uncinate process: projection of the lower part of the head, posterior to the superior mesenteric artery & vein The neck: anterior to the superior mesenteric artery & vein. The body: anterior to abdominal aorta The tail ends as it passes between layers of the splenorenal lig.

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PANCREAS

Tail

Body

Head

Pancreatic ducts: Major pancreatic duct : begins in the tail of the pancreas. The main pancreatic duct join the bile duct and forms the papilla of Vater, which enters the descending part of the duodenum at the major duodenal papilla of Vater.
Minor pancreatic duct: drains into the duodenum, above the major duodenal papilla at the minor duodenal papilla 69

BLOOD SUPPLIES

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ARTERIAL SUPPLY OF THE GASTROINTESTINAL VISCERA & ASSOCIATED ORGANS

The gastrointestinal viscera and associated organs are supplied by the anterior branches of the abdominal aorta. Celiac artery (celiac trunk): branches from the abdominal aorta below the aortic opening (at the upper border of vertebra LI) and supplies foregut derivatives.
abdominal part of esophagus, stomach, upper 1 parts of duodenum up to duodenal papilla of Vater, liver, common bile duct, pancreas, spleen

Superior mesenteric artery: branches from the abdominal aorta at the lower border of vertebra LI and supply midgut derivatives.
Lower 2 part of duodenum below the duodenal papilla of Vater, jejunum, ileum, cecum, appendix , ascending colon, right of 2/3 transverse colon

Inferior mesenteric artery: branches from the abdominal aorta at approximately vertebral level LIII and suplies hindgut derivatives.

Left of 1/3 transverse colon ,descending colon, sigmoid colon, rectum, upper part of the anal canal above the pectinate line.
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ANTERIOR BRANCHES OF THE ABDOMINAL AORTA

Superior mesenteric artery Celiac trunk Celiac trunk

Superior mesenteric artery

Inferior mesenteric artery Abdominal aorta FOREGUT

AORTA ABDOMINALIS

MIDGUT

HINDGUT

Inferior mesenteric artery

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CELIAC ARTERY (CELIAC TRUNK): BRANCHES

Left gastric artery:
Run downwards along the lesser curvature. Branches: esophageal & gastric branches Run along the superior border of the pancreas Branches: Short gastric artery: supply the fundus of the stomach Left gastro-omental (gastroepiploic) artery: run along the greater curvature of the stomach. Pancreatic branches Splenic branches

Splenic artery:

Common hepatic artery:

Right gastric artery: run along the lesser curvature Hepatic artery proper. Near the porta hepatis it divides into: right & left hepatic artery Gastroduodenal artery. Downward to duodenum. Branches: Supraduodenal artery Right gastro-omental (gastroepiploic) artery: run along the greater curvature of the stomach Superior pancreaticoduodenal artery: supplies the head of the pancreas and the duodenum. 73

Left gastric artery Splenic artery Common hepatic artery Celiac trunk

CELIAC TRUNK AND ITS BRANCHES

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SPLENIC ARTERY AND ITS BRANCHES

Short gastric artery

Gastro-omenta (Gastroepiploic) artery

Splenic artery

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COMMON HEPATIC ARTERY & ITS BRANCHES

Right hepatic artery

Left hepatic artery

Proper hepatic artery Gastroduodenal artery

Common hepatic artery

Right heparic artery

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SUPERIOR MESENTERIC ARTERY

Crossed anteriorly by the splenic vein & the neck of pancreas. Posterior to the artery: left renal vein, uncinate process of the pancreas & inferior (horizontal) part of the duodenum Branches:
Inferior pancreaticoduodenal artery:
duodenum the head of the pancreas & the

Intestines arteries ] jejunal & ileai arteries Ileocolic artery ] colic, cecal & appendicular branch Right colic artery : the ascending colon & the right flexure colon Middle colic artery: right 2/3 of the transverse colon
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SUPERIOR MESENTERIC ARTERY & ITS BRANCHES

MIDDLE COLIC ARTERY INFERIOR PANCREATICODUODENAL ARTERY
SUPERIOR MESENTERIC ARTERY

RIGHT COLIC ARTERY

JEJUNUM

JEJUNAL ARTERIES

ILEOCOLIC ARTERY

ILEAL ARTERIES APPENDICULAR ARTERIES

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INFERIOR MESENTERIC ARTERY

Branches: Left colic artery: supplies the left 1/3 of the transverse colon & the
descending colon Anastomose: middle colic & sigmoid arteries

Sigmoid arteries: supplies the lowest part of the descending colon

& the sigmoid colon Anastomose: left colic artery & superior rectal artery

Superior rectal artery: supplies the rectum & canal anal above the
pectinate line Divide into 2 terminal branch at the level vertebra SIII: right & left brances. Anastomose: middle rectal artery (branch of internal illiac artery) & inferior rectal artery (branch of internal pudendal artery)

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INFERIOR MESENTERIC ARTERY & ITS BRANCHES

RIGHT COLIC ARTERY

INFERIOR MESENTERIC ARTERY

SUPERIOR RECTAL ARTERY

SIGMOID ARTERIES

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VENOUS DRAINAGE OF THE GASTROINTESTINAL VISCERA & ASSOCIATED ORGANS

Venous drainage from the spleen, pancreas, gallbladder, and the abdominal part of the gastrointestinal tract (except for the inferior part of the rectum)

PORTAL VEIN

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PORTAL VEIN
Venous blood from stomach, duodenum, jejunum, ileum colon, rectum, pancreas, gallbladder & spleen enters the liver through hepatic portal vein sinusoids of liver hepatic veins drains into inferior vena cava enters the right atrium of the heart. Formed by the union of the splenic vein & superior mesenteric vein, at the level of the vertebra LII.

Course: passed posterior to the superior part of the duodenum & enters the hepatic portal vein with the bile duct & proper hepatic artery.
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PORTAL VEIN

PORTAL VEIN

SPLENIC VEIN INFERIOR MESENTERIC VEIN SUPERIOR MESENTERIC VEIN

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VENOUS DRAINAGE OF THE ABDOMINAL PORTION OF THE GASTROINTESTINAL TRACT

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PORTOCAVAL SYSTEM
Anastomosis (communication) between portal vein (portal system) with the vena cava (caval system). Forms collateral circulation in portal obstruction. Important sites: Abdominal part of the esophagus: Umbilicus
esophageal tributaries of the left gastric vein (portal) with esophageal tributaries of the azygos & hemiazygos veins (systemic)

Bare area of liver

paraumbilical veins (portal) & epigastric veins (systemic)

hepatic venules (portal) with the intercostal veins & phrenic vein (systemic) Veins of retroperitoneal organs (portal) with the retroperitoneal veins of the abdominal wall & the renal capsule (systemic) superior rectal vein (portal) with the middle rectal & inferior rectal veins (systemic)
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Posterior abdominal wall Anal canal

PORTOCAVAL SYSTEM
Tributaries to azygos vein

V. PORTA ROUND LIG. (LIG. TERES HEPATIS) &.PARAUMBICAL VEINS Superficial veins on abdominal wall INFERIOR VENA CAVA SUPERIOR RECTAL VEIN

INFERIOR RECTAL VIEN

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PORTOCAVAL SYSTEM
Portal vein obstruction portal hypertension Caput medusae at the umbilicus Esophageal varices at the gastroesophageal junction Haemorrhoids at the anorectal junction

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LYMPHATICS
Lymphatic vessels & nodes of the gastrointestinal tract & associated organs pre aortic lymph nodes Almost all the lymphatic vessels of the gastrointestinal viscera & associated organs drained to thoracic duct Run with arteries of the gastrointestinal viscera Pre aortic lymph nodes contains :
Celiac nodes (nn.ll.coeliacus) :
Receive lymph from the foregut origin: gastric (nn.ll. gastrica), hepatic (nn.ll. Hepatica) & pancreaticosplenic (nn.ll. Pancreaticolienalis) nodes Also receive lymph from superior & inferior mesenteric nodes

Superior mesenteric nodes (nn.ll. Mesenterica superior):

Receive lymph from the midgut origin: Mesenteric nodes, ileocolic nodes Also receive lymph from inferior mesenteric nodes. Drains to celiac nodes

Inferior mesenteric nodes (nn.ll. mesenterica superior):

Receive lymph from descending & sigmoid colon, superior part of the rectum, superior part of the canal anal. Drains to superior mesenteric nodes
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LYMPHATICS
Gastric nodes ] lies along lesser curvature. Receive lymph from the esophagus, lesser curvature, posterior-anterior-inferior aspect of the stomach. Hepatic nodes ] lies with hepatic artery. Receive lymph from the stomach, duodenum, liver, gallbladder & pancreas. Pancreaticosplenic nodes ] lies along splenic artery. Receive lymph from stomach, spleen & pancreas. Mesenteric nodes ] lies along superior mesenteric artery. Receive lymph from the jejunum & ileum (except from the terminal ileum) Ileocolic nodes ] lies along ileocolic artery. Receive lymph from the terminal ileum, appendix, cecum, ascending colon. Transverse mesocolic nodes ] between transverse mesocolon. Receive lymph from the transverse, descending & sigmoid colon.

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CELIAC & SUPERIOR MESENTERY NODES

NN.LL.COELIACUS

NN.LL.GASTRICUS

NN.LL.PANCREATICOLIENALIS

SUPERIOR MESENTERIC NODES

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CELIAC NODES
CELIAC NODES

CYSTIC NODES

HEPATIC NODES

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SUPERIOR & INFERIOR MESENTERIC NODES

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INNERVATION
Parasymphatetic : Increase peristaltic movement Increase secretion of the digestive glands Symphatetic : Inhibitory to peristalsis Increase contraction of the sphincter muscle

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INNERVATION
PARASIMPATIS Pusat : craniosacral Dorsal nuclei N.X esophagus, stomach, liver, pancreas, duodenum, jejunum, ileum, ascending colon , proximal 2/3 of transverse colon Sacral 2-4 1/3 proximal transverse colon, rectum, anus

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INNERVATION
SYMPHATETIC
Center : thoracolumbal Prevertebral ganglion : Celiac ganglion Superior mesenteric ganglion Inferior mesenteric ganglion
Stomach

Duodenum
Pancreas Spleen Liver

Jejunum, ileum, ascending colon, proximal 2/3 of the transverse colon

Distal 1/3 of the transverse colon, sigmoid colon, rectum, anus Urinary bladder Genital organs

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PARASYMPHATETIC Constricts pupil Inhibits tear glands

SYMPHATETIC Stimulates tear glands Dilates pupil Inhibits salivation, increases sweating Accelerates heart Dilates bronchi Decreases digestive functions of stomach Secretes adrenalin Decreases digestive function of intestine Inhibits bladder contraction 96

Increases salivation Slows heart

Constricts bronchi

Increases digestive function of stomach

Increases digestive function of intestine Contracts bladder

INNERVATION
CANAL ANAL
Above pectinate line:
symphatetic plexus hypogastrikus L1,2 parasymphatetic

Below pectinate line :

somatic (inferior rectal nerve)

97