RSR – 2014

FACULTY OF MEDICINE – UPH

LIPPO VILLAGE KARAWACI – TANGERANG - BANTEN

MANUAL OF ANATOMY LABORATORY

Bernard SM Hutabarat; dr, PAK

GASTROINTESTINAL BLOCK

MORTUI VIVOS DOCENT

( THE DEAD TEACH THE LIVING )

GENERAL RULES AT THE DISSECTING ROOM.

STUDENTS MUST:

1. Follow Code of Ethic of Anatomy ( Based on Mortui Vivos Docent )

1.1.Respect the cadavers as the students respect their living teachers.
1.2.NOT make fun of cadavers or parts of the cadavers whatever the condition of the
cadavers or parts of the cadavers might be
1.3.NOT throw part of the cadaver if his / her fellow student wants to borrow the
specimen
1.4.Give / take directly the specimen from his / her fellow student if he / she wants to
lend / borrow the specimen.
1.5.NOT damage cadavers or parts of the cadavers on purpose or for fun.
2. Prepare him / herself for Laboratory practice, including :
2.1. Study the Lab. Manual accordingly
2.2. Bring along Anatomy dissecting instruments ( minimum 1 for each group )
2.3. Bring along Lab. Manual, Anatomy atlas and ( if necessary ) lecture materials
2.4. Wear the required Laboratory dress properly
3. Work very carefully to avoid accidents from dissection instruments.

WEEK TWOO , JANUARY 11 ,14 AND 15 , 2016

TOPICS : LOWER G I T

COMPETENCY AREA : 5 ( APLICATION OF ANATOMY AS SCIENTIFIC BASIC

FOR GASTROINTESTINAL BLOCK )

COMPETENCY LEVEL : 4A ( ABLE TO IDENTIFY )

LEARNING OBJECTIVES :

After finished laboratory practice Students are able to identify :

1. Components of Lower Gastrointestinal tract:
1.1. Location of each components
1.2.Parts of each components.

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 1.3. Boundaries of each components
2. Vascularization of Lower G I T
3. Innervation of lower G I T
4. Accessory digestive organs : location , vascularization and innervation

ATTENTION FOR STUDENTS :

To achieve the learning objectives Students at Dissecting Room must do the

following procedures:
1. Identify at the cadaver location of the lower GIT by using quadrant of four and region
of nine methods.

2. Discuss among the group characteristics of the small intestine (intestinum tenue).
Identify it at the specimen.
à plica kerchringi
à villi intestinales
à jaringan lymphoid (PLAQUE PEYER) à noduli limfatisi
3. Discuss among the group what is the difference in external appearance
between.duodenum and jejunum/ileum.
à tidak ada penggantung
4. Discuss among the group the differences between jejunum and ileum.
Identify as much as possible those differences at the specimen.
No. Pembanding Jejunum Illeum
1 Vasa recta dan arcade arcade tidak bertingkat vasa recta kelihatan lebih
(simple) shg vasa recta pendek karena arcadenya
kelihatan lebih panjang bertingkat-tingkat
2 Absorpsi makin ke distal Surface area dan pembuluh Surface area dan
makin sedikit/ darah lebih banyak pembuluh darah lebih
berkurang sedikit

2

3 penampang/ diameter
4 Lumen
5 Mesentrial fat (adiposa
mesentericum)
terutama di antara vasa recta
Plica; lebih rapat, tebal, vili lebih sedikit (kurang
padat, dan vili panjang velvetty)
(velvetty feeling)
lebih merah (banyak o
pembuluh darah)
jejunum > ileum
ileum > jejunum
tidak sepenuhnya sampai ke tertutup rapat, jadi tidak
tepi, shg meninggalkan ada mesenteric window
bagian radiolucent
(mesenteric window/
venestra mesenterica);

6 Noduli limfatisi Satu (soliter) Agregati (berkelompok)

à Vasa recta dan arcaden

5. Identify at the caecum anatomical structures at the location where terminal ileum
(pars terminalis ilei) ended. Look for:

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 5.1. Ileocecal valve (valvula ileocaecalis)
5.2. Ileal orifice (ostium ileale)
5.3. Frenulum of ileal orifice (frenulum ostii ilealis)
5.4. Superior ileocolic lip ( labrum ileocolicum superius ) à yang deket colon
5.5. Ileocaecal lip ( labrum ileocaecale ) à yang deket cecum

à fungsinya untuk mencegah regurgitant ke ileum (ileocecal junction)

LARGE INTESTINE ( INTESTINUM CRASSUM )

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1. Discuss among the group composition of large intestine.
2. Discuss among the group characteristics of the large
intestine. Look for those characteristics at the specimen.
à Taenia coli (taenia liberae) àbebas, kalau 2 taenia lainnya:
- Taenia mesocolica tertutup mesocolon
- Taenia omentalis tertutup omentum
à Haustrae: terbentuk karena taenia coli; plica longitudinalis dan plica circularis gak
sama panjang
à Appendices epiploicum/ omentum = peritoneal-covered accumulations of fat
3. What is the clinical application of taeniae coli?
à bisa cari appendix dengan menelusuri taenia coli, lihat ileum terminalis juga
bermuara di cecum
4. Discuss among the group which of the taeniae coli that has clinical application. Why? Taenia
liberae?

5. Identify anatomical structures that ended at caecum. Look for :

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5.1. Terminal ileum ( pars terminalis ilei )
5.2. Vermiform appendix ( appendix vermiformis )
5.3. Discuss among the group variety of the position of vermiform appendix
according to Wakeley. Which one is the most usual position ?
à meneliti modifikasi appendix pada cadaver
à paling banyak à retrocecal
à paling banyak kedua à ileocecal

5.4. Orifice of vermiform appendix (ostium appendicis vermiformis )

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 5.5. Discuss among the group how to determine the position / location of vermiform
appendix. Make the projections of the location at the cadaver:

5.5.1. Line of Lanz

à untuk menentukan posisi dari orifice appendix vermiformis (muara
caecum)

à garis yang melewati umbilicus ke

SIAS 5.5.4. Point of McBurney
à 1/3 lateral 2/3 medial dari umbilical dan SIAS; semua sakit terpusat di
sana
6. Study the colic flexures ( flexurae colicae ). Look for ( if the specimen are not
available, use your anatomy atlas ) :
6.1. Right colic flexure ( hepatic flexure, flexura coli dextra , flexura coli hepatica )
6.2. Left colic flexure ( splenic flexure , flexura coli sinistra , flexura coli splenica )

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 6. 3. Why did those flexures were also named; hepatic and splenic flexures ? karena
nekuknya di bawah hepar dan spleen
7. Where do transverse colon ( colon transversum ) ended ? flexura coli splenica à just
below the spleen
8. What is the name of the continuation of transverse colon ? descending colon?
9. What is the name of the continuation of descending colon ( colon descendens ) ?
Sigmoid colon

ACCESSORY DIGESTIVE ORGANS ( ORGANAE DIGESTIVAE ACCESSORIAE )

1. Discuss among the group Accessory digestive organs. Make the projection at the
cadaver of :
1.1.Its components: tongue, salivary glands, pancreas, liver, gallbladder
1.2.Its location
1.3.Their excretory ducts

2. Identify:parts of the liver ( hepar ) at the specimen. Look for ::

3.
2.1. Diaphragmatic surface of liver ( facies diaphragmatica hepatis )
2.2. Visceral surface of liver ( facies visceralis hepatis )
2.3. Superior surface of liver ( facies superior hepatis )
2.4. Anterior part of liver ( pars anterior hepatis )
2.5. Inferior border of liver ( margo inferior hepatis )
2.6. Coronary ligament of liver ( ligamentum coronaria hepatis )
2.7. Right triangular ligament of liver ( lig. triangulare dextra )
2.8. Left triangular ligament of liver ( lig. triangulare sinistra )
2.9. Falciform ligament of liver ( lig. falciforme hepatis )
2.10. Bare area of liver ( area nuda hepatis ). Discuss among the group why that part was
named bare area. Karena bagian itu tidak dilapisi peritoneum

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2.11. Round ligament of the liver ( ligamentum teres hepatis )
What is the name of its embryologic origin and function ?
à sisa embryonal dari penggantung vena umbilicales, yang menyalurkan darah
kaya oksigen dalam fetal circulation à akan berhubungan dengan lig. Coronarium
dan daerah ini tidak tertutup oleh peritoneum à AREA NUDA HEPATIS]

2.12. Inferior vena cava ( V. cava inferior )

2.13. Discuss among the group the lobes of the liver. Look for :
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à di bagian dorsal liver terdapat fissura sagitalis dextra et sinistra, dan porta hepatica yang
membentuk huruf H
à Porta hepatica membagi struktur di bagian:
- Dextra: vena cava inferior dan vesica fellea
- Sinistra: Lig. Venosum arantii (cranial) dan Lig. Falciformehepatis/ teretis
- lobus caudatus (cranial) dan quadratus (caudal)
2.13.1. Right lobe of liver ( lobus hepatis dexter )
2.13.2. Quadrate lobe of liver ( lobus quadratus hepatis )
2.13.3. Caudate lobe of liver ( lobus caudatus hepatis )
2.13.4. Left lobe of liver ( lobus hepatis sinister )
2.14. Discuss among the group what is the pattern of facies visceralis hepatis.
Identify it and the anatomical structures located there. Look for :
2.14.1. Left lobe of liver
2.14.2. Gastric impression ( impressio gastrica )
2.14.3. Fissure for ligamentum venosum ( sulcus ligamenti venosi )
2.14.4. Ligamentum venosum ( lig. venosum ) Arantii.
What is the name of its embryologic origin and its function?
à dari Ductus venosus yang bypass liver di fetal circulation

2.14.5. Groove for vena cava ( sulcus venae cavae )

2.14.6. Fossa for gallbladder ( fossa vesicae biliaris , fossa vesicae felleae )
2.14.7. Gallbladder ( vesica vellea ). Identify its part, Look for :
2. 14.7.1. Fundus of gallbladder ( fundus vesicae biliaris , fundus vesicae
felleae )
2. 14.7.2. Neck of gallbladder ( collum vesicae biliaris , collum vesicae
felleae )
2. 14.7.3. Body of gallbladder ( corpus vesicae biliaris , corpus vesicae
felleae )
2.14.7.4. Infundibulum of gallbladder ( infundibulum vesicae biliaris )
2.14.7.5. Spiral fold / valve ( plica / valvula spiralis Heisteri )
2.14.7.6. Bile duct ( ductus choledochus , ductus biliaris ).
What ducts form ductus chodelochus ?
2.14.7.7. Discuss among the group :
2.14.7.7.1. Where do bile duct endedpars descenden duodenum
2.14.7.7.2. What is the name of anatomical structures form by
bile duct and pancreatic duct ( ductus pancreaticus
Wirsungi ) at the duodenum papilla duodeni majori
2.14.7.7.3. The name of anatomical structures form by those
ducts before ended.Ampulla hepatopancreatica
2.14.7.7.4. Look for the above mention anatomical structures
at the specimen.

2.14.8. Porta hepatis.

2.14.9. Identify anatomical structures located at porta hepatis. Look for :
2.14.9.1. Common hepatic artery ( A. hepatica communis ). Where is the
origin of this artery? Truncus coeliacus
2.14.9.2. Common hepatic duct ( ductus hepaticus communis )
2.14.9.3. Portal vein ( V. porta )
Discuss among the group what veins make portal vein..
à V. lienalis dan V. mesentrica superior (dan V. mesentrica inferior)
2.14.9.4. What is the name of ligament that covers those three structures?

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 à Ligamen hepatoduodenale (menutupi a. hepatica communis, V.
porta, ductus choledochus)

2.14.10. Omental tuberosity ( tuber omentale )

2.14.11. Colic impression ( impressio colica )
2.14.12. Renal impression ( impressio renalis )

3. Identify parts of the pancreas. Look for :

3.1. Head of pancreas ( caput pancreatic )

3.2. Neck of pancreas ( collum pancreatic )
3.3. Body of pancreas ( corpus pancreatic )
3.4. Tail of pancreas ( cauda pancreatic )
3.5. Pancreatic duct ( ductus pancreaticus Wirsungi )
3.6. ( If available ) Accessory pancreatic duct ( ductus pancreaticus accessorius
Santorini )
3.7. Excretory ducts of pancreas form a fish bone appearance. What is the name
of that appearance ? Discuss it with your fellow students. Herring Bone
System/ appearance (ductus pancreaticus beserta ductuli pancreatisi)

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4. Discuss among the group vascularization and innervation of the lower G I T.

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Tambahan: Lien (spleen)

Posisi lienalis à ada incisura lienalis pada margo anterior ( yang teraba saat palpasi
Schuffner’s line)
à Arteri lienalis (harus berakhir di lien); setelah dipercabangkan dari arteri colliaca/
tricuscalari akan berjalan di permukaan cranial dari pancreas.

SPECIMENS :

1. Cadaver
2. Organs of lower G I T.
3. Organs of Accessory digestive organs.
4. Plastinates

INSTRUCTORS :

1. Bernard SM Hutabarat,dr,PAK
2. Stefanus S Sumali,dr,MBiomed
3. Deisy Budiono,dr

REFERENCES

1. Atlas of Anatomy:
2. Lecture materials
3 Nomina Anatomica, 6th edit,Churchill Livingstone,1989.
5. Terminologia Anatomica, Federative International Programme on Anatomical Terminologies
( FIPAT ), 2nd edit., Georg Thieme Verlag, 1998
5. Textbook of Anatomy

GOD SPEED AND BLESS THE STUDENTS

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