ANATOMY OF GASTROINTESTINAL

SYSTEM

ANATOMY DEPARTMENT
FMUI

1 Anatomy/2008 Upload : 30 April 2009

 GASTROINTESTINAL SYSTEM

Alimentary canal
(gastrointestinal tract):
digestive tube.

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

Accessory digestive
organs

Teeth, tongue.

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

2 Anatomy/2008
 ABDOMINAL WALL

Boundaries:

Superior: xyphoid process &
costal margin

Posterior: vertebral column

Inferior: upper parts of the
pelvic bones.

Layers of the abdominal wall

3 Anatomy/2008
 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

4 Anatomy/2008
 ABDOMINAL WALL IA
INGUINAL REGION

Inguinal ligament

Inguinal canal

Structures passing through
the canal (male & female)

Superficial inguinal ring
(annulus inguinalis lateralis/
superficial)

Deep inguinal ring (annulus
inguinalis medialis
/profundus)

Conjoint tendon

Inguinal hernias: direct &
inderect

5 Anatomy/2008
 CANALIS INGUINALIS (MALE)

6 Anatomy/2008
 CANALIS INGUINALIS (FEMALE)

7 Anatomy/2008
 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).
8 Anatomy/2008
 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

9 Anatomy/2008
 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)

10 Anatomy/2008
 ABDOMINAL REGIONS AND QUADRANTS

Midclavicular plane

Subcostal plane

Transtubercular
plane

(a) (b)

Divisions of the anterior abdominal wall for mapping the digestive organs into
abdominal cavity
(a) The nine surface regions of the anterior abdominal wall
(b) The abdominal viscera as they relate to the nine surface
Anatomy/2008
11
 ABDOMINAL REGIONS AND QUADRANTS

(c) Simpler scheme of four quadrants

centered at the navel

12 Anatomy/2008
13 Anatomy/2008
 GASTROINTESTINAL TRACT

14 Anatomy/2008
 THE MOUTH

Boundaries:

Anterior: lips

Lateral: cheeks

Superior: palate

Inferior: tongue

Posterior: fauces of the oropharynx (
isthmus faucium)

Divided into:

The vestibule (vestibulum oris)

Oral cavity proper (cavitas oris
proria): lies internal to the teeth

15 Anatomy/2008
 ORAL CAVITY
ORAL CAVITY PROPER
Roof:

Anterior: hard palate (palatum durum)

Posterior: soft palate (palatum molle)

Floor:

Mostly anterior 2/3 of tongue,

gum (mandible side)

Base of mouth

frenulum of tongue: a single median fold that
continuous with the mucosa covering the floor
of oral cavity.

Right/left to frenulum of tongue
opening
of submandibular glands

16 Anatomy/2008
 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

17 Anatomy/2008
 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.

18 Anatomy/2008
 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

19 Anatomy/2008
 IA
SWALLOWING MECHANISM

20 Anatomy/2008
 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

21 Anatomy/2008
 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

22 Anatomy/2008
23 Anatomy/2008 23
 ESOPHAGUS IA

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

24 Anatomy/2008
 ESOPHAGUS
Thoracic part IA

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)

25 Anatomy/2008
 ESOPHAGUS IA
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.

26 Anatomy/2008
 ESOPHAGUS IA
CLINICAL APPLICATION

esophageal Varices

cardia achalasia

Hernias

27 Anatomy/2008
 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.

28 Anatomy/2008
 THE STOMACH J - shaped
Regions :

Cardia : opening of oesophagus into
the stomach)

Fundus (dome shape): area above
the cardiac opening (orificium
cardiaca)
Lesser curvature

Body of stomach (corpus)

Pylorus:

Pyloric antrum (cave): wide area
of pylorus

Pyloric canal : distal end of the
Graeter
curvature
stomach

Pyloric sphincter

29 Anatomy/2008
 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

30 Anatomy/2008
 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

31 Anatomy/2008
 STOMACH
Relation to other organs IA
(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

32 Anatomy/2008
 STOMACH
IA

• 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

33 Anatomy/2008
 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.

34 Anatomy/2008
 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

35 Anatomy/2008
 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

36 Anatomy/2008
37 Anatomy/2008
 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

38 Anatomy/2008
 JEJUNUM & ILEUM

Jejunum (proximal
2/5 of jejunum-
ileum; mostly in left
upper quadrant)

Ileum (distal 3/5 of

jejunum-ileum;
mostly in right
lower quadrant)

39 Anatomy/2008
 CHARACTERISTIC OF JEJUNUM & ILEUM

Or “windows”
40 Anatomy/2008
Mesentery of jejunum Mesentery of ileum
 CHARACTERISTIC OF JEJUNUM & ILEUM

Characteristics Jejunum Ileum

Location Upper left quadrant Lower right quadrant
Diameter 2 – 4 cm 2 – 3 cm
Lumen Wider Narrower
Walls Thicker and more vascular Thinner and less vascular
Circular mucosal folds (plicae
Larger and more closely set Smaller and sparse
circulares)
No Windows windows present
Fat less abundant Fat more abundant
Mesentery Arterial arcade, 1 or 2 Arterial arcades, 3-6
Vasa recta shorter & more
Vasa recta, longer & fewer
numerous
Lymphoid nodules
absent present
(Peyer’s Patches)

41 Anatomy/2008
 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

Characteristic: appendices epiploicae, taenia coli,
Appendix epiploicae

sacculation (haustra), semilunar fold

42 Anatomy/2008
 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.

43 Anatomy/2008
 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

44 Anatomy/2008
 McBurney’s Point

45 Anatomy/2008
 CECUM & APPENDIX IA
APPENDICITIS

Rovsing’s sign

Psoas Sign (Cope):

Obturator sign (Cope):

46 Anatomy/2008
 APPENDIX

Position of the appendix:

a. Pelvic
b. Retrocecal
c. Preilieal
d. Postileal (retroileal)
47 Anatomy/2008
 COLON
(2)

(3)
(1)

Colon extends (4)

superiorly from
the cecum.
48 Anatomy/2008
 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

49 Anatomy/2008
 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.

50 Anatomy/2008
 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

51 Anatomy/2008
52 Anatomy/2008
 RECTUM
a)
Rectum shows 2 types of curvatures:

Anteroposterior curves:
a) Sacral flexure
b) Perineal flexure b)

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.
53 Anatomy/2008
 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.

54 Anatomy/2008
 RECTUM IA
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

55 Anatomy/2008

Terminal part of large intestine

Lies between the 2 ischiorectal fossae
ANAL CANAL
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

56 Anatomy/2008
 ANAL CANAL

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

CLINICAL APPLICATION IA

Haemorrhoids external & internal

Anal fissure

Fistula ani

57 Anatomy/2008
 ACCESSORIES DIGESTIVE
ORGANS

58 Anatomy/2008
 IA

T
E
E
T
H

59 Anatomy/2008
 IA

TEETH

Vessels of the teeth

Innervation of the teeth

Upper: anterior, middle,
posrweioe superior alveolar
nerves

Lower: inferior alveolar nerve

Innervation of gingivae

60 Anatomy/2008
 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

61 Anatomy/2008
 TONGUE
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.

62 Anatomy/2008
 TONGUE
INNERVATION

63 Anatomy/2008
64 Anatomy/2008 64
 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

65 Anatomy/2008
 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

66 Anatomy/2008
 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,
67 Anatomy/2008
 ACCESSORIES DIGESTIVE
GLANDS

68 Anatomy/2008
 LIVER

Location: right hypochondrium &

epigastric region or right upper
quadrant

Surfaces:

Diaphragmatic surface: anterior,
superior & posterior direction

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

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

69 Anatomy/2008

Lobes: divided into left & right lobes
by the gallbladder & inferior vena
LIVER
cava. Includes caudate lobe on the
upper part and quadrate lobe on the
lower part of 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
liver-stomach

Hepatoduodenal lig: connect the
liver-duodenum

Bare area of liver: an area between
the liver & diaphragm which is
devoid of peritoneum. (The right colic flexure & colic transverse)

Relation to other organs.

70 Anatomy/2008
 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
liver-stomach

Hepatoduodenal lig: connect the
liver-duodenum

71 Anatomy/2008
 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.

72 Anatomy/2008
 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.

73 Anatomy/2008
 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.

74 Anatomy/2008
 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
75 Anatomy/2008
 BLOOD SUPPLIES

76 Anatomy/2008
 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 ½ 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 ½ 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.

77 Anatomy/2008
78 Anatomy/2008
 ANTERIOR BRANCHES OF THE ABDOMINAL AORTA

Superior mesenteric
artery
Celiac trunk
Celiac trunk
Superior mesenteric
artery
Abdominal aorta FOREGUT
Inferior mesenteric artery

AORTA ABDOMINALIS

MIDGUT

HINDGUT

Inferior mesenteric artery

79 Anatomy/2008
 CELIAC ARTERY (CELIAC TRUNK): BRANCHES
Left gastric artery:

Run downwards along the lesser curvature.

Branches: esophageal & gastric branches

Splenic artery:

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

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.

80 Anatomy/2008
 Left gastric artery

Splenic artery

Celiac
Common hepatic artery
trunk

CELIAC TRUNK
Anatomy/2008
AND ITS BRANCHES
81
 SPLENIC ARTERY AND ITS BRANCHES
Short gastric artery

Gastro-omenta
(Gastroepiploic) artery
Splenic artery

82 Anatomy/2008
 COMMON HEPATIC ARTERY & ITS BRANCHES
Right hepatic artery

Left hepatic artery

Proper hepatic artery

Gastroduodenal artery
Common hepatic artery

Right heparic artery

83 Anatomy/2008
 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: the head of the pancreas & the
duodenum

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

84 Anatomy/2008
 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

85 Anatomy/2008
 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)

86 Anatomy/2008
 INFERIOR MESENTERIC ARTERY
& ITS BRANCHES

RIGHT COLIC ARTERY

INFERIOR MESENTERIC ARTERY

SUPERIOR RECTAL ARTERY

SIGMOID ARTERIES

87 Anatomy/2008
 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

88 Anatomy/2008
 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.

89 Anatomy/2008
 PORTAL VEIN

PORTAL
VEIN

SPLENIC VEIN
INFERIOR MESENTERIC VEIN
SUPERIOR MESENTERIC VEIN

90 Anatomy/2008
 VENOUS DRAINAGE OF THE ABDOMINAL PORTION OF THE GASTROINTESTINAL
TRACT

91 Anatomy/2008
 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:

esophageal tributaries of the left gastric vein (portal) with esophageal tributaries of the
azygos & hemiazygos veins (systemic)

Umbilicus

paraumbilical veins (portal) & epigastric veins (systemic)

Bare area of liver

hepatic venules (portal) with the intercostal veins & phrenic vein (systemic)

Posterior abdominal wall

Veins of retroperitoneal organs (portal) with the retroperitoneal veins of the abdominal wall
& the renal capsule (systemic)

Anal canal

superior rectal vein (portal) with the middle rectal & inferior rectal veins (systemic)

92 Anatomy/2008
 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

93 Anatomy/2008
 PORTOCAVAL SYSTEM

Portal vein obstruction
portal hypertension

Caput medusae
at the umbilicus

Esophageal varices
at the gastroesophageal
junction

Haemorrhoids
at the anorectal junction

94 Anatomy/2008
 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
95 Anatomy/2008
 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.

96 Anatomy/2008
 CELIAC & SUPERIOR MESENTERY NODES

NN.LL.COELIACUS

NN.LL.GASTRICUS
NN.LL.PANCREATICOLIENALIS

SUPERIOR MESENTERIC NODES

97 Anatomy/2008
CELIAC NODES

CELIAC NODES

CYSTIC NODES

HEPATIC NODES

98 Anatomy/2008
 SUPERIOR & INFERIOR MESENTERIC NODES

99 Anatomy/2008
 INNERVATION

Parasymphatetic :

Increase peristaltic movement

Increase secretion of the digestive glands

Symphatetic :

Inhibitory to peristalsis

Increase contraction of the sphincter muscle

100 Anatomy/2008
 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

101 Anatomy/2008
 INNERVATION
SYMPHATETIC Stomach
Duodenum

Center : thoracolumbal Pancreas

Spleen
Prevertebral ganglion : Liver

Celiac ganglion Jejunum, ileum, ascending colon,

proximal 2/3 of the transverse

Superior mesenteric ganglion colon

Inferior mesenteric ganglion

Distal 1/3 of the transverse
colon, sigmoid colon, rectum,
anus

Urinary bladder
Genital organs

102 Anatomy/2008
 PARASYMPHATETIC SYMPHATETIC

Constricts pupil Stimulates tear glands

Inhibits tear glands Dilates pupil

Inhibits salivation,
Increases salivation increases sweating

Accelerates heart
Slows heart

Dilates bronchi
Constricts bronchi

Decreases digestive
functions of
stomach
Increases digestive
function of stomach Secretes adrenalin

Decreases digestive
Increases digestive
function of function of
intestine
intestine

Inhibits bladder
Contracts bladder contraction
103 Anatomy/2008
 INNERVATION
CANAL ANAL

Above pectinate line:

symphatetic plexus hypogastrikus L1,2

parasymphatetic

Below pectinate line :

somatic (inferior rectal nerve)

104 Anatomy/2008
 Referred pain

105 Anatomy/2008
 Referred pain

106 Anatomy/2008
107 Anatomy/2008