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Nov.9, 2011
Dr. Elevazo
A.LIPS
2 fleshy folds that surround the oral orifice
Covered on the outside by skin and lined on the inside by mucous
membrane
Substance is made up by the orbicularis oris ms & muscles that
radiate from the lips into the face, and contains labial blood
vessels and nerves, CT and salivary glands
o philtrum Shallow vertical grove seen in the midline on the
outer surface of upper lip
o labial frenula Median folds of mucous membrane that
connect inner surface of the lips to the gums; cause problems in
the fitting of artificial dentures
Food is chewed by the teeth and saliva from salivary glands
facilitates the formation of bolus
o Deglutition (swallowing) is voluntarily initiated
B.VESTIBULE
A slit-like space that communicates with the exterior thru the oral
fissure when mouth is open and communicates with mouth
rd
proper behind 3 molar on each side when jaws are closed
o Lies between lips and cheeks (externally)
o Lies between gums and teeth (internally)
The vestibule and oral cavity proper are separated by teeth and
alveolar processes of mandible and maxilla
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Page 1 of 17
E.PALATE
Forms roof of the mouth; floor of nasal cavity
Separates oral cavity from nasal cavity and nasopharynx
Divided into two:
o Hard Palate
o Soft Palate
HARD PALATE
o Anterior palate; continuous behind with the soft palate
Formed by palatine process of maxillae and horizontal
plates of palatine bones; bounded by alveolar arches
o Covered with mucous membrane
o Space filled with the tongue when it is at rest
o Foramina: Areas where dentist injects anesthesia
o Incisive fossa: Slight depression post. To the central incisor
teeth
o Incisive canals and foramina that open into the fossa contain
nasopalatine nerves
o 2 openings found in the postero-lateral end:
Greater palatine foramen (pl, foramina)
- Medial to the 3rd molar tooth; pierces the lateral border of
the bony palate from which greater palatine vessels and
nerve emerge
Lesser palatine foramen (pl, foramina)
- Transmit lesser palatine nerves and vessels
- Posterior to the greater palatine foramen, pierces the
pyramidal process of the palatine bone
o Undersurface is covered by: mucoperiosteum, and possess
median ridge
Has palatine raphe and transverse palatine folds
o Mucous membrane covered by stratified squamous epithelium
(at posterior, possess many mucous glands)
Muscles of Mastication
o All are innervated by mandibular branch of CNV and all crosses
the TMJ
Temporalis Elevates (anterior fibers) & retracts (posterior
fibers) mandible
Masseter Elevates mandible
Medial pterygoid Elevates mandible
Lateral pterygoid Depresses and protracts mandible
o Buccinator muscle is an accessory muscle of mastication
o Muscles that protract the mandible:
Pterygoids (internal and external)
Masseter
Temporalis (anterior fibers)
o Muscles that retract the mandible:
Temporalis (posterior fibers)
CLINICAL CORRELATON
Excessive contraction of lateral pterygoid muscles can
dislocate the jaw anteriorly (most of the time, because head
is in front of anterior tubercle) due to the intrinsic ligament
and glenoid tubercle
In surgical correction, facial nerve and auriculotemproal
branch of mandibular nerve are prone to damage
SOFT PALATE
o A mobile fold attached at posterior of hard palate
o Closes the nasopharynx
o Covered on its upper and lower surfaces by mucous
membrane
o Contains aponeurosis, muscle fibers, lymphoid tissue, glands,
vessels and nerves
o Laterally continuous with the wall of the pharynx
Joined to the tongue by the palatoglossal arch and to the
pharynx by the palatopharyngeal arch
Palatine tonsils masses of lymphoid tissue, one on each
side of the oropharynx; each lies in a tonsillar sinus (fossa),
bounded by the palatoglossal and palatopharyngeal arches
and the tongue
Uvula conical projection at its free posterior border in the
midline
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Palatoglossus
Palatopharyngeus
Musculus uvulae
Main Action
Tenses soft palate
and opens the
pharyngotympanic
tube during
swallowing and
yawning
Elevates soft palate
during swallowing
and yawning
Elevates posterior
part of tongue and
draws soft palate
onto tongue
Tenses soft palate
and pulls walls of
pharynx during
swallowing
Shortens uvula and
pulls it superiorly
Innervation
Medial pterygoid nerve
(a branch of mandibular
nerve CN V3)
o Root canal transmits nerves and vessels to and from the pulp
cavity through the apical foramen
o Apical foramen transmits blood vessels, lymph and nerves. It
is the opening at each root
o Pulp cavity internal tooth portion
Odontoblast, a single layer of cells, surround the dentin layer
Surrounded by dentin (the most sensitive part of the teeth)
Contains blood vessels, lymph and nerves
Protected by enamel at area of crown
Protected by cementum at area of root
o Alveolar periosteum - anchors the teeth
Pharyngeal branch of
vagus nerve (CN X) via
pharyngeal plexus
F. TEETH
Functions:
o incise, reduce, mix with saliva, and grind during mastication
o support and protect the oral cavity articulation(speech)
There are two sets of teeth
o Deciduous teeth (temporary) / milk teeth
o Permanent teeth
DECIDOUS TEETH OR MILK TEETH
o Begin to erupt about 6 months after birth
o Completely erupted by the end of second year
Central incisors (6-8 mos)
Lateral incisors (8-10 mos)
First molars (1 yr)
Canines (18 mos)
Second molars (2 yrs)
o There are 20 in number (5 on each side of the jaw)
4 incisors
2 canines
4 molars in each jaw
Teeth on the lower jaw usually appear before those on upper jaw
Lower central incisor first to erupt (temporary set) around 6 months
PERMANENT TEETH
Teeth on the lower jaw usually appear before those on upper jaw
Lower first molar first to erupt (permanent set)
It is connected to the bone via special type of fibrous joint called
GOMPHOSIS or Dento-alveolar syndesmosis
PARTS OF A TOOTH
o Crown part that protects beyond the gums (it is above the
gum/gingival)
o Neck constricted portion between crown and root
o Root embedded in maxilla and mandible (alveolar
periosteum); attached to alveolar process of mandible or
maxilla
G. TONGUE
Mobile mass of voluntary striated muscles covered with mucous
membrane
Anterior two thirds lies at mouth
Posterior lies at pharynx
Muscles; attach it to styloid process and soft palate above, and to
mandible and hyoid bone below
Also used in phonation
Arises from floor of mouth
PARTS OF THE TONGUE
Roof inferior, relatively fixed part attached to the hyoid and
mandible and in proximity to the geniohyoid and mylohyoid
muscles; it is the pharyngeal portion of the tongue
Body remaining part: anterior 2/3
Apex pointed anterior part of the body
Dorsum posterosuperior surface of the tongue, which includes a
v-shaped groove(terminal sulcus), the apex of which points
posterior to the foramen cecum
Upper surface of the tongue
o Fibrous septum divides tongue in left and right halves
o Sulcus terminalis divides mucous membrane of the upper
surface of tongue into posterior thirds (pharyngeal part) and
anterior 2/3 (oral part); apex directed posteriorly
o Foramen Cecum a small pit that marks the apex of the sulcus
projecting backward; remnant of thyroglossal duct (where fetal
thyroid starts to develop)
Anterior 2/3 of the tongue (upper surface)
o Papillae increase the area of contact between the surface of
the tongue and the contents of the oral cavity; for proper
handling of food
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CLINICAL CORRELATON
If there is lesion in the peripheral nerve, when you stick out your
tongue you expect it to go to the direction of the lesion
Table3. Muscles of the Tongue
MUSCLE
ACTION
Extrinsic
acting bilaterally: depress central
Genioglossus
part of tongue, acting unilaterally:
fan-shaped
deviate tongue toward contralateral
side
depresses tongue, pulling its sides
Hyoglossus thin,
inferiorly, aids in retrusion
quadrilateral muscle
(retraction)
retrudes the tongue and curls its
Styloglossus small
sides, acting with genioglossus
short muscle
creates a trough during swallowing
Palatoglossus
elevates tongue, pulls down soft
primarily pharyngeal
palate
Intrinsic muscles not attached to bone
Superior longitudinal
muscle thin layer
curls apex of tongue, makes dorsum
deep to mucous
of tongue concave longitudinally
membrane on dorsum
of tongue
curls apex of tongue inferiorly,
Inferior longitudinal
makes dorsum of tongue convex
muscle narrow bands
superior and inferior makes
close to inferior
tongue short and thick in retracting
surface
the protruded tongue
Transverse muscle
narrows and increase the height of
lie deep to superior
tongue
longitudinal muscle
flattens and broadens the tongue
Vertical muscle runs
inferolaterally from
transverse and vertical makes
dorsum of tongue
tongue long and narrow
NERVE SUPPLY
Hypoglossal
nerve
Pharyngeal
plexus
Hypoglossal
nerve
Note:
- ALL muscles of tongue are supplied by hypoglossal nerve EXCEPT the
palatoglossus ms, which is supplied by the pharyngeal plexus
- The pharyngeal plexus is from vagus n., glossopharyngeal n., and
sympathetic n.
Table 4. Taste Buds
GENERAL SENSATION
Anterior 2/3
Posterior 1/3
TASTE
Chorda tympani (facial
Lingual n. (mandibular
n.) EXCEPT vallate
br. of trigeminal n)
papillae
Glossopharyngeal n.
posteromedial aspect partly innervated by Vagus
nerve
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LOCATION
ARTERIAL SUPPLY;
VENOUS DRAINAGE
Parotid glands
- largest of the major
salivary glands
- duct is called
Stensens duct
along body of
mandible
floor of the mouth
between mandible &
genioglossus ms.
submental a.;
submental v.
Submandibular gland
Sublingual gland
- smallest & most
deeply situated
sublingual a. &
submental a.
o
o
o
o
o
II. PHARYNX
From base of skull to lower cricoid cartilage (C6 level)
Behind the nasal cavities, the mouth and the larynx
A musculomembranous tube
Funnel-shaped; common passage of food and air
Upper, wide-end lie under the skull
Lower, narrow end becomes continuous with esophagus opposite
C6.
Has musculomembranous walls, which is deficient anteriorly
(replaced by posterior nasal apertures, oropharyngeal isthmus
and inlet to larynx)
Pharynx connects with 7 cavities anteriorly
(R) & (L) nasal cavities (choanae/nares)
(R) & (L) eustachian tube (lateral)
Oral cavity (front)
Laryngeal cavity
Esophagus (below)
A.MUCOUS MEMBRANE
Continuous with the nasal cavity, mouth and the larynx
Continuous with the tympanic cavity thru the auditory tube
Upper part, pseudostratified ciliated columnar epithelium
Lower part, stratified squamous epithelium
Transitional zone where the two areas come together
B. FIBROUS LAYER
Pharyngobasilar fascia strong internal fascial lining of the
constrictor muscles
o Between the mucous membrane and the muscle layer
o Thicker above, strongly connected to the base of the skull
o Becomes continuous with the submucous coat of the
esophagus
Buccopharyngeal fascia thin external fascial lining of the
pharyngeal muscles
Pharyngeal aponeurosis: covers the the pharyngeal muscle which
if extends to esophagus, will be the muscularis mucosa of
esophagus
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C. MUSCULAR LAYER
Table 6. Pharyngeal Muscles
MUSCLE
External circular
Super constrictor
Middle constrictor
Inferior constrictor
Cricopharyngeus
Internal longitudinal
Stylopharyngeus
Salpingopharyngeus
Palatopharyngeus
ACTION
aids soft palate in closing off
nasal pharynx, propels bolus
downward
propels bolus downward
NERVE SUPPLY
Pharyngeal
plexus
CN IX
Pharyngeal
plexus
Clinical Correlation
Pharyngeal tonsils, when enlarged, are called adenoids which
can block the Eustachian tube opening
Tubal tonsil may cause otitis media when it blocks the opening
of the Eustachian tube
OROPHARYNX
o Digestive function; stratified squamous epithelium
o Behind the soft palate to hyoid between laryngeal inlet and soft
palate
Superiorly: bounded by soft palate
Inferiorly: base of the tongue
Laterally: palatoglossal and palatopharyngeal arches
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E. VENOUS DRAINAGE
External palatine vein (paratonsillar vein)
Retromandibular v. union of superficial temporal and maxillary
veins
o Drain into pharyngeal venous plexus into internal jugular v.
E. LYMPHATIC DRAINAGE
Directly into superior cervical group of nodes (runs along IJV)
Indirectly into retropharyngeal or paratracheal nodes then into
deep cervical nodes
All eventually drain into deep cervical lymph nodes
III. ESOPHAGUS
Extends From Lower border of cricoids cartilage (C6) to are where
it inserts at cardia of stomach at level of (T11)
Goes down and enters the super and inferior mediastinum of
thorax
Enters esophageal hiatus(T10) to enter cardia of stomach (T11)
Conduct food from the pharynx into the stomach
A muscular collapsible tube 10 in. (25 cm) long
Joins pharynx to stomach
Greater part lies within the thorax
Covered anteriorly and laterally by peritoneum
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PORTAL SYSTEM
SYSTEMIC SYSTEM
esophageal branches of (L) gastric
esophageal branches of
vein
azygos veins
when abnormally dilated: esophageal varices
superior rectal veins continuing as
inferior and middle rectal
the inferior mesenteric veins
veins
when abnormally dilated: hemorrhoids
E. BLOOD SUPPLY
Cervical part: inferior thyroid a. (r & l thyrocervical, sca)- branches
of thyrocervical trunk from subclavian artery
Thoracic part : esophageal arteries (branches of descending
aorta) & branches of bronchial arteries (2 on left 1 on right), right
posterior intercostal arteries
Abdominal part :comes mainly from left gastric a. (br. Of celiac a.)
And recurrent branch from left inferior phrenic a.
+++may also come from short gastric artery from splenic artery
that supplies fundus of stomach
F. VENOUS DRAINAGE
Drain into the left gastric vein, tributary into the left gastric nodes
o Cervical part: (R) & (L) inferior thyroid veins to (R) & (L)
brachiocephalic veins
o Thoracic part: azygos and hemiazygos v.
o Abdominal part:primarily to portal venous system via left
gastric vein (portocaval anastomoses) on lower 1/3 of
esophagus
o +++submucosal venous plexus penetrate entire wall of
esophagus forming peri-esophageal venous plexuses
Clinical Correlation
Liver cirrhosis progressive destruction of hepatocytes, which are
replaced by fibrous tissue; fibrous tissue surrounds intrahepatic
vessels, impeding the circulation of blood; there is then retrograde
flow of blood; submucosal plexuses becomes dilated and tortuous
causing varices which are prone to hemorrhage-> bleeding
esophageal plexuses.
++obstruction of portal vein because of alcoholic cirrhosis of liver
will cause retrograde flow of blood back from portal vein, left
gastric vein, peri-esophageal sinuses and back to submucosal venous
plexuses producing esophageal varices> liver cirrhosis
H. LYMPH DRAINAGE
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A. GASTROESOPHAGEAL SPHINCTER
V. STOMACH
Expanded part of the digestive tract between the esophagus and
small intestine.
Acts as a food blender and reservoir
Its main function is Enzymatic Digestion
Can hold 2-3 liters of food
Gastric juice converts food into a semi-liquid mixture, chime
Position and Shape
o Size shape and position can vary markedly in persons of
different body types.
o Found in left hypochondrium and epigastric area and may
extend to area of umbilicus
o In supne position, it commonly lies in the upper right and left
quadrants
o J shaped, and vertical (in tall,thin person)
o Fixed at both ends, but mobile in between
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F. Venous Drainage
Right and Left Gastric veins
o Drain directly into hepatic portal vein (at neck of pancreas, L1,
L2)
Short gastric and Left gastroepiploic or gastro-omental veins
o Join splenic vein, which drains into the superior mesenteric vein
(SMV) to form the hepatic portal vein
Right gastroepiploic or gastro-omental vein
o Drains into the superior mesenteric vein
Note:
- Portal vein is formed by the union of superior mesenteric vein
and splenic vein.
- Prepyloric vein: ascends over pylorus to drain to right gastric
vein; being use by surgeons to identify the pylorus
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G. Lymph Drainage
Gastric Lymphatic Vessels follow the arteries along the greater
and lesser curvatures to:
o Left and right gastric nodes
o Left and right gastroepiploic nodes
o Short gastric nodes
All lymph from stomach eventually passes toceliac
nodeslocated around root of celiac artery on posterior
abdominal wall
Celiac node cysterna chili thoracic duct
Clinical Correlation
In carcinoma of the stomach, the spread of cancer is hard to contain
because lymph nodes are shared
H. Nerve Supply
Parasympathetic vagus nerve
o Secretory nerve fibers to glands and muscles
o Anterior vagal trunk anterior surface of stomach, pyloric
branch to pylorus (Left)
o Posterior vagal trunk posterior (main) and anterior surface
of stomach (Right)
Sympathetic celiac plexus / thoracic splanchnic nerves
o Pain transmitting nerve fiber
o Greater splanchnic T6-T9
o Lesser splanchnic T10-T11
o Least splanchnic T11
H. Histology of the Stomach
Mucous membrane
o Thick and vascular
o Rugae numerous folds of the mucous membrane of stomach,
longitudinal in direction
o Magenstrasse
Pliable, linear rugal folds or groove of the gastric mucosa
along the lesser curvature that is the route food and liquids
tend to take in moving toward the pylorus
Has no oblique muscles
Bounded externally by the gastrohepatic ligament
Frequent site of most spontaneous gastric rupture (peptic
ulcer formation), due to the lesser curvature's lower
distensibility
Muscular walls
o Oblique innermost coat, loop over fundus and pass down
along anterior and posterior walls, parallel with lesser
curvature; not seen in curvatures
A.DUODENUM
First part of the small intestine and the shortest one
10 in. (25 cm) long
Also the widest and most fixed part
C-shaped tube that course around the pancreas and joins the
stomach to the jejunum
Runs from pylorus on right side to the duodenojejunal junction
/flexure (an acute angle) on the left
Junction occurs at the level of the L2 vertebra, 2-3 cm to the left
of the midline
Receives the openings of the bile and pancreatic ducts
Situated in the epigastric and umbilical regions
First part is smooth; remainder is thrown into circular folds called
theplicae circulars
Most of the duodenum is fixed by peritoneum to structures on
the posterior abdominal wall and is considered
partiallyretroperitoneal except the 1st inch that is
intraperitoneum
Parts of the Duodenum
o SUPERIOR: FIRST PART
2 inches (5 cm) long ,Lined by smooth mucous membrane
Ascends from the pylorus and is overlapped by the liver and
gallbladder
runs upward and backward on the right side of the first
lumbar vertebra (L1)
Lies on thetranspyloric plane
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Page 11 of 17
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Page 12 of 17
ILEUM
o third part of small intestine and ends at ileocecal junction
(union of the terminal ileum and cecum)
o 12 feet long
o Forms the lower 3/5 of the jejunuileum,
o Ends at ileocecal junction
o mostly lies at right lower quadrant
CLINICAL CORRELATON
Meckel's diverticulum
Congenital anomaly.
Persistent vitellointestinal duct
Small bulge or malformation found in the terminal 2 ft. of the ileum
Usually asymptomatic, but can sometimes form an intestinal
obstruction
May develop inflammation that can be confused with appendicitis
(Meckel's Diverticulitis), mimicking its signs and symptoms
In distinguishing the jejunum from the ileum in
radiographs, note that the JEJUNUM has a feathery
appearance while the ILEUM has a solid appearance.
Table 11. Summary of the differences between jejunum and ileum
Page 13 of 17
Anterior
Posterior
Medial
B. APPENDIX
Blind intestinal diverticulum (6-10cm) that contains masses of
lymphoid tissue
Arises from the posteromedial aspect of the cecum inferior to the
ileocecal junction
Attached to lower layer of the mesentery of SI by a short
mesentery of its own called mesoappendix
Usually retrocecal but variations may occur
In relation to the anterior abdominal wall, its base is situated 1/3
of the way up the line joining the RIGHT ASIS to the umbilicus
(McBurneys point)
Anatomical position of the appendix will determine the site of
muscular spasm and tenderness in appendicitis
C. ASCENDING COLON
Location:
o lies in the right lower quadrant;
o Extends upward from the cecum to the inferior surface right
lobe of the liver
Turns to the left at the right colic flexure /hepatic flexure (lies
deep to the 9th and 10th rib) and becomes continuous with the
transverse colon.
Retroperitoneal
Greater omentum separates the ascending colon from the
anterolateral abdominal wall
Right paracolic gutter deep vertical groove lined with parietal
peritoneum that lies between the lateral aspect of the ascending
colon and the adjacent abdominal wall (see Figure 2.49 page 245
of Moore)
Narrower than cecum
Table13 . Boundaries of ascending colon
Anterior
SI, greater omentum, anterior abdominal wall
Posterior
Iliacus, iliac crest, quadrates lumborum, origin of
tranversus abdominis muscle and right kidney.
Iliohypogastric & ilioinguinal nerves cross behind it
C. TRANSVERSE COLON
Longest and most mobile part of the large intestine
Location:
o crosses the abdomen from right colic flexure left colic
flexure
o hanging to the level of the umbilicus (L3)
-in tall, thin people, it may extend in to the pelvis
left colic flexure/ splenic flexure
o more superior, more acute and less mobile than the right colic
flexure
o anterior to the inferior part of the left kidney
phrenicocolic ligament suspends the splenic flexure from the
diaphragm
transverse mesocolon mesentery of the transverse colon,
suspends the transverse colon from the pancreas
root of the transverse mesocolon along the inferior border of
the pancreas and continuous with the parietal peritoneum
posteriorly
D. DESCENDING COLON
Location:
o Lies in the left upper and lower quadrants
o extends downward from the left colic flexure left iliac fossa
or pelvic brim
Retroperitoneal
Has a left paracolic gutter on its lateral aspect
Covered anteriorly and laterally and attached to the posterior wall
by the peritoneum
Table15 . Boundaries of descending colon
Anterior
SI, greater omentum, anterior abdominal wall
Posterior
Lateral border of left kidney, origin of tranversus
abdominis ms, quadrates lumborum, iliac crest, iliacus
and left psoas.
Iliohypogastric, ilioinguinal, lateral cutaneous of the thigh
and femoral nerve
E. SIGMOID COLON
S-shaped loop, links descending colon and rectum
Location: extends from iliac fossa S3, where it joins the rectum
Rectosigmoid junction termination of teniae coli, approx 15cm
from anus
Sigmoid mesocolon long mesentery of sigmoid colon; attaches
the sigmoid colon to the posterior pelvic wall
Root of the sigmoid mesocolon inverted V-shaped attachment,
extending first medially and superiorly along the external iliac
vessels and then medially and inferiorly from the bifurcation of
the common iliac vessels to the anterior aspect of the sacrum.
Distinguising characteristics
o Teniae coli disappears and then come together to form a broad
band of longitudinal fibers in the walls of the rectum
o Omental appendices are long
Table 16. Boundaries of sigmoid colon
Anterior
Urinary bladder (males), poetrior surface of the uterus
and upper part of vagina (females)
Posterior
Rectum, sacrum, lower coils of the terminal ileum
F.RECTUM
pelvic part of digestive tract, 5 in. (13cm) long
follows the curvature of the cecum
extends from S3 up to the area where it pierces the levator ani
muscle
peritoneum covers the anterior and lateral surfaces of the upper
1/3 of the rectum and only the anterior surface of the middle 1/3,
leaving the lower 1/3 devoid of peritoneum because it is
subperitonium
is S-shaped when viewed laterally
has NO mesentery, sacculations (haustra of the colon), taenia
coli, appendices epiploicae
continuous proximally with the sigmoid colon, distally with the
anal canal.
lying anterior to the S3 vertebra is the rectosigmoid junction,
where (a.) teniae of the sigmoid colon spreads forming a
continuous outer longitudinal layer of smooth muscle, and (b.)
fatty omental appendices are discontinued
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Page 14 of 17
lies posteriorly against the inferior three sacral vertebrae and the
coccyx, anococcygeal ligament, median sacral vessels, inferior
ends of the sympathetic trunks and sacral plexuses
Rectal valves- support the weight of the feces and prevent overdistention of rectal ampulla (2 on the left namely the superior and
inferior rectal valves and 1 on the right called the middle rectal
valve)
Rectal ampulla distal dilated portion above the levator ani
muscle; NOT covered by peritoneum (proximal third is covered
anteriorly and laterally by pelvic peritoneum, the middle third is
covered ONLY ON ITS ANTERIOR aspect by the peritoneum)
In Males: the peritoneum that covers the rectum goes down and
covers the posterior aspect of the urinary bladder forming the
floor of rectovesical pouch
o rectum is related anterorly to the fundus of the urinary
bladder,terminal parts of the ureters, ductus deferentes,
seminal glands and prostate
For Females: the peritoneum that covers the proximal 2/3 of the
rectum covers the posterior fornix of the vagina to form the
rectouterine pouch (Pouch of Douglas)
Pararectal fossae
o (one in the right and one in the left) formed in the lateral
reflections of the peritoneum from the superior third of the
rectum (in BOTH sexes); permit the rectum to distend as it fills
with feces
o follows the curve of the sacrum and coccyx forming the sacral
flexure of the rectum
o ends anteroinferior to the tip of the coccyx that perforates the
pelvic diaphragm, immediately before the sharp posteroinferior
angle of the anorectal flexure of the anal canal (an important
mechanism for fecal continence)
o apparent anteriorly are the three sharp lateral flexures of the
rectum (superior and inferior-on the left side, intermediate-if
right)
o flexures are formed in relation to three internal infoldings
(transverse rectal folds/valves of Houston): two on the left,
one on the right;
Transverse rectal folds
o overlie thickened parts of the circular muscle layer of the rectal
wall
o support the weight of fecal matter to prevent its urging toward
the anus
o superior to and supported by the pelvic diaphragm (levator ani)
and anococcygeal ligament
o receives and holds fecal mass until it is expelled during
defecation
o ability to relax to accommodate initial and subsequent arrival
of fecal material is important in maintaining fecal continence
G. ANAL CANAL
1.5 in. (4cm) long
extends from the superior aspect of levator ani muscleor pelvic
diaphragm down to the anal orifice (anal verge) outlet of the
alimentary canal
begins where the rectal ampulla abruptly narrows at the level of
the U-shaped sling formed by the puborectalis muscle
lateral walls are kept in apposition by the levatores ani muscles
and the anal sphincters except during defecation
Dendate line- lower border of anal column joined by anal
valves;important landmark (derivative if ABOVE: HIND GUT, if
BELOW: ECTODERM)
Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.
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A.CELIAC TRUNK
Artery of the foregut supplies GIT from lower of esophagus to
middle 2nd part of duodenum
Arises from Abdominal aorta T12
Branches:
1. Left Gastric A.
o Goes all the way up to provide branches to the abdominal
portion of the esophagus and occupies the upper lesser
curvature of the stomach
o Anastomose with Right Gastric A.
2. Splenic A.
o Going to the spleen via behind the stomach and upper
border of pancreas
o Gives rise to
Left Gastroepiploic A- supply the greater curvature;
Short Gastric A - supply the fundus and greater curvature;
some branches to pancreas including the dorsal
pancreatic artery
3. Common Hepatic A.
o Runs to the right along the upper border of pancreas
o Gives rise to
Right Gastric A., - supply the other part of lesser curvature
and pyrolus of stomach
Proper Hepatic A., that enters the portal triad, and
Gastroduodenal A.
Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.
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V. LYMPHATIC DRAINAGE
Follows the arterial vessel mesenteric nodesceliac
nodesmesenteric duct
Lumbar nodes: drains lymph from rectum, descending colon
Superficial inguinal nodes and ext. iliac nodes: below the
pectinate line, anal canal
Internal iliac nodes: upper canal (drains into inf. mesenteric
nodes)
Lacteals - specialized lymphatic vessels in the intestinal villi that
absorb fat that empty milk-like fluid to lymphatic plexuses in the
walls of jejunum and ileum
o lacteals mesentery lymph passes through 3 groups of
nodes: Juxta-intestinal (close to intestinal wall), Mesenteric
lymph nodes (scattered among arterial arcades) and superior
central nodes (located along proximal part of superior
mesenteric artery) superior mesenteric lymph node
lymphatic vessels from terminal ileum follow ileal branch of
ileocolic artery to the ileocolic lymph nodes
VI. NERVE SUPPLY
Parasympathetic
o From VAGUS nerve
o From SACRAL PLEXUS, S2 to S4
o The vagus nerves supply preganglionic parasympathetic
innervation up to the splenic flexure and then the sacral
parasympathetic nerves (S2-S4) take over
o Postganglionic neurons are located within the walls of the
organs (Meissners and Auerbachs plexus) where
postganglionic fibers are given off
Sympathetic
o From pelvic splanchnic nerves
o Sympathetic innervation is provided by the preganglionic
greater (T5-T9), lesser (T10-T11) and least (T12) splanchnic
nerves pass through the diaphragm and synapse at the
prevertebral ganglia (celiac, superior and inferior mesenteric)
and postganglionic fibers follow the branching of the arteries.
o Additional preganglionic sympathetic fibers from the lumbar
splanchnic (L1-L2-L3) synapse at the postganglionic neurons
inferior mesenteric ganglion to supply postganglionic fibers to
the lower digestive tract and the pelvic organs
Plexuses formed by the Parasympathetic and Sympathetic Nerve
Fibers in Walls of Intestines are:
o Auerbachs plexus
Located between inner circular and outer longitudinal layers
of muscle
Regulates peristalsis
o Meissners plexus
Innermost, in the submucosa
Regulates glands of mucosa and smooth muscles of
muscularis mucosae
Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.
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