GIT Anatomy Learning Objectives

1. Oral cavity (The oral cavity is the most cranial part of the alimentary canal. The teeth are arranged in dental arcades (or arches) and separate the oral cavity into two parts): y y y y y First part: Larger, enclosed within teeth and is the oral cavity proper. Second part: Narrow space between teeth and lips and cheek, which is the vestibule. Floor and roof (hard palate in front, soft palate behind) of oral cavity continues posteriorly into pharynx. Uvula, hangs from posterior edge of middle of soft palate. Anterior palato-glossal and posterior palato-pharyngeal folds (or arches) pass down sides of soft palate. In between these folds lies the palatine tonsil. The anterior Palato-glossal fold marks the posterior limit of oral cavity. Muscles forming boundaries of oral cavity: orbicularis oris (front), buccinators (sides), geniohyoid, mylohioid and anterior belly of digastric (floor).

2. Soft palate (fibromuscular structure): y y Muscles contributing to formation of soft palate are palatoglossus and palatopharyngeus, forming arches of same names and tensor veli palatini and levator veli palatini. Tensor veli palatine arises from base of skull and lateral aspect of Eustachian tube, hooks around hamulus of medial pterygoid plate and radiates horizontally into palantine aponeurosis. Levator veli palatine arises from base of skull near mouth of carotid canal, dorsal and medial to Tensor veli palatine and from lower margin of cartilage of Eustachian tube. Descends medal to upper border of Superior Pharyngeal Constrictor and inserts into palantine aponeurosis, producing bulge in mucous membrane below opening of Eustachian tube.

3. Tongue: y y y y y y Tongue has a root through which extrinsic muscles gain entry to it. The sulcus terminalis (dorsum of tongue) marks the junction between anterior two thirds (oral) and posterior one third (pharyngeal) of tongue. Median Glosso-epiglottic fold. Pair of Lateral Glosso-epiglottic folds. Valleculae. Three types of papillae on oral part of tongue dorsum: 1) Numerous filiform papillae, posteriorly directed tip 2) Less fungiform papillae, which are rounded 3) Circumvallate papillae, which are large and round surrounded by trench, anterior to sulcus terminalis. Foramen caecum (marks embryological site of down growth of origin of thyroid). Pharyngeal tongue has no papillae, but numerous lymphoid nodules (cobblestone appearance). These nodules are called the lingual tonsil. Extrinsic muscles of tongue: genioglossus (originates genu of mandible), styloglossus (originates styloid process), and hyoglossus (originates hyoid bone).

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4. Salivary Glands: y Parotid gland and relationship with ramus of mandible, sternocleidomastoid and masseter and facial nerve. y Parotid duct (opens into vestibule opposite crown of upper 2nd molar). y Superficial and deep submandibular gland and relationship to mylohioid muscle. y Submandibular duct (opens on either side of frenulum). y Sublingual gland and its gland. 5. Muscles of Mastication: y Temporalis (closes mouth), masseter (closes mouth), lateral (opens mouth) and medial pterygoid (closes mouth). Note origins, insertions, how protrusion, retraction, elevation and depression of the mandible is achieved and how lateral chewing movements are accomplished. 6. Pharynx: y In a sagittal head identify: subdivisions of pharynx. I.e. Nasopharynx (behind nasal cavities down to soft palate), oropharynx (lies behind oral cavity) and laryngo-pharynx (behind laryngeal inlet and cricoid cartilage). y Eustachian tube (air into middle ear, ensures even air pressure on either side of tympanic membrane). y Tympanic membrane. y Tubual elevation. y Salpingo-pharyngeal fold and salpingo-pharyngeus. y Pharyngeal recess and pharyngeal tonsil. y Palatoglossal and palatopharyngeal arches (oropharynx). y Palantine tonsils. y Lingual tonsils and their attachments. y Inferior constrictor (cricopharyngeus). y Stylopharyngeus. 7. Pharyngeal Innervation: y Stylopharyngeus- Glossopharyngeal nerve (9th). y Tensor Veli Palatini- Mandibular branch of Trigeminal (5th). y Remainder- Pharyngeal plexus composed of:  Branches of Glossopharyngeal.  Vagal fibers.  Accesory nerve fibers in vagus.  Parasympathetic secretomotor from facial nerve after pterygopalantine ganglion.  Sympathetic fibers from cervical sympathetic trunk.  Sensory fibers.

8. Oesophagus: y esophagus, its origin and path through thorax to abdomen. y Relationship to trachea, vertebral bodies, descending aorta, aortic arch, tracheal bifurcation, left main bronchus, left atrium, diaphragm and stomach. y Left and right recurrent laryngeal nerves (groove between trachea and oesophagus). N.B. Locate the 3 physiological (permanent) constrictions of oesophagus. *Seems like a good exam question*. 9. Diaphragm: y Structures penetrating diaphragm: oesophagus (oesophageal hiatus, T 10), L & R Vagus nerves (oesophageal hiatus), oesophageal branch of L. gastric artery and L. Gastric veins (oesophageal hiatus). Surface marking of oesophageal hiatus is 7th L. Costal cartilage. y Left (L 1 L2) and Right (L 1 L3) Crura. 10. Abdominal Parts of the Alimentary Tract: y Parietal and visceral peritoneum. y Peritoneal cavity (greater and lesser sacs). Greater sac is main cavity; lesser sac is a diverticulum of greater sac aka. omental bursa y Mesentery or peritoneum (esp. Omentum). y Parietal and visceral peritoneum. The space between these two serous membranes is the peritoneal cavity. Identify function of the cavity: i.e. to act as a bursa allowing freedom of movement of viscera. y Openings into the peritoneal cavity: None in males, uterine tubes in females. y Note the root of the mesentery (posterior abdominal wall). Runs down and right from duodeno-jejunal junction to ileocolic junction. y Superior mesenteric vessels in root of mesentery. y Note ileal mesentery fattier than jejunal mesentery. y Structure of small intestine. Especially note differences in arcades between jejunum and ileum as well as vermiform appendix. y Structure of large intestine. y Transverse mesocolon, mesoappendix and sigmoid mesocolon. y Ileocolic valve.

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Stomach: y Location of stomach (upper left quadrant). y Lesser curvature and lesser omentum (composed of hepato-gastric and hepato-duodenal ligaments). y Greater curvature and greater omentum (note 4 layers). y Transverse colon. y Spleen (to left of stomach). y Gastrosplenic ligament (connects spleen to greater curvature). y Cardial orifice. y Fundus, body, antrum and pylorus (all parts) of stomach. y Cardiac notch of stomach. y Incisura angularis (angular notch). y Right and left gastric arteries from lesser curvature. y Right and left gastro-epiploic arteries from greater curvature. y Epiploic foramen.

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Duodenum (first and second parts): y Location of duodenum and relation to stomach. y First part of duodenum: Note relationships to lesser omentum, bile duct, portal vein and hepatic artery. (N.B. Brunner s Glands). y Second part of duodenum: Note relationships to R. Kidney and R. Ureter, inferior vena cava, transverse colon and mesocolon. Note relation to gall bladder (common bile duct) and pancreas. Both ducts open into duodenum at the posterior-medial Duodenal Papilla y Third part of duodenum: Superior mesentery vessels anterior, inferior vena cava and aorta posterior. y Ampulla of Vater. y Sphincter of Oddi. y May be an additional Accessory Pancreatic Duct.

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Pancreas: Identify head, neck, body and tail. Note relationships of splenic vessels: supply body and tail of pancreas. Note relationship between head of pancreas and duodenum, bile duct and vena cava. Note relationship between neck and superior mesenteric vessels. Posterior body of pancreas: in contact with aorta, superior mesenteric artery and L. Kidney and its vessels. y Tail of pancreas: reaches spleen in lineo-renal ligament. y Main pancreatic duct (opens into hepato-pancreatic ampulla of Vater together with bile duct) opens into second part of duodenum. y Attachment of transverse mesocolon (dorsal body wall) runs across middle of anterior pancreas. Upper part of pancreas is therefore in lesser sac. y y y y y

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The liver: y The location of the liver and relationship to gall bladder and pancreas. y Falciform ligament (embryologically ventral mesentery of stomach). Insertions and structure. y Ligamentum teres (remnant of the umbilical vein), located in free lower border of falciform ligament. y Coronary ligament. y Left triangular ligament (joins liver to diaphragm). y Posterior and inferior surfaces. y Caudate and quadrate lobes and fissure for ligamentum venosum. y Bare area (bordered by inferior and superior layers of coronary ligaments and IVC). y Locate porta hepatic (inferior surface; contains bile duct, hepatic artery and hepatic portal vein).

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Vessels and lymphatics: y Coeliac trunk. Note relationship to aortic hiatus and L. Gastric, Splenic and Common Hepatic arteries. y Splenic artery: Gives rise to L. Gastrosplenic artery. y Common Hepatic: Gives rise to Gastroduodenal, R. Gastric and Cystic arteries. y Superior mesenteric artery: Arises immediately below Coeliac Trunk. y Branches of coeliac trunk (Jejunal, Ileal, Ileocolic, R. Colic and Middle Colic). y Jejunal and Ileal arteries: Right of superior mesenteric artery. y Ileocolic artery and its appendicular branch: Left of superior mesenteric artery. y R. Colic and Middle Colic: Additional right side branches of superior mesenteric artery (supply proximal colon). y Portal vein: Formed by union of splenic and superior mesenteric veins behind head of pancreas. y Hepatic artery. y Hepatic veins: Drains the liver and join IVC. y Hepatic ducts: Join to form common hepatic duct. y Cystic duct: Leaves gallbladder to join common hepatic duct to form common bile duct. y Main pancreatic duct: Opens into ampulla of Vater. y Superior mesenteric vein: Collects drainage from jejunum, ileum, duodenum, head of pancreas and R. Hemi-colon. y Inferior mesenteric vein (joins splenic vein behind body of pancreas): Drains L. Hemicolon. y Lymphatic drainage of stomach, small bowel and associated structures: Drainage passes through chains of nodes alone main arteries beneath serosa of gut and in mesenteries behind dorsal parietal peritoneum. Drainage reaches midline dorsal body wall at cisterna cyli (located at root of mesentery).